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Click on your preferred podcast player link to listen wherever you enjoy podcasts Welcome to the show notes for Episode 107 of the OT Schoolhouse Podcast. Our guest today proves how it is possible to make the best of a situation when unforeseen circumstances happen. The Covid Pandemic derailed Alvin from starting his private practice. Still, it allowed him to build up his social media and do something he enjoys, video editing. He has created videos to share with others about occupational therapy and his “P.L.A.Y on the Go Approach.” He shares content about treatment approaches, occupational balance, self-care, and even has “Toy Tuesday,” in which he shares different ways to use games that have easy accessibility in therapy rooms or clinics. Tune in to learn the following objectives: Learners will identify what P.L.A.Y stand for Learners will identify ways to help a child feel successful and confident Learners will identify the difference between adaptions and modifications Learners will identify the importance of incorporating students' interests during therapy sessions Earn Continuing Education for Listening to this Episode Wish you could earn professional development for listening to the OT Schoolhouse Podcast? Now you can! Click here to purchase the professional development opportunity that corresponds to this episode. Here's how it works in three simple steps: Listen to the episode on this page or wherever you listen to podcasts. Purchase the professional development opportunity. Take the short quiz and earn your certificate. It's the professional development you want on your own schedule. Earn your certificate of completion for episode 107 now. Guest Bio Alvin Pineda MS, OTR/L Alvin Pineda is a Pediatric Occupational Therapist based in the San Fransico Bay Area. He is the owner of Alvin P. Occupational Therapy Services and Outside The Box Treatment Solutions LLC. As a pediatric OT, he has experience in multiple settings from home health, school-based, and currently outpatient private practice. He specializes in child-led therapy in sensory processing, developmental delays, and self-regulation with experiences with a wide range of abilities and age ranges from 3- 21+. Aside from his clinical work, Alvin is the online content creator behind OT.Outside.The.Box on Instagram and Facebook. He has created his platform to inspire other pediatric practitioners to be confident and creative therapists. To facilitate creative clinical reasoning, Alvin created The P.L.A.Y on the Go Approach to guide practitioners to adapt and modify any activity to meet their client’s just right challenge. Notable Quotes “We need to think on the go, on learning how to adapt, learning how to modify and meet each child's needs within that just right challenge. So it's really working on facilitating that ability to really kind of look at an activity and look at the task analysis” -Alvin “I think that's so important to advocate that and really showcase that decreased core can also impact handwriting ability, not many kinds of educators know that, so that's where our OTs lense in development comes into play.” -Alvin “In all of our evaluations, we have to tie the overarching occupation to those component skills, and vice versa. You’ve got to tie it back and forth” - Jayson “Sometimes we have to do what we have to do. We have to make sure we're 100% for ourselves because then our sessions and our evaluations, and our reports will be 100 times better.” -Alvin Resources P.L.A.Y. on the Go Approach Handout Occupational Therapy Practice Framework Alvin's Instagram Alvin's Facebook Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT school house podcast. Your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host. Jayson Davies class is officially in session.    Jayson Davies     Hey everyone. Welcome to Episode 107 of the OT school house podcast. Thank you so much for being here today. Thank you so much for hitting that play button. Speaking of the play button, play you are going to hear that word a lot in the next hour or so, and I will tell you why in just a moment. Well, you might already know, considering you saw the title when you hit that play button. So today, we are doing something we haven't done in a while. We are actually offering continuing education for those of you who decide to listen to this podcast episode and would like to earn a certificate of completion for doing so, and you can learn more about that. You can go ahead and get that certificate of completion by using the link in the podcast description, wherever you're you are listening, or by heading over to OT schoolhouse.com/episode 107, over there, you'll be able to learn how that process works, what it cost and yeah, how simple it is to learn on your own time and earn some professional development while you're heading to work, heading home from work, or maybe even at the gym. It's the easiest way to earn professional development, and I hope it helps you out, and I hope it makes your life a little bit easier and saves you a little bit more time. So what are we talking about today that is so important? Well, I already mentioned it play. We are talking about play, but we're not just talking about it as a noun or a verb, which as occupational therapy providers we know is so important for our students, for the kids that we work with, maybe even for your own little ones at home. Today, we are talking about play as an acronym that you can use to guide your therapy. Joining us today is Alvin Pineda, and you may better know Alvin from his instagram handle, which is ot outside the box. He loves to create reels and marks again, to talk just a little bit about his real creation today, but we are going further into his play on the go approach, which he uses to support his clients. By the end of this episode, our goal, Alvin and myself, our goal for you is that you will be able to identify the following, what the acronym play, P, L, A, Y stands for a few ways to help children feel successful and confident. The difference between adaptations and modifications and the importance of incorporating students interests during therapy sessions. Of course, we're going to talk about play, using Play to support our students and keep their interest. We're going to do all of this through the structured interview that you know and love from the OT school house podcast. We're going to have fun doing it. So let's go ahead and jump right into the heart of this episode with Alvin and discuss the importance of play as a noun, a verb and now an acronym to help support you. Let's do it. Alvin, welcome to the OT school house podcast. How are you doing today?    Alvin Pineda     Hey, Jayson, I'm doing pretty well. Pretty well. I'm glad to be on and thank you for having me.    Jayson Davies     Yeah, thank you for being here. Man, it's been amazing watching all of us kind of grow together on Instagram, on podcasts, just on the web as a community of occupational therapy providers that are supporting people. So thank you so much for being here.    Alvin Pineda     Of course, and that's what I love about kind of social media, just the growth in the community that we have, supporting each other. I think it's awesome. And just to see the growth of everyone within their businesses and just advocating for our profession is amazing.    Jayson Davies     Yeah, 100% and, you know, as as occupational therapy providers, you know, there's kind of that we have two sides of it. We have the social media side, which is very much like marketing, getting ourselves out there. But as occupational therapy providers, we can't just say whatever the heck we want to say on social media platform. We really have to have the research behind it. We have to know what we're actually talking about a little bit, and we can't just say random things. So I know that both you and I put a lot of hard work into making sure that what we're saying is actually accurate, and not just putting anything out there. So we're going to talk a little bit about that, but I first want to invite you to just share a little bit about how you got into OT and you know why you went down the OT route?     Alvin Pineda     Yeah. So I think one of the biggest influences I have is my family. So I grew up with a huge family. When I say huge, it's my mom had like 12 brothers and sisters. My dad had 13 and yeah, so I had a whole bunch of cousins, kind of growing up, and I was that person, kind of just hanging out with all the little kids, kind of as I grew up. So I was kind of like working in peds already as a teenager. It was very natural for me to just. Just jump into that role. So I've always had this passion for peds, and then I just slowly, kind of expanded my way into the special ed realm with ABA. I know OTs and behaviorals kind of clash, but I think it was a good foundation for me to get that experience and figure out what works and what doesn't work with kids. So it was a good learning experience, because with the OT realm now, like I understand how all of these other aspects, like sensory and actual motor development can impact performance as well. So I started out working as an ABA therapist. I worked with preschool, elementary age kids and then a middle school range to do an ABA, both in the classroom and in a home setting. From there, I went to OT school. I actually went to a weekend program. So it was a different type of OT program. I worked throughout ot school, and I was in school Friday night, Saturday, all day and all day Sunday. So yeah, and that we met every two to three weeks. So it was a big kind of learning curve of understanding what I needed as a student, to be independent and to be successful. It kind of just threw you in the realm of being independent. So I think that helped in my own kind of learning experience, in advocating for my needs and my learning needs as well. So, yeah, let's see.    Jayson Davies     Can I, well, first, can I ask you two follow ups on that? Actually, first of all, because I do have a lot of people that are kind of in a similar situation that that approached me and asked, you know, I'm working full time. How do I do OT school? Would you mind sharing the program that you went to?    Alvin Pineda     Yeah, so, so I'm East Coast based. I grew up in Jersey, and then I went to school in New York. It is a small university or college called Dominican college. They have one in California, Dominican University.    Jayson Davies     Dominican University.     Alvin Pineda     Yeah, I don't know if there's a relation, but, but yeah, they do have programs like that there that are like these bridge programs for individuals who have a bachelor's degree and individuals who have who are codos as well too. So you can work full time throughout, and then you can kind of work on the weekends throughout that.    Jayson Davies     Very cool, very cool. And then the other question is, you mentioned being an ABA therapist, although it doesn't sound like you went to get your BCBA. Where did that decision process come in. And when did you decide? You know what? Hey, I'm an ABA therapist now, but I want to go the OT route as opposed to the BCBA route.    Alvin Pineda     Yeah. Well, I think I initially just jumped into it because I wanted experience. I knew I wanted to work with kids. I considered being a teacher, and people were like, oh, you should work with special ed. You have all this patience and everything. So I think that was my foot in the door, just to get some experience. But having that experience, I considered all these other areas, like PT, OT speech, and I did consider being a BCBA, but it was just so systematic. I didn't fully agree with all the approaches, but I love the kind of holistic views that ot has, the again, the motor development, the sensory aspects, and the approach we have where we can engage in natural occupations like play. I love that I'm not like a sit down the table type of therapist. I'm on the floor with the kids. I'm following their lead. So I thought that was more my realm than anything else, and compared to speech, PT and PCBA. So.     Jayson Davies     Yeah, very cool. Awesome. All right. Well, let's jump ahead then. So you you've got your ot degree. What happened after that? What kind of settings have you worked in since graduating?     Alvin Pineda     Yeah, so I had a couple field works in a school based setting, and then I had field work in a sub acute. And I actually loved working in a sub acute I think the the adults have a greater appreciation for for what therapist than the kids do. So I love that, but my true passion was with impedes. So my first job out of OT school was actually like a non public school in the Bronx in New York. So I worked in a visually impaired school with visual impaired students and blind students as well. So it was just a great experience. I had an awesome team to support me throughout that time, and it was just an awesome experience of learning and adapting all these activities to meet each of those students needs. So I absolutely am so grateful that for that experience and for all those therapists, let's see. But from there, I started out as a travel occupational therapist in the school system, so less than a year out of school, I decided to travel cross country, and I worked for multiple non public schools in the California Bay area. So I got to jump into all of the IEPs. I got to do all those evaluations and whatnot. So a lot of these schools were very much kids who don't have proper placement at their local districts. So these were kids who needed more behavioral support. So I think being a male therapist, you kind of get those tougher kids most of the time. So that's where kind of that ABA get. Kind of came into play, and it helped support me and figure out what worked. And I just kind of used the combination of that, ABA plus OT and really helped build each child skills and further increase their independence throughout that. So yeah, I did three years of that, and then right before COVID, I decided to go private practice, and everything blew up because we weren't working, yeah. And then it kind of turned into social media. I was able to start off a little platform and then kind of build from there, yeah, 100% Yeah. I think it, it timing wise, kind of stars aligned in a way for me, for for me to start that up.    Jayson Davies     Yeah. And you know what, let's, let's let's talk about that, because we are going to talk about the play on the go approach that you kind of developed. But I know that your social media world played into that development a little bit. You learned a lot as have I from communicating, from talking with people, and so, you know, you talked about the pandemic kind of leading the way. I think you had the account before the pandemic actually started, right?    Alvin Pineda     Yeah, I had it. I think I started January 2020. Just started, yeah.    Jayson Davies     All right. And then so kind of at the same time that you were kicking off your IG account, reels came into play, and Instagram started saying, Hey everyone, let's rip off Tiktok and Snapchat, and let's start putting together reels. And so you, like, dove full force into reels. Talk a little bit about what kind of inspired your reels and maybe how you developed those a little bit.    Alvin Pineda     Yeah. So I think one of the best ways I kind of leaned into reels is because I'm like an older millennial who loves technology, who grew up with technology. I had my space. I was all into video editing. When I was in OT school, I was actually voted, like most likely to utilize technology within my practice. Like I'm not gonna say, I'm not gonna say what videos, but there are videos on YouTube which I have, like, ot wraps, and I have, like, all of these things. And like, those are all my projects. We will find them. If you scroll hard enough on my IG, you'll find it. Yeah, but I was always doing these video projects throughout ot school. So I love video editing, I love technology. I love social media. I mean, I was part of the first generation with with MySpace Facebook, so it was just a natural way for me to incorporate my passion of technology, just growing up in it. So it was very easy for me. I know I'm looking to teach other people about Instagram and reels pretty soon. So I'm looking to kind of share that passion and start to help other people kind of find their way for Instagram. I know it can be a lot, but in terms of your question of, how do I kind of find that inspiration, you know, I just, I'm just scrolling kind of throughout Instagram, I see other accounts, especially teachers or other kind of nurses or physical therapists, and then you kind of figure out a way how to relate it back to what your niche is and what your area expertise is. So I always find my inspiration for other people, or I'll look to adapt that. Or if I have an idea, I'll just figure out something that's trending, and I'll trending in terms of a music or a little voice grip. So, yeah, I'll figure out a way to kind of adapt that and then showcase that on my on my page.    Jayson Davies     Yeah. And so when it comes to actually incorporating the occupational therapy side of it, are you, I mean, do you primarily focus on evaluations? You promote focus on therapy or what? What's kind of your niche? What do you really like to focus on?    Alvin Pineda     Yeah, so I think my main kind of niche is very much a treatment, treatment activities and really helping other practitioners feel confident and creative in their treatment approaches. So what you'll find on my Instagram account is a lot of like, multiple ways to play. I have therapy toy Tuesday, and I talk about different ways to use different games that are easily accessible within most therapy rooms or clinics. So I like to change things up and break the rules of different games and play in different ways. So you'll find a lot of that, and you'll also find a lot of kind of confidence, kind of building, or mind mindfulness activities throughout and then I also like to kind of really promote occupational balance and self care within our profession. I think it's important that we remember like mental health and physical health is so important, and if we're not putting ourselves first, we're not going to provide the best service for our clients. We're constantly putting our students first, but we have to learn how to put ourselves first too. So I think that's super important.     Jayson Davies     Yeah. And, you know, before we hit record today, we're talking a little bit about your vacation, and I know that you recently posted a reel that was literally just telling people, remember to use your PTO your paid time off. You know. Yeah, as most of my audience are, we're school based occupational therapists, and so a lot of us do work es y extend the school year, but we still, you know, have maybe two weeks here or there. And absolutely we gotta, we gotta use that time. I mean, we're so busy during the school year, we gotta use the summer and go out and have a good time.    Alvin Pineda     Exactly. And I know, like, when I worked in the school system, I always, like, felt a little guilty, like taking, like, a mental health day or like taking a little three day weekend, but like, sometimes we have to do what we have to do. We have to make sure we're 100% for ourselves, because then our sessions and our evaluations and our reports will be 100 times better.    Jayson Davies     Yeah, I know I don't want to get too far into this conversation today, but I always talk to those people, you're right. They feel guilty. They feel guilty about taking a Friday off. And it's not just OTs right. Teachers feel the same way. Because, I mean teachers, if they take a day off, they had to write sub plans, so it's almost like they have to do more work to take a day off. For us as occupational therapists, a lot of times, we don't have subs, period. And so if you miss a day of treatment either A, those kids are never going to get made up, depending on how your district policies are, or B, you have to find time to make those kids up the following week, or whatever it might be. And you don't get paid extra for it, but you do get your day off that you took. So yeah, but definitely take your time during the summer, enjoy it, and even during the school year, I'm right there with you and saying, You know what, if you want to take a Friday off, don't feel bad about it. Take that Friday off. And you know what, if your district is saying, well, when are you going to make those up? We have to remember that it's also the district's fault for not putting something in place for you to take a day off. You know, teachers have substitutes. There needs to be a system in place for OTs.    Alvin Pineda     Exactly. And that's definitely a missing piece in the puzzle, I think. So.    Jayson Davies     Yeah, yeah, all right. So play on the go approach. I want to get into that. So my first question about that is, we're going to dive deep into it. So give me a second. But what inspired you to develop the play on the go approach, and also, did your social media world play into that inspiration?    Alvin Pineda     I think it definitely did. But in the foundations of everything, when I first had an OT student, as a school based practitioner, this individual was kind of struggling, and I think that's when the framework kind of was structured in my mind. When we talk more about the approach, I'll talk about like different body positions we can do activities and different ways to adapt different activities. So I started to teach this student the various ways to look at an activity and to think about different ways to play a simple board game and incorporating in goals. So I think that's where the foundation started. But once I developed this social media following, and I wanted to somewhat monetize it and teach other ways, the same kind of mindset in the same way, I think within treatment sessions, is when I was like, Okay, I think I need to really start putting an effort into structuring this approach and really developing it. So I think when we talk more about it, you'll see how the different ways we can play and ways we can adapt that. So.    Jayson Davies     Yeah, yeah. I really just want to take a second though to to appreciate what you did though, because you literally took what you already knew that you were doing, but you hadn't, kind of compiled it into something nice and clean, a manual per se, and by bringing on an OT student, that's what allowed you to really have to think about what you do on a daily basis, and to, like you said, kind of clean it up for that student, so that they had an idea of what you were doing. That's great. Because, I mean, you helped that one student, and that one student helps you to really, kind of, you know, put it into a nice, clean, you know, this is what I'm doing, and now you have the ability to share that that's awesome.    Alvin Pineda     Yeah. You don't even realize what how it how you're doing it in the moment, but in reflection, I'm like, Oh, wow, yeah, so.    Jayson Davies     Right. We help students, but they also help us. So it's a two way street.    Alvin Pineda     Yeah.    Jayson Davies     All right, so let's start by saying, Why is it called the play on the go approach, and then we'll dive kind of into the individual aspects of it.    Alvin Pineda     So it's called the play on the go approach, because it's kind of like a little acronym. We'll talk more about what P, L, A and Y stands for, but it's something we need to remember that kids, for kids, their daily occupation is play, and for us to make it therapeutic, we need to be quick on our feet, and we need to think on the go, on learning how to adapt, learning how to modify and meet each child's needs within that just right challenge. So it's really working on facilitating that ability to really kind of look at an activity and look at the task analysis and feel really confident in being able to downgrade. You upgrade that activity.    Jayson Davies     Awesome. So we have PLA and why, and was there as you were developing this. I mean, I know we talked about how you kind of started with this student, but what is some of the research that kind of influenced the way that you developed this?    Alvin Pineda     Yeah, so when I was like looking back on kind of all my information, I think, as I mentioned, one of the first things we learned in OT school was task analysis and activity analysis, right? So I think having that experience and being able to modify it for multiple levels of students that help my transformation of this mindset. So just all of that research and how important task analysis is and activity analysis it's, it kind of helps shift that. And then when I was looking at the different kind of models and the different frameworks I was trained in in multiple areas, like dir and floor time, and then, like sensory integration in the star Institute, sensory process of sensory processing. So all of those kind of models are very child led, and sometimes we forget how important it is to kind of follow a child's lead. So a lot of those models and those frameworks kind of help influence that as well. And then looking from like another, like ot school perspective of like theory and models a big factor, I think, was like the PEO and the peop model, because we're looking at the person, we're looking at the environment, and we're looking at their occupation, and how it's impacted with all of those factors. So sometimes we learn about all these theories, but we forget how it's impacting our clinical reasoning. And I was able to look back, and I'm like, Oh my gosh, this can be correlate back to this theory. This can correlate to back back to that theory. So we're kind of thrown all these things in our in OT school, and we forget to use it. But when we think about and we when we reflect on it, it's ingrained in our mindset, and we're using all of those items within our clinical reasoning already, I think so it was good to see that.    Jayson Davies     Absolutely, that's awesome. And so you talked about play as an occupation, and that's part of what played into the whole play on the go approach, the OT practice framework, it lists many other occupations. We have education, we have mental health, even this kind of worked into there. Now, all right, would you say your this approach solely focuses on play, or do you think that it uses play as a means to also focus on other potential occupations?    Alvin Pineda     I think it could definitely be related within kind of multiple layers of occupation. It's all about kind of that adapting and modifying. So whether it be like realizing what can impact like sleep or like leisure and social participation, and being able to modify it, and being able to meet that just right challenge within those other occupations is is super important, and it takes that clinical mindset to figure out how can I adjust it, and how can I figure out what exactly is impacting this individual's performance.    Jayson Davies     Yeah, yeah. And, you know, we we so much of what we do has an impact on other areas, whether we want to or not. You know, you work on one thing, and you have no idea some of the things that it could impact later down the road. And so play is such a huge area. In fact, I recommend that everyone, no matter, or every pediatric OT, you need to learn about play, because play is just so important. So then you're a pediatric OT, you work in a clinic, and I think you do, do you do home based as well? Are you mostly in a clinic?    Alvin Pineda     I'm mostly primarily now in a clinic.    Jayson Davies     Okay, so would you say that the play on the go approach as we dive into it? Is it very specific to a clinical based model, or could it also be used within the schools or a home based model as well.    Alvin Pineda     I think it can definitely be used in multiple settings. The main thing is really identifying what performance skill you're working on. I think especially if you are in a home based setting, you're working with whatever the client has in their home. So learning to adapt a toy they have in their home to their skill set. Meeting them where they are with a specific activity is super important. So just looking at one thing, okay, this was too hard. I'm going to adjust it, maybe change the body position, or maybe incorporate something that they're motivated with, incorporate a character or a song, and figuring out how you can increase their motivation to engage and increase participation. So whether you're home, home health, school based, I think it'll, it'll adapt within any setting. So.    Jayson Davies     absolutely, I'm right on there with you. When that, when I first watched a little bit about the play on the go approach, I was like, yeah. This absolutely applies to, you know, every session that I'm working on, especially in a pull out model, it's a little bit different, I think, when you push in, because, you know, you're in a more structured setting. But anytime that you are in a pull out model, definitely, although I think that when we get to letter A, we'll also talk about potentially going in to the classroom a little bit. So let's dive into the four letters, then P, l, a, y, let's start with P. Go for it. I'll let you dive in.    Alvin Pineda     Yeah. So breaking it down, the P is in terms of positioning, right? So one of the things we want to ask ourselves is, can you change the body position in particular, and then can you change the position of the various manipulatives? So I like to think of this as like, if you're doing a puzzle, if you're doing some writing activity, if you're doing a craft, if you're playing a board game, do you have to work on the table? Do you have to do do it a sit down work? Or can you shift their body position? So some things you can take into consideration is taking it to the floor. You know, work prone, prop on your elbows. Work seated in a criss cross position, you know, so they can get a little bit of that kind of postural challenge. You can work in a tall needle. You can work in a half meal, I mean, OTs, go to like that vertical surface, right? You can put things up on a wall. Go in that tall meal position. Work on a lot more of those postural control muscles. You can work on a therapy ball. You can work on an air discs, just to get a little bit more input. So there are so many different ways you can, kind of shift your body into play. It's not just sit down work. I think maybe school based therapist. It's a little bit harder to think outside of that box. And we usually go to, hey, let's go to the table. Let's do this because we're working that school based model. But one of the things I want school based therapists to take into consideration is that, yes, your outcomes have to be educational based, but your treatment approach does not have to be educational based. You can still work on facilitating play and work on those underlying skill sets within your treatment, because in the end, your outcome will still increase their educational outcomes as well, too.    Jayson Davies     Yeah, and that's exactly what we talked about a moment ago. How, you know, using this as a means to more of an educational end, per se, using play as a means to increase that educational access, that's awesome, you know, as you're talking about that, you know, I hear all this, all the things that you're saying when it comes to maybe you're working on a one on one session, and you're working on posture specifically. But as school based occupational therapists, we can do that in the classroom as well, through accommodations, through recommendations for the teacher as well. You know, I have had students that I have talked to the teacher and let them kind of understand, hey, he works. This student works so much better when we get rid of the chair and he's just standing up and he's doing his work standing at his desk, and at the end of the day the goal is for him to complete work. What's the difference whether he's sitting down or standing up? So I think that it can go both ways. It can it can be that pull out model, focusing on on the positioning, but then in the classroom, you're focusing on the work, and using whatever position facilitates, facilitates that work, I guess so. Yeah. I think it can kind of be used in both, both areas.    Alvin Pineda     Yeah. And if we're taking, like, the next letter into play, l, which is going to be body language, we can read their body language, and it can tell us they need movement right so we can change their body position into something where they are meeting that just right level of like movement, and they're at that just right level of arousal so that they can attend, so that they can participate in A classroom based activity or lesson. Even more so kind of just incorporating that and teaching teachers how to read their body language too, and figuring out what they need is super important.    Jayson Davies     Yeah, absolutely. And so staying with that. L, what do you really look for when you're looking at the body language? Are you mostly looking at, you know, facial expressions? Are you looking at the entire body? What are you looking for?    Alvin Pineda     Yeah. I mean, we're looking at everything, right? Whether you're working with a speaking or a non speaking student, you're looking at their facial expressions. Are they kind of overwhelmed? Are they overstimulated? Is are they transitioning from a very busy, over stimulating, auditory classroom. Do they need some a couple minutes to just re regulate, kind of decompress? Are they like well regulated for the activity? Because if you don't have a student who is well regulated, you're not going to have that maximum potential to engage in whatever activity you need. So you need to figure out what their body language is telling you, like kids can just come into a classroom frustrated because maybe there was like a social interaction, so it's important to remember that and then just be there for them and read their cues. In many ways mean we teach students to read body language and to read social cues, but sometimes. We forget. As therapists, we need to be there for them. We need to figure out what they need, too. So it's not just about work. It's not just about goals and outcomes. Sometimes you need to build that rapport. Take a second, take a minute to be there, ask them what they need, or problem solve together and figure out what their body is telling us.    Jayson Davies     Yeah. And you know, when I when I hear the term social skills and body language a little bit. I 100% think that OTs work on social skills in that, however, I know there is some perception out there, especially when you get out of the world of OT that when you discuss social skills, that might be more aligned with the speech pathology world, per se, I think as OTs, we are constantly trying to share with our administrators and whatnot that, you know, we can do social skills as well. But I know for a lot of places that it's kind of social skills are within the realm of SLPs. So I guess what I'm trying to go down is, have you worked with SLPs collaboratively at all with social skills, or even working on language skills alongside of a speech therapist?    Alvin Pineda     Yeah, a lot of my num non public schools, I've very much kind of CO traded and worked hand in hand with them. I think where our expertise comes into play is understanding body language in terms of regulation and arousal level. If they're like, moving around, if they're bouncing off on their chair, that's their way of telling us they need movement, right? Whether they are kind of feeling a little silly, like in that green zone, or if they're like, over stimulated with auditory input, that's where we come into play of recognizing what kind of the sensory environment, how it can impact their participation. And I think in collaborating with speech therapy, you can kind of intermingle a lot of those two and kind of figure out what their actual like language is telling us as well, plus understanding their their sensory language and what their body is telling us. So I think taking both into perspective is super important when looking at body language.    Jayson Davies     Yeah. So before we move on to letter A, I want to kind of talk a little bit about evaluations as it regards to P and L, the positioning and the body language. So when it comes to evaluations, how might you evaluate that positioning?    Alvin Pineda     Yeah, so when I do my evaluations, I'll typically go to, like the standard kind of the seated position, see how they do in that body position, and then just shift it up if see how long they can kind of maintain that before displaying fatigue. And then you can kind of bring it against gravity, or you can bring it to the floor to see what other areas they're having difficulty with. Say you go prone, prop on elbows. Do they have enough shoulder support and shoulder stability to maintain that position? If you're working on a vertical surface, are they able to have full range to maybe reach for something up tall? Also, when we're talking about like position as well, you we're also talking about positioning of manipulative So are they able to cross midline, if you're working with different kind of like, if you're working on the bot, if you can put the pennies somewhere else, on another side, are they able to cross that midline? Are they able to reach down to the ground, if we drop the pennies on the floor. So, like, even just little things like that, like, if we're cleaning up the pennies for the bot, right, we see how they shift. We see how they reach down. So it tells us a lot, even just with simple clinical observations like that. But yeah, whether you're you're changing up the body position on the floor, you are working at a toll needle. You're looking at those transitional movements, and those transitional phases from seating to standing to going in into a crisscross position on the floor. You get it can tell us little things about their motor plan. It can tell us little things about what position they may work best in, and what actual skills like strength in core, upper body, even lower body. Are they lacking within their overall engagement?    Jayson Davies     Yeah, yeah. And so I want to ask you a little off the cuff, challenging question here You talked a lot about more of those personal skills per se, right? The individual skill to cross the body, the individual or to cross midline, the individual skill to not fatigue in school based OT, we're always trying to relate it back to education. And so if I can challenge you really quickly, how might you, within your actual report itself? Use what you kind of just maybe you you know, you report that the student's not crossing midline. You report that the low fatigue, or whatever it might be, how might you relate that back to education when you're reporting for the teacher, the administrator and the parent?     Alvin Pineda     Yeah, I think in particular, with like postural stability and postural endurance, can relate it to stability to attend like when a student is. When a student demonstrates decreased kind of postural stability and they fatigue very easily, their ability to attend to a lesson will be much more difficult. Their ability to write legible work will be much more challenging. So really advocating the importance of the developmental approach of core to shoulder stability, to find motor ability and how it can impact overall engagement, like attending, and how it can impact handwriting as well. I think that's so important to advocate that and really showcase that decreased core can also impact handwriting ability, and not many kind of educators know that. So that's where our OT lens in development comes into play. And then when we talk about, like, bilateral coordination, when we talk about difficulty with crossing midline, we make it we make it more functional, we talk about how it can impact legibility. When in terms of when we're writing, they may not use, like, their stabilizing hand and how it can impact legibility, maybe difficulty with dressing or buttoning or zipping, and their various manipulatives, kind of throughout the classroom setting, so making it more functional and relating it back to how it can impact an individual's performance within the educational model is just super important. And that's where it takes that clinical reasoning to realize, okay, this can impact this. This can impact that as well. So remembering that is something we have to start doing a lot more and advocating and educating various professionals with.    Jayson Davies     Yeah, you know. And I like to tell school based OTs a lot of times I find that school based OTs focus on one side or the other. They focus on the big picture, and they might say that a student is not able to hand write legibly, or on the flip side, they might focus on the individual skills and say that the student has poor fine motor skills, poor crossing the midline, but they don't tie it back to the handwriting, or they don't tie it back to the attention. And I think that is something that is key in all of our evaluations. We have to tie the overarching occupation, the overarching activity, to those component skills, and vice versa. You gotta tie it back and forth one way or both ways. So, yeah, I like that, that you use the postural and all the other things to then talk about how that impacts the occupational performance. And what about language development? Or, sorry, not language development, body language. Are you actively evaluating body language, or is that more on the treatment side that you're looking for that as you treat.    Alvin Pineda     Um, I think in terms of evaluating, like I would see how they react to certain things, like if they are, if they hear a really loud noise, or if there is, You're doing your evaluation with a busy classroom next door, are they able to attend? Is that noise distracting? Is that sound of the lawn mower distracting? So during my evaluation, I'm going to note that and talk about and discuss how it may impact their performance, because in the end, if they're in a busy classroom and that auditory stimuli is just too much and too overwhelming, it's going to impact overall engagement. It's going to impact their ability to attend to the teacher led discussions. So little things like that. It's those are just clinical observations that I'll note, and then I would note, how can impact, then that occupational performance, and then how can impact overall engagement as well. But yeah, little things like that. What else? Um, yeah. If I if we see difficulty with kind of overall strength, then I would also kind of talk about how the strength can impact overall engagement as well, whether it be like engagement in kind of PE or any physical activity, or engagement in a lot of my middle schoolers just demonstrated a lot of fatigue, of carrying their backpack or carrying their books from one classroom to the next. So like simple accommodations, like having those books in the classroom already, so that they don't have to carry them throughout classroom to classroom, just so that they don't have to fatigue, and then they can increase that attention level throughout lessons as well. So just understanding how those impacts of body language can also kind of impact overall engagement and and correlating it back to that again, is super important, especially in that school based model.    Jayson Davies     Yeah, and I, and I earlier, you kind of started to talk a little bit about training the teachers, and I think that's important, especially for the body language, you know, training the teachers to understand what they're really seeing when they see a student act in a certain way, right? That goes back to some of the behavior components, some of the kids who are falling asleep in class. You know, what does that mean? And does it mean that we should be mad at them for falling asleep? Or it doesn't mean that. Need to work on something else. So 100% teaching teachers and paraprofessionals a little bit about what to look for within their students. So yeah.    Alvin Pineda     I think that's especially important with kids who are in that that Gen Ed kind of settings with typical peers, right? I'm just giving them reminders of what this can look like, and then how we can help facilitate that, get them to that kind of just right arousal, so that they can engage. So, yeah, it's super important in a gen ed setting.    Jayson Davies     Yeah, when it comes to, you know, a popular term, it's not as popular now as it was a few years ago, I don't think, but sensory diet. And a lot of people teachers, they wanted a very prescriptive sensory diet, and I was kind of against that, because we can't just say this student needs five minutes of trampoline time every hour. Like that completely takes out what you're talking about, the body language. We're not looking to see what their body language is. We're just saying every half hour, every hour, they need five minutes on the trampoline. Well, what if the students engaged in an activity and it's like all right time to jump on the trampoline, because it's the hours up, right? And so when I create a quote, unquote, sensory diet, I actually don't call it a sensory diet. I call it more of like a sensory preference sheet. And the way that I will format it is I will have that body language per se, that like what this looks like. So if the student is more lethargic, this is some body language things that you might see. And here are some activities that you might be able to use when you see that body language. And same thing when they're over stimulated, what you might see. And here's a few things that I've done with the student that helped bring them back down a little bit. So I really like that body language aspect that you're talking about. I don't think it's something that we use very often As occupational therapists, or at least not mindfully. We are always looking at it, right? We know that we have to look at body language within every treatment, but we don't talk about it, so.    Alvin Pineda     We definitely, we definitely have to take the next step to advocate and teach educators and their power professionals how to read that body language too, because we know exactly what to do in those environments and know what to do in those settings. But we need, in the end, we want them to be fully engaged all across classroom settings. So that's something we as OTs definitely have to have to work on. Whether you're school based, you're at home, working with the families, or you're working in a clinic setting. Yeah, that's some we want to see generalization in the end. That's our goal.    Jayson Davies     Absolutely. All right, we talked P and L pretty extensively. Let's move on to letter A I mentioned this earlier. I think this is a super important one, so I will let you have at it.    Alvin Pineda     Yeah. So A is called areas of interest. So things we should be asking ourselves, is this activity client centered? Does this activity include something that they're interested and then are they motivated to participate in this activity? So different ways you can include their area of interest is to just make it fun. Include a game. Add different challenges, like, Oh, we're going to do we're going to do exercises, but so and so did 30 in one minute. So adding a little bit more motivation to that. You can incorporate themes, especially with holidays. Kids love holidays. So different themes and different characters are another way to include something motivating and then just including a preferred task. If there's a game that they really love, include that into therapy. And then you can change the body position. You can change the position of those manipulatives. You can include, say there are small manipulative. Say they really love Connect Four. You put those chips into like putty, they have to pull that out, and then they can play Connect Four with that. Or you can write letters on the chips, and then every time they get a Connect Four, you have to write out those letters. So just being able to take whatever they're interested in and then include it within our therapy sessions, and then use that clinical mindset to adapt and modify that activity, whether you're using body position or changing the manipulatives, is just super important to just increase that motivation.    Jayson Davies     Yeah, and so when it comes to being school based OT, oftentimes we do have that pull out setting where we can do a lot of that. But how might you recommend to a school based ot that is using more of that collaborative consultation model. How might they incorporate areas of interest? Do you have any ideas on that?    Alvin Pineda     I think especially just having in terms of a writing aspect, maybe just having special kind of paper available? Maybe you can just spend time to make their specific adaptive paper a little bit more motivating. Maybe add some characters or some stickers on there. Maybe you can just add a little once they write it on a piece of paper, they can cut it out. They can put it on a construction paper or something with their their favorite color. They can write. With their favorite color as well. I think any fun way, maybe you can do it. Or even just if they have to write sentences, or they have to write a word, make it a word based off of a TV show they like, yeah, so just including that into writing can definitely be beneficial.     Jayson Davies     Yeah, you know. And just like you were talking about how you get inspiration for reels by looking at what other people are doing on Instagram. I think the same thing comes for for therapy too, right? Like it's died down a little bit now, but, you know, a few months ago, Wordle was huge. And so using Wordle as a therapeutic activity, you know, you come up with a word and then you have some green and yellow tiles, and based upon what were there, right? You put some green and yellow tiles on it, or something like that to, kind of to help them out a little bit. So, yeah, you know, I think just trying to make it fun in any way possible, obviously, like Pokemon, huge, several other other areas, Minecraft, Roblox, all of those can be used as a therapeutic tool.    Alvin Pineda     Yeah, especially with, with those therapists working with like the middle school or high school ages, you got to figure out ways to motivate them. So figure out what's interesting, and then, like, you can write stories about their minecraft adventure or whatnot, so you don't have to just write random stuff that they're working on in school. Make it more motivating, engage their interests and whatnot. So.    Jayson Davies     Yeah, and if you were talking to a teacher, how might you explain to them the importance of areas of interest, even within academics?    Alvin Pineda     I think when incorporating that with teachers, just using kind of our evidence and showing that look so and so was able to write five sentences and look how legible it was. It was because he was actually really motivated. We wrote and we talked about his favorite game. So really just showing evidence that he can actually do this skill, it's not a lack of motivation. I think is super important that that underlying foundation is there, and they just need to fine tune what they're working on, and then they'll find that, hopefully, that generalization within the classroom setting as well.    Jayson Davies     Yeah, and you know, it's easier when kids are younger, when they're older, you know, the the task demands get a little bit tougher. But I think at any level, teaching teachers, or working with teachers to help them to actually develop curriculum that is interesting for your child, for your student that you're working with, and they may need help with that. Like you can't put it all on the teacher, but if you do meet with that teacher once a week or once a month, and you're just meeting with them and saying, All right, what's coming up? What can I help you with to help this student be more motivated, even you may need to do it more upfront, but as the teacher has more experiences with you, more experience with a child, they may start to realize how they can adapt an assignment to make it a little bit more motivating for that child, and it can go much further, and the student might actually complete work. So yeah, always gotta keep it motivated for the child.    Alvin Pineda     Yeah, I think even just when having accommodations in place, it's like really educating the teacher of what kind of his skill set is like he will fatigue after three sentences. So yeah, educating them where their skill levels is at, and then determining when they need a break and what that looks like when they need a break too. So, but that's where that body language comes into play as well.    Jayson Davies     Yeah, all right. So quick recap before we dive into letter Y, we have P for positioning, L for body language, a for areas of interest, and now letter Y. What do you have for letter Y?    Alvin Pineda     Letter Y is, yes, I did it.    Jayson Davies     All right, go for it.    Alvin Pineda     Yeah. So we want to make sure kids are walking away from whatever activity feeling confident, right? So this is where we think about, are they meeting the just right challenge? Because if an activity is too easy, it's too boring, they don't want to do it again. If an activity is too hard, they're not going to do it again, because it was just too hard, and they don't have that growth mindset to try again. So certain things we're asking ourselves, do they feel successful in the first 10 to 15 seconds? Are they walking away feeling confident? And then one thing to realize too is, are we reinforcing the process or kind of the end product as well? I think that's super important in terms of walking away from a treatment session or finishing an activity as well, too. So.    Jayson Davies     Explain that a little bit further. Yeah, just or sorry, you said the process versus the end product. Dive into that part a little bit more.    Alvin Pineda     Yeah. So say we finished an activity. We finished some writing from there. So sometimes I'll hear, Oh, good job. That looks amazing. So that's. Kind of reinforcing the end product, versus if I were to say, oh my gosh, you did awesome at keeping those letters on the ground. I love how you kept the size of those small letters, or, like, Good job problem solving when it got hard, and figuring out what errors you made. So looking at kind of the whole process of of their problem solving and really reinforcing that is really important. Because if we're constantly saying, Good job, good job, what are they being reinforced for just their work or their the end product, versus their ability to problem solve when something went wrong, or good job at keeping those letters nice and straight and keeping the appropriate size. So.    Jayson Davies     Yeah, so being mindful of praising the skill, not necessarily the outcome. Yes, that makes sense. All right, cool. That makes sense. And then you also mentioned, and I want to dive into this, because I had never heard you mentioned the first 10 to 15 seconds, making sure that they're feeling confident within the first 10 to 15 seconds, even that's very quick. Why? Why is that short period of time so expensive, so important?    Alvin Pineda     I think it's so important because then you want to build that momentum right? If they are kind of lost or unable to complete the activity, that momentum is going to be lost very easily. So if within the first 10 to 15 seconds, they're having some difficulty figuring out what cues or what assistance they need within those first few seconds to be successful, for them to kind of engage within those activities, even more so let's see. That's where I think our therapeutic use of self and that just right challenge comes into play, we can really determine okay, this kid is having a lot of trouble, and okay, I can give some verbal cues or just give a little prompt for him to get that initiation. I think something to consider is whether your client maybe have some difficulty with some processing and they're processing skills and their own abilities. So that might be a little different for those type of students who have difficulty with task initiation or ideation. So that might range a little longer, but I think again, that will be behavioral momentum, and just finding success will increase that independence overall within those first few seconds.    Jayson Davies     Yeah, absolutely. So yes, I did it. That I love that you finish up with that. We still have to talk about the on the go part. But what do you hear when you hear a student say, Yes, I did it. What does that mean to you? And what should it mean to other people who are constantly working with that student?    Alvin Pineda     Yeah, yeah. I think to me, first, that means that they feel proud in their work, that I met their just right challenge. And one of the things I asked them, was that easy? Was it hard afterward, too? So that if they say it was hard, they recognize that, and then that increases the likelihood of them engaging activities that they perceive as difficult, because a lot of our kids might have a lot of difficulty with that growth mindset, like, if something's really hard, they're going to give up really fast. Yeah, and I think again, that's where the 10 to 15 seconds comes into play, because after a kind of learned behaviors, I'm not good at this. I'm never going to do it. We want to give them that success. We want them to feel really successful in that activity. And that's where our therapeutic activities come into play. I mean, I've seen therapists just practice writing, writing, writing here and there. But if we think about the actual activity we can have like para professionals practice just writing worksheets all day. What makes it therapeutic is them feeling confident, knowing that we are reinforcing the process, knowing that they are doing proper, legible work, and that they're again feeling confident, and they know what areas they're having difficulty with, and they know that they can do hard things walking away from an activity.    Jayson Davies     Absolutely, yeah, that's great. And I think it's so important for us to share those Yes, I did it moments with the teacher, with the parent, let them know about, you know, send a quick note home, or send a text message, an email and just say, hey, you know what? This is what we did today in therapy. And Johnny loved it. He was successful at it. And I would highly recommend that, that maybe you use that in the classroom by doing this and share some ideas with the teacher that they can do to get that yes, I did it moment.    Alvin Pineda     Yeah, one of the things I loved, I took this star training in Colorado, and they have these aha moments where parents realize, Oh my God, you did this, you did that. And that model is very parent friendly. So they have parents included. So it's good to see for them, to see the actual progress, and they're like, Oh my gosh. They have those, those aha moments. So it's, yeah, definitely so important to share. That, because then they can start to generalize that, and they can hopefully start to see those little moments as well too.    Jayson Davies     Yeah, all right, and so the last part of the framework, it's play on the go approach, on the go. We don't want to forget that piece. And I think this really resonates with school based OTs, because we never have one place. We are constantly moving. We may or may not actually even have a therapy room. We may have a therapy closet, a therapy stage, a therapy bench, outside in the hallway, whatever it might be. So share a little bit about that on the go, approach.    Alvin Pineda     Yeah, I definitely think as ot practitioners, we are always constantly on the go. So whether you are in a school based setting, you have one therapy bag of items. You are working in a hallway, in a stairwell, you're working in the client's home, or you are working in a busy clinic. You are always on the go. You have students to see, you have IEPs to write and reports to write. So we are constantly in that mindset being on the go. So within treatment, specifically, we need to be able to take whatever's in our therapy bag and use it with an individual in kindergarten to first grade, all the way to like, fourth and fifth grade, so being able to think quick on your feet and feel confident in adapting and feel confident in modifying that activity to meet that client's needs and meeting that just right challenge so that they feel all of those things of feeling, yes, I did it after they complete the activity, so.    Jayson Davies     Yeah, and it's, it's so hard to adapt, because, you know, you could be at a kindergarten class, you know, in the morning, and then you could end up being in a middle school or high school. And I totally recommend, and and hope that, hopefully you can put together a separate bag for some of the but you're right. We need to be able to adapt and we needed to be able to modify. In the school, you know, a lot of times adapt and modify are used interchangeably. I think in the schools it is a little bit more defined. The difference between an adaptation versus a modification, because they actually use those terms for curriculum. An adaptation is changing the activity to where it's still the same activity, but it's slightly maybe we're allowing them to type instead of handwrite. That would be an accommodation or an adaptation, but when we get to a modification. Now it's a completely different activity, per se. So now instead of being expected to write an essay, they're expected to maybe write an outline, so it still shows that they have the ideas there, but they're don't have to put it all together into an essay that might be more of a modification when you're changing the actual standard. So I think in education, those those two words are a little bit more defined than what they might be in a clinic therapy world, right? We kind of use them a little interchangeably, talking about how you're going to adapt in a therapy tool or whatnot. But either way, you need to be able to do both. You need to be able to understand accommodations versus modifications, and be able to use the terms that the teachers might use to best resonate and get through to teachers. So on the go, man, we are always on the go.    Alvin Pineda     Yeah, you definitely are, I think, just to kind of full circle moment where it's like, yeah, when we're thinking on the go and modifying, we then have to consider all of those things. So consider, how can we change their body language? How can we shift and manipulate the manipulatives so that they can work across the midline, they can do all of these little things, and then we can figure out, okay, if they're not motivated, how can we make it more challenging by including areas of interest? And then we're just reading their body language again, so figuring out what their body is telling us, are they aroused? Are they able to attend to the activity? So and then figuring out, are they walking away with activity saying, Yes, I did it. So all of those four things kind of come into play, especially with adapting and modifying and thinking on the go. So.    Jayson Davies     Yeah, would you say that? I mean, it's a lot to think about when we're in a therapy like when we're in a therapy session, it can be hard to remember P, l, a, y, on the go, all that good stuff. Do you think that at the heart of it, we need to always be thinking about all of these? You think maybe one session we could be focusing on the positioning, and another session potentially focus on this. I know it can be a lot to take in and and learn everything. Ultimately, we want to know everything, but yeah, what's your take on that?    Alvin Pineda     Yeah, I think taking it step by step, this way of thinking definitely, just like as regular practitioners, we have to go on a learning curve, take little steps and adapt and making sure we're meeting our own just right challenge, right we're not overwhelmed ourselves with trying to put things into perspective and work on implementing certain things. So take things little by little and make progress in small, little steps. Is. Important, I think.    Jayson Davies     Absolutely, 100% you know, we, I like to say, you know, as an OT, we have to know what we can do, but we also have to know our own limitations and what we potentially will struggle with, and how to we, for lack of a better term, combat bad and how do we, you know, take it slow and get to the point where we are ultimately a better therapist, but getting there one step at a time. All right? Alvin, well, go ahead. What was that?    Alvin Pineda     Yeah, we definitely do. We have to give ourselves Grace within that. So,     Jayson Davies     100% all right. Alvin, well, first of all, before I let you go, thank you so much for coming on here, and I want to give you one last opportunity. Well, two more things, actually, I just want to ask you to share a word of wisdom with anyone who is out there who's maybe struggling with seeing progress with their students. You know, just a little bit of Word, words of advice from one ot to another ot that might be struggling with having some some progress. You know, maybe they're taking some data and they're just not seeing that progress that they'd like to see with their student. What's a little word of encouragement or advice that you have for them?    Alvin Pineda     I think, first and foremost, take a second and forget about data like build that relationship within the next few sessions and really start to incorporate their areas of interest for me, relationships are so important. Within my therapy sessions, you have to have a strong relationship with your client to push them past their comfort zone. So reflect on your relationship with your clients and see if you have a strong relationship where you can kind of push them past their limits. Then once you realize you have that give yourself grace to all your work, because your students are just so lucky to have you, and then slowly start to determine what is truly kind of impacting their students. Performance, is it one performance area? Is it just the fine motor? Is it the visual motor integration? Is it the core strength? Take things one step at a time, look at one thing and just build on it and determine, Okay, is this what I should focus on? And then if that found it, check the next thing off our clinical reasoning hats or our checklist. So just take a second, give yourself grace, and then just rethink our and rethink and problem solve. What else can we be addressing and what can we do differently?     Jayson Davies     Great. Yep, always have to have that rapport with students before we can can move forward. So thanks for sharing that. That's a great tip for anyone out there who's just struggling a little bit. So awesome. All right, now I want to make sure that anyone listening who has just appreciated what you have had to say today, I want to know or let you, let them know, I guess. Where can they learn more about you? Where can they learn more about your reels, your play on the go? Approach.    Alvin Pineda     Yep. So you can definitely follow me on Instagram and on Facebook. At ot outside the box, I have my website. It's currently down, but I have a lot of things coming in the works, whether it be education to different therapy tools. So definitely follow me on Instagram. That's where you'll find the most up to date information. And I'm on Facebook as well. So.    