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Picture this. A first-grade teacher just showed you a handwritten note from a concerned parent requesting an initial special education evaluation for their child. The note details the child’s difficulties in school—trouble with focusing, struggles with handwriting, and frequent fidgeting during class. And at the end of the note, in clear handwriting, the parent has specifically requested, “Please make sure OT, PT, and SLP are included in the evaluation.” You pause. There are certainly areas of concern, but should OT be a part of the initial evaluation process? While the parent’s request is understandable, you’re also aware that some of these concerns might be addressed through other services or strategies without involving an OT assessment just yet. Do you agree to assess right away, or do you wait for the psycho-educational evaluation to provide more clarity? As school-based OTs, this scenario is a common one, and making the right decision isn’t always straightforward. In this article, we’ll explore: When an OT eval should be implemented during the initial special education evaluation request When you may want to wait for the psycho-educational evaluation And three ways to respond to a parent’s request for an OT evaluation (during the initial special education request) By examining various situations, we can ensure that our evaluations are purposeful, timely, and aligned with the student’s specific needs. Understanding the Initial Evaluation Process When a student is referred for special education services, the first step is typically a comprehensive psycho-educational evaluation. This evaluation is conducted by a school psychologist (often with the support of a special education teacher) and typically assesses cognitive, academic, and emotional functioning to determine if the student meets one or more of the 13 qualifying criteria for special education services. From a district’s perspective, waiting until the psycho-educational evaluation is completed before conducting additional assessments, like OT, may seem logical. It allows the team to determine if direct instructional services, such as resource programs (RSP) or specialized academic instruction (SAI), can address the student’s needs first. By waiting, the district may hope to achieve one or both of the following: Avoid unnecessary evaluations that could lead to services the student may not need Preventing therapists' caseloads from ballooning and, ultimately, saving the district money. However, as OTs, we know there are times when waiting isn’t in the best interest of the student. Some concerns are simply not best assessed in a psycho-educational evaluation— they are concerns that fall squarely within our scope of practice. When an Occupational Therapy Evaluation Should Be Considered Immediately In my perspective, there are a few areas where an Occupational Therapy Evaluation should be part of the initial evaluation. These are situations where waiting for the psycho-educational evaluation may delay critical services the student needs. Here are some of those situations: 1. Sensory Concerns Impacting Education Access When sensory processing challenges are present, they typically won’t be captured in a standard psycho-educational evaluation. Even worse, the sensory-related concerns may be misidentified as strictly behavioral concerns , which could have service-related implications for years to come. Students with sensory concerns might struggle with attention, behavior, and participation in the classroom. These difficulties often have a significant impact on their ability to access their education. If sensory issues are reported by parents or teachers, it makes sense to assess OT from the start, rather than waiting. 2. Fine Motor Skill Deficits Impacting Education Access Fine motor difficulties, such as challenges with handwriting, using scissors, or manipulating classroom tools, are areas we are uniquely qualified to address . If these concerns are noted early on, conducting an OT evaluation as part of the initial referral can help get the student the support they need right away. Even in younger students where handwriting might not have been formally taught, if fine motor delays are evident, addressing them sooner rather than later can prevent future frustration. 3. Activities of Daily Living (ADLs) Impacting Education Access ADLs, including self-care skills like donning/doffing a sweater, toileting, and feeding, are often overlooked in the typical special education evaluation process. If there are significant concerns in this area, we can provide crucial support that other services may not address. Even if services are not warranted after the OT evaluation, any consultation and accommodations we provide could go a long way in supporting both the student and the school staff. When to Wait for the psycho-educational Evaluation While there are clear cases for immediate OT involvement, there are also times when waiting for the psycho-educational evaluation might make more sense. Here are a few scenarios where it may be best to hold off on an initial OT evaluation: 1. No Clear OT-Related Concerns If the primary concerns are academic or speech-related, and there is no indication that the student is struggling with fine motor skills, sensory processing, or other OT-specific areas, it’s reasonable to wait. In these cases, the psycho-educational evaluation will often uncover the main areas of concern, and OT may not need to be involved unless something specific arises later. 2. Concerns That Can Be Addressed by Teachers For younger students, difficulties like handwriting or scissor use can sometimes be supported effectively through classroom instruction. If a student hasn’t yet received formal handwriting instruction or hasn’t had the opportunity to practice fine motor tasks in school, it may be best to wait until these foundational skills are taught before assessing OT. Similarly, if a student is still adapting to school routines, they may not need OT support at the initial referral stage. A quick note on Delaying Referrals as a Means to Manage Caseloads. Lately, it’s becoming more common for districts to delay OT evaluation requests—regardless of the concerns—until after a student has undergone a psycho-educational evaluation. While I understand the financial pressures and the need to manage service provider caseloads, this type of blanket policy seems to undermine the spirit of the Individuals with Disabilities Education Act. The purpose of IDEA is to ensure that every student’s needs are met on an individualized  basis. While I fully agree that not every student referred for special education requires an evaluation from every related service provider. However, implementing a policy that delays or prevents related service evaluations, regardless of the specific concerns raised, goes too far. The core of IDEA is individualization—the decision to include any service provider in the evaluation process should be made based on the student’s unique needs, not because of a broad, one-size-fits-all policy. Let’s be clear:   managing staff caseloads should never be the primary reason to avoid evaluating a student . While it’s important to ensure we are not conducting unnecessary evaluations, decisions should always be driven by what’s in the best interest of the student. If a student’s needs do not clearly fall within the OT scope, it may indeed be appropriate to wait. But that determination should be made by the team on a case by case basis, rather than through an inflexible district policy aimed at controlling caseloads. Responding to a Parent’s Request It’s no secret—parents often request a full evaluation from all  service providers, including OT, even when their concerns don’t align with our scope of practice. When you receive such a request, it’s crucial to approach the conversation with empathy and understanding. Remember, most parents aren’t familiar with the intricacies of IDEA or the evaluation process—especially if this is their first time navigating special education. Their understanding may be based on a few hours of online research or even a quick chat with AI. Our role is not only to assess but also to guide parents through the process with clear, compassionate communication. So, how do you address a parent’s request for an OT evaluation that doesn’t seem warranted? The best starting point is simple: pick up the phone. A personal call can go a long way in building rapport and clarifying misunderstandings. Take time to listen and understand the parent’s concerns. Often, they may not fully grasp what an OT evaluation involves or may assume it covers areas outside of our scope. By directly addressing their concerns, you can clarify whether an OT evaluation is likely to provide useful information. And if you feel the eval is warranted, this conversation can serve as your parent interview to learn more about the child. However, if after understanding their concerns, you believe an OT evaluation isn’t necessary at this stage, explain how waiting for the psycho-educational evaluation could provide valuable insights that could help guide the need for OT services later. If the parent is receptive and agrees, it’s a good idea to ask them to send a follow-up email confirming that they’re withdrawing their request for an OT evaluation. This ensures there’s a written record of their decision. And if the parent remains firm in their request for an OT evaluation, you have a few options: Conduct the evaluation, even if OT services may not be warranted.  This allows you to gather data and make an informed recommendation. Collaborate with the school psychologist to include a brief OT assessment section as part of their broader evaluation.  This provides a middle ground, addressing the parent’s concerns without requiring a full OT evaluation. Discuss with your administrator or special education department the possibility of issuing a Prior Written Notice (PWN).  This would formally communicate the district’s decision not to conduct an OT evaluation based on the lack of OT-related concerns. Personally, I try to avoid issuing PWNs, especially for initial evaluation requests. Refusing to assess a student can put both you and the district in a difficult position. It not only frustrates the parent, but it can also create potential legal challenges down the line. If, at a later date, the student is found to require OT services, the parent could argue that the evaluation and services were unjustly denied from the start. #MakeupServices This is why I tend to err on the side of conducting the evaluation. I would rather gather the necessary data and conclude that OT services are not needed than make the decision not to evaluate at all, only to later discover that the student did require OT support. Having the data in hand allows you to make a more informed decision—and protects both you and the district should the need for OT services arise in the future. Conclusions At the end of the day, deciding whether to assess a student as part of the initial special education referral process should always be a case-by-case decision. Some students will clearly benefit from an OT evaluation right away, while for others, it makes sense to wait until the psycho-educational evaluation provides more information. Collaboration with the IEP team and open communication with site administrators is key to making these decisions, as is clear communication with parents. When we advocate for a thoughtful, individualized approach, we ensure that our evaluations are purposeful and lead to meaningful, timely services for the students who need them. My hope is that your district is not putting in place blanket policies that prevent evaluations. But if they are, I hope that you take small steps toward explaining such policies can be detrimental to the students who need services the most. And if you do decide to evaluate the student, here is how I would go about doing that .

Hey there everyone! Between working to startup the podcast and trying to stay up to date at the school sites, we fell slightly behind on this blog post. But we’re here and the world has not come to an abrupt stop. Thank goodness. Despite not having a theme for April, this Month of OT has turned into a month of posts related to productivity and organization for OTs here, so we are going to run with it. Last week, Abby posted a great post titled “Ten Time Management Tips for the Busy School-Based OT” and this week I want to follow that up with a few more specific tips and one useful document for all of you that either travel to multiple school sites or work with multiple therapists at several school sites. Let’s jump into the first set of tips! “Prioritize your time” This one is straight from Abby’s post last week, but it’s so important that I felt it necessary to reemphasize. Being a school-based therapist is hard enough at one school, but having to deal with 2, 3, or even more school sites is just ridiculous. Most school seem to have a six and a half hour day. However, between lunch, recess, and other daily activities it can sometimes seem like the kids are hardly there at all. And it's true, you really don’t have that much time in a day to see the students. It's absolutely imperative that you know the school schedules and organize your time to take advantage of it. Here are a few quick tips to take advantage of the school schedules: See older students when the younger ones are at lunch and vice versa. Start at an early start school and end at a later start school. Drive between schools during the time when most students are at lunch. (And don’t forget to eat your lunch - likely while driving...) Make sure you have a schedule and directory for each school. Don't forget to reference to it when setting up your schedule. A school map may even be helpful at the beginning of the year. Get on each schools' email list so that you know when fire drills or other drills may occur. That way you can plan around it and even potentially be at another school site when it occurs. Going to a school site just to see one student? Call the secretary or check the web (if you have access) to see if they are even there. Check In, Check Out I got a flashback just now to Mr. Miyagi from the Karate kid while writing that. But really, This has not happened to me (and I hope it never happens to you either), but I have heard stories about therapists getting accused of not being where they were supposed to be during work hours. Being a therapist that travels between sites comes with some extra responsibility. Many people in the district trust that you are where you are supposed to be and most do not check in unless they have a reason to. You definitely do not want to put yourself in a situation where your supervisor feels they need to check in on you. Plus, it just makes all of us look bad. So please, be where you're supposed to be. With that said, be sure to check in and out of school sites. That way if anyone did feel the need to check in on you, you can prove you were at least somewhere in the district. You can’t simply rely on a teacher or secretary vouching for you. Some schools have a related service sign-in book in the front office and others have a sign-in/out for each student being seen in the classroom. Whatever the rules are, know that they are there for both you and the students' best interests. If you want a little extra security, you can even set your phone up to track when you arrive and depart from somewhere and have it logged in a google doc using the IFTTT app. This can be a little tricky to set up, but if you’d like to know more about this, email me and I will try to help you out. Caseload Management One of the hardest parts for any therapist can be keeping up to date on what kids are at what school, what do their services look like, and when are all of their meetings due. In a perfect world, the case carrier keeps you informed on much of this, but we don’t always live in a perfect world so we have to keep up our own records. Below is a screenshot from a document we would like to share with anyone who would like it. We use a very similar document uploaded to google docs so that we can access it from virtually anywhere. Then we try our best to update it right there during the IEP meeting. Although, quite frankly, it sometimes does not get updated until a pupil free day such as spring break. Not only does this document track the details of each student, but it also is used to track how many students the OT sees versus the COTA at any school site so that you can easily determine if one therapist has more or fewer students and/or weekly contact hours. The summary page of this document automatically imports data from the other “School site” pages and auto-populates to give you a summary of how many students receive different levels of service at each school site. It will also help you plan for extended school year and help when conducting a workload study to justify the need for an additional support. We have used a version of this spreadsheet for the past five years and it has really helped to keep our caseload organized year in and year out. I also make sure to save a copy of the document at the end of each school year to compare to other school years. Traveling on a Schedule When I first began as an OT with multiple schools, I was almost fearful of traveling. Not the actual driving part, but the idea that I wasn’t seeing students. I felt as though I was wasting time. That was when I was only at 4 schools. Now I’m at 9! But the truth of the matter is that traveling is part of the job and we should treat it with the importance it demands. Travel takes time and if we don’t account for this time, we are bound to fall behind in our schedule. For this reason, be sure to schedule travel time into your day. Not just the time it takes to get from point A to point B, but also the time required to pack your things, check out, walk to your car, drive, check in at the new site (while saying a brief hello to the office staff) and finding/ getting set up in a room. This all takes time and is especially true for providers in rural districts as well as congested city districts where traffic can be bad. Real quick, this is also very important to track if you are in the process of, or wanting to, conduct a workload study. Workload studies are great and we are currently tracking data for our own study. We hope to bring that to you over the summer. One last thing on this topic to help you out, I promise. Be sure to track your mileage between school sites. You can either write it off on your taxes or have the district/contract agency reimburse you. In a rural area, this is well worth the time it takes to do. And That’s Just a Few There are so many other tips that could help a traveling school-based therapist and we hope to help you out with more in the future. Be sure to subscribe to our email list to get the spreadsheet from above as well as a few other free documents and stay in the know. Also check out the podcast for half-hour segments all about school-based OT. What tips do you have for our readers? Be sure to comment below so others can learn from them. Until next time, Jayson

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 115 of the OT Schoolhouse Podcast. What do you think of when you hear the phrase trauma responsive? This concept goes beyond trauma-informed care. Tune in to hear Dr. Gibbs speak about her book, Trauma Treatment in Action, and how as OTPs, we need to be more responsive to the needs of a client regarding their mental health, just as if we were working with someone who had a stroke or other physical ailment. Tune in to learn the following objectives: Learners will identify the five dimensions of trauma and how to use these in practice. Learners will identify what ACTION is and how it can be used in OT. Learners will identify how an OTP can address mental health with a student. Guest Bio Varleisha D. Gibbs, Ph.D., OTD, OTR/L Varleisha D. Gibbs, Ph.D., OTD, OTR/L, is the Vice President of Practice Engagement and Capacity Building at the American Occupational Therapy Association (AOTA). She previously served as the Scientific Programs Officer at the American Occupational Therapy Foundation. Dr. Gibbs is an occupational therapist, international lecturer, researcher, and author. Her areas of expertise include neuroanatomy, self-regulation strategies across the lifespan, health inequities, and trauma-responsive approaches. Dr. Gibbs founded and operated a private therapy firm for over 10 years. Dr. Gibbs began her career after receiving her baccalaureate degree in Psychology from the University of Delaware. She continued her studies in the field of Occupational Therapy, receiving a Masters of Science degree from Columbia University and a clinical doctorate from Thomas Jefferson University. Dr. Gibbs completed her Ph.D. program in Health Sciences Leadership at Seton Hall University. Memorable Quotes from this Episode “Mental health is something that we all have. That’s not a disorder… Everyone requires support. There are social drivers that could lead us to healthy outcomes or adverse outcomes” - Varleisha Gibbs, Ph.D., OTD, OTR/L “That's what we do… occupation is about the doing and the being. And we need to make sure that we're not just informed, but that we are addressing trauma in a responsive manner” - Varleisha Gibbs, Ph.D., OTD, OTR/L “I really don't know any other profession that does this. We look at the person. But we also look at the context and environment” - Varleisha Gibbs, Ph.D., OTD, OTR/L “Growth could happen at any moment. Despite the child that may have a severe diagnoses, they can still show some growth on that hierarchy” - Varleisha Gibbs, Ph.D., OTD, OTR/L "We need to keep in mind that we're supporting their students and we're doing the best job that we can do. But we also have to be mindful about their own mental health and how they are perceiving the IEP process in itself” - Jayson Davies, M.A, OTR/L “If we don't start to use that language that relates to mental and behavioral health, then we will continue to not have that seat at the table” - Varleisha Gibbs, PhD, OTD, OTR/L Resources: Dr. Gibbs Books - Amazon Seminars - Dr. Gibbs Sensory processing course - Dr. Gibbs Book on intergenerational Trauma - Dr. Degruy Epigenetics Research Article - Natan Pf Kellermann Video on Brain Changes Mental Health in Non-Psychiatric Settings - AOTA Mental Health and Wellbeing - AOTA CommunOT 988 and OT - AOTA 988 Suicide & Crisis Lifeline Dr. Gibbs Website Dr. Gibbs Instagram Dr. Gibbs Twitter Dr. Gibbs Linkedin Dr. Gibbs Email Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the otschoolhouse podcast. Your source for school based occupational therapy, tips, interviews and professional development now to get the conversation started, here is your host, Jayson Davies, class is officially in session.    Jayson Davies     Hey there. And welcome to the otschoolhouse com podcast. My name is Jason Davies. I am your host, and I appreciate you joining us for this show today. Now we've all heard of and have probably even taken several courses about trauma informed care. But is it enough just to be informed about trauma, or do we need to go deeper and actually better understand trauma and how we can respond to trauma. I think that's the truth. I think we need to go beyond trauma informed care, and that's why today, we're chatting with Dr varlisha Gibbs to discuss trauma responsive care. It's no longer enough just to be informed as school based occupational therapy practitioners, we need to know how to respond and act when working with students who may be dealing with various types of trauma. Now, Dr Gibbs is a leader in the field of occupational therapy. She is currently the vice president of practice engagement and capacity building at aota, the American Occupational Therapy Association, and she is also the scientific programs officer at the American occupational therapy foundation. So both aota and AOTF. She has been an OT for over 20 years, and has both an OTD and a PhD in Health Sciences. Dr Gibbs has published a handful of articles and was also one of the contributing authors of the OT practice framework, otpf Fourth Edition back in 2020, so it's very fair to say she knows occupational therapy very well. She is also the co author of a book titled trauma treatment and action, all capitalized action over 85 activities to move clients toward healing, growth and improved functioning. Much of what we're going to be discussing today actually comes from that book, like the five dimensions of trauma and the action from trauma approach, which encourages movement toward healing and growth. I'm excited to have her share this with you, but really, I definitely recommend grabbing this book on Amazon. You can get it for your Kindle. It's really, you know, only about 20 bucks or so, but it not only does a deep dive into trauma, but it also gives you 85 activities to support your students with all of that. Let's go ahead and welcome Dr Gibbs to the otschoolhouse Comcast so she can share with us more about trauma and how useful this knowledge is for you and your students. So please help me. Welcome to the otschoolhouse com podcast. Dr varleisha Gibbs, hello. Dr Gibbs, welcome to the otschoolhouse podcast. How are you doing today?    Varleisha Gibbs     Great. Thank you for having me.    Jayson Davies     Yeah. Thank you so much for being here. You know, I must say, I have heard so much good about you. I mean, a lot of people that I end up having on the podcast have actually been referred to by previous podcast guest, and your name has come up a couple times, and so I'm excited to finally get you on here and have a good conversation with you. So thank you so much for being here.    Varleisha Gibbs     Thank you. It's my honor to be here. I really appreciate it. Love chatting about everything OTs.    Jayson Davies     in the right place. You are definitely in the right place. Everyone listening is in the right place, because we're talking about ot today. And yeah, I wanted to first let you just kind of introduce a little bit about yourself, share some background about how you fit into the world of occupational therapy. Sure,    Varleisha Gibbs     Sure, so I'm an occupational therapist, and I've been one for 20 years, believe it or not, over a little over 20 years, which is really eye opening to me. You know, when you hit those milestones, it causes you to do a lot of reflection. And I've been really grateful about my career in OT I started off I went to Columbia University after not knowing what I was going to do with my life after undergrad. So with some introductions to OT in various ways, and even realizing that somewhere along the line, I actually received services and didn't realize who the person was pulling me out of the classroom, which was an occupational therapist at that time. So my career, my journey in OT, I should say, started well before I even realized. And so I've spent a lot of time going to school. Frankly, went to school for, you know, ot after my bachelor's in psychology, and then I end up going to Seton Hall for a PhD in health sciences. But I left that program because I love otschool. Had my own private practice for over a decade, and so really wanted the clinical piece of it, and then went back to finish that PhD once I got into academia. So to summarize, because we could go on all day about our journey, right, especially after 20 years, that could be a long discussion. But. Um, but I started the first occupational therapy master's program in the state of Delaware. So I was there at Wesley College, which is now with Delaware State University. And then from there, I was a scientific programs officer at the American occupational therapy Foundation, and currently I'm Vice President of practice engagement and capacity building at the American Occupational Therapy Association. And then I think what really pertains to our conversation today is my work, in, you know, giving talks and webinars and trainings on some of my books, and which really is a culmination of, you know, doing research as well as just being in a community and being in a clinic, working with families.    Jayson Davies     Wow, wow. You have run the entire gamut of things that you could do with occupational therapy, as far as owning a business, being a provider, getting into academics and now with our national association, wow, that's that's quite a bit.    Varleisha Gibbs     I'm tired. I'm kidding.    Jayson Davies     Definitely I understand. But I mean, 20 years, that's all that's it seems like a long time, but really, all that you just said, 20 years is not that long. I mean, to do all of that in 20 years you've been hustling. So yeah, kudos to you.    Varleisha Gibbs     That's probably the word for it. Yeah, I would say, you know, I started when I was 16, but that would be a lie, nah.    Jayson Davies     We all start when we start. And we can't get anywhere without starting, so we start exactly when we need to be starting. So yeah, you know, we were looking in, you know, just trying to find a little bit about you. And one of the things that we found was that it might have been your dream to become a doctor once upon a time. So where did that shift from being a doctor turn into being an OT microbiology    Varleisha Gibbs     is definitely a shift, being honest, that was well before I knew what occupational therapy was. But that microbiology, course, was just not my friend, um, along with some other things. And so, you know, I realized after going into college, into undergraduate work, I, you know, if you put your mind to it, yes, if you're a good student, you could figure it out, and you can get good grades. And but for me, I learned more and more that, as much as, you know, MDS, I wanted to be a pediatrician. And you know, as much as we interact and would face clients and patients, it wasn't as hands on as I wanted it to be. You know, I grew up really following my mom's lead, and she used to be an advocate in the community. She's no longer with us, but even, you know, throughout her whole life, she did a lot of work and community and supporting those who are at risk. I was actually identified as being at risk team growing up, and so it was important to me to give back and to be involved at that community level. I was also a dancer, so I loved, really, you know, the physicality of things and the artistic expression and being hands on. I love psychology, and so my advisor in college was telling me that, you know what you may want to think about something else. And she was the first to mention occupational therapy to me, because that obviously fit the gamut of those, the plethora of interests that I had. Wow,    Jayson Davies     yeah, you know, I remember back in school, I remember everyone who was pre pre med always complaining about micro. And, yeah, that is one heck of a class. Apparently, I never had to take it. But I have heard so many people say that that is a one tough class to get through so well, you know what? I will say this, I'm happy for micro because that gave us Dr Gibbs, I will say that right now. Yeah, so, so we led you into or micro led you into occupational therapy, but now you have really kind of honed in your skills with mental health. And so what drove you specifically to get into the mental health realm?    Varleisha Gibbs     Well, it's interesting, because, you know, when you're specifically, I would say in academia, and you know, you start off as an assistant professor, everyone says like, what, what is your platform? You know, what's your area of work and what's your area of expertise, which is important, because we do have standards, and you need to have faculty that run a gamut of all those different practice areas. I struggle with putting myself in a box because I work through the lifespan. People like to say I'm a pediatric therapist, which is fine, because I played that role before. You know, I definitely was a pediatric therapist. But I also, at the same time, worked in skilled nursing facilities with those who had cognitive, you know, disorders and dementia, all in the same day. So for me, I had to come up with an umbrella, even for me to understand what was my expertise, or what was it going to be, what area of research was I going to go into? And I realized that, hey, did you forget that you have a degree in psychology, and that was really. Basically, you know, like, what led you into this work and why you were interested, partially, you know, and interested in occupational therapy. And, you know, I came up with the umbrella term, really was the neural diversity and neuroscience piece of it. And you can't have, you know, neural without that psychosocial element. And so my my dissertation work for my PhD was looking at autism from a biopsychosocial lens. And so as we now look at where society is and the needs of society, we realize that mental health is something that we all have that's not a disorder. It's our mental health, it's a well being, and that everyone you know requires support their social drivers that could lead us to, you know, healthy outcomes or adverse outcomes. And so reflecting on where we are right now in society, I realized that I could lend my expertise in this way, because I've worked with families and Coney, Coney Island, right in New York, that were extremely low income, and even those who were in really upper class in New Jersey, literally mansions, that were dealing with the stressors of having a child with, you know, a genetic disorder. So I've done so much in terms of that work and redefining what mental health is that, you know, I when I first came to aota, that was one of my goals, was to kind of re reinvigorate mental health within our profession, that it's not isolated to those who work in a mental health facility, that we all do it, because we all interact with humans, and that's what mental health is. And I wasn't the only one beating that drum, but that was definitely my platform when I got into this position.    Jayson Davies     I love that, you know, I I've had that same type of thought process. You know, you go to a to aota, to conference, or you go to your state conference, and there's a few different courses going on at the same time. And sometimes, you know, you see a keyword, mental health, and you wonder, Is that the right course for me as a pediatric or as a school based OT? And internally, you kind of go through the thought process, right? You try to look for keywords. And if those keywords aren't there, you, like you said, kind of assume maybe it is for therapists who work in a mental health facility, and that isn't always the case. I mean, we all, like you said, we all have our own mental health. We all have to take care of our own mental health, and and other people need help with their mental health at all ages. And so I like that you said that, that you know, we can at all areas, that all parts of life support clients in their mental health. So awesome. Now, when we were planning for this, you said something that really captured my attention, and trauma informed care has been a buzzword for a while now, but you took it a step further, and you use the term trauma responsiveness, or trauma responsive. And so I wanted to give you a moment to kind of talk about just those two terms in general and how they relate to each other, or maybe how they're a little different.    Varleisha Gibbs     Yeah, great question. So for me, I was really intrigued when I started hearing about this thing, trauma and trauma informed care. I knew of trauma, you know, growing up in in the area I grew up in, and having some wonderful services that were available, resources available to me and other children in a neighborhood. And so I've heard about it, but I never quite heard it professionally until recent years. And so I was really intrigued. What is this trauma informed thing? And so the more I learned and the more I explored, I realized that, wow, this relates to the work that I've been doing. You know, all along, talking to a colleague, you know, she had expressed some interaction she had with another therapist, some of the intervention strategies that they were using. I'm thinking, this is what I've been using. And so, you know, it was really exciting to learn that we were already been doing that work, but a lot of the work had been and especially in the schools, and we can specify school based, there is a lot of attention, and and I would say trainings and support by the social workers, school psychologists, not occupational therapy. Just from my anecdotal view, I can't say for sure, but just from my experience, occupational therapy was not part of that conversation. Their trainings really were about this is what trauma is, and how we could be aware of it, acknowledge that it can exist, and be careful, kind of of how we interact, how we engage. Even speaking to one of my colleagues, who's a social worker, who really appreciates that self regulation, sensory piece that I work on, and she loves, you know, some of the content, you know, said to me that this is really. An area for OT and we're not seeing that, that interprofessionalism And so talking with her and her experience within the schools, I said, you know, the difference for me would be that you are informing. That's the first step, right? Because this is like a school wide initiative, parents and caregivers and teachers alike should all be informed that what trauma is, how it could impact us, and that it exists, and also do some, take some measures to make sure we're not re traumatizing, that we're providing support. As occupational therapists, we provide intervention services, right, direct services, or even at that you know, the different tiers and universal services, we need to be more responsive. That's what we do. We do occupation right? Occupation is about the doing and the being, and we need to make sure that we're not just informed, but that we are addressing trauma in a responsive manner as we would with any other condition or diagnosis that we work with, we wouldn't just be simply informed about a CVA or stroke, right? We would have to respond to the needs of that client with the stroke. And so I really wanted to highlight it for us in other professions, for example, even PT, you know, we don't like to double ourselves all the time, but you know, even our other profession, speech therapy like they need to recognize that they we need to do more responsive work as it relates to trauma.    Jayson Davies     Yeah, and I can speak to that type of training. I can remember about, probably about five years ago we had a trauma informed training at my school site. You know, we learned about ACEs, the adverse childhood experiences, if I'm recalling that correctly. And you know how, if there's so many, then you know that that's not great for the child, right? But we didn't really get the Okay, now what? What do we do beyond that? And so that's great to hear that you're kind of going above and beyond that first part that you know, being informed is great, but let's go on to the next part, what can occupational therapists do? And so I'm excited for that, because the title of your book is actually trauma treatment and action over 85 activities to move clients toward healing, growth and improved functioning. So it's not just about teaching them or teaching the OTS to read this book about informed care. It's about telling them here, here's 85 activities that you can actually do to help a student's mental health. Awesome. So, getting into your book a little bit, you speak about five dimensions of trauma. Could you elaborate on those a little bit?    Varleisha Gibbs     Yeah, so. And let me also preface this by saying the book is interprofessional, but you all know I had ot in my mind. You can't get away from that, right? And so, you know, when you are looking at trauma itself, I have to, I guess, give accolades to I'm trying to think your Body Keeps the Score. It escaped my mind for a second a wonderful book on trauma that talks about trauma living in the body, okay. And so when you think about trauma living in the body, that there is a physical aspect to someone's experience with trauma. And so I took that thought process in terms of looking at a framework, if you will, almost in terms of trauma being trauma responsive to better understand that it is something that is neurological, that is connecting to our nervous system, as well as there will be physical elements right that exist in terms of someone that's experienced with trauma. Now, not all, not all the time. You know, we all cope differently. Just because you're exposed to trauma or adverse experiences does not mean that you're going to your quality of life, for example, would be impacted. And so, you know, I started off thinking about the structural trauma, right? So when I say structural, you know, the structures that are actually part of your nervous system, that there are actual and people give the amygdala a lot of attention, because, you know, the amygdala is really connected to that, the fear and the emotions, which is great. However, the amygdala is not the only structure you know that is impacted by trauma. There's others. And so in summary, because don't get me on my soapbox of neural because I could wear all day. In summary, you know that those structures in your brain, as well as the neurochemicals, start to change based upon those lived experiences. Hence, I almost see it as micro, almost micro brain damage, if you will, in certain aspects. And so the structural trauma of the five dimensions is just that, you know that there are actual structural changes that occur in our neurological system beyond just the brain, but neurologically. Yeah. If that makes sense, yeah, and then yeah, okay, the other piece, right is the physical. The physical piece of it, as I mentioned the book, The Body Keeps the Score. That really talks about those, you know, the element of physical stress, the sympathetic nervous system really constantly being on watch, kind of like that watchdog waiting for things to happen. And we know when that occurs, you're going to have, you know, stress hormones, neurochemical reactions that are really impacting your body, even wreaking havoc on your body. I experienced children and even family members that had back pain at very early ages, and with is kind of that idiopathic pain, right? There isn't any reasoning why they would have this. They don't have jra, juvenile rheumatoid arthritis or anything like that. And so I started reflecting on that, as well as the children that I encounter that would do different things that may appear to be ticks, right and but they weren't, and they didn't have Tourette syndrome, or, you know, anything like that. And so researching trauma, I realized that a lot of those, the physicality of it, was connected to the adverse experiences, especially when it was pervasive. Which brings me to another of the five dimensions of trauma, which is complex trauma, right? Which happens over time? That is, it's pervasive. It's repeated. For example, someone living in a low income area or unsafe neighborhood, or an abusive, you know, relationship with a caregiver, would be examples of complex trauma. So I think I named three. So the next one, I think, would be intergenerational trauma, which And mind you, there the beautiful picture, and there's certain orders I'm just I'm kind of just giving it organically as I'm speaking. So intergenerational really speaks to how our loved ones experiences or our cultural experiences can be passed down through generations, whether it's stories, stories about enslavement, stories about those who are Native American Holocaust survivors, all those are examples of cultural trauma that we all get to hear sometimes, right? And you're exposed to it, but when it's within your own culture that exposure can impact you over time, and so that would be what we call vicarious trauma, in a way, or hearing stories about abuse or traumatic experience from your grandparents or your mother or father vicariously you then are impacted by it, in a way. But the other piece of it is epigenetics, that we carry trauma within our DNA. And there's a lot of research for those who are the ants or descendants or ancestors are met were in Holocaust or enslaved people, that there are actual there's actual proof that there's genetic changes that occur based upon those experiences. And so there's an aspect of the the book that goes into intergenerational factors, and also how you can do some family mapping, especially if they're if this is an area of work for you, you're working with clients with trauma, and you have permission to do this great way, to take family history and almost to better understand what you're seeing. Um, when you hear those things, I've done it for myself, and I better understand who I am and why I react in certain ways, whether it's through the vicarious kind of training of my caregivers, or also that epigenetic piece, as I mentioned. And then lastly, social and you have social and community trauma. Really looking at that social and collective, I should say trauma that we've all experienced through the pandemic will be the perfect example of that collectively we've experienced that, but socially, there are different aspects. For example, some that are in marginalized populations experience this trauma differently within their society versus everyone as a whole. So that's the five dimensions of trauma kind of just redefining what it is. It's not just PTSD for those who have been in war and return home.    Jayson Davies     Gotcha. Wow. And just to kind of recap, structural, physical, complex, intergenerational and social and cultural, those are the five dimensions that you kind of talked about in your book. I want to go back, actually, to the intergenerational. Because, as you mentioned, you know, the book that has been an influential book, The Body Keeps the Score. I mean, that goes beyond the body, Keeps the Score. That's like your ancestral line, keeps the score right. I mean, you're showing, or studies have shown, that we almost passed down some of our anxiety, some of our just mental health, in a way, I want to ask you this, and this is a little. Off the cuff, maybe you do, maybe you don't. But do you know of any authors, any books for someone who might want to learn more about intergenerational complexes, and I guess just this area of work, do you have any authors or books or journal authors that you might recommend    Varleisha Gibbs     trauma? I was going to name my book.    Jayson Davies     any other books, obviously we need to get trauma treatment, right. I    Varleisha Gibbs     would say Dr Joy DeGruy, and the spelling of her last name is escaping me at the moment, but she talks about, I think she calls it post traumatic enslavement disorder. So her work is specific to the descendants of those who are enslaved, but certainly the research and the messaging is similar in terms of how it's passed down. And there's another author, and I cannot think of her name at the moment, but her work, if you were to Google, is specific on she really looks at those that were in the Holocaust. And so if you look up epigenetics, Holocaust, her, she doesn't really have a book. This is a lot of research articles, and there are some publications that aren't as heavy in research. So if it comes to me, I will give you her name, but I would definitely start with Dr Joy DeGruy, and I will say I have cited a lot of those individuals in the work that have done that research. But very interesting topic, very interesting.    Jayson Davies     Yeah, I can imagine diving deep into that you're you're sure to learn a lot. Thank you. Yeah, and for anyone listening, we will find all of these pieces together, all the books, all the authors, and we'll put it into the show notes. So check it out there. Even if we can't recall the name on the podcast, we will be sure to grab it, find it, and put in the show notes, so check it out there. All right, so we just kind of talked about the five overarching dimensions of trauma, kind of more in the academic sense, in a way, right? We kind of broke it down into what it is. But how do you see this playing out with the children that you work with. How have you taken this knowledge that you have and implemented it into action in.    Varleisha Gibbs     your otschoolhouse being in a clinic, one of the the last, I shouldn't say the last, but one of the, the biggest events that I could relate this to has to do with some advocacy work I was doing with a family, with a young man who was having severe challenges within the classroom, as they would call it, and anyone that knows me, I define behavior differently, but as the school would call it, he was a behavioral child, and so during those encounters, we had a lot of discussion about him choosing to not do, making a decision, a conscious decision, to not follow the rules. And the justification was, will we seen him do it before he's capable of doing it? So when he's not doing it, he's choosing not to do it. And so my job was to, for one, have them acknowledge the trauma, which is one of the hugest pieces of trauma, informed care, right? And that's actually where the action approach starts with. A is about acknowledging and being aware of the trauma, and so telling his story. And without that story, the individuals that were, you know, challenged by him, challenged by what he was presenting, didn't understand the source of it. And once I got them to do that, then yeah, I can explain further about structural trauma. What does it mean to have those structural changes in your brain? So if you had a child that you knew, for example, had seizure disorder, brain injury, right? Or, you know, some other diagnoses, you would kind of give them a little grace, right? You know, I understand this is, let's give them some more support if we need to do A, B and C. Well, this child had an IEP, left the school district. Left the school district. When he returned to this school, they refused, or had neglected, to give him an IEP. But if he had a diagnosis right that wasn't simply Oppositional Defiant Disorder, then maybe he would have had an IEP and his services that he needed. So back to your original question. For me, it's a way of reminding ourselves of what does this really mean? It's not just simply someone stressed out and having poor coping skills and so they're just acting out. No, there's actual neurochemical aspects of it. There are changes from a child like him that has been exposed to trauma from in utero that we the expectations have to be realistic with him, and perhaps the setting may not be appropriate for him as well. And so when you're looking at that, it's really helping you to better frame realistic goals, right? That you know that's this part of having our smart goals that we need to make. Sure that you know that they're really supporting the needs of that child, and they're not going beyond what they're capable of, and not just that they're not capable of it, but they don't have the support in that moment to optimize right their their performance. And you know, with this child, you know, really thinking back to the things that he experienced, that I could form, formulate goals that are more about, and we'll get probably, I think, right to the hierarchy. I'll talk about that in a bit, but not at that level that he was at. We would call that, almost like brainstem level function. He was reactive based upon his trauma, based upon those structural changes, based upon the physical things he experienced, he reacted to things. That means that talk therapy is probably not going to be best for him, and I need to do more sensory based approaches to support him.    Jayson Davies     Oh, wait, okay, I want to expand on that part a little bit, because, as we mentioned previously, you alluded to, you know, there's a lot of trauma informed care for counselors, school psychologists, and maybe they're also getting kind of the what to do next through more counseling psychology perspective, OTs aren't necessarily getting that what to do next. We're getting the information right, what to look for, but not what to do next. So before we dive into the next question I want to ask you, how do you kind of see the difference between maybe how a psychologist or a counselor might address mental health with a client, as opposed to how an OT might address mental health with a client?     Varleisha Gibbs     Yeah, and certainly there may be some overlap. For example, if we use some breath work and coherent breathing, diaphragmatic breathing, right? Could be an overlap, but the biggest difference for me is really tapping into the body, preparing them for occupation, for the occupation of living. That's our job, for OTs and OTs as well. We don't want to forget about our our OTs, right? And so our job is to allow them to be in a space you know, to be able to do the work, to be able to learn, and so we need to do, as I said, more hands on, responsive treatment and intervention so we have an understanding of neuroscience and neuroanatomy. All of us have been trained in that, even if we may need a refresher so we understand better what fight flight means and what happens right to the nervous system. We understand threshold and so how we can address those needs first, so that they can be available then maybe for that talk piece of it. And so I stress the use of and I don't specify any theory, but sensory based approaches that allow the body to get to that state so that they can be available. That's the word I was looking for, to be available, right to engage and to provide for themselves, to do self care. So I would work with a lot of kids in the schools and what? What do we always hear handwriting, right? And so some of the children that I saw didn't need any real work on hand, on graphomotor skills. They needed me to allow them to feel safe. That's the first thing. So occupational therapy techniques and strategies can allow them to feel safe and empowered by being able to provide for themselves.    Jayson Davies     You are, in my mind. Dr Gibbs, I was just going to ask you a follow up question, and you answered it because I was going to talk about, right, we've all had those students where you pull them out one on one, and they've got the skills. They they do it, and then they go into the classroom, and, you know, the environment's different, and they don't have it. And I'm not saying the answer is always mental health, but that could be one of the things that we should look at when we see a student doing one thing in an individual session, but then not quite the same quality of work once we push into the classroom, potentially. And we've all had those kids, and so that's definitely something we could look into.    Varleisha Gibbs     Right? And, you know, Jason, to your back to your original question, one of the biggest differences, I think, from that, we stand out. I really don't know any other profession that does this. We look at the person, but we also look at the context and environment. Who else will go into the classroom and say, You know what? He can tie his shoes with me, because I dim the lights and open up the curtains and I we sit on a nice fuzzy rug that he enjoys. You need to make some changes in the classroom, and then maybe we would see him being able to perform the same way here. Let me help you with making some alterations to, you know, the flooring and the lighting and the seating. Who else does that? I don't know anyone else, except for occupational therapy, so that, to me, is a vast difference, right, in terms of supporting your needs?     Jayson Davies     Yeah, absolutely. I love tangents sometimes, because that's when some of the best things come out. And so speaking of tangents, now I can't remember who I was having the conversation with, but we actually. Talked about the stressors of school in itself, and how some students who have a disability more of a visible or invisible disability, they have gone through education very differently than a lot of their their peers, and they've gone through occupational therapy once a week for the last, however, many years, they've had speech once a week or twice a week or three times a week for the last so many years, ABA, the you could go on and on, psychology counseling and even that itself can almost be a little trauma inducing, having all those different services and whatnot. I don't really have a question here, but I wanted to open that up to.    Varleisha Gibbs     You, yeah, I talk about the intersection of trauma and diagnoses a lot, because that is exactly what you're talking about. That is it's one of those things that goes a little unacknowledged. We don't acknowledge that children that in adolescents and even adults, right? Let's say we'll use autism as an example. Have experienced trauma based upon their diagnoses itself, based upon the social piece of it, so the social trauma, but also the complexity of their day to day. And even when it comes to those children that are oppositional, as they like to define them, I don't choose that that word, but they're oppositional. They have experienced physical trauma, even with when we're talking about restraining things to that nature, including the caregivers, they've experienced their own trauma, as well as having a child that has either a visible or invisible diagnoses that they've been dealing with for decades. Some some of them right. A lot of the children I worked with were from the age of three to 21 within the school, so these parents have gone through a lot and the trauma also, let's talk a little bit about those who are receiving services. But, you know, they get to the point where they, they're, you know, services are no longer. They're going to go to high school, and maybe there's a consultation, maybe there's not, you know, the trauma that goes along with that of this huge transition, and typically you don't see the OT OTA at the table for this transition of care, and also outside from high school then to the real world, that we need to be more involved in that process.    Jayson Davies     Yeah, absolutely. And you know what I have been pounding my fist on the table that that needs to change. OTs need to be at the table when we're talking transitions. We had an episode on it just a few episodes ago with Justin lundstedt talking about transitioning from middle school to high school and then even into junior college or just beyond, right? And yeah, OTs need to be, to be at that table, both from the Mental Health sense, but also just from the physical skills and and all the other different occupations that that kids, young adults, and eventually, adults have to do. So yeah, thanks for touching on that. All right, kind of back to back to where we were going. You actually mentioned the hierarchy already, and I wanted to ask you to share a little bit about the seven level self regulation and mindfulness hierarchy that you talk about in your book. You have so many helpful charts in there. Yes, we did buy the book so that we could look at everything, but and everyone else should as well. But if you could share a little bit about that hierarchy, it'd be great.    Varleisha Gibbs     Absolutely. So the hierarchy started with as the title states self regulation, mindfulness, right? So it started in that that book self regulation and mindfulness, and when I got to do the work on trauma, I decided to expand upon it. Because I often, if I did a workshop, would get questions on, you know, how do I use this for, you know, helping me with my goals, treatment interventions. How do I didn't take this to align with what treatment intervention I should do, and we know that we're not prescriptive, like that's that's just not what we do. But having some guidance in that was something I wanted to do based upon the feedback and questions that I was getting. And so the hierarchy really is based on Maslow's hierarchy of needs, and it talks about how, you know, one's basic survival is the foundation of everything, and so you have despite diagnoses, because that's also one of the objectives of the hierarchy, is to eliminate that Need for diagnoses, and how we align intervention based upon diagnoses. We should be looking at the individual. And so it allows us to look at where they're at with their self regulation and how they, you know, the based upon the foundation all the way up to the top, how they progress and how they could grow towards being more mindful and more present, that can then help them with their, you know, with just engaging and with their occupations. And so we start at the base, at level seven, all the way up at number one is hopefully where most of us are, where we're mindful of, you know, our self regulation, as well as others, and the needs of others, and how we can support others. So. I acknowledge that it's, you know, it's not like one is good or bad. It's just where you are, you know. It's just where that person is. And that growth could happen at any moment. Despite the child that may have a severe diagnosis, they can still show some growth on that hierarchy.    Jayson Davies     Gotcha. So we're starting kind of with that base level, kind of the things that every single person needs. And then building up to where the top of the pyramid, or self regulation, self actualization, potentially in there a little bit to help people, so to help the kids in particular, we're talking about school based OTs, all right, so moving on from that hierarchy, then within the title of your book, you capitalize action. And so action has a big emphasis, and I'd love for you to share a little bit about what a C, T, I O N really stands for, and how you use that in practice,    Varleisha Gibbs     absolutely. So that is really guiding the program right from the beginning all the way through to how you're going to address trauma in your own practice. And so a is about acknowledging the trauma, and then you know ways to really assess for that. Now, the book doesn't have standardized assessment tools within it. It has some listed that you can utilize on your own, but really screening tools that are available for assessing trauma, as well as assessing your own preparedness to address drama, whether you need a referral out, or if this is something that you could address on your own as a practitioner, the C is about creating growth, and so creating growth is the way I like to look at what's our goal. And our goal isn't necessarily to heal. That's great, but there's a lot of weight right, and onus on the person. When we say heal. And so I say, in any moment and any day, we can show aspects of growth. And so we focus on growth, and there's ways of having growth charts and things like that available to be able to look at that. And then we look at teaching. And so as I mentioned in a story about the teachers that were working with that child that had experienced a lot of trauma, teaching them about the neurological aspects of trauma, teaching children about their brain. I use this wonderful video. It's not one of my owns when I found that shows how your experiences can actually make changes in your brain, that you don't have to be, you know, this person that is that has ADHD, that doesn't have to define you, that you can make growth and really improvement in your life based upon basic activities and things that we can do in in therapy and so really teaching that aspect of it is very important. And then when you look at the, you know, we talked about the intergenerational factor, so we had a nice conversation about that. So that's that next area of the action. And we also go into, you know, the L with looking at organizations and systems. And so that is really, really important, because we need the rules and the guidelines and supports within the general environment to be able to really do optimal work, and so I can, you know, pull out of the classroom as much as I want push in, but if I don't have the support or the resources, then how am I going to do that? This also speaks to the work going into not just pediatrics, but looking across the lifespan. And so that really is geared towards also, how can you support people within the work environment? How do you look at burnout, caregiver burnout, or workplace burnout as a form of trauma? So that's you know, that chapter is really expanding into just kind of different practice settings and population almost population health as well as community health techniques. And then lastly, the end is a call to action. It's now is the time for us to address trauma, and so it's really speaking to where are you within your work, reflective practice, how you can assess where you are as a practitioner. What things do you need to do to improve upon your work when it comes to dealing with individuals with trauma, and how do you acknowledge your own trauma? Is that last piece of it is really vital before you even consider Dawn care. So way back in the beginning of the book and a there's charts to be able to do a practitioner readiness checklist is available. But before you close the book, it's kind of that reminder of, okay, now that you got all this, what are you going to do with it?    Jayson Davies     Wow. And so kind of narrowing this scope down to school based OT, I feel like there's a few different ways that you could go about it. Maybe you want to start with one and then branch out to others. But in school based OT, you often have more of the individual side of things, one on one therapy. You have the smaller group side of things, you know, you with maybe three, four kids, and then you have the large scale RTI approach, right where you're providing training to maybe a few different grade level to. Teachers or the entire district, if you are really into RTI and you're in your school district, do you feel like this caters more to one of those particular types of intervention, or do you feel like it's just it can be broad, and it really lends itself to each part in a different way?    Varleisha Gibbs     Yeah, I think it does lend itself to each part. Certainly, there are a lot of techniques that are geared to one on one, and so the worksheets that are available really do highlight if it's something that the practitioner would do in terms of observation or support, or something that the client is expected to perform in a one on one session. So there is a little bit of both of that within each aspect of the work, the work in terms of the separated within two parts the act, and then the ion is the second part of action. So the two parts of the book really highlight the need to do all of that, and so I think it's important to acknowledge that we do need to do more universal approaches, and it's also an opportunity for our profession.    Jayson Davies     Yeah, yeah, definitely. And that's actually a great transition to this part of our of our conversation, because we alluded to this earlier, right, talking about OTS sometimes have this perspective, or just the general population, when mental health is is discussed on the news, right, instantly they go to talking about counselors. They go to talking about psychologists. They don't talk about OTS. And so OTS sometimes have a sense. Or OT practitioners, all of us have a sense. Well, wait, I don't necessarily know mental health. Maybe I had a few weeks of or maybe even an entire term back in college 1020, years ago, but I haven't done much more beyond that. I don't know what to do for mental health. What do you say to those ot practitioners who aren't quite sure how they can support mental health or even if they're able to.    Varleisha Gibbs     And that's understandable. I mean, I would say, of course, we want to make sure that we are doing our continuing education, because it doesn't stop when you know you finish and you get that degree and you pass your boards, it continues. So that's where that readiness checklist comes into place, because there may be gaps in your learning that you need to expand upon. But I would challenge them to really reflect on what we do in general. We're not simply helping someone that has, you know, physical disability get up to, you know, have better balance and to walk and, you know, to even just simply dress themselves, but we're helping them with that psychosocial aspect of, how do we address that? If they have anxiety, you're doing that work, right? So if you have a client that has anxiety and they don't want to get up to do, you know, an ADL with you because they're afraid of falling What do you do? I bet you do you do something to prepare them first before you get them up to do that activity. So for sure, you're already doing this work. When you have to work with, you know, a child that is expressing some aggression or frustration or fear, that you are doing something to prepare them for your session so that you're not getting rice thrown at your head every time you engage with them. You're already doing this work. And so one of the things that we've done at aota, I'll put that hat on for a second, is that we have developed a tool resource that looks at mental health and nine non psychiatric settings, and it does exactly what you're talking about. So there's a block on school base that talks about how you address mental health in schools, just in general, and everything that you know you do on a daily basis. And so you can get out a pencil and a paper, a pen. I encourage everyone that's listening after you're done in this podcast, write down how you're addressing mental health in your own time and again. I'm not necessarily talking about diagnoses, but how do you address mental health? How are you supporting caregivers? How are you supporting the teachers that are stressed out within a classroom? I bet you you're doing a lot of things that you are trained in and based upon your training and psychology based upon your training and human development that's addressing mental health already.    Jayson Davies     Yeah, yeah, absolutely. I mean, I have done that kind of exercise before, and really, I think it came out of a result of another podcast, but kind of looking at my practice and just seeing, where do I address mental health, and sometimes that's in that that three minute walk from the classroom to the OT room and having a conversation with the student. Sometimes it is with that teacher event session during lunch, whatever it might be, you know, just telling them that they are doing a great job, even when they don't necessarily feel like it. Sometimes it's with the parents before, during or after. An IEP, just sitting with them and really hearing out their concerns and and, you know, you talked about caregiver burden and caregiver stress. That's a real thing, and we have to remember that when we're in an IEP, you know, we we talked about how difficult it is sometimes to be the OT or the SLP or the or the administrator teacher in an IEP, but it is, I'm sure, darn hard to be the parent in an IEP, and so remembering that they're going through their own things, and that we could be a stressor for a stressor to them, I guess, or one of their stressors during that 60 minute IEP, three hour IEP, and we don't always remember that, and we need to keep in mind that we're supporting their student and we're doing the best job that we can do, but we also have to be mindful about their own mental health and how they are perceiving the IEP process in itself, because too often IEPs go downhill fast because of poor interactions between the district and the parent, and in a way, that's causing stress for everyone, which is good for nobody. So let's keep that in mind.    Varleisha Gibbs     And you know, as you're speaking, I could assume which I try not to do a lot of, but it seems as though you have reflective practice, and that's one of the reasons why. And I could be biased that I think in those meetings, a lot of times, I'll hear from parents and even family members that have OTS. I love the occupational therapist. I love the OTA, right? I love them. And why? Because, you know what, we have that training we can that we understand how validation of someone's experience is important, and not to say that other professions don't, but that's a huge part of what we do. That's the that's the mental health training that we received when we were in school.    Jayson Davies     Yeah, absolutely, it is funny, because that is often the case, right? The OTs, or the parents often do appreciate the OTs, and I kind of want to go to the different end of an IEP, right? What actually goes into the physical IEP, and that's goals. And the last, you know, maybe 10 minutes or so, we've really talked about bigger picture, supporting the teachers, supporting the students, supporting everyone. But when we get down into the the individual part of this, working with a student, is it out of line for an occupational therapist to create more of a mental health type of goal within an IEP. Or I'm sure you're going to say absolutely not, right? We totally can. But if OTS are feeling that pressure from their administrators, do you have any advice for them?    Varleisha Gibbs     Yeah, and this is it's a struggle with that, because I would say yes, absolutely. They also understand, you know, the challenges with that. I personally would put goals that related to communication back in a day, and I would get told, that's not your lane, you know, that's the SLP, stay in your lane. I'm like, No, it does pertain to this specific activity that you know. So we understand that sometimes there is that pigeonhole based upon a district or, you know, the director of special services may not always agree, but if we don't start to use that language that relates to mental and behavioral health, then we will continue to not have that seat at the table. So we have to find a way to use the language, but always remember, connect to scope of practice. And what is our scope of practice? It's occupation. It's occupation based, right? And so as long as we are tying it to that, then we're able to certainly justify a goal. And remember, we're the experts of our profession. You know, I don't care if someone has a PhD in another discipline, we are the experts of occupational therapy because we have that background and that training. So that's where advocacy comes in. Advocacy is great on the hill. It's great with our congress people, but it starts, you know, at that level of really justifying what you're doing and how it is within your scope of practice.    Jayson Davies     It's funny that you talk about that right through the advocacy, even through like an IEP and as you're saying that I've just recalled over the years, you know, 10 years that I've been a school based OT, what I have been known for personally on IEP teams has changed. And at one point it was Jason. He's the OT he's really understanding of, like, assistive technology. If you need an app on an iPad, go to Jason. But then over time, it's evolved a little bit, right? Originally, it was handwriting, because that's what I that's what school based OTS. We really start right? We list, like, everything's handwriting, but you start to shift around. And the more you talk about something in an IEP, the more you talk about it with the teachers at lunch, the more you talk about it after school with parents, whatever it might be, the more that people are going to remember you when it comes time to talk about mental health for their students. So even just by. Talking about mental health, talking about how you can support students in general with mental health strategies. You are slowly going to become known as a mental health expert, not because you have newfound knowledge, but because you started to talk about it more and advocate for yourself a    Varleisha Gibbs     little bit. Absolutely. I love that. Love that.     Jayson Davies     Great. Well, we're going to wrap up here in a bit. This conversation has flown by. Thank you so much for being here. But before we do, you mentioned aota a second ago. You talked about a mental health capacity form that they have right where you can go on and and kind of see examples potentially, about how a school based ot interacts in mental health. But what else is aota doing with mental health? I know there's a conference a few weeks ago, or maybe just happened, I don't know, by time this episode comes out, it'll be about two months ago, I believe. How was that, or what was, what was the response there?    Varleisha Gibbs     That was great. I didn't attend. One of our team members attended, you know, really, to kind of carry some of the work our group has been doing, and they had just a wonderful turnout. Registration was higher than expected. Student registration was higher and, you know, really, I think it reinvigorated the passion for mental health. And so it's a it's an exciting time. So that mental health specialty conference, I think, was kind of not just anecdotal data for us, but that, you know, quantitatively, we're seeing in Numbers, numbers, an increase in this area, and really an increase in mental health across practice settings, as we've been discussing. And so that's one thing that we've been doing. But as as a whole, in terms of across the association, we really put a lot of attention in this area, not just the resources that I mentioned, but there's also now a web page mental health and well being. So think the easiest way to find it if you Google aota mental health and well being, there is a page that we have just curated recently that really talks about a lot of different areas of practice and connects you to a lot of our resources within the practice team. And so that's going on. We also have worked with Jenny Stoffel, and a lot of you are probably familiar with Jenny as one of our past presidents and other titles within aota in terms of her work with the board. In other areas, she's now working with wolfet being a representative, and she has done so much work in mental health over the years that we knew when we started to delve into pulling members together that we should have her support, and she has been great in terms of volunteering her time. So we have a group that we call a micro volunteer group that has come together to really address what's called 988, and 988 if you're not familiar, is this. It's a number like 911, but it's specific to mental health support. And so you can look at our website, aota, 988, as well. And I can go on and on. We have members stepping in. We have presentations you can download, go to commune. OT, our commune. OT, page for 988, as well as the mental health. Sis, if you click on joining that commune, OT, you'll be part of that conversation about some of the meetings that are coming up. We have another one that's meetings that we are planning for inspire in April, and so you can get involved in a lot of these initiatives we have going on.     Jayson Davies     Great, great. You know, that's so much, and I'll give you, I'll give you the chance now to just kind of share, where is the best place for people to learn more about you and your initiatives going forward?     Varleisha Gibbs     Sure, I guess the best place would be@drvgs.org I'm also, I'm trying to do better with social media. I have ebbs and flows, but I totally understand. Yeah, I'm on Instagram, probably more so, but I'm also on Twitter and LinkedIn. I like LinkedIn. It's a little less intimidating for those who grew up in the 80s, but you can find me on social media. I'm, you know, once you get the spelling of my name, I don't think there's another Alicia out there. So you can find me on social media platforms and as well a OTA on our website, you can reach out, especially what it has to do with some of the work that I mentioned. Feel free to email me there as well.    Jayson Davies     Sounds great. Dr Gibbs, thank you so much for joining us today. We will make sure to put links to all of those different resources in the show notes, so they'll all be in one place, easy to find for everybody. And yeah, just I really appreciate you coming on to share with us a little bit about mental health and how OTS can support the mental health of their students and also faculty we talked about today. So thank you so much.    Varleisha Gibbs     wonderful. Thank you. It's been a joy.    Jayson Davies     Please help me one more time say thank you so much to Dr Gibbs for coming on and talking about trauma responsive care. Such a pleasure. Having her on she is so well versed in trauma and supporting students or people of all ages who have gone through trauma. So thank you so much. And please, please, please, feel free to check out Episode 115 show notes at otschoolhouse com slash episode 115 to see all the resources that we talked about today with Dr Gibbs, so thank you so much. Dr Gibbs, thank you so much to you for listening to Episode 115 of the otschoolhouse com and we will see you back soon for Episode 116 Take care. Bye.    Amazing Narrator     Thank you for listening to the otschoolhouse 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 116 of the OT Schoolhouse Podcast. Have you ever thought of having your students be the handwriting teachers? By having students apply what they learned during an OT session, they can go back into the classroom to share the letter stories and formations with everyone… including the teacher! This is a great functional way to help them solidify what they learned. Today, Cheryl Bregman is here to discuss some common handwriting norms on which she is flipping the script. We also dive into how children have been affected with dysgraphia and pseudo dysgraphia and how a collaborative approach can help. Tune in to learn about an awesome handwriting program Cheryl has created that can help a child learn to write in five weeks! Tune in to learn the following objectives: Learners will identify why it is beneficial to start with learning lowercase letters Learners will identify the reasons children may present with pseudo dysgraphia Learners will identify and understand how reading and writing collide and impact one another Learners will identify how handwriting heroes use a multi-sensory approach and how it is beneficial for all children, especially those with learning disabilities. Learners will identify specific assessments that do not correlate with handwriting outcomes. Guest Bio Cheryl Bregman, MS, OTR/L Cheryl Bregman, MS, OTR/L earned her Bachelor of Science degree in Occupational Therapy from the University of Cape Town, South Africa, and a Master of Science degree in Technology in Special Education from Johns Hopkins University. Her specific research interests involve handwriting development and the integration of assistive technology in school settings. With over 25 years of experience, Cheryl has extensive experience working with children who have developmental coordination disorders (DCD), learning disabilities, and attention issues. Quotes “We really do need to think about starting with lowercase, particularly for students with learning disabilities… They had a really hard time with differentiating between upper and lowercase” - Cheryl Bregman, MS, OTR/L “If we can make handwriting easier, more automatic to our students, then they can use that brainpower for higher level skills” - Cheryl Bregman, MS, OTR/L “Look more carefully at the students and what their needs are, not to just confine it to whether or not something is legible. Look beyond that, so you can help that child functionally” - Cheryl Bregman, MS, OTR/L “It's not that they necessarily have dysgraphia… they're in front of a computer for two-three years, and all they did was try and type, so they haven't had the experience” - Jayson Davies, M.A., OTR/L “Practice makes permanent, not perfect” -Jayson Davies, M.A., OTR/L Resources: Decosta Writing Protocol Handwriting Heroes Handwriting Heroes Blog Episode Transcript Expand to view the full episode transcript. Cheryl Bregman     And if we can make handwriting easier more automatic for our students, then they can use that brainpower for higher level skills.    Jayson Davies     Hey there, and welcome back to another episode of the otschoolhouse. Comcast, so happy to have you here today. The day that this is being released, is actually national handwriting day. So it is only fitting that we do have an episode about handwriting today. A few weeks ago, we talked about dysgraphia, and in this episode, we are talking with Cheryl Bregman, creator of the handwriting heroes app that was Cheryl, that you actually heard leading into my intro today. And that's a very powerful statement that she said there. She's basically saying that if we help students to better understand the physical act of writing, even the mental act of actually getting legible letters, legible sentences on the page, then they can use their brain for higher level activities. Think maybe writing longer paragraphs, entire essays, or maybe even doing other things while writing, like listening to the teacher or following whatever's going on on the board. So I'm super excited today to bring on Cheryl Bregman. She's going to talk to us all about handwriting and maybe some of those old school traditions that maybe we need to rethink a little bit, things like starting with uppercase letters and maybe about spacing and whatnot. We're going to talk about some of those age old traditions and maybe how we can rethink what we are doing with our students. So let's go ahead and Cue the intro music, and as soon as we come back, we will jump into our interview with Cheryl Bregman.    Amazing Narrator     Hello and welcome to the otschoolhouse 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     Cheryl, welcome to the otschoolhouse podcast. How are you doing today?    Cheryl Bregman     Hi, Jason, thank you. I'm really happy to be here.    Jayson Davies     Yeah, I'm just excited to have you here as well. We're talking about handwriting today, more importantly, or I think more importantly, I'm excited because we're going to talk a little bit about some age old traditions that maybe aren't always the best examples, and then maybe follow up with some some better ideas and some better things. But first I have to acknowledge your beautiful, wonderful sleeping dog behind you. I know everyone listening to the podcast can't see him, but he's just adorable back there.    Cheryl Bregman     Thank you. That's Milo. He's a sheepadoodle and my constant companion there.    Jayson Davies     I love it. I like to say this is a dog friendly podcast, so I'm excited to have him here with us today. All right, so, so tell us a little bit about yourself. You are an occupational therapist, but tell us a little bit about how you got to where you are today.    Cheryl Bregman     Sure. Well, I've been working in pediatrics for the past 25 years, in schools and in private practice, and particularly with children with learning disabilities and dysgraphia, I've also loved product and curriculum design, and I came up with a method for teaching handwriting that my students really responded to. I subsequently worked with animators and musicians, developers, artists to develop what is now a rather robust handwriting program called handwriting heroes.    Jayson Davies     Wow. And so you've developed that over basically 20 years of experience. It sounds like    Cheryl Bregman     exactly it's been, you know, a labor of love.    Jayson Davies     I know the feels definitely right whenever you create something from the ground up. We've all we've been there. We've started with nothing, and now we have something. And it just feels good, doesn't it,    Cheryl Bregman     that's wonderful, especially, you know, to see it sort of almost being completed. You know, it will never quite be done, because, you know, I'm a revisionist at heart, and always keep refining things. Absolutely,    Jayson Davies     absolutely, no, I again. This is not a question I plan to ask you, but I know from my experience with the OT school house, they this program. The otschoolhouse in general has allowed me to have conversations that I never would have had, to talk to people all around the world. And so I want to ask you, with the handwriting heroes you know, do you recall any specific email or any chat where someone was just so appreciative and really just was excited about your product, and wanted to share that with you.    Cheryl Bregman      I've had a lot of specifically from mothers, actually, who whose children have been, you know, first time writers and who haven't, you know, ever been successful at writing prior. I think they're incredibly grateful, and where, especially when the you know, their children have been completely averse to writing, and now they love writing. So that's a huge compliment. And you know, I love hearing from them. I just recently saw Instagram. Post from a parent who I don't know, but it was amazing how she shows the child just and she says something to the effect of handwriting heroes. Has got this child dedicated to saying the letters correctly, and that's a big deal.    Jayson Davies     Wow. So not even necessarily writing, just saying the letters correctly. Is that what you just said, right?    Cheryl Bregman      Well, saying letter stories, actually. So he happens to be, you know, you can see him in the video, and he's holding the different, it looks like cardboard letters and and doing the different strokes related to, to to the letter story saying I skydive down and get its.on top, and very animated. And just lovely to see that.    Jayson Davies     I love that. That's awesome. You know, we are going to dive more into that. I'd love to hear more about the letter stories. That sounds great. I love that you're putting storytelling into the writing process. That's awesome. And we'll get into that in just a bit. But I wanted to start off this podcast by kind of, I kind of alluded to it a little bit ago, but digging into some of those age old trends that have been around handwriting that we all have heard at some point or another with school age children, that maybe some of the research that you've done has kind of debunked that. And so I just want to ask you about what are some What are a few things that are common practice that maybe you're you're flipping the script on?     Cheryl Bregman     Well, there's a couple. The first trend relates to OTS feeling like they're handwriting teachers, and that this role is somehow demeaning, if you consider the fact that handwriting, automaticity, is the most important predictor of length and quality of written composition in elementary school, and that 30 to 60% of each school day involves handwriting. We may want to reconsider how we feel about our involvement in handwriting, and that's not to say that the status quo is ideal or they aren't, ways to improve it. The next trend that I want to mention is that of teaching uppercase first. In the context of today's classroom, where kindergarten students are expected to write from early on, I feel that we really do need to think about starting with lowercase, particularly for students with learning disabilities.    Jayson Davies     Yeah, why specific to learning disabilities?    Cheryl Bregman     I saw that my students who had learning disabilities when they were older, they had a really hard time with differentiating between upper and lower case. They were often writing only in uppercase, sort of stuck in that mode and still mixing the two scripts. So when one teaches lowercase, first gets that automatic and then teaches uppercase, you don't run into that issue because they have their lowercase cemented.     Jayson Davies     Yeah. And as I think about that, I wrap my head about more we do use more lowercase than we do use uppercase, right uppercase we use at the beginning of a sentence or with a proper noun, but typically we're using lowercase unless it's the letter i in a word. So yeah, okay.    Cheryl Bregman     It's a really functional script that teachers are needing kids to use sooner rather than later.    Jayson Davies     Gotcha. Okay. So we talked about, first of all was OTs, you know, being the handwriting teacher and having a little bit of a bias against that, or whatever you want to call it. I want to come back to that. I do. But then the second one was using lowercase letters. What else have you found?     Cheryl Bregman     Well, I also think there's a trend to do sensory motor training to address handwriting problems. And really, research has shown that this bottom up approach that works on underlying skills, so midline crossing, fine motor control, pencil grasp and so on, it's not as effective as direct, explicit handwriting practice. And I feel like we need to get away from feeling as though we need to do those underlying skills for handwriting remediation.    Jayson Davies     Okay, and I feel like that one really ties back to that first one that I wanted to jump back into, right is handwriting versus using the sensory motor approach. Sometimes those kind of go hand in hand. Some people want to do the direct handwriting instruction, or they want to do the sensory motor approach, or vice versa. And so I want to, I want to dive into those two concepts a little bit more. Because whenever I hear someone say, we're not handwriting teachers, right? And I agree, we're not necessarily handwriting teachers, but 2030, years ago, we would have loved to have been called the handwriting teacher because we were not even in the schools. We would have loved to get into those schools, and I think that has gotten us into those schools, but now we're so overworked. Right? And we're so bogged down that we're trying to almost pull away from it, because we're getting every single student that has a handwriting concern, and it's a little overwhelming for people. So I want to ask you to elaborate a little bit more on that. What you mean by our role in the schools with handwriting? Should we be doing more direct ot with students, one to one, with handwriting? Should we provide more of a consultative role? What do you think?    Cheryl Bregman     Well, I think it's a sort of complex question. We have been working a lot with one on one sessions or small groups, and not working enough in a collaborative model with the teacher, so I feel like we should be co teaching with the teacher, showing best practices, modeling and showing how multi sensory Teaching assists handwriting and slowly really move the responsibility of teaching handwriting back into the hands of teachers, and there's also a sense that we're responsible for all handwriting, and that's come to bear, primarily because of Common Core and Teachers feeling overwhelmed themselves, they're struggling to fit the curriculum in that they they need to fit in, and so they've given handwriting a side shift, unfortunately, unfortunately for students, and they're now those kids who, who may not have had handwriting problems, Do, because I actually call it a pseudo dysgraphia, Where? Where? Because they have not had the instruction that they needed in handwriting, they now have a pseudo disability, or a so called disability that they wouldn't have had if it weren't for direct, explicit instruction that the teacher provided. So it's something where I feel like the occupational therapist can guide the teachers. We just have to take more control of that role and modify it to suit ourselves, not to suit ourselves, but to suit the scenario, and help the teacher reincorporate handwriting, but still be very much involved, and especially when it comes to the kids who have the true disabilities, where we can assist and, you know, provide more intervention and and and more strengthening. So just a more collaborative model would be helpful in that scenario.    Jayson Davies     Yeah, I absolutely agree. And I mean, just to kind of flip the role, right? If 90% of our referrals were coming for a student using scissors, we'd probably be saying to all the teachers, we're not scissor cutting therapists, right? But we are occupational therapists. And as you alluded to, students are handwriting 30 to 60 or more percent of the day, depending on their grade level, and there is research out there that shows that. I know that research now is starting to get a little bit older, and maybe kids are using more technology, but still, they are definitely writing in the classroom, and so that is a very important occupation. But I think as we continue on, you're going to share with us even more about how the benefits that handwriting can have potentially over typing, and I think that's also important to remember when we're in an IEP and we're considering when to maybe transition away from handwriting to typing or or vice versa. So yeah, thanks for thanks for elaborating on the collaboration.     Cheryl Bregman     And I'll clarify, um, Jayson, I think handwriting is still very much part of the elementary classroom. What has happened to make things sort of worse is covid And where there was the span of two years, ultimately, where the kids were not on, you know, not using paper and pencil, and they were on their Chromebooks or their desks desktops. And now we're seeing kids, even in third grade, who cannot handle it whatsoever. And and schools are really struggling, and obviously OTS are struggling with their caseloads. And it's.    Jayson Davies     Yeah, and I think that kind of lends itself to that term that you use, that pseudo dysgraphia, because they weren't. It's not that they necessarily have dysgraphia, but like you said, they were in front of a computer for two, three years, and all they did was try and type so they haven't had the experience. Yeah, definitely. Yeah. Cool. So just to recap really quickly, we talked about the gripe that some OTS have with handwriting or being the handwriting teacher, per se. We talked a little bit about sensory motor let's, let's dive into that one. A little bit, actually more. I know there's research out there, and you kind of alluded to it right, where sensory motor approaches don't necessarily lead to handwriting. Improvements. Personally, when I'm working with students, a lot of times we do a sensory motor type of warm up, or something like that. Is that something that is fair game? Or what's your take on using sensorimotor within intervention?    Cheryl Bregman     Absolutely, I think that the more can be incorporated with the handwriting activity, the better we're working oftentimes with so called low tone children who haven't got the muscle strength or the dexterity to to coordinate activities, they've got, you know, possibly generalized motor planning difficulties. So depending on their goals, you can, you know, hit a number of those goals with sensory motor activities. But you know, ultimately, you have to have that direct handwriting practice. Without that practice, it's not going to get better, and also to to incorporate more sensorimotor activities within the handwriting so, so, for example, using a thumbtack to pin punch letters, that would be a great way to incorporate fine motor skills and and a handwriting task. So as long as you know you're not sort of straying too far away and and assuming that by working with Thera party, you're going to make substantial handwriting gains.    Jayson Davies     Yeah, yeah. And I, as you were saying that I love that, because that's definitely something I've done, right, using something to poke holes to make letters, or whatever it might be, I've used toothpicks, right? You can kind of hold it like a pencil and and poke holes. On the flip side, I've done the opposite too, where I've taken the letter, letter producing out of it, but kept the pencil in it, right? We've all think about like coloring activities. You're taking the writing out of it, but you're you're still using a crown, a writing utensil. But also, I've done things where it's just like pencil activities, but has nothing to do with actually putting the pencil on the paper, so just getting them used to a pencil, like we'll do little like pencil flips. Can you twist the pencil from your thumb and your index finger to your thumb and your pinky right, doing opposition, different activities. So I think that could be a great warm up. You're still, at least using the writing tool, which eventually, of course, is a a process of writing.    Cheryl Bregman     Right? Absolutely. And, you know, it reminds me there's like a small video, like a caterpillar, like a caterpillar inchworm, that you sort of scoot your fingers up, yeah, I love that. And then the rotation, so absolutely, using those to improve the dexterity, you know, and that comes into play when you're erasing, or when you then, you know, flipping and makes it more efficient, but to your point where you said taking the pencil out of the writing, that's completely valid. And I will say that for younger children, or children who have got significant impairments where they're not ready for paper pencil tasks, I will often do sensory motor activities or air writing in order for them to teach the letter form or the letter formation without even touching a paper and pencil, so they have got Confidence to learn that letter. They know the letter story even before they've touched a pencil and paper, and it just gives them confidence, that it takes away the anxiety, firstly, of the paper pencil task, because they've often had negative connotations with that, or there's a sense of permanency when you're writing with paper and pencil, that that Mark is there for everyone to see, and it's embarrassing for the kids who can't write. And you take that away, you separate the processes, and it makes for a much happier child who's who's suddenly prepared to work on handwriting, even though they don't know they're working on handwriting.    Jayson Davies     Yeah, definitely great. I want to jump into pencil graphs. But before I do that, I want to ask you, are there any other age old traditions, age old adages that we that you wanted to address before we move on?    Cheryl Bregman     Not that I can think of right now. You know they are. But.     Jayson Davies     Yeah, no. Well, we're going to talk a lot about a lot more about handwriting in this podcast. So we'll get into more things when pencil grip comes up. There are I feel like we are moving more toward the trend that is common knowledge that you don't need a perfect pencil grip to write functionally. I know, just a few weeks ago, Taylor Swift's video, her new music video, which is trending like crazy, right? Because she is the cross quadrilateral, something grip. I don't even remember. I didn't watch the video, but you know, that's coming out. And so what's your take on pencil grips?    Cheryl Bregman     Right? I saw that on social media. One, but also didn't watch the video. But from a research perspective, they've also shown that it's not that important. And again, like if you have a child with weak muscles and their pencil grip is going to reflect that the child essentially isn't defying you or choosing to hold their pencil incorrectly, so they can't magically change that just because you're asking them to. And if you think about the reason that we want a functional grasp, it's to it's essentially to prevent pain and fatigue when writing. So if a student has a fixed grasp and gets pain when they're writing, then I often show them an alternate grasp, like the stenographers grasp, or I'll encourage them to use pencil grips. And I'm not asking the child to change their grip, but rather to use a different grasp, even if it's for a short period of time to give the overworked muscles a break. So and that's often the case with older students where where they're coming to me saying, my hand is fatiguing. I can drive for long periods of times and can't keep up.    Jayson Davies     That was a great little nugget. I don't think I've ever worked with a student and asked them to use a different pencil grip temporarily, and I like what you just said, especially for those older students, right? They know that their hand is bugging them. They just need, like, a break. And so how can we give them, give their hand a break without breaking away from the writing process, per se, right? They need to get their work done. They can't they need to take an extended break. But can they just hold the pencil a little bit different that is still functional for them. And take that, give their whatever finger five minute break because they're using a slightly different grasp. I like that correct.    Cheryl Bregman     It just gives them that pause or pause, but they're still continuing to work.    Jayson Davies     Yeah, yeah. And, I mean, even when I think about that, I mean, it just brings up so many ideas, because you could work with a teacher, and you know, a lot of writing, especially for older students, isn't pencil to paper. A lot of it is planning. And so, you know what? Maybe you're taking a break from writing, but you're doing a slightly different part of the assignment. If they really do need a complete break from writing, right? Maybe they're just doing a different part of the writing process, per se, right?    Cheryl Bregman     I often, you know, say to my truly dysgraphic children, who are usually boys, that all they need is, you know, a good secretary to assist in the classroom, and, you know, get the work done.    Jayson Davies     Yeah. And you know what? Siri is coming a long way right now, if you're listening, we have something that's recording us right now. You know, Zoom has transcription into it, and there's a lot of technology out there that can help people with with the difficulties we all use, you know, we all use technology nowadays, and we all use it to amplify our own abilities. So why should we prevent students from doing similar activities, absolutely. All right. Well, the next question, I kind of wanted to dive in with you, because I know your program isn't completely about writing, and there's also some reading components with with language. And so I wanted to ask you how reading and writing collide to impact each other.    Cheryl Bregman     Sure. So for reading, writing a letter helps one to learn its shape and spatial orientation, and this letter perception contributes to better reading. It helps to connect letter symbol and letter names and sounds. So I've often heard otschoolhouse com read then we don't need to teach them how to handwrite. And I really consider that a missed opportunity, because I've had so many instances where learning to write has been a starting point, a jumping off point for a child's reading, and it's a safe place to start from, and learning, perhaps from a position of strength, where they now know how to form the letter L. They know that the letter L landed on a lemon. And there's that, firstly, the alliteration, they've learned the letter name, they've learned the letters, what the letter sound makes. And then there's that causal sort of relationship where it extends into just knowing the alphabet, the alphabetic principle, and yeah, it gives the child more confidence when, when they're posed with, perhaps something that's even harder being reading. Yeah. And then when it comes to writing, it's important to recognize that all the skills that go into writing, we don't often think about them you but you have to think about like the child's thinking about what they want to say, how to spell the words, how to. Organize a sentence, and then on top of that, they have to work out how to form the letters, where the letters go on the line, which way they face, how hard to press the pencil. So it's really taxing on one's working memory. And if we can make handwriting easier, more automatic for our students, then they can use that brainpower for higher level skills, but if but forehand writing to become automatic, the letters must be formed in the most efficient way. And I don't think that's often realized.    Jayson Davies     Yeah and I really you know, as you say, that that last little part that you said, you know, I think of those kids where we pull them aside, or the teacher pulls them aside, and they can write neatly one sentence, and then when they go back to their desk to write a paragraph, it's just gone like it's just a hot mess again, right? And that's because they haven't really automated the process. You know, when they're really thinking about legibility, they can make it happen, but when they're thinking about the assignment that they're supposed to be writing about To Kill a Mockingbird, or whatever it is that they're writing a paragraph about. They're not worried about letter formation, spacing, sizing, all that good stuff. They're worried about getting the words from their head onto the page in some way.    Cheryl Bregman     Right. And they can't devote that working memory, that attention to letter formation in that instance. So that's why the letter formation component falls apart. They've only got so much reserve. And unless it's automatized, we're going to have a child who, who's handwriting, deterior deteriorates at that point.    Jayson Davies     Yeah. So, so I want to push on this. I like this topic that we're at right here, and so OTs, I have, I have had conversations with OTS. I mean, I've been in that conundrum state of mind too. I'm like, What do I do with this student right there? They can write legibly when, when they're with me, but they go back to class. It's not legible. Do I discharge the student? Do I put them on console? Do I continue direct, what have you found to for you? What has worked with some of your students? I know it does. What works with one student works with one student. But is there something that you found that kind of helps with that? I guess automatic writing, I guess we could call it?    Cheryl Bregman     Sure so, A couple of things I just want to mention that you you touched on there one being potentially, we shouldn't be working alone in a room with a student, because it's just not a functional scenario. They're not producing schoolwork in that scenario. So when we see them and they can write leggedly, that's a false narrative. Essentially, I agree, because you've taken away all distractions, and you're making it essentially non functional, but, but you're coming up with a a result that is wonderful, and you're being able to then say, Look, you know, I've got this wonderful result. My students legible. He doesn't need ot not the case. Only in a functional environment. If we get a functional example of legibility and speed, then we can discharge that student. Or then we should think about discharging that student. It's it's function, you know, can't be defined just by legibility. Anyone can write legibly, even a dysgraphic student, can write legibly with a lot of cognitive energy and with a lot of effort put into that letter formation. But take that ability for him to, you know, focus that hard and to devote that much attention to letter formation, it, you know, and putting back in the classroom. It's not a it's not a functional scenario anymore. So the second thing you asked was whether I found, you know, interventions possibly that could could address that. So for a lot of students, what helps is working on automaticity with with alphabet sequencing. So I do a lot of handwriting where the child and I'll sort of motivate them to write the alphabet with good formation, but quickly, sometimes I'll put a stopwatch on and we'll, we'll graph the, you know, decrease in in speed. Or I've even used like a fidget spinner, and I spin the fidget spinner, and they have to do it faster than the fidget spinner. I love that. They love that. And, you know, I've gotten fantastic decreases in speed because of that same thing. I've got eight timers with different speeds that they run out just to make it more of a game, but that said doing that alphabet repeatedly and then. Also, I do pentagrams, so where they write sentences that have got all the letters in the alphabet. Just to improve, you try to improve the the speed that they're forming the letters in an efficient way. And that's why we want correct letter formation. And it's not because, you know, we're being pedantic and saying, this is, you know, something I, you know, insist upon. It's because it's writing a letter consistently, and in the best sequence, shows improved speed. So just and also practice, just five to 10 minutes of practice, I'll say the kids who, whose families I work with in private practice, who do do that practice. It's, it's a substantial difference, you know, related to the kids who don't. Yeah, they're developing that muscle memory and improving their speed. But I'll also say that they have to be practicing correctly at a formation. There's a phrase precise practice makes perfect. I don't know if you've heard that.    