Jayson Davies     Yeah, and we'll be sure to share those resources on the show notes at ot  schoolhouse.com/episode , 107, I can't believe I have 107 episodes. That's crazy. But thank you, man, thank you so much for being here today. I really appreciate you taking the time to share some of this information with everyone out there listening. And yes, be sure to go follow Alvin on Instagram. For sure. Honestly, you could spend an entire day just going through all the reels and learning so much from him, so be sure to check that out. And yeah, thanks again Alvin.    Alvin Pineda     Thank you.    Jayson Davies     All right. And that wraps up. Episode number 107, don't forget that you can earn continuing education for learning a little bit about the play on the go approach. You can learn more about that at ot  schoolhouse.com/episode 107, thank you so much to Alvin for coming on and sharing all about his play on the go approach. And also Alvin was very kind. He actually has shared with us a one page document about the play on the go approach. You can grab that for free, 100% free, over at ot  schoolhouse.com/episode 107, and the show notes there. Just scroll down a little bit to the resources and you'll see it there. I will see you next time on the OT school house podcast. Until then, have a great week and yeah, enjoy the first few weeks back to school. Take care and have a great one. See you next time. Bye.    Amazing Narrator     Thank you for listening to the OT school house podcast, for more ways to help you and your students succeed right now, head on over to otschoolhouse.com . Until next time class is dismissed.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast! 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 108 of the OT Schoolhouse Podcast. Have you ever thought about the shifts that have happened throughout the history of Occupational Therapy in the schools? Occupational therapy has been a part of the school systems since the ‘70s when legislation was enacted at the national level. In this episode of the OT Schoolhouse Podcast, we will discuss several shifts in this field within the past 40 years. Our guest today is Julie Bissell, one of the occupational therapists who jumped into the schools early on to address the educational model in schools. Julie discusses transitioning from a medical model to an educational model and shares how we can facilitate participation and help the children perform in the least restrictive environment. We will also discuss an article she co-wrote titled Frameworks, Models and Trends in School-Based. This publication discusses a few frameworks within occupational therapy and relates them specifically to school-based practices in individual states and the United States. Also, stay tuned as she enlightens us about an Israeli handwriting assessment and how she assisted in translating this fun card game into English. Tune in to learn the following objectives: Learners will identify how the World Health Organization model helps to look at a human and their participation regardless of disability Learners will identify what the Pedi-Cat assessment addresses Learners will identify what the educational framework for child success includes and how it relates to the school curriculum. Earn Continuing Education for Listening to this Episode Wish you could earn professional development for listening to the OT Schoolhouse Podcast? Now you can! Click here to purchase the professional development opportunity that corresponds to this episode. Here's how it works in three simple steps: Listen to the episode on this page or wherever you listen to podcasts. Purchase the professional development opportunity. Take the short quiz and earn your certificate. It's the professional development you want on your own schedule. Earn your certificate of completion for episode 108 now. Guest Bio Julie Bissell, OTD, OTR/L, ATP, FAOTA Julie Bissell has over 30 years of experience as a School-based OT. She received her Master’s and Doctorate in Occupational Therapy from the University of Southern California and had the opportunity to learn from Dr. Jean Ayres. Before her work in schools, she worked with California Children's Services. She is also certified in (RESNA) Assistive Technology and Sensory Integration. Resources Article by Julie Bissell - Frameworks, Models and Trends in School-Based Occupational Therapy in the United States OTPF 4th Edition OT Fidelity to Treatment Example Universal Design for Learning Guidelines for OT and PT in the California Public Schools (2012) ICF Model Quality of life at school RtI Link 1 RtI Link 2 RtI Fidelity of Implementation Rubric Example MTSS Link 1 MTSS Link 2 Self-Assessment (HHIW) Self-Assessment handwriting article Here's How I Write (Hebrew) Pedi-Cat Assessment Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.    Jayson Davies     What is happening school based occupational therapy practitioners. Hope you are having a great day as we wrap up August. If you're listening to this on the day that it comes out, but no matter when you're listening to this, I hope it's a great day, whether you're starting off the day finishing up the day, I just hope it has has been a good one for you. Today on the podcast, we are talking about frameworks used within school based occupational therapy. And we're actually going to do a little bit of a history dive. We're going to talk about school based ot over the past. Well, about 40 years, if you can, believe it or not, occupational therapy really got into the school systems back in the 70s. 1976 is actually when some legislation was enacted at the national level. So in this episode of the podcast, we will be discussing the several shifts within the past 40 years or so, and our guest today to help us do that is one of the occupational therapists who jumped into the schools early on to address the educational needs of students. Dr Julie Bissell has been kind of an unofficial mentor to me, whether or not she knows it, but she has been someone who I have been able to go to when I have questions about school based occupational therapy, and she's also someone who has been very heavily involved in some of the legislation and the activism, I guess you could call it here in Southern California and California as a whole, for school based occupational therapy. So today we are going to talk about her history as she moved into the schools away from a medical model, and she's going to talk with us about how we can facilitate participation and help the children perform in the least restrictive environment. We're also going to be discussing an article that she co wrote titled frameworks, models and trends in school based occupational therapy. This is actually an article that we looked at several, I don't know, maybe about 30 or 40 episodes ago, so I'm excited to get her take on it. This publication discusses a few frameworks within occupational therapy and relates them specifically to school based practices in individual States and the United States. Also stay tuned as we kind of wrap things up, because she's going to enlighten us about an Israeli handwriting assessment and how she assisted in translating this fun card game into English. If you want to check out all the links we have links over at ot  schoolhouse.com/episode , 108 also on the show notes, you can learn how you can earn professional development for listening to this episode and then taking a quiz afterwards, just like we did in episode 107 so because this is a professional development podcast episode, we do have some learning objectives for today, and so let me read those for you really quickly. Today. We hope that you will be able to identify how the World Health Organization model helps to look at a human and their participation regardless of disability. You're also going to learn what the PD cat assessment addresses, and you're also going to identify what the educational framework for child success includes and how it relates to school curriculum. So help me please give a warm welcome to Dr Julie BISSELL. I'm excited to have her on I'm excited for you to hear this conversation that we have. It's a fun one. It's an insightful one, and it is just a blessing to be able to hear her experiences as she goes through her career, as she went through her career. You'll hear me say congratulations, because she actually is retiring right now. So congrats again to you, Julie, for retiring. And yeah for everyone listening, enjoy the rest of the episode. Hello Julie. Welcome to the OT school house podcast. Thank you so much for being here today. How are you?    Julie Bissell     I'm well, thank you, and thank you for all that you do for school based practice. I love your resources, your podcast. It's always so much fun to tune in and see what you're up to.    Jayson Davies     Yeah, you know it's, it's amazing. You know what this started out is just trying to bring together school based OTs who don't always have other school based OTs to come to. You know, oftentimes we'll work in a district, and there might only be one or two OTs in the entire district, and so it's hard to talk about ideas and whatnot. So I'm so happy that the that the OT school house podcast has given OTs that ability to, you know, talk to someone, basically. So I appreciate, appreciate the thankfulness. So, yeah, you know, let's dive into it. You know, we're here to talk about an article that you and Dr Sharon Cermak worked on together. It's titled frameworks, models and trends in school based occupational therapy in the United States. But before we do. That I would love to hear a little bit about yourself as an occupational therapist. I know you just retired, congratulations, but I would love to hear about your career a little bit.    Julie Bissell     Okay, well, I started over 30 years ago in school based practice. I was working originally with children with orthopedic candy caps through California Children's Services, and then I became one of the first occupational therapists in schools to really address the educational model and look at ot needs as it relates to a child's education. And this is when school based practice was just getting started, and I was working with children, both in consultation model as well as working with their teachers, trying to bring those modifications and accommodations to help a child succeed in their classroom. And this was before we had any school based clinics, but as we got to know the needs of the children, the teachers and administrators were asking us to really set up therapy rooms in order to deliver therapy for children in the school setting. So way back in the day, we had therapy gyms. They were classrooms set up as ot PT therapy room. So we had a model of practice that ranged from working in the classrooms with teachers to working individually with children in the school setting, in an OT PT room. So that was the beginning of my practice. And then.    Jayson Davies     Yeah, I mean, obviously you've been doing this for a long time, and when you talk about that, what you just talked about, you said, you know, we went into the classroom, but we also had the OT, you know, room or the clinic style that we might have sometimes. And when you say that, I still feel that that is somewhat accurate to today. You know, sometimes we push into the classroom. Other times we do more of that pull out model. Some of us have a clinic like room, others of us pull out to the lunch table. You know, we don't always have that private space, potentially, but it actually, in that sense, it sounds similar, but I know things have changed dramatically over the last, you know, 30 years. I mean, idea was really only put in place in 1976 and it really didn't grab hold until, you know, about the 80s, and that's only 40 years ago. And so OTs haven't been in the field that long. So what shifts have you seen? You know, from when you started to now, when you're retiring. Do you think there's been a big shift, or has it remained similar?    Julie Bissell     I think there's been a big shift, and I think the shift has been for the better, for better and for worse in some in some respects. So back in the day, we were delivering therapy services based on our expertise and our in our knowledge, and we're writing goals and objectives and doing assessments with probably half the evidence that goes into the work in the clinical reasoning today. So a lot of our goals were, I would say, you know, 2030, years ago, not as measurable and and there was not as much accountability for our services. Even though we were delivering top quality services and seeing remarkable outcomes, we didn't have to have all the evidence that we do today that that really backs up what we're doing, why and and show me the data kind of thing. So yeah, there was a period of time in my career where some of the fun came out of occupational therapy, where we were going from a model, where we were all about working with the children and finding the best activities that would really support them in their education and and they were having a great time, and we were spending so much time in play. And then it got to the point where there were an increased number of referrals, a decreased number of staff to cover it, and an increased demand for accountability. And then, along with that, when idea came around in I think, 2004 2005 the parents a kind of a litigation shopping list of things that could be going wrong in special ed and and show me the data, show me the proof. And so we went from a feeling of really helping children and having a good time doing it to more worried about, Do I have enough data and trying to be more formal and accountable, I guess in our communication, which I think is a good thing. I think it was good for practice that it moved in that direction. So and I see now that we have more of a balance. OTs of play and accountability. So I think, I think it ended up at this point in a good way.    Jayson Davies     Yeah, you know, that's a great way to look at it. You know, you're in Southern California with me, and so you have seen the complete increase of advocates, lawyers, and even just informed parents that, like you said, you know, accountability. They want to hold us accountable to make sure that we are providing the services that we're supposed to be providing. And as much as that can be frustrating at times when we're in an IEP, I also appreciate their accountability, because they're not just holding us accountability as practitioners. They're holding the entire school district accountable, which, when you look at it from a bigger picture, if they're complaining to the district about ot services, what are they really saying? I think they're telling the district, hey, you need more OTs because your ot doesn't have the time to give my child the services that they need. And so I kind of look at it that way. You know, maybe it's a positive that these parents are reaching out to the district saying, hey, my ot has missed eight sessions this year with my student because that's then telling the district, maybe you need to look at things a little differently. So, yeah, I completely agree with that. You mentioned working at CCS originally. And for anyone who doesn't know that's the California Children's Services here in California, and then you moved over to the schools. Is that right? Yes, real briefly, can you just talk about how that transition was for moving from CCS, which is more of that, you know, medical, clinical model, into the schools. I know you did this early on, and you're really in the forefront of moving to the schools. But what was it like moving from that CCS realm into the educational realm, where you were having to focus on education, because that's where you were.    Julie Bissell     Well, I think, yeah, the transition was interesting, because in the medical model, which was, which was CCS, you look at a child's range of motion, their strength, their stability and mobility and activities of daily living, you know, such as, you know, dressing, feeding and just Independence at Home and and then, of course, California Children's Services in The schools, you you looked at some of those factors as it related to their positioning and orthopedic needs in in the classroom. But then when I transitioned into the educational model, it was so much fun, because the focus switched from just looking at, you know, making it through the day with with your activities of daily living, to really looking in an expanded way into play and participation and and what's it like for a child to actually begin and complete an assignment and to be successful on the playground and and it just opened up a whole world of play, which I really enjoyed and loved about my job.    Jayson Davies     Absolutely, absolutely. That's what we all get into, into ot for really, you know, it's the the service part, the actual therapy. I don't think any of us really get into ot to do the evaluations and to go to the IEPs. You know, we like that hands on approach working with a student, whether it's in the classroom or in the clinic, that actual therapy side of things. So definitely.    Julie Bissell     And then one more thing that helped in that transition is that I worked in undergrad, well, I guess it was graduate school with Dr Jean Ayres in her clinic, and was really interested in the outcomes that I was seeing with the sensory integration frame of reference. And then it was really nice to be able to apply that to a school setting, because I could see that some of the children were not participating in their everyday occupations at school, you know, doing their handwriting or paying attention to the teacher, largely due to some of these underlying factors. And then to be able to address that in a playful way was, I think, a fun transition and a nice addition to the educational system.    Jayson Davies     Yeah, yeah. I, as you know, I'm SIP trained as well, although, unfortunately, I didn't get to work with Dr Ayers. That would have been amazing, obviously. But, yeah, you know, having that si knowledge, I like to tell school based occupational therapy practitioners that even if you don't necessarily have a clinic to work in with SI, I do believe that it's important to have training in SI to understand just where that model comes from, the theory behind it, to understand the brain development and how sensory helps the brain to develop, I think that's so important, even if you don't have a an SI clinic at your school, to potentially do Si, true, Si, you know every day. I think that theory is just so important to still have.    Julie Bissell     And just to really be able to address those participation outcomes in school, because the education. Educational model is all about helping a child participate in the least restrictive environment. And if you can take a child aside and help them pull it all together and then go to the least restricted environment and perform and have that confidence that they they know what to do and how to do it, it's it's so rewarding, and it's good to be able to offer that to children. So that was an interesting part of my transition.    Jayson Davies     Awesome, awesome. Thank you. All right, so I want to dive into this article. I mentioned it earlier. It is the name of the article, frameworks, models and trends and school based occupational therapy in the United States. But as we dive into this first How did this article even come to be? I know it was published in the what was it? The Israeli Journal of Occupational Therapy, which isn't an art, isn't a journal that we, you know, always go to. So how did this article even come to be?    Julie Bissell     That's so random, isn't it? Right? Of occupational therapy. Well, Dr Cermak and I were working at the University of Southern California and and we were involved in a research project that had to do with a child's self assessment of handwriting. And this was a tool that had already been developed in Hebrew by Debbie Griever and Serena Goldstein, and they were involved with the Israeli Journal of Occupational Therapy. So as we were finishing up this research project, they asked if we would write an article on frameworks, models and trends in school based practice in United States. So they chose the topic and asked us to do it. And you know, after doing a research project and publishing, it's you feel like saying, maybe not, I my place simple, but we went ahead and did what they asked, and we were happy to do it, so.    Jayson Davies     Yeah, and this article comes from about 2015 so about seven years ago. And I'm always, I guess the word is kind of careful. You know, when we're talking about ot outside of the United States, you never know what it looks like. You know, even within the UK or Canada, those civilizations that we kind of compare, you know, relatively close to civilization. In America, it's still very different. And so in Israeli, I I've never or Israel, I've never talked to an OT there, and it's probably very different, actually in this study. And I don't know if you have the answer to this, do you know what school based ot in Israel even looks like?     Julie Bissell     You know, I didn't, but I got a glimpse of it when I was working on this project, and it's very advanced, I would say, in terms of, I'm not so sure about their educational system and how OT is integrated politically into the system, but what I learned is that they have some amazing research and school based assessments coming out of Israel. One that I just love is the quality of life at school, and that's an interview where it's been shown to be valid and reliable, but you can interview a child about different factors related to their school day. And on another note, this handwriting self assessment was that had been developed in in Hebrew, was very interesting to us, because how often do we ask a child's opinion? You know, we we look at a child's handwriting sample, we see what the the teacher is saying. We do our own fine motor assessments. But then what is it that the child thinks about his own handwriting. And so that self assessment component, I thought was really, I think, powerful, and I think that's what the Israelis are doing a really good job with in school based practice.    Jayson Davies     Wow. So it sounds like there is actually some some good work coming out of there. So I made note of those resources you just talked about the quality of life at school resource, as well as the handwriting self assessment and Hebrew. And we'll make sure to link back to those in the show notes, so we will find those and track those down. But yeah, so let's go ahead and continue on, because that actually shares with us. You know, there is stuff going on in Israel related to school based occupational therapy.    Julie Bissell     And just one thing to add to that if you put the link for the handwriting self assessment. So what Dr Cermak and I did was to translate their work into English. So we have an English version of this child self assessment, which is a really fun card game that you play with the children, and you show them is your handwriting look more like this or like that. And then they self assess what they think their handwriting is. And then you ask them if they would like to change their handwriting, or if they're happy with the way it is, or whatever. And then you get them to buy into yes or no I want to write a goal on it. So, so we translated their you. Work into English. So that's available too, if you want to add that link as well.    Jayson Davies     Yeah, definitely. We'll make sure to add both of those for anyone who maybe is in Israel listening, they can get the Hebrew version, and anyone here get the English version. Awesome. All right, so this article, it wasn't exactly your traditional research article. It wasn't like you were comparing one group to another group. It was really more of an informational article for occupational therapists. I guess your target audience would technically be like Israeli occupational therapist, but you still have to do research no matter what, and you guys have a ton of articles listed in your reference. So what did you do? You know, just kind of what information, what research were you looking for to ensure that you would be putting together an article that really did reflect everything going on in school based ot in America?    Julie Bissell     Well, what we did was to look at some of the seminal work in occupational therapy that that describes our role as occupational therapist using the A ot a practice framework. So that was a core model that that we used, we used idea our education laws that describe what an occupational therapist is or does in school based practice. And then we looked at the California Department of Ed's guidelines for OT and PT in the California Public Schools, and a number of other guidelines as well throughout the country, to see what was happening with individual states, and kind of put all those models together. And included the World Health Organization, which model of function and ability, which also inspired the A ot a practice framework, and is also mentioned in the California Department of Ed guidelines. So we included that as well. So we took some of the more important frameworks that are used by occupational therapists and referenced those and tried to explain how that all related to school based practice in the United States.     Jayson Davies     Yeah, definitely. So you guys had to really find some foundational, I guess that's foundational knowledge from ot A and then also looking at some of those models or whatnot that have developed over the, you know, 3040, years of school based ot being a practice. Now, I honestly wasn't going to ask these questions so a little bit later down the road, but you started to talk about some of those frameworks and models, and so I'd love to jump into that a little bit. There's two particular models that you actually really mentioned within the document, within the article itself, is the ICF, the International Class of functioning Disability and Health ICF, and then also the educational framework for child success. I want to discuss both of those. I'll let you choose. Which one do you want to dive into a little bit first?    Julie Bissell     Well, let's start with the World Health Organization model, because that's used universally across the world. So that might be a good place.     Jayson Davies     There we go. Let's start there.    Julie Bissell     Right, And so this was a way of looking at ability versus disability worldwide, and how to even measure outcomes form assessments. It's it's a way of just looking at a human in terms of participation. Because I think in the past, what had happened is that a person was looked at in terms of their disability and what they can and can't do. And this turns it all around and says it doesn't matter what disability you have as much as how are you able to participate in your daily life? And so key to this model is the concept of participation in whatever setting. So we're in school based setting. So our gold standard, based on the World Health Organization model, is participation in the curriculum which is really consistent with idea and all the school laws as well. So participation is key. And then if you, I know, you'll be posting the link to this model. It's in the article, and it's also in the California Department of Ed guidelines and models all over the place. You'll see it all over the place, but next to participation, on the same line, almost of importance, is activities. And what we find so many times is that a child can do an activity, but they're not participating. So what's that all about? Like we've seen them do it, but why aren't they playing? Why aren't they getting their work done? Why doesn't it happen in this context and and so I think that's interesting, to value the activities and verify that a child can or can't do an activity. But how does that matter in terms of his participation, like make sure child's participating, and that's why I love sometimes in assessments, the P, E, D, I that pediatric.     Jayson Davies     I can't think of it either, but I know what you're talking about.     Julie Bissell     The PEDI is a an assessment that you can send home to a parent in a link, and they answer a series of questions, but the questions are getting at you know, there's mobility and there's social and and then there's a participation scale that looks at is the child actually doing these and how much support does the child need for participation? So we're starting to see assessments now that actually help us tap into that participation level in our work. But and then, so you have participation, then you have activities, and then you have the foundations or the core body functions and structures that support those activities. So, for example, does child have use of their limbs? Are they mobile? Can they? Can they walk and talk and have range of motion? And can they? Can they access, you know, physically or through their sensory systems, can they access those activities and therefore participate? And then underlying that whole model is environmental factors and personal factors, because each person is unique in their own culture, their own setting and their own families. And so you look at environmental factors and personal factors as it relates to their body functions and structures activities and then their participation. So that's, in a nutshell, the World Health Organization model.    Jayson Davies     Okay, great, so that's the WHO World Health Organization, and then I know another one was the educational framework for child success. I personally love this one. I kind of view it as like the PEO model for schools, in a way. But I'll let you explain a little bit how that ties in everything, including the curriculum, which we talked a little bit about earlier.    Julie Bissell     Sure and that educational framework for child success was developed by a group of therapists that were nominated through the California Department of Ed to write the guidelines for OT and PT in the state of California. So we had, probably, I would say 15 therapists or more that were from preschool to high school in their expertise. They were from urban and rural areas. They were from universities as well as clinical practice and school based practice. So we had a number of therapists working on a team to develop the guidelines, and this is what came out of it. So this is the child's educational framework for child success. And what we love about the model as well is that the whole focus of the model, core is the child. The Child and Family is is at the very center of all this. And then you'll see on the link there are three concentric circles that that have curriculum assessment and intervention, with progress monitoring going between the assessment and and the intervention. So it's nice that curriculum is such a huge part of the child centered, school based practice, yeah, and that we're taking a close look at how this all relates to curriculum. And then there's a larger circle going around those three concentric circles, which is everything is evidence based, and team collaborated, so that you're collecting data and you're collaborating with the team. So it's a very comprehensive model with an arrow that shoots out to two boxes, and the first box, the top box, is the annual goals and the ongoing annual outcomes, and then the second box is post secondary outcomes. And you ask how practice had changed over the years, and I think this is one big way in which it's changed, and it's nice that it's reflected in in this model is that that back in the day, your goals were pretty much annual, that you wanted to see annual progress, and it wasn't as future oriented as it came out in later years, and reflected in the guidelines so that that in the second box is all those really important post secondary outcomes of education, like if you look at all the mission and vision of educational. Systems, whether it's national, state or or local, it's that children will reach post secondary education, get as many children into college as possible, and they would have competitive employment. They're not just, you know, sorting things or folding napkins or whatever, but try to find competitive employment for students and then find not only community participation, but independent living. And so when it makes you really think, when you look at this model, because when you are writing an annual goal, you have to say, how does this matter for getting a child into college, or how does this matter for a future employment or community participation, because it helps us prioritize the goal and the work that the child's doing on an annual basis, if we have our eyes down the road.    Jayson Davies     Definitely, yeah, and, you know, sometimes I have sat in IEPs and I've had that kind of conundrum with myself and with team members, because you're trying to think of an annual goal, and sometimes you kind of get stuck in that one year from today, and we forget to look out three years, five years, 10 years. How is the goal that we're producing today that is supposed to be met one year from today, supposed to impact the student for the rest of their life, right? And I think that's important to remember. When we're creating those individual annual goals, we have to think about the long term. Where is this goal actually going to lead to down the road? Sometimes you can even just say, oh, right, if I create this goal this year, what might be my follow up goal. Assume he meets that goal. Assume she meets this goal in a year from now. Well, then what? What's, what's that next step? And you know, if you kind of keep going, what's the next step, what's the next step, what's the next step, then you can kind of see where that student might get to, you know, five years, 10 years from now. So it's important not to only look at the the here and now, but as you mentioned, you know, the educational framework for child success, EF, CS, as I know us common with it, we'll call it. Those post secondary child outcomes are are extremely important, especially when you're starting to work with kids in middle school and and you're having those transition meetings, really making sure that we're looking beyond just this year and looking into, you know, meaningful college experiences, meaningful work experiences, and, as you mentioned, independent living, super important. All right, let me switch back to my notes here. We've been jumping around a little bit, and that's totally fine, because I like to go where the conversation leads us to another another. Sorry. Did we cover all the do we cover all the frameworks? We did the who?    Julie Bissell     One that is that is not exactly mentioned, it's or folk. It had a minor focus in the article. Was the, was the Universal Design for Learning,     Jayson Davies     Okay.    Julie Bissell     And, you know, that's a really important framework, and I think that kind of defines the occupational therapist role in school based practice. And I think most people are familiar with the the UDL guidelines and UDL framework of the core value of in helping a child with engagement, yeah, the activities, and then finding multiple means of action and expression to demonstrate their knowledge. So that's been a really core, a model or framework that's been guiding what we what we do in schools. And an occupational therapist could have been the author of that. I know it took, like a national team, but it's.    Jayson Davies     You know, funny story about that actually, is that, you know, in college, you know, I graduated in 2012 and I remember universal design being like a big topic within school. And then, you know, jump in fast forward, you know, three years into school, and all of a sudden we add the four learning at the end. I was like, Oh, I know what this is. I learned all about universal design. Now we just add the four learning, which just means it's related to education. Basically. I was like, Yeah, I know this. That was an easy, easy transition. So, yeah, I think you're right, easily. OTs could have, have been a part of that. Now, as we talk a little bit about UDL, I often, and you might do the same tie UDL within the same frame, per se of RTI, MTSS a little bit we're talking about that preventative model, as opposed to the wait to fail model. So with that, can you go a little bit further in talking about how you can tie in UDL a little bit potentially, with the MTSS, and how that became more that getting away from the way to fail model, I guess.    Julie Bissell     Right. And I just loved your question about, how have things changed over the years? Because it's really taking me back on the road of. My whole career to see how things have changed, and that's another wonderful change in the educational system is going away from that wait to fail model. It used to break my heart to see a child who I know was struggling in kindergarten needed special help. But no, let's wait till first grade. Let's wait till second grade, and then, you know, occupational therapy as a related service could not get involved until the child had had a modified diagnosis, as in a special education qualification. So so our hands were really tied, and the MTSS and multi tiered systems of support and Response to Intervention. Movements have really opened the door for children to get really good services, whether or not they need special ed, but to give early access to help. So that's been a wonderful development, I think, in education, and I think most people listening to the podcast know forwards and backwards. I don't think you know what RTI is and what MTSS is like. The RTI model came about, I think, in response to individuals with disabilities, act that said that children needed to be identified and that, as you know, whatever level of of help they needed there used there needed to be some kind of a universal screening early on to determine if a child needed help or not, and then it divided those children who ended up not needing help, and filtering out the children who needed a little more help into more a targeted approach in groups, and then those children that still weren't making progress would get help at the third tier, which would be more individualized help and instruction and may end up in a special education referral. But it's that's the RTI process. And and the RTI process is that came earlier than the multi tiered systems of of approach, because the RTI process itself started out to be more academically focused, to see if children were making progress in reading and math curriculum and and then we're tested every six weeks to see if they were making progress, and if the progress wasn't happening, switch gears and try to teach the child in it in a different way. So it was more academically focused, although it was still in those early days, taking it into consideration the behavioral component and the self regulation and the ability to be ready to learn. But that was more informal. And then when MTS, the multi tiered systems of approach, became more popular. You know, five or more years later, RTI became a component of that, and the multi tiered systems of support embraced, not only that, but really looked at behavioral components and social emotional components as as well the regulatory things that that get a child ready to learn.     Jayson Davies     Yeah.     Julie Bissell     So did I answer your question?    Jayson Davies     Absolutely, I mean, I'm going to go a little bit further. I because, first of all, I typically use the term RTI, RTI when I probably should use MTSS, because, like what you said, RTI is kind of a component of MTSS these days. I use them interchangeably sometimes, but I understand, yes, MTSS includes that behavioral, social, emotional, even mental health aspect a little bit which, as we know, is so important, and there's a lot of funding right now also going for mental health. So it's important to include that. I didn't realize, though, that MTSS came a little bit later than RTI, but yeah, okay, now everyone breaks down those three tiers of RTI a little bit differently. I know this can depend on what district you're in, what school you're in, what state you're in, per se, if you could Starting with Tier One, what are some examples that you would consider tier one interventions, and maybe a few that you've even been a part of yourself?    Julie Bissell     Okay, sure, I have a couple of good examples. One is in tier one. It's addressing the whole population, everyone and all the classrooms, all the teachers, general ed. And one example is staff development. So we've been involved in a lot of teacher training regarding how to have a comfortable classroom, to look at the ergonomics of the desk in the chair, to make sure there are some sensory tools that children are getting enough sensory breaks just to make the learning and. Environment comfortable so a child can be ready to learn. And so many times I'll go into a classroom and there will be a desk that is up to the child's neck, and the feet are dangling on the floor, and the teachers are reporting that the children are squirmy. They can't sit still. They're sitting on their feet. And I I said, Well, how would you like to sit in a bar stool all day, you know, that not and have the table up to your neck, you know? And so when I showed them a few things about how to make sure a child's comfortable during the day, and then, you know, we've had a lot of ideas about alternates, you know, sitting to go sit on a bean bag chair during the reading time and things like that. So just that, the staff development was a big one. And then one year, I had a really fun project in a kindergarten class, and it was a universal screening of all the kindergarteners, and we did a mini version of the print tool, where we had them write the letters of the alphabet. And this was, I think, in January of the kindergarten year. So they had had, it wasn't just kindergarteners coming in that that had not had any experience with writing. This was January of the of the kindergarten year, and there were some children that could write the whole alphabet, and there were some children that couldn't. And so we had after this screening, we grouped the children into targeted groups for those that that needed more specific help, and then we also got permission from the administration to send, luckily, Handwriting Without Tears was presenting in our area, so we sent the kindergarten teachers to that specific training, and we had the targeted groups on the Handwriting Without Tears program for six weeks, strategically Teaching them handwriting. And then from that group emerged only, like three or four students that really needed specialized help, because even with the targeted teaching in small groups, they still weren't getting it. And so that we knew these children needed more targeted help. So it was kind of a universal screening that kind of drilled down to the tier three.    Jayson Davies     Yeah, yeah. And actually, you know, you didn't use the words as you were talking about it, but you just shared tier one, tier two and tier three. And that that short story, right? Because, so let's just break it down really quick, you know, expand it out. Tier one was you doing the screening. It was also the teachers going and getting that that specialized training from Handwriting Without Tears. You know, personal development is also tier one. In my opinion. Even though they didn't send the whole school, those teachers were still improving their education so that that goes back to the, I think they call it first best instruction, right, making sure that everyone has first best instruction methods, okay, so that's tier one, and then from that screening, that tier one screening, you moved to tier two, which brought out some of the kids that needed a little bit more instruction, right? And so what did that look like? Was that you working with a teacher? Was that just them coming to you? What did that look like?    Julie Bissell     No, it was I went in once a once a week for the the core lesson, following the protocol from Handwriting Without Tears, and then they followed up the other days of the week. So I would go in and demonstrate using multiple means of action and expression. We were using the the chalk and the wet towels and the Play Doh and the magnets, and we were using the whole instructional protocol, and we were doing it in the order in which the handwriting and without tears specified. And then I would demonstrate, and then they would continue with those letters that week, and then next week, I'd bring in the next letters and and use the protocol that handwriting with OTs had. And then, you know, that's another important, very important, component of the RTI process is whether it's a teacher or an occupational therapist, when you are giving instruction or intervention, you need to use the fidelity to the treatment that you are implementing or to the instructional method. So So, for example, since I chose Handwriting Without peers, I wasn't hop, skipping and jumping to my own creative or I think I'll try this and I'll throw in this letter, or I'm going to throw in this or that or the other. It's like I use their protocol, and the only way we're going to know how to help students is by keeping fidelity to the program that you're testing out with them. For example, the teacher. Teachers learned a lot during the RTI process because they were doing that piecemeal language teaching. And so some children are auditory learners, some are visual learners. And if a child after six weeks is not getting your instruction, you couldn't tease out which part of it, if you just used a hodge podge. So what you needed to do is I'm going to do this particular program to the fidelity of the program, and then if this is not going to work, I'm going to switch to a different channel, like the auditory channel versus the visual channel. But if this concept of fidelity to the treatment or the intervention is such an important concept and and I use the fidelity to Handwriting Without Tears. So I would go in once a week, and then they would have small group instruction with the instructional assistant at one table, and the teacher was at another table, and I was at an at another table with the small group instruction.    Jayson Davies     Gotcha so. So you weren't going in for the entire classroom. You were just going in for that small group. Yes, okay, and you were following the fidelity of the handwriting without tears. Model. I want to pull that out a little bit, because that is something that I have never had someone talk about on this podcast before, 100 and whatever episodes in, and I don't think we've ever talked about following something to the fidelity, you know, following a program, whether it's size matters, whether it's Handwriting Without Tears, or some other program, following it to to the T I think when we see a student individually, you know, we really rely on our personal evaluation, and we have that leeway to mix things up a little bit, maybe not follow a program to the T but I'm understanding what you're saying. As far as when you are doing RTI, that's more important, maybe because you haven't done like a formal evaluation, and because, like you said, you want to be able to determine, you know, if the student is not making progress, where was the disconnect, per se, did what I say sound accurate, or was there anything that?    Julie Bissell     It sounds accurate, and I think I know where you're going with this is that, of course, occupational therapist is dependent upon for that professional leeway, because when you see a child struggling, you have to try, you know, this, that and the other. But what I meant by the fidelity, say, like using handwriting without tears as an example, is that, you know, the first letters that you teach are the the letters that started the, you know, the top left, the D, the E, that.    Jayson Davies     straight lines, nice, easy lines to make, and so.    Julie Bissell     What I meant was that I I used that sequence as they recommend, and I didn't jump like, oh, well, let's try the the F. Now let's do an S, or let's do us a lower case, or let's do like, I stuck with the letters that they recommended in that motor planning, easy to more complex strategy that they have set out for the success of their program and so, so you can stay with the fidelity, but make those modifications as as you need, like, pull in some, you know, different things that along the way. So, you know, because I could have used, I could have used those same letters and used finger paint, or I could have used which, you know, is not really sold by Handwriting Without Tears, but I could have used finger paint or a salt tray, or I could have used a, you know, a bunch of different things, but I would stick with those letters as they have different letters of of the week and a progression.    Jayson Davies     Yeah, and you're still using the multi sensory approach, Which is important within, within handwriting, thought, tears, using the different senses, not just strictly look at a board, watch what I write, copy it. You know, you're including that finger painter that Play Doh, or whatever it might be, the little wet sponge, yeah. So, okay, great. Well, thank you for for going a little bit further on that. And then so we talked about tier one, we talked about tier two and the next step, you said there's, you know, just a handful four kids, maybe that needed even more, and that's tier three. I know some people consider tier three being a ot evaluation, and going from there, others consider tier two, tier three a little bit different. In your practice, what has tier three looked like?    Julie Bissell     Tier three has looked like strategic support for the teacher, if the child has not been identified as a child that OT is permission to assess, because we were very careful not to assess without permission or screen. But what I had the teachers do is have them, for example, have the child draw the shapes that you would see in the VMI, the visual test of the very visual motor. Test, test of freedom, motor innovation.    Jayson Davies     I know, again, with the with the evaluations, I can never remember what they're all called, but we know that one.    Julie Bissell     The formal, the formal title of of that one, which I use all the time, but, but you can have the teacher, have the child draw the shapes. And from that, you can tell that developmentally, based on the shapes that this child can and can't draw, that they're probably functioning at the two to three year level, and somehow they're in kindergarten, and it's never been picked up before that the child has that that developmental delay. So the tier three would look more like an informal screening with no name on it. It would be more of a of helping the teacher help identify and then go to the school psychologist and try to go through the proper channels of the system to get to get the assessment.    Jayson Davies     So potentially leading helping the teacher to make that referral. Per se. You know, because you went through tier two, you saw that developmental delay while you were trying to work on, you know, the easy, tall, straight line letters, you saw some difficulties. So then you work with the teacher, potentially to go to the psych, make that official evaluation so that ot services can potentially begin. Does that sound about right?     Julie Bissell     Yes, exactly. And what the beauty of this process was, is that when the teacher went to the psychologist, she had more to say than I think this child has problems. We had a lot of data on the child. We had that first screening I did with everyone that the child just made squiggles, and then we said that we've had strategic teaching using valid and reliable program, yeah, and a six weeks program of that, and progress was not made. And here, here are the work samples. And now here are the shapes the child can, can't do in the psychologist could see right away that this is like, what a two or three year old does, you know? So that it really helped with a portfolio of referral data.    Jayson Davies     Yeah, yeah, absolutely. I think the same exact thing every now and then I would for tier three, I would be as I would be part of an SST or a step meeting for that child. So before they, I don't know, they're called different things in every school, but it was kind of a one step below an IEP. It was still a team meeting, but it wasn't, you know, an IEP. The student didn't have an identified disability per the school, but the teacher would be a part of it, maybe the administrator. And at step three, I may not work directly with the child. I may be working with them, you know, at tier two, but I can provide the teacher with some, I mean, pretty specific strategies I haven't evaluated the child, so I can't, like, you know, narrow it down completely, but strategies that I would try with anyone I can provide to the teacher to try with this child, and oftentimes I've already expressed that to the teacher, because, like you said, you know, during tier two, maybe the teacher sees what you do, or maybe after you do your small group, you have a debrief with the teacher, and you say, hey, you know what? You know, the kids did really well today when I use finger paint, or the kids did really well today when I use the wet, dry try and they'll maybe they carry that over. But yeah, I know tier three is always a little different depending on what district you're in. And yeah, it's a little messy sometimes, but yeah.    Julie Bissell     You just have to be careful with with identifying strategic activities individualized with the child's name on it. And I love what you said about that you find activities that would be important for that child, but that you could give to anyone, and it's wasn't like therapeutic treatment activity with a name on it.    Jayson Davies     Right? I think the best way I've described it is it's a general strategy for a specific student, because, you know, it's any It's a strategy that you would just use for any kid. I would use it for my child, but I'm providing it to the teacher to use specifically for that student. I guess.    Julie Bissell      That's good, right?    Jayson Davies     Yeah, all right, we kind of went into RTI MTSS, really hard. I love it. I love RTI and MTSS, and I want to dive in beyond the RTI and the MTSS. We just kind of actually scratched the surface with this a little bit with tier three potentially leading to a referral. Have, I mean, I've seen it. I'm sure you probably have the increase of referrals for occupational therapy. What have you seen over the years, and how do you think it has impacted ot at this point?    Julie Bissell     Well, that is, I think the number of referrals has accelerated over the years. I think we've we're getting more and more referrals out every year, and I think it's impacted occupational therapy in a way where. Yeah, I think, come to think of it, it kind of was one of the things that ignited my interest in advocacy for occupational therapists, to be able to have a voice at at higher levels of administration to help manage all this. Because, as you know, I've been involved with the Occupational Therapy Association of California and for the school credential initiative and based on occupational therapists and physical therapists not having a credential and not having access to leadership positions that deal with budgets and managing referrals. I think sometimes occupational therapy is left out of solutions to this problem based on a more systemic problem of not being at the bargaining table with the other administrators. So I think we're handed large caseload sometimes and handed referral processes that we could probably better manage if we had higher level leadership positions.    Jayson Davies     Yeah, I agree. I mean, at this point, if I'm getting flooded with referrals, the only thing that I can do is let an administrator know. I will often tell people, you know, if you don't tell an administrator, your boss, whoever might be, that you're drowning, then the burden is somewhat on you, and you're going to feel like I'm not doing enough. I can't stop because I need to do more. But if we let our administrators know that we are getting flooded, and we have the data to show our administrators that, you know, every year there's two more evaluations, or I'm averaging an extra three evaluations year after year after year, it's only growing. It's growing. It's growing. And you can show that to your administrator, then it's somewhat on them to help fix the problem. You're taking the burden a little bit off yourself. That is part of their responsibility is to figure out staffing, to figure out workloads and case loads. And I think sometimes we let we we kind of put the burden on on ourselves, and you know, we need to do something about it. But, you know, unless we can get to that administrative level, or unless we can convince our administrators to change something, then our hands are a little tight. I mean, let's just be honest, we don't have the ability necessarily to say caseload cap of 45 or workload cap of 20 hours per week, or whatever it might be, of treatment. So yeah, I think that's important. And as you know, I'm working on the on the credential with you as well, trying to get California to figure that out so that we could potentially have more of a say within within the school district.    Julie Bissell     Yeah, one thing about referrals in in our district, what we have done is to limit the access to who can refer to. Ot so if you look at the educational or the organizational structure of a school, you know you've got the administrators, and then you've got this school psychologist, and then you have the speech therapist, OTs, PTs, and then in also you've got the the teachers, etc, if a teacher is able to refer to occupational therapy, you have the potential to have hundreds more referrals than you would if you limited the referral process to the school psychologist. So what our teachers have to go through the school psychologist to get access to us. They can't just say, oh, somebody in my classroom is having a problem. They're walking on tiptoes, or their feet are turning in or, can you come take a look? Because that just, you know, drains the flow of our of our workday. But if that, but the child could be doing very well on the participation scale. Like, everything's fine. They just their feet are turning in or something like that. But if, if a teacher, there's hundreds of teachers, and there's probably, like, 20 or 30 psychologists, say, or whatever, a lot less, a whole lot less psychologist than you have teachers. So yeah, so if the teachers have to go to their psychologist who already screens for a special ed need? They had the whole picture of what's happening with all aspects of the child's education, and they will know when is a good referral for OT and PT. So that that really kept a lid on ot referrals at a time when we were just being caught in the hallway, you know, from a teacher, a principal, like just, I don't know, we were way too accessible, so we, we narrowed it down that way that helped.    Jayson Davies     That's one way to do it. Also, I think RTI. I think RTI and MTSS also helps because, you know, I had a conversation with Sarah Leon or Lyon. She has another podcast. Cast ot potential podcast, and I was on her podcast recently, and one term that came up, or a little analogy you could call it, is, you know, you can go upstream to prevent those downstream evaluations. And that's exactly what RTI is. You know, you're going putting it right. You're going upstream and you're taking time out of your day to go upstream, and it is going to take time out of your day. But how does that impact your downstream evaluations? You know, I would spend easily. I mean, over the course of the entire evaluation, I would say it takes up a full day, you know, between the IEP, you know, the talking to the parent everything, right? It takes up eight hours or so. But if you go upstream, you know, and maybe you take two hours a week to do some RTI, then can you prevent three evaluations, which equates 16 or 24 hours? So yeah, I think that was a great analogy to kind of put it up going upstream to prevent some of those downstream evaluations.    Julie Bissell     Love that idea. Love it.    Jayson Davies     Yeah. All right, so let's go ahead. We'll wrap up the article. I still have a few more questions for you, and I know there's so much more in this article, so please, please, if you're listening, go read the article. We're not going to get to everything, but we're hitting some of those main points. And Julie, I want to ask you one last question really related to the article is what stood out the most to you when working on this article? I know you had been a school based ot for a long time, but was there something that really like just hit hard as you wrote this article?    Julie Bissell     I think what my take home from the article was that that ot matters in school based practice, and that that the emphasis of using those models and and frameworks really helps in an organized way to help a child and to target a child. So each, each one of those frameworks and models really served as a as a roadmap for not only addressing the needs of the child, but but helping to explain what we do in a either theoretical or, I don't know, research backed way of of the value that we bring to the student, and it just gave, I don't know, comfort to my practice to have it all in one place and to really reflect on different conversations I've had with administrators or parents or attorneys or what have you that these models and frameworks that have been developed over the years in the United States have really been useful in doing, explaining and delivering what we need to do for children.    Jayson Davies     Yeah, yeah, you know, and models and frameworks, they're they're so helpful. I think as OTs, we often forget to go back and look at them. You know, we went to OT school. We know everything, right? But no, that's not the case. We have to remember to go back and look at whether they're old models that we haven't looked at in a long time, or things that are evolving. And if we don't go back and look at the research, we don't see that stuff, all those models, those frameworks that you know people have taken time and actually put evidence into to develop. We don't know they exist, and we don't know that they can be helpful, not only in our own practice, but also explaining to other people our practice and what we can and also, I like to say we have to know what we can do as well as what we can't do. But those models and frameworks can be so helpful in explaining what we do to some of the people that can help us make decisions. And so understanding those models is is very important, and we need to, we need to go back and look at them every once in a while to confirm that we're, we're staying on the right direction. So yeah.     Julie Bissell     And what, what I loved, too, is that that World Health Organization model and, and how random was that the Israeli occupational therapy world was interested in United States, school based, based practice and, and how unifying that model is, and how nice it is to look at a person with a disability, whether it's an adult, a young adult, or a child in school, as a human being that is valued and is looking to participate in in daily Life. And it's it's a universal language across the world. So it's, that was a fun thing to reflect on, I think, as well.     Jayson Davies     Yeah, absolutely. Now I have one last question to follow up. Not to follow up, really, actually, a whole new question. The article was published about seven years ago, personally, as we've had a discussion today. I don't think too much has changed since 2015 when this published was published. I know RTI and MTSS are definitely more ingrained than they were seven years ago. And it's it's more common, right? Someone you say RTI, they typically know what you mean now versus in 2015 that wasn't necessarily the case. I don't think where do you see school based ot going beyond 2022 and and, I mean, what do you anticipate? Do you think there's going to be changes? Do you think we're on a on a straightforward trajectory, or do you see something changing?    Julie Bissell     I think the future is bright for occupational therapists going into school based practice, because over the years, there have been some rough patches. You know, we talked earlier about some of the more litigious years, or the new quest for data driven services and all that. But I think that as time goes on, it's easier and easier to have more efficient, comprehensive, easy to implement assessments. I think it's easier to have the data driven services with some of the new assessments that are, that are coming out. And I think that, well, like One example is the easy the the air sensory integration test, and the PD cat, yeah, these are, these will all be computer assisted technology that will, it won't be these long, you know, two hour tests. It'll be tests that are computer assisted with artificial intelligence that you can be giving a test and find out the key factors that that describe the child. And you can, you know, stop testing after a few items, versus, like, 20 items or something. But I so I think assessments going to get easier and more comprehensive and and give us more to go on to more specifically help children. And I think that it will reduce the burden of us, of our some of the guesswork that goes into our clinical reasoning. It'll will have better tools, and I think, more, hopefully, more time to play. I think that the more efficient you can be with your collecting of the data, the more time you have with the child on the playground or in the therapy room or in the, I don't know, cafeteria area, wherever you're you're able to to play. So I think there'll be more time for play easier assessments. And I think that around the corner, occupational therapists across the United States will have the professional equity of of a credential. So we'll be at the decision making tables that will open up increased access for children to have more occupational therapy and for OTs to have more reasonable caseloads and workloads and things like that. I think the future is bright, but it does take a lot of work. There's a lot of research that goes into some of these assessments and and a lot of volunteer work that goes into getting.    Jayson Davies     White papers and attendings California Department of Education meetings and, yeah, all that good stuff. Yeah,    Julie Bissell     it takes work, and I encourage people to, you know, step up to the plate, because it's a nice thing to do, and it's, it's easy once you get involved. But I think the future is bright, and I think there will be more time to play and and less worry about I don't know, all the extra work.    Jayson Davies     The extra stuff, yep, yep, great. Well, Julie, thank you so much for coming on and again. Congratulations on your retirement, I know you have several grandkids that you get to spend all your time with now, right. Rolly, quickly though, I do want to give you the opportunity. If there is anyone listening in out there and they're just, you know, thinking, hey, I have one question that I would love to ask Julie. Is there somewhere that they can find you? Maybe on LinkedIn or something like that.    Julie Bissell     Um, I have retired, you know, no, I love to be available, but I'm not sure how. Maybe they could email you, or I'll think about it, and then we'll put a link on the links.    Jayson Davies     Sounds good. Well, thank you so much for for being here. Thank you for just opening up a little bit about your your career as an occupational therapist, and also sharing a little bit about your work. This is only one of the several articles that you have helped to get published. I know you have been very busy within the SI field. You've written several articles, or CO written several articles within that and so thank you so much for your contribution to to occupational therapy in general, especially here in California too. I know you've been on the board that has worked on credentialing and making sure that OTs are advancing within schools. So thank you one more time again. And yeah, I appreciate you for being here. Thank you so much.    Julie Bissell     Well, thank you and thank. You for all you do. I just love ot school house and your podcast and your easy communication and bringing us all the resources that you so readily share. So thank you so much.    Jayson Davies     All right, and that is going to wrap up Episode 108 of the OT school house podcast. Thank you so much for being here. Don't forget to earn your professional development for listening to this podcast over at ot  schoolhouse.com/episode , 108 there are also a ton of links over there. Julie gave me links to so much that she talked about today, including that PD cat assessment, as well as the Israeli handwriting assessment and the translated version. So go ahead check that out over at ot  schoolhouse.com/episode , 108, thank you so much again, Julie for coming on and sharing your wealth of knowledge. Congratulations one more time on retiring from a very fulfilled career, and I hope you get to enjoy this next chapter in your life, spending time with your family, and especially those grandchildren that you have for everyone listening. Thank you again, so much for being here, especially for listening all the way to the end. I really do appreciate that. It means the world that you find value from second one to the final ending, not even a credit, but whatever. This is the end of the podcast, I appreciate you being here. Take care and we will see you in episode 109, have a good one. Bye.    Amazing Narrator     Thank you for listening to the OT school house podcast, for more ways to help you and your students succeed right now, head on over to ots.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! 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 109 of the OT Schoolhouse Podcast. Did you know that transitional services can be implemented even before a student gets to high school? In this episode, we talk about how community-based instruction (CBI) can be implemented in the elementary school setting and how these children benefit greatly from starting early. Debbie Schwind discusses how she developed a campus-based CBI program for the students with just a coffee cart and how the program grew with the help of supportive teachers, staff, and administrators. Tune in to learn the following objectives: Learners will identify what community-based instruction looks like in an elementary school setting Learners will identify a model that can help with CBI program development Learners will identify the benefits of a CBI program Earn Continuing Education for Listening to this Episode Wish you could earn professional development for listening to the OT Schoolhouse Podcast? Now you can! Click here to purchase the professional development opportunity that corresponds to this episode. Here's how it works in three simple steps: Listen to the episode on this page or wherever you listen to podcasts. Purchase the professional development opportunity. Take the short quiz and earn your certificate. It's the professional development you want on your own schedule. Earn your certificate of completion for episode 109 now. Guest Bio Deborah Schwind, DHSc, OTR/L, BCP, SCSS Deborah Schwind is an occupational therapist with 30 years of experience in various pediatric settings, with the past 17 years in the public-school setting. She completed her doctoral dissertation from Drexel University. Her research focused on developing job skills, work behaviors, social skills, and self-determination skills through a school-based Community Based Instruction (CBI) program for students with autism in elementary school. She has presented nationally on transition skills, community-based instruction, IADL intervention, accessible curriculum, and adapted art tools. She has also been published on these topics, including a co-author of a chapter in Best Practices in School-Based Occupational Therapy. She graduated with an undergrad degree in OT from East Carolina University, where she completed internships at Duke University and Johns Hopkins University. She received her graduate degree from Old Dominion University in educational administration. She has worked in pediatric rehab, early intervention, home health, and inpatient (including NICU) as well as outpatient settings, most recently being in school-based practice. She is an active member of the AOTA Community of Practice Transition work group. She is Pediatric Board Certified through AOTA and has a School Specialty Certification. She recently received an Innovation in OT Award for the National Board for Certification of Occupational Therapy. Resources CBI in Elementary School - Research Article Logic Model FBA Project Search Program ESSA MTSS STEAM Problem Based Learning IDEA Closing the Gap on Transition Success AOTA Article Using Typical School Routines to Build Transition Sills AOTA Article Episode Transcript Expand to view the full episode transcript. Deborah Schwind     So community based instruction is an evidence based teaching strategy, and it allows students to take knowledge from the classroom and apply it to a community setting. And that community setting, typically is off campus, but the community setting can also be the school community, and it's very functional, it's very purposeful, it's very meaningful, it's authentic learning, it's applied knowledge, and it's really OT.     Jayson Davies     Hey everyone, welcome to another episode of the OT school house podcast. What you just heard was arguably My favorite quote from today's episode, today we have joining us, Dr Debbie Schwinn to talk all about community based instruction and how she uses CBI in elementary schools to support students in their long term outcomes. We're talking about their ability to live independently, to have a job, to go to college, even all those things we start talking about early and community based instruction is a way that we can help support those students. Dr Debbie Schwinn actually started with a coffee card as her initial community based instruction program, and it has just grown from there. And so you're going to hear all about that in this episode. So let me go ahead, queue up the intro music, and when we come back, we're going to head into our episode for the day. So stick around, enjoy the intro music, and I will catch up with you in just a sec.    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     All right, and welcome back. Thank you one more time. So much for being here, for listening, whether you're on your drive home, on your drive to work or at the gym. Thank you for listening in today. I'm excited for today's episode because we have had some some episodes about transition age students and how we need to start having goals that go beyond high school. But today we're taking it back to that early elementary age and starting on some of those functional skills way earlier than we've talked about previously. We're talking about starting at the elementary school age, supporting students with on campus, community based instruction. Now I don't know what comes to mind for you when you think of the term community based instruction, but today we're going to be talking about programs that can be implemented as early as elementary school, such as coffee carts or other classroom jobs or maybe organizing the staff lounge, things that students at all ability levels can both accomplish and learn from. So this is going to be a great learning experience. We have someone coming on. Her name is Dr Debbie Schwinn, and she knows all about this. She's been implementing a similar program for many years, and she's even done the research on it. So she's going to share with us a ton of information, but before we do get into that, this is a professional development opportunity, and you can earn a certificate of completion for listening to this podcast and going and taking a quiz a little bit later, maybe once you get home. But because we're doing that, we do have some learning objectives. So our three learning objectives for you today are that you will identify what community based instruction looks like at an elementary school setting. You'll also identify a model that can help CBI program development, and finally, you're also going to identify the benefits of a CBI program. Now I'm not here to pretend like I am a CBI expert. I have definitely gone on my share of community audience with our students in the high school level, but this whole CBI in elementary school, this is totally new to me, and because of that, I am super excited to introduce to you, Dr Deborah Schwinn, Debbie has 30 years of experience as an occupational therapist, including the past 17 years in the public school setting. Debbie completed her doctoral dissertation from Drexel University, and as you might have guessed, her research focused on developing job skills, work behaviors, social skills and self determination skills, through a school based, community based instruction program for students with autism in elementary school. So please help me to welcome to the OT school house podcast. Dr Deborah Schwind, Debbie, welcome to the show. How are you doing today?    Deborah Schwind     I'm doing great. How are you?    Jayson Davies     I'm wonderful, enjoying enjoying the weather, enjoying the end of summer. It's hot, but I know a lot of school based OTs are getting back to school. What about you? Are you heading back into the schools this upcoming fall?    Deborah Schwind     Next Wednesday is my first day back.    Jayson Davies     Awesome. And so actually share with us a little bit about that. Where, where are you in the world? What are you doing, as far as school based ot?    Deborah Schwind     so I am outside of DC in Northern Virginia, and I work for a fairly large suburban school district, and I am very fortunate in that I get to work with students preschool through age 22 and in part of a Project SEARCH program, which I'm really always excited about.     Jayson Davies     That's awesome. And you know, we're talking about community based instruction, and actually we're talking a lot about more in line with what most people would think happening in high school that transition period, but we're really going to flip that around, and we're going to talk a lot about actually elementary school today, which is which is unique. A lot of people are doing what you're doing, but at the high school level. And so I am excited to talk about community based instruction in the elementary schools with you. Before we do that, though, I was on LinkedIn, just browsing a little bit, and I saw that you've been with your district for quite a while. How has it been being in one place for so long? How have you been able to grow within your school based ot community?    Deborah Schwind     So I have been there for 17 years, and before that, I worked in early intervention, home health, inpatient, outpatient pediatric settings. Have taught at the college level in occupational therapy assistant programs, doing the pediatric courses and assistive technology courses. So I have a lot of years of experience, if you will, but have seen a lot of changes in school based practice these last 17 years, especially with ESSA and MTSS and our role as sis as well as our role as related service provider. So there have been a lot of changes, and it's been, those have been really good changes.    Jayson Davies     That's awesome. Yeah, and you just mentioned a lot of acronyms. I'm not going to get into all those. All of those have already been mentioned on the podcast before, and we'll be sure to throw them into the show notes, because school based OT is full of acronyms. It's just everywhere.    Deborah Schwind     Say that I have my undergrad in OT. That's how old I am. So I have my BS and OT from East Carolina University, and I designed my own graduate degree, taking half of my classes in healthcare administration and half of my classes in educational administration. And then I've recently, in 2018 received my doctorate of Health Sciences from Drexel.    Jayson Davies     Okay, I was wondering about that, because you have your doctor in health sciences, but you also have a master's in education, correct, right? I want to ask you about that, because I thought about getting my master's in education. What did you learn throughout that master's of education that helps you as a school based OT?    Deborah Schwind     So it's a master's in educational administration, so it was really leadership type classes, and talking about how to create a culture in a school, addressing the climate in a school, and really taking on a lot of Leadership type of coursework. So it's definitely been very beneficial in my role as an OT even though I'm not an official administrator, I do feel like I am a leader within my department.    Jayson Davies     Yeah, I mean, we're all leaders in one way or the other, even if we don't have that official title.     Deborah Schwind     So absolutely.     Jayson Davies     Yeah, awesome. All right, so we are here, really today to dive in to your article evaluating a novel approach to community based instruction, also known as CBI in elementary school for students with autism. So let's go ahead and jump into that and to kick things off, why don't you share with us how this research even came to be. Was this your doctoral Capstone? Were you just a curious clinician or or, how did this come to be?    Deborah Schwind     So I was working in my doctorate classes where you have to do a dissertation, and I had this passion for transition, and when I started reading about some of the outcomes for adults with disabilities. It was actually really shocking that the unemployment rates are so incredibly high. So I feel like our whole purpose and education is to prepare our students for life after school and to prepare students to be contributing members of society. And when I was reading this, I just felt like, you know, we're really failing our students with special needs and different abilities, and I felt like we really need to do better as OTs and I felt like OTs had really play a big role in this. And as I was doing my research. Search for my classes, and was kind of grappling with what to do my dissertation research on. I kept explaining this program that I had created to my advisor, and it was actually her idea to do a program evaluation on this program that I had created, and I had been doing it for five years, so it wasn't a brand new type of a program, but that's kind of how it It started out and came to be part of my dissertation, or my dissertation, I should say,    Jayson Davies     gotcha. And so what made you decide to go the route like I mentioned earlier, a lot of people think about transitions. They think with the high schoolers, what made you decide to start earlier with those younger kiddos?    Deborah Schwind     So in our school division, our elementary school students were doing CBI, but they were going off campus, which is traditionally what you think of with CBI, and it really was not working. These were kids in third through fifth grade, and I know every school district is very different with how they teach students with special needs. And in our division, our students go to their neighborhood schools, and if they really everyone is Gen Ed, unless for some reason, there are significant behaviors or modifications to the curriculum that would not be helpful for the student to be in that gen ed classroom. However, saying that all of our students do go into Gen Ed, they just may not be in there all day. Okay, and so the students that are in our self contained classrooms really have, you know, significant impacts. They all have FBA is VIPs. You know, many of them have AAC devices. They have significant modifications to the curriculum. There's a lot of behaviors. And we were taking them out into the community. And we were taking them to places like the grocery store, restaurants, chain stores, and these were places that they weren't even going with their own families, so they were very unfamiliar settings with unfamiliar people, and it was very overwhelming. And what ended up happening is it really became a loss of instructional time because they weren't able to really access that community atmosphere. But then when we came back to the building, we were still dealing with the ramifications of that outing, and so we lost even additional instructional time. At the end of the school year, I was supporting it. I was going out with a teacher every week. And it also was really causing a divide in the community, because it's, it was a very sensory, overwhelming environment, and it was, you know, not showing our students strengths and in the community. So I just went to the teacher and said, You know, I want to support the students. I want to support you, but let's come up with a different idea. And so what we talked about was adopting the school as our community and building routines and behaviors and habits in a familiar environment with familiar people, and that's how it kind of came to be.    Jayson Davies     That's great. I mean, first of all, I just have to say kudos to your your district, your area, for even starting that young. I mean, I know in the district that I live in and and have worked at community outings aren't even happening till oftentimes, high school, maybe middle school, so even just starting at that third to fifth grade is just quite amazing. But with that, I kind of understand where you're seeing that divide. We want to we want to show off the abilities of our students, and we want them to be successful, and if every time they're going out, they're not having great experience, and people aren't seeing them being able to have that great experience, I can see where it could cause some disconnect. So.    Deborah Schwind     Right. It was, yeah, it was causing a divide, if you will, and it wasn't promoting acceptance of our students. So yeah, it turned out to be something way more than I ever thought that it would be. And because of that, we really were able to introduce a lot of different tasks and activities and occupations in this familiar environment with the. Familiar people. So we really were able to build habits and roles and responsibilities and routines, which is what our students all really need. Yeah, so it is perfect. It was the perfect storm, actually.    Jayson Davies     Yeah, you know. And in the article, you have an entire little chart of several different activities that students can be a part of, as well as the time of year. Taught that they can do this. So just for instance, please, if you're listening, go and look at the article so you can see this chart. But you have things such as stocking the teacher's office, coffee supply, Bin, running an outdoor garden, a farmer's market, stacking chairs, feeding the birds, composting like there's so many things here. Please, everyone, if you're listening, go look at the article so you can see this. But were you focusing on one particular community based instruction for your article's purpose?    Deborah Schwind     You know it was the looking at the program in general. Because one of the other driving forces for me doing this research was that there was some hesitancy within the school division that, and it wasn't from administrators, but that parents may not be supportive of a program like this because of the seemingly approach to functional living skills that may not be so academically heavy, and so there was a concern that the parents may not be supportive of it, and why really needed to find out if that was true. Because if that was true, then I don't feel like the program was going to be successful or accepted or adopted, because parents are a crucial part of the team, and so that was another really big driving force as to why I wanted to do the research on this.    Jayson Davies     That's great. I'm just going to be a little meta here. You know, as part of the podcast, we love to pull out quotes from the podcast, and we post those on social media. And as you speak, I'm just hearing things that, really I know is going to resonate with those listening. Some of the things you know, making sure that parents are on board, they are an important part of the team, making sure that teachers are on board and making sure that we're meshing the community. Those are all very important things that sometimes go overlooked. So I'm so, so happy to hear that you know you took into account those things. You weren't operating in a vacuum per se. You You didn't just say, I know this will help the kids. I'm going to do it no matter what others think. You want to get that that valuable input from others. So kudos. I may have jumped a little bit ahead, and so I want to take a step back really quickly and community based instruction. A lot of people may have heard that term, but not be so familiar with it. So before we go much further, can we get just a working definition for community based instruction CBI?    Deborah Schwind     absolutely. So community based instruction is an evidence based teaching strategy, and it allows students to take knowledge from the classroom and apply it to a community setting. And that community setting, typically is off campus, but the community setting can also be the school community, and it's very functional. It's very purposeful, it's very meaningful. It's authentic learning, it's applied knowledge, and it's really ot it has so much purpose for the students. It's so relevant for the students. So if you're talking about counting in the classroom and learning one to one correspondence, well, let's do that in the garden when we are picking the sunflowers. And we can count the sunflowers. We can measure how long the sunflower stems are. We can estimate how many we grew. We can have a farmers market and do money skills. We can read directions on how to make bird seed wreaths or those sorts of things. So the important thing to remember is that it is academics. It's applying the academics in a functional way. So that's the really key piece of it, it's doing what you're already doing, but then taking it to the next level and applying it.    Jayson Davies     So interesting. You know, I once heard that a lot of the research for students in general education starts with research from special education, because we learn how some of our students in special education can learn, and as you're talking about, you know, the different things that you do outside with sunflowers and whatnot, what I'm hearing actually, is a lot of things that might sound like steam, steam learning, science, technology, engineering and math, right?    Deborah Schwind     And so, yeah, thanks to learning, it's. PbO, it's solving problems, day to day problems in a very functional way. Yeah, yeah,    Jayson Davies     it's quite a feat when you can use real life in education. And sometimes that doesn't happen, you know, you got to get away from the textbooks. You know, we learn you learn that skill, but then you got to apply that skill outside. And, yeah, use it. So that's awesome. All right, I really want to move forward further with the research. But I have to ask you this, because I know this is true in the article you talk about how individuals with autism are the costliest group to serve with vocational rehabilitation services. Explain that a little bit are either why or how that comes to be.    Deborah Schwind     So there's many reasons that our students, even those without autism, are unemployed, and we can look at the predictors of transition success. And when we don't have those predictors of success, they become barriers to success. So not having those skills is as detrimental to the student as not having these predictors of success. So having social skills and workplace behaviors are a huge predictor of success. Not having those is a huge barrier to success, and for many of our students with autism, even those who are going away to college, who are going to be getting, you know, undergraduate degrees, these workplace behaviors and social skills really interfere with their ability to be successful. So not being able to work as a team, not being able to work as a group, that would be maybe something for someone at the college level, not being able to resolve a roommate conflict, not being able to interact with a professor. And then for some of our students you may not be going to college, just you know, having good hygiene, keeping your hands to yourself, having consistent behaviors, knowing how to ask for help, all of those sorts of things, these social skills and workplace behaviors can interfere. But the other things that can interfere are not having independence with ADLs and ideals, and that also goes to the college level, not being able to navigate the college campus, not being able to take your medication independently, not knowing when to shower or how often to wash Your clothes or shade, all of those kinds of things are really what interferes with our students who have disabilities. And I think some of the other things that are really important to understand is that most of our research on autistic individuals are really geared towards the younger person. We don't have a lot of people in their 40s and 50s who have autism, so we don't have those to study. We're really just starting to get to the point where we have autistic individuals who are in their 20s and 30s. So we're really just starting to realize these really poor outcomes. So as far as more specific reasons, I think that that's going to be research that is going to be continuing to evolve. A lot of our research right now, I call it this slice and dice. It's looking at fine motor skills, behavior skills, social skills, communication skills, behavior, we're looking at all of these foundational skills. We don't really have a lot of studies looking at functional outcomes and the end all be all, if you will. So hopefully, you know that can change as we have more and more students graduating with autism, but most people with autism are still in the school system. So, you know, there's a lot of opportunities for research.     Jayson Davies     Yeah, yeah. And I think that, I mean, obviously there are people, there are autistic individuals, that are outside the school system, but those are hard to they're hard to find. They're not a population that you have readily available, because you know that they're in the schools. So when it comes to research, you know, for every research article, we need participants, and it's nice, because in the schools, you have participants, you can reach out to the school and you can find them fairly easily, but, yeah, I absolutely agree, though, it'll be nice to see compare students who maybe are in a program where they start CBI at such an early, young age, you know, third grade, and compare that to a school district that doesn't have that program, and see what some of those outcomes are for those students do more than. Go into the workforce. Do more of them go to a community college or a four year university? I think that would be a great follow up study for their next.    Deborah Schwind     I think the other question I always have is, we have so many OTs that aren't working in the high school or provide consultative services in high school, and what would the outcomes be if ot was more involved? And could co teach these ideal classes or functional living classes? Could that even alone alter some of the outcomes?    Jayson Davies     Absolutely, absolutely. All right, so we're going to dive into the next part of the article. But as we do that, this little transition piece, I guess you could call it, is to break down kind of your overall aim. What was your goal with this article? We've talked about some of the some of the barriers and some of the reasons, but what was your focus on why this article exists?    Deborah Schwind     So it was really to evaluate the program, we wanted to determine what kind of attitudes people had about the program and what kind of knowledge they had about the program, and we wanted to get that information from three different stakeholder groups, so We looked at staff members that were in this particular school, both gen ed and special ed. We looked at administrators that were within the school and within the central office who had observed and seen the program, and then we also really wanted to get input and feedback from the parents. And we did parents of students who were currently involved in the in this class. So when I was setting up the program, I used a logic model to kind of set up the program. And the nice thing is that the logic model kind of really goes into the same program evaluation type outcomes. So if anyone was interested in setting something like this up, I would say, start with a logic model and then go from there.    Jayson Davies     Okay, I have no idea what a logic model is. I'm just going to say that what's the logic model?    Deborah Schwind     So it kind of breaks down a program that you are thinking about trying to develop, and it talks about all the tools you're going to need, the materials you're going to need, the people who are going to be involved, what your short term outcomes are going to be, your midterm and long term outcomes will be. So it kind of is a plan, if you will, to develop a program.    Jayson Davies     Gotcha, okay, and then so you have this program. You've already been doing the program, and now you're actually going to evaluate said program. When you set out to actually evaluate and you kind of started down this road. So I want to go a little bit further. It sounds like you had kind of three program evaluation outcomes that you were looking at learning action and impact. Is that correct? And how would you break that down?    Deborah Schwind     Okay, so the learning impact and those are actually outcomes that you will be looking at as part of a program evaluation. So when you're looking at a program evaluation, you have short term outcomes, these intermediary outcomes, and then long term outcomes. And you usually don't look at all of those different level outcomes at the same time. So because this program had never been evaluated before, we wanted to start at those short term outcomes, which are the learning outcomes, and within those learning outcomes are knowledge and attitude, because if you don't have good knowledge and there aren't good attitudes, then you really probably should stop the program, and you don't need to look at your intermediary or long term. You need to fix these things at the first level before you can continue on. So.    Jayson Davies     Great. And then if we, if we start to kind of look at that methodology, how did this? How did you actually, how did you collect these perspectives? I mean, were you having interviews? Were you doing questionnaires? What did that look like?     Deborah Schwind     So we designed a survey, and when I say we, it was the research committee, the dissertation committee, so we designed a survey that was on a Likert scale, and then we also came up with focus group questions, so everyone who decided to voluntarily participate, took the survey, and then anyone else who was interested could volunteer to be part of a focus group.     Jayson Davies     Gotcha. Okay, so everyone started with a survey, and then they had the option to opt into a little bit further of that focus group, right? Okay? And so just out of curiosity, what did those do you have off the top of your head, kind of just the numbers how? I'm assuming it was relatively small, because you were doing this just with one program. But you obviously had some parents. You had some teachers. What did that look like?     Deborah Schwind     An administrator? So an administrator, I had 10 administrators, and again, they were within the school and from central office, so special ed supervisors, autism supervisors, principals, assistant principals, that sort of thing, Transition Specialists. Then I had eight parents of current students, and there was usually only eight to 10 students in the classroom. So that was really a good number. And then we had 56 staff members do the survey. So we had a total of 74 survey participants.     Jayson Davies     That's not small, no. And then, so that's everyone that completed the survey. Did you have a decent amount of people that opted in for for that next step of the focus group?     Deborah Schwind     Yes. So focus group was a little bit tricky in that we had to do it at the end of the school year because we needed to make sure everyone had time to, you know, be a part of the program, if you will. So we did it at the end of the school year, and just naturally at the end of the school year, it's just crazy and chaotic, lots of things to do. So I was worried that it was going to have a difficult time, and I really wanted to keep the focus groups less than 10 people, just because it gets to be too difficult to try to transcribe. And, you know, it gets too long and lengthy, the actual focus group itself. So I had six administrators, I had three parents. I actually had five who wanted to do it, but two of them had transportation issues that day, so I only had three and then I had eight staff members, but I actually had more staff members that expressed an interest, but I had to make sure I had fair representation of general ed, special ed teachers and TAs so we obviously have a lot more gen ed teachers in our classroom. So I had to kind of separate it out like that.    Jayson Davies     And so when you ran the focus groups, did you speak to each of those three subsets individually, or did you kind of mix them up a little bit?    Deborah Schwind     So I had a neutral facilitator so that it was not biased, because obviously all the teachers, administrators and parents know me, so we would did not want them to feel pressured to support the program if they didn't. So we had a neutral facilitator that came in, and she met with the groups homogeneously. So it was just administrators, just parents or just staff, and the reason for that is that we did not want the parents to feel pressure from the administrators. We didn't want staff to feel pressure from the parents or, you know, the life, so we separated them out, and actually worked out really, really well.     Jayson Davies     Awesome. So let's dive into some of some of those themes that that arise both from the survey and then also from those small group sessions.    Deborah Schwind     So the themes were really very eye opening. I think doing a mixed methods study like this was really, really beneficial, because the numbers came out very high in knowledge and very high in attitudes. So that alone didn't really give us a lot of information, except that there was good knowledge and good attitudes. But once we were able to transcribe the focus groups and really analyzed and provided coding and themes to the focus group transcripts, what came out of it was really eye opening and was very, very helpful. Some of the themes were that there was a positive attitude about the program. They gave great ideas for program expansion and program enhancements and expansion. They talked about the culture of inclusion that this program promoted inclusion and supported inclusion. They talked about self determination and self esteem through these new roles that the students were learning. They talked about how this program really promoted authentic skill development, which is really what CBI is supposed to be all about. And then the other theme was that it really increased the expectations of everybody, including the student, of what they could do and what their potential. Show was, and what everyone saw them doing that it showed their the child's strengths.    Jayson Davies     Wow, wow. So did you feel like each of these subgroups, the three groups, were giving you the same type of responses, they were all saying this, or was there any difference in difference in their types of response? Was there one group that was more supportive and one group that was a little less supportive? Or were they all generally on the same page?    Deborah Schwind     It was really everyone on the same page. I mean, the feedback that they gave was really incredible. And I would say what really separated out the three groups is that it was actually really interesting, because the administrator groups really took on the perspective of organizational change and climate and culture. The parents really took on their focus was really about their child, very personal. And he talked about how much hope they gained from seeing their child perform these skills. And then the staff members really talked about they had the lens of just the day to day operation of the program. So it was really interesting to see their different viewpoints come out in the focus group.    Jayson Davies     Wow, that's really amazing. It's it's high praise when people are already trying to figure out how to expand a program. I mean, the I just the idea that someone's coming to you and not only do they appreciate it, but they want you to expand it, especially with that coming from administrators. I know many of us as occupational therapists in the schools. I mean, we can't get administrative support to save our lives. And so by doing this study, you were able to you were able to share what you do with the administrators. They saw what you did. They learned that it was beneficial. They also learned that the parents enjoyed it, appreciated it, and the teachers appreciated it. So I can only imagine that your administrators are more supportive of you now, even if they were supportive of you before, they're probably even more supportive of you after this study.    Deborah Schwind     You know, the the parents perspective was so incredible. I don't think this research would have been nearly as robust if I we did not have their perspective. And the idea that they talked about how this gave them so much hope, and some of the parents even talked about, you know, I've always felt like the future is very bleak for my child, and when I can see that they can work in the garden and they can work on the coffee shop, it gives me so much hope for the future. It is just really eye opening. I have a little story, actually, that is not it was not part of the study, but one of the moms that was in this had told me this little story at the end of the school year, he was getting ready to transition, and she had seen a couple of things that he had done, but she said, You know, I trust you, but I just can't imagine my son doing all of these things. And I said, Well, would you like me to take a video of him and send it to you? So I did, and I didn't even think my finger was off the send button. And she replied back, and she said, I am crying. My friends always have things to post on Facebook about what their children do, and I never have anything to post, and now I do, and it's just it really shows you that they just want to see their child successful, and that may not Always be academics, and that's okay.     Jayson Davies     Yeah, I agree. I agree. I mean, there's a few things that I have honed in on since actually reading up on idea, and some of other, some other educational documents, and I think that there has been this conflict, especially within the OT world of everything needs to be academic versus what about functional life skills? And I know, over the course of my 10 years as an OT, I've gone back and forth on that, you know, I think about goal writing at IEPs. I'm like, Oh, it needs to be focused on academic. If I collaborate with the teacher, it's going to be academic. Because, if they're talking about Common Core State Standards, or state standards in general, and if I'm tagging on to that goal, it's going to be academic. But as you're alluding to, and well, not even more than alluding to, you know, there's other things you know, the ability to have. Have a job beyond camp or beyond school, and you need more than academic skills to hold on to that job. So, yeah, I just, I think this, everything is quite amazing. You mentioned this is mixed methods. We talked a little bit about that qualitative side. What I don't think we've discussed the quantitative side of things. Was there? How did you do that, or what did that entail?     Deborah Schwind     The quantitative was a Likert scale survey that the committee developed together my advisory committee. And I was very fortunate with my advisory committee, because I had one professor who her specialty was qualitative. She was actually from George Washington University. I had a professor whose expertise was quantitative, and then I had a professor whose expertise is program evaluation. So she has done many, many different types of surveys and looked at many different types of programs. So we came up with just a 10 question survey. They were mixed together in that I had five questions that really looked more at attitudes. They were kind of belief questions, I believe this, and then five questions that were knowledge questions that were very factual in nature. And then it was on a four point scale, so that nobody could be neutral. They had to pick a side. So.     Jayson Davies     I recommend I have a master's thesis groups, and yep, I always recommend that always have an even number, so that people can't split the middle. That's right,    Deborah Schwind     which I didn't think that wasn't even an issue at all any of my results, but I did not know that when I was preparing the survey. So yeah, you    Jayson Davies     know, I do want to ask this, because it does happen sometimes, and if you don't ask, you may not get the answer. Were there any outliers? Was anyone a parent, a single administrator, a teacher? Did they have an opposing view to the majority.    Deborah Schwind     We didn't have any outliers in the focus group or in the survey, but as part of the survey, I did have a comment section, and there was also a couple other questions in the survey about, how have you learned about this program? Newsletters, flyers, brochures, actually working on the job, being a customer, those sorts of things. But there was one person who commented about some of the jobs, and some of the comments were very true in that from this person's perspective, you know, the jobs were redundant, or the jobs were messy, but that's really what we want we do. The redundancy might get boring for the teacher or the professor or the assistant or whoever. I don't know who, who had these responses, but that's really what we want. We want consistency. We don't want to have new jobs every day. We want them to gain independence and do the job more independently. So when I saw that, to me, it just meant that I needed to do more education that that was more of an education piece on my part. So.    Jayson Davies     Yeah, that's an important thank you for important note. Thank you for sharing that. Because I get that even from occupational therapists, occupational therapists and OTs, they often will feel especially those that are newer to to a school based ot position, they feel like every week they need to do something that is very different, vastly different from what they did the week before. And oftentimes we have to remind ourselves, you know, I don't learn a skill in 130 minute session. I need to practice over and over and over again. And I think as OTs, we feel like we have to do something new. We have to do something interesting. And I think we have to take a step back and remember that for these kids, doing something twice, for them, it's actually exciting. They like to do the same thing over and over and over again, exactly, especially considering the first time they probably fail. I mean, I failed the first time I did many things in my life, and so we have to give them that opportunity to improve. And I think if you do use that same or a very similar type of project, or whatever it might be task, you can help them to become more confident and improve those skills. So I'm sure you've seen the same thing throughout this project.    Deborah Schwind     Yeah, and the other thing is just, you know, with our OT lens and our ability to task analyze and to, you know, scaffold tasks and break down tasks and adapt tasks, modify tasks, we can take one task and do it 100 different. Different ways, and we can also grow independence. So that is one thing that I have been able to see with some of the teachers, is that the way the program gets implemented is I teach the students in the classroom how to do the job, and we do it as a group, and I do it along with the SLP. And as after we do it for several weeks, if we feel like some of the students are ready to start doing it in the school community, then we start adding it to their visual schedule, or they we start adding it to their choice board, and they can decide if they want to do that job. And at that point, the teacher and the assistants are really doing the jobs with them in the school community, but then I will come back and observe them. And so that's where I can say, You know what, let's do this now. Let's add this step. Or, you know, maybe it's somebody who is, you know, working on writing, for example, and we're doing a backpack delivery service. I'll say, you know, he has a goal of writing now, so let's bring the dry erase board, and when he has to find backpack number 25 in the cart, let's have him write it first. Or let's have him trace it first. Or Let's have him, you know, find it on a board, or whatever. So I can kind of, you know, change and enhance the jobs as they become more independent. So that's that's also really nice.    Jayson Davies     Yeah, definitely. And so you kind of alluded to this a little bit in here, so I gonna dive into this, this program, it's going on even when the OT isn't necessarily doing it with them, right? This is really more of an OT design program, but is being carried out by the teachers and the paraprofessionals. Is that correct?    Deborah Schwind     That is exactly right.     Jayson Davies     Okay, okay, I've got so many questions, and I I'm trying to, I'm trying to organize them in the most efficient way possible. So first I'm going to finish up kind of the the article per se, or those, my goodness, my my brain is trying to go on to the whole focus on the on the actual project itself. But I want to ask you, did you take a look at any of the student perceptions? Or is that something you would like to do in the future, or wish you would have done?    Deborah Schwind     I would love to do that in the future. That was not something so I had to get the IRB to approve this at the university level and within my school district, and that was just not something that they were going to approve. So I could not do that. But I think getting the perspective of the students within this classroom as well as the perspective of the students that are in the building, because many of these jobs are, you know, whole school jobs, so we have a library job that the gen ed students are doing as well. So our students go with their Gen Ed peers and do the job. So it would be really fascinating to get the perceptions of their peers, and they the peers know all of these students. I mean, they High Five them in the hallway. They know their name. They are. I was trying to find a quote that one of the teachers stated in during one of my focus groups, but it was basically that these students are in the very fabric, and they're woven in the very fabric of our school. And sometimes when you hear about self contained programs, you hear about, you know, the classroom in the basement, or the classroom at the end of the hall, and the students are not included, and that's not the case with this, and I think the Jobs had a lot to do with that, and that's also been very eye opening and very heartwarming actually, to have our students so included and so accepted and so embraced.    Jayson Davies     Yeah, yeah. I'm reading some of those quotes as you speak, and you know, one, it benefits the kids in our school community, all the kids, all the students, who are benefited. They are developing empathy, compassion. They are helping. They're an integral part to our community, and that's from a staff member. So, yeah, that's just, that's, that's invaluable. I love it. Okay, at the end of the day, what can an OT practitioner and OT, or an OT a or maybe even a teacher that is listening right now that's read this article. What is your hope that they would take away from this.    Deborah Schwind     I think, kind of circumventing back to a comment that you had made about idea, and idea is certainly something that is very supportive. Academics, but it's also supporting functional living skills and vocations and leisure. And how are we supporting those areas for our students? Are we looking at vocational skills from a very early age? We know our students need a lot of repetition, and the goal really should be that at 16, our students should be going off and doing internships, volunteer work or paid work. So at 16 we can't really start just looking at transition. Some states require you to look at it at 14, but even then, it's too late. Our students have already established possibly poor habits, and we need to address it much earlier than that. So I would encourage OTs to collaborate with teachers to figure out how we can incorporate ADL ID else into the curriculum, how we can incorporate vocational opportunities from a very early age, even in preschool. You know, so many of our autistic students don't really do pretend to play. So how in the preschool can we incorporate pretend to play and play firefighter and play nail salon and and play chef and and play all of these things? That's where our students, really early on, start taking on that role of vocation, and it's a way for them to start building some interests and ideas. So I would say, definitely collaborate with your teachers. And it's not just the special ed teacher. So in the middle school, I support my students and their family and consumer science classes and their tech ed classes, because research also shows us that students who are more independent with IDL skills are more likely to be employed. So if they can, you know, do laundry, they might be able to work in a hospital and do laundry in a hospital. If they can make a sandwich they could work in a restaurant. So there's a lot of correlations between ideal skills and employment. So I go in and I work with the teachers. I modify the curriculum, I modify the tasks, and make sure our students can access that curriculum in middle school. And I would really encourage other OTs to do the same.    Jayson Davies     Yeah, wow, so much to digest, and so much goodness. All right, we're gonna wrap up the article. I know I keep saying that, but we're really gonna wrap it up here with one last question, and then I want to talk about actually how you got started with the program a little bit, because I know that actually came first. This was just evaluating the program. If there's an OT out there that wants to potentially expand on this, or even you yourself want to expand on this, what do you envision as kind of the next steps for maybe the next program evaluation that you want to do or or whatnot?    Deborah Schwind     Yeah. So I've actually thought quite a bit about that. I actually have just submitted a secondary analysis of the focus groups to a journal. I just submitted it last month, so I have not heard back from them, but when I went back through the focus group transcripts, there was a lot of information in there about what people saw as some of the barriers to the program, as far as actually setting it up. And what were some facilitators, you know, what did you really need to have in order to get this program started? And one of the things that kept coming out through staff, administrators and parents is that you have to have administrator support, and if you don't have that, it is a huge barrier to program success. So I'm hoping that that article is accepted and we can publish that because it doesn't just have implications for a CBI program. It's really for any program. If you don't have an administrator who understands inclusion, who supports inclusion, who embraces all students, then some of these programs are just not going to work.    Jayson Davies     Absolutely, great. Well, I'm just going to say this out loud, if anyone wants to potentially, you know, take this for a capstone and run with it. Recommend finding Debbie. She's on LinkedIn. You can find her there and just reach out to her and see if there's any way that you. Can help, because this is an amazing program. It's in her district, but maybe you are in a different area of the country, and maybe you can potentially help your school district potentially to develop a similar type of program. So reach out to Debbie. I'm sure she would, she would love to love, love the support.    Deborah Schwind     Awesome. I've had quite a few ot students that have reached out to me that I've been able to mentor. So that's been great.    Jayson Davies     Great. All right, we have about five minutes left, and so I want to go way back before, not too far back, but before the before this article came to be, and you've been practicing for 17 years. I know from my experience that the longer that you are in a district, more people get to know you, the administrators get to know you. You can do more just because you built those relationships a little bit. But how did this program even get started? Did you actually initiate it? Was it already going? I know earlier you kind of said that kids were going off campus, but now it's on campus. Share with us the beginnings.    Deborah Schwind     Yeah, so we were going off campus, and it just was not working for our students, and so collaborated with the classroom teacher, and we really kind of thought, how about if we adopt the school as the community. And really, you know, we scaffold tasks, and we scaffold, you know, how we sequence things and but we don't always think about scaffolding the environment. And that's really what we did. We took this big off campus community of parking lots and grocery stores and school busses and said, you know, what? If that is too big for them, what could we do that's smaller? And it was just natural for us to think about the school as the community, and for some of these students, you know, just walking down the hall in their school building was difficult and challenging. So how can we expect them to be able to go off campus to places they've never been before and be able to be successful? I mean, it's just a very sensory, overwhelming task that we were asking them to do, so we decided to really, let's make the community smaller for them, so it's not so overwhelming. And then the first thing that we did, I think we must have had the first coffee cart in the country. So we started a coffee cart, and that was really how it all got started. And it just kind of started blossoming from there. One thing kind of led to another. The coffee cart led into stocking the condiments in the teachers lounge, and teachers starting to interact with our students and getting to know the students and having very functional conversation and using their AAC devices in a functional way. And then we started talking about, well, if they can stock the sugars, then how about if we ask if they can do something in the cafeteria. So we started having them stock condiments in the cafeteria. And then my son was getting ready to do his Eagle Scout project, and he went to the school and asked if he could build a garden. So the garden started through his Eagle Scout project, and the garden just really took off as well, and just gave us a whole new area to expand in, because he started planting and watering and lots of problem solving in the garden. You know, the hose is kinked. What do we do? The water is not coming out. How do we solve this problem? And you know, initially the students might get really upset, like it's not working, and they might throw it down. And then we would just say, well, let, let's think about it. What could we do? What can we look at? How can we solve this. It's okay. And problem solving is a big issue on the job. It's one of the workplace behaviors that our students have a really difficult time doing. So from the garden, we could water, we picked the crops, we started a farmers market. They sold the items from the farmers market. We would make things. We've made herbs and dressings and sold those. We Valentine's Day will make chocolates and they sell. The chocolates will make heart shaped rice crispy treats and sell those. We from the garden. We talk about healthy eating. What's good for you, what's bad for you, what should we eat? A lot of, What should we eat a little of we plant four different color carrots. So we do white, orange, yellow and purple, and then we separate them out. We talk about greater than less than we count them. We do the same thing with potatoes. We do purple potatoes, red potatoes, yellow potatoes. So. So there's just so much function in it. And so we talk about how to take care of ourselves. We'll do yoga. We bring the school nurse in, and she brings all of her medical instruments in, and the students get to kind of play with those, if you will, listen to their heartbeat, put the blood pressure cuff on so that the doctor's office may not be quite as scary, but all of this started with CBI, and it just has blossomed and grown. And there's so many different little, you know, avenues you can take from the jobs.    Jayson Davies     Wow, yeah, I think we need to get some of those kids playing ot like we need to. We need to have an OT game to let them play. They could be the one training the kids and the other skills for CVI or something, I don't know, but wow. Okay, I have two more questions for you, and then we'll wrap today up. And that is one these kids. You brought them back on campus. Have you gotten to the point where maybe it's time to go back off campus, maybe when they're a little older, potentially. What are your thoughts on that?    Deborah Schwind     So our middle school students, so one of the other themes that kind of came out in the dissertation research was within, I shouldn't say, a theme, but this overarching concept that was embedded in all of the themes is this idea of a continuum, that our expectations are on a continuum, inclusion is on a continuum. And the community, inclusion is a great example of that, that we can start small and grow the community so that it's more of a continuum, if you will. And so that idea of a continuum was actually pretty profound, and because of that, the school system has really kept our third through fifth graders at the school, and then as they move to middle school, they start going off campus, so that we're slowly expanding the size of the community as part of a continuum.    Jayson Davies     Gotcha. Okay, cool. And then so there is that expansion. And then my final question that I really want to ask, and I love hearing the answers to these, is, if an OT is in a school. They're in an elementary school. What would be some advice that you might give them in potentially starting a community based instruction program similar to this one.    Deborah Schwind     I think the big thing is collaboration. You know, maybe jotting some ideas down, maybe even starting to fill out one of those logic models that I had talked about, which you can just go online, search it, and you can get one, and then taking that to the teacher, getting her feedback and her input, and if the teacher seems to be on board, then going to the administrator and really talking to the administrator about it. It definitely takes collaboration. It's not something that you can just completely do on your own.    Jayson Davies     Absolutely, yeah, and I was just second that, you know, start with one teacher, because you'll be amazed by how things spread after you get that one teacher and one administrator on board. You know, you have that list of 20 different activities, but you start with one activity, one teacher, one administrator, and you'll, you'll be amazed. You know, next year you do two activities and two teachers volunteer three activities, three teachers.    Deborah Schwind     That's exactly right. And the other thing is to pick, try to pick activities that the school has already, is already doing. So, for example, the library job at our school, we were already doing that, but the students in the self contained programs were not being asked to be a part of it. So look around your school and see what's already being done, and if you can kind of embed some of the OT within that program, or make it a more inclusive program and try to make it more of a CBI type of a program.    Jayson Davies     Great. Well, Debbie, it has been such a pleasure. Thank you so much for sharing all these. I just kept nodding with everything you said today. So I really appreciate you being here, and I'm definitely going to have to follow up with you when that next article gets approved and we get to read that one so.    Deborah Schwind     Well, I want to thank you so much for, you know, spotlighting this article and these students, because, again, it's the whole reason why we're in school is to make sure they're successful when they graduate, and It does have to start early, so I really appreciate you taking an interest in this research and having me on the program.    Jayson Davies     Absolutely. Thank you one last time, and enjoy the rest of your day. Take care.    Deborah Schwind     Thank you.    Jayson Davies     All right, one last time. Thank you so much to Dr Deborah Schwinn for coming. Coming on the podcast. Debbie, it was a real pleasure having you and thank you to everyone listening to this podcast. To you, you know, again, I like to tell people I know that we have the best occupational therapy practitioners within the OT school house community, because you are willing to listen to an hour long podcast on your drive home to better support your students, to better support the teachers you serve and everyone you work with. So thank you so much for being here. And you know what? You just could have earned an hour of professional development to do that, all you have to do is head on over to OT schoolhouse.com/pd and click on Episode 109, and you could be on your way to earning one hour of professional development for listening to this episode that may be good for both your NBC ot registration as well as your state licensure. So be sure to head on over ot  schoolhouse.com/pd , click on Episode 109, and you could take a quiz to earn your certificate of completion. Thanks again for being here. Really appreciate it, and I will see you in episode 110 thanks again. Take care everyone. Bye.    Amazing Narrator     Thank you for listening to the OT school house podcast, for more ways to help you and your students succeed right now, head on over to ots.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! 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 110 of the OT Schoolhouse Podcast. School-based OT practitioners are not handwriting teachers! However, handwriting is often the most common reason for referral. In our chat with Debra Collette today, we are discussing a recent article where she surveyed teachers, administrators, and therapists on the missing pieces of handwriting in schools. Ten years ago, common core began to take over school standards, but the standards neglected to include handwriting. Tune in to learn how common core standards have impacted handwriting and how you can support students and teachers in implementing a handwriting curriculum. Tune in to learn the following objectives: Learners will identify the connects and disconnects between the common core curriculum with handwriting Learners will identify the impact common core has made on children’s written expression Learners will identify how common core and handwriting can impact OTPs Learners will identify what OTPs can do to support curriculum and handwriting on a systems level Earn Continuing Education for Listening to this Episode Wish you could earn professional development for listening to the OT Schoolhouse Podcast? Now you can! Click here to purchase the professional development opportunity that corresponds to this episode. Here's how it works in three simple steps: Listen to the episode on this page or wherever you listen to podcasts. Purchase the professional development opportunity. Take the short quiz and earn your certificate. It's the professional development you want on your own schedule. Click here to earn your certificate of completion for episode 109 now. Guest Bio Debra L. Collette, OTD, OTR/L Debra Collette is an Associate Professor and Program Director at Russell Sage College in Troy, NY. She was a school-based OT for 18 years with experience in K-12 and Assistive Technology. Debra has presented findings through AOTA and NYSOTA and has published them in AJOT and OTJR. In addition, she is an instructor for the AOTA Fieldwork Educator Certification Program (FWECP). Quotes “Teachers don’t get handwriting instruction in their college or academic programs” Debra Collette, OTD, OTR/L “We have this set of common core standards that tells us what we should be doing in education. But because there is nothing specific to handwriting, it's easy to set it aside and not think about it again” Debra Collette, OTD, OTR/L “40 minutes in a week is really not enough… we practice for musical instruments, or we practice for a sport, we have to put a lot more time in than just 40 minutes a week. So that foundational component of handwriting would be much more beneficial if it was a greater number of minutes per week” Debra Collette, OTD, OTR/L “As we type more and more and as high stakes testing is turning towards a typed response versus a written response… there's also research out there to support the fact that motor skills of learning handwriting, support that overall type response to if you know it, you're going to be quicker at the type response” Debra Collette, OTD, OTR/L “The teachers benefit from seeing it, and the child benefits from being able to be successful in that classroom in front of the teacher,” Debra Collette, OTD, OTR/L “...pick a few that you're strong at and that you feel good about, representing where a child's strengths and challenges are within. If you don't understand the language behind an assessment, is that worth giving?” Debra Collette, OTD, OTR/L Resources: Handwriting and Common Core State Standards Article - Debra Collette A Historical Journey Through the Development of Handwriting Instruction Article -Denise Donica Handwriting Instruction in Elementary Schools -Asha V. Asher OTJR Proloquo 2go Article -Debra Collette RTI Handwriting assessments: THS-R Minnesota Manual Dexterity ETCH Evaluation Tool of Children's Handwriting Peabody Developmental Motor Scales BOT-2 Sensory Profile Sensory Processing Measure Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT school house podcast. Your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host Jayson Davies, class is officially in session.    