Jayson Davies      Yeah, yeah. I've always heard, you know, practice makes permanent, not perfect, unless you're doing it right, right.    Cheryl Bregman     Exactly. Whereas you know, practice makes permanent, they, you know, writing year after year, day and so much of their days filled with writing, that when they write with bad habits, those are going to become permanent Exactly,    Jayson Davies     exactly. So, you know, two things that kind of came to my mind as you were talking, as I kind of alluded to you, as we were jumping on the call. I like to think about what John Jessica, whoever's listening to this podcast, what they might want to ask based upon what you said. And one of the things that I have struggled with at times is is having a child write the alphabet as quickly as they can, is that a therapeutic intervention, right? Like, what is the difference between us asking a student to write the alphabet quicker than a spinner can run out of spinning. Or, you know, how is that a therapeutic intervention? Because I'm on the same page as you, but I want to hear your your idea. Why? Why is it something for the OT to do and not something for the parent to do?    Cheryl Bregman     Right, or for the teacher, for that matter? Yeah, sure. And I think there's a distinction between what I would consider the 70 to 80% of children who can learn with given a systematic, structured intervention like program, those children with you know that teacher's direction are going to learn to write, and with practicing activities, practicing words and phrases, they're going to improve their automaticity and their speed. And then the OTs, I feel like, are responsible for those you know. Let's say, you know, children who really do struggle and need more.    Jayson Davies     Yeah, the 1010, 20% whatever it might be,    Cheryl Bregman     exactly, exactly. So I think you know. But ultimately, we're not born with the ability to read and write. It's not innate, and it has to be taught, and so it has to, you know, do with more differentiation and finding out who actually needs the OT intervention and who needs that additional creativity that we offer, or the repetition or the multi sensory learning strategies, that's the distinction that should be made.    Jayson Davies     Yeah, definitely. And you know, as occupational therapists, you alluded to, right, we're doing an evaluation to determine what area we need to work on, and we might find that it's not a visual perceptual difficulty that the student has, maybe it's a visual motor or vice versa, whatever it might be, but that is leading us to choose this intervention as opposed to something else. And to be quite honestly, I had never thought about doing that activity that you had talked about. And I'm an occupational therapist, so I doubt I don't know how many teachers out there have thought about doing something like that, and then the way that you implement it, I think, is different from the way that someone who is not an OT might implement it. So absolutely, I really like that idea. I'm gonna steal that one. But do you also, as an occupational therapist, maybe you're doing that. You're timing the child right, getting them to race themselves, per se, do you also provide that as a sort of quote, unquote homework. I know something that you mentioned was that that five to 10 minute practice, unfortunately, especially as a school based, OTs right, we're typically seeing a kid at most once a week. So how do you incorporate that practice?    Cheryl Bregman     You have to work with a teacher. There's just, there's no way around it. I've often, whether it be a parent or a teacher, the main thing to address is when that practice is going to occur, and I try and do it when the child, for example, comes into the classroom, when there's that time that everyone's hustling and getting things ready and doing their own thing. To some degree, there's five minutes right there, because it's not instructional time, and there is, you know, the kids are fresh, and my homework does not take more than two minutes, and it's fun. It's done usually on a dry erase worksheet, so that, you know, there's no photocopying of papers that have to be done. They just, you know, take out their dry erase sheet. They practice the letters, and they're done. It has to be also very repetitive, very easy to execute. And you take away the task, or you know that it's burdensome on perhaps a teacher, and also make it the child responsibility. Bribery is a good idea. Where, currently I have a child working you know, every you know, actually we've extended to every you know, month now, but he gets Mountain View, if he's you know, got all his his work checked off by the teacher, and so it's his responsibility to get those checks done.     Jayson Davies     All right, all right. So I like the idea of definitely finding that time with the teacher. A lot of our students will be in general education, but maybe they also go to the RSP resource specialist, teacher or something like that. That's someone I will often collaborate with. A lot of times in RSP, there's multiple kids in, like, a small group, and I find that they do have some downtime, and so I will use that kind of to our Hey, you know, what? Is there any downtime in between two groups or whatever, where Johnny can just do the alphabet A few times? Here's a fidget spinner. He can even use this fidget spinner as a, you know, sand clock, or whatever. You know, the whole what are those called the sand timers. I don't even know.    Cheryl Bregman     Sand timer, yeah, timer, an egg timer, an egg timer    Jayson Davies     is that? I don't know, but anyways, basically, they're using a fidget as their fidget spinner as their timer, right? Yeah, you know. And that's something that we can collaborate with on a teacher, and that could potentially replace a 30 minute, one time a week direct treatment with that child. It may not, you may still need to do that direct treatment, but over time, a lot of OTS asked me, what do you do with consults? And these are ideas that what you could do with consults, right? You could be working with the teacher to put something in place in the classroom, right?    Cheryl Bregman     I've also used the time where my student, we have initially done like a direct session with them, and then go into the classroom and the student gets to teach the class or their small group, and they sharing the stories or the letter formations with the whole class. The teachers love it. They actually will often say, really, that's how former D I never knew, and you know, will have a lesson inside, the inside the classroom, or the small group, where they get to then retell what they've learned. And that's, you know, a really functional way to to get them to appreciate their learning, to solidify it.    Jayson Davies     Great, awesome. Thanks for that. I like that idea, right? Let the let the student become the teacher. I absolutely love it, all right? So we have two more overarching topics that I wanted to discuss today. One is assessments, and then the others, I want to really dive into your handwriting program a little bit. So starting with the assessments. Now, I know it has become pretty popular belief, right, that the VMI the bot to some of those assessments that don't even, yeah, you use a pencil to complete it, but has nothing to do with writing tasks don't really relate to handwriting. Sure, I think you have more information on that, right?    Cheryl Bregman     I definitely used to, I guess, like as a younger therapist, depend on those assessments. And I think what has happened, they haven't necessarily been updated, especially, you know, post pandemic. So I will often find improvements, functional improvements in legibility and fluency, for example. And then when I reassess my student with assessment. They're still in the first percentile, but they have the best handwriting in the classroom, so it's not necessarily telling the right story the same way that, yeah, the VMI shapes, for example, aren't you? Exactly prescriptive of success with with handwriting. And you know, brings up the another sort of myth, perhaps, that you need to have those seven or eight developmental shapes in place before you start handwriting. I often find that that is a barrier to have these children essentially waiting when their peers are moving along and learning how to handwrite, and then they're just further behind because they don't know how to make the diagonal line. And so, you know, as OTs, we're still working on pre pre writing and making a triangle when the rest of the class has moved on and they're working on the alphabet, and that's where you know what we had spoken about previously, where letter formation doesn't necessarily have to be a paper pencil activity, where we can do it in other with other means and just the speed of that has to hasten. We can't necessarily rely on, you know, what's so called, developmentally appropriate. It has to be more functionally appropriate as well, so that kids can get on par with their their peers. But you know, to get back to the assessments, I think, you know, pairing it with a standardized assessment is fine, as long as you're not counting on that assessment to give you too much information regarding handwriting.    Jayson Davies     Yeah, yeah. And do you ever use another tool that we've talked about a lot, or a few are the etch and the ths are some of the handwriting assessments. I know the thsr is standardized, the etch is not, but they at least look at handwriting.    Cheryl Bregman     I find them, you know, to be long to administer, and so I don't personally use them. I, you know, I have developed something called the Quick handwriting assessment, and it's literally just a dictation task and a copying task. The dictation task looks at the letters in their letter families so that one can pick out which there's oftentimes, like a letter family that a child is struggling with. They may be struggling with the letters that start like C or, you know, the diagonal letters. And by doing them in those groups, I quickly pull out which letter group that child might be struggling with. And then the copying task I do. It's a one minute copying task, and that gives me information on speed and fluency. And see, you know, that's a real barrier for the child. So I guess I've moved away from standardized testing just in favor of speed.    Jayson Davies     for the handwriting part of it, at least, exactly. Okay, very cool. Now, one last part of the assessment process, I guess you could call it that I want to talk about, because, I mean, we've already discussed a little bit, right? Is digital? AI to digitalization. If I can say that, right, people are going every which way. I mean, there's so many ways to get your words onto paper without a pencil these days, right? You can do speech to text. You can use a stylist, potentially, you can there's a anyway. There's a variety typing. So do you do evaluations at all? To the point where you're trying to figure out, should I focus more on going digital as opposed to writing. Do you do that? Or do you really focus on the handwriting part?    Cheryl Bregman     110% I actually, I will say that I, when I initially encountered, you know, children struggling with handwriting, my inclination was to completely veer towards assistive technology, so much so that I did a master's degree in technology in special ed, and I, you know, this is, you know, for another time, but I developed an application called a Willie pad. It was for the iPad, and that worked on that was word prediction, and it was a keyboard that one could modify and so on. So I really, you know, love assistive technology. I see it as a wonderful answer, especially for kids with dysgraphia. It, you know, with regards to word prediction, text, speech, speech to text, I think it's, you know, I think being struggling with handwriting in today's world is much easier than you know had, had you been around 10 years ago with the same condition, and it's definitely an outlet for for the kids who need it. I obviously sort of went back to handwriting. And the reason why that happened was I did notice how, how, what a big difference it made, even if a child could write their name. And you know, in terms of self esteem, kids want to be able to write their name, and then, you know, the same was true with, with the Association of reading and writing. If kids understand the letter form, there's a kinesthetic connection with with reading. And that importance to me was, you know, significant.    Jayson Davies     Yeah. And you know what? I actually wanted to bring this up because in my email box the other day I actually popped into my email box was an email from you. It's an auto it's an auto sequence email from you, but it is a very helpful one that comes as part of being on your email list. And it was the three reasons why you focus on handwriting, even in this digital age. And so the three reasons were, and I'll let you elaborate on these were, it leads to increased memory handwriting does it uses more brain power than typing. And then your third reason was, actually writing by hand benefits the whole body. And I thought those were three great things, so I wanted to bring them up, and actually kind of let you, I mean, you already kind of alluded to a little bit of that, but I'd love to have you elaborate a little bit more.    Cheryl Bregman     Right? Well, these are all from, you know, actual studies that were were conducted, and one of the authors and researchers that I love reading is studies by Virginia Berninger, and she's done a lot of work with handwriting and the brain, and she's basically made real advances that show the connection Between handwriting and how, for example, students will remember more when they're taking notes, when they're handwriting, than when they're typing. So when you're typing, you act more as a you're just taking notes, whereas, because you can't write as quickly as you type, you have to sort of summarize what you've written, and therefore you're thinking about what the lecturer has said, and you're making, you know, a consolidated or summarized version of that note. So it's a more active process. So yeah, that you know, comes into using your brain power and improves your memory and the benefits for the whole body. Yeah, it just, it increases the way again, because of, it's a kind of static activity, it increases that. I'm not sure if you, you know, you've ever sort of rewritten notes just for the sake of, for the sake of learning or highlighted or repeated, you know, writing a word that's a kinesthetic learning mechanism. So it's all really beneficial. I just remembered as well in terms of assessments, I just want to go back to that, because there is, you know, one assessment I do want to mention that I think brings things together a lot more functionally. It's also, I don't believe it's standardized at all, but it's the Costa writing protocol. Are you familiar with that?    Jayson Davies     I've heard of it. I've never used it.    Cheryl Bregman     So basically, it looks at writing as writing the task, and it helps you decide which tools are going to best serve the student so and it recognizes that the student might do better with paper and pencil in one scenario and with keyboarding or word prediction in another. And it allows you to sort of do the composition tasks, the dictation tests. But it's very comprehensive. It looks at keyboarding speed versus handwriting speed, and really takes a functional stance on what is going to be the best option in different scenarios for the child. So for example, and I often say to a student, you're fine doing your spelling list in the handwritten form. Anything beyond that, maybe you want to consider keyboarding the activity, or you can do four to five sentences beyond that, you want to start looking at the keyboard as an option. So I think it offers, offers that kind of thinking process.    Jayson Davies     Yeah, and that's something that we as OTS should be doing in general, right? Like, if a kid's just going to write their name, it makes no sense to bust out a computer, open up Word Processor, write your name, press the Print button. But if you're going to do a longer paragraph or essay, then maybe it becomes more worth the effort to get out the computer or whatnot. So go. Great. I love that. Thanks for sharing.     Cheryl Bregman     And also, yeah, and the child again, needs to become like, especially by second or third grade, when when the writing load becomes a lot more, they have to start self advocating, because oftentimes teacher isn't familiar with word prediction or with speech to text, and the child needs to take more of a role in advocating for themselves.    Jayson Davies     I mean, let's be fair, a second grader knows more about an iPhone and iPad in a Chromebook than any teacher does. So exactly makes sense. Alrighty, great. Well, you know what I want? I want to, I think transition to our last topic for the day, which is your handwriting Heroes program. And I think a great way to actually make this transition is talking a little bit about how you got to where you were. Because if I remember right, your handwriting Heroes program started out as an app, and we were just talking about some digital stuff, and you've, kind of have transitioned away from an app and if you have a computer system now, right?    Cheryl Bregman     Well, I think, yeah, that's essentially just a matter of where technology has gone. There's been a shift from iPads to Chromebooks, not specifically    Jayson Davies     when it comes to schools, right? They're using Chromebooks.    Cheryl Bregman     Exactly. So that was just from a in terms of what I did learn through this whole process of becoming a, you know, a designer and a developer. Not that I do any of the coding myself. I'm just the idea person behind it, but that these things change. So it's not as though you can create something and just let it go. It needs constant nurture and constant updates. And it was basically out of necessity, because of that, you know, major switch from iPads to Chromebooks within the school system that I had to go web based, and so it wasn't, and I'm currently, hopefully soon, relaunching the app version as well. Awesome. So so that, because I, you know, I really like the tactile nature of the iPad. I enjoyed more than the Chromebook screen interface. But essentially, the content has remained the same. And I, you know, and the methodology, obviously, has remained the same throughout.     Jayson Davies     Gotcha. Great. So then, why don't you share with us a little bit about handwriting Heroes program, just kind of an overarching for someone who's never heard of it. How do you like to share about it?    Cheryl Bregman     Sure, well, it's a multi sensory handwriting program. It's used you know, in individually or in classrooms. And as you might guess, it starts with lowercase letter formations and and then we practice lowercase for it's taught in five weeks, there's five little groups, and it's taught in five weeks, which gives the child the opportunity to start writing right right when they finished that five week program. But also has then approximately 10 weeks of a print practice where we do activities like that alphabet, the you know, the alphabet, speed activities, and working on words and short phrases. And then lastly, I teach uppercase over a period of six weeks. So the program takes about 21 weeks, and it can be modified for, you know, and differentiated but, but primarily, I like to get that five week done as quickly as possible, to give them, to give the kids the tools that they need.     Jayson Davies     Yeah, absolutely. And so is this geared more toward OTs, more toward teachers, parents, all the above. What would you say?    Cheryl Bregman     Well, all the above, I really, you know, do feel like teachers need to reclaim the responsibility for handwriting, and one of the benefits of the program is that it is something that can be taught as a whole group in a classroom. So there are strategies that lend a two whole group teaching and, you know, whether it be the videos, where the videos can be shown to the whole group, or air writing, where a classroom teacher can observe all the children, airwriting at one time and then at the same time. It works nicely in a home environment, one on one, or a home school. And. Environment where the child can just navigate their way through the game independently.     Jayson Davies     Gotcha, okay, cool. And, I mean, I took a look at it. I did the free trial, and I saw, like, some of the videos that you've got going on, some of the games you got you use the sky, the clouds, the grass and the dirt analogy that I know some people, some people use. And so I guess my question is, you said it's multi sensory. Just explain a little bit about all the different ways that you made this multi sensory.    Cheryl Bregman     Sure. So basically, I've embedded multi sensory strategies throughout the program. So for audit auditory learners, each group has a theme song that emphasizes the common stroke, and each letter, as I mentioned, has a story that explains why the letters are formed the way they are. The students can retell the story as they form the letter to help them order the strokes. So for example, K sky dives down, a little bird kisses K and flies away. And if you saw that in your mind's eye, you would understand the stroke sequence. And so it provides a rationale for why the strokes occur in that in that sequence. Then for visual learners, the images and the videos, especially the slapstick moments of very engaging for kids and then for kind of static learners, lots of finger tracing and air writing to stimulate the multi memory parts to make learning the letters very efficient. I'll also say in terms of the kinesthetic learners, there's five letter groups. So just like you know, other programs have used letter groupings, we've got it done in story format. The skydivers, LT, K, I, J, they all skydiving down. The bouncers are H, b, r, N, MP, and they drop down, bounce back up and over. The cannon pops are the ones that start like C and so on. And I think I should also, you know, make note that a differentiator is that I have all those letters practiced at once. So the emphasis is on learning the common stroke, but also understanding the differences within the groups. And it makes, essentially, instead of writing, taking five letters and writing focusing on one letter each day of the week, we're going to focus on the entire group for the whole week. So the kids write LT, K, ij, and the oftentimes people will say, Well, you can't, like, introduce five letters at once. The you know this Charles in kindergarten. And I'm like, it's never not worked. It's just never not worked. It doesn't matter who the child is, what their disability is. I might alter the the output mechanism that they're using. So I might, you know, have them do it in sand or foam or, you know, something that's more appealing than a pencil and paper, but they can learn that L, Sky dives down, he lands on a lemon. T, Sky dives down a two can, tosses a tomato, and they see the stories. It's like watching a Short Cartoon for them, and they're practicing that core group every day of the week, then the next group gets introduced in the following week, and you still review those initial five, which takes all of you know, 10 seconds to write at that point.    Jayson Davies     Awesome. That's great. So you've got it chunked into smaller groups, but rather than doing one a day, we recommend kind of working on all of them together so that they can kind of see the difference says between them in real time. Really,    Cheryl Bregman     right, right? And it's, it's just something that you know has proven to be manageable for the children and and very effective. It's also builds that like motor memory without being repetitious. So I find that if you have a child doing R 10 times, there's no real point in that. They get sort of, you know, the brain sort of blocks it out eventually, and they're just sort of being repetitive without, you know, being active learners.    Jayson Davies     Awesome, awesome. And so handwriting heroes.org . That's the website. If someone goes over there with, what can they expect to find without even having to pay a single dollar? What do you have over there?    Cheryl Bregman      So they can sign up for a free we. Long trial as you did, and with that, you'll be able to basically execute the first full week of the program, being the skydivers. And just to get a sense of that, the workbook is available for, for the practice pages, and all the videos are available for for the skydiving letters, so you'll be able to just get a real feel for the program and get a sense of whether your child or your class enjoys us.    Jayson Davies     I love it, yeah. And I mean, I'm even on the page right now, even before you sign up for a free trial, there's a lot of different ideas that you can draw from it, just by looking at many of the pictures and animations you have on the website before you even sign up for a free trial, something like the finger puppets that I'm looking at right now, right? Making a little finger puppet to trace the letters. That's a great idea, just in itself, right?    Cheryl Bregman     And the kids love that. It's something that's used in the pre K classrooms and in the kindergarten classrooms, where it just animates the process and it makes a writing real fun so so they can take that to you, essentially a different level.    Jayson Davies     Absolutely well for everyone out there listening and you want to check out handwriting heroes. It is@handwritingheroes.org Cheryl, thank you so much for coming on today. Really appreciate it. Is there any last words that you would like to share with any ot listening today?    Cheryl Bregman     Just to work with your your classroom teachers and to enjoy the process of being, you know, of being involved in this process of handwriting and to look more carefully at the at the students and and what their needs are, not to you know, just confine it to whether or not something is legible. Look beyond that so, you know, so that you can help that child. Functionally.    Jayson Davies     Great. Well. Thank you so much for all the wonderful tips. I really do think that some people are going to leave today just having so much more in their ot you know that that tool chest, or whatever you want to call it, right in their ot toolbox today. So thank you so much. Really appreciate you being here, and I look forward to staying in touch.    Cheryl Bregman     Thanks Jayson.    Jayson Davies     Thank you so much for sticking around all the way to the end of the episode, I really hope that the conversation between myself and Cheryl really helped you to reevaluate a little bit about what you know about handwriting. It was really eye opening to me, especially when we talked about the starting with lowercase versus uppercase letters, because I do see that right. We see kids that get fixated on using uppercase letters, and we're trying to teach them those lowercase letters, and it's just not happening. So if we know that a student might have difficulty with generalizing or maybe learning multiple variations on a single item, then maybe we should be starting with the lowercase letters first and introducing uppercase letters as needed. Anyways. I hope this episode really helped you to maybe rethink, or at least question some of the things that you know about handwriting, the instruction that you do with the students and what you teach to the teachers with that enjoy the rest of your day, the rest of your week, and I will see you next time on the otschoolhouse podcast, take care. Bye, bye.    Amazing Narrator     Thank you for listening to the otschoolhouse 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 117 of the OT Schoolhouse Podcast. Being OTPs in a Teacher’s world is not always easy. In this episode, I am sharing a supportive tool I have used to support my students and build rapport with the teachers I work with daily. I have provided small and large group collaborative in-services for teachers since my third year in school-based OT, so I am excited to share with you some research that supports this strategy for all of the reasons I know and love. Listen in to hear how you can use live and recorded in-services to support teachers, students, and yourself. Resources: Read the full article here (a subscription may be required) Join OTS Collaborative , where you can earn professional development and get support implementing best practices in school-based OT. Article Citation: Jamie Mac Donald & Heidi Baist (2022) Using Virtual Collaboration and Education to Increase Teachers’ Ability to Promote Self-regulation, Journal of Occupational Therapy, Schools, & Early Intervention, 15:4, 403-417, DOI: 10.1080/19411243.2021.1983497 Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey everyone, and welcome to episode number three of 2023 and before we kick off today's episode, I want to take a time machine back to 2019 before the pandemic kicked off and and remember how little technology played a part in your therapy world at that point, you know we weren't using zoom at all, or at least, very few of us were. We definitely weren't using zoom for treatment or Google meets for treatment. I know some of you had to bear along with Google meets, like I did for a little bit, but we didn't have all that now fast forward back to today, and everything that we've gone through from 2020 2021 2022 and now here to 2023 we have used technology for so much more, whether it's using zoom for treatments, using Google Forms to collect data, using email and other services to collaborate and consult with other team members on the IEP, we have done so much, and just because now that we are getting back into the schools, supporting our students in person, doesn't mean that we have to forget about all of that technology. Today, on the podcast, we're going to look at an article that talked about using virtual collaboration to support students self regulation. So it's pretty awesome. We're going to use all that technology that we used during the pandemic, that maybe some of us are using less so today, now that kids are back in campus, but let's use it to our advantage. Let's not just let those three years of online therapy go to waste. Let's go ahead, use what we learned to continue to promote self regulation. So let's go ahead and Cue the intro music for today, and when we come back, we are going to dive into an article titled using virtual collaboration and education to increase teachers ability to promote self regulation. So stay tuned and we'll be right back.    Amazing Narrator     Hello and welcome to the otschoolhouse 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, before we dive into a little bit of the background information and the literature review that the authors did, let me go ahead and share with you exactly what we're diving into today. The article is titled, using virtual collaboration and education to increase teachers' ability to promote self regulation. This comes from the Journal of Occupational therapy schools and early intervention, and it was published in October of 2021 the authors are Jamie McDonald's OTD, otrl, and Heidi based OTD, M, E, D and otrl. So let's go ahead and dive into the background review, and then we'll talk about the hypothesis and what they did as part of their methods. There were three main themes that I gathered from reading their literature review, and the first is that they identified what self regulation is, as well as some populations that may have difficulty with self regulation in a school setting. And I'm not going to dive into all the details, but what I really appreciated about this particular part of the lit review. In fact, the entire lit review is that they pulled information from both occupational therapy research as well as education research. Now they don't allude to this at all, but I can just tell from the references and their in text citations that they obviously went outside of the occupational therapy realm to gather some information about this. The second thing that I wanted to point out is that they really took a moment to both understand and describe the CO occupation that exists between teachers and students. Now this is something unique that you don't often find in research, or at least I haven't, but they took a moment to kind of share how the struggles that a teacher may may have or may exhibit can impact the students, and vice versa, the struggles that a student may have can then impact the teacher. And it's kind of like a circle. It goes back and forth, back and forth, and you have the teacher impacting the student, impacting the teacher, and that constant co occupation going back and forth can have impacts that you may never see in another classroom. Right? No two classrooms are the same, and each classroom has its own dynamic. And I thought that was a really awesome part that they actually included within their lit review. The third and final theme that I took away from their lit review was something that you're probably already familiar with, and that is that, well, it's two parts that teachers don't necessarily know how to address self regulation, and in part, that's because they're not really taught about self regulation. Right? And then tying into that theme is that OTS can support teachers in understanding self regulation better, so that they can support their students in their classroom. They noted that the more that OTs and teachers work together, collaborate together, there are benefits for that. So the more that they collaborate together, you see increased carryover of therapy plans. You see improved rapport between the OT and the teacher. You see classroom specific recommendations from the OT to the teacher, and likewise, you see both of the professionals, the OT and the teacher, learning from each other and improving together. There is, of course, more to their literature review, but these were the three main themes that I pulled away from it that I really wanted to share with you based on that lit review, and what they were able to find by looking at some previous research. The team developed two main goals for this project that they were working on, I won't say first, because they go hand in hand, but the two goals were a to just basically help general education teachers better understand occupational therapy through both education and collaboration, and then also through that process, They wanted to increase the teacher's knowledge of self regulation. So increase teachers knowledge of self regulation, and also increase teachers knowledge of what occupational therapy practitioners do and can do to support them. To do this, they recruited seven teachers, although two did drop out. So they had five teachers that completed the study from start to finish, and these were all general education teachers with that said, one of the five teachers did have a background in special education, and you'll see that that skews the results a little bit, because it seems as though that teacher with special education background knew a little bit more going into this than the other teachers might have. Also, one thing you might notice as I'm talking is that there was only five teachers who completed this study from start to finish, and yes, that is a very small sample size, but as we get into the intervention used and also the results, I just want you to keep in mind that you don't have to have a huge study for something to be meaningful. And I really do think that what we're about to talk about right now can be individually implemented by you, and that you can see results by doing this. So let's talk about the intervention. The program itself lasted five weeks and consisted of two activities a week, those two activities being an asynchronous video as well as a synchronous live collaboration time that lasted between 15 to 30 minutes. In addition to those five weeks, there was a pre intervention week as well as a post intervention week, where data was collected, the recorded modules that were presented covered topics such as self regulation and social emotional learning, the role of OT in the school system, self awareness, adaptive seating, as well as teacher impactful interaction, so how teachers can have those very strong interactions with students, the synchronous collaboration times included one or two teachers in addition to the OT and were kind of a reflection on the lesson that was asynchronously presented, so any follow up questions that might have come up, or maybe even a specific student that someone wanted support with, that is What they used that synchronous time for now, I know some of you might be saying, Okay, well, how long did this take? They said that the synchronous collaboration session lasted about 30 minutes. They didn't necessarily say how long the videos were, but I would assume probably in that same 15 to 30 minute range as the collaboration time. So all in all, we're looking at maybe up to an hour per week for the teacher and for the occupational therapist. It was really 15 to 30 minutes of the collaboration session, plus however long it took to initially record the synchronous, sorry, the asynchronous videos that were put out. And of course, those can be reused. So if you were to do this program again, then you would only have to do the collaboration sessions. This was five weeks. So if we put it at one hour per week, then we're talking about five hours total per program session. So five hours, that's not too bad. They were able to help in five hours or a little bit longer, with all the different various collaboration sessions with a few different teachers, they're able to help five teachers to better understand occupational therapy and self regulation. So that's not too bad. Imagine doing this on a little larger scale. You could potentially help more teachers in a fairly safe. Similar amount of time if you increase the size of the groups, so not bad. One other thing to consider is that this did happen in September of 2020, so six months about after the pandemic started, everything was virtual. They did have to change their plans a little bit. They really wanted to incorporate more adaptive seating and other strategies that they were really training the teachers in, but as you know, during online instruction, that was a little tricky, so they kind of had to adapt a little bit, but they were still able to get some data. And with that, let's dive into the data itself. The researchers used a self created pre test and post test to collect both qualitative and quantitative data. Again, that was the week leading into the program and the week following the program. They used some Likert scale questions, some true false questions, as well as some open ended questions, to get that qualitative data prior to sending out the test and survey to the teachers. They actually had some pre testing and piloting going on behind the scenes with OTs and teachers just to check for validity and make sure that the questions were actually asking what they thought they were asking. The Likert scale questions that they asked revolved around asking the teachers if they really understood occupational therapy and what an occupational therapist might do, asking them if they understood self regulation, and then also asking them if they knew what to do if they were having difficulties with self regulation. And students of those 10 Likert scale questions, they found significant statistical changes in five of the 10 questions, no change in two of the questions because they were already maxed out, and then no statistical significance in three of the questions. Now I'm not going to read all the questions. If you want to see all of them. You can check out this article, but to see that five of the 10 questions has statistical significance of an increase with the the teacher's understanding of either a occupational therapy in the schools or B self regulation among their students, that's pretty significant to see that there was an increase among education of the professionals through this five week program. The no changes that we saw, I think those are significant, because the teachers already understood that general education teachers can be supported by OTs and social emotional learning students. So there was nowhere to go from there. They already strongly agreed that OTS could support likewise, there was no change. When asked if telling my students when I have a strong emotion is beneficial, all the teachers strongly agreed that that was correct. In addition to the Likert scale questions, the researchers also had a truefalse quiz. And what's nice about the truefalse quiz is that there are correct and wrong answers, and so you can quantitatively score it. So the pretest results range from 33 to 100% for the individuals with a mean score of 65 the average post score was 93 which, again, is a statistical significance. So we are seeing that this five week program did increase the knowledge of self regulation in educators. And just like the Likert scale questions, if you want to see all the different truefalse questions that were asked, please check out the article. They're all there, listed for you, plain as data C and the final part of the qualitative analysis here within their questionnaire or survey was the open ended part. They wanted to see what the teachers would input if they were given some space to share about social, emotional learning, self regulation and what causes a student to frequently fall or move around their chair? And the only thing that I really want to mention here is that the terms that were used before this intervention were fairly you know what we'd expect. Some terms included emotions, triggers, awareness, discomfort. But after the program, we actually start to see some of the educators use terms that we might use, such as poor strength and proprioception challenges. These are terms that were not used in the pretest. But after the intervention, we're seeing that teachers are better understanding how proprioception challenges might actually impact a student's behavior in the classroom. All right. So there you have all the data. And now I want to jump into some of the author's conclusions before I also provide some of my own conclusions and takeaways. And so the first author conclusion that I want to point out is that something that's very important. Important, you know, they found that the teachers had increased perceived understanding of the OTS role in self regulation. And they also pointed out, right in the same sentence, that this was happening during covid. So it's not like this was happening when, when teachers were self regulated themselves, you know, they were stressed out, and they were having to deal with new technology. And even while all that was going on, the OTS were still able to get through to the teachers and help them better understand OT and also help them better understand self regulation and how self regulation impacts social emotional outputs. So that's pretty great because, you know, it's hard enough for us to get through to our teachers when we are on campus, meeting with them in their classroom, maybe talking to them after school. They were able to do this during the pandemic. That is a pretty big achievement. One other thing that they pointed out that I haven't mentioned yet is that they found that virtual, asynchronous instructions paired with interactive elements is what really worked in this situation. I don't know that they would have had the same outcomes if they only sent out an asynchronous video, that synchronous interaction that they had on Friday afternoons for 15 to 30 minutes, I think really tied it all together for the teachers. So after reading this article, I came away with really three of my own key takeaways. And the first is that I really like this. I like what they did here, and not only because it worked, but also because of its feasibility, the modules that they provided to the teachers were recorded and thus were taken in by the teachers asynchronously. Now asynchronous is not always the best way to provide provide information to teachers. It's not always the best way to provide information to anyone, but when you follow that up with the synchronous collaboration time that they did on Fridays that really worked well. Now, because they had those recorded modules, they can repurpose this and redo this, this intervention, not just this, not just this research, but also this intervention. They could redo it relatively easily, right? So maybe they did this at one school, they could pick this up and move it to a new school with relative ease. They only need to then send out the videos, which they already have, and then redo the collaboration time with the teachers for 15 to 30 minutes, as they did. So I really like that. It's very much scalable in a way. So that's awesome, not to mention you could also change it up, right? They did it for self regulation and social emotional skills. You could easily record five videos about fine motor skills, about handwriting, about recess behavior, something like that. And you could redo this in different ways. So I really like that they did that. I think I've already mentioned this one. But again, knowledge does not come from passive watching. Knowledge comes from intentional back and forth interactions, and they did that with their Friday collaboration times. I think that is amazing. You cannot just give someone a video and expect them to learn everything we need to make sure that we are actually collaborating with them, having those discussions and supporting them and implementing what maybe they did learn from those asynchronous models. In fact, I love this so much that we are using a similar model in our OT school house collaborative community, where we are doing live professional development courses that can also be watched recorded, but then we are following up every single professional development course with an interactive component where we kind of talk about what we learned in the professional development activity and how we can incorporate that into our practice, just kind of like what they did, they provided the asynchronous video, and then they had the synchronous collaboration time. So yes, knowledge comes from intentional, back and forth interactions, not passive watching. That's something I really took away from this. And then finally, the last takeaway that I really had was that ot practitioners, us, both OTs and OTs, we need to get out there more and seek out opportunities to provide professional development or to provide resources for teachers. Not only is it going to help the actual teacher to better support their students, but it's also going to open up doors for us. A lot of people ask me, What is the easiest way to start pushing into the classroom? And my answer is often, get to know the teachers. The more of a rapport that you have with the teachers, the more you consult with them, the more you collaborate with them, the more you say hi to them in the lunchroom, the more likely you are to be effective when you start working with them in the classroom. So this is one way that gives you a purpose of actually providing that a. Uh, that intervention with them or to them, but it also helps build that rapport that you so desperately possibly want, right? We all want to be more included in the school, so we need to find a way to make ourselves more included in the school, and by providing resources and and services, whether they're synchronous or asynchronous, that can be a great way to build that rapport. All right, so that's going to wrap up our session for today. This is the otschoolhouse, Comcast number episode number 117, I cannot believe we are up to 117 the article that we took a look at today was titled, using virtual collaboration and education to increase teachers ability to to promote self regulation. It was authored by Jamie McDonald as well as Heidi based and yeah, it was just a great article. And I really hope that this helps you moving forward. Maybe you take this and you run with it, and you produce your own set of videos that you can send out to teachers, and also set up some collaboration time. If you do, let me know. I would love to hear how it goes with that. Thank you again, so much for being here. I really appreciate you, and I look forward to our next session together. Take care. Have a great week. Bye, bye.    Amazing Narrator     Thank you for listening to the otschoolhouse 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 118 of the OT Schoolhouse Podcast. Today, we're talking about one of the most popular and versatile tools in the world of school-based occupational therapy: LEGO. That's right, we're diving into the benefits of using LEGO in therapy sessions. LEGO provides a fun and engaging way to help children reach their therapy goals by improving fine motor skills and promoting creativity and problem-solving. Listen to hear nine ways you can support educational tasks using LEGO blocks as your therapy modality. Listen in wherever you get your podcasts. Resources: AJOT Systematic Review Lego activities on TeachersPayTeachers.com Braille Bricks An image of activity 7 - Building from verbal instructions Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey everyone, welcome back to another episode of the otschoolhouse, Comcast. Today we are going to have a fun one. We're talking about one of the most popular and versatile tools for school based occupational therapy, Lego That's right, we're diving into the benefits of using Lego bricks in therapy sessions and also in the classroom, from improving fine motor skills to promoting creativity and social skills and even problem solving. Lego provides a fun and engaging way to help children of all ages reach their goals, and it can also help us to support teachers. So I'm actually recording this intro for this episode on january 28 because that happens to be national Lego day. Why you ask? Well, it turns out that Lego, the original patent from godfred Kirk, Christiansen. I hope I'm saying that right, was actually first submitted on january 28 back in 1958 so January, 28 is now known as national Lego day. This podcast is coming out a little bit later, but I'm recording this on the 28th before we get into nine of the many ways that you can use Lego in therapy. Let me share why we are talking Lego today, and I promise it's not just because national Lego day just passed. Lego has been researched, but it has primarily been researched in the terms of social skill development and even some cooperative play. I did a quick search on Google Scholar, Asia, a few other places, and we're starting to see some more research come out related to using Lego to improve other developmental skills, but it's not quite to where it probably will be in about 10 years. There are people that are actually calling themselves Lego therapists, and they are using Lego in play to support children as occupational therapists. I think we all realize the benefit that Lego can have on things like fine motor skills, visual perception, even communication and self regulation. And we also value the occupation of play. Play impacts the development of skills and the development of skills impacts play right occupation supports skill development. Skill development support occupation also as school based occupational therapy providers, we often use play to develop skills that will be used primarily in the educational realm, things like color identification, sorting by shape, planning and building using stereognosis and visual memory to take notes while not looking down at your paper. These are all skills that play an important role in school and often are developed long before a student even enters kindergarten. But these skills have not yet been officially linked back to Lego play in research. I'm sure that's coming, but we're not there yet. So although there may not be research revolving around Lego and fine motor skills, how can you, as an occupational therapist, use Lego to build skills that your students use every day in school? Well, I've got nine ideas for you, starting with the most basic ideas and moving to some more complex, outside of the box strategies. I hope you're ready for this. I've got my bricks in front of me. I hope you have your bricks either in front of you or you're thinking about them on your school site. Let's go ahead Cue the intro music, and when we come back, we're going to dive in to nine ways that you can use Lego in therapy. Stay tuned.    Amazing Narrator     Hello and welcome to the otschoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host, Jason Davies class is officially in session.    Jayson Davies     All right, let's dive into Lego. Obviously, Lego is really known for building, right? You can build all sorts of things, from Harry Potter, castles to Star Wars, ships and just crazy things in the road, but before you even start to build with LEGO, the first things that kids really do with Lego, even starting with Duplos when they're a year old, is sorting, matching and understanding 3d visual spatial orientation, one of the first skills that students learn in school is to identify shapes, colors and other attributes, and since so many kids are already familiar with Lego or Duplo, what better way to do this than by incorporating their favorite block toys? You can use Lego to identify to match and sort blocks by color, shape, size, numbers of dots and more, depending on the pieces that you have available. 