Jayson Davies     What is happening in school based occupational therapy practitioners. That is a mouthful. SB, OTs, what's happening? Thank you so much for being here for another episode of the OT school house podcast. We got a lot of great things going on at the OT school house right now. Some I can talk about. Some I just can't let out of the box yet. But we had a great, a wonderful, fantastic, ot school house, back to school conference at the end of August, and we are just building off of that momentum right now to bring more content, more opportunities for you all to interact. That may be a little hint, but I'm just excited for you all, for the OT school house, for all the students and the teachers that we support as school based occupational therapists, and I know that you just like myself, we are making a difference in the lives of students and also the teachers that help us to support the students, or we help the teachers support the students. So I'm excited for everything going on, and I'm also excited for today's chat with Deborah Colette, today, we are talking about a hot topic. We're talking about handwriting, more specifically, handwriting within Common Core. It's like a hot topic within a hot topic. You know, people either love it or they hate it Common Core. And likewise, people love that OT is within handwriting and also hate that OT is within the field of handwriting, or maybe it's reversed, that handwriting is within ot but you know whether you love it or hate it, it is not untrue that the most common reason for referrals for us as school based OTs is handwriting. Now there are a multitude of reasons for that. We're going to dive into that today with Dr Deborah Colette, and you know, it's going to be a good chat. You know, there's going to be some things that you full heartedly agree with. There's going to be other things that make you wonder, what the heck is going on with education these days. But this is going to be an episode that is going to help you. You're going to get a lot of language that you can take back to your staff, to your administrators, and say, Hey, why isn't handwriting in Common Core? And what can we do about it? So that's what we're here to talk about, Common Core handwriting where they mesh, where they don't mesh. And yes, so we're going to dive into it before we do here are the objectives for today's episode. This is a professional development episode, so you can learn how to earn a certificate of completion for listening over at ot  schoolhouse.com/episode 110 and so let's go over our objectives real quick, and then we will dive into it. We have four objectives today, and those are that you will be able to identify the connects and disconnects between the common core curriculum and handwriting. You'll also identify the impact Common Core has made on children's written expression. You'll identify how common core and handwriting can impact occupational therapists, and you'll learn you'll learn how to identify what occupational therapists can do to support curriculum and handwriting on a systems level. So it's going to be a good one. We're going to address handwriting and Common Core and occupational therapy. Now I would love nothing more to introduce you to Dr Deborah Colette. Deborah Colette is an associate professor and program director at Russell Sage College in Troy, New York. She has actually been a school based occupational therapist for 18 years before moving into the academic role that she holds now. She has presented findings through a OTA as well as the New York State ot Association, and has published them in the Asia ot as well as the OT Jr In addition, she's also an educator for the A OTA field work educator Certification Program, also known as the F wecp. I haven't yet taken that one, but from what I understand, it is definitely something to consider if you are taking on field work students. With all of that said, please help me to welcome to the OT school house podcast. Dr Deborah. Colette. Deborah, good morning. Welcome to the OT school house podcast. How are you doing today?    Debra Collette     I'm good. Thanks. How are you?    Jayson Davies      I'm doing fantastic. It's, you know, to be completely transparent and honest. You know, not everything is great. And you know, we were a little bit behind today. I had to wait for my mom, my babysitter. There's traffic, but she's here now, and we are good to go. So I really appreciate you being here. It's a pleasure, and I'm excited to talk to you about common core curriculum and handwriting. Before we do that, though, we're going to dive into your article. We're going to do a really deep dive into it, but before we do that, I'd love for you to share a little bit about yourself as an occupational therapist. Maybe I. Just where you are physically located and what you've been up to.    Debra Collette     Okay, so I am a faculty member at Russell stage College. I am the program director of the master's and newly accredited occupational therapy doctorate programs at Russell stage college. I taught in pediatrics for several years, and now I teach in research as well. So I have a couple of articles out there, and I'm working on lots of other things. I was a school based practitioner, though, for 18 years while I came into academia. You're my doctor in 2011 at Rocky Mountain University, and my bachelor's from Utica College in Utica, New York. And so here I am.    Jayson Davies     Awesome, and so, so did you say that you earned your doctorate at the school that you're currently working at, or were they two separate schools?    Debra Collette     No So, Rocky Mountain university I earned my doctorate at, and I I teach at Russell Sage College in Troy.    Jayson Davies     Okay, there we go. Gotcha. Thank you. And you mentioned you have several years in school based practice. What was that like? How do you enjoy that experience? And yeah, just tell us a little bit about that experience.    Debra Collette     So I I was not interested in working with children when I first got into ot I worked in rehab in New Hampshire for a short period of time, and ended up moving back to New York and found a school based practice job near my home, and loved it fell in love immediately. I really enjoyed working with children, teachers, administrators, families, within the school based setting. I really wanted children to have success, and I think that I helped many, many of them get there to feel that little bit of success that they were struggling with outside of their struggles in school. So that was my motivation for staying and then I met a couple of wonderful women from Russell Sage college and taking field work students at that school. And through both of them, I kind of ended up getting my doctorate and coming into academia.    Jayson Davies     Wow, wow. It's always amazing how we end up where we are today, and so that sounds like a wonderful journey. You mentioned that you're kind of in charge of some research now, and you have a few different things in the works. Would you mind sharing with us, other than just the article that we're talking about today, what other things are you interested in, research wise, and what's going on?     Debra Collette     Sure, so response intervention is one of my favorite things to talk about, and it's one of the future directions I would like to go. I think that it is implemented so differently in one local schools, but two across the nation. I think there are some people who do it very, very well, and we could all use some advice from them. And I just think that from a New York state perspective, I would like to head toward like state board or our nysoda organization, and really work to get RTI a little bit more consistent across occupational therapy and school based practice.    Jayson Davies     I love that. I don't know if you've listened to one or 100 episodes of the podcast, but I am a big believer in RTI, you know, I've been using the, I don't know, it's not an acronym, it's a little metaphor, I guess, you know, going upstream. And I call going upstream using RTI to prevent those downstream evaluations, or even the students that just, you know, we can support them earlier, sooner than later, and going upstream to support them may help them down the road. And so you're preaching to the choir. I think most people that listen to the podcast love when we were able to talk about RTI, and they they are really interested in starting up ot within their school's RTI program as well. So who knows? Maybe we'll have to have another another discussion with you later down the road on RTI, especially if you have more research coming out about that, that would be fantastic.     Debra Collette     Sounds good. I don't have research in the works now. It's, it's on my next of Things To Do List.    Jayson Davies     All right, we'll give you, we'll give you three years.     Debra Collette     Sounds good.     Jayson Davies     I know that's not very long when it comes to academic research time. But    Debra Collette     right and right now we're really looking at, I do have a study out right now looking at the effects of child development from COVID, how children are managing school. Now, preliminary results state that, you know, it's children are struggling. They had a year of doing different things than what they were doing in school. So we're continuing that. And I also do some field work educator research, so.    Jayson Davies     Wow. Okay, awesome. That's great. Well, let's go ahead and dive into this article a little bit. The the title of the article is it from 2017 handwriting and Common Core State Standards, teacher, occupational therapist and administrator perceptions from New York State Public Schools. And this was published in the Asia OT. And I guess you know, obviously you have a background in school based OT, but what drove you to specifically look into common core and handwriting?    Debra Collette     So Common Core came out in 2010 was implemented in 11 or 12, and forgetting the. Actual academic years that it was implemented in. But it just seemed like while their guidelines and they were very well intentioned, I think that it added a lot of stress to teachers based on the guidelines, the very strict things that that the Common Core Standards were asking for. We teach a lot to standardize tests, high stakes tests for schools, it's aid driven, and I think the common core standards really stressed a lot of people out in schools. Added a lot of components, but didn't remove any components. So as an occupational therapist, looking at the increase in referrals during that time, it's also the time I was earning my doctorate, so I was really paying attention to what was happening. Was happening. We seemed to get an influx of referrals for handwriting, and I really felt it was because teachers were now not teaching handwriting as much in the classroom, response, intervention, I think that we I ended up supporting a lot of teachers in the classroom with classroom based instruction using several different programs and modified programs. But it just made me think that I wanted to look a little deeper into what really is happening.    Jayson Davies     Gotcha. Absolutely and you know, before we get too far into this, I don't think I have this in the in the notes, so I apologize if this is a difficult question, but I know that there are some states that have kind of they switched to Common Core and they've decided to go against it. I know here in California, we do use common core. It sounds like in New York, you use common core as well, but I know that there have been some states that have almost pushed against it a little bit. And I'm just wondering if you have read up at all in understanding why that is the case, or maybe what some of their reactions are?    Debra Collette     I don't actually know, the states that don't have it was one of my future directions, actually, in this article, to really look at the states that are not using common core. And I never did circle back to it, but I think Common Core is a great concept. It's a great thing to have guidelines for schools to go by. You know, when we have some schools that are very highly driven academically and have high academic standards, and some schools that are maybe a little bit lack space, I think it's appropriate to have specific standards across the nation. I don't know the difference, though, between the states that are rolling it out versus the states that have New York state specifically revised, I think Common Core in general was revised in 2017 right when this article was coming out. But there's not a ton of difference in what that is. There's a couple more developmental perspectives added to it, thankfully. But other than that, I haven't seen a ton, but I also haven't looked deeply into it.    Jayson Davies     Yeah. Okay, awesome. And then kind of a following up with that, you know, I came into the school based ot world around 2012 and you said the shift for Common Core was when, again?    Debra Collette     It was developed in 2010 Well, I think it was really rolled out in 2010 states were really starting to roll it out into their schools in 2011 2012 and, You know, speaking with some people in education leadership, their perspective is that it's the implementation of it that was the challenge. It was rolled out. It wasn't really widely educated. Teachers were not necessarily educated in how to best this, and so therefore it was left to a lot of interpretation of states and then local districts to roll it out the way they saw fit, and it was just confusing. I think there was a lot of push to meet higher standards without a lot of guidance as to what do we let go of then.    Jayson Davies     Yeah, and I know that is that's still struggle today. I think my my wife's an assistant principal, and she goes to PLCs with all of her different grade levels and and trying to get them to teach the to the standards is still struggle, even today. Where I was going with that was that I was coming into the world in 2012 which sounds like it's right, as Common Core was just kicking off. I think I probably started hearing that word Common Core probably closer to 2014 2015 is when I really started to understand what it was, for those of us who have not been a school based ot for more than a decade, 10 years or so, what was in place before Common Core?    Debra Collette     So looking at curriculum prior to Common Core, I think I didn't. I wasn't taught about instruction in school, neither was I in school. So I had to learn. I had to go and speak with the teachers about what is it that they're teaching. So I would go to the kindergarten, first grade, second grade teachers ask them what their curriculum was figured out, what levels of reading, writing, math, production, participation, they were at. They followed standards. This was back when state testing came out, and they were teaching to high stakes testing. So I worked closely with teachers to find out what they were working on. I can't say it's 100% different than Common Core. Common Core, though, I think standardized curriculum across the country so that it. As what was happening in New York was similar to what was happening in Florida, California, Texas, Minnesota, you know, so things were kind of consolidated and more consistent.     Jayson Davies     Yeah, yeah. And again, we kind of alluded to it earlier. I know some states are going like, kind of going back against common core, and I don't fully understand the reasoning about it. I'm sure that there. I'm just going to say it out loud that I know right now there has been a lot of political debate over what is taught and not taught in schools. I don't know if that has anything to do with it or if it's something else, but either way, you know it, I like the idea of having it kind of a universal standards. You know, if you're in Arizona, if you're in California, if you're in Washington, New York, whatever the kids are being taught the same thing. And I think part of that was that you had kids moving and something might have been a standard in the third grade for one state, that might be a standard in second grade at another state. And so if they transferred after their second grade year, then maybe they didn't get whatever it was that was supposed to be taught in third grade, I don't know, but yeah, yeah. So.    Debra Collette     I actually had an example of that one of my mentors for when I first became an occupational therapist working with children in school settings, she was taught, I think, in her original school, she was supposed to learn cursive in second grade, she moved in between. I think I'm saying it back, but she moved in between, and she missed cursive teaching, so she learned how to write cursive. So when she was working with children in school based practice, she has to teach herself right in cursive. So she could teach cursive, you know. So it is true, different different different grade levels in different schools and different states, teach different things as all of the concepts for, you know, character building and social skills, social emotional learning, all of those things came in, we get this build up of all of these things that we have to teach in schools. We have to teach more and more and more consistently. And I think the Common Core really gives us that guidance as to what are those basic skills, but they're missing that single component of handwriting.    Jayson Davies     Gotcha, and you know what? That's what we're going to dive into. So you know, every good research article that comes out, or any research article that comes out, good or bad, typically has a literature review. And I know we've already dove in, or we've Devon, am I a dove? I don't know. The we've already looked at the Common Core. We've talked about that a little bit. But when you were doing and the team was doing the the literature review for all this, was there anything that you found that you didn't know before that comes to your mind, or was there maybe something that you were looking for that you couldn't find? Does that make sense? What did you find out during that literature review?    Debra Collette     It does through my experience and my observations of children and teachers. I really wasn't surprised by any of the information out there. I think the research articles supported what my assumptions already were. You know, in working with children. I saw the children who struggled with handwriting. I saw the teachers who did fabulous jobs with teaching handwriting and wanted ot as a support to just follow up with the little things. I saw that in the research, I saw the curriculum, the handwriting curriculum that were out there and that teachers were using. I saw it be successful. I also saw again, teachers struggle with it when all of these other curriculum requirements were being added. So when I looked at educational articles on handwriting, I saw those struggles. Danica wrote an article. I believe it was Danica who had information in there about teachers don't get handwriting instruction in their college their academic programs, you know. So I don't think anything surprised me, but I wanted to add to that too, so I article is helping at least some people understand a little more.    Jayson Davies     Yeah, that Donna article is one that I referenced too occasionally as well for that same reason. So thank you. And then on the flip side of that, you know you things made sense for what you saw, but was there anything that you were expecting to find, maybe from research. Obviously, every time you you dive into research world, you're you're answering a question. Your question was handwriting and Common Core was, what was the mesh or the disconnect. Was there anything that you were hoping to find that you couldn't find during your literature review?    Debra Collette     I was really hoping to find something out there developmentally that told me how much I needed to be teaching handwriting, and how do I support handwriting instruction in schools? I had a conversation at one point with an instructional technology director who said they're not even teaching typing anymore because kids are learning a keyboard through texting and through gaming. That's very different. Correct, very different. And I was like, you can't take this stuff out of instruction. We still have to learn it as a developmental skill, and if you just put it in there at the beginning. And then practice it, you know, a little bit each day, until you get good at it. Then we all have that basic skill. So I was hoping for that Common Core doesn't, didn't give it back in 2010 and it still doesn't in 2017    Jayson Davies     Gotcha. Yeah. So then Common Core, it sounds like it lost its place, or handwriting lost its place within Common Core. You know, I remember learning to handwrite back in elementary school, and I think many of us do. But why do you feel that you mentioned, you know, texting and whatnot? Why do you feel that handwriting has lost its place within Common Core? Why do you think maybe those who develop common core didn't focus on handwriting, and this may be a research backed question that I'm asking you, or may just be a be an opinion.    Debra Collette     It's anecdotally, I think that it has that skill has just gone by the wayside. And it's while some people still believe in it and teach it, they do it because they know it's important. And other it's not a, maybe a forethought to education. You know, when I look at the standards of even in pre kindergarten, that students have to use a combination of drawing dictating oral expression and emergent writing to talk about familiar topics. That's a lot for pre kindergarten, and there's writing in there, but there's not that development of how do you write? Yeah, talk about math and numbers. There's all sorts of counting things. There's all sorts of use of the hands to count, and what does it a number mean, and what does it represent? And then, how do you use it? We've forgotten that with letters. I think it just needs to be put back in a basic level of education.    Jayson Davies     Yeah. And I think too, my opinion on this is that when I look at the common core standards, you see that word right? You see that word right? They will write. They will write, they will draw. But there's nothing to kind of show what writing means, because there are so many factors that go into writing. A kid, a preschooler, a kindergartner, will write, well, like, okay, are they going to write a sentence? Are they going to write a word? Are they going to like, what are we really expecting them? Are we expecting them to copy a sentence or to write from their own head a sentence? I mean, those are very different concepts, and when you understand that as occupational therapists, and I think that teachers would appreciate that more specificity, I guess, you know and understand like, okay, when the Common Core kindergarten standard says write, what they're really talking about is copying near point, copy from the board or whatever. So, yeah, I think that's a difficult area with Common Core.    Debra Collette     Right, right. And that structure of writing, that that motor skill, with the cognitive component of what I put on paper, what I draw on paper, the more I practice that motor plan, the easier it's going to be for me to be able to express my actual cognitive thoughts. And then I can function in school. I can participate in in activities and be good at it and feel successful at it.    Jayson Davies     Yeah, good thing. Schools have occupational therapists. We can, we can help them out with these things.    Debra Collette     Continue to do that?    Jayson Davies     Yep, yep. All right, so obviously, we're talking about the article. We're talking about handwriting, Common Core, the connections, the disconnect. But what were some of those key questions you wanted to answer with this study?    Debra Collette     So I wanted to look at the present instructional strategies that teachers were using for handwriting under the background of Common Core, I wanted to look at what supports were offered for handwriting in schools. And then I wanted to look at the impact Common Core made on children's written expression. Overall.    Jayson Davies     Awesome. And so what was, what was the methodology? How are we going to how are we going to do this?    Debra Collette     Yeah, so we did a survey and interviews. So we set up a survey. The survey had, I don't know, a lot of questions overall. I think it was over 100 questions total. I was    Jayson Davies     surprised by that. I think it was like 121 or something like that. Is a lot of questions.    Debra Collette     something like that. But when you look at the survey, the survey, not one person answered 121 questions. So every person answered demographic information to figure out who's answering what, and then there are about 10 to 15 questions, depending on the title of the participant, as to what number of questions they were answering. So principals answered about 10 questions, teachers and occupational therapists answered about 14 or 15 questions.    Jayson Davies     Gotcha. Okay, so there's kind of broken down into what your role was, and that makes sense. You're not going to ask administrators what they're doing in the classroom for handwriting, because they're not doing anything in the classroom for handwriting. Got it. Gotcha. All right. And so you had this survey. Was it a was it developed by the team? I'm assuming the survey.     Debra Collette     So the survey came about because I read an article in 2006 that Asha Asher had written, and she had done a survey regarding handwriting, and I loved the article, and contacted Asha as I think all authors would love to be contacted about the research, and we revised the survey so she had a team of researchers, students at Xavier University, and. And I had mine here at Russell H College, and we revised the survey to be more directed towards common core questions and handwriting instruction. Once we were done with that, she was in, she was heading on to the next, her next direction in life. And I took the survey and ran with it here and put it out to New York State educators, principals, occupational therapists and curriculum instructors or directors in New York State.    Jayson Davies     Awesome, great. And so you sent this out to it was within New York, New York State, all of New York State, right? It was Yes, all right, awesome. And so how did you get this out to everyone?    Debra Collette     So our survey was done on Survey Monkey, and we looked at the New York State Education website. We pulled it was over 600 schools that we pulled all of the contact information from. So we developed a master list, which, of course, changes every year as teachers and principals move from place to place. So it's never consistent. So we use that website to send out over 600 surveys, survey requests to specifically those people in New York state. So we knew that it was only going to people within New York State. And then from that, we got 100 we received 131 responses.    Jayson Davies     That's not a bad response rate, one in six. No, not bad at all. Was there? Was there any incentive?    Debra Collette     There was not incentive. Wow. Even better, yeah, yep, just please answer our questions, because we're interested.    Jayson Davies     Awesome. And so you had about 121, 21 I think it was    Debra Collette     131.    Jayson Davies     Do you kind of just have a rough breakdown? Was it? I could see occupational therapists being really eager, and maybe administrators a little less eager to to respond. What did that look like?    Debra Collette     So we actually had 33 principals, 24 occupational therapists, 62 teachers, two directors of curriculum, and eight special educators. So yeah, one of our higher numbers is actually principals, which is impressive.    Jayson Davies     Yeah, and when I when I hear you talk about when you say those numbers in my head, that kind of makes sense, given the amount of OTs that are within a state versus the amount of teachers that are within a state, like you're going to have more teachers because there are more teachers, you're going to have a little less administrators because there are less and then same thing with directors or coordinators. Of course, you're going to have less of those because there's only one director per district, potentially, or something like that. So that makes sense. All right, cool, great. Well, thank you for that. I guess the next step is to really start diving into some of the results and the data, and so I don't know where you want to start with. What were some things that came back?    Debra Collette     Well, what came back is that there's not a consistently used handwriting curriculum, and I think, well, there doesn't necessarily have to be using one to begin with. Is important, you know? So we have this set of common core standards that tells us what we should be doing in education, but because there is nothing specific to handwriting, it's easy to set it aside and not think about it again. So if you have that curriculum in front of you, you have that workbook, even though, you know, not a huge proponent necessarily, of worksheet, worksheet, worksheet, but if you have that curriculum, you can at least embed it into everything else that you're doing, you know, on a consistent basis during the week.    Jayson Davies     Yeah, and I'm looking at the the table that you have here, and just for those who are listening, we've got, I think 20% responded that they used Handwriting Without Tears, 16.7 use fundations. 13% Zainab sir, 6.7% other and then 43% none Correct. That's telling.    Debra Collette     It is very telling. Keep in mind, though, with those results, some of those teachers, well, they were K through two teachers at that point, and there were 30 of them who responded. So that's, you know, maybe they were second grade teachers that didn't, weren't necessarily working looking at that person or and weren't teaching cursive. So there could be a reason that they weren't using a material or curriculum per se, but it is still, it's challenging to know that there are teachers without not a background curriculum to support them.     Jayson Davies     Yeah, yeah, absolutely. And, and the other thing, I mean, I know from my own, you know, reading of articles, that when it comes down to it. It's not necessarily that one program is better than another. It's just that you need to have a program, and even if it's your own curriculum for handwriting, that is probably okay, but you need to have structure. And going back to kind of our conversation about common core, right? Common Core was supposed to make everything standardized from California to New York. I also think it could be tricky if you know your kindergarten teachers using handwriting without tears, and then your first grade teachers using foundations, and then your third grade teachers using the Size Matters program, that could be very confusing for for kids. So.    Debra Collette     Language even. Of you know, top to bottom, left to right. The you know, the language of the directions of forming letters. Where do your letters sit? What do you call those lines? You know, what do you call the dipper letters? That language, if you don't have a consistent language across a school? And again, you talked about children moving from school to school too. There's a lack of consistency within the language of how letters are even formed.    Jayson Davies     Yeah, yeah, definitely. So that's the the difference between potentially handwriting curriculum you also had in here, different time spent per week about, I'm assuming that information mostly came from teachers, the amount of time that they're spending per week on handwriting. What did you resolve from from that?    Debra Collette     So most people were teaching a very small amount of time, 30 what? So less than 40 minutes per week was one response. About 10 minutes per week was another response. A curriculum director stated that it should be taught 30 minutes times two sessions per week when it's instructed, so as you're learning those instructional components. But then for the practice sessions, it could be, you know, 15 minutes, three times a week, which still is not very much, as children are learning the skill. So I'm thinking, you know, k1, two, and children are really looking at learning the development of writing and becoming more proficient at it, and then, as they progress through first and second grade, getting smaller handwriting, quicker handwriting, more words on a page and paragraph organizing. You know, all of those instructional pieces should be a little bit more than that, and 40 minutes in a week is really not enough. When we think about the if we practice for musical instruments or we practice for a sport, we have to put a lot more time in than just 40 minutes a week. So that foundational component of handwriting would be much more beneficial if it was a greater number of minutes per week.    Jayson Davies     And by chance, did you guys talk at all, or did you have research from before that talked about kind of, what is that recommended amount? I don't know what likes I don't know what some of the programs recommend. Do they recommend? You know that daily 15 minutes? Or what have you seen?    Debra Collette     Yeah, 15 to 20 minutes. I think he had running without tears as 20 minutes per day. Site, I know size matters, is out there. And I was listening to the podcast about had done with you recently. And I don't necessarily know those components, but I know when I was in school working with kindergarten, first grade, second grade, I would try to get in there at least 20 minutes, a couple times a week to assist. And, you know, many teachers were very welcoming. Other teachers are like, I got this, I can do this. And other teachers sometimes pass.    Jayson Davies     Yeah, yeah, no, that's that's how it is. That's definitely how it is. Okay? So we've got different handwriting curriculums, we've got different amount of time spent. I'm assuming that a lot of that information came from teachers. What did we learn from maybe some of the other people involved in the survey? You had teach, or you had administrators, you had OTs, what were some of the information you got there?    Debra Collette     So principals didn't realize that handwriting was was necessarily a problem. They didn't realize that the teachers weren't teaching handwriting. So that was definitely one of those surprising factors. They knew that it was in the curriculum. They didn't realize the disconnect necessarily between common core and the decrease instruction of handwriting as that was being rolled out. Okay, handwriting was still still occurring.    Jayson Davies     So they just figured, you know, there's no there's no common core we aspect to handwriting. There's nothing that says teachers have to teach common or handwriting within Common Core. We are telling them to follow the standards, but at the same time, they should also be teaching handwriting. I just think that's a little comical.    Debra Collette     And it is, and without that explicit statement of, well, keep teaching handwriting, it can certainly go by the wayside. And with everything that teachers have to teach, I also wonder there's a lot.    Jayson Davies      Absolutely and that's what exactly common core is telling you to teach this and this and this and this. And if you're constantly being told to teach this, then you're going to stop teaching other things that you might have usually taught in the first month of the school year. So yeah, that makes sense. Yeah, all right, and so that's what kind of some of the administrators, did you find anything surprising or shocking or relevant from the occupational therapy providers?    Debra Collette     No, just that they would typically, I think most tried to use response, intervention kind of components to go in and support from a classroom perspective first, and then pull children either work with them on the side of a classroom, or pull them out of the classroom to work with them on handwriting. Referrals did seem to be increasing, but I think in general, the OTs certainly supported what was seen with the decrease in instruction through teachers. So I think. Are very familiar with handwriting curriculum. I think OTs were, and I don't think I have this in the article, but I think OTs in general, tend to be those people who go in and make all those modifications for paper, for, you know, providing strategies, giving out those pencil grips, you know, supporting, supporting the teacher, but also the student for that success.    Jayson Davies     So, and what you just kind of alluded to is what an OT might do to support. Did you have some questions embedded in there, like what a teacher might do if a child was struggling, and maybe what some of their answers were? Did they talk about reaching out to an OT, or did they have some general strategies that they would use by chance?    Debra Collette     So one of the, one of the flaws of our study was the fact that we asked about handwriting instruction and not specific instructional perspectives. So we didn't add ask specifically about what handwriting instruction do you do, what supports you give? I think the teachers did say that they would, you know, they would modify timing, they would modify the lined paper. They would give a pencil grip or a different type of pencil if they had one otherwise. The OTs also gave all of those supports when the teacher was was at that loss.    Jayson Davies     Awesome, great. All right, we talked about the majority of the participants. And I don't know that there's an answer to this, but you talked about having one to two coordinator directors. Did you guys gather any data from that, or was it worth looking at, or what?    Debra Collette     From the instructional the curriculum directors?    Jayson Davies     I think so. Yeah, you talked about some sort of directors. I don't know what position they might have been in, but yeah.    Debra Collette     So we call the director of curriculum in this study there. So I think typically the director of curriculum, they are interested in, how do we make education better for children? I think that's just their nature. So the one response that I put in the article was the fact that they believed there should be a specific amount of time per week that is dedicated to handwriting instruction, but that position is few and far between. There's usually one or two per school, if that. So I think that that person, while they're supporting the handwriting instruction, also has to support the remainder of curriculum in general, but the two that we had as part of our study were absolutely in support of keeping handwriting instruction as a practice time.    Jayson Davies     Well, it's good to hear. You know, it's not just us as OTs that are kind of banging our banging our fist on the table saying we need to have it there. It's other people within education that are saying it as well. Correct. Awesome. All right, you do have a topic within the article called The impact of Common Core on children's written expression. And I think as OTs, this is one of those things that we know, and it sounds like maybe it's something that your other other educators also know. But what are some of those downstream impacts of writing that not teaching handwriting at the get go can impact?    Debra Collette     So I think if we don't teach the handwriting skill, the motor components of writing don't get embedded in that motor plan for a child, they end up drawing the letters instead of truly writing the letters. They're not as fluent in their writing, so that makes them a little slower. It makes their thought process a little more challenging. So when they have to add that cognitive component of the writing, what they want to say to that motor act of writing, that combination ends up being a lot harder. Graham was one of the authors who I have quite a few articles in my literature review portion from Graham and his colleagues, and they really talk about that fluency, the timing, speed of writing, and how that affects the child's performance. If you choose samples of handwriting and you have, you know, they could be exactly the same content, you have a messy sample, and you have a very neat sample. The neat sample is going to get graded higher by that by the teacher than the messy sample, because it's just easier to read. And yet, the feeling of those students as they're writing those samples is probably the student who's writing messy is probably much more stressed. So there's that, you know, that child understanding and lack of feeling successful when they're practicing those writing skills, too.    Jayson Davies     Yeah, yeah. And like you said, you know, kids get graded per se on their legibility, and that could impact their overall grade on assignment, even if the knowledge has been learned and expressed, the legibility could bring down the grade for me. I know I to this day, I still have terrible handwriting, unless I really put effort into it, I can write nice. But for me, I just want to get things out as quick as possible. I'm someone who's very, very time. I always like to save time. You know, it's like, do you do I turn right at this light or the next light? Which? Which lights gonna save me that 30 seconds? And that's how it is for me with writing, too, and it always has. And my writing has always been messy, and I think that there's so many various factors that go into handwriting, but at the same time, we are very much judged by our handwriting, whether it's nice or not, and that fair unfair, you know, it is what it is. And I think as all of us, you know, there's a lot of, there's a lot of, I don't want to call it talk, but there's a lot of just understanding, you know, we have to start to understand ourselves, our own biases, our own what we what we do, what we don't do, and why we make those decisions. And as teachers and OTs and educators as a whole, we have to understand that as well, and we have to know that, you know, just because a student's giving us handwriting that's not the neatest doesn't mean that they're not smart or, you know, those don't connect. And I really liked what you said that student that does have the messy writing. It could mean that they're stressed. It could mean that they're rushing. It could mean that they're focusing on the content over what my handwriting looks like because they're afraid that they're going to run out of time. So there's so many different things that that could mean.    Debra Collette     Right? And with high stakes testing, too, the teacher who teaches the child all year long is not necessarily a person who is grading that child's writing sample, you know, so someone who's not familiar with that student does not understand what that child's trying to say because their handwriting is messy. Is also on a one to four rubric, or 04 rubric is going to score a lower score based on the messiness of that handwriting. And it does not mean that that child is not intelligent. It doesn't mean that that child doesn't have a lot to say and that it's perfect with that child saying it just means it's messier and was graded differently. So that's that is a challenge too, of supporting all of our students regardless of what that handwriting looks like. Typing definitely comes into play with that. I think that as we type more and more, and as high stakes testing is turning towards a typed response versus a written response. That may help. But there's also research out there to support the fact that that motor skill of learning handwriting supports that overall typed response too. If you know it in handwriting, you're going to be quicker at it with the typed response.    Jayson Davies     Interesting. That's, I know that there's research about, you know, the remembering factors when you write them versus typing. I know often there is that motor memory, or whatever it is, the motor aspect to writing can help you potentially retain more information when you write it down, as opposed to typing something out. I don't know if there's newer research on that. That was a while ago, but that's interesting to see that if you can write out things, then you're likely going to be able to type out things as well. Is that kind of what you said?    Debra Collette     It is. And I don't necessarily have evidence to support that, but I know in my experiences of working with with children who needed to use a type, needed to type rather than write, because their writing was just that challenging, they were not necessarily better typers, their responses were not necessarily longer. So that would be a really cool study to look at in the future, you know, to see if that was the case. But I know we are all fat with typing than we are with writing at this point, because we've practiced it for so much for so much time, but I think kids were learning to write. It's tougher.    Jayson Davies     Sorry. I'm laughing over here because I I always say that there's a reason I have a podcast and not a very active blog. I am terrible. My writing is not neat. I probably type at about 25 words per minute, which for many of you, I know, that is like terribly slow. And I know for some people that's fairly fast, but for a lot of people, I envy the people that can, like, type 100 words per minute and have a conversation with me at the same time. I'm like, How are you doing that? But those are also the people that have the nice writing like my wife does. So there we go. All right, I do want to talk a little bit about how this research can impact occupational therapy providers. But before I dive into that, I want to give you one last opportunity. Was there, was there anything that we missed that we didn't talk about today, about the research, anything that shocked you, anything that just came to light, or anything that we just missed?    Debra Collette     I just, I want to just make sure that I convey the fact that OTs are there to support teachers in school. You know, we are very collaborative. We can provide a lot of solutions. It's important for us to check in with teachers to make sure whatever strategies we're providing is something that that teacher can actually follow through with in support. My favorite thing to do is to go in and teach with the teacher in those activities, the handwriting activities, whether it's, you know, practicing cutting skills, if they have a class that's challenged, or whatever, to be a direct support to that teacher and and be there with them, rather than hand them some things and have them follow through, because teachers just cannot do one more thing. So Right? I love that a bit. Ability to do that. And I feel like the teachers who took this particular survey felt that the OTs who were coming in and assisting them were doing that.    Jayson Davies     That's great. Actually. I, I am a big proponent for getting outside of the OT literature, as you did for this instruct, for this research, too, you had to go into the education world and do research. And I did that as well. For a recent presentation I gave, and I found articles from teachers that were talking about working with OTs. And you know, like 65% wanted more time with their OTs to learn more. And one thing that really stood out to me was that what they felt was a facilitator, was when the OTs came into the class and showed them how to do something, modeled it for them and their aids, and they it was a quote, unquote, you know, turn off, or lack of a better word, if they didn't do that, if an OT was just telling a teacher something to do. Then it wasn't something that they wanted to hear. They really wanted to see the OT in their room working on that skill with the student so that they could observe it, see how to do it, and then carry it over the next day, the following day, the next week. And so, yeah, we definitely need to get into the classrooms. I think it's okay to do something with a student outside of a classroom, you know, pull them out and work on something. But then once you have that skill down, once the kid has that skill down, then transition into the classroom, you know. And you know, you taught Billy how to write a few letters outside the classroom. Now let's go into the classroom. Let's do it in the classroom where the teacher can see exactly what verbal cues work, what prompts work? What, whether it's behavioral or sensory strategies, what works for that student in the classroom?     Debra Collette     I 100% agree with that. I think the teachers benefits from seeing it. The child benefits from being able to be successful in that classroom in front of the teacher, you know? So you do    Jayson Davies     that. That's big. I like that. I like that, right? The the student benefits. Sorry, I want to make sure everyone heard that the student benefits from the teacher seeing that student being successful in the classroom. Absolutely.    Debra Collette     You know, a lot, some of the kids that we see in OT Haven felt a whole lot of success. So when we teach them to do something successfully, we bring them into the classroom and we set up those opportunities for success. The teacher sees it, the peers see it, you know that. And then the child feels that level of success, and you know that makes them motivated to continue working towards more success.    Jayson Davies     Yeah, yeah, absolutely Sorry, I keep saying we're going to jump into the next part, but occupational therapy providers, you surveyed them, was there any questions related to like, Do you have a role in handwriting curriculum in the in the school, or anything like that? Or was it more of just, how do you support the teachers?    Debra Collette     I think it was more, how do you how do you support well, how do you support handwriting in general? Let me just take a quick peek at the at the questions for OTs, how does your role as an occupational therapist support handwriting instruction in the classroom? What is your philosophy on handwriting instruction? Common interventions that you use? So that was in the article, the adaptive paper, pencils, etc, the handwriting. Yeah, so I think I'm not answering your question, but no, I support the how to support teachers.     Jayson Davies     Okay, yeah. And I think the only other thing that I might like to see again, for anyone looking to do their OTD or their PhD is, how are OTs even going beyond supporting teachers? But are OTs going above that step to the next level, are they potentially working with that curriculum director to potentially do something? Because I think OTs we kind of we work side by side teachers, and I think in a way, it's great, obviously, but it also limits us if we're not able to get to the next level and have those conversations with the directors on the importance of of handwriting, on the importance of sensory just related to the classroom and other areas that we have knowledge about that could help all students, not just the students that are struggling and we're getting called in to ask for and so I would love to see again, for anyone out there looking for a project. How are OTs working with the next level up, the next administration, basically, how are they working with administrators? Or are they, I think that'd be great to see.    Debra Collette     Yeah, I agree with that. I think OTs need to embed themselves in the school culture overall, not just with children and teachers, but with administration. Administrations should know who you are. You should be able to advocate for budgeting items, to be able to support children in classrooms after school programs, you know, I think, to be known by all of the people who work in a school, faculty and staff and administration. Our cafeteria workers knew us because we would go in and we would see children. In and around their their meal times to make things either more fun or to support with a snack. All of the faculty and staff knew us because we were in multiple classrooms. Our administration knew us because we attended meetings. I think it's important to as an OT to embed yourselves in in every part of the school culture that you can.    Jayson Davies     Yeah, absolutely. So going in, and we'll wrap this up with a little conversation about how OTs can take the knowledge from what we talked about today and move forward with it. And we've already done that a little bit, but I like to break up the process of occupational therapy within education into three kind of main categories. I know there's larger there's more to it, but pre evaluation, which can kind of be like systems levels, RTI type of stuff, the evaluation process, and then even interventions itself, you know, after the evaluation, working with students directly. And so if we look at those three areas, let's start with that pre evaluation, the systems level, what would you like to see a takeaway for occupational therapists? What can they do to embed this the knowledge that they have now about curriculum and handwriting? What can they do at a systems level?    Debra Collette     One know what the curriculum is to have conversation at grade level meetings of what is the curriculum that you're supporting. What is it that the children are struggling with within that curriculum? Get some support from administration to be able to do some sort of response to intervention where you're working with either a grade level or classrooms. So again, as you had said, working with all children, we benefit every child, and then identifying those kids who need a little bit more help from there. So that's what I would say from the system. Would say, from the systems.    Jayson Davies     That's great. And before we move on, I don't know how familiar, familiar you are with Every Student Succeeds Act. I know it just came out in 2015 right around the time you're putting all this together. And we talked about the rollout of of Common Core, maybe not being the best. And now we're seeing that again, I think, with ESSA. And you know, within ESSA, we are identified as specialized individual support personnel, SASP, but that's supposed to support all educators, or all of education, not just special education, which is kind of where our role has been for the past 3040, years. But again, we're just seeing that that poor rolled out from administration and how we can support all students. And I think that that RTI, that MTSS roll out, is something that we need to be a part of. So thank you absolutely. And now, so that was the the pre evaluation. Let's talk about evaluation, and maybe even the IEP, you know, goals, services, putting services together. What do you think we should take away from this article that can help us with both the evaluation process and maybe the the IEP, the planning of services process?    Debra Collette     As far as evaluation, I think that evaluations can take a really long time if we allow them to. I think that we need to streamline, you know, those, those key assessments that we know are going to identify what we believe the problem is, become proficient at those so that we're rolling them out very quickly and writing them up effectively, really looking at what are the strengths, what are the weaknesses, or the challenges of the child, and then how would you, as the OT support them, and be very clear and concise in how we put that On paper, but also to follow through with that, with our services that, I think that takes us into the intervention piece too, sorry, of really being direct with the number of not the number of children, the types of of issues children are are showing, you know, obviously you've mentioned sensory we've mentioned handwriting. You know, what are the types of things that we can work on. How can we support from a systems perspective, if there are several kids, maybe in a classroom or grade level, how do you get the most bang for your buck? OT, and then advocate from, you know, a perspective of, how do we support the children who have those major the bulks of the problem?    Jayson Davies     Yeah, but I can ask you a question about Sorry, sorry, save that last part again?     Debra Collette     Just streamlining evaluation, getting really good at it.    Jayson Davies     And I know you're not currently practicing, but you were a school based ot for a long time. Can I ask you maybe what some of your common go to assessments were, whether related to handwriting or otherwise?    Debra Collette     sure I appreciated the evaluation tool of children's handwriting, handwriting, oh my goodness, the ths test and handwriting skills. The Minnesota is a very quick one. I think for me, it depended on how much time I had in the grade level of the child as to which I was going to choose. I think I tended to use the ths more, the Tesla handwriting skills more with kindergarteners, and then the etch Valuation Tool children's handwriting with first and second graders. Typically, I appreciated the Peabody developmental motor skills for a younger population. But because quickly the bot, I'm not going to pronounce that on here I.    Jayson Davies     Neither do I.    Debra Collette     Printing still Swarovski test of motor, so that would be the, the one that I would use for motor skills higher than that sensory profile, sensory processing measure. You know, I think that there is major evaluations are out there. I'm probably missing some, and sorry for those authors who I, who I am missing that I used, but I think to pick a few that you're strong at and that you feel good about representing where a child's strengths and challenges are within if you don't understand the language behind an assessment, it's not worth giving, you know, so to get really good at, what does that mean for the child, and how does that relate to their function in a classroom? You know? You can, I can say that their fine motor skills are not great, but how does that impact them in a third grade classroom, when they can't pick up tools, they can't use them, they can't write proficiently. So I think those are important things to be able to support from that school based perspective.    Jayson Davies     Absolutely. Now I come from the California side of things, I would love to hear just from like New York. Did you guys have kind of a recommended time that it should take for evaluations when you're in the school? Or was, I mean, you because you talked a little bit about time, and you're right. We need to stream like this. We need to, we need to have a system in place so that we know what we're doing. We don't lose track. We stay on target. And we get we get it done. I I'll, I'll start, and I will say, I typically say an average evaluation, the moment you get the referral to the point that you're done with that, that write up for me, especially, you know, before I got really, really good at it, it could take about eight hours, I think whether, I mean, obviously not all in one day, not one work day, but over the time. I think it would could, could honestly take about eight hours. Do you mind sharing what it would look like, potentially for you or someone within your setting?    Debra Collette     Yeah, if you look from the referral process to the write up, I would say eight hours is, you know, certainly is real. I think because of the processes that I put in place over the number of years that I was in practice, and I still do assistive tech evaluations. So I still am a little bit into iterations go, I would say between, if it's a more straightforward evaluation, two and a half hours to maybe four hours. I think I could get it down into that time frame. And as OTs, with full case loads. You know, we're busy people. We have to really figure out, how do we streamline those time frames to sit down and write up the evaluation to before that score the evaluation. So I think getting good at streamlining using templates, you know, the Find and Replace names and ages and that stuff. So, yeah, I would say between two and a half hours and four hours once I was really proficient.     Jayson Davies     Gotcha Great. Thanks for sharing that. All right, we did the evaluation. We took our forward eight hours, whatever it might be, and now we are planning for that IEP and I really want to focus in on goals here, because we're talking about common core. We're talking about handwriting. Handwriting, we know, is probably one of the most common goals that an OT is a part of on an IEP. How can we use common core to mix with our handwriting goals, to create good goals? Should we be incorporating Common Core?    Debra Collette     I believe yes, we should, because we are in educational systems to support children in their education. So I think it's it's 100% okay to use a common core goal to support whatever that piece is that we're working on. So since we're on handwriting, and I'm going to use the handwriting perspective, so I have pulled up in front of me the fact the child, and this is a pre kindergarten goal, needs to use a combination of drawing, dictation, oral expression or emergent writing to state an opinion about a familiar topic in a child centered, authentic, play based learning. So I would pull a piece of that out. So if I knew a child didn't have letters yet, I may say a child will use drawing abilities, such as the lines, circles, squares, triangles, to support a kindergarten based assignment, or pre kindergarten assignment. So I would use something that we work on, that a component of handwriting within that common core goal, to show that I'm working on what all other people in the school are working on for that particular child, but with my little spin on it.    Jayson Davies     Yeah, definitely. I think that's great. Here in California, it's kind of caught on, but not quite completely. Is that they really want teachers to actually tag all of their goals with the Common Core State Standard that it ties to. And I don't think that that necessarily has to be limited to teachers. I think that as OTs, we should also begin because, again, we're in the educational field tying it back to a standard. I know that there are some instances where that may not be the right thing to do. There aren't a lot of standards that tie back to some of the functional skills that we might work on, but when possible, especially if we're doing something related to handwriting. So. Something that is that is related to the core curriculum. We should be tying it back to that, to that core curricular, core curricular standard I have bookmarked on my Chrome. Google Chrome, a website. I don't know if it's California specific, but it has all the state standards. And so it tells me, You know, I can click on kindergarten, I can click on ELA, or language, language arts. And I can look at this, the different standards, and I can say, You know what, I can support this one, this kids in kindergarten. I can support this kindergarten state standards. So I think, yeah, also collaborating with teachers to create goals. I think that's another way to really ensure that you're supporting education is, you know, meeting with a teacher two weeks before the IEP and saying, Hey, what are you working on? Right? I'm sure you kind of are, are an advocate for this. Do you have thoughts?    Debra Collette     I think constant collaboration with teachers is important. We need to know where the children are in the classroom. We need to know what they are and are not doing. We need to be able to support our goals with functional information and data from the classrooms as to, you know, how are they doing on these things and how often, and then move them forward. Know where the baseline is and be able to move them forward. So I do think that it's important for all OTs to know the curriculum. You know, same thing as if you were an acute care hospital, you'd want to know all the diagnostic criteria and all the rules of the hospital, the billing practices, we have to know all of those same things in a different manner in an educational institution.     Jayson Davies     Absolutely, great. I love it. Well. Deborah, thank you so much for joining us today. I think we got through everything that we wanted to talk to and maybe even a little bit more. But do you have any last words for occupational therapy practitioners that are listening that you know they're starting off the school year here? Maybe, I don't know. By time this comes out, it might be like October, but a month in or so, any words of wisdom?    Debra Collette     Be an advocate for ot be an advocate for the child. You know, send, send wonderful things home. Talk to families as much as you can. We don't have tons of time for that, but I think all of those components of being able to support our profession, to advocate for ourselves in all areas of education is really important. I'm always happy to chat about ot advocacy as well.    Jayson Davies     I love it. And one last question before I let you go, Deborah, Is there anywhere where people can Is there a place where they can find more about you or follow you, or even just find where all your different research articles are?    Debra Collette     Sure, my email is C, O, L, L, E, D@sage.edu , that's probably the easiest way to get in touch with me. I am on LinkedIn, and unfortunately, I'm not a social media follower. Otherwise the LinkedIn would would be the extent of it for the moment. But I have an article on a OT, this particular article, and I have another one on ot Jr, on a study that I did on Provo protocol and children with autism. Yeah. So anyone's welcome to contact me if they have questions are.    Jayson Davies     Alright, I'll be the first one. I'm gonna, I'm gonna send you another calendar link for scheduling up to talk about Proloquo to go. That is a topic we haven't Yeah, because you said you're doing at technology or AT evaluation. Still, I know a lot of people need help with that. So maybe one day that's, that'll be our next topic. All right, Deborah, well, thank you so much for coming on. I really appreciate having you, and I'm sure everyone out there listening is really appreciative of everything that you shared today. So thank you one last time, and I look forward to to keeping in touch.     Debra Collette     All right. Thanks you too.     Jayson Davies     All right. Thank you so much, Deborah, for coming on the OT school house podcast and sharing so much of that wonderful information. Some of that information, you know, comes directly from the survey and the research that you did, and some of that is just the experience that you have learning as a school based occupational therapy provider. So thank you so much for that. Some of the things that just stood out to me was that you know, 40 minutes of handwriting is not enough. And even worse than that, 43% of teachers are not even using any sort of curriculum, whether or not it's a you know formal program or even just a you know curriculum that maybe they developed, it's something that we as school based OTs can help teachers with so that they can support all of their handwriters, which is everyone, not just the students that quote, unquote, need ot so again. Thank you so much to Deborah for coming on the OT school house podcast. Thank you to you for listening to the OT school house podcast. And don't forget to check out all the show notes. We have several links to some of the common handwriting assessments over at ot  schoolhouse.com/episode 110 I'll see you over there, and I'll see you in the next podcast episode. 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 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! 