3d visual spatial orientation is also super important, right? The ability to understand that the same Lego can look different based upon how it's turned. Of course, a square looks pretty similar no matter what way it is turned. So. But shapes like circles or shapes like rectangles and other complex shapes that some Legos have, it is nice when students can be able to identify that shape, even when it is turned a certain direction. You can work on identifying matching and sorting blocks with various different ways, right? You can find worksheets that actually describe a block or show a block and ask the student to find that same block in a different form, or to find all the green blocks or to find all the squares. You can do that very easily. You can also take pictures with your iPad or your phone and then use those to support the student, or to say, can you find the pieces that match this one? That way you're taking out some of that language, right? If a student doesn't necessarily know what a rectangle is, you can just show them a rectangular block and say, find all the rectangular blocks. So you can start with that. There are several worksheets on teachers, pay teachers that can actually help you with this, but it's really easy just to take a picture on your tablet and go from there. Now, not specific to this first activity that we're talking about, one of the things that I love about Lego is that you can get so many of them, which makes it great for groups. In fact, that research that I discussed earlier about working on social skills, of course, that was actually used in a group. So Lego is just fantastic, because you can get so many pieces. And yes, you can do any one of these, sorting, matching, visual, spatial orientation skill activities on your own, one on one with the student. But you can also do this in a small group. You could also do this in an entire kindergarten classroom, which you know the kids are gonna love, and you might be surprised by how much the teachers love you for it as well, because you are giving them something, something new, something interesting, that you are bringing into their classroom. You're helping them do it, and then they can do it in the future. So that is our first activity, sorting, matching and understanding 3d visual, spatial orientation, all right. And the next activity that you can work on with your little ones, or even your older ones with Lego, is pattern recognition and directionality after recognizing an individual blocks, shape, color, all that good stuff. Students must learn how they relate to one another, and they do this through patterns, again, patterns of colors, patterns of shapes, patterns of designs, or even a combination of any of those. Right, you could have color, color like red, green, red, green. You could have Red Square, green rectangle, Red Square, green rectangle, or anything else beyond that, patterns are everything in the world. They are everywhere, and they help the brain to make sense of things. The ability to read fluently is facilitated by knowing and seeing patterns. The ability to count by twos, fives, 10s. It's all a pattern, right? And we can start our kids off early by making sure that they understand basic patterns. Another nice thing about using Lego to build patterns is that you can go in different directions. You can build a pattern that goes across like in a train, right? Where they're not even necessarily connected, but they're creating a long train of a pattern. You can also do a pattern where blocks are stacked upon one another, right, so it's building upwards. You could do more diagonals. There's so many different ways that you can incorporate patterns. And as you're incorporating the patterns, you can also incorporate directionality, which your speech pathologist will love you for, because they are often working on this skill, the ability for students to understand directionality terms, such as under on top of, next to in the middle. There's so many other ones, but those are some skills that you can work into your pattern building, and when your SLP walks into the room, they will be ecstatic to hear you using some of that terminology, because so many kids need that need help developing that skill. And now moving on to our third activity that you can do kids now understand after our first two activities, they understand the blocks. Maybe they know the different shapes and colors and attributes of each Lego block, and so now we can actually get to using Lego for what it was actually designed for building. So the third activity that I have for you when it comes to Lego is following visual instructions, and when you buy a Lego kit today, this is exactly what it is intended to do, right? You get a box of Legos. On the front of the box, you see a Harry Potter train, and the instructions inside show you how to build that Harry Potter train for many of our students, that Hogwarts train. Train is just going to be way too difficult, and honestly, it's more something that can happen at home than at a therapy session or in an educational setting. But you, as the occupational therapy practitioner, you know how to grade this activity up or down. Let's not start with the train. Let's start with a four block design, a six block design, and let's create instructions to building that design. Now you can probably find very simple designs on the internet somewhere where you can copy and put them on or just print them out, even put them on your tablet, or print them out and show them to your student. I personally like just to create my own abstract designs. And then I take a picture each step. Oftentimes I actually put it together completely whatever the design is. I take a picture of it. I take off a block or maybe two blocks. Take another picture of it. Take off a block or two blocks, take another picture of this. You can completely grade this up or down. You can make it very simple, or you can make it more complex for your more advanced students, and you get to choose how many blocks are in each step beyond some of the basic skills that we've already covered in activities one and two, the skills incorporated within this activity include visual spatial skills, visual memory, motor Planning and find motor skills among others, we're now identifying the block as well as taking the next step of figuring out where that block goes. So we need to really understand that 3d placement of how something might attach to something else or relate to something else. The skills used in this activity can be linked back to many educational tasks, such as learning to draw or write shapes, letters and numbers. As students get into Geometry, they're often visuals that must be broken down to find a solution. This could also be a step in teaching a student to use a visual schedule in or out of school, right? The ability to follow directions is often or visual directions, I should say, is often used in a visual schedule, right? You put down 345, visual schedule steps, and the student follows that just like they would with a Lego set of instructions. Visual instructions are used well beyond school as well. I remember one of my first jobs at Taco Bell, rather than having directions written out, oftentimes, you would find a little visual instruction out on the counter of what to do when it came to, I don't know, providing napkins and hot sauce. And then now as an adult, Ikea furniture, right? We've all been there. We've all had to put together Ikea furniture, just completely with visual instructions. No words. So this is a lifelong skill, the ability to follow visual instructions to complete an activity. Once a student has really mastered following visual instructions, we can move to our fourth activity, which is copying designs. And what that means is just removing the instructions, remove the visual instructions, and have the student see a completed object, reverse engineer that without instructions and then rebuild it. And of course, just like following visual instructions, you can grade this activity start with something small, such as a four block wall, and have them put that four block wall together. As you start to see students mastering four blocks, add more blocks, add more three dimensional items to it, right where blocks stick out different directions. It's no longer just a flat design, but it has 3d components to it. If you buy a Lego set, it will not often come with directions of this manner. You will have to do this more independently. And so again, you you build a design, take a picture of that, and then break down the blocks and give the students the blocks that they need to build that design. Another way that you can grade it up or down is to either a just give the student the exact blocks that they need, or to also include other blocks that maybe the student doesn't need. So now you're giving them 10 blocks when they only need five blocks to complete the design. This is going to promote some executive functioning skills as the student has to compare and contrast the blocks that they have available versus the blocks that they absolutely need. You can even break this down further and actually teach them to say, oh, right, let's first before we even start building let's first look at what blocks we need, and let's get rid of those other blocks that we don't need. Right? Think about on a test. When you would take a multiple choice test, there's four answers, often, maybe there's more, but oftentimes, the first thing you do is eliminate the immediately wrong answers, right? And we can kind of use that terminology to show to show a student how in this activity, we can eliminate those obviously wrong blocks to make our life a little bit easier. So. So all of this can be tied into copying designs. You could even do this that last part that I just mentioned, you could do that with the building from from visual instructions as well. But as we create more advanced tasks for our student, we are really highlighting the executive functioning skills that that student will need to develop the process. And again, what is great about Lego is that it is so adaptable that we can grade it up or down so easily. I mean, you could even remove a block that maybe is necessary for the student to create the design, and that will lead to a different learning capacity that has to happen at that point. Right when they get halfway through the structure, they might say, I need a green block. Where is that green block? We don't have it. Or do they simply use a red block instead. And what does that mean? What does that matter? How can you turn that in to a learning exercise? Now, if you ever have a teacher or a parent or an administrator ask, you know, wait, how is copying Lego related to academic skills? Well, I mean, there's so many things, right? We copy without instructions in class all the time. We constantly are asking students, whether we know it or not, to break down tasks into smaller, more manageable steps. Think about those word math problems where we're always asking students to eliminate the data that is not necessary and only focus on that data that will help you solve the problem. The ability to see a larger project and break it down into smaller items will be used throughout the student's life. And you can find a way to relate this back to an IEP goal, if you really try. I'm thinking of goals where a student is asked to do a three step action. Copying designs can lead to that three step action. I'm thinking of goals where a student is asked to complete an assignment, the same thing, right? What is required to complete that assignment, breaking it down from the entire assignment into smaller, more manageable pieces. That's exactly what we're doing when we're asking a student to copy a design, and we are just using that as a stepping stone up to the larger occupation, and that brings us to our fifth way to use Lego in therapy, and that is to take away the visual stimulus, no visual directions, no visual stimuli to copy. We are just using either our memory or building from our own preconceived design within our head, or the student is building from whatever is in their head, building from memory. We often can use letters, words, numbers, math problems, or even any other tangible item that maybe we want to build from. We can also build a design for the student, tear it apart and ask them to rebuild it again, just like with the other items, you want to start small right. Start with a four or three block design. Make sure that they can master that from memory, and then go from there. If you're going to work on letters, words, numbers or even math problems. This can be great for an in classroom activity. You can actually work on the ability to remember how to form letters and words and numbers by using Lego. Now, when you're going to be forming letters and numbers from Lego, there is no top to bottom, left to right formation right. We're not using a pencil, but we can work on that visual memory of what the letters and numbers should actually look like when we are going to build from our own preconceived notion of whatever it is that we want to build. This is actually working on that creativity side of things, even the ability to put a sentence together that can be worked on through that ability to think about what you want to build in your head without any stimuli and then building upon that. So a student might say, I want to build a giraffe, or a student might say, I want to build a car, that's perfectly okay to let them do it without another stimuli of how to build that giraffe or that car. Let them get creative. Let them figure out what blocks they need. You can even separate this out into a multiple therapy session, right? You could do this over several therapy sessions. Maybe the first week, they're just identifying maybe what pieces they think they need, and then you put those in a Ziploc bag. The next week, they come back and they create an initial design, and then maybe they realize, maybe I need more blocks, or maybe I need different color blocks, and then you move that on to the next therapy session. This could easily be three or four sessions built out with the student constantly evaluating their. Own progress and seeing how they're getting better, or seeing where they need to maybe get better, how they can adapt their own activity to make it better. If what I just said about, you know, adapting everything that you're doing and then changing it, and then adapting again, self evaluating, sounds familiar. That's because that's exactly what we do as OTS. That's exactly what teachers do at teaching right? They take data every four, six weeks and then recreate their curriculum based upon that. It's exactly what every student does when they're writing a paragraph or an essay. They're constantly trying to improve, and that is part of executive functioning and skills, and so we can facilitate that initial skill set for executive functioning by using play. I know that that's hard to wrap your head around for people that aren't necessarily OTs, but by using Lego and using play, we can start to plant that seed of executive functioning that will obviously have great implications in the educational classroom. All right, so the first five strategies or activities that I had for you were pretty basic. In my opinion, they were very similar to what you have probably done with Lego blocks before with your students for the last four I'm going to get outside of the box a little bit. I'm going to bring up some things that may be great for you and others. You might kind of say, Eh, whatever. I'm not so sure about that one. This first one, number six, is actually something that you can use to grade up or grade down some of the activities I've already discussed, or you can use it completely on its own, and that is to use stereognosis, if you remember from otschool, or maybe you use this word frequently, stereognosis is the ability to find something in your hand without using visual stimuli. So the ability to reach into your pocket and find the difference between the quarter or the penny that's in your pocket and pull out the correct coin. Well, Legos all have a very distinct feel to them, especially with the dots on top right and the size of the block, and so you can use that to develop that stereognosis ability within your student. It's very simple, right? You take a few blocks, throw them into a bag, and have the student pull out the I was about to stay to pull out the red block with four dots, but obviously they won't be able to see that it's red, but have them pull out the block with four dots and then see if they're able to find the block with four dots, or do they find the block With eight dots? That is stereognosis. And as I mentioned, you can either do this independently, or you can actually use it as a way to grade up an activity that I've already mentioned. So maybe this week, you just focus on stereognosis and having the student reach into the bag to find the block with four dots on it. And then next week, you use stereognosis to not only find the block with four dots, but also find the block with four dots and place it correctly onto the other block that it says in the instructions. In my opinion, stereognosis is a very undervalued skill, especially coming from someone who has a really difficult time typing without looking at the keyboard or even writing without looking at my hand on the paper. I really feel that stereo diagnosis is key to writing fluency, and I think the better that someone understands their hand in space and their feel on a pencil, the better that they will be able to write without necessarily looking right down at their paper. And so if you have a student with a goal to copy from the board, if you have a goal for a student to near point copy or to just right neat or whatever it might be, I really feel like working on stereognosis can move the needle for that skill. On the flip side of having a student reach into a bag and find a block that you have visually described, you could flip that around and have them reach into a bag describe the block that they're feeling and then pull it out to see if it matches what they said. So they reach in, they feel that block that has eight dots on it. They feel that it's a rectangle, not a square, and they pull it out, and then they see, oh, wait, it only has four blocks on it. That's a good way for them to visually understand, wait, I What is my hand telling my brain like they are going to get very purposeful direct feedback from themselves through that activity. All right, we are on to number seven. Now I have three more activities, seven, eight and nine. And seven is by far my favorite. It is the one that I use a lot because it incorporates a lot of the skills that we've already talked about. And. Then some we're going to be talking about communication here. We're going to be talking about the ability to motor plan without any stimuli. This is a fun one for this activity. I'm going to show you how I would do this individually with a student, and then I'm going to hopefully describe what that might look like in a group. So individually, what it looks like is I have an iPad in front of me, and on that iPad I have a stimuli of a build, right? So maybe it's six or seven pieces put together into a build. Now between me and the student is a folder so that he or she cannot see what I have on my iPad, so I have to verbally describe to the student how to build what is on my iPad. So you're seeing the communication here that is necessary. The student then has the pieces. And as we talked about earlier, you could either give the student the exact number of pieces that are necessary, or you could give them extra pieces depending on the level and how you want to grade this activity. On my end, it's extremely important that I am very intentional with what I communicate to the student. I need to make sure that I am describing the brick very well, or if I'm grading this, I can describe the brick a little less well and see how the student can do, or I could intentionally withhold some of the information about a block that they need to build and hope or to facilitate that they will ask me a follow up question for more information about what block they need or where that block goes. This gets really complex, or at least it can, or it can be pretty simple, because you could use the pattern building that we talked about earlier. You could make this super simple, such as, find the red block, put the green block on top of the red block, the yellow block on top of that, and then the orange block on top of that. Wait, are there orange blocks? And they go, I'm sure there are. But anyways, it could be that simple, right? It could just be four blocks on top of the other and even what I just said really isn't that simple. If those blocks are not square, then you might see the student turning the blocks in different directions as they put them on top of the block. So when you were just trying to get a simple wall. They might have blocks pointing out in all different directions. So you can make this simple, or you can make it more complex. You could also flip the script and have them be the one with the iPad and the stimuli in front of them, and they have to give you the directions on how to build whatever it is that they're seen. Now, you might already know kind of what it is that it's supposed to be built, but still, right? You can play along, and you can ask those clarifying questions. If a student says, find the red block and put it on the blue block, you can ask, you know, wait the red block with four or eight dots, or does it need to be in the middle of the blue block or off to the side of the blue block? Does it need to stick out in one direction? Did you say it goes under or over the other block? Those are types of questions that you can incorporate and also get the student to think about what they are telling you, what are they seeing on the iPad. They need to double check that their visual spatial skills of what they're describing is what they're actually seeing. So that is what this could look like if you are working with a student one on one. Now imagine if you are working with two students at a time, and you give them the ability to take on both roles. One student is the facilitator and the other student is the builder. One student has the iPad, the other has the Legos, and they have to work together to put the build together. You can again, manipulate or grade the activity by making the build more difficult or easier. You could also give the builder the exact number of blocks that they need, or less or more blocks than they need to make the build. You can facilitate communication by the way that you set this up. I love this activity because whenever I use it in a small group like that, the students really work together as a team. They see themselves as a team that needs to get this build done together. I've never had students fight or argue and blame each other for not getting the build correctly. And at the end of the build, once both people, both of the kids, agree, you know what we're done, we got all the blocks together. Then you take down the folder and you let the kids compare what the facilitator has on the iPad in front of them and what the builder has built, do they match? And if it doesn't match, what went wrong? And how can it be fixed? This activity has just led to so much growth in my students, and I hope it will help you and your students as well. You can also do this with a third student. You could have one facilitator with the iPad, and then you could have. Two students that are builders, and none of them can see what the other is building. So now you have three or Well, three stimuli, two builds and one iPad build to compare and contrast and see what went right and what went wrong. I see this Lego activity as being the ultimate Lego activity. You are taking away the directions that some so so frequently tied together with Lego, but you're adding that group conversation, and you're working on social skills, you're working on visual perceptual skills, you're working on strength and fine motor to build those Legos. And there's just so much going on here. The executive functioning skills even are just off the chart, because you really have to think about not only what someone is sharing with you, but you have to have trust in them. You have to have empathy that they don't have all the answers, right? They only have one stimuli picture in front of them, and they don't know what you have on the other side, and then that builder has to plan out based upon what they're told about how to make that look on their end. There's just so much good things within this activity, and I really hope it helps you and your students out. If you have any questions about this one, feel free to shoot me an email. I'd be happy to kind of give you some more information, and I'll be sure to post a picture of what this looks like from when I did it on the show note at otschoolhouse com slash episode 118, all right, we are down to the last two, and number eight is to Use Lego to tell stories. Oftentimes our students have difficulty taking what is in their brain and getting it onto paper. Things get lost a little bit. But we can use Lego to help them out. We can have a student build out or draw out what they are seeing in their brain. Perhaps they draw it, then they build it, or perhaps they go straight to drawing, but that can help them to tell stories, that can facilitate their thinking of where they want to go with writing. I've had students use the little Lego people to tell a story, to create a story, and then use that story in what they're able to write down on the paper. You can either do this with a prompt, or you can do it without a prompt. It doesn't matter. It all depends on what the goal is for the student and what you want to work on. But having them use the Legos to build out a story really makes that story that's in the brain more tangible, and it makes it more fun, makes it more occupation based for them. And so I really encourage you to try that. Just give them some Legos and say, Hey, we're going to write a story. But first I want to let you build that story. You know, is there a tree? Is there a house? Are there people? Let them build that out. And then they can actually go back and forth between writing and back to their build to continue to create and modify the story as they go. And that brings us to our final Lego activity. And this is a very specific Lego activity. It's something that Lego has built out of request from the visual impairment community. They actually have Braille bricks, and so if you work with a student who's visually impaired, I would definitely recommend that you ask your administrators to purchase a set of these Braille bricks that you can use with your students. If you work with teachers of the visually impaired, maybe they already have some, but if not, you might want to let them know so that they can go out and pick up a set of their own. You can find these on the internet. I will post a link to the website at the show notes so you can find them if you need them. Also, I gotta give a shout out to Kelsey, who kind of gave me some info on these and led me to the website where you can actually purchase them. I had heard of them, but I didn't know where you could get them. So, so happy to be able to share that Lego has Braille bricks that you can use to teach your students Braille, especially if you work in a school for the visually impaired, definitely a must have. Even if you don't work in a school for the visually impaired, maybe you have one or two students that are using braille. This could be a great addition to your therapy toolkit. All right. Well, I hope you have had a brick of a time learning about how you can use Lego in your occupational therapy practice. I shared with you nine different ways that you can use Lego in your practice, and I hope at least you know maybe three or four just really stuck with you. I would love to see you using Lego in your practice. If you do after listening to this episode, snap an image, put it on Instagram and just tag me in it so I see what you did. I would love to see you either use one of these activities or maybe show me something else that you like to do with Lego. It's been a lot of fun putting this episode together. I've got a Google doc here that I'm going to save for future reference, because there's just so much good here. Be sure to check out the show notes at. Otschoolhouse, com slash Episode 118 so that you can see a few of the links that I have for the research that I talked about earlier, as well as a page of TPT links where you can find some Lego handouts and that picture of what activity number seven looked like, so that you can incorporate that into your practice. Until next time, have a great day. Use some Lego and I will see you in the next episode of the otschoolhouse podcast. Take care.    Amazing Narrator     Thank you for listening to the otschoolhouse 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 119 of the OT Schoolhouse Podcast. Do you know how your engine is running right now? Is it high, low, or just right? In this episode of the OT Schoolhouse Podcast, Sherry and Molly discuss the OG self-regulation program that helps all ages understand their alertness. Using analogies that The Alert Program® utilizes helps people understand their alertness in an easily comprehensible way. Listen in wherever you get your podcasts. Resources: The Alert Program Website Youtube Channel Facebook Page Engine Analogy? One Metaphor Does not fit ALL! Who can benefit from Alert Program®? Preliminary Findings on Children with Fetal Alcohol Spectrum Disorder Guests Bios Sherry Shellenberger, OTR/L, is an occupational therapist who has always wanted to enhance the school experience of children. She believes working together with the educational team allows for positive change to happen. She has over 30 years of experience working in different settings, including a camp setting. She has focused on developing practical ways to teach people of all ages how to incorporate sensory integration theory into everyday living. She has published numerous products and books relating to self-regulation. Molly McEwen, MHS, OTR/L, FAOTA , has a professional career spanning over 30 years. She has practice experience in major medical centers, public and private schools. She has established and maintained a private practice serving children and youth developed a professional continuing education business, and provided consultative services to educational institutions and industry. She has been an occupational therapy educator at Texas Woman’s University, the University of Texas Health Science Center at Dallas, and most recently at Pacific University in Oregon. She is currently in private practice in Hillsboro, Oregon. Molly has received both state and national awards for contributions to the profession and is continually promoting occupational therapy as a cost-effective approach in supporting and maintaining healthy communities. Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the otschoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.    Jayson Davies     Hey there. And welcome to Episode 119 of the otschoolhouse com podcast. Thank you so much for being here today to kick off this episode. I have a quick question for you, and you might have heard this one before. How is your engine running right now? Are you running a little high? Maybe you're running a little low, or is your engine running just right now? I must admit, right now, my engine is running a little bit high, and that is because I just had a wonderful conversation with Shelly Schellenberg and Molly McEwen about the Alert program and now how it has evolved since Sherry And Mary Sue Williams first implemented the program back in the 1980s now if you're not familiar with the Alert program or the reference I used to kick off this episode, you should be the Alert program is one of the OG self regulation programs out there, and it has been used worldwide to not only support people who don't quite understand their own arousal or alert levels, but it has also provided caregivers and adults of children to have the language and analogies to use to better help their students, their kids understand their self regulation. Sherry Schellenberg is actually one of the founders of the Alert program, and also joining us today is Molly McEwen, who has actually helped Shelley and Mary Sue to build the wealth of research around the program and help to create what it is today. So let's go ahead and cue that intro music, and when we come back, we're going to dive further into the Alert program to talk about the famous car analogy, the research behind the program, and how you can use the program in your classrooms with success. So stay tuned, and I'll be right back with Sherry And Molly. Sherry Molly, welcome to the otschoolhouse podcast. How are you doing today, Sherry? We'll start with you.    Sherry Shellenberger     Oh, awesome. Thank you, Jason for having us. It's good here. I'm in Albuquerque, and we got a little bit of snow. Any moisture we get is always welcome. So it's been a great day to hunker down and be with you on the podcast.     Jayson Davies     Absolutely. Thank you for joining us from Albuquerque and Molly. What about you? Where are you joining us from today?     Molly McEwen     Well, I'm joining you from White Salmon, Washington on the Columbia River Gorge, looking out at Mount Hood and all its glory, and that beautiful Columbia River, so beautiful, sunny day, cold, I think    Jayson Davies     it's cold just about everywhere right now.     Molly McEwen     It feels like, yeah, like.     Jayson Davies     Yeah. So Well, thank you both so much for being here. Really appreciate it. You know, the Alert program is definitely something that I learned about early on in my career, it is one of those programs where it's been around a little while. Thanks to both of you, and we really appreciate that. I know a lot of the newer programs that have come out that talk about social emotional learning and social emotional skills self regulation, really kind of throw it back to you all at the Alert program as kind of the founding a little bit. So I'm excited to talk a little bit about that before we do dive into that, though, I want to give you both the opportunity to just kind of share where you are at right now in your ot journey. So Sherry, you want to go ahead and share that first sure,    Sherry Shellenberger     in terms of my ot journey, it started for me really about how I became an OT in terms of the I have a brother who is quite a bit younger than I am, and I was 12 when he was born, and he had Down syndrome, and so I got to see this is so now you're we're dating ourselves and myself. And I knew anybody that can do the math can figure out where I am in life. But I was 12 when he was born. He was born in 1970 it was the beginning of a lot of the early intervention programs. You know, up until then, a lot of our work in OT didn't exactly involve that particular population and so, so what I got to see was this little guy who needed a lot of extra support and got to go from two months until throughout he was 21 to different for his school career, basically, if you will. So the early intervention was like a half day program. It had OTs, PT, speech and some teachers, early learning specialists. And so it was a time when I was like, this is beyond amazing, and I want to know more about this. And so that's how I kind of got into OT. And then I think pediatrics in general has been fascinating to me, and I kind of haven't ever left you know what I mean? I have a great. Of working in the schools. That's where I started my career. And so I think right now, we'll talk later in the podcast about kind of where the Alert program information has evolved, what we've added, stuff like that. But for right now, that's probably the best kind of general background of where I am in my professional journey. Which the cool thing that I realized, too about myself and OT was that the thought of doing one thing for forever in the rest of my work career was appalling to me, like almost, that's almost death by nervous system. And I thought ot seems like a very good bet, because there's so many incredible areas that you can work in. If you felt one wasn't a match for you, you wouldn't get out of school and go, Oh, no, I have done a terrible thing.    Jayson Davies     Absolutely, you know, it's amazing, right? You hear about OTS that, you know, they come to school based occupational therapy for the first time right out of college, or they don't come to school based ot until they're 40, 5060, years old, even sometimes. So you're absolutely right. It's nice that we can work the gamut of the life cycle as an occupational therapy practitioner. So yeah, love it all right. Molly, what about you? You want to share a little bit about your ot background?     Molly McEwen     Yeah, I, I've been kind of all over the board, but always pretty much working with children in pediatrics as well. And I came to OT from two parents who were both healthcare professionals, and thought that at the time, when I went to school, there weren't a lot of options that talk about dating you for women that were very exciting. Education was one in nursing. My mom was a nurse. She said, Absolutely not. You don't want anything. You don't want to so the allied health professions were a real viable option. And ot won the prize, and it has served me very well. I think what has served me the best is it's not a technically based profession, it's a philosophically based profession, and so it's a way of life. And so once you become an OT, you live it and you practice it in your own life, in addition to the services you offer as an OT. So I worked, started first in the schools. Was my first before 94 142, was even in enacted. It was a very progressive school in Minnesota that I started with and learned a lot and moved on, had other positions, and ultimately ended up in academia and taught for a while, and now doing primarily consultation and but not I'm not working much. I'm in up here on the Columbia River porch, enjoying time    Jayson Davies     sounds like a great place to be and talking to you, yes, yes, and thank you for talking to us. We really appreciate it. So you know what we've learned a little bit about you both. Let's go ahead and dive into it. And I don't know which one of you wants to take this question, but I just want to ask you how you define self regulation? Well,    Sherry Shellenberger     I will start and I will let Molly wrap it up, which she is very excellent at doing. And so despite her trying to give her all the time, she needs to be able to relax, I count on her a lot for what I would term higher level questions. So but we talk about self regulation, it's the ability to attain, maintain and change arousal appropriately for a task or a situation. And that's, you know, the words of it. It definitely involves many neurological connections and different levels in the nervous system. And so that's how we define it in our courses, and in in the original in the leaders guidebook, and then mal you want to talk a little bit about some of the parameters of that need.     Molly McEwen     I think an important concept when we talk self regulation is context, how we attend based on the activities we're involved in and the environment in which we are engaged. So that's pretty important. Piece of it is so how well we are able to stay alert and attend is dependent upon the demands of the environment. There's been a lot of emphasis of recent on this concept of self regulation, and it really can be defined differently depending on the frame of reference or discipline from one where one comes, for example, psychologists will define it very differently than a basic scientist who's studying it, neurologist who's studying it, or a teacher who is looking at it. Research and study in this concept has helped us obviously get a lot better understanding, and it has helped us to come up with and identify different levels of self regulation. These levels of development are developmental. They're intertwined with each other, and they coincide also with the hierarchy of the nervous system. So now. Know, which we didn't know before. There are different types of self regulation, and we're going to be talking a lot about that today. But as OTs and the schools well know, sensory regulation has really been seen as a really important skill set for kids, and it helps determine success in learning. So teachers, educators have been more and more focused on it. And often what teachers and educators focus on in self regulation is emotional self regulation, which is not the self regulation that we're going to be talking about today and that the Alert program focuses on primarily, but the Alert program focuses on all levels, but the underlying sensory motor self regulation is really the focus of the Alert program as a as a good basis and a foundation for higher level learning.     Jayson Davies     Great, you know. And I want to dive into that in just a moment, the sensory motor versus the emotional self regulation. But you hit on a very important topic that I think a lot of us overlook, and that is that everyone defines self regulation differently. The same is said for sensory like you're talking to a teacher, and they have a completely different view of what a sensory item is compared to an occupational therapist. Same thing with self regulation, as you mentioned, they tend to think of that emotional self regulation where, depending on what we're looking at, we could be talking about emotional self regulation or more of that sensory motor regulation. So I just want to thank you for bringing that topic up. That's not something we've ever really discussed on the podcast before. So thank you. Now, diving a little bit further into that. You did mention sensory motor regulation and emotional self regulation. So can you dive a little bit further into that and how they influence each other?     Sherry Shellenberger     Also? I'll give a start, and then we'll see where we go with it here. Because I do think it's really I get reminded, Jason, you have such a good point. I get reminded of my anatomy teacher years and years ago in the coursework in otschool, going, let's get oriented here. And it's like, you don't want to start trying to identify a body part till you know what you're doing and what you're looking at, right? And I love that, that kind of framework, and I think that's true with our definition. So just having those conversations with people about, Oh, tell me more about what you mean or what you see, as far as that, because to me, sensory motor self regulation is when what we start with first in the Alert program, which is using sensory motor strategies to change how alert you feel, okay and emotional regulation being typically more about your feelings, you're sad, you're mad, you're you know, whatever. But being dysregulated or well regulated in both are hugely important. And of course, even though they're two really distinct different forms of regulation. They are hierarchical. They are entwined. When you're really great at sensorimotor self regulation, it supports you and provides a foundation for developing good emotional regulation. When you're good at emotional regulation, it helps to support the lower level sensory motor self regulation. So while they're really they affect each other. And I know as OTs, we all know a lot of this by focusing first. Our experience was by focusing first on the sensory, motor self regulation that that gave a really good baseline. It was also something the individual, if they have the potential to be independent in self regulation, could do for themselves. It was strategies that our teachers could use and build into routines. And it just, you know, if we want higher levels of the brain to function optimally, we want to assure that those foundational levels are strong and solid and in good place, so that both can support each other. And so I think that's where that defining what we mean and being really clear, and not only assuming that when we say self regulation, that it's only emotional regulation. So Mahler, I know you might want to build on that a little bit.     Molly McEwen     Well, or give an example quite simply, if one if your level of alertness is too high or too low for appropriate attention to whatever task or demand comes from the environment, then learning at a higher level, that's problem solving. Being able to learn a new task can't occur or doesn't occur? Well, the system then will either overreact. You'll have, will have temper tantrums. Even adults have temper tantrums. You have a lot of disorganized behavior, or you underreact. For example, you shut down, you withdraw, you don't participate. So emotional learning can't really evolve. Beyond this, what we called, and I think most of these have heard the fight, flight, fright response, that's very much of a biological level. And when that is not organized, then emotions are, you're you're emoting, all right, but you can't use those emotions, identify them, explain them, in order to problem solve and learn at a higher level, more sophisticated learning just will not occur if those lower levels of the brain and sensory motor regulation don't have some degree of organization.    Sherry Shellenberger     Sorry, Moll didn't mean to step on you there, but yeah, I mean, that's really the deal. And so kind of the differences in these two self regulation systems, I think, make it really hard for a lot of us as practitioners, because much of the literature, not all of it, but a lot of it, addresses the perspective of emotional self regulation and doesn't really address the nervous system, the central nervous system, arousal systems that what we call for obvious reasons, because I did not want to run groups where I'm talking about arousal with young children, so we named it the Alert program, and took that liberty. But this is where I feel like as OTS week, I get so excited, because this is a wonderful piece that we have to offer that is so valuable, and to help our teachers and our parents in this podcast, that's the scope we're looking at right to help them understand the concept of sensory, motor self regulation that's totally in line with our holistic view of how we treat and wanting, You know, treat children, treat clients, and how we consult and support our colleagues, our teachers, our our counselors, our social workers, all those folks, is that an awareness of that, of that part of self regulation, I think, plays a really huge role.     Jayson Davies     Absolutely. I love how detailed you both get in your answers. This is awesome, I love it.    Sherry Shellenberger      May not feel that way by the end, but okay.    Molly McEwen     we're also very excited about this. This is corner of the market for OTS. I hope they absolutely understand that more and more many do, and many have yet to learn about it. So hopefully they will.    Jayson Davies      Yeah, and so, you know, Sherry, you started to dive into it. And so the Alert program, one of the most famous analogies from the Alert program, I think everyone knows it, is the car engine analogy. And so I want to just open the door and let you all talk about how that car engine analogy fits into self regulation for children.     Sherry Shellenberger     Cool. Well, I may, I may hog this one up in terms of answering, but Molly will stop me if, if she's got something to add here first. So Mary Sue was the person. Mary Sue Williams was the person that really initially started the work and that, and I'll talk a little bit about how that got started. But basically what we've ended up finding is that, but just by saying, how does your engine run, or if your body's but rather than making it a question, we really want to do the teaching, we said, if we had one thing we could do over is we wouldn't say, how does your engine run. We would talk about the engine analogy first, and then allow the individual to tell us about it. So, so I'll just disclaimer right there, but we talk about, if your body's like a car engine, sometimes it runs on low, sometimes it runs on high, and sometimes it runs just right. And as I said, Mary Sue developed that terminology. We work together on it. The main purpose was to avoid jargon and to avoid blame. So I don't want anyone in the podcast to think I'm talking down to them about their knowledge level, but keeping it simple seems to help the most in terms of how we can get buy in and understanding across different disciplines. So So basically, when we avoid jargon and blame, which we want to do, of course, it just helps everyone to understand. We all have engines. They all fluctuate. So what do we do about that? And how do we be able to be more independent in our ability to support ourselves, right? So it's appropriate the engine analogy, I think what happened is, it's just it struck a chord. It just made sense to people, right? You know, you don't drive at 70 miles an hour all the time, but sometimes it's really fun to drive at 70 miles an hour, right? And we don't get into miles per hour. But I mean, just the engine analogy, I feel like has a lot of resonance per people. So what we found is that the engine analogy is appropriate for all kinds of levels, cognitive and age levels. Oftentimes, if it's older students, like middle school or high school, I would say something like, when I talk to kids, this is what I tell them, right? So that they're getting to be able to be part of that analogy, but not necessarily having to embrace the engine words if that's too deemed to be too babyish or whatever, right? So we want have to have language that everybody can use and that caregivers can use, so that because if for those who don't have words yet, or may not be able to have words in their development, it'll be their caregivers that are going to need to do the identifying of engine levels and to be able to build things into the routine to provide good, comprehensive care. So, and that's kind of addressed in a couple of the links I gave you guys that you're going to be putting in to a couple of the blogs and some of the information that way. So that's kind of the engine thing. Mal, did you have anything you wanted to add on to that? No, we're good.     Molly McEwen     Actually, go ahead,    Jayson Davies     if I can really quickly. I was actually going to ask Molly if she wanted to add on to that. But also, do you change how you're talking about the engine run program, if you're talking to maybe a teacher and a therapist, as opposed to talking to a child, do you explain it a little bit differently? Or how does that look? Or is it the same?    Sherry Shellenberger      Yeah, me, it's kind of the same. All I do is put in front of it. When I'm talking to children, I say, da, da, da, right? And so they still can understand the analogy as adults, but I'm not kind of comparing them to a car, right? Or I could say we use the metaphor of a car in order to be able to describe this.    Molly McEwen     It gives a framework. Doesn't matter how old you are, but it gives a framework to understand the analogy, just as once it whether you're, you know a three or five year old or 90 year old, you understand the concept. And once you understand the concept based on a simple engine analogy, you can use a lot of different vocabularies, but you have the concept and the organizing construct to deal with it.    Sherry Shellenberger     And I will add, I know I'm always adding, Jeez Louise, so, but I will add that in the courses, we really go into depth in that about that, Jason, because it's such a great question that you bring up, and that it's not that we need you to stay with the engine analogy. That's the way to introduce it. When children have something else they are totally jazzed about. Of course, we would use analogies related to that, right? But in order to kind of get everybody on the same page at first, that's what they're where we go. And then, if we want to customize it, we'll get into that later, especially in different cultures or different countries. You know, may be much more appropriate to do a different analogy, but start just so we know what the language is about. Yeah,    Jayson Davies     yeah, absolutely. All right. So I might have, I might have jumped the gun by jumping straight into the car engine analogy. A little bit. Call it clickbait. Call it ear bait for podcasting, I don't know, but taking a step back, you mentioned Mary Sue, can you give us just a little bit of background on where the Alert program came from and how it got started?    Sherry Shellenberger     Sure, sure. So Mary Sue and I are both occupational therapists, as most of the people here would know, but she had in and now again, I'm dating myself here because but see good things can last for a long time and be and be modified and updated. So that's always fun. So in 1987 she had the opportunity to work with an 11 year old girl who was very bright and very capable, but her engine often went really low. And what Mary Sue realized is she wasn't understanding what her arousal levels look like. There was no vocabulary. So she like we have vocabulary around feelings as we develop as children, we don't have vocabulary around our alert levels. And so what she realized is she wanted a non jargon, non blaming way to teach this young woman who is so bright and capable that she could be responsible for and understand more about her own self regulation. So that's when she got into the analogy of your body's like a car engine. Blah, blah, blah, blah, right now. Again, this was a really bright, capable young woman, so and she was also such a wonderful truth teller, if I if you will. You know so many of our kids are right? And she said, after she understood the concept, because she was very bright, it was just more like, Oh, she said, You know, I think I maybe get in a fight with my siblings in the morning so that I'm in a better place to be able to get myself ready to get out the door, right? And I know. And so what a beautiful thing, right? So it could be called emotional regulation. Oh, is she depressed? Is she anxious? We can go into all those things. And I'm not saying none of those are concomitant at the same time, of course, but you know, it's, it's that moment of giving kids language, just like we have for feelings about our alert levels that's really. Goal. So the engine analogy, great. But, you know, obviously customization really good. And in this case, even though she was 11 and a real bright, capable kid made total sense to her.    Jayson Davies     Great. And I guess driving off of that you've already kind of started to mention, right, that this program has been around for 30 plus years, which is 40 plus years, no four, no 30 plus. 33 or so sounds like. Anyways, it's been around a long time, and as we all know, things must adapt. I mean, Disney has had to adapt. Country, everything has to adapt, right? And so what about the Alert program? How has it adapted? And what has driven some of that adaptation over the years.    Sherry Shellenberger     Great. Well, again, I'll probably start it off, and Molly will chime in here. So basically, what's happened is we kind of thought we were going to only be developing work that related to the kiddos that we were working with at that time. Mary Sue and I, as we, as we started to use the analogy more, right? So let's started with it. First of all, it's based on sensory integration that airs developed. It's a framework and not a recipe. This feels so important to me. This is our, you know, our jam as OTs, right? Is not recipes, but frameworks. And like Molly had said, even philosophies right reflecting the art and the science of what we do. So it has three stages and 12 mile markers. Those have proven to be constant, and we continue to refer back to those, because what we did was we put those down as we worked with the information. We put those down and laid them as the order in which one learns about self regulation. It doesn't mean you have to spend a different session on every one of those things, but this is what we found to be true for children and for adults, because, of course, the adults in the individual's life need to know what's going on and why we're talking engines and all that good stuff too, right? So originally, we had designed it thinking, Oh, it'll be for children who have some learning disabilities between the ages of eight and 12. It's a population that we had the most, that we were directly working with at that time. What happened was the engine analogy made sense to people we really didn't have language to talk about all the great observations that we do as OTS about alert levels, and so basically that when we shared that information, it expanded into other populations. And that's better because we had our colleagues saying to us, oh, here's the application in this particular area, and cognitive ability and developmental ability and that kind of stuff. So the framework thing, I know I might kind of beat this to death, but the framework is really important to me. It's so easy to say, Oh, we're just going to do a treatment plan, and here's how you do it, and then that, and we're going to assess what you know, what the outcome was at the end. And that's just so belittling our wonderful knowledge as therapists, right? And in terms of been best practices, lots of our colleagues contributed to us learning more, expanding it across different diagnostic and age populations. So we feel really good and really confident about how it has started and then how it's evolved and and expand it so, Moll, you want?    