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 111 of the OT Schoolhouse Podcast. As OTPs, we were taught that our profession was founded on providing a safe space for those with mental illnesses, and we were there to help them engage in meaningful occupations, yet we tend to forget the importance of this. Today, we speak with Moni Keen to address her capstone research on being an interprofessional team member and mental health in school-aged children. OTPs are often not seen as mental health providers, but we must advocate and change that narrative. Tune in to learn how we can advocate for mental health and how we can address mental health individually with our students and on a systems level. Tune in to learn the following objectives: Learners will identify reasons why mental health is not being addressed in schools Learners will identify why OTPs are not labeled as mental health providers Learners will identify mental health diagnoses of school-aged children and youth Learners will identify and reflect on the causes of mental health issues among our students Learners will identify how to advocate for mental health in OT Learners will identify how to advocate for students on a systems level Guest Bio Monica Keen, OTD, OTR/L Dr. Monica Keen is currently an Associate Professor at Presbyterian College. She is the Doctoral Capstone Coordinator and comes to Presbyterian College with 33 years of clinical experience. Dr. Keen retired in May of this year after 27 years of school-based practice. She is an adjunct instructor at Baylor University and she is a contributing faculty member at the University of St. Augustine. She was an adjunct instructor for 7 years with the Medical University of South Carolina. Her 33 years of clinical practice included working in mental health at the Institute of Psychiatry at the Medical University of South Carolina, acute care, and nursing home settings. She owned a private pediatric practice for 12 years and closed the doors of Developing Abilities when she took on full-time academia. She has authored two separate chapters for colleagues’ books: one on school-based and infant mental health and the other on handwriting. Dr. Keen has done two webinars for OccupationalTherapy.com where she presented her Capstone work on OT being a part of an interprofessional team member for mental health in school-aged children. Her second webinar was on how COVID-19 impacted the behavior of school-aged children. In September of 2022, Dr. Keen was a guest on Jayson Davies’ OT Schoolhouse podcast where the topic of discussion was occupational therapy and school-based mental health. Currently, she is the co-chair for Mental Health for her state’s professional organization, the South Carolina Occupational Therapy Association. Dr. Keen graduated with her bachelor’s degree in Occupational Therapy from the Medical University of South Carolina, and in 2008 she earned her master’s degree from Boston University. In 2019 she graduated with high honors with her clinical doctorate degree from the University of St. Augustine. She is passionate about Occupational Therapy and has a distinct interest in mental health, trauma-informed care, and pediatrics, particularly autism. Mental health is a passion for Dr. Keen. Her capstone was on serving as a member of an interprofessional school team to address mental health issues in school-based practice. Her research findings were sobering and have ignited a desire to discover ways to re-establish OT as a recognized mental health provider. Monica resides in Greenville, SC, and is a proud mom to two amazing adult daughters. She has two adorable Boston Terriers (Bubbles and Boomer), she loves college football, enjoys running and hiking, and being in the sun by the pool or beach is a favorite pastime. Quotes “We have got a significant amount of work that we have to do to regain the momentum of getting back into being recognized as a qualified mental health provider” - Monica Keen OTD, OTR/L “It is paramount that whenever we document on a therapy session, that we do include something about the mental health aspect of that 30 minutes” - Monica Keen, OTD, OTR/L “We know mental health is important, but we don't constantly look at it unless we put it at the forefront of our brain” - Jayson Davies, M.A., OTR/L “Sometimes that IEP objective has to take the backseat for a session because that's not what the child needs at that point in time. Sometimes we’ve just got to meet them where they're at, and get them through that moment and then pick up the ball the next week” - Monica Keen, OTD, OTR/L “It is being their voice for those who cannot advocate for themselves. We are their voice and we need to take that seriously” - Monica Keen, OTD, OTR/L Resources: Powerfully You- Self Regulation Education How Does Your Engine Run?® The Out-of-Sync Child - Carol Stock Kranowitz Beyond Behaviors - Dr. Mona Delahooke Monica Keen - Linkedin keene@presby.edu -Email Mollisoo@aol.com -Email Intentional Relationship Model Occupational Therapy Mental Health Parity Act Kawa Model School-Based Occupational Therapy and Student Mental Health Course Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies, class is officially in session.    Jayson Davies     What is happening school based occupational therapy practitioner, I hope you're having a wonderful day. I'm having a great start today. And yeah, I hope you are as well. I'm excited for you to be here for this very episode today. We are talking about mental health in school based OT and to do that, we are bringing on Dr Monica keen. Before I introduce her really quickly, I just want to share why I am so excited for you to be here today. As many of you know, occupational therapy was founded in the mental health realm way back in the teens and the 20s of the I guess that was the 20th century, right? The 19th, 1900s or whatever was in the 20th century occupational therapy, we started in mental health, and over the last 100 years, we've wavered within mental health. We've gone up, we've gone down. And right now, some people would argue that we are kind of in the lowest of the lows when it comes to occupational therapy and mental health, and I think that is also true when it comes to school based occupational therapy. As ot practitioners, we understand and we also value the importance of mental health, but I don't think we often bring it to the forefront of our brain. We don't maybe write a goal for it. We don't actively work on mental health during our sessions, and maybe that leads to not documenting about mental health when it comes to writing our daily notes or our three month progress reports. But that may not be the best route to go, and maybe we need to reconsider that. So that's why I'm excited to bring on Dr Monica keen today. She goes by Moni, and she is just an amazing person, her attitude, her personality, is just so bubbly. I'm excited for you to hear from her. And yeah, it's going to be exciting. We're going to be talking about different mental health disorders that you might come across in school based OT. We're going to talk about why mental health and OT just aren't jiving right now. And then we're going to also talk about what we can do to help OT and mental health Jive a little bit more. We're also going to dive into a little bit about advocacy. So this is going to be a very fun filled podcast, a very knowledgeable podcast. I hope you will stick around for us, or with us. I guess I should say for this entire one. Monica is amazing. And yeah, before we dive into it, though, Dr keen is currently an associate professor at Presbyterian College. Before that, though, she was a school based occupational therapy provider for over 26 years, she has a lot of experience in school based OT and she's going to tell you all about it. So without any further ado, let us jump into this podcast with Dr Monica keen. Hello, Dr keen, welcome to the OT school house podcast. How are you doing today?    Monica Keen     I am doing wonderful. How are you doing today Jayson?    Jayson Davies     Fantastic. Even better. Now that I've got you here, you are just a bubbly person. I love having you, even in the short communications that we've had together, it's been a pleasure.    Monica Keen     Well, back at you. I'm honored.    Jayson Davies     Yes. So thank you for being here. We are talking about mental health, especially mental health and school based occupational therapy today. But before we dive into that, I would love for you to share a little bit about your current role in occupational therapy.    Monica Keen     Sure. Well, I just recently retired in May of this year from let's see about 26 years as a school based practitioner, and I have traded that in for full time academia. And I am an associate professor at Presbyterian College, which is located in Clinton, South Carolina. We're a brand new program, and we are currently going undergoing accreditation, and I am the Capstone coordinator there, and I also teach the mental health classes to the OTP students there, and it's been a wonderful transition, and I'm learning so much    Jayson Davies     that's awesome. And so if I can just follow that up as the doctoral Capstone, we have some students that listen to this podcast. What is it that the students have to do for their doctoral Capstone?    Monica Keen     Well, the biggest thing that I like to promote is that it has to be your passion. Whatever topic that you are choosing, it's got to be a passion of yours, because by the time everything is said and done, once you start the Capstone process, you are going to be involved in that for good, gracious, two full, three full semesters with field work in between, and so you are going to be an expert in that field by the time it's said and done. And as I tell all of my students, my goal for them is that their capstone will be such a dynamic project that wherever they implement their project, they will get off. A job to come on board, because there's just so many ways Jayson that occupational therapy can be used, can change the world, can make a difference. And so it's really a very exciting process.    Jayson Davies     Absolutely, absolutely. Thanks for sharing that. As you mentioned, you have retired, quote, unquote, at least from the school based world. But I'd love for you to share a little bit about your experience in the school based world. I think you were working for someone, but you also owned your own private practice, correct?    Monica Keen     I did. I juggled many, many balls prior to coming into full time academia. As far as school based is concerned, I was actually introduced a school based practice through a contract when I was working with a private company that was based out of Easley, South Carolina. And at that time, many, many years ago, I feel that school based practice, even though it was already in place, was just starting to catch hold in the state of South Carolina. And so, for example, when they hired me through the contract, I was only allowed to be in the in the county, in the school district, 22 hours a week, just 22 hours a week. And they had, I believe, four CODAs that carried out the therapy sessions. You know, I would go and do the evaluations. I would set up the treatment plans and they would carry that out. I would attend IEP meetings and write the IEPs as well. Well, jump ahead about a year and a half later, I was then an acute care team leader at the Medical University of South Carolina, and I ran into my old supervisor from the school district, and she was like, Monty, please come back. We would love to hire you full time. The state has a lot of us funds to hire our own OT and my life was never the same. I never looked back. It has been such a privilege to be able to watch how public education has changed over the years, some for the good, and some, not so much for the good. And it's really given me an opportunity to look through different lenses and to just see how occupational therapy has just absolutely grown and flourished in school based practice. And you know, as I sit back and reflect on those years, I wouldn't have wanted to do anything else. It was a very, very cool job, and I'm very grateful for having had all of those years to be able to do it.    Jayson Davies     That's quite an amazing story. I love speaking to occupational therapists who have some years behind them, because you hear about some of those. Does that change that has occurred over the last 2030, sometimes I talk to people and they've been around for 40 years in the OT world, and to see those changes from idea just coming into existence, and then the No Child Left Behind in in 2002 four, whenever that was that that made a big difference as well. So thank you for sharing a little bit about that. Sure. So then, when did mental health come into your world as a school based OT, you know, we know about mental health. I think a lot of us do, but our goals typically don't revolve around mental health. So what drew you into the mental health aspect of occupational therapy?    Monica Keen     Well, I think I need to go back just a little bit to kind of give you some perspective on where I came from. So when I was in school, back in 1983 and going through classes and we covered the mental health, you know, things, I was like, I will never work a day. And mental health, I you know depression, that's just, you pick yourself up by the bootstraps and you move forward. Well, you know what? The Lord had different plans for me, because when I graduated, the only job that was left in Charleston was at the Institute of Psychiatry, and so that was my very first job out of school, and did I learn so much? I left that job with a brand new appreciation for what mental health is and how it impacts life and occupation. So I worked there for about two and a half years or so, and it wasn't until I went back and got my doctorate degree, which I started in 2017 I knew mental health was important, and I was practicing, you know, of course, with any client that I was working with. But when I did my capstone, it revolved around, is occupational therapy, a school based occupational therapist part of the interprofessional team that addresses mental health concerns in our school age children, and the way my needs assessment was completed through a survey that I did through currently, actively practicing ot ours and actively practicing CODAs in the state of South. Carolina in the school district, so I weeded out a bunch of the fluff and just made it for school based practitioners. And I am one of those examples of I did not receive the feedback from my survey that I thought I was going to get, and the the Yeah, the questions that I asked were, let's see, we started off with some demographics, like, how long have you been an OT How long have you been doing school based practice, so on and so forth. Then I would ask some like heart scale questions, like, are you addressing mental health? And if so, what, what interventions are you using? And then I ended it up with open ended questions where I was looking for themes, you know, with the responses that I got, and overwhelmingly Jayson, I got feedback that was stating, I don't address mental health. No, we're not part of a team. I was just, you know, for those that said, Yeah, I do kind of sorta, and they would throw out a couple things that they were doing, and it just made my heart so sad, because that is where our roots are from. We are grounded in mental health, and I'm thinking that because we were not putting a standardized assessment in front of a kid and literally assessing for hard data, you know, they didn't think that they were addressing it. And I was like, No. Every time we are with a client, regardless of the age, we are always assessing their mental wellness and how they're doing, and through our therapeutic use of self and the intentional relationship model, we address those needs right there on the spot. And if we feel that further assessment needs to happen, we'll break out those standardized, you know, assessments. So it was at that point that I decided I've got to do something. I want to address this. But then, of course, those little, you know, words of discouragement come up, and I think, How can I do anything about myself? You know, I cannot make a difference, but things have changed along the way that has given me opportunity, and we'll talk about that later, to be able to have platforms to address it. So that's how my interest was totally reignited about OTs, we've got to stop graduating generations of therapists practitioners who do not believe that they are addressing mental health with their clients. We've got to get back to our roots.      Yeah, definitely, you know, and I just took some notes from what you were saying. I want to come back to it, but the intentional relationship model, let's come back to that later. But from what I understand, you had a mental health related job right when you got out of college, and then you jumped into school based ot for 2628 whatever, many years, and then you dove back into mental health now, during those years that you were in school based OT, how would you have responded If someone asked you, maybe in year 15, do you address Mental health concerns for our students?    Monica Keen     I would have said, absolutely I do. And I would give examples such as, you know, again, going back to the comment that I said, I've been able to watch how occupational therapy has grown through my 26 years of practicing in school based practice, I've also noticed that the responsibilities of our children that are put on their backs from the home setting gets greater and greater and greater every year. And so as I teach my classes about school based practice, I'm like, You guys have to understand that in a school that might be the only place these children get a warm meal. These might be the only place where they are told they have a purpose. This may be the only place where they have indoor plumbing. This may be the only you know, it just goes on and on and on, because I have witnessed time and time again kindergartners coming into school looking so weary because they had to get themselves up to come to school, to, you know, to get on the bus to come to school. Or the child who has autism, his day has absolutely been shaken because his routine in the morning was messed up because mom didn't have fruit loops instead of the Apple Jacks. You know, the kids who are experiencing, sadly witnessing domestic abuse, yeah, things of that nature. That is such a huge part of what we are addressing in school today. And so that is what I would be sharing with the people who ask me, Are you addressing mental health? We're also addressing behavior modification. You know, we're working very closely with the ABA therapist, and we're supporting each other in the behavioral techniques that we're implementing in the classroom and teaching the parents. We're supporting our teachers inside and outside of the classroom. I mean, I really feel that once you start. Up into the halls of that school. You're already on the mental health train, whether you're working with the kids, oh yeah, the teachers, the administration. It's just an all encompassing, you know, topic.      100% you know and that leads to a discussion, because my wife, she's an assistant principal at a school, and so we've had conversations about that, you know. I mean, she had to interview a custodian not too long ago, and she's got in the back of her mind, you know, he's not just a custodian, or she's not just a custodian. She is a member of that campus, and her or his interactions with the students is just as important as the teachers, the OTs, the principals, anyone else on campus.    Monica Keen     Without a doubt. I mean, you know, I think back to my high school days, when I'd been going through the lunch line, and there was one particular lunch lady who reminded me of Granny, and she would so lovingly look at me every day and say, Sweetheart, can I give you some more French fries? And she will never know the impact that she had a brightening my day. It could have been a rough, you know, start to the day I failed to test or whatever. But when I saw that lady who represented a grandma to me, and she was kind and considerate and intentional, yeah, it made all the difference, you know, in that moment.    Jayson Davies     Yeah, 100% so now this is kind of where that discussion that discussion that I was talking about leads to. Because, despite what I would call, you know, all OTs, we are mental health providers, we are often not deemed mental health providers. So what stands us apart from a the quote, unquote mental health providers that are often counselors, psychologists, so forth, and then we have OTs, and then we have teachers, administrators who fall into that realm that we're just talking about. They're not mental health providers, but like your granny and the lunch line was definitely a mental health support person for you. So that discussion, I guess, is, you know, why aren't we mental health providers, in your opinion, why aren't we labeled as mental health providers in many places? Because we are. And what do you think? Or what can we do about that? I guess.    Monica Keen     Oh, that's a multi faceted well to begin with, did you know that in the United States, out of all of our states, only eight of those states recognize occupational therapy as qualified mental health providers. That, to me, is disturbing, yeah. Why do I think that we are not recognized? There are many, many reasons. Number one, insurance companies feel that there are other disciplines that can do the same thing that we do however they are not trained to approach it. From the psychological aspect that we are implementing that activity, I feel that another part is that we as practitioners, even though we may be implementing a certain technique, we cannot bill for that particular technique under a mental health category. Does that make sense?      Yeah, you know. And that's hard in school based OT, because in school based OT, the billing is different from everywhere else. But anyway, sorry, continue on.    Monica Keen     Another reason is I feel also for occupational therapy, we have not been advocating for ourselves. It's kind of like, you know, we have to take responsibility and accountability for not promoting ourselves in that area of practice as well, and so we've got a significant amount of work that we have to do to regain the momentum of getting back into being recognized as a qualified mental health provider. Now, to let you know, I am the co chair for our state's professional organization South Carolina Occupational Therapy Association, and one of my mottos is that I want to use that platform to get the state of South Carolina's occupational therapist recognized as qualified mental health providers. And one of my capstone students is actually working to write that legislation to help promote that. But our state senator, Senator Tim Scott, is supporting the Mental Health Parity Act. Have you heard of that?     Jayson Davies     Yeah, actually.    Monica Keen     Yeah, it's it started, I believe in Delaware, and he supported the senator who actually wrote that bill, and my class, I had my class write letters to the senator thanking him for supporting this bill and then actually taking it a step further and explaining why we as occupational therapists should be recognized as qualified mental health providers in. Beautiful thing about that piece of legislation is that it specifically calls out occupational therapists as individuals who are poised and ready to be a part of the mental health team to address mental health issues. So I feel that this could not have come at a better time, and I do think that COVID 19 also was a blessing in that it has unfortunately brought on more mental health people who are struggling with mental health, but at the same time, our government is pouring more federal monies into the pot that helps to address those needs, but the people who can do it, the disciplines that can address it, are very short, very short staffed, and so hopefully we will be jumping on that train to assist them. Yeah, and you know what you mentioned, the the Mental Health Parity Act. I have to give a shout out to a OTA last week. I think it was just last week I was on the OT, a virtual Hill day, and we were speaking to senators and Congress people in California about advocating for Senate Bill 4712 is what it is that is the OT Mental Health Parity Act. So everyone out there, if you're hearing this, look up Senate Bill 4712 the mental health OT, mental health parity legislation bill, and, yeah, write in a letter, you know, take a take a page from Dr King students what they've been doing, and send in a letter. Send in a call, ask for that support, because it is a national bill, but it will basically impact all 50 states. It requires, I think it's the Secretary of Health to kind of put out information related to OTs as a mental health provider. So definitely.  Absolutely. And today, I was attending the A OTA Leaders Conference, and one of the sections that we talked about was advocacy, and it really matters what you do to advocate, not only for occupational therapy and all the different areas that you can but just simply calling your Senator, writing your senator and saying, Can I make an appointment to talk with you about this? Can I you know, as you were saying about your writing, you're writing the white letter for something in your state. That's exactly what we need to do.      Yep, absolutely, yeah. All right. Well, you know what? We got sidetracked in a good way, and so I'm happy we had that conversation. I love it. But let's, let's dive back into specifically what you did in relationship to some of your research, and so you talked about earlier how things kind of didn't quite go as what you expected. So let's start with that very first part, because research, we have to come up with a an idea of what we expect, right? What were you expecting to get back from your survey?    Monica Keen     I was expecting for, you know, close to 100% of the people that I surveyed to say, of course, I'm addressing mental health, and these are the things that I'm doing. Some of the practitioners would identify things like the zones of regulation that they implement that have you heard of that social emotional learning curriculum. They talked about doing that, or they would say, Well, yes, I use sensory integration to help a child who is in emotional distress. And I'd be like, Okay, that's that's another avenue that you can do. But the mere fact that they were not identifying the strategies and interventions that they were doing as directed towards mental health emotional regulation, just was discouraging to me, just very you know, it did not sit well with me, and so it drove me to Be more cognizant in my day to day activities, and even in my interactions with anybody within the school setting, from administration down to the resource officer, the school resource officer about you know, be intentional about what you're doing with that child. Let's talk about this behavior, and let's figure out what triggered it, what is causing this to happen, and then when we could figure it out, then coming up with a strategy to be able to address it, if it should show itself again. And the success stories across the board, you know, for the years thereafter, you know, my my research came out, I found it to be very positive, very positive.      Awesome. So, yeah, all right. And so now, when you were at a school based in a school based position, were you actually writing specific goals related to mental health, or would you say it was. More of a behind the scenes. Maybe you didn't have a specific goal on the IEP, but you were still doing it.    Monica Keen     That was it exactly. It was something that we did behind the scenes, because, you know, our teachers are held to such incredibly tall standards that they are not going to specifically put down behavioral goals in in most cases. Now, we did implement some accommodations where we would have, like a check in, check out, for the child to come in. How is your day starting? How did your day end? That might be a specific mental health type of goal, but typically it was done behind the scenes. And again, I feel that if we have a child that's coming into a therapy session who was not emotionally regulated, how are we going to effectively address the IEP goal until we have assisted them in regulating themselves emotionally. Yeah? So it really is a catch 22 that you're going to do anyway. I just don't think a lot of practitioners recognize that's exactly what they're doing.      Yeah, yeah. I also think that some practitioners do realize that they are doing mental health, but on the flip side, are they doing mental health, kind of, again, kind of on the back end, on the on the down low, and would they consider that being a mental health service, or are they just saying, Yeah, of course, I do mental health, right? I always check in on the student, but I wouldn't necessarily call it a mental health service, because I'm not documenting it. I'm not writing it down that I did this, of course, I worked on the handwriting goal. I didn't work on mental health today. Now, I did some of those other things, but maybe they're just not documenting it, and therefore I'm not, quote, unquote, I'm not doing mental health. I'm working on handwriting.    Monica Keen     I see, I see what you're asking. I see what you're stating, and you know what, when I would do my documentation, I did include the mood, the behavior of the activity, especially, or the session, excuse me, the therapy session, especially if it was really good, as opposed to, you know, having a difficult time the week before, or if there was something, some type of behavior that was just out of out of sorts for for that child, if that makes any sense, yeah. So, I mean, think about it, attention to task, executive functioning, those, those types of components, they are impacted directly by how a child is feeling. If, you know, if they're in the red zone and they're out of control, no, they're not going to be able to attend to a task and complete it. If they're not feeling well, if they're if they're getting sick, they're not going to be ready to learn, to be in that zone where they are ready to learn. But I think it's also our due diligence. When we have the child that comes in who is modulated and emotionally regulated, what do we need to do to maintain that, to sustain that, to have a successful session from start to finish. Does that make sense?      Yeah, yeah. I agree. And I think that takes learning, and I think that takes maybe some professional development to really understand what you can really pull out of a session. And you're not just pulling out the handwriting legibility. You're not just pulling out the ability to cut on the line, but also pull out the mental health side of things. And, you know, it's, it's a lot, you know, we have 30 minutes or so to work with this student and to pull out all of that, it really takes a keen eye. And that comes back to the whole we're OTs, and we have that activity analysis view. You talked a little bit about the Kawa model and the intentional relationship model, and so those are all things that if we don't stay on top of it, if we don't think about on a regular basis, we kind of lose we don't lose sight of it. We know mental health is important, but we don't constantly look at it unless we put it at the forefront of our brain.    Monica Keen     Correct. And I think you also said something that was very poignant. Jayson, when you when you talk about documentation, I think it is paramount that whenever we document on a therapy session that we do include something about the mental health aspect of that 30 minutes, whether, if it's just a brief statement, affect was full range. Student was interested in all aspects of the activity. Student looking sad today, you know, inquired talk to student about how he was feeling. Student was able to identify, you know, at. X, Y and Z, because sometimes, and I know you appreciate this as a school based practitioner, sometimes that IEP objective has to take the back seat for a session, because that's not what the child needs at that point in time. And sometimes we've just got to meet them with where they're at and get them through that moment, and then pick up the ball the next week, when we when we go into into therapy, just taking the time, here's that word again, to be intentional and to address those types of needs with our children. Builds incredible relationships with our children who are on the spectrum. It builds trust. And I feel that the that our kids that have autism, when, when we have earned their trust, that's a bond that can never be broken, and that takes time and intentionality.      Yeah, absolutely, absolutely, I 100% agree. You know that bond that you build with your students is so important, and I will, in fact, I say it in my course. You know the first, the first few things that you have to do before you try to dive into the physical interventions is to build that relationship, whether this, whether it's an autistic child, a student with autism, or a student with ADHD, or a anyone else, right? Anyone, even a teacher, you have to build that bond before we can expect to get the support both ways from them and for them. Definitely.    Monica Keen     Exactly. Can I piggyback a little bit on the ADHD, yep. So when we talk about children who have that diagnosis, what are those children typically referred to as, the kid, the child, is being bad, high energy, bad. And we as practitioners, because we know about ADHD, that child is not bad because he doesn't have control over what he's doing. But if that is what that child hears day in and day out, in the classroom, at home, in the principal's office, or whatever, that is going to be a concept that he is going to embrace and believe in himself. And so there is a perfect example of educating teachers and administration, as well as the little one about behavior, about self control, about emotional regulation, and using that opportunity for ot to just really shine in the many areas where we can address that particular need. Yeah, so that, I think that's a that's an excellent specific example of how we address mental health in particular diagnoses.      Yeah, and you know, I'm familiar with the Kawa model. I think some people that listen are as well. I hope to have, I think it's Dr awama on to sometime talk about the Kawa model in school based OT, you mentioned the therapeutic use of self, and then you also mentioned intentional relationship model. And I'm not familiar with that one, so I'd love to invite you to just share just a synopsis about it, because I'm imagining that it kind of plays hand in hand with what you were just talking about when it comes to, you know, that student with ADHD and making sure that you're using intentional positive language and whatnot. So can you just briefly share the intentional relationship model?    Monica Keen     Absolutely. I mean, it's, it's really being cognizant of and being aware of how you are interacting with any individual, but particularly let, let's break it down to our kids with with with disabilities. It is taking the time to understand and appreciate where they are at. It is taking the time to step in their shoes, if we can, to try and truly get a glimpse and a feel for what they are internally, feeling what they're dealing with externally. It's being their advocate, with their teachers with their peers. It's being their buddy. It's taken the time to just intentionally get to know them, intentionally understanding how they tick and intentionally being that person that they can count on consistently in the school house. Again, it's like, aren't you intentional with the relationships that you build with the people you love, with your wife and with your children and with your mother and your you know your father? It's the same concept with the children that we work with. It's just really being present for them all the time.      Yeah, yeah, absolutely. And you know, I know there's some occupational therapists. Sorry, this just came to my mind as you were talking. I know there's some occupational therapists that their schedule is so tight and they're trying to figure out, how do I make use of that three or five minute walk from one part of the campus, from the kids classroom back to the OT room. And this is. Exactly what you could be doing during that that five minute right during that walk that is part of your treatment. It is not just a right. It's not just a transition time. I mean, it's more it's a transition time, plus it's a time to connect.    Monica Keen     And you know what? And I know you've experienced this Jayson, but I think of one of the kids that I worked with for like, four years, when I would come to the door to to get him for therapy. He would light up like a Christmas tree and get up and run to the door. And when he was he started off as non verbal, and we know music can help bring out bring out words. And so I started to sing, how is Thomas? How is Thomas? And I want you to know, by the end of the school year, he was able to sing, I am good, I am good. And we would sing the entire song from the time I picked him up until we got to the therapy room, and the last time I was able to work with him right before I retired, that would be our song that we did every single time I would pick him up. And, you know, the relationship that I was able to build with that child there, there's no money in the world that I would pay for that, you know, it's that kind of stuff that we, we were intentional in, in building that relationship, and it made a difference.      Yeah, absolutely alright. We've, talked a lot about, you know, I mean, we've talked a lot about a lot advocacy, we've talked about some models. And I will admit, I figured we'd spend the first 20 minutes really talking about your research, but we jumped right into a lot of strategies, a lot of things that are going on. And I love that you mentioned how you weren't expecting things to go the way that they did. And you mentioned they on the broader spectrum, you were surprised that OTs weren't working on mental health. Let's get more into kind of some of the specifics there. What were the really big findings that you found, maybe on a smaller level, not just that they weren't doing mental health, but what else did you find out from the research.    Monica Keen     I found out that they felt that they if they said no, that they weren't addressing it, they felt that they didn't have time, or, you know, their caseloads were too high, or they were too busy, you know, doing other things, or they felt that they were not educated, knowledgeable about how to implement mental health strategies within their therapy sessions, or they didn't feel confident. That was another big one. Their confidence level was very low when, you know, for a lot of them, when they said they did not feel that they were implementing mental health strategies. Another thing that I found was very interesting, and you might be able to compare this with your wife being an assistant principal. Many of them reported that it was administration who was taking care of the mental health aspects of things as they were, the ones that were, and I can attest to that in one school, Mr. Farmer's job was to do all of the write ups, all of the suspensions, all of the bus write ups, you know, all of that kind of stuff. Never did you find him stepping into a classroom to see how the teacher was doing with instruction because he was so busy, you know, doing all of the write ups. And so that was another response that I got from the survey was, we don't need to address it because our admin and our guidance counselors are doing that. There was just a plethora of different excuses, but those were many of the top, top ones that I recall.    Jayson Davies     Yeah, in the survey, I can kind of agree to that, because I know my wife has a kindergarten student who probably about one day a week, she ends up in the classroom for an hour or two, or sometimes even longer, to support that student in the classroom. And so yeah, you're absolutely right. That is not her job in particular. But of course, as an administrator, everything's your job. So yep, she ends up that person. You're right. Okay, so you also did some work. I mean, as COVID came around mental health, obviously you already referenced it, right? COVID brought around a lot of talk about mental health, and brought around money for mental health, but I believe you did some research in in and about this. So why don't you start us off with that area?    Monica Keen     Sure. So occupational therapy.com . Invited me to do a presentation, an additional presentation for them, about school based mental health. And when they asked me, What did I want the topic to be? I had noticed when we when when COVID hit, and especially when we came back to school, how there was a drastic change in our children's behavior. And I said I would really like to do a presentation on that how COVID has impacted school based behavior. And they were like, Great, let's do it. So as I was planning on how I was going to do my research, I decided to do it from a three tiered approach, starting with, how did COVID impact our teachers, then how did COVID impact our the parents of our students. And then how did COVID impact our students, knowing that the fallout from the top from our teachers was going to roll down to our parents, and then it was going to pick up the the difficulty that the parents was having, and then all of that Fallout was going to be falling on our children, who we know are not emotionally developmentally ready to handle the issues that were falling in their laps, much less handling their own dysregulation from which COVID had dumped on them in their little lives. So let's, let's look at that a little bit deeper. From a child's point of view, they are going from their occupation, their main occupation, which is to be a student, to get up and go to school every day and literally, literally overnight, was taken away from them, and not just for a week, no, for a whole school year and a half of another Yeah, and they are now learning from a computer, which they have to sit in front of. There, there's, oh, my goodness. It just, it's, it's huge, yeah, and we, you know, society was expecting when school got back in, okay, we're just going to pick up where we left off. No, my research showed that with our children, well across the board, teachers, parents and children, massive increases in anxiety and depression. Teachers again feeling like they were not doing a good enough job. What they went from teaching in a classroom to all of a sudden, we've got to do virtual teaching. And what they had to do, according to my research, takes a year and a half to master. To teach virtually takes a year and a half to master. And they weren't given the option. They were told, do this. Get out to your classrooms and do this. Okay, so that's the teacher's point of view. Now you've got the parents who have been told, alright, now you sit by your kids while you're trying to do your job from home and make sure that they're doing their schoolwork and they're understanding all the concepts again while you're doing your job. And then we've got the children who don't even have a concept of what's going on. They've all got to sit in front of this computer all day long. I want to go and play it just was a cacophony of a mess, a bunch of spaghetti noodles. Yeah, absolutely. And then, you know, we've noticed that there was an increase in video games. So there's an increase in isolation, yeah, they're not able to get out and be with their peers because we have to stay inside of the house. It was fascinating. All of the fun that, while very disturbing and very sad, it was fascinating. So again, that pull put even more fire on or more gas on my fire to get moving along in mental health and occupational therapy and using what I've learned in my practice day to day when I was in the schools. Gotcha, we could talk for hours about that.    Jayson Davies     Right, So, I mean, you obviously found that everyone affected. Everyone is what it really sounded like. And you know, kids went from using a computer to play a video game to using a computer all day long for for class. And I did not have a child at that time. Now I do. I can. It's hard for me to sit here and do my work while grandma's with him in the other room. And I mean, to have him right next to me would be even more difficult. So I know that was a struggle for the adults as well,     Monica Keen     Right. And so we're putting that demand on the parents, which is increasing their stress, increasing their anxiety, which is making them more short tempered with family members, including the children. I mean, it just and this was happening day in and day out again for an extended period of time. And so we are bringing back children into the school house that are still emotionally trying to figure out what they've been through for the past year. Year and a half. We are having children who academically were not ready to be advanced to the next grade because they weren't understanding the concepts that were taught to them, you know, while they were a virtual which, okay, let's, let's talk about that. That is going to make them feel like a failure because they're not understanding their concepts while they're plasma. States are moving ahead, and so what do they do? They shut down, and when they shut down, they're going to do one of two things. They're either going to isolate themselves and be very quiet, or they're going to increase their behaviors and act out. So again, I have seen regular ed students come back from the COVID pandemic, literally being assisted on either side of them screaming while they're going down the hall, because something just, it was like the what the straw that broke the camel's back, and they just ability to regulate their own emotions has been so intensely challenged. And if that's going on with our kids in regular ed, can we only appreciate how much more difficult it is for our children with special needs? so their lives have been rocked as well.    Jayson Davies     Yeah, and you know it's you did this research as a kind of hindsight looking back at COVID. And now I know that a lot of stuff going on with okay. Now what moving forward? Los Angeles Unified School District, they recently, I don't want to say that they were hit with it, but the Office of Special Education, oh gosh, OSEP, they came down on La and said, hey, you need to create a plan for all the stuff during COVID and provide services, because we know that ot services over the computer, while yes, you still provided them, they don't necessarily add up to what the student would have gotten. And speech therapy services, special education, Sai services. So what is part of the solution? I don't expect you to have the entire solution, but what is part of that solution? As school based OTs, you know, we've been back in the schools now. Some of us have been in there for nine months. Some of us have been back for a year. So what do you think we need to start doing if we're not already doing it?    Monica Keen     There's a couple of things. I think it would be phenomenal if every school, or at least every two schools, could have one ot of their own. That's a dream. That is a huge dream. Can you imagine the change that could be brought about Jayson, if that were the case, I feel that our schools need more funding for more occupational therapists, for an asunder of reasons. I also think that we need well, not only ot but I feel that our schools need to look at occupational therapies caseload as a workload and not a caseload. I think that it that whole point of view needs to truly be considered because, you know, people are in such a frame of mind that 30 minutes once a week is literally picking up a child, going into a room, turning on a timer for 30 minutes and walking. That's not what it is that is not what it is our workload is addressing students needs from the time we enter that school building until we go home at night. But as we are right now, I feel that we need to work in the the best way that we can with our teams, starting from the teacher down to the adult support. I feel that we all need to be unified as a team, truly working towards the best interest of the child. I feel that maybe we As occupational therapists need to maybe take a step back and look at our treatment sessions as a whole, and really reflect on, are we truly doing client centered therapy, even with the demand of following an IEP objective? And you're probably saying, What in the world do you mean by that? You can address IEP objectives in numerous ways. Just because, let's say we have a handwriting goal, does not mean that we have to sit down every single week with paper and pencil and write, write, write. We can do different activities to make the art of handwriting fun without picking up the pencil and paper. So again, maybe taking a step back and looking at our therapy sessions and saying, What can we do to make this an even more pleasurable learning experience for our kids? And I also think this is important. I think we as individuals have to step back and take a look within ourselves and find out and to turn be honest and say, what do we need to change about ourselves so that I can be the best interventionist that I can for this child and. Uh, during this therapy session every day of the week.    Jayson Davies     Yeah. And to add to that, I think if you think of the IEP as a IEP team specifically, you know, we have to, as an IEP team, really take that step back and really figure out what are the most important things that we want to focus on the next year. You know, because any IEP team could have 100 goals for a student, but we need to break it down and find those five, maybe six, things that are most important that we really want to focus in on and work toward those. And maybe mental health is more important this year than handwriting or using scissors or numerous other things, and so as a team, we can come together and make that decision to prioritize mental health.    Monica Keen     So absolutely, absolutely.    Jayson Davies     One of the things that you pointed out, or you pointed out several times, is supporting teachers. And I like to think of school based ot being on two separate levels. School Based OTs can obviously help the individual student, but school based OTs also work at that systems level, where you're talking about the whole school, and I think when you talk about supporting teachers, you're talking more at that systems level. I guess when it comes to mental health, a little bit. I guess you've already kind of done this. You've already kind of broken down some things that you can do for the teachers. But at a systems level, I guess the larger picture, are there any programs that maybe you recommend? Is there any thing that you might do to help the entire school, as opposed to supporting the individuals?    Monica Keen     I think education Jayson is the key. I think that while we can maybe even take the programs that are already in existence at individual schools. So like, for example, in the district where I work, the entire district had adopted zones of regulation to be in each individual school. So taking the time to educate our teachers on what does that exactly mean? What does yellow look like? What does green look like? You know, those types of things. I can't even tell you how many times when I could have a conversation with a teacher about how, how Johnny behaved in therapy today, and why I think X, Y and Z happened, and she would step back and say, I never looked at it through that lens before you. I think you're on to something. It's really I feel at a systems level, taking the time to communicate, to problem solve, to brainstorm about these children individually. You cannot group them all together. We are all beautifully and uniquely wired to function differently and so providing our teachers with those ideas of, for example, you know, why can't Susie pace back and forth at the back of the classroom while you're lecturing? Because movement helps her, you know, get the information. That's what she needs to do in order to to hear and learn the information our teachers don't know about how sensory impacting all the sensory systems really is how we best learn. It is advocating for that child at a systems level of this is what we feel they need to do in order to be successful in the classroom. It much like, you know, it goes so much further and deeper than an IEP objective. It's, it's being their voice. For those who cannot advocate for themselves, we are their voice, and we need to take that seriously.      Yeah, I think as a whole, we need to, because I believe this is true. We need to understand that we can support students just as much by supporting other people around the student as we can if we pull them out for a 30 minute session.    Monica Keen     Absolutely, absolutely. And I think we as practitioners as well as school personnel as a whole, I really do think that we need to look at that a little bit differently and be given the permission as the provider to address it in more unique and creative ways. Because again, we have to go back to being client centered, and not every child is going to respond to the same book intervention that you know, has been created over the years. I find that if, if we are given the permission to really explore how to best. Reach that child that's going to help us be more successful in our interventions?      Yeah, absolutely. Monica, thank you so much. It's been a pleasure. I have two more questions, at least two more questions. They're going to be more rapid fire, though, okay? And they're really quick. Hopefully they're pretty easy. What is one online resource you would love people to check out related to mental health and students. It can be a journal article, a website, whatever it might be.    Monica Keen     One of the websites I would really encourage is called powerfully you. Powerfully you. And it is a social emotional learning curriculum that was written by two occupational therapists based here in Charleston, South Carolina, and it is very big on interoception, and it talks a lot about teaching the child how to understand what Their body is feeling in in times of emotional dysregulation, as well as how it feels when one is emotionally regulated. It truly is a fascinating program that is catching popularity very, very quickly, and it's it's really worth taking the course.      Great. I'll have to look into that myself. I've never heard of that one, so thanks.     Monica Keen     Oh, good, yeah.    Jayson Davies     All right. And then on the flip side, something that is offline, maybe a book or something. Is there something you recommend to therapists? Maybe to check out?    Monica Keen     Oh, my goodness. There are so many. I think you know some of the oldies, but goodies, especially for our younger kids, like, how does your engine run the out of sync child? Those are two that come to the the top of my head to begin with. But I feel that anything that you can get your hands on to read about how to better understand our students their behavior and what makes them tick, is going to be a priceless read for you to invest your time in to always give us better insights into into our students behavior. And those are those types of writings are coming out all the time. So.      Yeah, you know. And if I had to answer this question, I just picked up a book, and I'm excited to read it. And it's by Dr Mona de la hook, and it's called Beyond behaviors. And I know she you looked at the polyvagal theory and how all the things in the world influence our behavior, not just, you know what we want to do. There's so many things that impact our behavior. So that would be, that would be my response. But thank you so much for mentioning the out of seeing child, the How does your engine run, program and yeah, that's, I think all I have for you, other than where can people potentially learn more about you and the work that you're doing? If they'd like to learn more.    Monica Keen     Absolutely, I can give you my email address. Would you like for me to do that?      You know what you can say really quickly, if you want to. And then we can actually, we'll just put it in the show notes. I think I'll also tag your LinkedIn account. Your LinkedIn seems to be?    Monica Keen     Yes. You can find me on LinkedIn. You can also find me at Presbyterian College. My email there is m keen@presby.edu or you can contact me through my personal email, which is Molli soo@aol.com M, O, L, L, I, S, O, O, @ aol.com , and it has just been such a privilege to spend time with you, Jayson, and to talk about really, what I'm so passionate about, and I hope that that has been presented in today's conversation.      Absolutely you are definitely passionate about this, and I think you're going to make some others passionate about it as well. So thank you so much for being here. Really appreciate it, and I know we will be staying in touch. Thanks again,    Monica Keen     thanks again, bye, bye.    Jayson Davies     And there you have it, school based OT and mental health. There's so much more that we can be doing. There's so much more that we should be doing. So please help me give one last thank you to Dr keen for coming on and sharing all of that wonderful information. Thank you also for being here today, for listening through this podcast. If you're still listening, I know you got so much value out of this. I know that you are working to make yourself a better school based ot practitioner. And I thank you for doing that. I thank you for being here, for getting that professional development. And even if it is listening to a podcast, it's still professional development. I appreciate you being here. I appreciate you being on the school based OT, ot school house podcast being here today, and I look forward to seeing you in episode 112 until next time, take care. Have a great two weeks, and I'll see you next time take care. Bye.    Amazing Narrator     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! 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Click on your preferred podcast player link to listen wherever you enjoy podcasts Welcome to the show notes for Episode 112 of the OT Schoolhouse Podcast. Were you flabbergasted when the CDC changed the guidelines for developmental milestones In February? You weren’t alone. But it is important to look deeper at why these changes were made. The CDC was tasked with updating the milestones and making them less confusing for those who rely on them most - parents. The milestones are still (mostly) the same, and they are backed by research, as we discuss with Dr. Kate Barlow in the episode. Kate is an ambassador for the CDC, and she talks to us about the milestones that are established for the first 5 years of a child's life. Kate describes why this is important for us OTPs that are in schools. Tune in to find out why! Tune in to learn the following objectives: Learners will identify what the developmental monitor program is used for Learners will identify why the 75th percentile is no longer included on the CDC milestones checklist Learners will identify how the CDC milestones app can be used by OTPs Guest Bio Kate Barlow, OTD, MS, OTR/L Dr. Barlow is an Associate Professor at American International College. She is also the CDC’s Learn the Signs. Act Early. Ambassador for the state of Massachusetts. Dr. Barlow received her BS in Occupational Therapy from Boston University and her MS and OTD from Virginia Commonwealth University. She has over 20 years of clinical experience in pediatrics, and her areas of expertise are in pediatric feeding and early identification of delays. As the CDC’s Act Early Ambassador for Massachusetts, Dr. Barlow has been working in Public Health to promote developmental monitoring and screening within Head Start and WIC centers across the state. Dr. Barlow won the 2022 NBCOT Innovation award for her work in global outreach. She founded the International Interprofessional Mentorship Program in June of 2019, which currently provides mentorship to therapists in low- and middle-income countries. Quotes “Prior to COVID, when the research was done, the CDC was estimating that more than 50% of the children that need services before age three are not receiving them” - Kate Barlow, OTD, MS, OTR/L “Developmental monitoring is done by everybody in the community…Parents, teachers, clinicians, YMCA workers, at-home day workers, Headstart teachers… This is a public health tool” -Kate Barlow, OTD, MS, OTR/L “Now it's much clearer, you check one of these boxes, go see the doctor. So I really like that it's much more direct” -Kate Barlow, OTD, MS, OTR/L “I'm glad now that we're hearing the reason it came off is because there wasn't the research to support that 75th percentile for crawling… as a profession, we try to be research-based and now we know why that happened” -Jayson Davies, MA, OTR/L “You know, and a lot of times people don't have the same pediatrician, so they're seeing someone different every single time. So it's a great tool to help families communicate with their doctors” -Kate Barlow, OTD, MS, OTR/L Resources: Dr. Barlow’s Linkedin International Interprofessional Mentorship Program Learn the Signs. Act Early CDC Massachusetts Act Early Campaign Apple Podcast CDC milestones- AOTA WFOT article Feeding Matters Conference Project ECHO SOS Approach to Feeding Association for Education of Young Children Infant Mental Health Endorsement CDC Milestone Update Video Watch Me Training -CDC Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.    Jayson Davies     Hello, wonderful occupational therapy practitioners, and also hello to anyone else who is not an OT practitioner listening to this podcast, I've been receiving a few emails recently from non OTs reaching out and saying this the OT school health podcast has been very helpful for them, so I'm excited to hear that both OTPs and non ot Ps are benefiting from this podcast. So thank you all so much for being here. Today we have another amazing episode. I know I say that all the time, but that's because I really do feel that every episode is pretty awesome. Today, we're talking about the CDC milestone guidelines. And if you remember not too long ago, earlier this year, in 2022 at the end of January, early February, the CDC updated their milestones. And to be honest, there was a little bit of a frenzy. And whether you believe that that frenzy was warranted or not, we're going to have a discussion about it today. And to do that, we are bringing on Dr Kate Barlow. And Dr Kate Barlow is an ambassador for the CDC. Learn the signs act early in the state of Massachusetts, and so Kate is going to come on and talk to us all about what happened with the CDC guidelines, what the changes were, and how it impacts us today. We're also going to talk about a few other things, but there's a lot of good stuff in here, so really quickly, let me introduce Dr Barlow, and then we will get on our way. Dr Kate Barlow is an associate professor at American International College, and as I mentioned a moment ago, is also the CDC Learn the signs act early ambassador for the state of Massachusetts. She received her Bachelor's in OT from Boston University, and her master's and OTD from Virginia Commonwealth University. She has over 20 years in clinical experience in pediatrics, and her areas of expertise are pediatric feeding and early identification of delays, which goes perfectly with being an act early CDC, learn the signs. Act, early ambassador as the CDC. Act, early ambassador for Massachusetts, Dr Barlow, has been working in public health to promote developmental monitoring and screenings with the Head Start program and the WIC which we will get into because I did not know what WIC stood for. So Kate is going to fill us in what the meaning of WIC is in just a little bit also before we dive into this, I must say Congratulations to Dr Barlow. She recently was awarded the 2022 NBC ot Innovation Award for her work in founding the international interprofessional Mentorship Program in June of 2019 this is some passion work of Kate. She is helping OTs, not only in the United States, but throughout across the globe, and it's really doing amazing things. We will dive into that a little bit so you can hear more and learn more about that, in case you want to get involved. But yeah, we're going to talk about that. We're going to talk about the CDC milestones, the WIC program, how she is supporting head starts. So this is going to be a great episode. I hope you stick around for the entire thing. Put that phone in your pocket. You've got your headphones in. We are good to go. Please help me with a warm welcome for Dr. Kate Barlow, Kate, welcome to the podcast. How are you doing today?    Kate Barlow     I'm great. Thank you for having me.    Jayson Davies     Yeah, no problem. Thanks for joining us. And really quickly, where are you? Where are you calling in from again?    Kate Barlow     I am in Massachusetts.    Jayson Davies     We're at about in Massachusetts. Are you near Boston? Or we're at?    Kate Barlow     Yep, I am an hour and 15 minutes west of Boston in this tiny town called Wilbraham, Massachusetts.    Jayson Davies     Fantastic. And you know occupational therapy is very it's it's very broad, right? We tend to be more in the pediatric, the school based realm of things. But even that is different from state to state, county to county, and so I would love to just kind of start off and ask you about kind of your career in in occupational therapy in general. Where have you been? What are you doing now?    Kate Barlow     Okay, great. Well, I started my career in 97 I graduated from Boston University, and I started working right away in the Boston Public Schools. I did that for four years, and then my husband got me to move to Virginia. I was, you know, a little kicking and screaming about how to do it, but it worked out. We got married, so I guess it was a good choice, but I worked another eight years in the public schools down in Virginia, and then I decided to move into a management position. But I did realize right away that management was not really for me, but I wanted to go back and get my my doctorate, because at the time when I was managing, I had all. These PTS that had their doctorates, I had OTs and flts that had their master's degree, and I had my bachelor's degree. So the thought was in my head that I wanted to be a feeding expert, and I wanted to have students come in and really learn how to do feeding while they were still students. And so that was really, like, sort of my passion and my goal at the time. But, you know, things develop, change and develop over time. So I went into a hospital based outpatient clinic while I was finishing up my doctorate, and one of these fellow colleagues who was also getting her doctorate, Bonnie Riley, she was like my BFF through the program. She was a professor at Shenandoah University, and she had asked me to come and guest lecture on feeding. And I did. I was so nervous. And then because, you know, she's so wonderful, she was like, Kate, you really should submit papers to present at the Virginia State Conference. And of course, she pushed me to do this, and I did it. This is what good friends are for. And then I was so nervous, I actually threw up, got gave myself my brain, because I was so nervous to present. And keep in mind, I've been practicing, like 15 years at this point. But in the audience was another professor from VCU, where I was going to school, but I didn't know her, and her name was Carol Ivey. Is Carol Ivey, and she had asked me to guest lecture at VCU on feeding. She was like, This was great. I would love this for my students. And so from that experience, I sort of developed a relationship with her. And then when an adjunct position in pediatrics came open at VCU, I got my first sort of hands on teaching experience teaching adjunct there, and then I graduated in 2015 with my doctorate. And then I started teaching full time. Moved back to Massachusetts, and now I work at American International College. I'm an associate professor there. We do it's a small teaching college, so we get a political day. So I've been working in early intervention since I started as a professor full time. So, yeah, so I've kind of done this, you know, zero to 22 in my pediatric I've never done acute care. That's sort of the one area that I really haven't worked in. But I do have a fairly good background in pediatrics.    