Molly McEwen     I think it's important to all species self regulate.    Jayson Davies     This is true.    Molly McEwen     Across the age. So it isn't a concept that only applies to children or to children with special needs. You know, some people say, well, that program was developed for children, so it's not appropriate for this population. I have, I have to tell you, I can't enter a room in socially, personally, or enter a therapeutic environment for services provided without taking in information about how this person I'm talking to organizes their nervous system through sensory motor input, through self regulation. It just is automatic, and it is the basis, based on that I can kind of predict how they occupy their time, or what they're not doing or need to do. It's self regulation is normally developing in normal developing individuals. Is quite automatic and self conscious subconscious. We don't even conscientiously attend to it, but we all know that people have varied degrees of competence in their ability to self regulate, and the better self knowledge we have, the more competent and self regulating, and that's another piece of this program is it allows children and people across the age span that learn to understand their own nervous systems in a way they never have in the past, the stuff that comes automatic they just think happens, but no, this is what your nervous system needs to be able to attend. End, this is what your nervous system needs to be able to stay alert and be at your top place for taking this exam or for playing in this tennis match or whatever. How do we set up ourselves for optimal function? And once it's well understood and used, then that becomes automatic. People will integrate that piece of knowing that it's not important, necessarily necessary to follow the stages and milestones as a program is developed. But as Sherry said, that is a developmental continuum. Once you understand that concept, then you know, if somebody's not getting it, you need to go back further developmentally and understanding it. There's a developmental continuum to understanding self regulation and how we all learn it and become aware of it, and to develop it and to get more sophisticated in using it to learn optimally.    Sherry Shellenberger     I'm sorry, the blog that relates probably the most to what Molly has just said is called engine analogy. One metaphor does not fit all, so that's just kind of a fun one. People could check out on the website if they were interested. I know I interrupted you there, Jason,    Jayson Davies     I was just going to kind of feed off of what you were saying, or both of you were saying, about the recipe versus the framework, good or bad, that is true. I mean, sometimes I get, I get frustrated with ot because of that very reason, it's hard to tell people right, we have we work off of a framework. A lot of times, not necessarily. Recipe is what people want, right? They want that step by step by step. How do you get from point A to point B? But sometimes there's a one, a, two, A, three before you get to B, and a lot of sub areas, and you kind of have to go back and forth a little bit. So yeah, just wanted to touch on that. And then the other thing was, I was going to ask about what population the Alert program was designed for but I think both of you somewhat answered that in your response, and that initially, it was for this 11 year old girl who maybe had a learning disability. It sounds like that. The Alert program was based off of air sensor integration, which I know was primarily looking at learning disabilities in students or in young children. And now, as Molly kind of alluded to, right? Everyone has to self regulate. And I know this program has been adapted and adopted by entire schools and entire districts and whatnot, and so they're not using it just for learning for students with a learning disability. They're using it for all students, which is really cool. I don't know if either of you want to kind of elaborate on that point a little bit.    Molly McEwen     Go ahead, Sherry.    Sherry Shellenberger     Well, yeah, I'm really again, that kind of is like point of pride for me that we're looking at something. And that was the, probably the thing that I loved the most when we were working in the schools is that we had administrators who once they understood what we're talking about, and that we could help to, kind of basically help to solve the problems, right? If, as a principal, you've got this kid that's constantly in trouble, and we can find out how to help that to not happen quite as often. That's an amazing thing as a teacher, if you've got a kiddo who just can't handle more than a couple minutes of time before they get distracted or disrupt others, or whatever it's the it's the cool thing is, it's true for all of us. And I kind of think that maybe the pandemic emphasized that a little bit, right? Because we found out a lot about ourselves. How do we work? How do we concentrate? How do we focus? Is it good? You know, they had articles and stuff, and that's kind of a fun thing about the are your best self online course that I'll get into later, but, but, but it's like There were articles all over the place, zoom, fatigue and this and that. And how do we work? And can you carve out a place where you you need to do your work alone in a quiet place, and then the kids are doing school over here, and all these other things. So there were so many tough things about the pandemic, but actually, it makes sense like it, it almost amplified a lot of the information that we had to learn about ourselves and how we work and how we work best, and when we work best, and what we do, like you said, mild to set our nervous system up to be as successful in what we're doing as possible.    Molly McEwen     Well, we limited our environment to just home. For a lot of us, we weren't in lots of different environments. We many people were isolating. So they isolate. That in itself, was a huge change in input to their central nervous system, almost the fact that if they went out every day to a highly stimulating environment, all of a sudden they have to stay home. I mean, it took people quite a while to, I always say, find their pulse again, to figure out. Where their set point was to figure out what that's all nervous system modulation, nervous system, you know, their level of attention, arousal of the nervous system, to figure out where that is, and then what it is that sets it off in a positive way, and what it sets off in a not so positive way.    Sherry Shellenberger     Yeah, so that I think you're exactly right, Jason, that it just self regulation is for all of us, and the more we understand about it, the thing that I've been excited about is that what we see then is a lot more compassion about what other people are going through and understanding rather than, Oh, that's just so and so, and they irritate me and they're just awful. And then, you know, like, if we can start to learn more about that, it then helps with our compassion and understanding, even, even in terms of the emotional regulation, right?    Jayson Davies     Yeah, so one of the things that I really appreciate about established programs like the Alert program, being around for 30 plus years means that there's been some time for others to take a deep look at it. There's been some time for researchers to get their hands on it. And so I wanted to ask you, of course, I know there's been a lot of research, but if you could boil it down, what are some of the key research over the years that you have just been super proud of about the Alert program that has come out, and I'm sure that has driven the program forward. So just wanted to ask for maybe a few highlights within the research that that you'd like to point out.    Sherry Shellenberger     Yeah, perfect. The first thing I'll say is it's so interesting because, of course, we're not doing our own research. I Mary Sue and I will fully say we are not researchers. We are clinicians, through and through and so so other people do research on your information, and then sometimes you find out about it, and sometimes you don't right. And so the great thing is that what has happened for us is that, especially in the FASD populations, there have been some beautiful more, more what people are looking for, sometimes especially our administrators, in terms of published studies that are significant. And again, that whole social science thing you address, Jason of you know, well, what did they do, and how did they do it, and da, da, da, da, but the FASD population research, especially, and you can find that in our on our I have it the link that I gave you for posting for people, and then just on our website, in the footer, it has all the research. But for instance, like there was in 2018 there was a wonderful study that they did, and it and, oh, and I should brag on what I think Molly has helped me to organize and make so much better for practitioners, which is, it's not just a list of citations for the articles. What we did is, and Molly was so helpful in this is we went through and listed, kind of the different levels of research and down to popular press right from the big, more scientific stuff. And then also, we made a comment after each of the articles so that you could know generally what that article was about. Is it worth your time and effort to go look it up right, as though we all have time to go. Oh, yeah, sure, I'll look up these all pages and pages worth of citations that don't end I get them and I don't even apply to my setting, right? So that part feels like important to say. So when people go to that document, they'll be well led as to what might apply to them. But the one that I'm probably the most proud about was this one by Nash in 2018 and you'll be able to find it in the in the document on our on the website there, and it's called preliminary findings that a targeted intervention dealer program leads to altered brain function in children with fetal alcohol spectrum disorder, and That was in the journal for Brain Science, but basically our comment about that one is, and we have a YouTube on this one too, because previous research showed that the Alert program improved behavioral regulation and executive functioning, specifically self regulation, in children with emotional problems. So these in this study, they had already been identified as FASD and having emotional challenges. So the study asked if the Alert program also leads to improved neural function in associated regions, and they go on and tell the population and the age range and all about the how they did a randomized control design study with pre tests, post test measurements. Go no go. Functional MRI. You know, they go into all of it. But what was so cool is that at the end, they said that the findings suggested that the treated FASD groups were starting to resemble children who had never been exposed prenatally to. Alcohol, possibly implying that more mature neural integrity was actually a result, you know, so to have evidence like that, where and and functional MRIs, like, that's just, like, totally got me psyched, because then you're talking about, oh, okay, we're really seeing things. And I think that speaks to the whole and it's appropriate for all different populations, especially those that are having executive function challenge from a treatment perspective. But just that one got me like super jazz. That was pretty fun, you know. So let's see.    Molly McEwen     Not very often that we get some basic research technology and evaluation strategies that help us look at Applied clinical practice and its impact on actual change of the nervous system. We know we change the nervous system because behaviors change, but we don't often have neuronal visible neurological changes that we can see in some of those CAT scans and MRIs and stuff, and this showed some. So that was very exciting.    Jayson Davies     Yeah, I was just trying to figure out how to summarize that up, and you did a perfect job of it. Molly, you're right, like, we don't get that type of research a lot. So that's very cool that that they were able to do that awesome.     Molly McEwen     I do want to say in this, before we change topics here a little bit, is that I want to remind practitioners out there, research informs practice, and practice informs research. So just as the Alert program at various levels and it's intertwined in different types of regulation, self regulation, research and practice, do the same things, and Sherry reflects what and I'm an academician, so I can say that I'm also a clinician, but I'm a clinician. I'm not a researcher, but I am here to say as practitioners, we are researchers by virtue, virtue of measuring baselines, evaluation of your patient or client, and evaluating and measuring outcomes of your programs. And if we do that, well, which is what I call program evaluation. And if you set it up, it is very significant means of research. It is research you are providing the foundation and the basis for more highly sophisticated you know, your PhD type of research is where you can have control groups and all that, but we provide the data that suggests that further research needs to happen. So we need to make sure that we don't this our own data that we produce on a daily basis. It's very valuable. It helps us, guides our treatment on a daily basis. It doesn't have to come out of a formal research project of how we make decisions. It's also based on our experience and interaction with our clients and patients,    Jayson Davies     absolutely, and we've been talking about that a little bit more on the podcast about creating your own evidence, and that's something that practitioners can do, and it is. It's not easy. It does take a little bit of work, because you do need to, when you're implementing a program, you need to actually know what you're implementing, and that takes time and energy to set up beforehand. If you're coming up with an individual treatment on the fly. It's hard to put those together and say that you have collected data on a specific program, but if you do kind of put your treatment plan together at the beginning and think about, okay, this is what I'm going to do over the next several weeks. Then at the end of that, you can go back and say, did that work or not? And then you can repeat it or change it a little bit and get more and more data. So absolutely great point Molly.     Sherry Shellenberger     Well, one of the things that Molly, and fair point Molly about that, I think a lot of times as clinicians, we don't think of ourselves as researchers, so I'm really glad, glad you brought that up. And the thing I was thinking about there is that Molly constantly reminds me, you know, the road that we should not take is to not consider what outcome are we looking for before we start the doing, right? You know, just giving fidget toys and movement games and stuff like that, without knowing what it is that we're wanting as the outcomes. And that's one of the things, Molly, I feel like you've been so valuable in in talking about that are stepping back. Jason, you referred to it too, like stepping back looking at, what is the treatment that, what is it that we are feeling needs to change or needs to be supported for this individual?    Molly McEwen     And that's, that's your outcome. I mean, that's what you're measuring. And sometimes researchers, that I will say, or clinicians, will measure the success of whether or not a child goes through the milestones or hits the various stages. And that's the outcome, success, no. Success. Well, that's part of the process. But you know, if a kid gets through the mile. Milestones, but behavior doesn't change. Then, you know, then are we successful or not? No, we there's a reason why we're using a particular intervention approach, like the Alert program. We use it because we have a problem that is interfering with one's ability to be competent and successful in their daily routines and occupation. And what is that problem? This is one. This is another. If one of them relates to self regulation, then that's the Alert program is a viable tool. But when you apply it, you have to see, is there change in those behaviors or not? And that tells you whether you're successful.    Jayson Davies     I love it. I love it. I love this feedback between Sherry, kind of, like giving big picture and then Molly, just like boiling it down to, like, exactly. It works so well.    Sherry Shellenberger     How come we really need each other? There you go.    Jayson Davies     All right, so diving into our next area of this discussion, I guess we can call it. I want to talk about some of the best practices for implementing the program. And I'm sure you have a ton to say about this. You already talked about the different steps to getting to supporting a student, but what are some of those best practices for implementing this program to make sure that we're actually going to as we've just kind of talked about, use a program that actually makes progress?    Molly McEwen     Well, one of the one of the best practices for implementing the Alert program, I believe, is that we when we're working with children, particularly if they'll just keep it to children this situation, the more we as adults understand our own nervous systems and how we ourselves self regulate, the better we can understand the kids we work with. I can't tell you the number of teachers that go in and the teacher say, you know, help me with this student. I've got this and this and this. And as I watched the teacher stress, dealing with a lots of students, lot of special needs kids, or just regular kids, I watched that teacher's nervous system, and how that teacher regulates, or doesn't regulate, where they can pull themselves together, where they become organized, how they do that, and when I can mirror that back to that teacher and integrate that with the concept of the engine analogy. It looks like your engines running pretty high. Mine would be too if I had to deal with these kids, blah, blah, blah. You get into that. Look how you are, helping yourself get back organized so you can focus on your kids in the classroom, that kind of conversation. Sometimes I don't see the child for treatment over a couple sessions because I'm working with a teacher. Once the teacher has that, sometimes the child ceases to even be a problem in the classroom. The teachers got it can just intuitively go at it. Once they go, ah, oh, that's like me when I do this. But and I need to help the teacher maybe come up with different strategies, more age appropriate, different sensory diets than the teacher needs. So that is a huge best practice to me. We have to make it worse. The teacher's while to support the self regulation. We have to have them, but they have to have a buy in. If they don't, then they have the pull out mentality, take the kid, fix them, bring them back. Well, the teacher has more knowledge and skills. They feel more satisfied with their job, more efficacious when working with a child. So we can do a lot of modeling in the classroom. That's another big piece of implementing it, demonstrate with the class of the child, so others can see how it's done and support the child and the adults learn a lot from that,    Jayson Davies     absolutely. So I have a question. Then, when implementing the Alert program, is it best to implement individually, in a small group and a whole classroom? Can it be all the above? But maybe one works better? What would you say about that,    Sherry Shellenberger     I would say all of the above, because I've done all of the above, and it requires, but it does require different setup, different amount of time, different level of commitment to and like Molly said, you know, modeling things and giving teachers tools, one of the things that I find a lot is therapists, and why we stay away from jargon so much is that we don't want to teach the teacher to be a therapist. We want to teach support them to be able to be a teacher. If they have new math concepts, they have to get through these their standardized testing that's going to happen related to this, then we want to give them what they need to be able to do the math concepts right? And so that's what I think is beautiful about what you had said there, Mal and in I in our online courses, we really get into, what would you do if you were doing a group? What would you do? How do you share information with this person, this kind of person, versus that kind of person? So. I'll just say even an example of that is for teachers. If a teacher has, when you go through the course and when you do some of this work, and they look at, say, a sensory motor, the sensory motor preference checklist that we have for adults, if a teacher loves to do things in the movement area, then those would be the first things that make the most sense and they feel the most comfortable within their classroom. It doesn't mean that eventually they can't do things in all five areas of mouth, move, touch, look and listen, right strategies, but we kind of want to start with where are our teachers comfortable? How do we support them? All that kind of thing. So I'd say in terms of best practice, make sure that you get trained, make sure that you stay up to date. We have Facebook and emails and newsletters and YouTubes and stuff like that. Use a lot of the resources. We have a lot of free resources on the website designed for individuals, groups, you know, that kind of thing. So just, I would just say the thing that I found a lot in terms of helping people, making it like kind of lightening the load for therapists, was a lot of the free resources that we do have put up there. But definitely you can do it in all those different ways I joke about, and I think this is in the in the Alert program online course, that you might not want to start out with a whole classroom of kids that have behavior disorder, diagnos and give everybody fidget toys. That's not probably your first go, right? What you want to do, though, is find out what works for these particular kiddos, and then we go ahead and introduce those things into the classroom and help to support the teacher. So, I mean, that's kind of a duh, but I mean, it's also a thing that sometimes, as OTs, we get very gung ho, and we're going to start out with the hardest situation. Let's give it some time. Let's find out what's working. As Molly said, Do fidget toys even work for that particular individual? We don't know. We're going to try it out. We're going to assess whether that seemed to be a right match for that individual. So I hope that answers kind of the whole ball of wax, really.    Jayson Davies     Yeah. And I was going to ask you about some of those activities you have up on the website, games, Songs For Children, but you kind of ended that answer and with the word assessment, talking about assessment. And so I want to ask you about that. I don't think we even technically had this maybe in our questions today, but when it comes to assessing students, is there a particular tool within the Alert program, or do you recommend a specific tool for kind of assessing students, self regulation? What would what would you recommend?    Sherry Shellenberger     Well, no, there is not a specific tool in the Alert program. What happened was it really, and our emphasis really is on when we know that there's identified behaviors or challenges for self regulation or executive function or that kind of thing, then definitely we can try the Alert program as a viable thing to do, but there are plenty of different standardized kind of things out there, I mean, and things keep evolving. I don't have any one favorite thing, because I think sometimes just even doing general motor skill evaluation, we can see the regulatory components right? And so I'm not dissing on standardized things. I'm just saying I think there's we kind of assess it in all that we do, right? Molly was talking about, there's    Molly McEwen     some. There are some the Canadian occupational performance measures. Copm has a tool for kids that is a checklist format. And I think if you use a Likert scale checklist, I've used that with teachers a lot, where they can observe a whole classroom, or they can observe an individual child, and there are B behaviors in which they say, this child is good at this or not. And those behaviors are very basic, fundamental self regulatory behaviors like can turn transitional from transition from one activity to another, gets along with his peers, you know, on and on. If you look at those type of activities, you have to have pretty good self regulation to do those for elementary school. So those are there are, yeah, therapists have extrapolated from existing tools certain developmental skills that require a high amount of self regulation, and use those as ways to measure on a scale of maybe one to five how good this kid is. And then you have a baseline pre test, post test.    Jayson Davies     Thank you. I was fully going into that question, assuming that the response was going to be, you can use the sensory profile, you can use the SPM, and that's not the response that we got. And I actually appreciate that, because so many times we I get questions, and you probably do as well from school based OTS is like, how do I interpret the SPM? How do I need to. Do the SPM or the sensory profile to look at sensor to look at self regulation. And what I just heard you both say is that you can use alternative types of tools. You can use the copm, you can use some more observation based assessments to get some of that information, as opposed to relying just on the SPM. And maybe you do use the SPM or the sensor profile to help you a little bit, but there are alternative methods.    Sherry Shellenberger     Yeah, definitely. And one of the things that I loved when we did a couple little projects with some students, especially middle schoolers that Molly you had met, we had talked about doing the copm, and it's so interesting because the the middle schoolers perceptions of what they're great at and what they're not is very disparate with the other adults, right? And so then that tells us something, right? Because then we have to be very gentle about how we show, oh, you know, some people would say this is how we show that we're really good at these particular skills, right? But it's that it kind of speaks to that, while we're teasing about the car engine analogy, this is really personal, right? It's our nervous system, for gosh sakes, and so we don't really want somebody point out to us, Hey, you don't do this, and you don't do that, and I know that's not what the OTS that are listening here would do, but remembering how scary it can be when we're talking about changing how our nervous system feels.    Molly McEwen     If I can just add one, I know we're probably running short on time here, Jason, but you have to ask yourself, why are you evaluating? Are you evaluating to determine the underlying issues that interfere with one's ability to perform their task, or are you evaluating a level of task performance which is like the copm, which you can get a baseline and then watch that performance and see if it's better, because that performance requires self regulation. So there's two reasons there for evaluating. And, I mean, there's probably more, but those are, yeah, yeah, exactly. I could come up with some more, but anyway,    Jayson Davies     no, but that actually kind of leads to the next topic that I wanted to discuss. And, you know, I remember in otschool, this was very common, and it's still a common discussion between therapists using top down or bottom up approaches, and so I wanted to ask you how you feel, or where you feel the Alert program fits on that top down versus bottom up approach, and the benefits of that approach.    Sherry Shellenberger     Yeah, great question, because that's a little bit of especially in the schools, I would say that most people are thinking about top down, right? We're gonna, we're gonna think our way through this. We're gonna by golly, once we're past second grade, we don't get an afternoon recess, or whatever the rules that are currently in play are, because now we're big people, and we can sit for longer and that as though that's a goal, right? You know, but the Alert program incorporates both of them, because that's what we needed in our setting when we were utilizing it, that depending on the individual's cognitive level, it would be a terrible shame to waste the ability to use both when it's used well, the Alert program is supporting from a bottom up way for that top down to be able to be reflective, problem solving, all those other good things, right? So I guess my opinion is that this is again, where we shine as OTS. A lot of programs are only thinking it through. So now I'm gonna, I have to be careful how I word this, but there was a professional from another discipline who had said to me at one time, I know you guys are doing all this great stuff with your kiddos, and I came across this program where every five minutes, this buzzer will go off and the kid has to check whether they were paying attention or not. Ugh, right? Like the like, my innards get tight. You're just hearing that that that's such a top down way. Now you've interrupted the person, if they actually were paying attention. Now you've interrupted them with this alarm. And so what a bad use of technology, in my opinion, there. But this is where as OTS we we get it. We know that we want both. We want to support the nervous system from the bottom up, and we want to use top down skills to say, well, this is where we have to always use our words. This is where we have to know that if we can't use our words, we need to take a break. This is where we know that we can ask the teacher for this help, you know, whatever, and and kind of piggybacking on that, I'll say that this is a big emphasis to me, and it's important, if you've been trained in the Alert program, you understand that we would have separate gages, because these are separate areas of the neurological system, one for measuring our engine speedometer, one for measuring our emotions. Don't put them together. High does not equal angry and low does not equal sad, right? We I can be in a low state of alertness, taking a nap on the couch. I am perfectly content, right? So this is that moment to just be really clear, as great as we are holistically, being very precise in how we're supporting the correct neurology of those kind of things, and we want to have both. But what we found is we needed to start the kiddos we were working with and young people that we were working with. We needed to address that sensory motor part, support that then we could have conversation time from that top down kind of way about, well, what happens when this happens, and what do we do? And what are acceptable things that won't cause other people trouble, won't cause us trouble, those kind of things. So I've gotten into some into the weeds a little bit there. Moll, you want to help pull me out.    Molly McEwen     Oh, I think then just, I think, as OTs, we need to remember we don't function like a fluorescent bulb, we function like a very intricate crystal chandelier, and we go in lots of different directions, up and down, all to get the lights to go on. And so fluorescent bulb, you just start the beginning, and you work your way through. But a crystal chandelier is just all the pieces that come together for excellence, competency and health.    Jayson Davies     We shine bright, like a diamond, if I may. All right. All right, moving on. Thank you for that answer. I think it is. It's a tough one, but I really appreciate you going into the detail that you did. It's not an easy answer, and it's something that I think we have various beliefs on. And I don't think there is one right answer. And I think Sherry kind of really narrowed it down. You know, it really depends on where the student is, some students, you might be more effective using a top down approach, and other students, you might need to use more of that bottom up approach. And also depends on what their goals are, where they are at in life. And there's so much right, like, that's why I love the PEO model, right? You have to look at the person, the environment and the occupation. You can't just look at one all right, earlier. I think it was Molly, you mentioned a little bit about program evaluation. That is something that I have seen OTs, especially in the schools, struggle with, mostly because we don't have time to do that. But it's very important, you know, that's what leads to us developing that evidence that we talked about a little bit earlier, as well being able to create our own evidence comes from program evaluation. So I want to ask you, when it comes to the Alert program, is there a way to evaluate your own program that you use with the Alert program as a school based ot?    Molly McEwen     Absolutely, program evaluation is my big, big thing that I would like to see OTS tick and just run with it, but I think it goes into that category of research, and it makes everybody apoplectic, and they get intimidated and all that, but not necessary. It's not that difficult. First of all, in implementing the Alert program. Training really provides accurate guidelines, and the training manual provides what we call fidelity measures, which is the degree to which an intervention or program is delivered as it was intended. Because sometimes research comes out and they say, Well, they probably didn't do this or they did that. Did they apply the the intervention appropriately? Did they implement the Alert program? Right? Well, the fidelity measures, which the manual really doesn't explicitly go through, but implicitly goes through. Are there the the we are planning to publish a list of fidelity measures so therapists in schools and researchers more in the scientific research month, and could use those to make sure that when they are using the Alert program, all the pieces of it are well implemented. Program evaluation. When therapists start at the beginning of the school year or start with a child, it just if you have a basic outcome you're after, you evaluate the level of that on some Likert scale or some standardized test, and you determine all the strategies that you are going to use to be able to get to them, and you just list them. And then you go through and implement, and you look how to and you come back and you evaluate, did I succeed or not? Is the behavior change? Is the child's performance as we anticipated or not, what went well, what did not? All of those are program evaluation. If you don't do that, you just go blindly and applying therapeutic interventions without really knowing if your time is well spent. I worked with a a. Whole school system up in Canada who implemented the program because the OTS were getting more and they were getting more referrals than they could handle.     Jayson Davies     Sounds familiar.    Sherry Shellenberger     And yeah, nobody else has had that problem.    Molly McEwen     And much of the issues, a lot of the issues, it was early elementary school, were self regulation, and so we created a program the therapist and and I consulted with them over a period of about six to nine months where we took the Alert program and we said, these are all the pieces of the Alert program that we want to implement in this classrooms, for teachers in regular classrooms that have some special needs kids. Some of those kids came out for special intensive treatment, but the teachers were trained, and then we evaluated. We listed out the tools, the strategies, how we had stuff on the portal for them to go and get, you know, boosted up on information of this or that, all the ways that we could really bolster those teachers ability to implement a program in the classroom. And we had them all outlined, then we implemented it, and then we had an evaluation, which was a checklist at the end, the improvement the teacher's response, the teacher's sense of efficacy, the teacher's sense of being satisfied much more in the classroom was astounding. They could take that data into the Board of Regents, which is what they have up in Canada, and they got more positions funded. There are other programs I've worked with where they do a pilot, go to your administrator. There are lots of grants out there, small grants that will give you monies to either pay for your time or for equipment. There are lots of principals who, right now, when they're really struggling, would say, Oh, fine, what do we need to do get it going on a small, one school basis, two or three classrooms, teachers who want to learn something new, put it into place, but create your program evaluation framework before you start, then implement it and evaluate. And you have your data    Jayson Davies     so simple.    Sherry Shellenberger     I know, and I will say Molly did a brilliant job, and these were great OTS up there too. But the in my mind Molly, another payoff, besides that it was so incredibly effective, was that some of the things that the therapists were spending a lot of time doing, so again, coming back to how limited we all feel about our time, were not the things that the teachers found to be the most helpful to them, that's the beauty of the program evaluation. They dug into this. And so then as a What a relief. As a therapist, oh, I don't have to do that. Frees me up to do these other things that because, mil, you are always so great at saying, we kind of sell ourselves short on the amazing amount of information that we have to offer people, and we just think it's kind of a given, and it's not. We have to explain all the good stuff we're doing and why we're doing it in the way that we are. But I found that to be such a fascinating component of that program evaluation that you did with them mal the things that were so labor intensive for the therapist that they thought they needed.    Molly McEwen     Promote necessary, right?     Sherry Shellenberger     Yeah, yeah.     Molly McEwen     And, you know, and that's that'll get a teacher, a therapist, an administrator, buy into that, because when there's only so much time and so much money, if you want to use your human resources well, if you want to use your your financial resources to buy equipment. Let's buy the stuff that's going to work. Let's use the time where we want to, you know.    Jayson Davies     Absolutely, absolutely, and that's fantastic I could do. I mean, Molly, maybe we need to have you come on again and just talk an entire episode about program management one day. But I think it's something that many of us need to start doing, and we're not doing, and I think we might see the value of it. We should. I don't know if our administrators see the value of it, and we need to better connect that value to them. We need to share with our administrators how it could be even beneficial to them, for us to do a program evaluation. I think administrators have become scared of OTs, PTs, speech therapists, doing program evaluations, because it often leads to spending more money. And I think we need to figure out how to be more on the same page with them, so that they're more inclined to to encourage us to do program evaluation. So, yeah, that's kind of my take on on that a little bit, but we need to do more of them.     Sherry Shellenberger     All right. I'll just say to them, I know, I know we're getting along, but that my experience, basically my experience in the schools, was that people said, If. You keep telling everybody information, you're just going to get more referrals for OT. And we actually found that to be the opposite, that when we gave classroom teachers enough to support to deal with the couple little things that were going on the classroom, they didn't turn into being major things. They didn't turn into more referrals. We got more appropriate referrals, but we did not get more in number referrals. So I think that speaks to some of that fear of the administrators you were saying, Jayson.     Jayson Davies     Yep, yep. And we need to let them know that. I mean, they just assume that they hear us complaining, they hear us saying that we're drowning, and they assume that if they listen to us, we're just going to say we need help by having more OTS on staff, but there are other ways to say, I need help, but I don't need more OTS. I need to be allowed to do this, or allowed to do that, which can sometimes be just as effective as bringing on another therapist to the team.     Molly McEwen     So we need to be smarter. We need to do this smarter. We need to change the model. We used a model for so long, and the model isn't always working, so let's, let's pull back and not let the flurry and the craziness of what's happening in the systems just move us. We need to stop and say, We got to do this a different way, and this is how.    Sherry Shellenberger     And we got into a little bit of a trap, or at least they that we did in in my main time being in the schools, where somehow individual treatment was preferable to treatment in the classroom or support in the classroom. And our poor parents, you know, they're trying to get the best for their kids, so if they're told, Oh, individual tree, you must demand individual treatment, and you must demand that the therapist do this and this and this and this is we kind of boxed ourselves into a corner and didn't again, look at the context of it, right? Moll, I mean, yeah, just interesting.    Jayson Davies     Another topic for another day, I promise. But with that, let's go ahead and start wrapping up. I want to let you all share. You've already mentioned it a few times. Share. You all do have a course. Now I was just looking at it, at least the one I was looking at, it's two CEUs, which is 20 hours, aota approved. I want to give you a moment to just share a little bit about the program that you have over on the website.     Sherry Shellenberger     Sure. Thank you. So we do have the Alert program online course. That's the one you were looking at. We also have, and that is for when you're going to use in your practice, taking through and teaching your client about their own self regulation. Okay? And then the your best self course is one that we developed a number a couple years ago now here, and that is for adults to learn about their own self regulation. So we have a lot of businesses that use that with their employees. We have a number of folks that work in trauma and behavioral health and stuff like that, and those counselors, social workers, those kind of folks that need to maybe understand that sensory motor component of that so that they can help to show their clients information, but also to know it about themselves, right? So, and I think I'm really excited about the possibilities that we've had with certain agencies, training their whole agency in the your best self. Course, that one is, I think it's eight contact hours through a OTS. What is that point? Eight? You can go do the math and look at it on the website, but on them, on the main website, is the menu tab courses. And both the courses are listed there, and kind of the differences of them. But I'm really thrilled, because, you know, it's that same thing again, it applies to self regulation. Applies to all of us. If, if you are a runner and you get hurt and you can't do your running, you notice a difference in your self regulation, and you would hopefully want people to be able to help, help you, or inform you about what you could do, so that you don't just re injure too quickly. But you go ahead and, you know, so it should be part of discharge planning. It should be part of all those good things. So I'm really excited about that, course, because it's new. I will say that one not like we are deep into the neuro because that's not really our jam. But, I mean, we it's neurologically sound, the Alert program. But I like to to describe it as like the Alert program, and the lack of jargon is kind of like the express lane for Neuro and if you want to go on the wonderful country roads and do all the other great things of learning all about neural pathways and all that kind of neurochemistry and all that good stuff, then that's the stuff where maybe you want to be trained In polyvagal theory and all those kind of good things. We actually have that as one example in the your best self courses like this is the express lane. We're talking neuro on Mr. Potato Head here, not in the very detailed way. And then we're going to go ahead, and if you want to dive into it, know that there are wonderful other resources. So those are. The two courses that we have, we have lots of books, game songs, all kinds of stuff like that, on on the website, as you said, and and we are an aota approved provider of professional development. So I won't belabor this at this point. Who wants to listen to that? Just go look at it if you're interested in it.     Jayson Davies     Yep, you say you hit on the nail right there, right everyone, just go to Alert program.com you'll find it all there, and we will have all the links that we've mentioned in this podcast. I want to give a huge shout out to Chandler, who helps us find all that good stuff and put it into the show notes. For the show notes for this episode, you will find them at otschoolhouse com, slash Episode 119 or if you're listening to this on a podcast player like Spotify or Apple, just click on the link somewhere below where the play button is, with that. Sherry Molly, thank you so much for being here today. It was wonderful talking to you all about the Alert program and program management or evaluation and all the good stuff. Really appreciate it, and we'll have to stay in touch.    Sherry Shellenberger     Absolutely. Thanks so much for having us    Jayson Davies     take care. All right. I hope your engine is still running well right now. Thank you so much to Sherry And Molly for coming on explaining the Alert program and how it has evolved to support people around the world, be sure to check out the show notes for this episode at otschoolhouse com, slash episode 119, or you can simply head to Alert program.com to learn more about the program. If you go to the Episode notes, we'll have direct links to the parts of their websites for all the things that they talked about. So that might be a good starting point, and then just have a blast looking at their program. They have courses. They had tons of free resources over there. So be sure to check it out until next time. Take care, stay safe and keep collaborating.    Amazing Narrator     Thank you for listening to the otschoolhouse podcast. For more ways to help you and your students succeed right now, head on over to otschoolhouse 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 120 of the OT Schoolhouse Podcast. Are you an OT who wants to level up your knowledge on how to work collaboratively with SLPs to support students in school? Well, you're in for a treat! Today's episode features a special guest, Rose, a school-based speech therapist and Founder of ABA SPEECH. She will share her wisdom on the important role that SLPs play in schools and how OTPs can collaborate with SLPs to provide the best possible support for students. Tune in to learn more! Listen now to learn the following objectives: Learners will identify what the role of an SLP in a school setting is Learners will identify what the SETT framework is Learners will identify what the communication matrix assessment is and how OTs can utilize it Learners will identify how to work with the SLPs at your school to best support the students Resources: ABA Speech -Rose Website Rose -Instagram Rose -Tiktok Communication Matrix SETT Framework Impactful Quotes From the Episode “There might be ways that you can collaborate and make your life easier, and maybe the speech therapist is this wealth of information.” - Rose Griffin, CCC/SLP, BCBA “Having some type of social connectedness is going to help you as an adult when you have a job. And so being able to practice those skills in a smaller environment, I think is very impactful for our students” - Rose Griffin, CCC/SLP, BCBA “The IEP is a living document, and things can change. We make our best estimate of what is going to support that student right now, with the information that we have” - Jayson Davies, MA, OTR/L Guest Bio Rosemarie Griffin, MA, CCC/SLP, BCBA, is an ASHA-certified Speech-Language Pathologist, Board Certified Behavior Analyst, and Product Developer. She is the founder of ABA SPEECH. She is passionate about helping individuals with autism find their voice and become more independent communicators. Rose is the host of the Autism Outreach podcast and is a sought-after speaker. Her mission is to help all autistic learners find their voice. She does this by providing CEU courses, therapy materials, and free resources for parents and professionals alike. Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey there, and welcome to episode number 120, of the otschoolhouse com podcast. Thank you so much for being here. I am your host, Jayson Davies, I am an Occupational Therapist, a school based occupational therapist with about a decade, just a little over a decade, actually, of experience. And I'm excited to have you here. I'm also excited because we have a very special guest today. You know, typically on this podcast, we're talking to an occupational therapist, but today we are going outside of that scope, and we have on with us today. Rose Griffin. Rose is a school based speech therapist and an expert in supporting school based SLPs through online courses over at ABA speech.org she also hosts the podcast titled autism outreach podcast, where she shares research back to guidance from a broad range of experts. Now I've asked rose to join us today, because when I was a new school based OT, I remember not exactly understanding the role of the speech therapist. You know, I knew that they worked on speech in some capacity, some form, but I didn't know the details of what that entailed. I have since learned so much how they go beyond speech to language and communication, but I didn't know that at first, and so I've asked rose to come on today to share a little bit about what she does as a speech therapist in the schools, and also how she has collaborated with other providers, including occupational therapy providers. So we're gonna dive into all of that in just a moment. I'm excited for you to hear this if you are a new school based OT, or maybe you're just a school based OT, not just a but maybe you're a school based ot who's been in the school for a little while, and you just haven't taken a moment to really get to know your speech therapist. This is the perfect episode for you to listen to. All right, so stay tuned. We're going to dive into the intro music, and when we come back, we are going to have a wonderful conversation with Rose Griffin of ABA speech.org     Amazing Narrator     Hello and welcome to the otschoolhouse com, 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 rose and welcome to the otschoolhouse com podcast. How are you doing today?    Rose Griffin     I am doing great. Looking forward to our conversation today.    Jayson Davies     Absolutely, and you know, before we jumped on here, we were just talking about the time difference completely threw me off. But you already have your kids home. It's 330 I think you said, right, yes, yeah, I have a little one now, and so we might hear him in the background. Who knows, maybe we'll hear one of yours in the background. But that's okay. It's a podcast. We are educators, and we are here to to share some knowledge, so I'm excited to have you. Thank you so much for being here.     Rose Griffin     I'm excited to talk today,     Jayson Davies     And to get us started, I just want to give you a moment to share a little bit about yourself as a speech and language pathologist, and just share a little bit about your journey as an SOP.    Rose Griffin     Absolutely I did not know what I wanted to do with my life. So my senior year of high school, my mom was a teacher. She was teaching a career course, and she gave me a career assessment after I asked her to and one of the careers that came up with speech therapist, which I had actually never, ever heard of, we subsequently had a family friend who is a speech therapist, and she was older than me by about 10 years, and so I did a ride along with her, and she worked at a nursing home, she worked at a school, she did all these amazing things, and I knew exactly that day that I wanted to be a speech language pathologist. And so I declared my major my freshman year, spring semester, and I just never look back. I've done this for over 20 years now, and feeling like a seasoned therapist is what I'm calling myself. And I just really love what I do. I love being able to wake up every day and help support clients, and now to help support other professionals as well.    Jayson Davies     Absolutely, and I was just going to kind of lead into that with the next question and ask you, how do you currently support practitioners at this point?    Rose Griffin     Absolutely. So I started my own business about five years ago called ABA speech, and we provide professional development. We have a blog, we have products that we sell, action builder cards, double up game, and we really are here to help professionals, help students who are autistic or students who are not responding to traditional speech therapy. So those students that are, quote, unquote, sometimes hard to help. That is where I come in. And I want to help everybody, help their students find their voice.    Jayson Davies     great. And that's exactly why I wanted to bring you on. You know, just like occupational therapy, speech therapy can just run the gamut of where you can work, right? You can work in a hospital, you can work in probably a skilled nursing facility, anywhere. And it's the same thing with OT, right? And so I know you are specific to working with speech pathologists who work in the schools, and so. So happy to bring you on to talk just about that. So with that, I actually want to let you first share for anyone out there who just maybe they haven't, they haven't reached out to their SLP at their school yet, and they haven't really learned about speech pathology in the schools. How do you define what a speech pathologist does in a school position.    Rose Griffin     Absolutely, we are here to help students with their speech and language skills, and so we know that if a student has a delay or a disorder, it may have an adverse impact on their educational performance. I worked in the schools for 20 years, and so we are there to be the detectives and see, well, what is really going on here and how we can be that related service to help support not only that student, but really the entire team, and to be a support to the parent as well.     Jayson Davies     Absolutely, absolutely. And again, a lot of this is going to sound very similar for everyone listening to OT, but there are some very key differences. Obviously, you're working on that speech and language component, but there's also some other differences, and one of those differences that I found is in most states, speech therapists are allowed to carry their own caseload, if you want to call it, or they're allowed to be the the sole provider for a student, as opposed to OT we have to be on an IEP as a related service provider, meaning that the student already has to receive some other service. And so I want to ask you about that. How does that work? When a speech therapist is the only provider for a student.    Rose Griffin     that is usually a stressful situation for a speech therapist, to be completely honest, because I actually just had my friend over this weekend, and she was like, oh my goodness, I'm the case manager for like, 20 kids, because she was working with the older students. Now she's working with younger and so she has some students that are quote, unquote, speech only. And so that does mean that the speech therapist is running the ship on the IEP and case managing, which is usually not our role. And so that can actually be an added stressor for everybody involved. And so that might be a student who maybe is working on a speech sound, or a student maybe who stutters, and that might be a way those are just examples of why a student may qualify and be considered a speech only IEP. And so that is a whole other dynamic, and definitely something to learn. I know I was working with older students, middle high school, middle school, high school for the past 10 years, and I had two or three students who stuttered, and I just love working with those students. They've since graduated now, and it was really hard for me. I really had to lean on my resource teachers and my school psychologist as far as the logistics of the paperwork, because if you're not used to doing all that stuff, it can be very hard because it's infrequent. You're not doing those things all the time. So those might be ways that students qualify that way.    Jayson Davies     absolutely, and you did bring up that word qualify in occupational therapy, I'm very hesitant to use the word qualify, because there really isn't anything from idea or anything from our state that quantifies how a student qualifies for occupational therapy. Is that the same for speech? Or is there a set guidelines for qualifications? Does it vary? Or what can you share about qualifying? Yeah,    Rose Griffin     I think it really varies. I know that the district I was in was in a very affluent district, and we really took it on a case by case basis. So, you know, I remember I had one student who was extremely gifted, was in gifted programming, but did have a medical autism diagnosis, and did have some social support and things of that nature. And so that student qualified. So I think it really is a very individualized process. There might be really large districts that have, oh, the student has to be two standard deviations below and things like that. But the places that I worked, we it was very much a case by case basis, and we kind of took a holistic approach. It wasn't just a standardized score, it was, how is whatever this communication delay or disorder is, how is it really affecting the student in their day to day life?    Jayson Davies     Gotcha Absolutely. And it's amazing how some of these things kind of, they don't come out of thin air, necessarily, but like, two standard deviations below, or one standard deviation below, someone is putting these processes into place, and typically they're above our head. Or, you know, maybe it's the director of special education that's working with a consultant speech and they're putting that in place. We don't know. But like you said, it differs from place to place, and so for anyone out there, if you're an OT or a speech therapist, you need to make sure that you're talking to your other speech therapist or your other OT department colleagues and trying to figure that out. A if it already exists or if it doesn't exist. Should we create something to make that happen? Yeah, all right, now I asked you about what that qualifying criteria may be, but does that differ between those speech only kids versus those kids who you might see on an IEP from another another provider, where the. If teachers the case carrier or whatnot.    Rose Griffin     you know, like, Let's take an example a student that stutters. I mean, that's going to be really different based on that student. So you might have a student who stutters and it really isn't having an adverse impact on their educational performance. So it doesn't mean that they would automatically qualify, just like a student who has a medical disability has having autism. That doesn't mean that the student would qualify for services. You know, the one particular student I was talking about, they came in from another state, which is a whole other situation, but you want to give those parallel services do your own evaluation. And the where I was working, we were hesitant to ever take something away, because, gosh, in middle school, that's just such a at least for me, it was a traumatic time. It's a hard time for kids, and especially with covid and, you know, all those things that we had to take into consideration. So it really is just really dependent on how is that communication disorder or delay affecting that specific student at that moment?    Jayson Davies     Absolutely. And you know, as you mentioned, Middle School is a tough time, especially when you think about not just the speech side of it, but the language side. And when you get into middle school and high school, there's so much more language components going on between social skills and, you know, a lot more peer collaboration going on. You've talked a little bit about the stuttering, maybe the speech sounds a little bit. But what about on the language side? What are some things that that speech pathologists work on?      Yeah, so for some students, they may just have a hard time understanding language. They may have a hard time, especially third or fourth grade, when we start to read material and have to answer questions about the material. There's a major shift there that happens in about fourth grade, and you really see the students who are struggling language wise, and they may start to get resource support. And I work really closely with teachers and know what's in the curriculum. How can I support their vocabulary that they're learning? How can I be a support? Sometimes the teachers would come down and say, you know, I was in middle school, and sometimes those classes are extremely difficult. I was in a very high performing district, and it's, it's hard, you know, you would read a sentence in the vocabulary word, and me and the teacher would just troubleshoot. How can we help this student who really does have a language delay. Understand this very abstract concept, because if they can't understand it, they're going to be lost in their classroom. They're not going to perform well on this unit. It's going to piggyback on the next unit. And so we would talk about those types of things a lot, and then also just supporting students with social skills. I always say social skills get extremely nuanced starting, you know, gosh, really, once you enter preschool, but you know, it just it never ends. Actually, I'm 44 and I still think there's, like, really nuanced things, whether it's online, in real life, in my neighborhood, there's a lot of really nuanced things. I would always tell the kids, just think of me as your social support. I'm here to help you if you have something that comes up. Because what's so funny about that I, you know, and I have a TPT store, that's kind of how I started my business, making these digital and physical products. But you could never make up some of the things that my kids really needed help with. You know, someone post a Tiktok, or someone did this, and these things didn't exist when you're making these products. So just being very specific to what your student needs support with.     Jayson Davies     Absolutely. I love that, all right. So then one of the things that I noticed about IEPs, right? We have those 13 different qualifying criterias that students can fall into. And there is no ot qualifier on the IEP but there is SLI speech and learning or speech and language impairment. Sorry, do students have to have that speech and language impairment on their IEP to receive therapy services, or can they qualify under several of the other qualifications and still receive speech.    Rose Griffin     I'm not 100% certain, but I think that if a student had, for example, autism, that they would also be able to qualify for speech and language obviously inherent to the disability of autism and how it impacts, oftentimes, communication. So pretty sure about that.    Jayson Davies     Yeah. And again, that might be more specific to specific regions, potentially here in California, what you just said is exactly the case. A lot of students who have a UT or autism on their IEP, they don't have that secondary of SLI necessarily, because under autism, there is kind of that speech and language component kind of built into it. Therefore it doesn't have to be a qualification. We're kind of assuming, with the autism that there may or may not be the difficulties with speech. So yeah, that's what we see here as well. All right, I love RTI tiered intervention, and I think you do too as well. And so I want to just get your take on RTI and maybe how speech therapists can work at the different levels to support students and    Rose Griffin     teachers. Absolutely, RTI for us was very specialized to our bill. Building. So I worked in for the past 10 years. I worked in a very small district, and so it was very much talk with your special ed director, which I always did, and talk with your building principal, because your building principal had all the the keys to the kingdom of as far as like, yes, we doing this. This is how we do it. This is the framework. It was very different from elementary to middle school, and so I really worked with my principal. I also worked with parents, but we did provide RTI, not really where I was going in and doing whole class instruction. I might have a student who doesn't qualify because they're working on R but it's not having an adverse impact on their educational performance, and I'm able to work with the principal and the parent for short term intervention. We called it collecting data, and I had a whole tiered system where I'd get permission and things like that. We wanted to make sure that parents understood that that was not going to be, you know, maybe I was going to recommend an evaluation, but maybe the student wouldn't qualify for that. I think that's what's really hard, at least for me, to be a public school employee, is that, depending on your district and how do parents have money to pay for outside therapy? Do they? Can you say that as a speech therapist, when a parent says, Well, does my student need extra therapy. I don't, you know, like, do I honestly? How do I answer that question? I always those things always made me sweat as a public school employee, because I was always trained that if you say that, yeah, sure, your child, you know, who wouldn't benefit from a little extra, if it's good therapy, that then the district might have the responsibility of paying for that, and so other districts weren't like that. Other districts I worked in, you know, we'd have a list of speech therapists you could contact and but I think every single district handles that so differently, so that always kind of made me nervous. So I always worked with my sped director, and I worked with the principal in my building. Because my district was so small, we didn't have these huge frameworks for this is our district. This is how we do it. It was very building specific. Yeah,    Jayson Davies     and I love working in small school districts. It's the best because you are so close to your special ed director, you can talk to the principals like no one feels like they're above, you know, your pay grade or above being asked questions about and sometimes you get lost in the larger districts, and you know, it's like, you meet with the OT team, where you meet with the speech team, but like, that's all you talk to, and you don't have that ability to talk to the the other team members or the people above you, and and even time to work with the paraprofessionals. So yeah, definitely love all that. Now, you did mention taking data. You mentioned, you know, working to collect data, not only for the students who may qualify, but those who may not qualify. And as IEP related service providers, we have to take data for IEPs, we have to make sure that we're writing goals that can be monitored. And so I just wanted to get your take on any tips that you have, or any way that you found that works for you when it comes to measuring progress for your students, do you use a certain type of data sheet? What works for you?    Rose Griffin     I really love taking I take handwritten data. I do it's plus or minus. I do a lot of cold probe or first trial data. So I might have a student who's working on labeling basketball because they love basketball, so I may work on that label five times during our session, but I may only take data on that first trial. And so that is how I started to write my goals as well, because I may still work and practice that skill, but I'm going to take data on that first trial, or sometimes it's called co cold probe data. I think that's important. When covid hit, and my district had a really great response to covid, I thought, you know, when we started coming back in person, it was just the students who had more complex communication needs. So I was there, but it was just everything was different, and it was hard. It was hard to learn new things. But something I did during that time is I started to keep data online, just through Google Forms. I only work three days a week in the public school setting, so I wasn't there every single day. I didn't have a caseload of 90 I had a manageable caseload, and so for some of my students, I created a Google form, which was nice for me, because then I would have the answers sent over to a Google sheet, and then when it was progress report time, I could really analyze that and input some specific progress into my reports, which I always like to do. So those two things work for me. I wasn't using any type of big electronic system because I didn't have, you know, a caseload of 80 or anything like that. So I was really just coming up with my own framework to try to make things seamless.    Jayson Davies     Gotcha, I love using Google Forms for that reason and many more. So yeah, talking to the right person who likes Google Forms, even for teacher consultations, I would use a Google form. You could just send them a quick google form. How's Jesse doing? Is he making progress on? This goal, and they can give you quick feedback. So absolutely. Now, talking a little bit about assessment tools. In the OT world, we have some very common assessments that we use, the bot, the M fun, the sensory processing measure, just to name a few. In the speech world, are there a few super common, super common assessment tools that you use, and if you just want to share maybe, like a little one line about kind of what you're looking at when you use that assessment tool.    Rose Griffin     Yeah, one that's common for younger kids is the PLS, and that just looks at a student's ability to understand and use language. There's something called the Goldman fristoe That looks at speech sounds. How is a student using their speech sounds? And then once students get a little bit older, we use things like the expressive one word, which we're showing them a picture, or a group of pictures, they're labeling it receptive one word we're showing them like four pictures, and can they point to the correct one? And then the self is a pretty popular language one, and that gets into more nuanced, higher level grammatical understanding. And one that is also really nice is the Communication Matrix. And actually, this might be nice for ot too. And I don't know if you've heard of it, Jason, but it's online assessment. It used to be free. Now I think it's really affordable, and it is for students who have very complex communication needs, so students who are really not communicating. I used it for a student who had physical disabilities, had an intellectual disability, and I did that with her ParaPRO, but the OT was looped into that the physical therapist, because we were really trying to help this person find a way to communicate. And it was very difficult, just because of all the different medical concerns that they had going on. So the Communication Matrix. If you haven't looked that up, you can just google search it. We did a blog about it at ABA speech. It's a really nice tool that's pretty comprehensive.     Jayson Davies     Gotcha, I haven't heard of that one. I've heard of the set framework. I don't know if you've heard of that, which is about kind of collaborating together with the team to determine if any sort of augmentative communication or other accommodations are necessary, but I haven't used that that one that you were just talking about, so definitely something to look into. I will say this, though, within that answer, you talked about collaborating a little bit, and so I'd love to get your take on collaborating. You've already mentioned a few instances, actually, but I'd love to hear your take on collaborating, whether it be with other other species pathologists, maybe outside of the school, or maybe with OTS in the school, or other related service providers and teachers.    Rose Griffin      Yeah, I actually it's funny. I actually just went to happy hour with my old ot that I used to work with, that she quit the district five years ago. I just quit last year, so we haven't seen each other in four years. But I saw her last week. I was telling her about this podcast. She has listened to it. So I was like, but yeah, so I would do, I worked really closely with our OT I just loved it at the middle school, high school level, we had this group of students. We all worked in elementary and this kind of big group of students moved to the middle school. And so we would do these really fun vocational slash Leisure Group. So we had this really great group of kids, or about six of them. And so me, the teacher in the OT, would create these units. Actually, this was really kind of fun. And so let's say we were learning about working at a clothing store. So I would come up with a writing prompt or reading prompt. Some of the students could read. Some were non readers, you know, differentiated instruction, trying to make sure everybody had access to it. So I would go over that part. We would read that together. We would do some of the vocabulary together, and that was the speech therapy part. And then the OT would come up. And then we would work on a skill, an extended skill. So we were working on, how do you hang a shirt on a hanger? How do you hang pants? It's very different than a shirt. How do you use the folding board like you see at Nordstrom, wherever you like to shop. And so that is how we did those groups. So we would start with maybe a question of the day, which I would do. We would do a reading passage vocabulary, which I would run. Then our occupational therapist would run the extension activity, and we would have groups of students that were practicing vocational skills, and then we would end with a leisure skill. And so those were some of my very favorite times working in the schools. Is this collaboration with the occupational therapist. So it was fun for us, it was fun for the kids, and really, I made a lifelong friend in that, in that collaboration as well.    Jayson Davies     That's the best part. And it sounds like you were doing this in a classroom. So then you also have the teacher involved, and maybe some paraprofessionals, potentially, if they're in so was that? Was that the case here?     Rose Griffin     That was the case. Everybody was involved. And it was really, really nice. I was close with the teacher too. She was a friend of mine, and, you know, she was reinforcing the vocabulary at times throughout the week when they didn't have this group. And so it was just kind of that gold standard collaboration that you really, you still talk about, because you know that it's hard to come by. There's a lot of barriers to us all working cohesively together. And then, you know, when I left, we didn't have that type of cohesive group anymore. So it didn't make sense to do that type of group. Everybody was scattered in their skill sets and what they needed to work on. And so that time where we did that group for a year or two, it was just a really special time because it was cohesive, it was collaborative, and we were able to work together. And the kids really enjoyed. It too.    Jayson Davies     Awesome. And I'm going to ask you off the cuff question related to that, but how did that come together? Because I know in the OT world, I often get asked like, look, that sounds great, but I don't know how to get started with that. So I want to ask you, how did that group get started? Did you reach out initially to the ot the teacher, or was there a student with an IEP goal? What happened? Yeah,    Rose Griffin     I think that I was just working really closely with the OT because we had a lot of students who had these shared goals, where they were a lot of overlap and what we were working on. And so we just kind of forged a friendship. And then I'm kind of a visionary of how, you know, I would like things to run, or how it makes sense to all do things. And wow, if we could all see the kids together, and this would hit all the IEP goals, they would be learning new skills. We could collaborate and do all this together that would be really powerful for everybody. And so maybe I suggested it, and kind of kind of helped get that going, and then once we had the framework for it, that was it. We just that's what we did. And another thing that was cool from that that same group of students then went on to the high school, which I was in a really small district, so I also was their speech therapist in ninth grade. But I created, over the course of that whole ninth grade year, I created this vocational binder, which is one of my top selling TPT products, because I just went through and I created these reading passages and these vocabulary and questions and these extension activities, and it was just so organic, because it was what I was doing in my everyday in my everyday work. So I might have just had, you know, that thought of, let's do this, but everybody was on board which made it easy.     Jayson Davies     That's awesome. I find that that's how it typically does start for me. I worked in a high school and my speech pathologist, her office was right next to mine, so same type of thing. We became good friends, and the next thing you know, we both started going into the life skills class at the same time. And from there, we started to develop a program, basically, and it became a great, great avenue for everyone involved, the teachers, the paraprofessionals, enjoyed it, and, of course, the kids as well. Now, one of the things that I find with speech pathologists as opposed to the OTs, is that they tend to see kids more frequently, and then they also tend to see kids sometimes in different settings. You know, for ot we might see a kid one time a week in a pullout method, or one time a week in a push in method. But I'm always jealous of my speech therapist, because they'll often have one of each they'll like, have a push in and then also a pull out, or a group or something like that. So what is a frequent service for some of those kids that you see and kind of explain maybe why you might do that use multiple services. Yeah, absolutely.    Rose Griffin     And it is really individualized. I think that was what was cool about my school gig, is that, and I didn't leave it because I didn't like it. I really did enjoy it. I just got too busy, but I could be individualized and what the kids need. So I might have a kid who is in 11th grade and they're going out to a job site, and maybe I see that student quarterly, out on the job site, and maybe I attend their meetings, because it's a small district. I've known the kids in sixth grade, and I can give the team this type of history. But for some of my students, let's say I have an autistic learner, because that's what I'm most passionate about. Let's say I have an autistic student, and maybe I see them one time individually, where I actually pull them out into my therapy office with a pair of professional for support and generalization, or I see them down in the classroom, in their work area, and then I'm working on more language skills, maybe some speech skills. And then when I go into the classroom and maybe do a whole group lesson, that's where I'm helping to work on social language skills, or just group cooperation, leisure skills. And so it's nice to have that and be able to serve students in that way, but that is a kind of a traditional style of seeing students, maybe one time as a pullout, maybe one time I'm going into the classroom. But really, for the upper grades, rarely did I ever see a student in my office unless it was a student who stuttered or a student who had selective mutism or a student who needed something very specific, related to social skills, where I wanted to see them one on one to work on it, for their privacy and things like that?    Jayson Davies     Absolutely, and I want to kind of push on that last little part that you said, because you've been doing this for a long time. Did you always start out that way? Never seen an older student in your office, or when you first got started? Would you see them in your office? And it maybe took you some time to figure out how you can do that outside of your office.    Rose Griffin     Yeah, that's a good question. I feel like in the beginning of my career, I wasn't working in the school. Schools at that age group, I was working in a private center. You know, one day a week, I always worked in non public programs for students who had unsafe problem behavior. But I don't know I wasn't by the time I got to middle school, high school, I was kind of like, this is how I'm doing it, I mean, and that made us why I have my own business. But I did get into fights, you know, professional disagreements with I'll never forget a school psychologist who I actually really like, but one year, I don't know, he just, we just got into a disagreement, and I wasn't going to let it go. And he had a school he had a student psychologist, and we tested a student, and they wanted me to see the student in the class, in my office, to work on two step directions, and this student was fully immersed in the general education curriculum. Absolutely was not appropriate. And I just really put my foot down. I talked to my director. She had my, you know, she was supporting me and all of that. And I just, you know, I'm really in it for what's my best interest of the client. And so sometimes that might be hard. That might be hard, you might get into disagreements, or professional disagreements with people, but yeah, I mean, when I feel strongly about something, I I go with it. I don't just, you know, I'm not going to say, Yeah, let's just do three times a week in my office for an 11th grader who is failing English, you know, I just it's not appropriate for the kid, and I knew that,    Jayson Davies     yeah, and you should feel strong about that, I asked that question a little for myself, honestly, but hopefully it's helping people that are listening, because it took me a while. I mean, I started working in the high schools, and for a little while, there I was pulling students out, and it took me a, a, just some time to navigate, you know, the whole new setting that is a high school, and then B, to realize how I can work with those students in a different model. There were some times where I would meet that 11th grade student, especially if we're talking about those kids that are fully immersed in general education, I would meet them, but even then, I wouldn't necessarily meet them in my office, right? Because a I'm like, calling the teacher, hey, can you send Johnny to the OTS room? Like that? Just Not That doesn't work. Like the last thing you need, right? You're asking Johnny to go to the OT room. No. So what I would actually do is I would sometimes, because it was during class, I could potentially meet them halfway at the quad or something like that. And those would usually be shorter, more type of check in seeing how they're doing with something that we already put in place, or something like that. But it took a while to get to that point. You know, a lot of us, we start in that that elementary school age where it is common to pull a student out and going to that high school level or even middle school, you kind of got to figure out where to kind of go from there, and how you can potentially see the students in another in another format. So thanks for sharing that.    Rose Griffin     Yeah, you know, I really love that age group, and I actually just did a CEU presentation about functional speech therapy for middle school and high school students. And it was really well attended. It was like a lunch hour. Well, for me here on the East Coast, lunch hour for you guys, nine o'clock breakfast. But it was nice because I had about 50% of people that signed up actually attended live. It was over 150 people on a Friday, because there is not a lot of information out there for that age group, and we know that we want to support those students, and that's all I did for the past 10 years. So I feel like it is, it is just a different beast to work in a middle school and at high school, that's even way different. I mean, it's just collaborating with the teachers. You know, I would love it when I have a kid on consult for a high school kid, it's a kid I didn't know. It's like, well, how do you consult on a kid you don't even know? I would just discreetly say, like, Oh, hey, I miss Griffin. I'm the speech therapist you have. You know, speech is a consult that's what it means. You know, bebop into the classroom. Pretend you're not even in the room, shrink down as small as possible. Don't make eye contact. But the kids I worked with were very, very friendly. Only one time in 20 years did I have to have a meeting with a student, a parent and a principal because a student was dodging me for therapy. So I think that's pretty good for 20 years as a speech therapist, 10 being with older kids, because I, I do remember seventh grade. It was, it was rough.    Jayson Davies     Yeah, yeah. All of high school, most of middle school? Yep, exactly. So we've talked about we've talked a little bit about individual we talked a little bit about consultation. We've even talked a little bit about you going into a classroom and working either kind of with with a student just as an SLP, or working with everyone as a team, potentially. But I want to ask you about that small group setting. Why might a speech pathologist decide to use a small group setting to see a kid?    Rose Griffin     I love working in a small group setting, if you have students who you are working on maybe a specific skill, and then you want to generalize it to a little bit bigger of a group, so maybe six students or seven students. Is you can work on social language skills that way in a less intimidating, less overwhelming environment. And I think it's just a really nice way to practice skills before you go out into that larger school environment. And I that was always my, my most favorite time was planning group therapy. I think when we're planning group therapy, as an administrator, I've had some administrative roles. I would see people where I'm leading the group, and it's all teacher to student conversation. But what I really loved was working on peer to peer interaction, because even though the kids were in the same class, you're going to have some of the kids that is easy for them to socialize and say hi and do all those things, but you're going to have some students who really struggle with that, and they really need to practice that skill, just because having some type of social connectedness is going to help you as an adult when you have a job. And so being able to practice those skills in a smaller environment, I think is very impactful for our students.    Jayson Davies     Yeah, yeah, definitely. And I use a small group in a similar manner a lot of times to practice that skill in a smaller space, you know, whether it be handwriting, co regulation, self regulation, whatever it might be. And then they try to navigate that skill back into the classroom. I have had a few times in my career where I have, you know, recommended small group, and then it has just been atrocious, and we've had to change the service. And that's what I love about amendments. Have you had any situations like that where you just were adamant, you know, I know the students gonna thrive in this group, this individual, this in classroom, and then it just bombed, and you had to change it up a little bit.    Rose Griffin     I have definitely made amendments to IEPs. I do not remember all the specifics. I actually just made a Tiktok about how when I first started in the field, I had a lot of students who were not yet speaking, who had autism, were really emerging communicators, and they had yes, no goals, which I realized after I wrote those IEPs, that that's actually a very, very difficult skill, and definitely not an easy skill, and not one we should work on first. So I can't remember if those IEPs were amended, or maybe we just had not yet introduced that concept on the progress note, can't remember.    Jayson Davies     Yeah, I just honestly asked that question because you've had, you have had experience, and there's a lot of people that listen to this podcast. It might be their first week, their first month in in school, based otschool, whatever it might be. And you know, just know that the IEP is a living document and things can change. You know, we make our best estimate of what is going to support that student right now with the information that we have. And you know, things might change a month from now or two months from now. So don't be afraid. The IEP is a living document, and it can be changed absolutely. All right, well, we are getting toward the end of our talk today, but for OTS out there, who maybe they haven't had a chance to reach out to their speech therapist, they haven't met them. I know this is a very broad question, but what might an OT do to open up that conversation with this piece of therapist? Should they just go knock on the door? Should they send an email? Do you have any suggestions?     Rose Griffin     I would say, start with whatever communication style you're comfortable with and definitely just say hi. Say hey, I'm so and so I just wanted to say hi. I'm part of the IEP team, and there might be ways that you can collaborate and that you can, you know, make your life easier. And maybe the speech therapist is this wealth of information, and maybe they've been in the field a lot longer, and, you know, who knows? You know it could go the other way too. But I do think it's great just to have that person as a touch point, because maybe you're an IEP meeting and you need that person's support, and that person knows you. So I think just knowing who that person is and being able to reach out and say hi in whatever way you can feel comfortable doing, I think, is a great first step, absolutely,    Jayson Davies     absolutely and yeah, if you've been sitting in an IEP, whether it's a speech therapist sitting across from you or someone else, and you've been in like 10 IEPs with them, just say hi to them. I know it gets tougher after each meeting that you sit in without knowing who they are. So say hi, up run. It makes everything a little bit easier. And as rose mentioned, you never know. I have worked with wonderful speech therapists, wonderful OTS that have had never said hi, or maybe they said hi to me. There's so much information that I would not have right now, anything from using amendative communication apps to understanding visual boards and all of that. So much of that information Elise has come from speech pathologists. So say hi to your speech pathologist. All right, there's one thing that I have kind of actually been waiting for the end of the podcast. But you've mentioned a little bit. You mentioned that your website is Abass speech.com implying ABA as a part of your practice, which I know it is, I know you, and I know it is, and you are actually BCBA certified.     Rose Griffin     correct. Yes, it's ABA speech.org . Anybody wants to org? Sorry, that's okay. Jay. Yeah,    Jayson Davies     so I want to ask you, how does that ABA, that BCBA, part help within your speech pathology realm?    Rose Griffin     Absolutely. So, you know, I became a speech therapist over 20 years ago, and probably my second or third year into third year into the field. I started working at a non public program for autistic learners, and they used applied behavior analysis to help students communicate. And these were students who could not be educated appropriately in a public school because they had very unsafe problem behavior that was really a barrier to them being in a traditional classroom. And so I learned all about ABA, and I'll never forget working with an 18 year old student who had no way to communicate besides using unsafe problem behavior. I remember working with my coworker, and we were looking back at his progress notes. He had been in special education since the time he was three, but nobody was able to reach him. And us working together using ABA and speech therapy, he was able to use an AAC device for the first time to talk about music that he wanted to listen to, or to go outside to take a walk. And I just thought, you know, on one side I thought, and I remember saying, Jason to my coworker, I want to go places, and I want to talk to people about the science of ABA, because it's absolutely life changing for this student to be 18 and have no way to communicate. That's just not right, you know. So one side, I felt really joyous that he was able to find his voice, but on the other hand, I felt really sad that it took him till he was 18, and so that really lit a fire in me to learn more about ABA, because there are so many students out there who don't respond to traditional speech therapy, and we know the way that the field is growing now of ABA, that whether we like it or not, we're going to have to collaborate with BCBAs. And so that's really where my superpower is, is trying to build that bridge between speech therapists and BCBAs. It doesn't mean that we have to think the same way about things. It just means that we need to know how to advocate for our role too, especially for OTs, I have a friend that is more behaviorally oriented. She's a PhD level ot she's going to be on my podcast autism outreach here in a couple weeks, so I'm excited about that, but we need to be able to have those professional dialogs so that we can help our students, especially those students that are traditionally hard to help, and that's who I try to help. Focus on at ABA speech.    Jayson Davies     I really like the way that you described that you talked about how it worked with you, but then you also talked about that collaboration piece, and you're absolutely right. You know, there was probably once upon a time where teachers and speech therapists didn't get along. There was probably once upon a time that OTs and teachers people don't always get along, but we see the value that each and every professional can bring to the IEP table and can bring to that student. And we need to keep an open mind. We need to make sure that we're open to different ideas and figuring out how we can work together so well. Said, I appreciate that. To wrap this up, I want to give you an opportunity. You've already mentioned ABA speech.org I want to give you an opportunity to share. Where can people who want to learn more about rose and ABA speech go to learn more?    Rose Griffin     Yeah, visit me over at ABA speech.org that is where I have my podcast, autism outreach. It comes out every single Tuesday. And if you're over on Instagram, ABA speech by Rose is where I put informative posts up and or reels every once in a while. And I'm also on Tiktok, so come and follow me. There    Jayson Davies     you are. Everywhere. We will be sure to include links to all of those different places where you can find rose on the show notes. So be sure to click over to the show notes and you can find all those easy resources just for you. So rose, thank you so much for being here. Really appreciate it, and I look forward to just just keeping you in our OT realm of life and keep in touch with how things are going in the speech world with you. So thank you again.    Rose Griffin     Thanks for having me.    Jayson Davies     Yep, take care. All right, and that is going to wrap up episode number 120 with Rose Griffin. Thank you rose so much for coming on the show and thank you for listening to this episode. I really hope that this helped you just better understand what the speech therapist on your campus may be doing, and also giving you some ideas about how maybe you can work with your speech therapist and just get to know them. The better you know your speech therapist, the more likely you two are to collaborate, which may lead to more success for your students, your teachers and everyone that you support. So thanks again for listening, and we will see you on the next episode of the otschoolhouse podcast. Take care.    Amazing Narrator     Thank you for listening to the otschoolhouse 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

As school-based OT practitioners, we are constantly seeking ways to effectively support our students in the natural environment of the classroom. Push-in services, where we deliver interventions directly in the classroom, can be a powerful approach. With push-in school-based OT services, we can directly support the students in the environment they need to access. However, the success of these services hinges on careful planning, clear communication, and a deep understanding of our unique role within the educational team. In this article, we’ll explore when push-in OT services are most effective, how our role differs from that of para-professionals, and some common mistakes to avoid. What Makes Push-In School-based OT Services Effective? Push-in OT services can be a powerful way to deliver interventions within the classroom context, allowing students to simultaneously learn and practice skills in their natural learning environment. But push-in services are not a one-size-fits-all solution. Understanding when push-in OT is most effective requires a nuanced approach that considers the individual needs of the student, the classroom dynamics, and the goals of the intervention. Maximizing Natural Opportunities for Skill Application How often have you watched a student meet their goal in a pull-out session only to return to class and revert to old habits? Push-in OT services (as a standalone service or in conjunction with pull-out services) are particularly effective when the goal is to help a student apply skills in real-life situations. For example, students working on social skills, sensory regulation, or fine motor tasks to support classroom independence often benefit from incorporating these skills in the classroom rather than in a separate therapy room. The natural classroom environment offers opportunities for immediate application and generalization of skills, making interventions more meaningful and functional. Promoting Inclusion and Reducing Stigma Another advantage of push-in services is the promotion of inclusion. By providing support within the classroom, OT practitioners can help reduce the stigma that sometimes accompanies pull-out services. Students receive the help they need without being singled out or removed from their peers, fostering a more inclusive environment. This can be particularly important for students who may already feel isolated or different from their classmates. Sometimes, you may need to single out a student during push-in services. Other times, you can disguise an individual session as a group facilitation by interacting with other students in a limited capacity. There have been push-in sessions where I walk around the entire room supporting all students, but I keep a keen eye on the one student I am there to support. Facilitating Collaborative Problem Solving Push-in services also create opportunities for collaborative problem-solving with teachers and other classroom staff. Being present in the classroom allows OTPs to work alongside teachers, providing real-time strategies and modifications. This collaboration not only benefits the student receiving OT services but can also enhance the learning environment for the entire class. When therapists and teachers work together, they can develop more holistic and effective strategies that are integrated seamlessly into the classroom routine. Examples of Effective Push-In Scenarios With these principles in mind, let’s explore three scenarios where push-in OT services can be particularly effective: 1. Supporting Sensory Processing During Group Activities Imagine a student who struggles with sensory processing, particularly in noisy and visually stimulating environments. A push-in OT session during a group activity allows you to observe the student’s reactions and provide immediate, on-the-spot interventions. For instance, you might introduce calming strategies, modify the environment, or offer sensory tools that help the student participate more fully in the activity. You may even follow up on this session with an email to the teacher on what strategies seem to work and strategies they can try. At the next session, you can take data and test new supports as necessary. 2. Enhancing Fine Motor Skills During Classroom Writing Tasks Another ideal scenario for push-in services is during classroom writing activities. For students working on fine motor skills, being present in the classroom allows you to observe genuine abilities and provide immediate guidance to the student and staff. In a pull-out session, you might notice the student's grasp and focus on that, but in the classroom, perhaps you see the student struggle more when asked to copy from the board. With that observation, you can provide further suggestions beyond using a tripod grasp and help the teacher understand why the student is turning in incomplete classwork. 3. Facilitating Social Skills in Group Projects Push-in OT is also invaluable for students working on social interaction skills. By being in the classroom during centers and group projects, you can facilitate positive social interactions, model appropriate behaviors, and help students navigate the complexities of peer relationships in real time. This hands-on support can significantly enhance a student’s social participation and confidence. In these scenarios, push-in sessions allow us to observe and address challenges as they arise, making our interventions more relevant and immediately impactful. While some may argue, "That is a paraprofessional's job," your ability to observe and intervene during these situations is unmatched. The Distinction Between Push-In OT and Paraprofessional Support I, too, have sat in a classroom and wondered, " How am I providing a service different from that of a paraprofessional? " Before I get into the specifics, even if a teacher, administrator, or parent cannot pinpoint how you are different from a paraprofessional by observing you for a few minutes, that does not mean you are doing something wrong. After all, to the untrained eye, the keys on a piano all look alike. However, each creates its own unique note, harmonizing together to create a beautiful melody. T he role of an OT pushing into the classroom and that of a paraprofessional and both roles are integral to many students' success, but they are not interchangeable. Therapeutic Intent vs. General Support You bring a specialized skill set to the classroom that is rooted in research and therapeutic intent. OT interventions are designed to address specific areas of need, such as fine motor skills, sensory processing, or social participation. Unlike paraprofessionals, who provide general support and assistance, our role is to identify and implement targeted strategies that are grounded in evidence-based practice. Example: Modifying a Classroom Activity Consider a scenario where a student is struggling with a classroom task due to sensory sensitivities. While a paraprofessional might assist the student in completing the task, an OT would assess the situation and modify the activity itself, such as using a colored pencil instead of a crayon or allowing a student to use a non-distracting fidget. Your intervention is not just about task completion but about creating an environment where the student can thrive independently beyond this individual assignment. Collaboration is Key It’s also crucial to emphasize the importance of collaboration between OTPs and classroom staff. Our work with paraprofessionals should complement each other rather than overlap. Clear communication and mutual respect ensure that both the therapeutic and supportive needs of the student are met effectively. Sometimes, that means not pointing out something you might have done differently out of respect for their role. Other times, it might mean asking them if you can sit in with the students so they can "have a break" and watch how you support the students. And sometimes, it means that you will learn something new from paraprofessionals. And that is perfectly okay. Ready to learn how to support paraprofessionals rather than feel like you are a paraprofessional? In this 1-hour course, My Bui-Lewis and Danielle Delorenzo share the knowledge and resources you need to expand your ability to train and work with paraprofessionals, helping them to implement and support the carryover of strategies in the classroom. Access this course and more when you join the OT Schoolhouse Collaborative today! Common Mistakes to Avoid in Push-In OT Services Even the most seasoned OT practitioners can make mistakes when delivering push-in services. Here are some pitfalls to watch out for: 1. Poor Timing and Lack of Communication One of the most common mistakes is showing up at an inappropriate time—such as during a test or a transition period (unless you're working on transitions or test taking, of course). This not only disrupts the classroom but also diminishes the effectiveness of your session. Do your best to coordinate with the teacher to ensure your visit aligns with classroom activities conducive to therapy and the student's goals. Classroom schedules change from time to time, so don't be surprised if your usual time with a class has something else going on. If you can still work in a session with what is happening in the classroom, great. If not, document what happened and move on. You can ask your department and supervisors later how to move forward when this happens again. 2. Being Unprepared and Unintentional Another common pitfall is entering the classroom without a clear plan. Push-in sessions should be intentional, with specific goals and strategies in mind. Sure, your plans may change based on what you observe, but you should know what goal you plan to address and an idea of how you plan to address it. Walking into a classroom unprepared can lead to disjointed sessions that are not aligned with the student’s IEP goals or the teacher’s objectives. It can also make you feel inadequate and unsure of how to document the session. There have been times that I have stated in my own documentation something to this extent: "Pushed into Johnny's classroom to support alternative seating methods. However, upon entering, Johnny was visibly upset. As a result, the therapist engaged in co-regulation strategies and consulted with the classroom staff on co-regulation strategies they can use breathing and sensory strategies with Johnny in the future." It's okay if plans change, but you should have a plan of some kind for when you enter the classroom. 3. Failing to Build Relationships with Teachers Effective push-in services rely on strong relationships with teachers. Without mutual respect and understanding, it’s difficult to integrate OT interventions seamlessly into the classroom routine. Take the time to communicate openly with teachers, understand their perspectives, and work collaboratively to support the students. Rather than giving teachers something extra to do, try taking something off their plate - like printing out adapted paper for them or coaching the class through a breathing exercise so the teacher can watch and learn without the pressure of doing it in front of you. Teachers are constantly scrutinized by admin, parents, and other teachers. If they feel safe with you, they will likely incorporate what you have to share. The Wrapup Push-in OT services can be an incredibly effective way to support students within the natural context of the classroom. We can make the most of this approach by understanding when push-in sessions are most appropriate, clearly distinguishing our role from that of paraprofessionals, and avoiding common mistakes. As you reflect on your current practices, consider how you might refine your push-in services to better meet the needs of your students and collaborate more effectively with your colleagues. Remember, our goal is to create an environment where every student can thrive, and push-in services are a powerful tool in achieving that mission. Resources Cahill, S., & Beisbier, S. (2020). Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years.. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 74 4, 7404397010p1-7404397010p48 . https://doi.org/10.5014/ajot.2020.744001. Eddy, L., Wood, M., Shire, K., Bingham, D., Bonnick, E., Creaser, A., Mon-Williams, M., & Hill, L. (2019). A systematic review of randomised and case-controlled trials investigating the effectiveness of school-based motor-skill interventions in 3-12-year-old children.. Child: care, health and development. https://doi.org/10.1111/cch.12712. López-de-la-Fuente, M., Herrero, P., García-Foncillas, R., & Gómez-Trullén, E. (2021). Contextual, Client-Centred Coaching Following a Workshop: Assistants Capacity Building in Special Education. International Journal of Environmental Research and Public Health, 18. https://doi.org/10.3390/ijerph18126332. Ready to learn how to support paraprofessionals rather than feel like you are a paraprofessional? In this 1-hour course, My Bui-Lewis and Danielle Delorenzo share the knowledge and resources you need to expand your ability to train and work with paraprofessionals, helping them to implement and support the carryover of strategies in the classroom. Access this course and more when you join the OT Schoolhouse Collaborative today!