Jayson Davies     Yeah, you know, I love this podcast because, a you know, we have some questions that we definitely want to cover today, but at the same time, I get to ask whatever questions I want as follow up to your responses. And as you're speaking, there's a lot of things that I would love to actually ask you about, and I'm going to limit it to two things, a Where did you get some of your feeding experience and professional development? Did you take a specific course? Or what might you recommend to someone who wants to get into feeding?    Kate Barlow     Wow, so there are a lot of really good courses out there. When I first realized that I didn't have enough knowledge and feeding. I was getting a lot of children on my caseload, and the speech therapist there at this particular school wasn't doing feeding. And the last school I had worked in, there was two very experienced SLPs that did all the oral motor and feeding, and then it just never really fell on my lap. Well, now I was in a new position where it was coming to me. So the first real feeding conference I went to was Beckman oral motor. And it just really allowed me to understand, sort of what all the muscles do and how to assess them and treat them. So I was sort of doing, like, bubbles and whistles for everybody, yay and like, not really knowing, like, oh, they have, you know, poor lip strength, or poor cheek strength or poor jaw strength, like, I wasn't able to assess what the deficit area was, and Beckman really allowed me to do that. I also went to SOS, which I absolutely loved. It is so great for working with children who are picky eaters. And it's, it's, if you work with autistic children, it's just fantastic for really expanding children's variety of school foods that they eat. Um, the last few years, I've gone to feeding matters conference every year, and if anyone is interested in feeding I just feel like it's really like, I would never miss it. So I'll just put it out there like that, like I would never miss a feeding matters conference. They're just so great. And the good thing about it too is that there's something for everyone, as far as the levels. So there's something for beginners, intermediates and advanced clinicians within feeding. So I highly recommend the feeding matters, just to name a few, I could keep going.    Jayson Davies     No, that's great. You know, I was just going to tag on to that that, yeah, that's kind of what I recommend for people if they want to get into something right, start with that larger course, like the SOS or something that gives you a really good base. But then once you have that foundational knowledge, just like an OT in general, then you can go to the conferences, and you get so much. More out of those one two hour sessions after you have a really solid base in whatever it is that you want to be learning. So, yeah, great. All right. The other question, and you said it wasn't for you management, but I want to know what was that role? Was that in the school based role?    Kate Barlow     Actually, I was a director of rehab at a SNF, so when I started in the school systems, right out of school, I always worked PRN with adults. I always kept, you know, in the school system, you have your summers and weekends, and I had so much student loan debt that I worked, yeah, so I worked weekends and summers doing adult rehab. So actually, the truth is, is that we thought my husband was going to be laid off, and I didn't want to sign a school contract for a year, because we knew he was either going to be laid off or transferred, which actually ended up happening. So I didn't want to. We thought we might be moving to Kansas City, actually, so I didn't want to sign a school contract. Yeah, and then, but he ended up not getting transferred, getting laid off. So anyways, that's why there was a management position open. And I had been working PRN in the snip anyways. And so I ended up moving into the management position.     Jayson Davies     Gotcha, yeah, right now, there's just a big push to help get school based into management. And so I was really interested if that was a school based management position. I was I was gonna really ask you some questions, but it's not so anyways. Uh, continuing on, what are you really passionate about right now in 2022?    Kate Barlow     so I would say one of my biggest passions is my global outreach volunteer work. So I run an international interprofessional mentorship program, and it is really to provide mentorship to therapists in low income countries. So I'll tell you how it got started. So I did my doctoral work in Ghana in 2014 and then when I went to W F O T in 2018 I ran into a couple of the Ghanaian OTs there. And they were like, Hey, Kate, you know, we're, like, the first OTs in the country practicing, and we need mentorship. Will you mentor me? And I was like, of course, you know, like, I'm so excited that they came up to me. And I'm also on the W F O T task force for the University of Guyana. And so Guyana is in the same boat as Ghana in the in the sense that they graduated their first OTs in the country. So they have OTs where they either have to get their mentorship from a physical therapist or from an OT from another country. So what I did was I talked to the chair of the mentor the University of Guyana Task Force, David. And I was like, hey, what do you think about me? Just like starting a whole program, and like doing mentorship, getting these countries, even though they're in different continents, together, and just like starting a program, he was like, Kate, just go for it. So I did. So it started in June of 2019 and we we do mentorship. We started twice a month, but the group really felt like once a month would be better. And we used to have it always at the same time again, but the OTs felt like it'd be better if it was at different times. So we've sort of adjusted over time to what works best for the mentees in the group, and now we do like Tuesdays or Thursdays anywhere from like 9am to 2pm because we have people like in Zimbabwe that are eight hours ahead. So trying to keep in mind the time changes, that's sort of what we've landed on, but it's I love this program because it really just connects people on a global level, like today, I got an email from the CDC asking me if I knew people that could translate, and there was like, eight languages. So I fired off an email, and I've already got two people, you know, one Farsi and one Arabic that emailed back saying that they would help. So it's just a really neat way to connect, you know.    Jayson Davies     Yeah, absolutely. And I know the same thing with this podcast, you know, I meet people that I never would have had an opportunity to meet. I mean yourself included, right, without the OT school house podcast. And it's just been amazing meeting people from Australia, from the UK, from China. You know, it's just amazing. What can happen when you start trying to help others. It's pretty amazing. So you've told us about this, this mentorship program, that's amazing. It's all online, right? You don't travel back and forth. I'm assuming.    Kate Barlow     No, it's all online through zoom. I would really my goal for the program is to turn it into an echo. So echo stands for extension for community health care outcomes. So if you're not familiar with it, Echo is an amazing evidence based platform for communities of practice, continuing education. And I would. Really like to turn my program into an echo so that is really my goal. I went through the echo training last year, and where I work, AIC has now become a Project ECHO hub, but it's a lot of work. So I've actually partnered with MGH and Kathleen Leslie, who's a professor there. I'm going to take one of her, well, two of her students next year to really help me turn it'll be like their ot experiential project to really help me turn this mentorship program into an echo. I think it'll be much more accessible and it'll be better for sustainability if it was turned into an echo. I also long term goal, you know, I just shoot for the stars here, but I would love for this program to eventually be adopted from W, F, o, t, and have it be like one of their projects, so that I have recordings from all of the meetings. So I've had these amazing presenters, right? So the format is that a presenter comes on for like 45 minutes and talks about whatever their area of expertise is, and then we have like, a question and answer session. And these are these meetings have all been recorded and they're posted on the group's website. So this is such a great resource for therapists, for students, right? And so I would love for these recordings to be like housed, for everyone to access. I mean, right now, anyone can access them on my website, but no one, very few people know who Kate Barlow is and that this, they will now, well, you know, and that exists, whereas, you know, if they were housed on like, W, F, o, t, they could be then translated into different languages and just be much more of a utilized resource. So I try to get the word out there that this, you know, this website exists, but it's, it's not that easy.    Jayson Davies     Yeah, and really quickly, feel free to mention that website right now. And then also, if anyone's interested, is the best way to contact you through that website.    Kate Barlow     Yeah, well, right on the website is my email, so anyone can email me, which is kate.barlow@aic.edu but the website for the mentorship group, it's live guides like, l, I B, G, U, I D, E, S, dot, A, I, C.edu/ot .     Jayson Davies     All right, we'll be sure to put that in the resources.     Kate Barlow     Yeah, I don't even know what that is, but.    Jayson Davies     We'll put a link in the show notes so it's easy for everyone to find.     Kate Barlow     Okay, thanks.     Jayson Davies     Yeah, no problem. So when you were explaining that you briefly threw in there a little nugget, or maybe a little foreshadowing, you mentioned the CDC send you an email asking for translation. And you know, not everyone gets an email from the CDC, so explain to us how you are connected with the CDC and why they even, even would have reached out to you.    Kate Barlow     Yeah, sorry about that. So I am the CDC act, early ambassador for the state of Massachusetts, and it's an amazing role. I really hope that more OTs will work in public health for ot really working as the CDC ambassador since 2019 has really changed the projectory of my career, but also how I think about OT and moving forward, how I teach my students, how I want them to really look at when they're working in pediatrics, how they see themselves in that role. So I am a big proponent of OTs working in public health, and it's really from this role that I have with the CDC.    Jayson Davies     Yeah. And so how did you even learn about this position? Because I had never even knew that it existed, so I'd love to learn more about.    Kate Barlow     it. So there are two OTs that are CDC ambassadors. So every state has a CDC act early ambassadors the bigger states have two, as well as the territories, and Chris barnico is the other OT, who's also a CDC ambassador, and she posted it on commun OT, so this was back in like, 2018 I saw it. I was like, Oh, this sounds wonderful. You know, my career goal is to eventually work for the WHO, the World Health Organization. Alright, Kate just reaches right for the start. So, like Jayson, like, there's no joke, right? So I'm like, this would be so great. It would be like, you know, working for the who, but here in the US, like a stepping stone. So I applied, and I got it. So I started in 2019 and we actually, I posted the advertisement on commune ot this year for the applications for CDC ambassadors as well. So the position has now been filled, and I was re elected, but there will be applications again in. 2024 so anyone who is interested, be on the lookout for the applications for ambassadors for every state in 2024.    Jayson Davies     Awesome. Well, congratulations on getting re elected. So it's a two year term, it sounds like?    Kate Barlow      It is a two year term. Yes.     Jayson Davies     Wow. Okay, and it's funny, you mentioned 2019 twice now. And as we all know, in 2020 the pandemic kicked off in March of 2020 I guess, kind of how did the pandemic shape your CDC ambassadorship?    Kate Barlow     Well, it was sort of a silver lining to COVID, because the CDC provided grant funding for the CDC ambassadors, so I was able to really work with Head Start and WIC in a way that I hadn't before, because I was able to finance some of the initiatives that I wanted to do. So for instance, I was able to buy the CDC act early program has board books for one year olds or baby busies day. These are free. By the way, the two year old book is free. The three year old book is free. Just go on the Learn the signs act early website, everything is free. Everything is in English and Spanish. Just a little plug there. But so everything that I do is free to everyone else, okay, but I was able to purchase 1000s of books, these busy day books, and provide them to the WIC so that when families go into WIC at the baby's nine month appointment, they were given one of these books. Massachusetts is one of the first states to implement developmental monitoring, which is what the Learn, the signs act early program is across the state, in the WIC clinics. So we're really a leader in that way. And so I was really able to support that effort. I was also able to provide continuing education. So I had, I created a course, and it was approved by the Association for Education of Young Children, and I was able to offer it both in 2021 and 2022 but because it was virtual and COVID, I had so many people come. So the first year, I did a total of 10 webinars, and I had 661 attendees for that first year, awesome. And then in 2002 we just did a one all day webinar, but we had 70 people come and receive free CEUs. So the you know, the grant was able to pay for the CEUs, and the grant, also, this past year, I was able to offer infant mental health endorsement. So the grant was able to pay for 50 professionals in Massachusetts to go through the infant mental health endorsement. So I did advertise this on the Massachusetts ot Association. I had them send out an email. I was trying to, you know, do a plug for OTs in the state, so people who worked in Head Start WIC or early intervention as well as I did send out an email to OTs. So we had, we paid for, actually, 54 people to get their infant mental health endorsement. So, wow, yeah. So I just feel like it's a really great way to work across the state, and because Zoom is everyone's norm now, yeah, it was just a great fit. So it actually, I feel like it helped, it helped me with making connections across the state.    Jayson Davies     Yeah, that's awesome. And you know what, a week or two weeks before your episode is being released, we actually just had an episode on OT and mental health and school based OT. So I love that there is that emphasis on mental health right now in school based OT and OT in general. And OT, you know, we started in the world of mental health, and we're really circling back to it. We just need to, we really need to be identified as mental health providers, and all the states that we're not yet. So, yeah, that's great that you're able to basically get 50. You said 54 people completely certified in or not certified. But OT and mental health, what did you call it again? Sorry.    Kate Barlow     So it's the infant mental health endorsement. So this is a national organization, and then individual states have their own. So mine is mass aim. So Massachusetts infant mental health association, and other states have their own association. So I became endorsed to Massachusetts infant mental health.    Jayson Davies     Gotcha. And you, you mentioned one term that I'm not as familiar with. And I you might have mentioned it, but I didn't get the full WIC, w i c, that stands for?    Kate Barlow     So that is the supplemental, supplemental and Nutrition Program for Women, Infants and Children. So that's a federal program that provides a lot, so a lot of services to women and children up to five, as well as breastfeeding women, prenatal women and postpartum women up to. Year. And so it's, it's not snap. So a lot of times it's confused with food stamps, which is now called Snap, but it's not, it's a completely separate program. And so I, usually, I've always worked in low income areas. And so for an OT, especially an EI, going into the home, I'm always encouraging, you know, if, in Massachusetts, if you qualify for mass health, you automatically qualify for WIC. So it's just another way that we can help support families. You know, don't forget to use your WIC benefits before your SNAP benefits, because snap runs over and WIC doesn't right. So just really helping families. Or, you know, I lost my WIC card, getting them reconnected. Or one time, one of the moms was like, I really hate the women in that one office. And I was like, Well, have you tried the Main Street office, you know, because they're great, and that's, I take students into the Main Street office, and so just, just connecting families with these free, available resources to them, and just, you know, supporting families.     Jayson Davies     Yeah, so I must say, I'm really loving this conversation. It's so different than all the conversations I've had, because typically we are talking very specific about school based OT and I just really love that we're opening up today and talking more about that public health side of things. So it might have been my fault right now, because I kind of slipped over it and we jumped really into the specifics of what you're doing. But if we take a step back and look at that, CDC ambassador, I guess what is kind of the larger responsibility. How do they advertise it as why should you be a CDC ambassador? What is What are you going to get to do as a CDC ambassador?    Kate Barlow     Okay, so as the ambassador, my role is to really promote the learn the science act early program, which is a developmental monitoring program. So I really promote it within OTs, because a lot of pediatric OTs are not yet doing it, and I believe it to be best practice. And the research is showing that combining developmental monitoring with screening is the best way to identify children with delays. So prior to COVID, when the research was done, the CDC was estimating that more than 50% of the children that need services before age three are not identified. So my job is early identification of delays, and we as OTs, when a child comes to us, they've already been identified, yeah. So this developmental Monitoring Program is for everyone, right? So screenings are done by clinicians like us, physicians and teachers with you know, special training, developmental monitoring is done by everybody in the community, right? Parents, teachers, clinicians, YMCA, workers, at home, day workers, Head Start, teachers, so I am trying to get everyone in the community using this developmental monitoring program, talking about milestones. You know, this is a public health tool. It's like a, you know, quit smoking campaign, like, celebrate your child's milestones. You know, like, know what's going on with your child, so that we can identify these children in the community that are delayed and they just need some catch up services. So this is really my role, is to work with Head Start, work with WIC, work with, you know, OTs, like, I'm presenting at a ot A, so come see me, and I'll tell you all about it. You know, I have a poster on Saturday, and I will, I will give you the rundown. I will talk your ear off. I'm three to five on Saturday. So, yeah. So I'm trying to get OTs to use the program and PTs, if everyone in the community is using the same language, it becomes easier. And so that's that's really my job is to get people in Massachusetts using the Learn the signs, act early program to help children be identified.    Jayson Davies     Gotcha. Perfect. And if I recall, you kind of have a manuscript that's under review right now related to the developmental monitoring, correct?    Kate Barlow     I do, yes, good memory. So it is under review, and it's the first research to show that developmental monitoring within the WIC setting is increasing referrals. So it's really exciting. You know, if you need the research to show it's evidence based, right? And so we're really the first to take this data, collect this data, and we're trying to get it published. So fingers crossed that will be published soon.     Jayson Davies     Awesome. Well, yeah, I'm hoping for you, and I'm also just want to again, congratulations. You're presenting at a OTA. You've got a poster there. You're making your way to working at the who, gosh, you're on a way to great things.    Kate Barlow     pipe dreams. Pipe Dreams, but you have to have them, right?    Jayson Davies     Hey, it sounds like to me you are well on your way. You've got a lot going on. And also I know how well prepared you are for this podcast, so I know you are a very prepared person doing great stuff. So now, part of the reason that I initially reached out to you was because you happen to be a CDC Ambassador during the time that the CDC did a big revision to the milestones update, it was the first time they had done an update to the milestones in a really long time. So can you share a little bit about some of those updates? Or maybe, yeah, we'll start with that. Can you share some of those updates that were made?    Kate Barlow     Sure, so what they were seeing is that a lot of pediatricians were taking this wait and see approach, and so the group was formed to really update the milestones, to change the format a little bit, to stop this wait and see approach. So the old format of the CDC act early milestone checklist had one column on the left, which was, like, all these milestones that were around the 50th percentile. And then there was this purple box that had that said, you know, if your child isn't reaching one of these milestones, go see the doctor. And these milestones were, you know, 75 to 90% or more children had already reached this milestone, so we were referring children around the 75th to 90th percentile. The updates, what happened was, was that they removed the left column, so all of the milestones that were listed around the 50th percentile were removed, and so now your checklist just has, if your child is not meeting one of these milestones, go see the doctor, so it's, you know, there's about 13 milestones per checklist, and if your child isn't meeting one of them, go get a screen right so it there's no wait and see anymore. There's no like because some of them in the old checklist, some of them were around a 50th percentile. There was some confusion. Well, well, they have this, but they don't have this. Let's wait and see. So now it's much clearer, like you check one of these boxes go see the doctor. So I really like that. It's much more direct. The the updates that were made, the milestones that were chosen, were all in evidence space, so they were in research, and milestones that were removed did not have the research to support them so it it really, it is a parent friendly communication tool. It is not a screening tool. I know some therapists were like, I can't believe crawling was removed. Crawling is so important. Yes, of course, crawling is important, and we as therapists are going to continue to assess crawling and work on crawling like that. Our role is not changing. This is a parent communication tool, so we just need to keep in mind that there wasn't the research to support when 75% of children are crawling. So it wasn't kept in because there wasn't enough evidence for when children are reaching this milestone, and crawling actually is creeping, Commando crawling. How do you you know the definition of crawling is varied, and culturally, a lot of children barely crawl right? They're not put on the ground. They're they're held or not put on the ground. And so they sort of kind of go right to walking. So I think people, when they understand, really, why the changes were made, how the changes were made, and how you're supposed to use the tool, they're like, Oh, that makes sense. You know, I just think there was a lot of misinformation that was out there. I'll be honest, I get my news from NPR and BBC on my Facebook feed, like I definitely you saw it, some of my news from social media, but there was a lot of misinformation on social media. And it was, it was pretty upsetting to me personally, some of the comments that were being made because they just were inaccurate. So I actually made, like, a seven minute YouTube video explaining the changes. I'd be happy to send you that link. Yeah, Chris barnico and I did a podcast for a OTA explaining the changes. It's actually been viewed over three or listened to over 3000 times, which is great, right? So I think people want to know. They want to be educated. I just think that there was so much misinformation out there about the changes that that it was unfortunate the way. Rollout happened, but it is a wonderful communication tool. I really hope that all OTs will incorporate it into their pediatric practice moving forward. And I think people just once they're educated, then they understand the importance. It's just that education piece.     Jayson Davies     I agree, there was social media was really blowing up when it happened, and I took a conscious effort, actually, to not post about it, mostly because I knew I wasn't educated about it. I knew it was a big change, but I wasn't going to go crazy and blow up my instagram with, oh my gosh, it changed. They took off crawling because, like you said, obviously there was a reason they did it, and I didn't have that reasoning yet. So that's why I wanted to bring you on and talk a little bit about that. So I'm glad now that we're hearing the reason it came off is because there wasn't the research to support that 75th percentile for crawling that that's great. I mean, as a profession, we try and be research based, and so now we know exactly why that happened. So thank you for sharing that. Now you talked a little bit about the wait and see versus kind of where we're going. And I have a six month old right now. He hates, he hates when we try and get him to crawl. He'd much rather be standing up trying to walk. But I do have the CDC app, the milestones app, on my phone, and I go through and check it off, and it's very simple. It's either yes, he's completed this. Not sure or No, he hasn't. And as you said, he's he's met all of them. But I do play around with it just to see what happens if I say no. And sure enough, yeah, it's like, Hey, here's a little summary of what you told us. Take this to your doctor and show them that you know what. He met 10 out of the 13 let your doctor know about this. So, so that's great. I kind of what you talked about. I kind of equate to the RTI model in schools. Because traditionally, special education was kind of that wait to see or wait and see model or wait to fail. I guess you could call it, you know, it's you didn't get special education until you you basically were really doing poorly, and now we've integrated this RTI model that's supposed to give supports, you know, as needed over time, getting supports earlier rather than waiting. That I kind of equate to what you're talking about now to that, right? They don't need to be failing in math and English to get special education. They could be having difficulty in just one and get some support. So I really like that. I really like that. So in your role, you already talked about a seven minute video. We will link to that, and you talked about the A OTA podcast. We'll talk about or we'll link to that as well. I mean, you mentioned WIC, you mentioned Head Start. Is that primarily the way that you are getting this information out to the world?    Kate Barlow     Yes, so I do a lot of presentations. So say, Monday night, I did a presentation for over 70 people that were United Way Community workers in Massachusetts, so people that are doing screens in the community, and it was translated in Spanish. More than half of the people that attended were in Spanish. And so through my connections, through the state, I go to EIS, I go to different Head Start centers. That's i or i do it over zoom, you know, it, whatever. I also do it for school. So I did a presentation for MGH this month for their ot students to talk about developmental monitoring and the importance. So every time I do a presentation for the CDC, it's of no cost to to whoever is receiving it, right? So I'm always like, I'm free, so I really try to get the word out there through that way, you know, and through, sort of like, starting at the state level, we have a mass act early team, which has a lot of the Department of Public Health sort of directors on it, and sort of that trickle down approach. So really building community within Massachusetts for these different agencies really helps. I also have done a couple publications. I've written an OT practice article, you know, I've written for like, the SLP Massachusetts newsletter, you know, like, how can you get the word out there? I'm I'm willing to pretty much do anything that I can. I take sort of a varied approach, um, but I wanted to go back to one thing that you said about the wait and see. So you said that when you were filling out the checklist on the app, it said, yes, no or wait and see. I just wanted to highlight that that was one of the really good changes about the updates, was that now if you check wait and see, the directions are, try this milestone for two weeks, and if your child is not able to achieve the milestone in two weeks, go see the doctor. So it gives parents a specific amount of time to try to work on that milestone. And then if they're not that the child hasn't achieved that milestone to still go see the doctor, the chat. Necklace also now have a asterisk every time the child is due for developmental screening. Or if you're on the app, it will tell you. So from the time a child is born to age five, they get four developmental screenings that are recommended from the American Academy of Pediatrics. And so if we think about, let's look at Head Start. Say you're from Early Head Start, you transition to Head Start at two years nine months, so you've already missed the last developmental screening that you're going to get from the pediatrician, unless the parent brings concerns. So if we think about all the children in preschool or head start in that three to five, they're not receiving a screen from the pediatrician unless the parents bring up concerns. So this is a great way, a great communication tool for us to be like, oh, you know, I saw them do this. Have you seen them do this? Oh, well, you know, and really have that conversation. And then they can bring either the checklist printed, or Everyone always has their phone. You can make notes right in the phone. So my work and feeding that's where I make that I make notes right in the phone for the parents. Then they bring that to the doctor, and the doctor has that information. So in Springfield, where, where I work in early intervention, a lot of the families, English is their second language. So can you imagine how difficult it is to go to the doctor voice your concern? English is your second language, you know. And a lot of times, people don't have the same pediatrician, so they're seeing someone different every single time. So it really it's a great tool to help families communicate with their doctors of what's going on with their child. Because, you know, I don't think most people know that the pediatricians aren't doing screenings after, you know, two and a half, like, really, like, we need to be identifying these children. And how are we going to do it? And this is just one of those ways that we can help do it.    Jayson Davies     Yeah, and earlier you mentioned, you know, 50% of kids who need the services aren't getting the services. And so by changing up the milestone checklist, by making the app easier to use, what is the hope from the CDC is, are we hoping to do they have a baseline, or a not a baseline? I guess the baseline is 50% aren't getting services. Do they have a goal that they're looking for? Or maybe even, how are they, how are they monitoring?    Kate Barlow     So I don't know if there is a certain goal. I'm not in that. I'm not at that table yet Jayson, so I'm not in the now on that.    Jayson Davies      We'll give it another two years.    Kate Barlow     But, you know, it's an amazing group up there. And the group that started on the updates, actually, it started in 2019 and they began parent testing on the updates, actually before COVID. So some people were like, Oh, they updated it and moved everything back because of COVID. Actually not true, false. All of that is not true, but so this amazing, you know, interprofessional team that they have working on the updates, they will, of course, be updating it again, because every tool that we use needs continuous updates, right? And the data that I know that they are collecting is when you download the app and you open it up, it asks you what state you're in. So, like, I presented it to my international group, because a lot of times the a bunch of the countries of that therapists are tuning in from are in sub Sahara Africa, and they don't have a assessment that has been validated for their own country. So they're sort of like, well, something Free is better than nothing, right? So, so there is an international link there, but they are the CDC is tracking how many downloads from the so people that are using the app. They're also tracking there's a free continuing education module online called watch me. It's a it takes about 45 minutes to an hour to complete, but when you complete but when you complete it, you get a certificate of attendance. So this is a great you know thing to assign. If you're a professor, give it to your students for homework. But they also track the number of people that are doing the watch me training. So I will say that just so that we're all on the same page, although they track the number of downloads, the information that you put on the app doesn't go anywhere. So if you have a family that's concerned about their status, like I status, it doesn't go anywhere. It's not sent anywhere. You can, if you're working with a family, you can, you know, delete the information right afterwards. So like my students, they'll put like their first name, only you know, you can change the birthday by one day. So instead of July 6, July 7, if they were concerned, you can go through the checklist. You can have the results emailed to anyone you want when you're finished. But you can also, when you're done, just delete it right off. So you can just delete the child. So I always want families. To feel comfortable that the information isn't stored and isn't going anywhere, like you know the big government isn't getting this information about your child.    Jayson Davies     That's good to know. That's really good to know. We don't want the government doesn't need to know everything about our children. So all right, cool. We've covered so much, and you kind of talked a little bit. You just mentioned it almost in a jokingly matter, but I actually want to give you more of an opportunity to share about that data, you know, just to really make clear, this isn't data that was coming from children during the pandemic. You said this started in 2019.    Kate Barlow     Correct, right, so Jen zoopler is a pediatrician that works for the CDC, and she is the lead author on the publication on the CDC updates, and it's an open access article. I'll give you that link Jayson as well.    Jayson Davies     Got it here already. Good to go.    Kate Barlow     Because it provides the reason and the research why every single milestone was either kept or gotten rid of. So you can look up crawling, you can look up any single milestone that you want, and it provides the research to support it, or it gives you the reason, the reason why it was removed. So yeah, so this group started in 2019 and then they had already completed the revisions before they started to do parent testing in 2020 so it was not in response to COVID. The other thing that I heard was that they pushed back the milestones from children were supposed to do doing things that 50% and now they pushed it to 75 this is not true at all. We were flagging children at that 75th to 90 percentile or more on the old checklist, and now we're still flagging at the 75th percentile or more. So that did not change. So I think that's where a lot of the confusion was. So, for instance, let's say sits without support. So we expect children as OTs to sit without support at six months. It was on the old checklist at six months sits without you know, looking for, you're looking for the child to sit without support. And it was also on the nine month checklist, within that purple box of go see the doctor if your child doesn't sit without support.    Jayson Davies     But that's the 75th percentile, right at nine months.     Kate Barlow     At nine months, right? So now it's just on the nine month checklist.     Jayson Davies     Gotcha.     Kate Barlow     Right? So we're still flagging sits without support at nine months. It's just not on the six month checklist anymore, because we're not listing milestones around the 50th because it was too confusing. So we're still flagging at the same time. And this is, you know, people were like, it was six months, and now it's nine months. That's actually not, it's still nine months. So I think it's just an education and people really looking at the tools and I and I think that would be helpful. Oh, Jason, I have to mention one thing, any students that are listening to this do not study your your milestones from the CDC, because we as clinicians, if you look so I use the case Smith ot pediatric book in my class, and I believe that the NBC ot uses the case Smith book, and in her book, she has a list of milestones. And if you look at where the Kay Smith pediatric milestones are versus the CDC, you are going to see a vast difference, because the CDC is listening them for like, the 75th percentile, and K Smith is 50. So don't study for your boards from the CDC website. Please study from an occupational therapy source, because they are different. I just want to put that plug in there.    Jayson Davies     That's a great tidbit for all the students out there. Awesome. So I just want to confirm that. So what I'm seeing on my app, I won't see the sitting unsupported at six months. I'll only see it at nine months. You know, go back three years, four years. And if I would have been on this checklist, I would have seen it on the six months sitting unsupported. And if I would have checked, no, my son is not sitting at six months unsupported. What would it have told me? Would it have said, Just wait until nine months? Or would it have said, here's a few things that you can do to try to promote it. Or what did what was it like before?    Kate Barlow     Yeah, so on the back, there was activities that you could do, but there, there wasn't anything that you would do with the regular checklist, like the column on the left, there wasn't an action you need to do this. The only action was in the purple box. So, you know, sort of the red flag, like, if you you know, if you're not doing this, go see the doctor. The other ones was just like things that you should be looking for, and it just caused a lot of confusion. So I. I really do like the new milestones. You know, change is always hard. So people that, you know, I, one of my friends, was like, I really liked the having the 50th percentile, because it helps parents know what to do. But there are still websites for the CDC that still list the milestones in that manner, right? So that information is still available. It's just not on this communication tool. It's not on this Learn the signs, act early development monitoring program.    Jayson Davies     Gotcha, and remind me again, at what age does the checklist go up to? the milestones.     Kate Barlow     Goes up to five.    Jayson Davies     Okay.    Kate Barlow     So the American Academy of Pediatrics has a recommended child well, visit schedule and the Learn the signs, act early checklist, follow that same schedule. So two months, four months, six months, nine months, 12 months, 1518, 2436, four and five. Okay, okay, so that is when you're recommended to bring your child into see the pediatrician, and there is a coinciding checklist for those exact ages.    Jayson Davies     Gotcha. Okay, so then, now we've talked a lot about the CDC milestones, which we just established now is for the first five years of life. School Based occupational therapists who primarily listen to this podcast and OTs and some students as well. Kids typically start in the in school around their four and a half fifth birthday, depending on if they're going to preschool or whatnot, kindergarten, first grade. What do they really need to know about the CDC milestones? I don't want them to listen to this and say, hey, you know what? Those milestones only go up to age five. This doesn't really apply to me. So why does this apply to them?    Kate Barlow     So I really like this for when you're evaluating a child and they don't qualify for services, it's giving the parents a way to continue to monitor and advocate for their child. So a lot of times in the public schools, we evaluate children coming into the preschool, so between two and a half and three, we do a lot of evaluations. And so a lot of times the child is really smart and they have sensory concerns. Maybe they have a history of trauma, right? And so they have behaviors and sensory, but they're smart and they're not qualifying, and the parents are frustrated. You know, we can offer this as a way that they continue to monitor their child. And you know, in early intervention, especially, you know, come back in six months, because we know that as children grow and develop, if there is a delay, the gap is only going to get wider as they get older. So if the child is three and a half and they're in the 27th percentile, so they didn't qualify for services, wait a year, continue to monitor your child, right, and they might qualify next year if they really do have a delay. So I think it's a good way that we can help parents continue to advocate for their child. Parents also have multiple children. So you know, if you're working with one child, let's say the child is four, and the child is already on your service. Um, talk to mom about it, because they have another child that they just a baby that they just had right we really want everyone in the community to know that this is available. It helps teachers with milestones. It helps teachers assistants understand milestones. It's just a great tool. There are tips and activities that right on the app and on the checklist that we can do for children, for all of those age groups. So if we think about, you know, we're working with parents, preschool parents, special ed, we have a whole list of tips and activities that we can recommend for them to do with their children. And if the parent has the app downloaded, we can heart, which ones, you know, there's like a little heart, like to star, um, which, which ones that you would like for the parents to work on. So there's a lot of different ways that you can utilize the tool for early intervention. I love it because it has an appointment reminder, so you can set appointments on parents phone. But in the preschool special ed, we have an open house night, you know, you can put that appointment right in the phone. When I worked in the Boston Public Schools and they would have the open house nights, none of my parents ever came. Oh, it was such a Bucha, yeah, you know. So I can't, I'm, you know, work for the kids with special needs, and those parents didn't come. But you could, you could put it right into the phone these events that or an IEP meeting that you want families to attend. So lot, it's very versatile in the way in which you can use it.    Jayson Davies     Yeah, I love that idea. Like, the first idea that you really started off with going is you can use this as a recommendation to parents, because oftentimes, as school based OTs, right, we do that evaluation. And. And a parent might have a concern, but maybe it's not a school based ot concern. And so we can recommend, you know what? I know districts don't like when you recommend, you know, go see an outside OT, or go see an outside person, because they don't want that coming back to the district. But this gives you a way to say, hey, you know what? Download this app. This app will help you. By the way your doctor will want to see what you're putting into that app. So go ahead, use this app and give it to your doctor. Your doctor can then help make referrals as necessary to other professionals. And I think that's a great way for us as OTs, especially when someone doesn't qualify, or even if they do, even if we do recommend services, we can still say, hey, track along with us and follow this app. We're going to be taking data, but you can also be taking data very simply by using the app. So great idea. All right, so we're going to wrap this up with two last questions. Again. Congratulations on getting re upped in your CDC ambassadorship. What are you going to do next? What's the future plans?    Kate Barlow     So right now, I am working on planning the first ever Massachusetts statewide developmental monitoring and screening week. So this is a big undertaking. I'm not an event planner, so it's been interesting so far, but I have amazing group of women. Unfortunately, they're just no men. But it's, I'm not, it's not that men are included, but the team just happens to be all women from I have a representative from screen, every child from United Way, Boston Children's right? So it's this group of really amazing reach and Worcester of women that are trying to plan this event across the state. So I've actually reached out to colleagues at Regis and Vu and mgh, and you know, will you host a site, and getting all of these sites from WIC and Head Start and EI just bringing children in and having this awareness, we're doing it the same week as celebrating the well child. And this is, I'm just really excited, you know, it's, it's the grant that I had last year. I had some money at the end, and I bought sports $14,000 worth of books, so every child that comes to the event will get a book. I had them shipped to Boston and to Worcester and myself out here in Western Mass. So it's a big undertaking, but I'm hoping it's the first of many you know, Massachusetts is very siloed in its efforts for children. We don't have a Help Me Grow like other states do, so I'm hopeful that bringing all of these different agencies that are working together for the promotion of child well being. You know that we will come together and then continue to stay together in our work and our efforts Massachusetts, although you know the Casey Foundation, we were rated number one for child well being overall, which is amazing, but there's areas where we're really behind, like, you know, talking to Connecticut, we're so far behind in in some of our referral systems and some, some of our specific cities are not doing so well. So I'm really hoping to identify children through this effort, and we're going to track how many children get a developmental monitoring checklist completed, or screening tool completed, because if it's worthwhile, then we'll keep doing it. So that is my big focus for this coming year. It's going to be in April, so plenty of time to plan. But that's that's sort of my, my big project as ambassador for Massachusetts for this year.    Jayson Davies     That's awesome. That sounds great. Like you're you're you're gonna help a lot of kids that way. You said $14,000 worth of books, that's a lot of books. So you're gonna help a lot of kids. I love it, a lot of families. Awesome.    Kate Barlow     Thank you. Thank you. We're trying.    Jayson Davies     I'm sure, I'm sure, I have no doubt that you will succeed in this. And last question you, I think you already mentioned this a little bit. You throw out your email earlier, but anyone who wants to learn more about you, what's the easiest way to learn more about you and what you're doing?    Kate Barlow     Just email me. Absolutely. Email me. The mass act. Early website has information about what Massachusetts is doing, and my role as ambassador. And our events are always publicized. We do like a free continuing education event every year. So that's always on the on the website, and in my other, you know, my mentorship website, we have all of the information for meetings, upcoming meetings and recordings there. So yeah, if you're interested, get in touch.    Jayson Davies     Awesome. Yeah, we'll be sure to link to all of that in the show notes. So if you're listening, be sure to check out the show notes for this episode for all of those links. And yeah, I think that about wraps it up. Did you have anything else?    Kate Barlow     No, thank you so much for having me. This is fun.    Jayson Davies     Thank you, Kate. Have a great rest of your day, and I will see you next time. We're definitely gonna have to bring you back on for something. We'll figure something out.  Okay, great, thank you. All right, take care, Kate. Bye, bye. All right. And that is going to wrap up our episode with Dr Kate Barlow, one more time. Thank you so much, Dr, Kate, it's been a pleasure having you. Thank you for just clarifying a little bit about what's going on or what happened with the CDC milestones. There were some changes. Maybe it was a little overblown, but I'm glad we have got to the point. I'm glad you shared with us everything that that was changed and why it was changed. You know, it's all about the research. As OTs, we always have to point back to the research. And when the research says something great, we need to, we need to go with it. And when it says something isn't so great, or there's not enough research, we have to question it a little bit. And it sounds like that's what the CDC did here. So one more time. Thank you. Dr Barlow, thank you for listening to this podcast. You and yeah, I look forward to seeing you in the next episode of the OT school house podcast. Take care. Have a great rest of your week, and we'll see you next time. Bye.    Amazing Narrator     Thank you for listening to the OT school house podcast, for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast! 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 113 of the OT Schoolhouse Podcast. Have you ever thought about what it might look like working with transition-aged students? Even if you are currently working with them now, you may still question how to best use your skills to work with these older school-aged students effectively. Today, we are speaking with Justin Lundstedt, OTR/L, where he will discuss many areas of TAS and executive functioning. Tune in to learn how you can help these students find motivation and success in their life outside of school. Tune in to learn the following objectives: Learners will identify what transition-aged students are Learners will identify how OTPs can work with transition-aged students Learners will identify how the domains of the OTPF-4 play a role in transition-aged students Guest Bio Justin Lundstedt, OTR/L Justin Lundstedt is an occupational therapist of over 20 years. Over these two decades, Justin has worked primarily in pediatrics. He has spent time in physical rehabilitation, private clinic work, the special education field, and private therapy services. The majority of his professional career has been spent working in the special education field, where he has developed a strong interest in the development of executive function skills and how they are a key to so many of our student's ongoing struggles with regard to personal goal achievement. He specializes in the transition-age student because he believes this is an underutilized area for OT, and it has direct involvement with the success of our students transitioning from school to the community. Justin has developed his own practice and Brand to focus on these specific areas. He currently owns Achieve Life OT & PT PLLC and has created a separate entity to focus on the education and development of other OTs in the executive Function World named: The Executive Function OT. He has created an evergreen course called OT and Executive Function of the Transition Age student, has recently participated in Jayson Davies Back to School OT conference, and has hosted multiple other webinars on this topic as well. He hopes to develop a niche that will help our profession as OTs develop in a way where we are seen for our knowledge and potential in the world of executive function. Quotes “We're so focused on getting our students to, you know, a certain academic level or demonstrating this certain skill, that we focus again on those proximal goals so much, and we forget about the distal” - Justin Lundstedt, OTR/L “I do believe that we all have the capability, and motivation drives us, so if there's really that will to do, there's a way to find it” - Justin Lundstedt, OTR/L “You are not a one-to-one aid when you push into a classroom, you're not a teacher, you are an OT, and you have the skill set of an OT working with those students” - Jayson Davies, MA, OTR/L “What I'm really seeing at the older ages is, our expectations are high, where they may not have that development, and the development has changed” - Justin Lundstedt, OTR/L Resources: COPM Justin’s Executive Functioning Course Occupational Therapists for Executive Function Facebook Group Justin’s Instagram Executive Function OT Website Executive Function Book Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host. Jayson Davies, class is officially in session.      Hey there. And welcome back to another episode of the OT school health podcast. Thank you so much for joining us today. My name is Jayson Davies, and I am an Occupational Therapist in Southern California. So excited for you to be here today. Now I want to start off this episode by admitting something. I've said it before, but I've never kind of framed it in this way. I've never just said, You know what? I admit it working in the high schools is tough. As an occupational therapist, I have done it for part of my career, and I remember that first time after working in the schools for several years or in the elementary schools for several years, I should say, having to move in to that high school realm, it was tough, and I really had to reframe my thinking. In the elementary schools, I had become accustomed to working on things like handwriting, working on fine motor skills, how to use scissors, how to facilitate interaction at recess. Honestly, it was a lot of handwriting, a lot of fine motor skills and some sensory processing skills as well. But as I transitioned into the high schools, I really had to reframe my own thinking, reframe my therapy, and really get back to remembering that we are occupational therapists, not just handwriting therapists or sensory motor therapists. And that really helped me to kind of get in the game at the high school level. I started to really talk to the teachers and really find out what was meaningful for these students. I also talked to the students to find out what was meaningful to them, right? What was important for them, not only to do, but also to perceive they didn't want to stand out. Like my second graders didn't care about if I was in the classroom. They were happy to see me in the classroom. High school is completely different, right? So I'm excited today to bring on our guest. His name is Justin lundstedt, and he has worked with high schoolers for a long time, and he's also worked with young adults, I guess I can call them after high school. So he has a very unique perspective on this, and I'm excited to bring him on. He's going to talk to us all about executive functioning and how to work with transition age students, those students that are in the realm of 14 to 22 Justin lens that we had the pleasure of hearing from him at the back to school conference, and I just loved everything that he had to say. So we're bringing him on for an episode of the podcast. I hope you enjoy this. We're talking about executive functioning, how to provide therapy in the high school setting and transition age students. Please help me to welcome to the OT school house podcast. Justin Lundstedt. Justin, welcome to the podcast. How you doing today?    Justin Lundstedt     I'm doing great. Jayson, how are you doing?       Fantastic. I am ready for fall. It is finally cooling down here in Southern California, and we got some fall weather.     Justin Lundstedt     Yeah, same here over in New York. The the leaves are actually at peak this week, so it's been sort of Awesome.      Awesome, man, I we don't get red, orange or yellow leaves here in California. It just doesn't have it just doesn't happen. I gotta go somewhere to find them.    Justin Lundstedt     But yeah, yeah, it's gorgeous over here right now. Awesome.      So let's dive into occupational therapy and Justin lundstedt, I mean, you are here to talk a little bit about executive functioning and the transition age student. We're going to dive all into that. But first, I want to give you an opportunity to share a little bit about where you are today in the world of occupational therapy. How'd you get here?    Justin Lundstedt     You know, long story short, I actually started off in a Gen, Ed School District, and then went into children's rehab, where I first really, you know, explored and discovered, really, the opportunities of occupational therapy, and from there, went to a special education school district, and really got my feet wet with regards to education, the academics. But you know, even more of our scope from ot working with a lot of transition age students, the older students, and focusing more on what happens when they leave school, which really became my love. So I've been doing this for about up to 22 years now, and love what I do. And have even, you know, developed my own stuff at this point, and have gone into some private practice and, you know, so that's where I am.      Awesome. You know what? I want to dive into that a little bit further, because you kind of hinted at that beyond public school, or beyond, you know, high school level. And so what does that look like? Where do I mean, to be honest, you know, what happens to students after they graduate high school? Like it's kind of that in public schools, we kind of stopped at that 18 or maybe 22 Yeah, exactly. But, but what do you see beyond that?     Justin Lundstedt     I mean, I see a lot of challenge, you know, so, like, one of the biggest things that I recognize is that under employment rate, that unemployment rate and the, you know, the want of students to be able to go into secondary education with, like, college, etc, but not having the pathway to do so. So a lot of my students who have a lot of significant impairments, you know, we work with them and really identify their goals. So it's really looking at what is their look at, as far as outcome after school, whether it be working at a job, full time, part time, living in a community based situation, independently, going to college, all of those things, but how they're going to work it, and how they're going to be successful at it,       Awesome. And so then you've worked at the high school level, but if I recall, you've also done your own thing outside beyond the high school level, right? So explain that a little bit. What have you done with that next age level?    Justin Lundstedt     So I actually had the opportunity to create some executive function curriculum for some community college students, and was an instructor. So I was out of my ot realm, but in an instructor realm, as far as educating them with regards to their own executive functioning skills and developing those because a lot of the times, you know, our students, especially those with intellectual disability or in you know, more of the special education setting, have been sort of led through school, I found, and don't have that real individualized outlook on what they want or where they want to go. So it's almost to the point of where we were recreating what is a goal and how to develop that, and how to build from that, and then find their, you know, find their why?      Wow. And I mean, sorry, questions are just coming to my mind. None of these questions were on our document, but I love that you're answering them. What happens to an IEP when a student graduates? I would imagine you might have some insight into that. After they turn 18 or 22 and they go to community college, they go get a new job, what happens to that IEP, if anything?    Justin Lundstedt     So there's not really an IEP anymore. It's really more self advocation for your disability, you know, more so from the individual. But obviously, if you have supports around you, those people you're working with, you know, admissions officers and accessibility and disability office, you know employers, with regards to how that, you know, assists them.      So they're not sorry, but there's not like a formal program the IEP doesn't continue. It's more of I need to seek out assistance from either my employer, or from my college, I need to go to them and try and figure out what's available?     Justin Lundstedt     Correct, correct. So usually, there's an office of accessibility and disability in a college that you would go to and work with them with regards to your disabilities, where they can help you and assist you with either finding academic advisors or assistants or working with accessibility and modifications, those types of things.      You know now that you say that, I remember I went to the University of Southern California, and I also went to a local junior college, Mount SAC and I remember they're popping up some like, get paid to take notes for a class that you're in, and it was coming directly from the school, and they even kind of said, you know, you're taking notes for someone that's in that class that needs support with that. And I never thought about that, really, until just now. And you said that that could be like a support another student in the classroom, right? Takes notes, and then they you provide those notes, you get paid, potentially, to take those notes, and then you give them to the to the school, who then passes them on to anyone who might have a learning disability or something like that in the classroom. Exactly. Wow. Cool. All right. Well, you know, that was a great intro, way more than I thought it was going to be. So let's go ahead and dive into the transition age student. Ta, yes, and let's just start kind of here with a working definition, because not everyone works in high school, middle schools, not everyone has the same experience you have. So what is a working definition for a transition age student? What does that refer to?    Justin Lundstedt     I mean, So a transition age student really references an individual between the ages of 14 and 24 you know, there you can argue the beginning and the end ages. Some people say 16 to 21 some people say 14 to 24 but that's really the age group that you're looking at, those students who are beginning to look at, you know, the independent life after school. And yes, it does start early, but it starts early so that they're able to get there. You know, while there's again, looking towards adulthood and that independent sustainability. So this is the age where we're looking at the development of skills that'll really allow these students, you know, the ability to survive in their environment post high school, whether it's college vocation or daily living.      Awesome. And, yeah, it's my understanding that that. Early, we have to start looking at a transition plan at 16. But some states are moving closer to that 14 age range. They're starting to say, hey, let's start earlier. Correct? Why do you think that is actually?    Justin Lundstedt     I think it's really so that there's more of a focus on what the student's goals are for post high school, you know, post school age, so that they can really get all of their ducks in a row, per se, you know, it's, it's really, so that they can identify the goals and start working towards them in a purposeful manner. Because otherwise, it's just, and this is my professional opinion, it's just redoing all of those daily living tasks, those pre vocational tasks, without true focus on what the students really looking for and moving towards. And again, as OTs, that's what we're looking at. We're looking at, you know, the client's perspective of their lifestyle.      Yeah, yeah, absolutely. So we're going to dive into kind of what maybe a transition plan looks like in a little bit. But first, I want to ask you about kind of the historical reference of transition age students. You know, ot has only been in public education for about 3040, years. And I would imagine that working directly with transition age students, whether an OT or someone else, is probably relatively new to schools. So can you just give us a little background of maybe where or when school started looking at transition age students?    Justin Lundstedt     I mean, it really started, if I remember correctly, back in the 70s, 70s and 80s. You know when the Office of Special Education and rehabilit Rehabilitative Services programs started looking at outcomes and recognizing that there was a need for, you know, increased assistance with students with intellectual disorder and special education needs in order to promote their independence and their lifestyles post high school. And then through there, you know, you you really developed in the idea, you know, the reauthorization of 1990 1997 really brought about the development of transition services to promote greater independent life outcomes for students with disabilities.       Yeah, again, you know, idea really brought about ot within special education, and I'm sure the same way it brought about understanding, hey, students aren't graduating. Those with disabilities aren't graduating. We need to do something. And with every passing or reauthorization of IDEA, I'm sure that's an area of interest, mostly because all the research, I think, is showing those with disabilities are less likely to graduate, get a job, live independently. And we know how much I hate to use this term, but that's what really the government looks at, is how expensive it is to take care of someone once they're no longer under the care of their parents. Absolutely. Yeah. So, so that's, you know, it's kind of one of those catch 22 like it's, it's hard to think that we need to look at this so much, but at the same time, it's great that we are looking at it so much. So I'm sure idea will continue to to look at transition age students, absolutely. All right, so let's talk a little bit about what you have seen in your own personal research discovery as well as just what you're seeing out there with OTs in general or other practitioners. What are OTs doing in relationship to to working with students with that are in that age range?    