Click on your preferred podcast player link to listen where you enjoy podcasts Welcome to the show notes for Episode 101 of the OT Schoolhouse Podcast. In OT school, most students are tasked with doing a deep dive into the OT Practice Framework, better known as the OTPF. But have you taken a second to reflect on the OTPF since you landed your school-based OT job? It is important to periodically go back and review your practice as it relates to the OTPF, especially when it is updated (like it was in 2020). In today's episode of the OT Schoolhouse Podcast, we are taking a look at the OTPF and how school-based OT fits within the OT Framework with two of AOTA's Commission on Practice members who helped to write the most recent iteration of the OT Practice Framework. Joining us today, we have Susan M. Cahill Ph.D., OTR/L, FAOTA, and Julie Miller MOT, OTR/L, SWC. Susan and Julie are both lifelong OTPs who love our field and have volunteered with AOTA in a number of ways. Have a listen to learn more about Susan and Julie and hear how the OTPF-4 came to be and how school-based OT fits into the equation. Additional Links to Show References: Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. Am J Occup Ther August 2020, Vol. 74(Supplement_2), 7412410010p1–7412410010p87. doi: https://doi.org/10.5014/ajot.2020.74S2001 And a big shoutout to each of the Commission of Practice members who had a hand in the OTPF-4 Cheryl Boop, MS, OTR/L Susan M. Cahill, PhD, OTR/L, FAOTA Charlotte Davis, MS, OTR/L Julie Dorsey, OTD, OTR/L, CEAS, FAOTA Varleisha Gibbs, PhD, OTD, OTR/L Brian Herr, MOT, OTR/L Kimberly Kearney, COTA/L Elizabeth “Liz” Griffin Lannigan, PhD, OTR/L, FAOTA Lizabeth Metzger, MS, OTR/L Julie Miller, MOT, OTR/L, SWC Amy Owens, OTR Krysta Rives, MBA, COTA/L, CKTP Caitlin Synovec, OTD, OTR/L, BCMH Wayne L. Winistorfer, MPA, OTR, FAOTA And Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA Headquarters Liaison THANK YOU! Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the otschoolhouse 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 everyone. And welcome to Episode 101 of the otschoolhouse com podcast. You may be able to hear it in my voice, but I'm still reeling with energy from episode 100 where Sarah came on and actually interviewed me on the OT school house podcast. It was so much fun, I want to once again say thank you so much to Sarah for interviewing me on my own show. It was a very unique experience for both of us. It was the first time, I think, no, I don't think it was the first time she might have done it for someone else, but it was the first time being interviewed on my show, for sure, and it was the first time for her being the host of the otschoolhouse podcast, I really hope that you all enjoyed getting to know me a little bit better and hearing a little bit about Sarah as well. Today we are moving full steam ahead, and I have an episode for you that I think you're really going to appreciate. I had the opportunity to actually interview two of the members of the commission of practice from aota, or actually former members of that commission who helped develop the newest version of the OT practice framework, the fourth edition. So today, I am super excited to welcome to the otschoolhouse com podcast. Julie Miller, who is an occupational therapist, and Dr Susan Cahill, also an occupational therapist. Both of these guests have had a profound career within our profession of occupational therapy. They may live in different parts of the country, but together, along with the help from many other occupational therapy practitioners, they came together and wrote the otpf four, which has a major impact on everything that we do as occupational therapy practitioners. So I'm actually going to let them introduce themselves a bit. And yeah, you don't want to miss this episode. We are going to talk about the OT practice framework and how this all comes together for us as school based occupational therapy practitioners. So let's go ahead get into the meat of the episode. Here is Julie Miller and Dr Susan Cahill. Susan and Julie. Welcome to the otschoolhouse podcast, how are you both doing today?     Julie Miller     Doing well.    Susan Cahill     Great.     Jayson Davies     It's always interesting when I have more than two guests, because I have to remember that I can't just leave an open ended question like that. So let's go ahead and start. Susan, how are you doing today? What's going on?     Susan Cahill     Doing great. Thanks for having me here.    Jayson Davies     Absolutely. And it's a pleasure having you here. And Julie, we just realized that you are just on the freeway for me in Pasadena. How are things down in Pasadena?     Julie Miller     So far, things in Pasadena are probably similar, sunny,    Jayson Davies     looking good. So, Julie, you're in Pasadena. Why don't you go ahead and just start by sharing with us what you are doing as far as occupational therapy down here in Southern California?     Julie Miller     Absolutely. So my current position is, I'm the clinical director at pcda, which stands for professional Child Development associates for a non profit therapy clinic in Pasadena. Occupational therapy is just one service we are offering here, but it's really fun to be an occupational therapist, but also in a director role.    Jayson Davies     Awesome. And so in that director role, can you just kind of pull that apart a little bit? What does that entail?     Julie Miller     Oh, so many things I didn't ever realize that might entail. So I was actually the head of our Occupational Therapy Department here for about 12 years before I moved into this role and just a staff ot one of the department prior to that. And so had a really fantastic kind of upbringing in a multi multidisciplinary setting with other fields of practice to collaborate with all through my career, which was so fantastic. Then when you move into a leadership role, oh, you suddenly realize there's so many more details about what we do that we need to know. So now I'm far more involved in our funding streams, our contracts, communicating with our state funding systems and our insurance contracts, signing all the the financial behind the scenes paperwork for all of those school contracts, just all of all of that piece and then through covid, so much of my time really went to really breaking down what was going to keep our staff safe in those experiences and continue to deliver really high quality care throughout that experience. So that's the last two years has really been that's been top of what I've been doing.     Jayson Davies     Wow, yeah, you know, and at the otschoolhouse com, we often, I mean, we talk a lot to the people that are on the ground level, the actual clinicians, but yes, kudos. Appreciation to the people that are trying to keep us safe while trying to provide that effective therapy. So that's a lot. It sounds like you definitely have your hands full over there.     Julie Miller     Yeah. But I also do carry a caseload.     Jayson Davies     Oh, my goodness, what?     Julie Miller     Well, that's the fun part, I really enjoy all of it, but it's a part of the structure of this organization, is that we all also carry a caseload. It helps us really stay grounded in what we do. And so, you know, as we are making the adjustments between telehealth and in person care, I also was managing a caseload while I was doing a small fraction comparatively, but still really keeps me grounded in what is that we do as occupational therapists, and helps me better make decisions for my staff as well knowing what it's like for myself to go through those.    Jayson Davies     Yeah, absolutely. That's great that you actually do get some of that without just trying to make decisions without any know about what's going on at that level. Awesome, slightly Great. Well, Susan, why don't you go ahead and share with us a little bit about the world that you are in with occupational therapy right now?     Susan Cahill     Yeah. So I'm the director of evidence based practice at the American Occupational Therapy Association. I've been here since the summer of 2020, so that was an interesting time to transition. I do work from home. I'm based in Illinois, and so prior to joining aota, I was an MS ot program director and a faculty member at a couple of different universities. And then prior to that, I was a school based occupational therapist and also a school administrator in Illinois. So I oversaw the special education services for and related services for two school districts here in Illinois.    Jayson Davies     Sorry, I just had to pause because I'm like, I need to have you on for another podcast just to talk about that last part you said about being an administrator and overseeing a little bit of special education. That is, that's a whole nother topic in general, but that's really cool. Thank you for sharing that. So today we are here to talk about the otpf, the OT practice framework a little bit. We have the director of evidence for aota. We also have Julie Miller here, who was part of that. And I guess my first question is, how did this kind of come to be, where you guys came to work on it? I know a lot of people came to work on this together. It wasn't just you two. We just can't have 20 people on the OT podcast at the same time. So I don't know who wants to take this question, but kind of, what drove the otp for to come to be I know there's series of them. So what drove that to come, and how did you end up, kind of working together along with all the other people that came to work together with it?    Susan Cahill     So I can take this one. So the Commission on practice for aota is really the the body that works on updating the occupational therapy practice framework. And the first version of the otpf was actually published in 2002 and that replaced something that some listeners might know was called uniform terminology. So if you graduated otschool prior to 2021, or, you know, and before you probably were familiar with uniform terminology. And that document really just focused on sort of delineating and defining occupational performance and occupational performance components that were part of OT practice. But the framework really sort of fully articulates OTS distinct perspective and the contributions to promoting health and participation among persons, groups and populations through engagement and occupation. So that's sort of the difference, maybe, between the two documents. And then the OTPs is reviewed on a five year cycle by members of the Commission on practice, it undergoes, actually, an extensive review process by the members on the cop. And then we also seek input from outside members as well. And then the revision starts. So we're in the fourth version now, the current version of the otpf that was published in 2020,    Jayson Davies     awesome. So yes, as you kind of refer to there are just so many people that come together. You mentioned the term cop. Can you explain, though, in just a little bit further?  Yeah,    Susan Cahill     Yeah, so the CLP, when we're going to be using it today, stands for the Commission on practice. We know that there are also communities of practice that use the initial co p, but when we're talking about it here, we'll mean the Commission on practice, and that's really the body that come together to develop all the official documents for the association, the otpf being one of them. But And Julie, you might even have more current topics related to those official documents that are being worked on right now.    Jayson Davies     Yes, so Julie, how do you play into this? Everything?     Julie Miller     Sure, yeah, I actually, I joined the Commission on practice in 2019 so that's how I came in into this discussion. I was encouraged by a colleague to join the Commission on practice. So I applied and joined right as the commission was really finalizing the otpf Four. And so it was really a fascinating experience to join in at a time that I will acknowledge most of the heavy work was done by the time I joined. They were really in the final revisions, clarifying some of the tables, working on the glossary. But the fascinating part that I continually impressed by is that every time that there was a review process and members, external folks were given opportunity to give feedback to the document, how much was really taken into consideration, time after time after time. You know, emails would come in, and there we would be at the Commission on practice meetings, going through them, really trying to decide, did this review? Did this comment fit to the section we were talking about? Did this comment actually further the document in some way was that information found somewhere else within the practice framework. So it was really, you know, amazing to see how much time and attention really goes into listening to member feedback and stakeholder feedback to make sure that the practice framework really models who we are as a profession. So that was how I joined. I'm currently still on the Commission on practice. We do have other documents currently underway that we're working on, and similarly, those are the other official documents on the same five year review cycle that we go through. And, you know, work with content experts. Some things are handled internally. Some most have external authors. And similarly, those documents go up for review. We fine tooth comb those review comments, go through them, see what we need to update or revise. So it's really a fascinating process. I'm really glad that I joined.     Jayson Davies     That's awesome. And, you know, I gotta hand it to OTA, because, you know, I have the otschoolhouse com and I am just dedicated to school based practitioners. Obviously, you both have some pediatric experience, but a OTA, when they make a document, you know, sometimes they focus in on one area, but the otpf is not that document. It is very broad. And I'm sure when you're getting feedback from people, you're getting school based OTs, you know, providing feedback private practice, people from hospitals, acute facilities, all of that. And so I can only imagine the amount of time and care that it takes to go through all of those and try and figure out, Okay, does this actually apply to what we what we're talking about here? So again, thank you both for being a part of that.     Julie Miller     Yeah, absolutely, I would. I would add to that. I think that's why it's so important that the Commission on practice has really good variety of types of clinicians and practitioners from the field, because we all come with our background and our experience. So when we're looking at a certain document, how does that topic resonate from different areas of practice, different funding systems, different, you know, the context of our everyday experiences, and how did those documents resonate with everyone? It's really quite interesting. Awesome. Yeah, I can only imagine being a part of that and just trying to comprehend all the information coming in. And I'm sure it takes a large team to figure that out. Speaking of that, was I in the ballpark when I said around 20 people came together to write this as I mean, I don't know if you have the exact number, but that, does that sound about right?     Susan Cahill     Well, I looked it up. I looked it up because I wanted to make sure. So when there was some overlap between different groups on the Commission on practice, so some people's terms ended as others people began. So Julie and I, our terms overlapped when we were on the commission, but there was around 14 authors practitioners, right? So that's a makeup of ot practitioners, ots, and occupational therapist, and then also one staff liaison, and that's Deborah Lieberman, and she's the aota staff liaison to the Commission on practice. So when I was on the commission, I was definitely working in higher ed and just a member volunteer as well.       Gotcha,    Jayson Davies     Gotcha, wow. Well, I will, you know what I'm going to do at the end of this episode. I'm going to name all 14 people at the end of that document, because they deserve recognition for putting this together. So I will do that near the end. All right, so let's dive into the otpf a little bit. You know, when I like to look at articles, I think, you know, kind of like what they teach you in school, you know, do a little scan first. And the first thing that I noticed was how long this otpf document was. And I remember, I think we were in the second version when I was in school, although the third version is what I really remember the most, because that's kind of when I started to dive into research a little bit. And I feel like it's a lot longer than the third Bridget Hey, am I wrong about that? And is there just more charts? Or why do you think it's more extensive?    Julie Miller     Sure, I knew that this is my question to answer, and when I first read it, I chuckled with like, it's long, it is it's long, I think, like, like we just said a minute ago, how do we capture all of what ot practitioners do in our field, in all of our different types of settings that we work in? You know? How do we, how do we gather all that and stay true to what our professional identity is? So that that takes some time, and that takes some attention, I reached out similarly. I reached out to our AOT liaison, Deborah Lieberman, to say, how would you answer why this is longer? And you know, there are some pieces of that. This was a more significant revision than past times and particularly but the two major things I wanted to highlight first is this idea we added in this section of cornerstones of OT practice? So there's a section really about the cornerstones of practice, particularly with how an OT practitioner does the work between domain and process. So the thought that we have distinct knowledge skills, qualities that contribute to the success of our occupational therapy process, and then the corners specifically were identified as our core values and beliefs that are rooted in occupation, our knowledge and expertise in the therapeutic use of occupation, our professional behaviors and dispositions and our therapeutic use of self. So those were some cornerstones that, regardless of what context we were working in really consistent to really identifying who we were as occupational therapy practitioners. That's one area that took up some space. The other area that took up just length was that we really wanted to really make sure we were clearly identifying what do we mean by client. So in the document, every time we say client. What do we mean by that? And so a piece of that is really thinking about who is our client, in understanding that it could be a one on one client, it could be a group or it could be a population level client. And so if we really think about how that's different, of how we might articulate what we're doing between a one on one clinical session versus a group of individuals. So every time we needed to give examples, and we wanted to give examples of those three client pieces that those tables then got a little bit longer. So that's another piece that made just kind of the length get a little bit more notable, also the feedback that we got from members and the feedback that they got from students, that information in tables helped people apply the material Absolutely So rather than just a text heavy document as many places as they could, they were trying to add in the information in table format and with examples. And I think that's the part, when that part was done by the time I joined the commission, but when I read through, I just keep thinking about all of the members of the Commission who are trying to come up with examples for each one of those things. Then I think it really helps make the document more hands on and interactive, particularly for new practitioners to the field and students trying to understand that content.     Jayson Davies     I absolutely agree, and I didn't know that about the cornerstone. So thank you for interjecting that part, because we weren't even going to talk about that today. So I'm glad you talked about that. The one thing that I always go back to as well is, you know, our client, and from a pediatric perspective, whether you're in the schools or outside of the schools, we never have one client. You know, we have this kid, but the entire family, the teacher, the administrator, they are all part of the client. So I think that is very important for occupational therapists, especially you do have to delineate who your client is a little bit and now as school based, OTs, we're getting into more some of us are dipping our toe or going all in on RTI Response to Intervention. MTSS, and that is really getting into the larger picture of the entire school, potentially, and working with that. So, yeah, absolutely, we have multiple clients. And then the last thing that you touched on, I was just looking at it the last 50 pages. It's a 87 page document. Sorry, the last 60 pages of an 87 page document are almost all charts. And so as soon as you said that, I realized, yeah, every time I look at this document, I typically bypass the text and I go straight to the charts, because they help so much. So again, to the 14 people that all worked on this, thank you for the charts. Susan, I don't know would you like to add any, any additional comments on that?       I was just going    Susan Cahill     I was just going to mention the charts that Julie did it, but she definitely already did it. And I would just say that that really came up in some of the feedback that the Commission got when we were having people to look back at the OTS three about what were the pieces of that document that had been the most helpful. And again, those tables and charts were the things that were brought up and and we really felt like, instead of again having that text heavy narrative in the beginning, that it would be just so beneficial to put the information where people are looking and definitely be found when it came to defining and describing how the OT process worked with groups and populations, that people needed examples. So there, you'll see that there are a lot of the tables and charts that have separate columns for individual clients, groups and population.     Jayson Davies     Yeah, great. All right, so Julie talked a little bit about the cornerstones, but that's kind of one of the three big pieces within otpf. We also have the domain and the process. And so let's dive into the domain. Would one of you like to describe the domain and define that domain a little bit as it relates to the otpf and just our practice as occupational therapists.     Julie Miller     Sure, I can keep jumping on this one other piece that made it a little bit, not this, not markedly longer, but another piece that we were really talking about is, how do we visually represent domain and process and there's actually an infographic image within the OT practice framework that really was trying to get at, how do you visually represent how these pieces fit together? That was another piece that I joined into when I when I was on the commission, and there was lots of meetings of, how do we put this in a picture? Ultimately, the pictures end up being kind of concurrent rings so there's a Central Middle about achieving health, well being, participation through engagement and occupation being like this the central core. And then around that you would have the process or the evaluation and intervention outcomes. But all that circle all the way around the outside of that would be the domain, if that is context, performance patterns, performance skills, client factors, or the occupations themselves. I think it's really important to think about how they all fit together and how the domain really wraps itself around the process of what we're doing is that we're understanding what the domains of our profession are. So in domain, we have five pieces of that. So that would be occupation, context, performance patterns, performance skills and client factors. Do you want me to go in and describe those a little bit?     Jayson Davies     Yeah, I was gonna ask how they're kind of, are they fluid, interconnecting, or are they individual? And yeah, go for it. Sure.    Julie Miller     Sure. Well, if we think about each of these areas, we really as ot practitioners, we really dive in deep in understanding and defining each of these sections. And again, that's another piece. If you're looking at the practice framework and reading the text, it really goes through each of these just keeps lining them out. As we all know, as occupational therapists, that the idea that occupation is really central to our to a client's health, identity, sense of competence, and have some level of particular meaning or value to that individual. And then in that, and I know as a practitioner, sometimes we're asked to do one of these occupations, because the occupations could be ADLs, idls, health management, which was something that was added this time around, rest and sleep, education being one, work, play, leisure, social participation. And I know as a practitioner that sometimes I'm asked to work on like one of those. And that's the value of having this this document to keep reminding us, no, we work on all of these as occupational therapy practitioners, right? But there's sometimes funding or payment systems might pick out pieces. The next would be context. These are both environmental and personal factors which are specific to each client. Again, reminding us that client could be person, group or population, and they influence engagement and participation and occupation. How much do you want me to go into those? I can keep listing them up. There's so much     Jayson Davies     No, that's all right. That's all right. When I look at this, I'm looking at the image right now, and everyone you could find this image on page five of the otpf. And I see occupations, context, performance patterns, performance skills, client factors. And when I look at that, I see an evaluation. I see those are the pieces that I'm really looking at, when I do a school based, especially ot evaluation, I have to look at, you know, the environment and now virtual environment. I have to look at what the student they if they have a disability, what is impacting based upon that disability, their performance patterns, but then also what they actually care about. What does the student want to work on? What does the family want to work on? And a lot of that is just, I just listed terms that we might use every day, but those are terms that are part of this domain. And so I really think that it's just quite, it's quite an encapsulating image that you put here in this diagram. So I think that's awesome. Let's actually dive in. I wanted to get a little specific here related to school based occupational therapy. You know, I had a little a little exercise, if you might go along with me. And you know, you mentioned education as being the primary occupation per se for school. But obviously they also students being also engaged in social participation, play and even ADLs and so would you say that a child is constantly shifting from one occupation to another throughout the day, or does the occupation of education encompass these other aspects within school?     Susan Cahill     Well, I would say that definitely, students are shifting all across different occupations throughout the day. When I start to think about school based ot services, I like to start with the outcomes, right? And one of the outcomes that we're working on is role competence. And so I like to really think about all of this is in the context of student role performance. And so students in their roles, you know, children in their role as students, are engaging in education, for sure, but depending on the needs of the student, they're also definitely doing things in their day related to ADL, toileting, toilet hygiene, dressing for PE feeding and eating. Functional mobility. They're engaging in iadl, like communication, management, maybe they're taking care of a classroom, pet, maybe they're working on driver's ed, depending on the age of the student and sort of the setting, the school setting, also potentially meal prep, home management, task shopping, health management for any student with a chronic condition that has to manage the performance patterns to support their health, rest and sleep, for kids that are in early childhood who need to take naps. And then, of course, plan leisure, you know, on recess, in other types of school environments, and then social participation that's happening everywhere, in the classroom, on the bus, in recess, in the bathroom. You know, it's really happening everywhere. So to say that we're only focusing on education, I think, is sometimes limiting. And you know, idea really gives us the opportunity for providing occupational therapy as a related service, to address things that are educationally, developmentally and functionally relevant. And so that really gives us the opportunity, I think, to write goals and to address all different areas of occupation within the umbrella of education, really for the to support competence in that student role.     Jayson Davies     That's not fair. Susan, every time you started to speak, I was going to ask a question, and then you answered that question, that's perfectly fine. That's exactly how this should be. I love it, because you're right. We might feel like we get a little pigeonholed if all we focus is on the academics, the education within school based OT. And there is so much more to school based ot than just focusing on the academics. I mean, there's students and families that are in school and there, let's be honest, there are some families that could care less about the academics, because their student needs more functional output once they move on from school. And so if we were just focused on the academics, then would we be supporting these students? I don't know. But like you said, you have that functional aspect to it, which is, which is so important that we can be a part of. All right, Now we cover domain, and then we go into three processes, or three pieces to process within ot in the otpf, we have evaluation, intervention and outcomes. So starting with evaluation, what does the otpf really say about what we need for an evaluation?    Susan Cahill     So for evaluation, we know it's best practice, and we always want to start with an occupational profile, and then also do an analysis of occupational performance. And just want to plug one aota ebp resource, which are the choosing wisely recommendations, and one of them is very well aligned with otpf, which is, don't initiate occupational therapy interventions without the completion of the client's occupational profile and setting collaborative goals within the framework. And it's part of our choosing wisely recommendations. And I mean, we're really thinking about getting a great understanding of who the student is in that educational context, but also understanding how the family and the community influence, you know, how that student performs and engages in those occupations that take place at school. And then I think the collaborative goal setting part is really important too. So we oftentimes, I think, in the schools, that goals with the teacher and with the parents, but we can't forget that the child or the student is there, and that that child or student has goals too, and we have to really be thinking about how we can engage that child in that process. And I think occupational therapy practitioners are great at doing this, because we have the profile as a tool, and can really be a way that we can help to sort of ascertain what the child sees as priorities, if they're even identifying some of these things that all the adults are identifying as areas that they want to work on, or do they feel like they have bigger fish to fry, right? Maybe social participation is the thing that they want to address, you know? Or maybe it's math facts like we don't know until we really do that profile to find out what's making that kid tick? The other big part is the analysis of occupational performance, and this is really involved using assessment tools and strategies to measure the child's quality of performance and occupations at school. And so again, tools and strategies that can mean multiple things, depending on what it is you're specifically trying to assess, and that's going to come from the occupational profile, and, of course, also the conversation with the educational team in terms of those priority areas for the evaluation.     Jayson Davies     Awesome. Yeah, it's evaluations are multi pronged, but I love how you talk about starting with that occupation profile. That's exactly what I tell people. What I tell people when we're talking about evaluations, because we don't know where to go until we have that occupational profile. We don't know what we need to look for. A lot of times in the schools we might see on an IEP referral for OT and like, that's it. And we're like, Okay, well, why? What do you want us to look at? What is the team actually asking us to do? And so, until you develop that occupational profile, then you don't know where to go with the actual analysis to determine what skills are necessary, what occupations are we actually even even looking at? So awesome. Now I kind of want to put two pieces together. Earlier. We talked about client now we just talked about evaluation, and we kind of mentioned, I mentioned earlier that RTI piece a little bit. What might it look like for an occupational therapist to be going in and doing more of a larger evaluation when we're talking more of that community as a whole? Is that still very similar to, I mean, in process? Is it still similar to an evaluation of a single person, or does it look different?     Susan Cahill     Yeah, definitely. So in process, I think it really does look quite the same. So the occupational therapist is still really using the occupational profile and then doing that analysis of occupational performance, but you know who the client is, then is the thing that changes, right? So if you're looking, for example, let's say, like at the whole school community for more of like, a tier one style intervention, and you do your occupational profile, and you're collecting data from the teachers and the administrators to really understand sort of what is going on in terms of needs. And let's say they determine that it's like bullying in the lunchroom, for example, is something that they would like help to address. So the occupational therapy practitioner would look at all the different contextual factors that are going on, occupational therapists would make some decisions about what sort of data to collect, and maybe they're going to be looking at things like how the lunchroom is configured in terms of space, how long people are waiting in line, what they're doing after they're done eating, till the time that the bell rings for dismissal. And so it's trying to collect all the different information that's then to come up with a plan and to really determine, you know, sort of where the mismatch is between what's going on with the people at the environment. And then, you know, that bigger, larger occupation, so understanding what the school community values, again, thinking about what aspects of the context are supporting or limiting. And so maybe then the occupational therapy practitioner, you know, determines, or the occupational therapist determines that kids are aren't really talking to each other, they're not engaging in social participation in real life. They're only doing it, maybe virtually on screen. I mean, so maybe they want to start to work with the school community on some recommendations related to use of phones during lunchtime and and how they could potentially engage people during some calming cafeteria activities, or some games, things like that. So a lot of different ways to really address that. In addition to who's sitting with who, how the traffic flow is, getting kids to do something other than wait in line, could all be some some possibilities, but it would really be dependent on what's going on at that particular school. So when you do the occupational profile and this analysis, you sort of move away from these cookie cutter, sort of suggestions, and you really find the targeted response that's going to matter for that school, right in that community, or if you're going back to the individual level, that child in that classroom with that teacher this year, not sort of in general. And I think that that's really something that that we bring to the table, maybe that other practitioners or providers, perhaps don't.    Jayson Davies     Yeah, I mean that occupational analysis and the profile combined, really, that's what we specialize and we have that eye to really combine those two pieces, see them both individually, and then combine them, put them together to create a plan. Love that. Now, before we move on from evaluations, I have one more question, and this has been a I don't know that I've ever not heard this question every year that I've been an occupational therapist, and it has to do with standardized assessments being used in well, this in particular school based OT and we have some people who, you know, swear by standardized assessments. We need a standardized assessment. We can't do anything without a standardized assessment. Then we have other people who say that they're not functional and that what's the purpose of them? Because, you know, they're just giving me numbers, but they're not really telling me whether or not a student can actually succeed in the school, and so I just kind of want to ask for your opinion on standardized assessment tools. And I know I do not want anyone to speak for aota or anything like this. I don't think that would be appropriate, but yeah, what about what's your thoughts on standardized assessment tools within school Based?     Susan Cahill     I think standardized assessment tools are really one ways that OTS can collect information for the analysis of occupational performance, and we know the benefits of using those tools right? We get some standard scores. Sometimes we're able to compare with other assessment tools that have been done by other team members. Sometimes you get to compare the child performance to specific criteria, and in some cases, a standardized assessment tool, I think is the way to go. We definitely it also probably depends on what it is that you're assessing right? So I can maybe cut back to that in a second, but I think there's also a difference, and we can maybe educate team members on what's the difference between a standardized assessment tool and what's a formal assessment tool. We have many formal assessment tools that are not standardized in administration, because they allow flexibility to be used with with clients, and then the practitioner can grade them accordingly, so that the individual can be successful completing them and the right amount of information can be gained. And so that's one option I Think too. And OTS might also decide to do some structured observation, and that would involve having the student perform an activity or an occupation, and really doing that analysis to determine where the breakdown is in terms of, you know, performance, skills and components and things like that. So that's something to think about. I think too you mentioned RTI earlier, and when we start to think about multi tiered systems of support, the other thing that's really encouraged is progress monitoring. And so oftentimes we'll see some people favor progress monitoring data, if it's collected Well, favor that over the standardized assessment tools, because they're really actually then able to compare, you know, if they've got a lot of tier one data, that student against all the students in their local district, their local classroom, right and then, and really sugar. So a difference between how that child is progressing compared to the rest of the pack, and sometimes that information is very valuable. So that would be maybe another thing to consider in terms of assessment tool. The thing that I wanted to mention was that we have one more Choosing Wisely recommendation. I have to get my plugs in for that and just and I know many ot practitioners really provide sensory based interventions to students, but we do have a Choosing Wisely recommendation that states don't provide sensory based interventions to individual children or youth without documented assessment results of difficulty processing or integrating sensory information. And so this is so important. We know that many children and youth are affected by challenges and processing and integrating sensations, and that affects their ability to participate in school. But we also know that this is complex, and it has to really result in individualized patterns of dysfunction that have to be addressed in personalized ways. So we've got to have that stuff documented before we can move into intervention. And that when we think about RTI and MTSS is tricky too, because every teacher in the world would love a couple strategies that they could just sort of put into place. And we have to really be careful about thinking about, you know, sort of what's good in terms of, like, human development and, you know, child development in general. And then when we started to get really like movements good for everybody, right? Yeah. So when we start to get super specific about what these breaks might look like and what these options are, it gets a little bit dicey. We definitely want to have some documented evidence about what the needs are before we make recommendations.     Jayson Davies     That's a very good point.     Susan Cahill     Thanks for letting me get that plug in.     Jayson Davies     No, I have been really appreciating the choosing wisely campaigned. They don't come out as frequently as I wish they did, because I know a lot of work goes into them, but when they do come out, they are very impactful. And I think they get a lot of claps, you know, like, if they just, I'm thinking of the emoji, you know, the clapping emoji, just like when something like that goes on Instagram, it gets a lot of claps. And so I think that that's great. What I also appreciate, as far as sensory integration, is that we are getting more standardized tools coming out. We are getting the soci, I believe it's called from Dr Erna Blanche, and the easiest coming out, which hopefully will make things a little bit easier, rather than using the sift. And I think there's other tools. I mean, a lot of things are coming out. The SPM just got revised, and so it should be a little bit easier for people to get some of that data that you're talking about. So that's pretty cool. All right, so moving on from evaluation, whether it be sensory or whatever it might be intervention that is the next step and so, or at least within the process and in general, I guess. So, what does the otpf when it comes to intervention? What are some of the key points?    Julie Miller     Sure I'll take this one, and I think this is the part that I think is really amazing about what we do as occupational therapy practitioners, is each section flows into the next, so to try really hard not to be redundant, right? Think about all the work that we've done in the evaluation section. You have done. We've found some tools to measure what some of those performance skills look like. We've done the full occupational profile. I love that the two of you spent so much time talking about the occupational profile of how important that is to what we do and how we really understand that client or group's needs in the moment, so that we can make sure we're creating an intervention plan. Then that is meeting specifically the needs of that individual or that group specifically. And it's not just, oh, everyone who has this need, this is what we do for it, period, right? I think that this piece that makes us really different in the quality of intervention that we're doing. We're really thinking very specifically of what is needed for this person and how is this person's plan going to be established. So similarly, with the evaluation like we might really want to be including the teacher or other adults who interact with that student in throughout their day, there's also the piece about making sure we understand the family's needs, the family's interests, and that's true also for the intervention plan, so that they under so everyone understands what is it that we're doing together to help support the progress, like Susan said before, about how the students able to fulfill their roles in that setting, right? And so that the work that we're doing individually. Actually in the therapy process, is supporting that success in those roles. It's not just doing other things in that time, right? It's always going back to that itself. So, you know, sometimes it's looking at specific needs for performance. It might be looking at elements of the different context or activity demands, really looking at more of those client factors and making sure that we're using evidence to support those plans too. And that goes back again to everything that Susanne was just saying, is making sure that the the strategies that we're thinking we might use really are rooted in the research that our field has been trying to support and further as well. Similarly, we're not just randomly picking things on a whim and applying them, but we're really making sure that what we're doing is supportive to that client's needs and basic and science in our profession.    Jayson Davies     Yeah, and you mentioned the intervention plan, and personally in the schools, I see that as sometimes being a missing piece. We have the evaluation, and we have an IEP, we have goals, obviously, but there's nothing connecting those goals to the intervention, or at least nothing formal. And so I encourage all school based OTs, you know, you should have a separate document. Don't just rely on the IEP as your treatment intervention. You know, the IEP has goals, it has present levels and it has services, but it doesn't have the in between stuff, you know, the actual different things that you're you want to work on with the student in order to meet those goals. Sometimes I have, you know, well, I shouldn't say sometimes, all the time, I have my iPad up and I'm taking notes during the IEP and that's kind of what I'm jotting down. Also, what do I need to look up? What research do I need to go home or later, try and find based upon what we talked about in the IEP meeting? So that intervention plan is definitely a piece that we need to have, but I feel like, personally, I feel like, sometimes goes missing. We just kind of imply that if we have goals, then we have an intervention plan. So yeah,     Julie Miller     I think I would agree. I think that's a really important comment as well, to make that it's not just looking at the goal as written and repetitively, doing that thing over and over and over again, right? Is that we're using that goal as a measurement of the skills and roles that that we want, that students succeed in, right? And we do other, we do other intervention around supporting progress towards that goal as well.    Jayson Davies     Absolutely. Because, I mean, if we I'm just going to use it a handwriting goal, there's nothing that says paraprofessional can't ask the student to write letters, A through Z over and over and over again in the classroom. We have to do something different. We're not just doing repetitive practice. We are doing something that is skilled intervention, and that doesn't necessarily mean coming into the OT room writing A to Z over and over and over again. No, we're going to break that down, break it down into the components, potentially look at the context and build up. So yeah, absolutely need that plan before we move on from intervention. There's one key term that I really appreciate, and to this day, I feel like I understand it, but I would love more and and I know probably neither of you give you know trainings on this, but at least discuss a little bit the term therapeutic use of self. I'd love to just a little more information from you, potentially why this was such a key term within the practice framework.    Julie Miller     Sure, it's such an interesting piece to think of a value which is literally a cornerstone of our profession, and yet still sometimes, as an experienced clinician, we think, How do I explain that. How do I explain how I use who I am to help support these goals? And maybe also I'm going to embed in that how we recognize, how we might make assumptions based on our own life experience, which makes assumptions about other people, about their experiences. And I think that that's a piece to consider in therapeutic use of self, but it's how we can use ourselves and recognize about the exchange that we're working on. Really, what we're not doing is handing out. Here's your list of exercise do this. Really, rather, we're connecting, recognizing the emotional interaction that happens as we help facilitate change for that individual and for that client. And in that, recognizing the power shift that can happen between practitioners and clients, and really trying our best to minimize the power differential. In that, we're really trying to align side by side, we're doing this work together. So I was thinking about this, and I was trying to think of a really great example for you of you know what we might do. And something that comes up for me so often is, I think, when we're working directly with children, and the young children, so many of us as pediatric clinicians naturally get very playful and connect, and we try to make our work very meaningful to that, to that little one, maybe, right? I find myself really using therapeutic use of self more so when I'm connecting with that client's parent, particularly if that parent doesn't have a lot of interaction or get does an opportunity to see what's happening in the intervention or in the in the process of making sure I'm also using myself to help understand, help that parent understand. What is it? What occupational therapy is? What happens in our sessions? Why is this meaningful to them? How trying to gather more information from that family also so I can understand what's really meaningful to them that, you know, how that also helps us understand, how can I present this content in ways that maybe is more meaningful to this parent? You know, am I making my descriptions about occupational therapy as accessible to the parent and using that in part of that exchange? I don't know if that helped, or if Susan has any comments on that as well.    Jayson Davies     Yeah. I think Susan is, I think she's got something for us.    Susan Cahill     Yeah. So I was gonna say, you know, I think that when I think about therapeutic use of self, I'm really thinking about the sort of the client centered approach that occupational therapy practitioners take that is collaborative and really like sort of grounded in empathy, that promotes really that open exchange of information, and it is really honoring the client as a partner and the whole thing. And so I think even in the school, you know, we work with very young children. We work with students with with very significant disabilities, but but no matter who the student is like, they are our partner in this and so, creating a really inclusive, supportive environment where it's safe to take risks and make mistakes is super important also, I mean, to allow opportunities for choice and for kids to show agency, I think, is really important. But it does also extend, I think, to the adults that we work with too, and so, you know, those are the teachers and the administrators and and well, as well as the families and parents that are involved. I think I've really seen examples of it come to play when, you know, I've helped a student to sort of advocate to his teacher about what he wants in terms of an accommodation, particularly as they sometimes relate to classroom behavior management and for students to be able to really feel empowered to say, I want to do the job and I want to meet your expectations. But when you use proximity control, coming up to my desk and standing over me because you think that's going to make me stop talking, it really makes me angry, and then this is what happens next, right? And it's helping, I think, kids to have those words and to be able to know that you're supporting them to do something like that. But it's also then, you know, to support the teacher, because I think we come in with our all of our super great ideas and our bag of tricks to say that we're looking at what you're doing and the environment and what the students are doing, and we've got a million ideas as soon as we walk in, but you're still the captain of the ship, because this is your classroom, and ultimately you're responsible for the instruction of all these students here. And I am specialized instructional support personnel here to support or I'm a related service provider here to provide related services. And you know, however you're framing it, but I'm not always the captain of, you know, fourth grade. And so I think that that therapeutic use of self is also, I think, you know, having that same empathy and holding that space for the teacher to be able to say, I need help, or that's never going to work what you're suggesting in my classroom, because I cannot implement this or this. I need two people to help me implement this, and where will you be right? So I think it's, it's really being collaborative, and it always wanting to collaborate more, I think, which is sometimes hard because of our busy schedules, but I think when done, well, that's the sort of trust that we can build with other educators. And then they will look for for occupational therapy more for their students, because they'll see the value of it.    Jayson Davies     100% agree. I always, always tell therapists like that is collaborating, providing those quick wins, even if you can, for teachers, that is kind of the best thing that you can do to develop a rapport with them, and once you have that rapport with the sky is limitless. I mean, once you have that rapport, you can do so much more with a teacher, and so by getting in there, collaborating with them, collaborating with the students, yeah, you can do just about anything. So that's awesome. All right, the last step of the process we had evaluation, intervention. We come to outcomes. When I think of the word outcomes, I also think of a term out there is data driven decision making, dddm, and we also, I can't remember if it was Susan or Julie, mentioned creating our own evidence within like tier one, right? We almost are comparing a student to the rest of the kids. And I think of that with outcomes as well. Can we just kind of really briefly, we're getting close to our end time, but talk about how outcomes, kind of, in a way, start the whole cycle over again a little bit.    Susan Cahill     Yeah, the framework defines outcomes a little bit differently. So just want to sort of talk about that. So it's not always the individual child outcome, but it's more of the outcome of OT intervention, sort of like in a big picture way. So this might be something like increased occupational performance in a big way, or role competence in a big way, or participation, I think quality of life, right? These big outcomes, and we are definitely going to have IEP goals or. And performance goals that are going to be, you know, more manageable and definitely measurable, right? But when we're beginning occupational therapy evaluation in the schools, I mean, we always need to be thinking with the end in mind and and when I'm thinking about students, you know, if I'm working or I was working with an early childhood student or a second grader, middle schooler or high schooler, I'm always have to think about what's going to happen after this kid's done with high school, right? We always have to be thinking about that post secondary life, whether the student is in, you know, full time in general ed, or they're in a more restricted environment, but really thinking about, you know, what are the child's goals for that post secondary life? What are the family's goals, and what can we do to get them as close to that as possible, knowing those things could potentially change. But I think it's definitely important to be thinking about that. I think that when we do that, we really we focus on those larger scale outcomes, or we hold them close. When we're doing all that intervention planning, it helps us to not continue to do the same thing, maybe year after year, which is sometimes a challenge in the school systems, right? If a child's not making a goal, you brought up handwriting earlier, so I'll just stick with that. But if a child's not making progress, and handwriting is difficult, we have to start thinking at some point, is this the way? Is this what we want to spend our time on? We've got 30 minutes or 45 minutes or 60 minutes a week with this student, and that's that's the time that we can cause some big change or and with consultation with the teacher. But is that how we're going to get the biggest thing for a buck for that child for the course of their academic career? Right, leading to these, these outcomes? So we have to always keep them, I think, close when we're thinking about that data, I think, and sort of doing that intervention review can really help us to know when we should start to change course. And so again, that intervention review is that continuous process of really looking at and reevaluating and reviewing our intervention plan, and when we're seeing that students aren't making progress by the data that we're collecting. I mean, I think that's our opportunity to go back to the drawing board to say, Can we do something else? Is it time to shift gears? What other supports need to be provided? And is this still worth it? Is this the target that we should be going for, or is there something that's going to have a bigger impact in the student's life now and also down the road?      Yeah, absolutely. And thinking of that larger picture. You know, there's sometimes when I think a year is a really long time for a goal, and then there's other times when I look at the bigger picture, that I'm like a year is nothing. I mean, a kid is only in school for 12 years. And if you don't have that longer term goal, especially as you get into the middle school, high school realm, your time is ever so short with those students. I mean, not just us, the teachers, the administrators. We don't have a long time to make an impact. And if we sometimes focus on the little, tiny increments, we lose track of the bigger picture. Where's this student going to be once they are no longer within the school system and and thinking about that bigger picture? So Thanks, Julie. Would you like to add anything about outcomes?    Julie Miller     I really would agree with Susan. It's interesting because I work both in we do a little bit of school support, but mostly pediatrics, more of an outpatient setting, and so I have opportunities then to also see kids move into more young adult or community placements too, and to really think about, I think that's such an important piece of you know, over time, what are we hoping to see and how what's, what does success look like in those different places and ages and stages? And like you said before, Susan, not sticking to one goal year after year after year, but really re envisioning every year. What does success look like? What does independence in the setting look like? What does functional dependence look like, ongoing and when do we want to start looking at other areas to support that student succeed?    Jayson Davies     Yeah, and there's just one comment. We don't need to have a big discussion about this, but there's one comment that I did want to or quote, I guess, from the otpf, that I just was surprised to see it there, but was very happy to see it there. And it states that planning for discontinuation of occupational therapy services begins at the initial evaluation. And I don't think many of us think that way. We don't think about graduation of services until we don't see the student progressing anymore, or we don't think about discontinuation until they met all their goals. And you know, just like we are taught sometimes in elementary school, starting from the end and working backwards, it's the same thing when it comes to our practice, where do we want that student, that client, whoever it is, to be at the end? Because how will we know when they're ready to move on from occupational therapy services or anything, if we don't have that end goal in mind. So I don't know if either of you want to speak just a little bit more. Have anything to add about that?     