Justin Lundstedt     I mean, I'll be honest, I think there's, it's half and half. I think there's an awareness, but there's also an unawareness of what we're able to do with those students. You know, I think those that are in that field are really working towards developing the motor skills as well as the cognitive skills, which, you know, for me, that's sort of my my area of interest, utilizing those cognitive skills, the executive function skills, the goal directed skills, to really identify what you're trying to accomplish and how, and then from there, recognizing the strengths and weaknesses that you can use to get there. So it's really working with the student. You know, it's the traditional sort of definition of we're trying to modify, adapt or assist in developing those skills that the student needs in order to promote their adult lifestyle. So it could be anything, um, there's, there's a wide array. We can talk about academics, we can talk about vocation, we can talk about life skills, you know, we can even talk about social and leisure skills. Those are all things that impact our students lives. In secondary, you know, in high school, in middle school, and they actually are more focused in those grade levels, because now we're undergoing a lot more development and a lot more awareness and a lot more need. Needs to interact in order to get our own needs met.      Okay, cool. And then when you specifically have you had a chance to dive into the research at all. And you know, when we have a question about something, or when we want to look for something more about a particular topic, we often ask ourselves the question and look for the answer to that question, right? Have you found any answers to questions by looking at research? Or have you found that something's missing when you look at the research?    Justin Lundstedt     I've found a lot of information that states ot would be great at this, if we got more into it. You know, like with regards to even Transition Specialists, executive function, all of these areas. There's a lot of research out there that says we have great skills to assist with but there's not a lot out there that says we're implementing it at a regular rate.      I love that. That's like the everyday conundrum. It's so similar to the role that ot plays in RTI as well. There's a lot of work, or a lot of research out there that says, OTs say they want more information on RTI, but they're not actually doing it, but they would be great at it. But we need more research that says, hey, this is what you can do, right? There's RTI, or as being a transition, transition age or working with transition age students. So yeah, we need more research. That's the end of the day answer, absolutely. Alright, so let's talk a little bit about what we can do as therapists and the transition age student. I first want to talk about the plan, a transition plan, because I think that's kind of the overarching picture of what we need to kind of, it's like the IEP, right? Or it is part of the IEP. So can you share with us a little bit about that transition plan first?    Justin Lundstedt     So with regards to the transition plan in the IEP, you're really developing, and it should obviously be a collaborative process with your full IEP team, with honestly, the student heading it you're developing this plan in order to identify the expectations of the student for after high school, the you know, hopes, the goals for the student. I don't want to say hopes and dreams. I want to utilize the right terminology here, the goals for the student after high school and what skills or deficits they may have at that moment that are limiting them. So then we're promoting goals within that transition plan that are focusing on their exit. And this, you know, it comes about with utilization of evaluations and consulting with parents and teachers, you know, again, using the whole IEP team to collaborate, but focusing on the students what they really want in the future.    Jayson Davies     Yeah. And so, comparing it to an IEP, obviously, in an IEP, we have goals. What is the difference between a transition goal and an IEP goal? You just kind of mentioned, right? You're looking beyond.    Justin Lundstedt     Oh, absolutely so. And I'll tell you how we sort of do it. In my school, we take the transition goals and we create them as sort of this long term objective of what the student is seeking. And so let's say they want to go to college for computer design. Okay, so that's maybe their educational part of the goal. So then within the IEP, you're going to be looking at, you know, whether it be academic goals or motor still motor goals that are going to focus on that end transition goal. So you're actually taking the transition goals and then building it into those specific IEP goals as well.    Jayson Davies     I love that. That is a great example. I really like the idea of using I'm seeing this language more often distal and proximal goals. So you're creating a distal goal of that student going to college, that student getting a job, and then you're creating more proximal goals that you might fit into the IEP that are being addressed year after year, or are being measured, I should say year after year to lead to that distal goal. Absolutely love that. That's awesome. So I've got to share an experience. I have worked in a high school on and off a few years, not a ton. I have been a part of transition plans, because every kid in high school that has an IEP has a transition plan, but I must admit, they have been, for lack of a better term, fairly shoddy. These goals are for a student to attend a career fair. The goal is for a student to look into potential jobs. Yep. I mean, why do you think that is? And I'm at, like, a pretty, you know, a suburban upper end High School, that's kind of what's going on. Why do you think that's the case?    Justin Lundstedt     I think it's truly unfamiliarity with the process, you know. I think oftentimes we're so focused on getting our students to, you know, a certain, certain academic. Academic level or demonstrating this certain skill, that we focus again on those proximal goals so much, and we forget about the distal, you know, and something that I always say to I still work with one classroom of four and five year olds, and I actually just had a discussion with a parent the other day, and I said to them, the one thing I always state is think about them at 21 you know, whether it's behaviors or whether it's whatever you want to look at from your child, but think about what they're going to be if they stay how they are today at 21 and is that what you want? Because it's and again, I understand it's not about what the parent wants, but at that age, it is, you know, and we're really developing to a point where we want to focus on what the outcome is going to be, the long term outcome, and creating those short term goals in the sort of, you know, temporary time being. But when it comes down to it, we're so consistently looking at grade to grade that, you know, that 12th grade or that 21 years comes so quickly because we're so focused on all the other stuff involved. So I do agree with you. I've seen a lot of IEPs that are like, we'll go to a job fair, we'll, you know, search for a job in the community, and there's no, there's no meat to it, and then when they get to that later age group, it's like, okay, let's scramble. What are we going to do now?      Yeah, yeah, that's unfortunate. And you mentioned a little bit ago, I think you Gosh, what was the term you used? It might have been like the transition team leader or something like that. Like, I have not come across one of those here in our district. It was just kind of a collaborative effort, I guess you could call it, but it really was on the onus of the special education teacher. They were the ones the case carrier, that really led the charge. And if they didn't reach out to me about a transition plan, I didn't know about it until the IEP. So is that typical? Is it typically the case carrier, or are there other people working on this?    Justin Lundstedt     There It should be a collaboration. There's like so again, I'll give you my professional opinion. There should be a collaborative transitional team involved, because you're looking at all aspects of the child's life or the student's life, you know, most places. So a clinician may be the lead and a teacher may be the lead. It depends on the different districts. I know there's a lot of differences, you know, throughout my area, and then there are some districts that have a specific transition coordinator, but that, to me, is just starting to develop and become more popular because, again, it's another position put into place.    Jayson Davies     All right, cool. So I want to move into the actual side of the intervention. I think a great way to kind of transition over there would to be to ask you, we talked a little bit about shoddy goals, what are examples of maybe some good goals that might be put in place. And I know I'm putting putting you on the spot here a little bit, but what types of goals have you created that you think are halfway decent goals?     Justin Lundstedt     Um, none of them. No, I'm just kidding. I mean, from an academic perspective, I have created goals that really focus on so I can think of one student who really has, you know, some issues with dyscalculia, and really has difficulties organizing the math on paper, and actually wants to do more of engineering architecture, and is in that kind of a program right now, but is having difficulties with some of his math work. So one of his goals is to utilize, you know, specific, and I can't think of the goal off the top of my head, I apologize, but to utilize specific methods to perform the necessary concepts for his class work in math to, you know, promote and achieve the necessary grades that he needs to pass the class, because that is his goal, to their move forward and hopefully do more of that type of work. So that would be an academic type of goal. Does that make sense?     Jayson Davies     No, I like that, because you kind of shared the proximal and the distal side of it. The distal right is for him to eventually get into engineering, architecture, right? And then from there, you develop the more proximal goal that is the here and now, what he needs to do in his math class in order to work toward that long term goal. Great, love it. Thanks for sharing that.    Justin Lundstedt     No, no problem and and it's hard because, you know, we're trying to move towards those goals, where it's not just an OT isolated goal, but there is still a lot of that out there, you know, where we're creating our own goals and not working off of the full blown educational goals, which I think is typical in a lot of districts. But there's also a lot of districts starting to shift, and just everybody is focusing on those specific educational based goals.    Jayson Davies     Yeah, yeah, definitely. So we got completely way off topic. I'm going to try to bring us back here. I love it. I love where this conversation went. But now talking about that transition age student, we already talked, you know, 1421, 22 age range. When I think of, I don't want to use the word kids, you know, they're teens, they're young adults, when we think about that age range. We're talking a lot about social skills, emotional skills, obviously, cognitive growth in different areas. So now, in what ways can OTs really work in this age group? I get a lot of questions from OTs saying, I don't know what to do with high schoolers. Like, where do I even start?    Justin Lundstedt     Yeah, so I think my biggest way of identifying how to engage is really to either utilize something like the copm, the Canadian occupational performance measurement, or really doing a nice observation interaction with the student to identify their goals and their cognitive level. So yes, there's a lot of social stuff going on, and there's a lot of leisure based, you know, activity going on, mixed in with the academic and then you have the pre vocational. So it's really a conglomerate. And what I do is I break things down first of all, to see if they even have future goals. You know, because so often in the IEP, their goals are not theirs. And that's my first level. It's, it's the, you know, the old task analysis. I take it from, I'm looking at the client, and I want to break them down and task analyze them into each section, whether you know, from academic to vocational to ADLs and see where they're going. And like I said, there's so many of my students that don't have goals because they've been led through life rather than been asked what they want out of life. And so I'll ask students, what do you want to do? And they look at me like there's an after this. No, and it's, it's shocking. Well, it used to be shocking, and now I can sort of break it down and sort of prompt them with questions. So I use some coaching in there to prompt with questions. And then we together identify maybe somewhat of a plan, and then we work collaboratively as a team to develop that plan further.    Jayson Davies     Awesome. Awesome. Yeah, there have been some high schoolers that I'm working with that sometimes I think of the old, oh man, it wasn't, it was Allen Iverson that said, I'm just here so I don't, or it's just practice. I can't remember who it was that said I'm just here so I don't get fined. Like, it felt like the kids were just coming to OT because they had to. They didn't. I mean, there was no volition to be there. They didn't care what they worked on, and they even knew that the IEP team was often the decisions were being made by this IEP team that they didn't really have a say in. And so they're just like, I'm just here to work on the goals that you tell me to work on. Yeah, and I think that's a problem.    Justin Lundstedt     Yep. Oh, without a doubt. And that's where, and I get a lot of that too, especially with, you know, you're getting close to graduation. Oh, I'm here, what do you want me to do? And I'm like, I don't want you to do anything, you know? And that's where I first initiate that whole breakdown. Because they're like, Huh, you know. And they want to know, what am I supposed to be doing? And I ask them, you tell me, what are you supposed to be doing, and why are you doing it? Because if there's no why behind it and there's no motivation, you're not going to see any interest in success whatsoever. You're just going to have that student who's like, Okay, I'm here, you know. And sit, sit around and stare at you for 30 minutes, whereas, if there's a purpose for them and there's something that you could pull out of them that they really want to achieve, then you're going to have, you know that 30 minutes is going to feel like five.    Jayson Davies     Yeah, yeah, definitely. And I love that. You you tied in the copm, we'll be sure to link to that. It's pretty easy to find on Google, but for anyone who has any trouble, we'll link to that. So one thing that you did, and I love how you did this in a presentation at the back to school conference, is you broke down the domain of OT a little bit, and you broke it down to from occupations to client factors, performance, skills, and so we don't have to go through all of that. But if you had to look at occupations as a whole for this age range, what are maybe the two to three things that you're finding are most the biggest concerns, I guess, for the students, because obviously, an occupation can be anything, and the IEP team can come up with anything. But what are you seeing the the kids most focused or energized about?    Justin Lundstedt     So I think there's a there's a couple of things you could look at there. So I think one of them is really looking at the academic or the education area. So often we start to shed some of the academic expectations as they get older, because we're like, Okay, this is where they're going, and we sort of almost pre identify their their course, their path. For them where and like I said, this one student who I worked with with math, he wasn't even on the track to go into that kind of a course until a couple years ago, when we really identified that academics were of interest to him, you know. So it's really, again, pulling out their interest and identifying, hey, wait, there actually is more academics to be learned here. So that's one big area. I think way too often we pull back on that and focus on the life skills that they're going to need, but they may have those life skills, but where's the motivation to participate in whatever it is other than life skills that they want? Does that make sense?    Jayson Davies     Yeah, yeah. I can think of kids that I've had very similarly, right? Like, they just, I don't, I don't need academics. I'm gonna go start a business. Like, okay, well, well, what do you need to know to start a business? Yeah, right. And that can lead to some generation for them, or that motivation for some academic skills, right? Do you have the math that you're going to need. Oh, no, I just have a calculator on my phone. Okay, do you know how to use the calculator on your phone? Is your calculator a good enough calculator, like so many things, right?    Justin Lundstedt     Yeah, yeah. Can you do more than just access YouTube or the apps that you're looking for on that phone and you recognize it as a tool or just an entertainment center, you know? And that's huge. So from an academic perspective, there's that. And then, you know, pre vocational and leisure slash social are the other two big ones. You know, because number one, once you leave high school, you're on your own island, unless you're looking and finding what you need, or there's somebody finding it for you, which, yes, there's students that have a team that are helping them out, but then there's other students who are leaving and going into an abyss where they don't know what to do and how to access people and don't have transportation and they're at home.    Jayson Davies     Yeah, that's scary, scary to think about.     Justin Lundstedt     Yeah. And they rely on, you know, their video games to interact socially, which is great, but you're not getting that emotional attachment or that motivational attachment. It's just talking into a screen.    Jayson Davies     Yeah, you know, and this is off topic, but not completely off topic. Social media. I'm really surprised that OT, as far as I've seen, hasn't really gotten into social media. There's been, there's been aspects of people using virtual augmentative reality for therapy. But I don't even think we as a profession have acknowledged social media as a meaningful occupation, and I think it is almost necessary for it to be its own occupation, because it is part leisure, it is part education, it is part work. It is, I mean, there's so many pieces going into social media.    Justin Lundstedt     Yeah, no, I absolutely agree with you. And you know, fortunately, between myself, our speech therapist and our educators and our clinicians, it's, it's a nice collaborative where you have to be on top of that stuff too, because stuff goes on into the school that, you know, one student might be hurt by another student, and then there's students that are trying to get jobs and don't understand how to use the resume system on like indeed, or something like that. So, you know, there's so much from a social media perspective, to engage with and interact with.     Jayson Davies     Yeah, yeah, definitely. So we talked a little bit about some occupation at the higher end. We talked to me and about several we talked about academics, work, leisure, social media, if you want to call that an occupation, and then other areas of the domain. I'm just kind of kind of, you know what? Let's go down client factors. And you've already talked a little bit about this. I think this is, can be where the copm can really come into play. But that client factors, what do you tend to look for at that transition age range?    Justin Lundstedt     I mean, from client factors, I'm really looking at their first and foremost. You have to look at their environmental context, you know? I mean, you have to see where are they coming from, where are they living? What are they near? Who are they near? All of those things. Because, again, we're looking at how they're going to be able to engage. You know, another client factor is family wise. You know, do they have a strong knit family? Do they have that team around them that's going to be helping them build? Are they independent? Are they sort of on their own? Do they have many siblings that need care as well. You know, those factors, what are their values? What are their ethics? What do they really feel and believe about things moving forward? You know, what's what's meaningful to them? Do they have religion involved in their life? You know, all of these factors really participate in, you know, engage in their occupation.     Jayson Davies     Yeah, yeah, definitely. As OTs, you know, we all, we all have the access to the otpf for or at least we should, and so everyone needs to go through and look at the entire domain and how you work through each just kind of, it's almost like a chain, right? You just kind of move from the occupation, start large, and then move down. To figure out where you want to go. One last area within the domain that I do want to get your take on, because I think this is very unique to students of this age range. Is their roles, their habits and their routines. I think that they're very unique in the sense that, well, I mean, they're just in high school. High school is a whole beast of its own thing, and I think that high schoolers have a very unique set of roles and routines that sometimes we as adults think we know because we were there once upon a time, but obviously it's very different. So I'd love your take on that.    Justin Lundstedt     I mean, so before even saying anything, I have three teenagers in my house, you know. So I get sort of a cheat sheet there, because I see it on a daily basis. But it is so different from when I was a teenager, you know, just because, once again, you have social media, you have all of these constant sort of demands placed on the students, from a role perspective, they have to be a friend. They have to be responsible. There's definitely more responsibility placed on Gen, Ed, especially, I recognize more responsibility on what they're in charge of, what they need to take care of, you know, all of those things, from maintaining the school computer to, you know, looking on Google Classroom for their homework. It's not written down in class anymore. It's go check it on this, you know, web page, so it's carrying over all that information. So they have a lot more roles. They have a lot more responsibilities. From the fact that, you know, a lot of students are working at the younger ages. Still, they're getting jobs. But on top of that, now they have so many sports and so many after school activities, so they're bouncing from one thing to another. And our students in special education sometimes get lost in the shuffle in that, because they are brought to all of these activities. But then sometimes they lose those roles because they're just brought to them, rather than being engaged in leading themselves into them, and saying, This is what I want to do. So they may lose some of their roles, whereas other teenagers may be gaining multiple roles, if that makes sense.    Jayson Davies     Yeah. I mean, I think that even kind of encapsulate, encapsulates some of the changes in special education as a whole. You know that used to be a a clear goal, basically, of students to participate in everything, and I think that that goal is now changing to allowing students to choose what they want to participate in, right? It used to be, hey, you're in high school. You're going to go to all the classes that a typically developing peer would go to. So we're going to put you in a in a math class. We're going to put you in PE no matter whether you like it or not. And we're starting to see that change a little bit. And so we're giving them more power to make decisions on their own.    Justin Lundstedt      Now with that power, again, comes, you know that traditional saying, with power comes responsibility, right? Yeah. So with the responsibility we have to look at, and this is something that I think gets overlooked, often their cognitive level or their neurodevelopmental level, and that's where my sort of love for executive function comes in, because so many of our students, they are missing pockets of that cognition or of that executive function, and we just have expectations that they can do because they present as such. But then when you dig deeper, and as an OT this is where I task analyze, and I sort of figure out what's missing, what piece isn't happening, you recognize that, oh, man, they're not even you know aware of that, or they don't have the impulse control to even you know, be able to hold that in or the working memory to retain that information, you know? So those types of things are what I'm really seeing at the older ages, is our expectations are high where they may not have that development, and the development has changed. You know, there is definite research on that.    Jayson Davies     Yeah, yeah. And if you're listening right now and you're thinking of a particular student, you're not alone, so am I? So yeah, you know, that's what we do. Is over to use, right? Man, I could go in so many directions, but one thing that I have had only one student, even really this concept, come up with, and it's the student that I am thinking about is sports. And students that are in a more mod severe classroom, maybe they have, you know, they've got some skills, kind of like that kid that you're just talking about, right, that you can see that they've got a lot, but when you look underneath everything, you see the difficulties that they really have. Yeah, and kids should have the ability to participate in sports, participate in music, participate in all the extracurricular stuff. And so I'd love to get your take on on that. And if you've ever had the the ability to kind of work on those extracurriculars with a student.    Justin Lundstedt     I have not had like particular because I'm in a special ed school. We don't have all of those opportunities. What we do do is we make sure that if they have the interest, that they have the opportunity in their home district to go in and participate. I haven't had the opportunity to really have that kind of interaction, but I will say that my opinion is where there's a will, there's a way, you know, it's really finding that modification or that adaptation, or, you know, educating the other professionals as to the limitations that there may be in order to find other ways to be more inclusive. So it's really to me, I don't see any barriers or walls. I'm always that guy who's like, full steam ahead and trying to crash through. Because I do believe that we all have the capability and motivation drives us. So if there's really that will to do, there's a way to find it.    Jayson Davies     Yeah, absolutely. And, man, I can't remember where where it is, but I believe in idea. It does point out that idea includes extracurricular activities. So if you're in a position where, you know, you've got a student who wants to play baseball or whatever it might be, advocate for them now that may come with a little bit of a cost, you know, it's really hard. You might need to be the person that goes out to baseball with them as the OT, and you're going to have to try and make that work, you know, or is there someone else that can go out there isn't a higher during that time, or talk to the coach and, you know, try and work out some sort of system. But I do believe that there needs to be more done outside of the eight to three o'clock, whatever school hours is, you know, for kids who want to go out and beyond, definitely.    Justin Lundstedt     And I think that's another role that ot has, is to really interact and create more of that collaborative process, because we're able to recognize those adaptations and modifications and speak with those other parties that may not have the awareness.    Jayson Davies     Yeah, you don't realize how much of a specialty it is that you may be the only person actually thinking to go talk to someone. Yep. I mean, just the idea that you have, that you know the student, and just say, hey, why don't we go talk to the talk to the coach, like other people may not even think to do that. And as an OT when your task analysis, or do your task analysis, you might come to that conclusion and and go for it.    Justin Lundstedt     Yeah, absolutely, absolutely. And that's where I feel like ot as a whole is very unique, because we learn from that sort of task breakdown perspective.    Jayson Davies     Yeah, yeah. So I want to talk to you about two things that often come up. I'll start with this one, RTI, and that is because even myself, when I speak about RTI, I am often speaking at speaking about it from more of that elementary age level, starting young, so we can prevent evaluations, unnecessary evaluations, not all evaluations When a student gets older, but RTI can absolutely apply to all grade levels. And so I want to get your take on RTI as it relates to the high school.    Justin Lundstedt     I mean, from my perspective, utilizing RTI, you have your direct services, which are great, but there are ages. You know, there are students in those age groups that don't need necessarily direct treatment, but they need something, something more to help them. So those tier one, those tier twos, can be more utilized to promote some of that. So, you know, co teaching at a tier two. So if you look at RTI and you're looking at your tier two, co teaching is one of the possibilities. You know, working in a group with a teacher, that's something that I do in my own school. And I work in some of the English classes or the history class, and I work with a whole group of students, we work on a specific thing as far as locating some of the research and finding the answers. And how do we do this? And you know, both the visual perception as well as the cognitive awareness of what we're looking for. It works as a whole. It doesn't necessarily need to be direct treatment. It can be indirect. It can be co teaching. We can be using tier ones to create programs like those that you're speaking of, with regards to athletics or music. You know, we can be creating programs for bullying, and that's I think, even in the you know, best practice book through ot a discusses that developing programs is another way, because we have that awareness of our students needs and deficits, where we can incorporate it into a more inclusive environment.    Jayson Davies     I love those ideas, and now I'm going to push you, because I know someone listening right now is wondering, wait Justin, just said he goes into a classroom, he sits with a group of kids, helps them find research, helps them find answers. And they're thinking to themselves, because they they tell me, this is that's a one on one eight. And so I want to ask you, why, why are you not acting as a one on one aid. When you do that?     Justin Lundstedt     Because I'm using skill based intervention to recognize the deficits from a cognitive perspective, you know, I can as a one to one aid, yeah, I can sit there and I can feed them information, and I can tell them what to do, but I don't know their neurological development. I don't know, the breakdown of their perceptual skills versus their understanding of the question versus their ability to retrieve the information from, you know, previous classes, and you know, then I'll one up you on this that I'll get the why can't it be speech? I'm not saying it can't be speech, but that's where you have to work on your collaborative team and identify who's taking this role and why, you know, and it may come down to, well, they also have some motor issues with writing or taking the notes. So maybe that's more you Justin, you know, or maybe it's just a cognitive, expressive issue. So maybe that's more you speech, you know, that type of a thing, but I get the same questions all the time, and I responded to those types of questions on Facebook all the time, just because I want to be that guy that promotes ot but, yeah, I definitely recognize why people think you're just a one to one aide, but you've got to recognize you're using your skills that other people don't have.    Jayson Davies     100%, See, I'm not the only one who says that. Everyone listening. It's not just me. You are not a one to one aide. When you push into a classroom, you're not a teacher. You are an OT, and you have the skill set of an OT working with those students. Yes. Oh, right. Now, that's tier two going into the classroom. I gotta ask you about tier one at tier one. Have you either a developed any sort of program or B? Have you done in services for high school teachers? I'll have a follow up, but I'll let you answer that first.    Justin Lundstedt     I have done in services in the past for high school teachers, more focused on the vocational aspect of things and how we break down skills, from motor skills to cognitive skills to even emotional skills, why we're seeing some of the behaviors we see, you know, and that has really been effective, in my opinion, because it gives the staff, and now this is teachers and aides together, the awareness of really what we're looking at. So, you know, then you could say, now they've got some of those skills to see it, right? So maybe I don't need to provide that direct intervention, and we can go from there. So now we're not utilizing me as a direct intervention person, but we're utilizing me as an educator to promote so that they don't need me.    Jayson Davies     Yep, absolutely. My follow up was going to be what what courses or what development you've given to the teachers, but you kind of answered that, what is the most I don't know. Maybe you get requests or don't get requests. What have you had requests for when it comes to speaking to teachers, whether it be from teachers or maybe from admin? Are there any things that kind of continuously come up that they want you to present about?    Justin Lundstedt     More recently, it's become more about behavior, and so I put a flip on it, because I really recognize it more as executive function and goal directed skills. And a lot of times, our students don't have the self awareness to be some of their behaviors are not goal directed, their their automatic reactions or learned reactions. So they're not utilizing their, you know, neurological skills to promote this behavior. They're usually utilizing a mix of trauma and, you know, a mix a mix of trauma and learned reactions, and getting that reaction from others to then sort of use those as a functional response. Yeah. Does that make sense?    Jayson Davies     Yeah. I think that's fair. I mean, again, coming back to you're an OT and you have the ability to look below or beyond the behavior and go to the next level, what is really the behavior? What the behavior is more of an outcome than it is a cause or reason for what you're seeing on the outside. And so by looking at the executive function, you're getting deeper.    Justin Lundstedt     Right? And you're you're able to sort of break it down in, then through breaking it down, create the relationship, and then sort of build back up.     Jayson Davies     Wonderful. All right, you know what we are getting close to wrapping up, but I want to do a few rapid fires.     Justin Lundstedt     Oh boy.     Jayson Davies     Yeah, rapid fires. And just for everyone listening, Justin has no idea what I'm about to come up with. So let's go handwriting and high schools. Handwriting intervention in high school.    Justin Lundstedt     it depends on the student, and it depends on their goal. I have students who still work on it at times, but not for you know, they're not writing essays. They're they're typing their essays, and if they really want to work on getting their handwriting down, they may write a couple of sentences from the board, but. But that's because that's their goal, that they want to be able to effectively do or signature, you know, that's another big one for people. But and those that still write out checks, you know, we still have some of that too. So I'm not saying it's obsolete once you're in high school, because it's not, there are things that can be utilized. It's also the student's goal, you know, it's, it's really what their what their focus is.    Jayson Davies     Perfect, perfect answer, in my opinion, at least well the next one I had, I had working on sleep for a student at the high school range.    Justin Lundstedt     I mean, this isn't something you hear often, but, and I haven't had a specific goal for it, so don't, don't, you know, think that I'm all into the sleep situation, but I do have goals with my students about identifying their schedules to promote their ability to function, because so often you have students who are, you know, sucked into social media and Video games until two or three o'clock in the morning, and then they're rolling out of bed at 530 and coming to school, and that's where, again, breaking it down, identifying what their goals are and seeing how to get there.    Jayson Davies     All right. See everyone listening. Knowledge consults only in high school.     Justin Lundstedt     No way. If Listen, yes, there are, there are situations where consult only is fine, but if you have a student who doesn't understand their own impairment, they need more than just a consult. They need to understand what's going on themselves. It's individualized, you know, and there might need to be some direct service in there so that you can work with the student to understand their own strengths and weaknesses. Again, I work with students, and I ask them, What are your strengths and what are your weaknesses? They can give me 10,000 strengths, but as soon as it comes to weaknesses, they don't know anything. There's, there's nothing wrong. I don't have any issues, you know? So it's, it's self awareness, you know, it's recognizing those deficits.      Great answer. All right, last one here, I got for you the most unique goal you've ever written, or a student on an IEP.    Justin Lundstedt     Oh gosh. All right, you're gonna have to deal with my processing skills for a minute. I don't know, there definitely been a couple of vocation based goals that people have looked at me sideways because they didn't think the student was able to do them, you know. And one of, I know one of them, and this was more of a middle schooler, but back a long time ago, was actually creating a musical track on the iPad, because his focus was music, and he loved to take music and recreate it. But nobody really sort of saw the that potential and how you could engage academically. So we actually used, I forget the what's the app called Garage Band, and he created this remix, and I have it somewhere still, because it was amazing, and had like, six different organized parts through the orchestra, and just created this whole thing together. But instead of just doing it as, like, this piecemeal thing where he was using his own mind. It was breaking it down into steps, and he was following the directions to do it, rather than just doing the creation part. And nobody understanding how it's created. Does that? Does that make sense?    Jayson Davies     Yeah, yeah. And it works on more than just music, too. I mean.    Justin Lundstedt     Right, Without a doubt, it was. It was more focused on completing multi step direction. You know, it was, it was being able to follow instruction rather than just impulsively create.    Jayson Davies     Yeah, yeah. I never did it, but I always figured that if I worked in high schools long enough, there would come a time that I would write a goal related to social media, in some way for a student to access, Instagram, Facebook, whatever it might be, because that's how they communicate. That's how students communicate in in high school. And so, yeah, if I were to stay there long enough, I'm sure, I'm sure something like that.    Justin Lundstedt     Well, and you've given me ideas, as far as you know, moving forward, because there's definitely that impact. And again, with the cognitive piece, there's a social breakdown too, because sometimes you don't understand what the other person's saying, and you respond back to and it doesn't make sense, and then they come back at you. It becomes, you know, just this sort of whirlwind of a breakdown.    Jayson Davies     Likewise, the implications of what you do send or don't send.    Justin Lundstedt     Exactly, exactly. And there's a lot of that sort of digital literacy and digital citizenship out there and understanding it, you know, because the kids are often taught it in different classes, but understanding and comprehending and really applying the knowledge is different.    Jayson Davies     Yeah, yeah, definitely, yeah. If you wouldn't say it to someone's face, you probably shouldn't send it in a text message.    Justin Lundstedt      Exactly.      Alrighty, Justin, I think that's going to wrap up the the bulk of what we got going on today. But I would love to ask you if there's anything else you'd like to share for for those OTs out there who are maybe in year one and working in a high school, or maybe they're in year five and they're just still not feeling super confident about it, just a little word of advice or words of wisdom.    Justin Lundstedt     I mean, my biggest word of advice is follow your gut. You know, not the outline that people have created. I think too often our profession has been sort of identified by other professions as to what we do. And I think that if we really look at our education and the breakdown of what we've learned and apply that there's so many more areas that we could be that we could impact with our students. So do not hesitate from following your gut. Do not hesitate from going off the beaten path and take that leap, because if you don't, you know somebody else is going to do it, that's great, but they may not have the same skill set that you have.    Jayson Davies     Yeah, 100% you know, other people do work on occupations, but we are occupational therapists, and we come at it from a very unique way. And there's definitely something to be said about the way that we that we support students, so go for it absolutely All right. Well, before we sign off today, I do want to give you the opportunity to share a little bit about what you have going on, because I know you have a course, and so I'd love for you to share what what you're working on.    Justin Lundstedt     I do have a course out there focused on executive function and transition for the occupational therapist. So for those that are interested in developing their skill set, it goes over in detail. You know, really what executive function is, how it relates to occupational therapy and then how we apply it with transition age students. Because, like you said, transition age and executive function is a real passion of mine. I think it's an area that is often forgotten about. So I also do have a group for those you know, newer grads or people that are wanting to learn more about executive function, executive function for the occupational therapist, and that's on Facebook. And I'm currently developing a couple of more courses that are really more for the occupational therapist right now, my focus is to educate the occupational therapist. So I do, do you know, some coaching with therapists? I do, like I said, I'm creating more coursework so you can find that stuff on the executive function OT, so that's where I'm at right now.    Jayson Davies     Awesome. Sounds great. We will, we'll tag the Facebook group, we'll tag your website. And yeah, anything else we can find about you, we will tag people or tag you so that people can find you over on the OT school house show notes. So head on over to the show notes. You'll get all that info. And yeah, one last time. Justin, thank you so much for joining us today on the OT school health podcast. It's been a pleasure.    Justin Lundstedt     Oh, thank you so much. It's been my pleasure as well.    Jayson Davies     All right, everyone, take care. All right. And there you have it. So much goodness on how to support our students in the high school setting. Really, remember, there is more to occupational therapy than handwriting and fine motor skills and sensory motor skills. We are occupational therapists. We have the power to look at the occupation of any person from zero to 118 whatever it might be, and support them. So the next time that you get, I guess, thrown in, or maybe you get told you have to work at the high school in your district, don't fret. You got this. There's so much that you can do with those high schoolers. So take advantage of it. Learn about them, learn about their perceptions, their occupations and what they would love your support with. Until next time, enjoy your week, enjoy your day, enjoy your gym workout. If that's where you're at right now, or hopefully if you're driving you're staying safe and not focusing too much on the podcast. But until next time, take care and yeah, just have a good one.    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 otsoolhouse.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! 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

School-based OT practitioners are well-acquainted with the challenges of balancing direct student support (like 1-on-1 services) and indirect responsibilities (like showing the teacher how to use an accommodation). Over the past decade or so, as caseloads have grown and administrative duties expanded, the 3:1 model has gained traction as an effective way to manage both. In this article, I’ll share insights on what the 3:1 model entails, the research supporting it, and why it’s worth considering in your practice. What is the 3:1 Model in school-based OT? The 3:1 service delivery model structures school-based OT work (or any related service provider's work, really) into four-week cycles, designating three weeks for direct intervention with students and one week for indirect tasks . This “indirect” week allows practitioners to handle essential responsibilities like teacher consultations, classroom observations to monitor goal progress, IEP meetings, and material preparation, all of which contribute to student success. The 3:1 model emphasizes a workload approach over a caseload focus , acknowledging the full scope of tasks that OTs manage in school settings ( Seruya & Garfinkel, 2020 ). Evidence and Support for the 3:1 Model While there is research on practitioner and teacher beliefs regarding using a 3:1 model, there is no research (that I could find) on the student impact of using a 3:1 model. As Seruya and Garfinkel ( 2020 ) analyze, practitioners strongly desire to transition from a caseload approach, which prioritizes direct service minutes, to a workload approach that recognizes indirect services’ critical value. While caseloads typically count the number of students treated directly, the workload approach encompasses all activities necessary for effective school-based practice, such as documentation, teacher collaboration, and program planning. In the study, many school-based OTPs reported being overextended due to large caseloads (Average = 41-50), high direct service demands, and insufficient time for non-direct service tasks. Practitioners also noted that balancing direct intervention with indirect responsibilities was crucial for providing quality support but cited barriers like limited administrative support, procedural knowledge, and time constraints in implementing workload-based models ( Seruya & Garfinkel, 2020 ). Additionally, a 2019 survey indicated that OT practitioners' ability to collaborate with teachers and provide services in the natural environment is impeded by high caseloads and inadequate support ( Schraeder, 2019 ). The 3:1 model directly addresses these issues by dedicating structured time to indirect tasks, potentially reducing workload-related stress and enhancing practitioner job satisfaction. Practical Benefits of the 3:1 Model for OT Practice As you might imagine, having a week dedicated once a month to non-direct treatment may provide you time to: Screen incoming kindergartners Support teachers Ensure the progress students are making in direct therapy is generalizing into the natural setting. And more However, I want to discuss three key ways the 3:1 model can impact OT practitioners and school communities. Enhanced Collaboration and Integration: With a designated indirect week, the 3:1 model could facilitate deeper collaboration with teachers and school staff. Teacher perspectives reveal a strong appreciation for OT collaboration in developing classroom strategies and enhancing student success when OT practitioners have time to consult and integrate their expertise into the classroom environment ( Bradley, Hassett, Mazza, & Abraham, 2020 ). Practitioners can use this time for proactive consultation on goals and whole-classroom support, aligning with the model’s aim to support not just students on our caseload but EVERY student on campus. Balanced Workload and Reduced Burnout: High caseload numbers and intensive direct service schedules often lead to practitioner burnout. The 3:1 model’s indirect week allows OTs to manage administrative tasks within regular work hours, aligning with best practices that advocate for sustainable workload management. This structure can alleviate the “always-on” demand of direct service and enhance job satisfaction among school-based practitioners ( Seruya & Garfinkel, 2020 ). When an entire School uses a 3:1 model, IEPs and other meetings can be scheduled during the "Flex week" (as some call it) to avoid missed services. Improved Service Delivery Quality: Research indicates that when practitioners have time for indirect tasks, the quality of direct interventions improves. During the indirect week, OTs can fine-tune therapy plans, observe classroom environments, and refine strategies with educators, ultimately creating more cohesive and impactful support for students across their school day ( Seruya & Garfinkel, 2020 ). This time away from direct therapy allows therapists to make data-driven decisions. Looking to ditch the Caseload Model and move to a Workload Approach? While at a rural school district with a caseload of over 100 kids , I knew something had to change. That's when I began to study where my time went and create a plan to get support. After changing how our program operated and convincing my boss to hire another OT, I created this course to help OT practitioners and other providers do the same. Click here for support making the transition! Current Research and Limitations While the 3:1 model holds promise, research specific to its implementation in OT remains limited. Studies in related fields, like speech-language pathology, have shown positive effects, but OT-focused research is still emerging. Seruya and Garfinkel’s survey underscored the need for further exploration into how workload models impact student outcomes. This research gap suggests a strong need for advocacy, both for adopting the model and for studies to validate its effectiveness in diverse school environments. Another consideration is that successful implementation may depend on administrative support and understanding the workload model's benefits. As a profession, we need to work toward sharing the 3:1 model's benefits in a way that administrators can relate to. We can also partner with our related service provider counterparts to do this together. Please note that the 3:1 model is not a quick fix for larger staffing issues! It is not designed to help you “see more students in less time.” Rather, it is a program to help you provide more comprehensive services to the students you already serve. Implementing the 3:1 Model: Considerations and Best Practices Implementing the 3:1 model effectively requires careful planning and advocacy. Here are key recommendations based on the research: IEP Documentation Adjustments: Adjusting IEPs to reflect both direct and indirect service needs helps parents and administrators understand that the indirect week is integral to quality service. By clearly outlining both components in IEP documentation, practitioners can facilitate broader acceptance of the 3:1 model ( Seruya & Garfinkel, 2020 ). I would typically do this by listing OT on the IEP service 3x a month or 30x a year. I would then add OT support to the IEP as a consult 1x a month. That consult would allow me to be flexible in supporting the student during the 4th week of each month. Advocacy and Education: Advocacy is crucial to gaining administrative buy-in. Many practitioners in Garfinkel and Seruya’s study highlighted a need for better advocacy resources, such as data on workload distribution and outcome tracking. Providing clear, evidence-based insights on the model’s benefits can build support among stakeholders, increasing the likelihood of successful implementation ( Seruya & Garfinkel, 2020 ). One tool you may consider using is the OT Schoolhouse Workload Calculator , which helps you identify your workload based on your current caseload. Feedback and Adaptation: Regular feedback from teachers, parents, and administrators is essential for ensuring that the model is meeting the community’s needs. Adaptations based on feedback can enhance the model’s effectiveness and foster a collaborative school culture where OT support is fully integrated. Debra B., a colleague inside the  OT Schoolhouse Collaborative,  recently shared how she adapted the 3:1 model. Rather than reserve an entire week for indirect services, she would block off a particular day each week for flex services. For example, each Friday would be reserved for evals, consults, and other tasks. This allowed her to still have five days a month for non-direct services without completely changing her routine for one week every month. The Wrap-up If you are considering using the 3:1 model in your practice, I say go for it! The model offers a structured, balanced approach to school-based OT that supports practitioners, teachers, and students. Although additional research is needed to validate its impact, the evidence and practitioner feedback underscores the model’s potential to enhance service quality, reduce burnout, and foster effective collaboration. Plus, I also don't think I could show you research that says a 4x month direct service frequency is any better. By addressing both direct and indirect needs, the 3:1 model can make school-based OT more impactful for both the students we serve directly and the students who don't need direct OT services. Keep the conversation going! Have you incorporated the 3:1 model into your practice? Are you considering it? Share your thoughts in the comments below. References American Occupational Therapy Association, American Physical Therapy Association, American Speech-Language-Hearing Association . (2014). Workload Approach: A Paradigm Shift for Positive Impact on Student Outcomes . Retrieved from https://pediatricapta.org/special-interest-groups/SB/pdfs/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-.pdf Bradley, E., Hassett, E., Mazza, A., & Abraham, G. (2020). General Education Teachers’ Perspectives on Collaboration With OTs in the School Setting. The American Journal of Occupational Therapy , 74 (4_Supplement_1), 7411505163p1-7411505163p1. https://doi.org/10.5014/ajot.2020.74s1-po5124 Garfinkel, M., & Seruya, F. (2019). Therapists’ perceptions of the 3:1 Service Delivery Model: A workload approach to school-based practice. Journal of Occupational Therapy, Schools, & Early Intervention , 11 (3). https://doi.org/10.1080//19411243.2018.1455551 Gjellstad, M. (2023). Impact on Teacher Ratings & Perceptions of Efficacy of a 3:1 Model of OT Service Delivery. The American Journal of Occupational Therapy , 77 (Supplement_2), 7711505150p1-7711505150p1. https://doi.org/10.5014/ajot.2023.77s2-po150 Hubert, W. (2011). A Survey Of Speech-Language Pathologists’ Attitudes Toward The 3:1 Service Delivery Model . https://doi.org/10.58809/jfiu5737 Schraeder, T. (2019). The 3:1 Model—One of Many Workload Solutions to Improve Students’ Success. ASHA Leader , 24 (5), 36–37. https://doi.org/10.1044/leader.scm.24052019.36 Seruya, F. M., & Garfinkel, M. (2020). Caseload and Workload: Current Trends in School-Based Practice Across the United States. American Journal of Occupational Therapy , 74 (5), 7405205090p1-7405205090p8. https://doi.org/10.5014/ajot.2020.039818

Click on your preferred podcast player link to listen wherever you enjoy podcasts Welcome to the show notes for Episode 114 of the OT Schoolhouse Podcast. Did you know that Einstein and Thomas Edison may have had dysgraphia? In our chat with Cheri Dotterer today, she discusses the truth about dysgraphia. A lot of us have had specific beliefs about what dysgraphia consists of, but the true definition may surprise you. She also explores the different types of dysgraphia and bilateral integration, which include interlaced, symmetrical, and asymmetrical. Tune in to learn even more about dysgraphia, and the results of a 6-week handwriting club focused on visual perception, visual motor, and memory with limited pencil use. Tune in to learn the following objectives: Learners will identify the different tiers and types of dysgraphia Learners will identify the different types of bilateral integration Learners will identify two-minute interventions that address the core components of writing Guest Bio Cheri Dotterer, OTR/L Cheri is an international speaker, author, and consultant who trains adults to shift their mindsets about struggling writers to strengthen the social-emotional well-being of people with dysgraphia so they can fully engage in life activities and unleash their potential to change their future and other generations through the written word. She has been an occupational therapist for 25 years. Her book, Handwriting Brain-Body DisConnect, has remained in the Top 100 on Amazon since publication in Handwriting Reference and Learning Disabilities. It was also a Top 10 Finalist in the Author Academy Awards in 2019. In addition, she was nominated for the USA 2022 Dysgraphia Expert of the Year by Global Health and Pharma Magazine. Quotes “Kids don't understand those symbols. And that's part of what we can do and help, as occupational therapists, is we can help them with understanding the overall concept, and how it applies to life” Cheri Dotterer, MS, OTR/L “Dysgraphia is a disability or delay in grammar, punctuation, capitalization, sentence structure, paragraph organization and clarity, and spelling” Cheri Dotterer, MS, OTR/L “Did they effectively get enough background in their education to understand the language…reading is truly a sensory process with a little bit of ocular motor going on” Cheri Dotterer, MS, OTR/L “We can help instruct the teacher or the aides on how to provide the student with the just right challenge and let them problem solve during their assignments, as opposed to giving them the answer or writing it down so that they're copying” Jayson Davies, MA, OTR/L “Visual perception, visual motor, and memory, because those are the big three core components of writing that are the foundation; if we don't have those foundations, language and cognition aren't really going to effectively integrate” Cheri Dotterer, MS, OTR/L Resources: THS-R Cheri Website Writing Glitch Community Handwriting Brain-Body Disconnect Math Dys-Connected - available soon Episode Transcript Expand to view the full episode transcript. Cheri Dotterer     But according to the DSM five, dysgraphia is a disability or delay in grammar, punctuation, capitalization, sentence structure, paragraph organization and clarity and spelling.     Jayson Davies     So no motor component.     Cheri Dotterer     There is absolutely no motor component in the definition,    Jayson Davies     hey there, and welcome to the otschoolhouse com podcast. If you have listened to a good number of the otschoolhouse com podcast episodes, you may have recognized that voice that you just heard. That is Sherry, daughter, occupational therapist and author of the book, handwriting, brain, body, disconnect, Sherry has actually been on the otschoolhouse podcast before she was on episode 31 where she really introduced us to dysgraphia. Now she's returning to the podcast to provide some updates on dysgraphia, including that definition from the DSM five on dysgraphia, in addition to talking a little bit about dysgraphia, yeah, I know I can't say that word enough times in this introduction, we're also going to talk a little bit about bilateral integration, and she's also going to share with us some two minute activities that you can either do yourself with students or provide to teachers to support students who might have difficulties with handwriting. So let's go ahead, let's Cue the intro music, and when we come back, we are going to welcome back to the otschoolhouse com podcast, Cheri Dotterer.    Amazing Narrator     hello and welcome to the otschoolhouse Comcast, 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     Cheri, welcome back to the otschoolhouse com podcast. How are you doing today?    Cheri Dotterer     Oh my gosh, Jayson, it's so good to be here. I cannot believe it's been so long since we've actually gotten to talk in person.    Jayson Davies     Yeah. I mean, well, I still don't think we've actually met in person. Now we've met on zoom so many times, but, like, it's crazy, right? We used to say, Oh, I met you in person, and that actually meant, like, at a conference or something, and now it's like, I met you in person on Zoom. It's funny.    Cheri Dotterer     Correct, I don't think that we've ever physically shaken hands.    Jayson Davies     Yeah, one day, one day it'll happen. But yeah, it's been three years since our last podcast conversation. Of course, we've talked since then, but three years, yeah.    Cheri Dotterer     That's really hard to believe.     Jayson Davies     Yeah. In fact, you had a big thing three years ago. You launched your book, and that's kind of part of what we talked about on that podcast. So how's that going?    Cheri Dotterer     It's still going. It has remained in the top 100 on learning disabilities and handwriting reference with the Kindle version ever since it was published, which still blows my mind to this day, that it's still it. I mean, yes, it has fluctuated up and down a little bit, but it is still out there and selling all over the world.    Jayson Davies     That's awesome. And for anyone listening out there, that book is titled handwriting, brain, body, disconnect, adaptive teaching techniques to unlock a child's dysgraphia for the classroom and at home. You know what we're talking about, dysgraphia. In a way, we're kind of doing an update from three years ago with this podcast. So really quickly, why don't you just give us a quick synopsis of what your intention or what your goal was with that book?    Cheri Dotterer     Well, when I was publishing or and looking and doing my research, I was like, there's nothing out here. There's nothing. Nobody knows anything about dysgraphia. A lot of people thought ADHD symptoms and dysgraphia were the same thing. A lot of people thought that dyslexia and dysgraphia were the same thing. And really they're they're not. Here I am switching slides so that I have the the one in front of me that I want to have, but, yeah, it's been very interesting over the years. So that was like the very beginning, basically creating a textbook for anybody who wanted to learn anything about dysgraphia. And since then, I've actually submitted manuscripts for three books this year. Oh, wow. It has been a very, very busy writing year. The Chinese University of Hong Kong is putting out a handwriting book for spelling practice. Okay, I'm messing up the name totally, but they're putting out a book on on handwriting, and I know it has to go to the publisher by the first of December, so it's getting close to that next stage of completion. I asked them recently if they had a an image for the book cover, and. And they are working on that till the end of the month, so they couldn't give it to me yet, but next year 2023 it should be out. Also that was one, is that the full book, or a chapter in the book, or I contributed to a chapter in a book? Oh, awesome. Yeah. And the textbook with for the universities, I was totally blown away when that one came through. Yeah. Number two is, I am co writing a book with Jon Elise zupanzik. Jonna Lee zapanzik is a spunky little and I say spunky and I say little spunky little a math teacher who thinks in math bigger than the procedures that you do in school math. So she really is found several what she calls a reference tasks that help kids from kindergarten through 12th grade, and you can see the progression of math along the way when you're looking at what she's doing. But she came to me and asked me if I could put in help her understand the neurology. And next thing we know, we're co writing a book, and it's gonna be really amazing, because we didn't just write a book that like a textbook, like I did the first time. We are writing a story, and we are taking scenarios from different kids that we now and we're incorporating them into this story that we have designed about a seventh grade classroom and why these kids are struggling in seventh grade, and what we could have done in kindergarten and first grade and second grade to help them along. And it's not just the math that's the issue. It's the writing part. They don't know what symbols are, so one of their biggest things is pattern recognition. And that brings me to one of the things that about the future is in january 2023 so if anybody's listening to this, like right when it comes out, look for a five day challenge that she and I are going to do in January, that really we're going to focus on pattern recognition and then how it relates to number sense. Have you ever heard of number sense before Jayson?    Jayson Davies     I've heard of number sentences, but not number sense. No.    Cheri Dotterer     number sense is just really understanding how one number relates to another. Is four greater or less than five, is negative four greater or less than negative five.     Jayson Davies     So now we're talking about those Pac Man symbols, what I always call the greater than and less than Pac Man symbols. That's how I remember them.    Cheri Dotterer     There you go. There you go. But one of the things that that I realized by having conversations with her, is kids don't understand those symbols, and that's part of what we can do and help As occupational therapists, is we can help them with understanding the overall concept and how it applies to life. So the lot of the what I've contributed to this book has been, what is the neuroscience like? What's happening in the brain and how does it apply to everyday tasks, beyond just being able to do math problems, and we have designed a whole bunch of what she calls quick dots. She created the idea I've just, I'm just have been applying it to what I'm teaching. And quick dots are really one of those things that's going to make or break a kid's understanding of the concepts, concepts of math. So yeah, look for math disconnected next year, and look for the five day challenge on math disconnected coming in January.    Jayson Davies     That sounds great. I'm definitely we're gonna have to get a link from you so that we can add those to the show notes. That would be when it's available. Awesome. And then I think that was book number two. You said you had one more, or was that it?    Cheri Dotterer     Oh, okay, yes, you're right. I did forget book number three. So book number three is called Becoming you, how to dream, achieve. I'm missing one, okay, basically becoming you and basically so what I did was I I wrote my backstory from back in 2015 before I ever published handwriting. Brain, body disconnect when I was contemplating suicide, which you may not have even known, that I was contemplating suicide, and the thing that stopped me was, Oh, my What if my kids find me and there and from there, finding, trying to find a purpose in life, and that purpose has become being an. Kit for all of the students, no matter what their connections are in the classroom, what are they with special ed? Do they have a label? Do they not have a label? How can I help all students in the classroom as an occupational therapist and help them become leaders, that they unleash that leadership potential inside them so that they can belong no matter where they are in life.     Jayson Davies     Wow. Well, I two things that I want to say that is a I'm glad that you are here and we are having this conversation today. And secondly, I don't want to get into it, but I have had similar experiences and similar family connections. I guess you could call it that. That was my processing as well. You know, What would other people think? And that has definitely guided my career, my life, the way that I act, the way that I see people, view people, treat people, interact with every single person and so, yeah, thank you for sharing that. I appreciate it.    Cheri Dotterer     Hey, you're welcome. So anybody who out there that is an occupational therapist and you're feeling defeated, you're feeling like you're alone, you're not you're not alone. There is more to my story. There is more to Jason's story. Obviously, we both have some kind of mental health, emotional connection that we didn't even know about until this very moment.    Jayson Davies     Seriously, we can't plan that. That is not something we planned at all. It's yeah, yeah, so, but that is great that you have have taken your life experience now and have figured out a way to to support others through a book, and to just just use a difficult time in your life now to turn that around and to help not only yourself, but to help others. So that's fantastic, cool. So we'll have to, we'll have to keep a lookout for those, all three of those books, and yeah, we'll figure out how to link or all that in the show notes. So if you're listening and you want to learn more about those, check out the show notes.    Cheri Dotterer      I may not have the information by the time this episode releases. You may have to back up add more information at a later date when I find out more information about them, but as soon as that information becomes available, I will pass it on.     Jayson Davies     Stay tuned for Episode 100 and we'll call it 35 of the otschoolhouse podcast. Be back on to talk about more. Anyways, so I want to take a step back to that second book, because what I heard a lot that was the one where you're talking about how you're working with Jan. I think it was on math, then that's going to be interesting. And that kind of leads into what I want to talk about more in this podcast episode, the different types of dysgraphia. I think you and your book mentioned three different types of dysgraphia, and then also I couldn't help but think to myself, you didn't say the term, but just calcula, and how it kind of is working into that way. So before we dive into dyscalcula, why don't we just do a quick review of your working definition of dysgraphia? For those who you interact with.    Cheri Dotterer     Yes, when I was writing the book, I had a difficult time finding a concrete definition of what dysgraphia was. I finally found it when I looked at the DSM five. DSM five, I don't think it. I think it was being published around the same time I published so I did not have access to it. So this definition is not in the book directly, but I talk about it every time I talk to anybody about what dysgraphia is, and when I read this definition to you about what it is and then what it is not, you're going to say, Wait a minute. I thought it was something else, believe me. Okay, so according to the DSM five, dysgraphia is a disability or delay in grammar, punctuation, capitalization, sentence structure, paragraph organization and clarity and spelling.    Jayson Davies     So no motor component.    Cheri Dotterer     There is absolutely no motor component in the definition. Now they do qualify all of the specific learning disabilities, which is the dyslexia, dyscalculia and dysgraphia, as part of it is when the activity demands exceed the student's capacity and there's an interference with activities of daily living. Still, does it say directly that there's a motor    Jayson Davies     problem? No, not at all. I mean, it does allude to that maybe a motor problem could be what is preventing the person from doing those concepts. But, yes, not a motor problem.    Cheri Dotterer     So this is what it says, that it is not okay, intellectual disability, right? A visual or auditory disability, mental health disorder, neurological disorder or psychological disorder. Interesting, okay, it also qualifies that at this. And it kind of like goes through that with and this is kind of like that combination of all three as well, a lack of proficiency in language skills and inadequate instruction. Now, I know you've told me that your wife is a principal, so we have had this last two years of chaos with education. So all of these kids that may be getting referred to occupational therapy for handwriting issues that lack of proficiency and motor skills and inadequate instruction are part of this definition. So we've got to really watch right now what we are classifying our writing errors in.    Jayson Davies     Expand on that.    Cheri Dotterer     So because we have had this these last two years where we basically been doing education by fire, we have this true understanding that maybe over the last two years, kids do not get educated the way that they would have liked to have been educated, correct? Not the kids themselves, but us as adults. So we really do need to keep that in mind as we are looking at these kids. Did they effectively get enough background in education, in their education to understand the language?    Jayson Davies     Okay, So, so we are saying, potentially, that kids are having difficulty with handwriting due to the lack of the lack of experience, the lack of exposure to written language. And I know some people will also argue that, and it probably is true that written oral language has a direct effect on written language. And so the lack of oral language, also within the pandemic time, could also potentially be impacting written language.    Cheri Dotterer     That is correct. And one of the things that I share with people is when I really look at the definition of reading in the DSM five, I look at the definition of written expression, and I look at the definition of math, one of the things that that I had this aha moment over the last couple years, and I believe it was, since the book was written, is reading is truly a sensory process with a little bit of ocular motor going on, but it really is when you're taking in the information in it is really that's the part of the process when we are actually doing that mental interpretation, and We need to feed something back out with reading fluency or reading comprehension that's actually either written expression or oral expression, and each one of those is a different neurological process. And my theory was confirmed by a research project done by Karen James back in 2017 and she shares in one of her articles this picture of the rain that has circles on it, and by different colors, one of them being reading, one of them being letter recognition and word recognition, and the third One is written expression. And although they are close, none of those dots overlap totally. It's more like a Venn diagram in every section of the brain. So every reading, each oral process, each written process, and every type of written process, whether it's an iPhone, Android, a tablet, a laptop, a computer, whatever it is, everything is a different neurological process. Your brain needs to create a new pathway every time you learn something new, like that. And the brain likes to learn things new, but it also likes to problem solve that's its main job. So keeping that idea of being able to problem solve things and not answer the questions for the kids is really one thing that'll help them with that proficiency in language skills and getting over the inadequate instruction pieces giving them creativity time.    Jayson Davies     Yeah, yeah. And I think that that piece, what you just talked about, is something that OTS can can do on behalf of a child. Oftentimes, we don't know what to do for students who are on consults, who have who have handwriting difficulties, um. That's something that we can do. We can help instruct the teacher or the aides on how to provide the student with the just right challenge and let them problem solve during their assignments, as opposed to giving them the answer or writing it down so that they're copying, which is obviously very different from coming up with your own words and whatnot. So, yeah, great, great strategy and idea there, awesome. Love it.    Cheri Dotterer     So one of the things that I've been working on is, like, I said, How to impact all the kids in the classroom. And one of the things that I tried, and this was, like, right before covid hit, it was after the book was written a while. I was out for a while, and I was working with a teacher in a public school building first grade, and it was amazing we even got this in. It blows my mind to this day that we even got this in before covid hit. But we were working with like we tried, we tried a handwriting club, but my goal was to teach her how to do handwriting club. So I was there more like the consultant, but one of the things that I did about handwriting club that may not be available for all OTs, but I encourage you to work on trying to get the education. And the collaboration with your teaching staff is we did a five day a week handwriting club in the morning before school started, and we only touched a pencil on day one and day 30, and we did it for six weeks. Oh, wow. So we were doing all kinds of activities that would support it. The big kickback I was getting was, well, we don't have 20 minutes every day. How can we do this? So I've been working on how to pare that down to an amount of time that's effective for the students that the teachers will like and then that they can manage. And I've actually gotten it down to two minute interventions. So I've been working on a process that cycles visual perception, visual motor and memory, because those are the big three core components of writing that are the foundation. If we don't have those Foundation, language and cognition aren't really going to effectively integrate, if that makes sense. So working on cycling, visual perception, visual motor and memory strategies over a 15 day period, and then recycle again, recycle again and recycle again. It's improving kids ability to engage in learning no matter what the topic is. They're getting better at math. They're getting better at writing. They're getting better at reading. I I had, don't have it published, because I don't have that capability right at this very moment. But it's out there and it's working. And what my focus is for 2023 is to educate as many teachers as I can on these two minute interventions. So I'm doing my own five day challenges in 2023 to help promote these two minute interventions that we are also going to incorporate a little bit into the math book as well.    Jayson Davies     Gotcha, that's great, yeah. And you're right, teachers. I always say, you know, we can't give teachers more work. We need to give them less work. And so if you can, anytime, you can turn a 20 minute lesson into a two minute lesson, they are going to love you, and especially because if it's two minutes, right, you can effectively train them. I mean, you said it's 15 lessons, right? So.    Cheri Dotterer     15 sessions, the kind of 15 sessions and encompassing all the components that impact handwriting and writing skills. So it's not all aspects of visual perception, it's not all aspects of motor function. It's those ones that really are going to target the writing skills and using worksheets and and that kind of activity in general, and school activities, learning, academic, academic in nature. And you can use these activities before social studies, before art, before music, before science, before math, before English, language arts and whatever else that I'm missing.    Jayson Davies     they can be used as transitions. And that's the simple thing.     Cheri Dotterer     Yep. I call them para moments. You have paraprofessionals. Well, those transition times between when. Transition time was really happening, and that moment before academic really begins, that para moment that right there, okay, I call these para moment interventions.    Jayson Davies     I like it. I like it. That works so, but it's, I mean, it's advanced, right? It's something that you have created, but at the same time you are making it very simple for the teachers. And if it's only you know, 15 or so two minute activities, it shouldn't take you too long to train the teachers in this or the paraprofessionals in this. Yeah, it might take you a little bit longer to train the science behind it, a little bit. But if the activities themselves isn't something that's daunting for for a teacher, love it.    Cheri Dotterer     and I've created several courses, trying not to put it all in one course, but I've created several courses that concentrate, one on the neuroscience, one on the interventions, one on the outcome, because I've also been looking at progress monitoring for these interventions and how to make it simple and easy for them. So I've been also working on evaluation, intervention and outcome, and trying to really delineate them as I am moving forward. So all of my course work is in my podcast community called the writing glitch.     Jayson Davies     Yep, and I'm a part of that, one of the one, one part of that. So yeah, that's we'll be sure to link to that as well. I want to ask you, though you have about 15 of these different activities, would you mind sharing just one or two?    Cheri Dotterer     I will do that. So one of the things that I have really been looking at is bilateral integration activities. And one of my first clients as an OT teaching OTS about handwriting and I were talking one day, and she was saying they were trying to do some different things with bilateral integration. And we started really getting into this. And then I started using the activities myself and sharing with other OTs, and we I had this oh my gosh moment one day, and I realized there's three types of bilateral integration. Are you interested in learning what they are?    Jayson Davies     Absolutely always more information the better.     Cheri Dotterer     Okay, so first one is asymmetrical bilateral integration. Okay, but let's break it down. Let's see if you can figure out what I mean by asymmetrical bilateral integration.    Jayson Davies     I'm assuming that it's more impacting one side of the body. That's what I'm thinking.     Cheri Dotterer     Good guess it's more like the pencils in one hand. The Helper hand is helping that. So you're not doing the same activity, yeah. Okay, so you're not doing the exact same activity, but both hands are necessary to get the task done.    Jayson Davies     Gotcha? Okay? So the hands are both at work, but doing different things.    Cheri Dotterer     Correct. Okay, then we have symmetrical so they're doing the same thing, but they're not doing it together. They're doing it together, but they're not doing it together, so it's kind of like a parallel activity. So the one that I like to use to demonstrate it is a lazy eight. Do you know how in the brain gym, they have you doing the lazy eight, where you have both hands out. I hope I don't hit the mic while I'm demonstrating this, we are doing a video so he can see me. Okay, so we're going like this with the lazy eight, where you're crossing midline, but you're crossing at that center point.    Jayson Davies     Your hands are moving together.     Cheri Dotterer     They're parallel. They're doing the same activity, but they're still separate. Okay, okay, then we have interlaced bilateral integration, so we can't just interlace our hands any old way, because we want to really enforce the writing down the road. So when we're interlacing our hands, we have our palms away from us. We're putting one hand behind the other, and then that you're both of your palms are facing away from you. Okay, and then the activity is they're doing the exact same thing at the exact same time. What's that doing? It's forcing both hemispheres and the corpus callosum to all interact together. So we are reinforcing the creativity pieces of the right brain, where encouraging the logic pieces of the left brain, and we are forcing multiple interconnections over the corpus callosum, and we're interacting with all parts of the brain at the same time. And kids are. Remembering it better. So what we're doing with the interlaced, bilateral negation integration is we're airwriting. So I don't know if I'm going to be able to do this and not hit the microphone, but with the interlaced I will have kids do full arm movements, the arms are going up over the head, and then I have them do vertical figure eight, because the figure eight being the hardest of all the numbers to write. And actually number eight, from a number sense perspective, is actually the hardest number to understand. So developmentally, because it's got two diagonals in it, you know, it like hits all of these hardest parts. So the number eight is the one that I like to target when I'm instructing people on this. Yeah, and if you can just sit back for a moment from your microphone and do a vertical eight with your interlaced hands, and then give me some feedback as to what you feel about happen, what's happening to your body.    Jayson Davies     I will say, I guess I have to get back closer to the microphone. I will say that it was a little actually tricky to get started. Once I got started, it was okay, but like, you know, you're used to writing an eight with a pencil. I'm not used to writing an eight air writing. I haven't done it in a long time. And so just like getting started was a little tricky, but once I did get going, it was, it was pretty smooth. You do feel both of your arms, right are? You're moving your arms together. My hands are inner lace, like I'm holding my own hands, as you mentioned earlier. So you do feel your entire both shoulders, both elbows, both arms completely engaged.    Cheri Dotterer     And it's forcing your pelvis to oblique as well, because you're having to force one side of the body to the other. So you're forcing your entire verti, your entire vertebrae, to shift so your hips are actually doing a left right oblique, yeah, yeah, as you're as you're going through it. So it really is also helping core strength. There you go. It's how it's helping visual perception, it's helping visual motor, it's helping memory.    Jayson Davies     All right, And you're hitting those three key areas that you were talking about,    Cheri Dotterer     and you just did that in less than two minutes.    Jayson Davies     Absolutely and and got the science behind it in about five minutes. All right, awesome.    Cheri Dotterer     So we're So thinking back to that handwriting program that I did that was one of the activities that we were doing as we were airwriting with the kids with the interlaced bilateral integration. And one of the kids in the classroom happens to be like my love at this point, because he just transformed so much. He was on the OT evaluation list. And like you, you've got to get this kid done like, ASAP, and we let's put him in handwriting club and see how he does. He was removed because his handwriting ended up better than all the kids in the class. Oh, wow, in six weeks.     Jayson Davies     Wow. And that's without using a pencil really like.    Cheri Dotterer     And that's only doing a pencil the first day to do a handwriting screening and went on the last day to compare them. Wow, that's amazing. So we were doing so the bilateral integration was one of the things that we were doing. Yes, we were there for 20 minutes. We were doing some other activities that were improving core strength, visual visual perception, visual motor and memory and but the thing that really made the difference for him, he said it, he's like this, doing with my hands together made a difference.    Jayson Davies     Wow. So when can we expect this professional development course to be ready?    Cheri Dotterer      It's already it's already there. It is the premier level of my handwriting community. So the writing glitch community, the amethyst plan is where you can get everything.     Jayson Davies     Oh, wow. Okay, very cool. And again, we'll link to.    Cheri Dotterer     We are. We are only going to as of 2023, we're only going to have one plan, one tier inside the community. So everything, there's some things that are separated. Right now we're going to move everything together. And by 2023 everything's going to be in one place. So if you want to learn just a little bit, you can take that particular program. If it if you want to learn more, you'll have a different things. If you want to get certified in my my program after a year, we have mastermind meetings once a month. You can get certified as a K to five dysgraphia specialist.     Jayson Davies     Oh, wow. Okay, very cool. So the three types of bilateral integration. Let me re make sure I have them all right, and so everyone else has a little recap. We have the integrated, right or interlaced, interlaced, interlaced. And then we have, gosh, my mom, my mind wants to use asynchronous and synchronous. And I know that's not the it's the where your hands are doing.     Cheri Dotterer     Think about the symmetric.    Jayson Davies     There we go. Tonic neck reflex. It was one of those ones that has an A in front of the word and then it's the rest of the word together. All right. So asymmetrical, symmetrical and interlaced. Integration, bilateral integration. Awesome. Thanks for sharing that, and I'm looking forward to it to more and more work on that from you in the future. All right, so those are the bilateral integration. They directly. They're different from dysgraphia, correct me, if I'm wrong, but they have an impact on a student who may display dysgraphia, correct. Okay, correct. So let's take a step back, because you mentioned earlier the DSM five definition, what it is and what is not. And we got distracted, but we are moving toward the three different types of dysgraphia, at least a little overview of them, because I think you mentioned them. We went over those pretty heavily in Episode 31 of the podcast. But how has what you've learned from the DSM five. Has it strengthened your three different types of dysgraphia, or has it blown it out of the water? Has it, what has that done for you in better understanding dysgraphia?    Cheri Dotterer     Just to recap the types of dysgraphia, or according to the International Dyslexia Association, are visual, spatial, motor and dyslexic, dyslexic dysgraphia is a difficulty with spelling. Okay, so if you look at the definition from Ida, and you look at the definition from DSM five, DSM five gets a little bit more detailed. I mean, it talking. It includes all types of language, not just spelling. Okay, so we have that sort of a disconnect between one versus the other. In my book, I talk about the types of dysgraphia, what I really needed to do with is clarify that these are intervention types of dysgraphia. These are not types of dysgraphia, really, as far as what Ida is is looking at and distinguishing these are really to help drive intervention. There's three tiers and six types. The bottom tier is the tier that I've been talking about this whole time, visual, spatial, motor and memory. The second tier is language based, and that's spelling and sentences. So syntax and all the the things that you need to create a sentence, the grammar, the punctuation, the capitalization, the top tier is cognitive, and that's paragraph.    Jayson Davies     okay, So it's kind of, it's a higher hierarchy of things, in a way, right? You have your your bottom level is the the skills that you need. The second part is the sentences and spelling a little bit higher. And then you get to the highest realm of what you want to call it, paragraphs and putting things together.    Cheri Dotterer     So if we don't have those foundations, we are not going to be able to be creative, to create narratives, expository writings, technical writing, or anything of those kind of natures, or we will, or we might learn one and not be able to engage in all of them. So as an adult, you might have these Splinter skills in writing, where you can write in your lane, but you get outside your lane and it's nothing happening.    Jayson Davies     Yeah. All right, cool. Thank you for that.    Cheri Dotterer     Sure. And can I just say that there are two people that I know of that were like that, that are very famous. One of them was Einstein. If you got Einstein outside of his wheel horse of knowledge, he had trouble with writing. He had and so did Thomas Edison. They both had scribes. And would you like to know the name of Thomas Edison? Scribe?    Jayson Davies     Uh, yes, but I wanted to try. What did they have the last name daughter?     Cheri Dotterer     No.    Jayson Davies     Oh, darn.    Cheri Dotterer     Good try, good try. No. It was Henry Ford before he broke away and created his own company.     Jayson Davies     Interesting,all right, from electricity, right? You said, Edison, right?    Cheri Dotterer     Thomas Edison, the light bulb.    Jayson Davies      Uh huh. And then two. Creating cars. Yeah, electricity is kind of important in cars, so I guess it makes sense. He had the knowledge from scribing for Edison and use some of that knowledge to develop a car. Cool. So, all right, so we've talked about bilateral integration, those types. We've talked about just graphy a little bit. Now, you know, I do want to everyone listening. Everyone wants to hear some practical stuff. And so just a little bit as far as when it comes to evaluations, you know, you get a student, and the first thing you see on that referral or something, as you're looking at their background, you see the term dysgraphia pop up, or maybe you just see the term difficulty with handwriting. Do you recommend any specific tools that a therapist should use during that evaluation? Any any recommendations for an evaluation?    Cheri Dotterer     Can I recommend the one that Nia should never use when you evaluate, that you should use, never use when you're evaluating handwriting, and that is the berry BMI. Okay, the berry BMI was not designed to be a handwriting assessment. It was designed for other reasons, and they have proven in a research study in 2015 that the berry is not correlating to handwriting improvement.     Jayson Davies     Okay. And the VMI, it looks at visual motor. There's three different areas. A lot of times, people only do two of them, right? You have the motor coordination, the visual perception, and then I'm blanking on what the actual name of the third one is where you're actually drawing within the lines. It's it's integration, visual integration, visual motor integration. I think that's actually the VMI part anyways. So those three parts. Now I do want to kind of push back just a little bit, because I understand that you mentioned just a moment ago, though, that visual perception, memory and was the third component, motor, motor. So how does that differ from the VMI, which looks at coordination, integration and perception, those it looks at similar things. So why doesn't it add up to handwriting?    Cheri Dotterer     When you compare the research study that I read when they compared the VMI from beginning to end of of 40 sessions of of handwriting instruction, they also did the test of handwriting skills, and they did the Minnesota assessment of writing okay, I might have that Minnesota writing assessment might be the right way to say that when they did a comparison and they looked at the results, the VMI did not reflect the handwriting improvement. And in their literature, there was three other articles that indicated that the correlation between writing and the VMI were not related. So there was four articles that total that are relating that so I've had a difficult time with the VMI. I never actually found it beneficial to help me with using it, so I use the dvpt, the developmental test of visual perception instead.    Jayson Davies     Yeah. And so I think what that research also kind of showed us is that, not necessarily that trying to get all three of them right again, motor visual perception and visual motor integration, not that those don't impact handwriting, but you don't necessarily see an improvement on The VMI if you work on improving handwriting. So, yeah, so visual perceptual skills, visual motor skills and motor skills, all those combined would have an impact on handwriting, but it doesn't necessarily mean that if you focus on handwriting, VMI scores are going to go up. So in that sense, we should not use a VMI from three years ago. Use it in our try and say, hey, look, they didn't make progress on the VMI. That doesn't mean that their handwriting didn't improve. So we should still do something like the ths, another handwriting assessment to compare handwriting to handwriting, as opposed to compare VMI to VMI.    Cheri Dotterer     Correct, The only handwriting assessment that I know of that's out there that has norms to it is the ths. The other ones are percentages of correctness, yep. And to my knowledge, they aren't finished with their research to have norms.    Jayson Davies     Yeah, that's that's what I have found as well. So that lines up with what I know to. So the ths. And to be honest, it's actually called the thsr. I know we all call the ths, but it's the ths revised. And, yeah, we'll link to that in the showness as well, so that if anyone's interested in learning more about the ths, to be honest, it's, it's so simple. I mean, you're just asking the student to to write letters, write the alphabet, copy a few words, or copy a few sentences and words, but yeah, it is, as far as I know, the only one that's standardized. So thank you for mentioning that.     Cheri Dotterer     that. Sure. And one thing about the thsr is that they're doing it without lines on the page. So it's very interesting when then you go back and you compare with them using lines on the page, and how they that compares to their understanding of the letter.    Jayson Davies     Yeah, yeah. And No, the one thing that I was always frustrated by the thsr was that it didn't have the lines. And so you're getting the standardized aspect of it, because, again, you're right. You're getting the standardized they're comparing whatever the results of your student compared to the numbers of other students. But at the same time, when we look at most work in the classroom, they have lines. So I will sit there in an IEP, and I'll say, look, standardized. The kids scored here on the ths, but there are no lines. So let's look at a piece of work from the student's classroom where they actually had lines. And then, of course, you have to talk about, okay, well, what about, you know, the worksheets that give you writing bubbles that don't have lines? Well, let's talk about that. You know, we can either put in accommodations potentially, there are other ways to go about that. It's hard. And I bring this up because when you do an evaluation like we want to just do one thing right? We want to just do the ths and and give our all of our results from the ths, but we need to be doing those observations to see what's actually happening in the classroom. And for those of you who don't have the pleasure of seeing us, Sherry just gave me a very, very exaggerated shaking of her head, no, so I'm going to let her add some clarity.    Cheri Dotterer     So one of the other things that I have done in my education process is got certified as an educational advocate. One of the things when I learned about in my educational advocacy school was that you need to do two assessments to really have a solid foundation. So in theory, that means that you should really do the sensory profile and the sensory processing measure and compare the two to get an idea of what their sensory processing is really like.    Jayson Davies     Yeah, and you say that you need to do at least two and to add on to that, that's why it's so important to know what the concern is, because you specifically mentioned two related to handwriting. Now, if there's a concern in another area, the ths doesn't look at the concern in other areas, it only looks at handwriting. So maybe you do need to do one or two more assessments if there's another area of difficulty. And I'm not trying to give everyone more work, I'm just trying to call it like what it really is. You know, we need to, we need to make sure that we are assessing the the difficulties or the need, and we can't just do the bot and say that we assessed handwriting, because there is no handwriting component to the bot. So yeah.    Cheri Dotterer     Yeah. So one of the things that you mentioned in that you do the ths and it doesn't hit all the concerns. There are some things that we can do that aren't formally assessed, but there are some norms out there for things. One of the things that really impacts handwriting, that people don't always think about are those primitive reflexes, okay, doing supine flexion and prone extension, like Superman and in turtle, doing an atnr assessment, doing an stnr assessment, doing a spinal gallon and a spinal pareese assessment are so crucial to understanding why a kid is having struggle sitting in their chair. If they can't sit in their chair, they're not going to be able to write. So even getting a little bit more granular with what I've learned about the writing is the primitive reflexes are a huge need that not everybody gets to assess. But you have also mentioned, I don't about spending more time. I want to flip that and say, if you don't do a comprehensive evaluation, you could get yourself into a situation where you've got an independent educational evaluator coming in and superseding your evaluation avoid that long term headache of having to go back and redo and redo and redo because. If you do it right, the first time, you won't have to. You'll save the kid, the parent, the teachers and the whole team a whole lot of headache    Jayson Davies     Yeah, and sometimes we have to explain that to our bosses, because they don't understand that. And it's hard, because our bosses do see they think in large numbers, right? And they think that if we do 1000 evaluations this year, and one student comes back with an IEE because of what an OT did, they see that as actually cost effective, because the other 999 students didn't necessarily need an IEE. So even though the evaluations that you didn't do maybe didn't warrant an IEE. You still need to at the end of the day, you need to best. You need to know that you did a good evaluation. And so I would if you have any evaluation, or, sorry, not an evaluator, if you have a boss at a whatever their position might be director, coordinator, who's telling you you need to speed up your evaluations. You know I would, I would just recommend that you push back a little bit and then, of course, a nice way, a polite way, and over time. It may not happen overnight, but I would definitely argue that we need to get the time that we need to complete a solid evaluation. We don't want IEE is we want to be effective. We want to be time efficient, but all that needs to be weighed out on making sure we have a good evaluation.    Cheri Dotterer     I have a list of a comprehensive ot evaluation on my website, in my Frequently Asked Questions page, that if anybody wants to really get an idea of where my brain is going with what a complete evaluation is, you can check out that page on my website.    Jayson Davies     Cool. We'll be sure to link to that as well. Awesome. Thanks for all the resources. All right, so let's move on here. We passed the evaluation. Now, you know, we could talk a lot about different interventions. I just want to ask you a few I few concepts ideas, and one that often comes up, and I get asked this question a lot, and I have my own response, and I think our responses might kind of align here a little bit, but at what time do we stop working on handwriting? Or how do we know when it's time to move on to typing? Same type of question that I often get, what are your thoughts?    Cheri Dotterer     Never stop working on handwriting. Yes, you can pull in assistive technology, but always find a way to incorporate some kind of handwriting into your work. So what that looks like sometimes is they copy or, okay, let me step back so they type what they need to, or they speak speech to text what they need to using whatever system technologies that they need to use. And then they take something that they've already completed that looks neat, that's has the capitalization, the punctuation, all the correct spellings and stuff like that, and that is what you practice typing on. So it's not something that they have to get done because they have to get it done for school. But if this teacher may not really want it in the typewritten form for the class, maybe it needs to be handwritten onto whatever it is. So utilizing the assistive technologies to do the first draft, fix it up, and then doing maybe final copy as a copy to whatever it is that they need to put it on. That's my way of of addressing that, that issue. Now it may be that it still takes a long time to do the copy. So you only might. You might only be copying one or two sentences, because it taking them 10 or 15 minutes to do that much work, but still do both.    Jayson Davies     Okay, yeah. And, I mean, I think, similar to you, I don't think that we should ever expect our students to not make progress on handwriting. You know, a lot of times people will ask, you know, at what age will kids stop learning to hand write? And when someone asks me that, like, I kind of, you know, not being devil's advocate, but kind of just thinking about other ways, it's like, okay, well, at what age will I stop being able to learn how to drive? At what age will I stop being able to learn how to use a computer? I'm a terrible typer. I know that I could learn how to be a better typer if I put effort into it, but I haven't taken that initiative to be a better typer. I don't go on typing.com every day in practice. So I hate, I very just very much dislike that question about like, at what age should we not. Expect a child to learn handwriting anymore. I don't think there is an age. I think that there are different ways to address handwriting, and that might change over time. You know, at a certain time, maybe we need to move from a therapeutic role of providing that handwriting, therapy for handwriting, into more of a consultative role, where we are teaching the teacher or the parent how to potentially work on handwriting, because they can do it for 10 minutes every day, where I can only do it for 30 minutes once a week, but we can still work on it. Does that make sense?    Cheri Dotterer     Oh, yes, absolutely. I'm totally with you.    Jayson Davies     Okay. And then a follow up question to this, a little bit, I think, is, and maybe I just answered that question on accident, but how do you tackle working with an older student as opposed to a younger student when it comes to handwriting and dysgraphia, or is it the same?    Cheri Dotterer     I like the phone. The phone has voice to text that is pretty well integrated into society these days. It's not like it was 20 years ago. So I use the phone a lot when I'm working with anybody who's in third grade or above. We will have discussions, and I will use some of the interventions, strategies that I'm teaching in my courses. I use images for writing prompts. I get their perspective. I'm recording the entire conversation so it might be a picture of bubbles in the foreground and something in the background. One of the images that I do have is bubbles in the front and trees in the back. And it's a campground, okay? And I asked the kids four questions in a statement. The four questions are, what do you see? What do you notice? How does it make you feel? What questions can you come up with to talk about this picture? And then I always ask them to tell me more. So that way, while we're recording it, I'm asking them the questions we can use a playback that playback can be copied by you, and then they copy it. That could be, they play and stop, play and stop. So it's a dictated style of regurgitation, up to from text to speech or text to written material. Or it could be they listen to the entire playback and then try to self generate their own new sentence. So there's, I utilize that a lot, depending no matter what the age of the student, I don't usually, well, okay, I really started around third grade, but I really tried to get them to engage in the conversation, and I am finding that images are a really good way to get an idea of what a child's perspective is.    Jayson Davies     Okay, and so that could work, like you said, you know, it could be a younger kid, or it could be maybe change the image, but it could work for a younger student or a potentially older student, similar treatment, similar activity, but it can be slightly modified, of course. Cool. All right. Well, you know what? I think we are going to kind of get toward the end here of wrapping up, you've given us a little bit of info about evaluations, a little bit information about a treatment, working, working with students, young, old, whether or not we're moving toward typing or not. And we also, very graciously, got a lot into your three different types of bilateral integration, as well as dysgraphia. So Sherry, I want to say before we get into this last piece, thank you so much for being here and for joining us and just dropping a lot of information today. And then I also want to give you the chance to share exactly where people can go to learn more about you. You've mentioned a few different things, but if people just to go to one spot, where should they go?    Cheri Dotterer     Cheri dotterer.com . all right, C, H, E R, I, D, O, T, T, E R, E R .com, yes, that's Cheri with a C.    Jayson Davies     Yes. And I have, over the last three years, I have made mistakes on your last name, enough that I no longer make mistakes on your last name. I've got it down. So yes, Sherry, you have made it into you have been ingrained into my brain with your last name and the CH so we are good. Thank you so much for being here. Thank you so much for all the information that you shared. Very valuable. And I can only imagine what, what else we might learn when we head over to the writing glitch community, it's going to be great.    Cheri Dotterer     Thank you. Thank you so much. And there is a link. Get one. cheridotterer.com on how to get to the writing glitch.    Jayson Davies     Awesome, great. Well, we will see you there. Take care. Have a great rest of your day.     Cheri Dotterer     Thanks. You too.     Jayson Davies     All right, that is going to wrap up Episode 114 thank you so much for sticking around with us. Thank you so much to Sherry daughter for coming on and sharing such valuable information. I'm excited for all the books you have coming out. I'm excited for all the all the programming you have coming up in your community. Cannot wait to learn more from you. If you're listening to the podcast right now, I would love for you to hit that subscribe or follow button so you don't miss a future episode and be sure to leave us a review. One star, five stars, anything in between. I would be so tremendously grateful if you leave a quick review. Thank you so much, and we will see you in episode 115, Until then, have a great day.    Amazing Narrator     Thank you for listening to the otschoolhouse com 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! 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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BONUS: Save all 7 AI Prompts to your Google Drive for FREE If you’ve been following along with the OT Schoolhouse, you know I’ve been an advocate for the ethical use of artificial intelligence (AI) by school-based OT practitioners. The truth is, none of us became school-based OTPs because we were passionate about paperwork . Rather, you got into this field for the same reason I did: to help students through direct evaluation and intervention, not to spend endless hours documenting. Fortunately, AI tools like   ChatGPT , Google Gemini , and Magic School can now help us reduce the time we spend on documentation and planning. In this article, I’ll share seven AI prompts designed to save you time while improving the quality of your documentation and interventions. But before we jump into the prompts, it’s important to touch on how to use AI responsibly, particularly regarding HIPAA and FERPA compliance . So, let’s talk about how you can harness the power of AI while staying within ethical and legal boundaries. Ready to dive in? Let’s go. Responsibly Using AI in School-based OT: HIPAA/FERPA Compliance Before jumping into the prompts, it’s crucial to understand that as healthcare professionals, we must maintain strict confidentiality and comply with HIPAA (Health Insurance Portability and Accountability Act) and FERPA (Family Educational Rights and Privacy Act) standards. So as you use the prompts below, please adhere to the following guidelines: Avoid inputting identifiable information Always use de-identified data when interacting with AI so no specific student can be recognized. Choose AI tools carefully Ensure that the platform you are using is committed to privacy and data security. While tools like ChatGPT and Magic School offer high levels of privacy, always verify. With any AI tool, check the account settings to see if you can limit the tool from “learning” or “improving” from your data. Double-check AI-generated content AI is not foolproof, and it’s important to ensure that any content produced aligns with your professional judgment and ethical standards. Never assume that what AI gave you is 100% correct. Always read it and make changes as necessary. At the end of the day, “I used AI” will not work as an excuse for why your progress report made zero sense.  Okay, now that we know how to use AI responsibly, let's get to the prompts! The 7 AI Prompts for OT Practitioners Now, let’s get into the practical part—how can AI help you save time and improve your work as a school-based OT?  Below are seven AI prompts you can use today. Please note that wherever you see brackets - (...) - you will need to remove the brackets and input your information to get a real result.  Let AI Write Your Observation Transforming classroom observation notes into a well-structured narrative can take time, especially when you’re trying to synthesize a lot of detailed information. This prompt helps you take your raw observation notes and quickly convert them into a (mostly)  polished narrative for your school-based OT evaluation reports. By automating this process, you can focus more on assessing the student’s needs and less on the time-consuming task of writing up the report. Prompt: Please turn my classroom observation of a student into a cohesive narrative that I can use in my school-based OT evaluation report. (Attach handwritten or typed observation notes) Extra tip : Ask Chat GPT to remove any OT jargon and ensure that it can be easily understood by a parent.  Create SMART Goals for the IEP Crafting individualized and measurable IEP goals is a key part of your role as an OT, but it can sometimes be overwhelming to get all the details just right. This prompt allows AI to assist in creating three potential OT-related SMART goals for a student’s IEP, complete with present levels of performance. It saves you time while ensuring that the goals are meaningful and aligned with the student’s unique needs. Prompt: Based on my observations, assessment results, and synthesis, please write three potential OT-related SMART goals for this student’s IEP, ensuring they are neuro-diversity-affirming. Also, include a present level for each goal, indicating how the student is currently performing on the goal. (Attach/paste your de-identified evaluation or specific sections of your report) Extra tip : In Word Doc, hit Ctrl + H (Command+F on a Mac) to quickly find and replace your student’s name with “STUDENT.” Now, you can input your de-identified report into the AI tool.  Get the FREE AI Prompt Bank with all 7 Prompts Enter your email to receive it now! Is the form above not working? Click here. Create a Custom Goal Measurement Chart Tracking progress is crucial, but creating charts to measure goal achievement can be time-consuming. This prompt allows you to easily generate a custom progress-tracking chart, ensuring you have a structured way to measure how a student is progressing toward their IEP goals. By automating the chart creation, you free up time for more meaningful work while staying organized. Prompt: Please create a simple chart to help me measure the following goal. Ensure it includes enough rows and columns to measure the goal at least [#] times. Here is the goal: [insert goal]. With a ready-made chart, you’ll have an easy, visual way to monitor progress and discuss it with the IEP team. Discover Occupation-Based Therapy Ideas Developing new, creative, and occupation-based therapy ideas for each student can be mentally taxing. This prompt generates a list of 10 therapy ideas to support the student’s IEP goal, organized from least to most task-demanding. It helps ensure you have a wide range of activities to meet the student’s evolving needs without starting from scratch every time. Prompt: Based on the following goal, please list 10 occupation-based therapy ideas that I may use to support the student in achieving it. Order them from least to most task-demanding based on your knowledge of the student. Here is the goal: (Insert goal). This prompt is perfect for streamlining session planning while ensuring that your interventions are appropriately challenging and engaging for the student. I'll let you imagine what a follow-up prompt could be... Imagine the detailed intervention plan possibilities. Analyze Any Task Using Theories/Models Task analysis is a fundamental skill in OT, but breaking every task into manageable steps can be time-intensive. This prompt uses AI to help you conduct a task analysis based on the theory or model you’re working with, such as sensory integration or motor learning. It saves you time while providing a detailed breakdown that you can use to plan interventions. Prompt: Based on [insert theory/model, ex. Sensory integration], conduct a task analysis of a child [insert task]. Example: Based on sensory integration theory, conduct a task analysis of a child tying their shoelaces. - Just try it! Then email me later... Write Quick SOAP Notes Using Just Your Voice Documenting sessions is one of the most time-consuming aspects of OT practice, especially if you type as slowly as I do. This prompt helps streamline the process by turning your spoken notes into a structured SOAP note format. Simply dictate what happened during the session, and AI will organize the information into a clear and concise note. Prompt: (Tap the little microphone to record your voice) Turn these thoughts into a brief and organized SOAP note – [speak to what you did during the treatment, how the student reacted, any data related to their goal(s), how you supported the child, and the plan for moving forward]. Bonus tip : Clicking on the headphones in the Prompt Bar will allow you to have a verbal conversation with Chat GPT . That's right! Chat GPT will speak back to you! It's not super helpful as a therapist, but it's fun to play with. Prepare Trimester/Quarterly Progress Notes Parents are key partners in the IEP process, but it can be challenging to translate clinical progress into language that is easy for them to understand. This prompt helps you create parent-friendly progress notes that clearly communicate how their child is doing in therapy. This helps ensure parents feel informed and included in their child’s progress without getting lost in jargon. Prompt: [Attach or paste previous notes and data] Based on the attached OT notes, please write a progress note for the following goal/s. The progress note should be written with the parent in mind as the primary audience. Goal: [insert goal/s]. This prompt will cut your progress on goal notes in half and make it easier for parents to understand your progress updates in a clear, digestible format. The Final Word As I hope you can see, AI has the potential to transform your school-based OT practice by saving you time, improving your documentation, and helping you to be more evidence-based. The seven prompts above are just the beginning, though. As you become more comfortable with AI tools like ChatGPT, Gemini, and Magic School, you’ll find that they can be customized to suit your needs. Remember, while these seven prompts can be extremely helpful, you must use AI tools responsibly. Ensure you comply with HIPAA and FERPA guidelines and always review AI-generated content to maintain the highest professional standards.   REMEMBER: Save all 7 AI Prompts to your Google Drive for FREE    Using AI in OT is no longer the future. It is here today. I hope these seven prompts will help you get started with AI ( if you haven't already ) and save you hours each and every week from now on!  Do you have a favorite prompt to share with your fellow OT colleagues? Paste it in the comments below to help a fellow OTP out!

Click here or scroll down for the free tool! Hello everyone, Welcome back to the School House. We appreciate that you have returned to see what is going on here. A few weeks ago, Abby wrote a post titled " Essential Components to any School-Based Occupational Therapy Assessment. " And in her very first step to completing an OT assessment, she referenced to completing an "occupational profile" for the student to help understand the strengths, weaknesses and any other necessary background information related to that student. Well it just so happens that AOTA has a form for just that. It's called the " AOTA Occupational Profile Template, " But to be perfectly honest, it's just not designed for school-based OT assessments. taking a quick glance at it, you can see that it was put together by someone who works with adults, likely in an outpatient rehab clinic. In case you are not familiar with the AOTA Occupational Profile Template, it is broken down into 4 sections that are very relevant to our area: Client Report, Environment, Context, and Client Goals. The creator of this form definitely looked at, and indeed referenced to, the OT Practice Framework when building this form. So I began using this form as a reference guide when completing my OT evals in the schools in order to make sure I was looking at all areas identified in the practice framework. Using this form helped a lot with my assessments. It naturally encouraged me to use the Person-Environment-Occupation (PEO) model, but over time I found myself starting to alter it a bit here and there with little notes. Likewise, I would have information on the student, but it didn't fit into any of the provided boxes. So one Saturday, I decided to adapt it for school-based OT evaluations. And well, this is what came of that Saturday morning. Share your email below to get your copy of the "Occupational Profile for School-Based OTs" The 4 original main sections still exist with similar traits, but the subsections are changed to take into account factors such as having multiple clients (student, parent, teacher, etc.) and environments related to school. Some of the subsections included are: Who is referring the child for OT services and what are their concerns related to school engagement? How does the student feel toward school? School related history (IEP services and goals, age first enrolled, RTI, grades) Physical Environment (desk, restroom, recess equipment, necessary tools, use of adapted materials) Personal (age, gender, likes and dislikes) Virtual (What computer/app based programs does the student uses successfully) Student’s Priorities As you can see in this short list of included sections to be completed, this form is designed to help you specifically in a school-based setting. It take into account the multiple clients and the extensive amount of information that we are expected to accumulate to put into our reports. For me, It has helped me to make sure I don't forget anything, especially the parent and student input. I encourage all of you to talk to the parents during your eval process, if you don't already. IEP meetings go much more smoothly when you have spoken to the parent, discovered their specific concerns, and have addressed their specific concerns in your evaluations. So, let us know what you think about our Occupational Profile. Do you already use something like this during your evals? We'd love your feedback. If you know someone who would love this form, please share it with them by clicking of the Social Media icon of your choosing below. Thank you everyone for spending some time with us today. Until next time, Jayson

As school-based occupational OT practitioners, we rely on a variety of tools to assess our students’ needs and guide our interventions. Among these, standardized assessment tools hold a special place, offering a consistent way to gather data, develop IEP goals, and track progress. Tools like the Sensory Processing Measure (SPM)  and the Bruininks-Oseretsky Test of Motor Proficiency (BOT)  are well-known options that many practitioners turn to for a structured approach to student evaluation. But just like any tool, these assessments aren’t set in stone. The recent release of the SPM-2  in 2021 and the current (summer 2024) launch of the BOT-3  remind us that updates are part of keeping our practices aligned with the latest research and student needs. And while I know some of you are eager to get your hands on the newest tools, others may have different feelings. In this article, we’ll explore: Why standardized tools are periodically updated Why some may not be Whether or not you need to update to the newest tools How to thoughtfully transition when an update occurs. And the possible ramifications to using an older assessment Whether you’re an advocate of standardized assessments or prefer to rely on your keen observations and less structured tools, understanding the “how” and “why” of these updates ensures you can make informed choices about the tools you use in your practice. Why Are OT Assessment Tools Updated? Standardized assessment tools are periodically updated to reflect advancements in research and technology, better serve the populations we assess, and enhance their practical use. The Sensory Processing Measure (SPM) , originally released in 2007 and updated in 2021 as the SPM-2 , is a prime example of how assessments evolve to align with current research and practices in sensory processing. Similarly, the Bruininks-Oseretsky Test of Motor Proficiency (BOT) , which is currently releasing its third edition here in the summer of 2024, introduces several important updates to improve its utility. The update for the  BOT-3 was designed to optimize test administration and improve scoring. New items were added to address floor and ceiling effects, the quality of test equipment was improved, and the coverage of both fine and gross motor items was expanded. The BOT-3 also includes new supplemental scores, updated normative data, and an extension of test norms to age 25, making it a more comprehensive and versatile tool for practitioners working with young adults. Updates like these ensure that the assessments we often rely on are as accurate, valid, and relevant as possible. They allow us to account for changes in population demographics, address gaps in the original test design, and incorporate advancements in both research and technology. Why Some Tools Are Not Updated While assessments like the SPM  and BOT  receive regular updates, others, such as the School Function Assessment (SFA) and the Sensory Integration and Praxis Tests (SIPT) , have remained unchanged for years. 🙄 This can happen for various reasons. Often, the resources required to update an assessment are considerable, and if the tool serves a smaller or more specialized role, updates may not be prioritized. Additionally, newer tools may emerge that fulfill similar purposes, gradually shifting practitioners away from older assessments. We are seeing this happen right now as the Evaluation in Ayres Sensory Integration (EASI) and the Structured Observations of Sensory Integration – Motor (SOSI-M) replace the SIPT Even without updates, some of these older tools can still hold value for specific cases, especially when practitioners have experience with them and find them effective within their practice. Enhance writing skills and progress monitoring for all students! In this course, Bridgette Nicholson shares how you can quickly and easily assess the written expreseeion of any student with the Online Assessment of Writing Methods. Access this course and more when you join the OT Schoolhouse Collaborative today! Why or Why Not Update to the New Assessment When a new version of an assessment tool is released, school-based OT practitioners are often faced with a critical decision: should I update to the latest version? While there are many advantages to transitioning to the most recent edition, it’s not always a requirement, and the choice depends on a variety of factors. First, consider whether your school or district mandates the use of the latest version. Unless you ask, you may never know if this is the case in your district. Some districts might require updates to ensure assessments align with current best practices, while others might allow for more flexibility. In some cases, there may not be a strict timeline for switching over, so you may have to advocate for why you think your department needs the updated assessment. Another important factor is the nature of the updates themselves. If the new version addresses significant gaps in the previous edition—such as improved scoring, expanded range of items, or better representation of the population you serve—then updating may offer more accurate data and better support your decision-making. For example, the BOT-3  now includes expanded fine and gross motor items and extends test norms to age 25, making it more versatile than the BOT-2  for a wider range of students. So, if you have been trying to find a tool to use with your young adults, then it may be worth upgrading sooner than later. However, if the updates are minimal or if you feel confident that the older version still meets the needs of your students, you might opt to continue using the older edition, particularly if you have a well-established process in place. Just be mindful of any differences in norms or scoring that could impact the validity of the results over time. Ultimately, updating to the latest assessment tool is a decision that depends on the needs of your practice, the requirements of your district, and the advantages offered by the new version. While staying up to date ensures you’re aligned with the latest research, there may be cases where sticking with the older version is still a valid choice. Click here to read what Pearson has to say about this. How to Transition to a Newer Version Transitioning to a new version of an assessment tool can be done smoothly with the right plan in place. Below are some practical steps to help guide you through the process: Familiarize Yourself with the Updates and Necessary Training Start by learning about the key differences between the old and new versions of the tool. This could include changes in content, scoring systems (going digital is in right now with new tools), and how data is interpreted. It’s also important to find out if there’s a recommended date by which you should be using the updated tool—or if it’s entirely up to you. Most publishers offer comparison guides, training workshops, or webinars that will help you get up to speed on the new version. Pearson has both free and paid training opportunities related to the BOT-3. Click here for the free BOT-3 training . Create a Transition Plan with Stakeholders It’s essential to have a plan in place before switching to the new tool. Decide on a timeline for the transition. You may opt to transition at a natural school break, or perhaps you just wait until you run out of the older protocols. Either way, make sure you order the new tools ahead of time and schedule any necessary training for yourself or your team well before the transition date. Collaborating with your team and administrators ensures everyone is on board with the plan. Decide If Older Tools Can Still Be Used in Some Capacity Some older tools, especially those with physical components like the BOT-2 , may still be useful in certain situations. However, it’s crucial that these materials don’t interfere with the standardization of the new tool. For instance, the BOT -2 pennies, mat, and red basket can still be used for other therapy activities, but maybe you don't use them in the same way that you would while giving the BOT. By following these steps, you can ensure a smooth transition to the updated assessment tool, making sure you have the proper knowledge and resources in place for a seamless switch. Potential Ramifications of Not Using an Updated Assessment Failing to upgrade to the latest version of an assessment tool can have consequences. Outdated tools may not reflect current research or population norms, which can lead to less reliable or valid data when assessing students. This could affect the quality of intervention plans and the appropriateness of IEP goals, potentially causing interventions to be less effective. Additionally, parents and student advocates may question the validity  of results from an outdated assessment. Using an older version might give the impression that the assessment is not aligned with current best practices, which could raise concerns about the fairness and accuracy of the evaluation. These challenges may lead to disputes or delays in getting students the support they need. Finally, using older assessments could result in non-compliance with district or state policies , especially if your school or district has adopted newer tools. This could impact your credibility as a practitioner and may complicate your ability to advocate for resources or support for your students. The Wrapup Whether you’re someone who frequently relies on standardized assessments or prefers a more flexible approach, staying informed about updates to key tools is an essential part of maintaining best practices in school-based occupational therapy. Transitioning to new versions of these assessments might take some planning and adjustment, but it ultimately ensures that you’re providing students with the most accurate and up-to-date evaluations possible. If you know that your state, district, or school has policies, or even just expectations for using the most up-to-date tools, then you can refer to those policies when requesting that your district purchase the updated tool. As new tools and updates continue to emerge, be sure to take the time to review the changes, plan your transitions, and engage in any necessary training. It’s all part of evolving alongside the needs of our students and the advancements in our field. . Resources SPM-2 examples and videos from WPS Pearson's guide on when to update An overview of standardized assessments from AOTA BOT-3 training and other resources OT created template for the BOT-3  (From Schoodles) Watch this video on pairing the BOT-3 with the Schoodles Fine Motor Assessment