Susan Cahill     Yeah, when I was listening to you say that quote, I was also just thinking about how we do sometimes think that the end of OT services is when the child leaves our building, or when the. Graduate, and, you know, really thinking of maybe a little bit provocatively about different phases of the students education, and you know, do they need to be on a caseload from kindergarten all the way through eighth grade, you know? Or Is there flexibility within a district for for students who receive services just in time, services when they need them for as long as they need them, and then to pull back, and then for it not to be such a big deal to get back onto the OT caseload. And is that a possibility, a more sort of flexible model? And I think, I think that would, that would feel so great to be able to have the opportunity to intervene at different points, and to really realize that, like, you know, we're talking about 30 minutes, 45 minutes of our time. But, I mean, you're right 12 years and like, six hours a day, or six and a half hours a day, and every one of those minutes is precious, and we can't if we could pull away so that the child could get more bang for their buck someplace else, then that might be the thing to do. So that sort of fluidy. And if you began with that end in mind too. I think, like it would like revolutionize the system, right? It would be really exciting to see how that would go. So that's what I thought about when I thought about that quote, the end of school, for sure, post secondary, but also, like, a more flexible model. And I think that that's where multi tier system support can really work in our favor.      Absolutely, totally agree. All right, so I have one more question for each of you before I let you enjoy the rest of your Monday evening here. And Susan, you just got done talking, so I'll move over to Julie. Julie, where do you see occupational therapy potentially moving forward, whether it be the occupational therapy profile or, sorry, not the profile, the practice framework, or just in general, what do you see as the next step for occupational therapy?    Julie Miller     What a great question. I am really excited that I think occupational therapy practitioners are really doing some of the work to really look at, who are we? What do we do? Who are the clients we serve, and all of the barriers that might be in the way for them, which goes beyond, I think, some of the more traditional skills based work that practitioners did in the past, and moves far more into how are structures or policies limiting to people's access to occupation? And I think that is the thing that I am most motivated by. You know, seeing students coming out of OT programs already asking those questions is really exciting. So I'm really excited for that.    Jayson Davies     That's awesome. Yeah, I never thought about that. I mean, you're right, though, I talked to newer grads, and they already have very, very big mindset, some very big ideas. So that's awesome. And Susan, what about you? Do you have any big picture things for occupational therapy? I    Susan Cahill     think when I think about occupational therapy in the school systems, I think we're starting to gain some really good traction as having other educators recognize us as specialized instructional support personnel. And so I think that that's really, there's a lot of momentum in our community right now to sort of focus and promote our role as this and I think that that would be something that I think, I hope, would continue. I think that once the building realizes how invaluable an occupational therapy practitioner is from providing, obviously, supports to the students that are receiving, you know, IEP services, but also the general student body, and then also their teaching staff, right their faculty and the other educational personnel, and how they can create environments that are supportive. I just I don't see why a building, a building level administrator, wouldn't say I want one of those in my building, maybe two or three. So I really think that I'm hoping that more ot providers, or current practitioners, rather, embrace that role as a sis and are not afraid of it, because it does mean doing things a little bit differently. But I think that ot practitioners are very adaptable, and really can think about how they can again, provide services to that whole building, not just the kids that are in their traditional caseload.    Jayson Davies     Absolutely. And yeah. Well said, If anyone has any other questions about Sisp, s, i, s, p, specialized instructional support personnel. We actually did an episode with Abe Saffer, which is a colleague over there at aota, all about Sisp and what he's doing in in Washington, DC, to kind of try and get the ball rolling, and what we can do to get the ball rolling at our district level. So be sure to tune into Episode 91 for that well, that is going to bring us to the end. Thank you so much for your big ideas about ot as well as walking us through the otpf a little bit quick question is LinkedIn the best place to find you both, if anyone might want to connect that sound like a good place.     Julie Miller     Okay, that's the way to find me.    Jayson Davies     Awesome. Well, I will link to both episode 91 I will link to to just your LinkedIn profiles. People can find you there if they like, in the show knows, and also make sure that we. Link to the otpf. I think you have to be an aota member to get otpf, or is that? I can't remember what is and what isn't necessary, but either way, we should all have that on file. We need that on our desktop to reference to at any point, so be sure to get the otpf. And yeah, with that, Susan, Julie, thank you so much for joining me on this episode of the otschoolhouse podcast.    Julie Miller     You're welcome.    Susan Cahill     Thank you.      Thank you. Take care. All right, and that's going to wrap up episode number 101 of the otschoolhouse podcast. Wow. It feels so strange putting three digits together to actually say where we are in the otschoolhouse com podcast. I want to give a huge shout out to Julie Miller and Dr Susan Cahill for coming on the show and just sharing with us not only how the OT practice framework comes together for school based OT, but also a little bit about the history behind the practice framework and the commission that put this together. And as I mentioned earlier in this episode, I want to thank every single person that had a hand in this, the OT practice framework document and the Commission on practice chairperson was Julie Dorsey. So thank you so much, Julie. But there were so many authors, as we mentioned earlier, and I'm just going to list them very quickly by name, because I want to thank them for everything that they have done for the field of occupational therapy. So in addition to Dr Julie Dorsey, we also have Cheryl boop. Dr Susan Cahill, who we spoke with today, Charlotte Davis, Dr ver Alicia Gibbs, Brian hare Kimberly Kearney, Dr Elizabeth Griffin, Lanigan, Elizabeth Metzger, we talked to Julie Miller today. We also had Amy Owens, Krista rivers, Dr Caitlin sinovic, I hope I pronounced that right, Caitlin, if you're listening to this, as well as Wayne winnistofer. And finally, we also had Deborah Lieberman. So to all of those, every single person who helped to develop the OT practice framework. And to be honest, I'm sure there were so many more that were not listed as authors on this document. Thank you so much for putting together a place for us as occupational therapists, particularly us the school based OTS who listen to this podcast, for having a guide to look to, something to help us guide where we are going. As occupational therapy providers, you know we all need a little help, and you have done that for us with ot practice framework. So thank you so much, and thank you for listening today. I really appreciate you listening all the way through if you have done that, I know you are a super fan, and I really appreciate it. Until next time I will, I'm gonna go enjoy myself, and I hope you do too. I hope you have a great rest of your week, a great rest of your May, and even a great rest of your day. So I'll see you in episode 102. Take care everyone. Bye.    Amazing Narrator     Thank you for listening to the otschoolhouse 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 124 of the OT Schoolhouse Podcast. In this podcast episode, Maggie Aschenbrener discusses how she applies her passions for water, children, and occupational therapy by utilizing aquatic therapy in a school-based setting. In addition, she shares valuable insights on the benefits of aquatic therapy, the types of individuals who can benefit from it, and how occupational therapy practitioners can incorporate it into their practice. This podcast episode is a valuable resource for anyone interested in learning about aquatic therapy or incorporating it into their occupational therapy practice. It provides both inspiration and practical guidance on how to make the most of this modality. Listen now to learn the following objectives: Identify key benefits of aquatic therapy for individuals with a variety of conditions. Identify specific populations that could benefit from aquatic therapy. Identify potential opportunities to incorporate aquatic therapy into school-based occupational therapy services. Guest Bio Maggie Aschenbrener, OTR/L, graduated in 2006 with an undergraduate degree in Occupational Therapy. She earned her master's degree in OT in 2010. She practiced school-based OT from 2006-2021. In 2021, she began working for Concordia University as their Pediatric Clinical Coordinator in the OT department. She has also practiced at a therapeutic horse ranch doing hippotherapy. She loves sharing her passion for OT with others. Quotes “A student who has difficulty with transitions, difficulty with sensory processing, or difficulty with attention or focus, being in the water can really help them regulate their body so that they can then participate in other activities” - Maggie Aschenbrener, OTR/L “We were working on that participation goal through water, and then generalizing it to the classroom” - Maggie Aschenbrener, OTR/L “Think about that auditory deprivation. There are no sounds underwater, so a lot of our kids with autism just loved to go under the water and just be little fish… because it just cut out the rest of the world” - Maggie Aschenbrener, OTR/L “If people didn't do what they love within the profession, then we wouldn't have things like hippotherapy and sensory integration may not even have come to play” - Jayson Davies, M.A. OTR/L Resources Qualitative Study Article Research on Aquatic Therapy with Children with CP Contact Maggie Episode Transcript Expand to view the full episode transcript. Jayson Davies     What is happening my fellow OTPs, so happy to have you here for Episode 124 today we are talking all about how we can use aquatic therapy to potentially supplement our traditional push in and or pull out services that we typically do within school based settings. So I think it's only fair to use the analogy that we are going to dive into this podcast head first and go for a swim as we talk with Maggie aschenbrenner to talk about how she has actually used aquatic therapy in her school based ot career to supplement the other types of therapy that she might also implement. Now I know some of you might be thinking to yourself, there's no way I could ever get access to a pool, and that's what Maggie, once upon a time, thought. So I want to just encourage you to have an open mind as we go through this episode, I could totally see during extended school year, or maybe even during the regular school year, some of you figuring out a way to work with your students in the pool. After hearing this episode, you'll know exactly how that could potentially look. So tune in. We're going to dive in right now with Maggie Aschenbrenner to talk about how aquatic therapy could augment your therapy services in school based OTS. Hang in there. Let's Cue the intro, and when we come back, we'll hear from Maggie Aschenbrenner.    Amazing Narrator     Hello and welcome to the otschoolhouse com 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     Hi Maggie. Welcome to the otschoolhouse podcast. How are you doing today?    Maggie Aschenbrener     I'm doing great. How are you?     Jayson Davies     Doing very well, you know, it's we're recording this at the end of March. It's almost ot month as we're recording this. And, yeah, I'm just looking forward to a fun conversation with you all about aquatic therapy. So to kick us off today, I love to just let you share a little bit about yourself and where you are in your ot career today.    Maggie Aschenbrener     Okay, okay, I have been practicing since 2006 the majority of my career has been in a school based setting. 13 and a half years of that was in a school for kids with pretty significant special needs, which is where I got into aquatic therapy. And then recently, in the last year and a half, I have moved to academia, and I am currently at Concordia University as an assistant professor and their pediatric clinical coordinator.    Jayson Davies     Awesome. That is great. And we're talking about aquatic therapy today, and I'm excited to dive into that, but you know, you shared some slides with me, and you actually labeled your presentation as augmentative therapy. And so I just want to tease out what's the similarity with those words. The difference, why is it augmentative? Why did it aquatic?     Maggie Aschenbrener     Yeah, so generally, you know, you think about traditional therapy, and I use aquatic therapy to support traditional therapeutic outcomes and therapeutic goals. So we're looking at, you know, using ot but using that water as the medium for the therapy in addition to traditional ot services.     Jayson Davies     Fantastic. That's a great way to explain it. Hence the word augmentative, because you're augmented in the traditional therapy session. Awesome. And diving now a little bit deeper into the aquatic part. How is aquatic therapy different from maybe a student who is going to private swimming lessons or maybe even getting that sometimes. PE curriculum includes some swimming. How is aquatic therapy different from that?    Maggie Aschenbrener     So, yeah, there's adapted swim lessons for kids who have special needs. And those are amazing, because swimming is such a great skill, and as you know, it's leisure is such a great occupation for kids. So we the difference, though, is that we're working on those traditional otschoolhouse com do with dressing, which may have to do with any kind of functional activity, whereas an adapted swim lesson is looking at the goal of swimming.     Jayson Davies     Gotcha. You know, I have worked in a high school setting before, and we had some kids who, for PE they would go and mostly during summer school, but I think also kind of at the end of the school year, they would get some swimming in. And me not being a very strong swimmer. I never got into that. I know our adaptive physical education teacher every now and then she would actually work with those students in the pool a little bit, and she loved it. But I never got into that. And I'm excited to hear more in this conversation about what that looks like, and we're going to dive into what you know a session might look like, but first, I want to talk about some of the benefits that you have seen when using aquatic therapy. And so just to kind of, I don't know, a quick synopsis. I know you could go on and on about this for days, but what are some of those skills that you do tend to try and work on within aquatic therapy?     Maggie Aschenbrener     Yeah, so there's so many things like you said. I could go on and on, but I think we have an hour and a half. But when you look at water as a tool, especially warm water, think about an individual who may have something such as cerebral palsy that causes high tone. Well, think about go back to all of our basics, and the things that facilitate lowering that tone, warmth is one of the first things. So just getting the kids out of their chair into that warm water, and just letting their tone loosen up and doing some really great range of motion is amazing. The ability to get those same kids in different positions, is amazing. In water, you weigh about 1/10 of what you weigh on land. So when we have those kids, you know, you talked about being in working with high school kids, and when you do have bigger kids who have high tone, as you know, it really is harder to move them, and it's, you know, not like when you're working with the little three and four year olds, where it's just really easy to do that kind of stuff. And as you know, tone gets worse with age, if you know, you don't do things such as normal ranging. So that's been great respiration. I live in Wisconsin, and one thing that we see with individuals with special needs is that it's really hard to get rid of those normal viruses and colds that typical children might have an easier time because of low tone within their core. So just being able to stretch those intercostal muscles out is great, as we know, digestion some of our kids who have autism, some of our kids even who have high tone sensory issues, constipation is a huge issue for kids with special needs. And so we can look at just moving that core in certain ways to help get that digestion going. So it's really the whole body that it works. And it's pretty amazing.     Jayson Davies     Wow. You know, the way that I host this podcast, I host it as though you know someone who's listening today would ask questions and follow up. And so I actually want to follow up with this a little bit, because I'm sure there are OTS out there listening and they're kind of thinking the line here might be blurred between educational model and that medical model. And so I want to dive into that, but first, I want to let you explain kind of in what capacity and what kind of setting you were actually providing most of this aquatic therapy.     Maggie Aschenbrener     Sure. So I was at a school called Lakeland school. It's a school for kids with pretty significant special needs. And so some of these kids, their function in school is to be able to tell they have to be able to tolerate sitting in a wheelchair throughout the day. They have to, you know, their goals might be transferring goals, so it's easy to work on that in the water. Additionally, though I did a lot of groups work with speech, with early childhood education, with PTS, where we would take a group into the water and really work on those school based schools. So maybe take foam puzzles into the water. Maybe take instead of, obviously, you can't bring a pen and paper, but you can bring a Magna doodle into water. So working on those shape drawings. So getting their body ready, innervating those gross motor muscles by swimming across the pool with their circle puzzle piece and then having to draw that circle. So really, getting that brain and body working together. Additionally, you can do things with you know, a lot of our early childhood kids had academic goals of one to one correspondence and counting. So okay, we're going to bring three pieces or three manipulatives across the pool, or we're going to sort them by colors. So really activating that movement and activating that brain through the movement. So yes, there were in the one on one sessions, we did work with some of the kids who had really significant physical issues, but we're also able to really work in those academic goals as well as really look at that interdisciplinary model, bringing everybody in together and looking at the child as a whole, which was very progressive. And I love to hear the Early Childhood Education teachers say, oh my gosh, oh my gosh. And she would bring in the iPad for the parents and say, Oh my gosh. Look at okay. They can do this. And now we're going to generalize this to the classroom again. That's where that augmentative comes in. Okay, wow. We got that brain and body working together. So let's get that motor memory going where they can do this puzzle, and they can do this. And then let's generalize that back to the classroom. Wow, yeah, you just answered both questions all in one. I love how you brought that back into the classroom, right? Like we're always as OTs, especially as a new school based ot you know, one of the first things they have to figure out is, is what I'm doing something that I would do in a clinic, or is what I'm doing, something I would do in a school, and that's always hard to mesh together. It a little bit, and it sounds like you kind of have figured that out. And I'm sure it wasn't easy at the beginning, actually, you know what follow up with that, like that first few times that you jumped into a pool with this student? I mean, did you have any training? Or how did you kind of get started with it? Yeah, I mean, the first time I jumped into the pool with a student as an OT I was actually like, chomping at the bit to get there, because my background was I was a lifeguard in college. I taught swimming lessons. I worked for Milwaukee Public Schools recreation department in their adapted aquatics program. So I already had this idea of like, wow, I am going to school for OT and I'm seeing, like, all of these things that water can do for kids, and now I'm going to apply it to that ot background and just watch the kids flourish. So once I got there, I was so ready to do it and so excited, and I was really lucky when I started at my previous job, a whole new building was being built. So we had a therapeutic pool with in the second year I was there, and because my boss was really supportive and she wanted to see we built this beautiful building. We have all these facilities. Let's use them. So I was one of those people who was so fortunate to have full support of my supervisors. Like, yes, we've got these tools and we've got these resources, and so let's use this. And so it was great.     Jayson Davies     That's awesome. And so as you were getting started, then, you know, you've already talked about working with maybe some kids who have high tone cerebral palsy. But how did you determine, you know, maybe what students this was for versus what students this may not be for? Did you have some set of criteria, or it sounds like you felt very comfortable in the water? I can imagine, if you feel very comfortable in the water, maybe you're going to try it with everyone. But how did that with everyone. But how did that work out for you? How did you decide maybe who this was and wasn't for     Maggie Aschenbrener     Well, you know, just based on basic contraindications. So there are students who have, you know, basic contraindications are students who have or individuals who may have different rashes, different skin conditions, trachs or stomas, we brought in a lot of people, and we just really worked with what they had. So like, for example, even though working in the water is obviously a contraindication for traches and stomas, we are OTs, so we modify and adapt. And so what I did with a small child, obviously, with parental permission, and she was one to one, so this is very safely doing it, though, was we put a puddle jumper on her, and then we put one of those things. She was a smaller early childhood student. So one of those things that you can use for kind of more toddler sized kids, where you can put both legs in and they kind of float around the pool, and then we also put another floatation device in between, so she was sitting up, and she could do things in the water with the top half of her body out of the water. So really, when we were looking at when we were going in with a early childhood group. I wanted her to be included in it, because that's the point of being at the school that those kids were at, that they could do things with other kids. And so I didn't want to leave her out. So she was able to do things throughout the water being in a seated position with one to one support and protection over stoma. It was pretty amazing.     Jayson Davies     Wow, wow. That is really cool. You also gave me, like an idea. I can just see a student sitting in one of those things you're talking about, but then it almost has like a floating desk so that they could do a lot of, like, fine motor stuff.     Maggie Aschenbrener     Yeah, absolutely. It has something in front of them. So you can do things like you can put a puzzle on there, or you can put, you know, any kind of Magna doodle, or you can put manipulatives on there, you know. And similarly, we use a lot of foam. They have big foam mats that you can put in the pool and different thicknesses. So some give you a lot of movement, and some give you a little bit of movement. So if you think about it, look at that. We've got a dynamic surface to work on right there. So I can do stuff in four point and move it a little bit. So we're working on children writing themselves, and really working on balance things like that. So really just thinking about, that's where the OT comes in. We're just thinking about, how is this? And how are these tools? How do they help with those therapeutic outcomes?     Jayson Davies     That's amazing. You know, I'm going to ask you more about that in a little bit, but you've already alluded to, kind of this brain body connection that that occurs within water. But I want to let you kind of more specifically talk about that, that brain body connection and how that water facilitates it.    Maggie Aschenbrener     Yeah. So well, one of the most amazing things about swimming is you're using when you're actually doing the strokes, is you're using all four quadrants of your body together. And so if you think about your Corvus collosum and midline crossing, which is huge, especially for school based OTS who are working on writing and visual tracking and visual perception when you get all four quadrants of the body working together. So even if you have a student who's not a swimmer, per se, but they have, you know, for our younger students, having a puddle jump around and doing that, paddling, one arm, one arm, and then those feet, one foot, one foot, what are you doing? You're sending those messages across that corpus callosum the whole time and just really activating both sides of their brain, which, as we know as OTs, is exactly what our exercises, when we think about doing exercises before working on that functional skill, lead us to. So just, it's just this natural, amazing place where we can work on different things. Also think about the vestibular system, how easy it is to get a child to flip over and to roll and to try different positions that you might that might be a little bit more difficult on land to do with kids. So     Jayson Davies     Wow. First of all, we're gonna jump into the next question. But for everyone listening, I know you can't see Maggie's face right now, but you can hear it in her voice. She is so excited about this.     Maggie Aschenbrener     I love aquatic therapy, and I also love the fact that as OTs, we can carve our own niche. And so I really one thing I like to at Concordia, like to tell my students is, you know, if you think it and if it's working towards function and therapeutic outcomes, you can do it. And you know, when I started and I had my interest in aquatic therapy, a lot of people told me, Well, isn't that more PT than OT? Isn't that more PT than OT? And it can be, but it also can very much be OT. And I think I found a way to really make meaningful therapeutic sessions and really get some great therapeutic outcomes using the water. So     Jayson Davies     Absolutely,That's awesome, you know. And if people didn't do what they love within the profession, that we wouldn't have things like hippotherapy and sensory integration may not even even have come to play, you know. So, yeah, totally agree. When I was in college, we had to write like an OT program, and I use film. I was a I loved film, and so I wanted to, I haven't implemented it yet, but I wanted to incorporate special education students with general education students using film as the medium to promote social participation and so many other skills. And so you're right, you know, using what we love and bringing that to the table for therapy. Awesome.     Maggie Aschenbrener     Yeah, that's so cool. Yeah, that's a great example, too.     Jayson Davies     Yeah, thanks. So you already talked about, you know, when you're in the water, you a student, anyone is 1/10 the weight, I think is what you said. Was that correct?     Maggie Aschenbrener     Yeah, it's around 1/10 of the weight. I'd have to look up specifics. It's right, it's right around there. I mean, if you, you know, just think about just picking up your kid, like I my 12 year old boy, who I could never lift on land. I could pop him right up, you know. So,     Jayson Davies     Yeah, and so I wanted to lead into that, because, you know, there is a quote, a very common quote, being that water is a great equalizer. And I think that kind of alludes to that. So when you think of that term, water being a great equalizer, what is? What comes to mind for you?     Maggie Aschenbrener     Yeah, I think about that. It allows children who may have different needs to participate with their peers, amongst their peers, and adults, for that matter, as well, to participate amongst their peers and feel a little bit more equal. So for example, for our young adult group, I did a water aerobics class, and so kids who are in wheelchairs and have decreased balance might be able with support. Well, they were able to, I shouldn't say might be. They were able to get out and with some support from an adult, either hold on to the edge and do some of the different like moves, or have support like at the waist of an adult. Whereas, if they were doing something on land, maybe a yoga class on land, or a Fayette class on land. Their wheelchair is obviously a physical barrier which keeps them physically away from their peers, but they also have, you know, they're strapped in with a belt and at their feet too, so they're not able to get that movement in. So that's one example. Also just if you're thinking about walking and you think about the Viscosity of water. Think about how it helps you with balance. So if you fall in the water, you're not going to fall to the ground. You're going to have this slow movement, and you're going to have this pushback, of which really helps with proprioception. Thinking about like, Okay, where is my body in space? I'm falling this way, or I'm tipping this way a little bit, but I can really feel that. So I'm going to write myself. And so it really helped us with balance. So if you think about walking and any kind of participation, even I would have kids, we had a bench in our pool, which was pretty amazing. And so those kids with lower body awareness, if you had them do something where their elbows and arms were supported a little bit by the water, floating on the water and doing a bilateral task, it really assisted with that as well.     Jayson Davies     Wow. You know, you every time I'm about to ask you a question, you just kind of alluded to it, but I wanted to talk about sensory supports, and you talked about that proprioception. You know, you do get so much more feedback when you're in the water. You weigh less, and you also get more feedback, apparently. But I want to give you the opportunity to dive even more into a little bit of that sensory support you've already alluded to a lot, but feel free to add more.     Maggie Aschenbrener     Yeah, and I mean, think about as OTs, how often we try to simulate deep pressure, whether it's wearing a, you know, a tight Under Armor shirt, or whether it's putting a compression vest on when you go into the water, you've got that automatic compression. It really is that calming feeling. Also, for those students who could go underwater independently, think about that auditory deprivation. There are not sounds underwater. So a lot of our kids with autism just loved to go under the water and just be little fish under the water because it just cut out the rest of the world. Another great thing, it was for our Crashers, those kids who just like to crash and jump in, jump in, jump in. I had students that I in order to prepare them for the afternoon, and being able to sit still during the afternoon just can be really hard for some of our kids, who've been holding it together all morning long in class, just do some crashing. And I would incorporate academics as well. So I did a lot of my my items come from the dollar store because, you know, we're school based, OTs, we don't have huge budgets. So I would get I one thing I remember specifically was, I took a foam sheet, which are great in the water, because they don't, you know, they don't get ruined like a regular pizza, and I wrote the alphabet, uppercase alphabet, on it, and then wrote with Sharpie on those glass stones that you can get at the dollar store, the uppercase alphabet. So he'd have to crash in, go to the bottom of the pool, the letter, bring it back. And I, of course, you know, we do that tender loving sabotage, where we pull it a little bit out of the water. So then he also has to use his whole body to pull himself out of the water. That's a lot of work, as we know as adults who maybe aren't as in as good of shape as we used to be, so pulling himself all the way out of the water, matching that letter, and then jumping back in. And you really, what I really found through time is you can ask teachers what they're working on. You can ask like, what sight words are you working on? What math problems are you working on? What things so when you have these sensory breaks, quote, unquote, they're still getting academic pieces in it.    Jayson Davies     Wow. You know, as I listen to you, a lot of memories are coming back to me from from therapists who provide sensory integration therapy. And you know, we haven't talked about swinging, but we've talked about crashing, we've talked about proprioception, we've talked a lot about just understanding your body in space. And so I see a lot of similarities. So thank you so much for sharing that.     Maggie Aschenbrener     Yeah, and you know, it's funny that you bring up swinging, because linear movement can be so calming. And so instead of swinging in the water, I call it swishing and just taking a child back and forth, side to side, back and forth. And it's again, with that, you know, reduced body weight. It's really easy to do that linear movement in the water as well. So just, you know, and a lot of times to make it more child centered, just adding music to it. So, you know, like, what was the song about? The mouse going up the clock and the clock striking one? So having, yeah, be the clock going across and dinging at the you know, so just using, you know, what we know as Pete's therapist, and bringing it to the water.     Jayson Davies     Yeah, and, I mean, there's so many other opportunities for for vestibular input. I mean, it sounds like you've had kids that just want to jump in. I mean, that's a ton of vestibular input, running, jumping in, or whatever that. And then you also talked earlier about that floating mat and trying to balance with a floating mat. I mean, that's very similar to, like a platform swing, trying to remain on a platform swing while it's going back and forth or whatnot. So so many similarities.     Maggie Aschenbrener     Yeah, and even like thinking about like in the water when you, I don't know if you and your little guy have done swimming lessons yet, but when you start with those, parent, child, swim class, swim lessons, a lot of things. One of the first things they have you do is you kind of crunch them up on the wall, and then you do these blast offs where they shoot themselves back. So think about those integrated reflexes and those movements where you go from going all the way in and then all the way out. So it's just really, there's a lot of things that you're like, oh, this happens so naturally in the pool, and it relates so much to OT. So just applying that, like, Huh? I did this with my kids at their scoring lessons. But guess what I'm gonna do? I'm gonna bring this because I know what else it's doing because of my ot background.     Jayson Davies     Absolutely,  absolutely. All right, I've got one more question for you, and then we're going to take a quick break. But I think we've actually talked about this on the podcast before, that one of the leading causes of children with autism is drowning, and I know there has been some research about that. Obviously, at school based OTs, we do work with a lot of kids who have autism, and we also work with a lot of kids who have other disabilities. So how do you just provide and monitor that safety awareness throughout the sessions? And I'm actually going to add to this just a little bit. Do you have non OTS working with you in these sessions, and what role do they play also in this safety?    Maggie Aschenbrener     Sure, one thing that I am really strict about, especially when I'm doing my group sessions, is, if I don't feel safe with the staff to student ratio, which was usually one to one or two to one, we would have to do something like breaking the group in half and doing it in two sessions. Because, you know, I know when you're maybe doing a handwriting session or a yoga session, sometimes they're like, oh, this group is a little big. And, you know, I don't know if they're gonna get the best outcome from the size of this group, but in the water, it's an absolute NO. If it feels like it's too much, then it's it's just not happening. And so another thing that I do is routine, routine, routine. With my early childhood kids, we had them line up right outside of the door. They put their proper flotation devices on, and then they walked hand in hand to the side of the pool. And then we had this very strong routine where we would do body awareness things with sponges, and then they would stand up and be a tree. So just really training them through routine, which all kids crave so much, and then also thinking about the using the proper flotation devices, as well as knowing, you know what we're using those flotation devices for. So for example, water wings aren't the safest safety device. That's redundant, but they're not the safest flotation device.     Jayson Davies     There we go.     Maggie Aschenbrener     Because if you think about it, a kid without core strength can drown with two water wings on. But think about that head going down and those arms being up, right?     Jayson Davies     Yep.     Maggie Aschenbrener     But what we do use is we do use one to one therapist to child with water wings, because they do provide a little bit of flotation. There's that one to one to keep them up. And think about that shoulder stability and shoulder strengthening that you need to use water wings. So we're using those as a therapeutic device. So really having proper flotation devices, knowing what they should be using, used for routine and having that adult proper ratio is, was really the way that I kept things safe.    Jayson Davies     Absolutely and, you know, just just like everything we do, trying to find that just right challenge, right? You know, we don't want to give them too much support, make it too easy, and we don't want them to drown. So finding that just right support, where they're activating their core, whatever it might be, whatever we're working on and giving them that support that they need, but not too much. So, right?     Maggie Aschenbrener     Exactly.     Jayson Davies     Awesome. Well, Maggie, I am loving this conversation thus far, if you can't tell already, but we're going to take a quick break, and when we come back, we're going to dive into the assessment process and then also maybe a little bit about what a typical session might look like. So stay tuned. All right. Well, let's continue on, and let's kind of go about this in a case study, I want you to think of a student that's memorable for you, and we're going to dive through kind of that assessment process. What you kind of did, you know what those sessions look like, and maybe talk about some outcomes. So starting at the top, an assessment. What did an assessment look like for a kid that maybe you remember? How did you decide yes, aquatic therapy, based upon your assessment, is the right way to go?    Maggie Aschenbrener     Well, like I said, it's an augmentative therapy. So I'd already done the traditional evaluations and the traditional goal writing, so really looking at their function. And then I would think about the student as a whole and what their deficits were, and then think about, okay, can water help support this? So again, really thinking about water as the medium to get to those therapeutic outcomes. Specifically, I think of a kid, a little buddy. He was an early childhood student, and he Had just really low body awareness. He did not like to be around his peers. So if we were doing circle time or music group, he just wanted to be across the room. And he would kind of one of those kids who was kind of listening from the corner, and you could tell he was listening, but his sensory system was just could not be near the group, near that noise, everything. So I thought, okay, the water might be a really good way, because he'd have deep pressure all the time. It would help with body awareness. But it turns out he was very fearful of the water, and so, you know, it created a huge barrier, as we often see in OT we have all these different barriers, and our job is to overcome them. So what we did was, while the rest of the group was working in the water on our early childhood group session, I brought in just a tub of water to put in front of him, so just one of those Sterilite containers that you could get at Walmart or the Dollar Store wherever, and I put those toys in to that they were working with in the group, into his little bins so they could, he could hear and see over there they were working with the turtles today. They had the numbers on them, and so he would have those over there, and he could kind of touch the water and be a part of it. And so he was thinking about and he was taking his time, and he was doing it on his own time. So that was great. So we did a few weeks like that. And then I went and I got one of those small backyard pools, those plastic backyard pools, and I put about two inches of water in it, and we put him in there. And then we started working there with different tools. And like I said, we wanted to be inclusive, so really trying to get him to do and modeling those fun activities that they were doing in the pool, and then putting a little bit more water, a little bit more water not and kind of stealthily sneaking in a little closer to the pool every week. And then finally, we just kind of tried it, and we didn't force it. We held them really tight, because a lot of times when kids have sensory challenges, especially challenges with not gravitational insecurity, not having that anchor in the water, can be hard. So just really holding him and showing him what they were doing. And then as time, as time went on, he started participating. So he started to do the activities that we were doing, the wall walks and the activities. And eventually, with flotation devices, he would let us go across the pool and do those activities. So eventually he was totally integrated to the therapeutic activities that they were doing as a class. And it certainly took time, but he did it on his own time. And as we know as OTs, that's a pretty amazing thing. So that's a specific just success story that I just really love, and we had to get creative. So I like the ones where you have to think really hard on and so it was, it was great. It ended up being a great situation for this particular student.     Jayson Davies     Yeah, that is a great example grading an activity for an autistic student to get him fully included. Now I want to ask you, just because this is augmentative therapy, right? So you talked a lot about what you might have done or what you did do with the student in that pool setting. Were you also seeing the student then more in the classroom setting, or was another therapist seeing the student in a classroom setting, and what did that look like?     Maggie Aschenbrener     Yeah, those were all children who were on my caseload. So they had that group time in the water. But then they also, we also saw them in the classroom, whether it was we practiced different models. I was very incorporated into the classroom. So we did a music and movement group. We did traditional one to one therapy in the classroom. We did different multidisciplinary stations in the class. So yeah, we the ultimate goal is to make sure that carryover is happening, to make sure, you know, and for that student, particularly, we want participation, which is a huge part of OT we wanted to be able him to be able to participate with the class. And we were working on that participation goal through water and then generalizing it to the classroom.     Jayson Davies     That's awesome. I love that we're gonna, we're gonna kind of wrap this up before we dive into, you know, sharing with with other OTS what they might be able to do if they want to get started in this. But one of the things that I see that we as an OT profession, we as a related service profession, even not just OTs, but PTS, SLPs, is that we're not always great at measuring our successes on a larger scale. We don't do the best program monitoring. And so I want to ask you is, did you have any opportunities to kind of really grade this on a larger scale at all? Like, you know, saying when we're using aquatic therapy, we're seeing that students are reaching their goals more frequently. Have you had the opportunity to do that at all?     Maggie Aschenbrener     Yeah, you know, that's a good question. I feel like it was so incorporated into the curriculum for early childhood that it was just part of what they were doing and just Overall, we would see these things, and it was more anecdotal. For the older kids, you know, we would have different things, like parent report and so like, oh my gosh, I love how they're doing this. For example, I had a student, since we had benches in the pools, we could work on transfers in the water, which was really great. And so parent report things like that. One thing that I did measure specifically was I was looking at fitness levels of adolescents with and young adults with special needs. So in Wisconsin, we go up to 21 in the schools, where you could, you can be in the schools until 21 and so I did have students measure how they felt before exercise and then how they felt after exercise. So on a scale of one to 10, we had them do comments and self report, and then that one to 10 scale. And we did see some slight improvements. One thing that we did, you know, when you do research and when you're looking at things, there's always kind of those outliers. And one thing that we noticed was students who weren't used to normal exercise. You know, when you get that feeling, when you're exercising and your heart starts to pump and you know, you're working hard, since it was an unfamiliar feeling, they weren't sure that they liked that. And so even though they were doing something that was good for their body, they thought, this is unfamiliar, and I'm a bit uncomfortable with that. So we did see some students who went down afterwards because, you know, and we had to really talk them through, like, okay, but that's what happens when you work hard, and that's what it you know, fitness is, is about, and so just getting them used to being able to talk them through that. So that was an example of something that was measurable that we did, and we did see some good outcomes with that     Jayson Davies     Awesome i love that you just even thought about to do that, because that is something that, just as a profession, I don't feel like we are the best at doing. You know, we we often see our individual students make progress, but we never, kind of put it all together to show that as a whole, we are supporting all the students, or just in general, that our entire school, our entire program, is supporting students. So that's great that you even had the wherewithal to go ahead and and do that.     Maggie Aschenbrener     Yeah, and I think some, some of the things that's things that are challenging about research is like, if I looked at two aquatic or two EC classes, because we did have morning and afternoon classes, if we wanted to really compare the rates, then one group would have had to not get aquatic therapy. And so that's one of those things too, where you're like, oh, you know. And as you know, we're, you know, kind of stretched for time in school. And so it's like, okay, yeah, we could do it, but it would just when you're in the clinician mode. You it's sometimes you forget about that research portion, and now that I moved to academia, I'm like, Oh, that is so important. That's so important. We need more research backing this up. But when you're in the moment of like, as a clinician, I think sometimes you're like, Okay, I'm just going to meet my I want to meet my minutes, and I want to get the most bang for my buck. I want to do the best things I can in the little amount of time I have. And so you get, you move away from that research piece a little bit.     Jayson Davies     Yeah, you know. And I did have a, I took a course with Dr Roseanne Schaaf, and right now she is huge on talking about data, data driven decision making. Dddm, is what she calls it, and that just that ability to create our own research, even as a clinician, that as long as we are showing you know what this was the assessment piece, this is what I said I was going to do. I did it this way, and then we had positive outcomes. And doing that, you are creating your own research that way You can go back to that IEP, and you can say, this is what I did that facilitated these goals. And once you've done that, you've shown that whatever you did, it worked for that one student. It may not work for another student, but you have data that shows that it works for that single student. So, yeah, I think we all need to do that a little bit more. And I think we also need to advocate for ourselves. You know, just the the time that that does take, we need to get that you know, we are professionals. We need planning time, just like anyone else in the world does. So, yeah, yeah. All right, go ahead.     Maggie Aschenbrener     I was just gonna say another cool thing that I saw throughout my time there was the carry over into occupation as a family member, because one thing the water did do was give students the opportunity when you're used to it and when you're comfortable with it and you love it, well, in the summertime, you can go to the community pool together. Or I even had one student who had a pool in her backyard, so I went and I did a session at her house with her mom, so she her mom could see, okay, this is what I'm doing, and this is some of the stuff I can carry over. Carry Over in the summer. So some of that carry over into occupations at other occupations was pretty amazing and exciting as well. And I recently, I will give you the article or the link to the article, so you can post it if you want. But there was one study that I just looked at with. Individuals with autism and swimming, just in general, but just how it was a great way for them to participate in a typical close up family activity. So that is, you know, I to me when we can even go beyond that, yes, we're working on those school goals, but when you can see even greater outcomes, it's really cool.     Jayson Davies     Absolutely, and that's what I love, right? Things that aren't just we can only create so many goals on an IEP, right? But a lot of times when we work on those goals, we see just development, facilitation, progress in so many other areas. So that's that's awesome, that you're able to see that.    Maggie Aschenbrener     Right? And if we're looking at those quality of life aspects, if you're just in general, expanding and improving quality of life. To me, that's so important.     Jayson Davies     Yeah, all right, so now I know for a fact that not every occupational therapist, occupational therapy assistant listening to this podcast episode has a heated pool at elementary school, middle school and high school. But for anyone listening out there that you know may just want to dip their toe in the water and, you know, maybe reach out to an administrator or try this a little bit, what are some recommendations that you have for them?     Maggie Aschenbrener     Well, I will say that one thing that's great is there has been more and more research. So start with the evidence. When I got my master's in, I graduated with my master's in 2010 there was a lot less research. So in just in the past 12 years, now I'm working on my doctorate, there's so much more research. So bring that evidence in and say, like, look what we're able to do. And we, if you have a school pool, we have this tool, so let's use this and even start with supporting inclusively. So if a student as part of their gym unit, if they have a swimming unit, say, You know what, I'm going to take my student in to the pool, I'm going to be with them in the pool, so we can see how they can participate along with their classroom for gym. Because it is, it can be really inclusive. It's not just that particular school that I was in. So you can do those things. And you know, also, it is a niche, and like, not everybody wants to get in the water. Like to me, I think, well, why wouldn't you want to? But if you have that want, just know, like, maybe other people don't want to. Yes, that's me totally mad. Yeah. So, you know, think about like, even though you think that this, to me, is the best and most exciting thing in the world, you might be one of few people who want to get into a swimming suit at work. So you can raise your hand and say, Hey, I'm willing to do it if nobody else wants to. And then go ahead and expand and create from there. When you have, you know, outcomes that you can show people, and once people start to see it does become contagious. You know, I had some speech pathologists that I really kind of had to convince to get into the water. But when once I had them convinced, they were sold. And so really just using that, just start with that little seed and then grow it.    Jayson Davies     100% and you know, also, for some of you out there, you know you love school based OT, but maybe you're also thinking that you want to do something else. And if you love water, there's a lot of people that are starting niche type of businesses, and I could imagine this aquatic occupational therapy being a potential business that your area needs. And just like a clinic might, there might be options for you to actually be a contractor for a school district and still provide some services for that school district, but at your clinic after school, or whatever it might be, or you just see private clinic or private clients whenever you want. So just don't feel limited because you're school based OT, that you can't do this there. You might be able to do it at school based OT, or you might be able to find a route to do it elsewhere,     Maggie Aschenbrener     Right? And, you know, one thing, because I have done things outside of school on my own too, and I will say that having the summer off as a school based therapist, you know, I've done hippotherapy, I've done aquatic therapy. So really thinking about, like, okay, you know, how can I make this work? You know, being a school based therapist during the school year, and then I have this extra time in the summer, and so I can kind of spread my wings and maybe try things, and then bring those ideas back to the school. And, you know, it's just a matter of having an idea, getting some insurance to cover your small business, and then going from there. So, and it's, I mean, I've done it. And paperwork isn't something I totally love, but you work through all the billing stuff, and you get through that. So you just, you do. And I actually hired somebody else to help with, like insurance billing for hippotherapy. So, you know, things like that, just getting creative. Like, I know I'm good at this, but billing insurance like might not be my strong suit, so I'm going to hire somebody to help me do that in the beginning and then teach me. So there are ways. I guess my point is, there are ways to get things done and to meet your own personal goals as well.  Absolutely. Maggie, I love everything that we've talked about today. I want to give give you the opportunity to share your information for anyone who is just super excited about aquatic therapy, and maybe they want to reach out to you or find more about you. Where can they go to learn more about you? Well, I have an email address, a private email address, so I can give you the link if you want to post that, and I guess that would be it. I don't have any kind of podcast, any website, anything like that, not yet. But I anybody with questions. As you can see, I'm really passionate about aquatic therapy, and I'm also really passionate about helping people who are in the beginning stages of OT. Love ot as much as I do. So if you have questions or you even just want to chat about aquatic therapy, feel free to email me and reach out to me.     Jayson Davies     Sounds fantastic. Thank you so much for sharing all that you did today about aquatic therapy. Really looking forward to a just learning more from you. You know, from now until the rest of time, but also just, I know that we're going to receive emails myself and you are going to receive emails from people that listen to this podcast today and started, started using aquatic therapy to augment their regular therapy. I'm excited to hear emails like that from people. It's going to be awesome. And yeah, just thank you so much for being here today.     Maggie Aschenbrener     Thank you so much. It was my pleasure    Jayson Davies     one more time. Thank you so much to Maggie for coming on the show and sharing about how she uses aquatic therapy to augment her everyday school based occupational therapy within the schools. Really appreciate you all listening in and let me know what you thought about this episode. Hit me up on Instagram or Twitter at otschoolhouse com. I would love to hear if you think maybe you can implement some aquatic therapy in your school setting. I'd love to hear more from you, and yeah until the next episode, take care and I will see you next time.    Amazing Narrator     Thank you for listening to the otschoolhouse podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners! 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 125 of the OT Schoolhouse Podcast. How much do you really know about dyslexia? Join us as we explore this often-misunderstood learning disorder. Jayson and Penny dive into the importance of evaluation, therapy, and the crucial support needed for teachers and students facing dyslexia. Tune in to learn more! Listen now to learn the following objectives: Learners will identify the ties between dyslexia and mental health . Learners will identify what dyslexia is and the common misconceptions . Learners will identify effective teaching strategies for supporting students with dyslexia in the classroom . Want to Earn CEUs for listing to this episode? Members of the OT Schoolhouse Collaborative can earn professional development by listening to this episode of the OT Schoolhouse Podcast and others. Join the OT Schoolhouse Collaborative to earn professional development from the OT Schoolhouse Podcast and get support as a school-based OT practitioner. Guest Bio Penny Stack, OTD, OTR/L, CLT, has over 30 years of experience as an occupational therapist, which includes working with children who have special learning needs. Penny is certified in Handwriting Without Tears, has a master’s in Occupational Therapy from Samuel Merritt College, and a doctorate degree in Occupational Therapy from Loma Linda University. Her research on closed-head injuries and cognitive retraining has been published in the Brain Injury Journal. Penny’s current research is entitled, Dyslexia and Its Impact on Occupation: The lived experience. Quotes “So as occupational therapists and teachers and people who support and work with children, we have something that really is unique to us, and that is the skill of observation, and it's powerful” - Penny Stack, OTD, OTR/L, CLT “It sounds like dyslexia is a symptom of a problem, not the actual problem itself." - Jayson Davies, M.A., OTR/L “They have the ability, but their performance is much lower than their ability, that gap. That's the dyslexia” - Penny Stack, OTD, OTR/L, CLT “If they have a specific learning disability, they fall under an IEP with that category, the likelihood of them having dyslexia is most likely pretty high” -Penny stack, OTD, OTR/L, CLT Resources Dyslexia RX DTVP- A:2 Developmental Test of Visual Processing Skills BERRY VMI -Visual-Motor Integration The Woodcock-Johnson Test of Cognitive Abilities CTOPP -The Comprehensive Test of Phonological Processing GORT - The Gray Oral Reading Test Jordan Left-Right Reversal Test TIPS - Test for Information Processing Skills Episode Transcript Expand to view the full episode transcript. Jayson Davies     In school based occupational therapy, we often talk about dysgraphia and how that impacts students. But what about the other dy S word common in the educational world? I'm talking about dyslexia. Today we are chatting with occupational therapist and founder of dyslexia RX Penny stack. Penny found her way into dyslexia through a personal story, which she will share with us in just a moment. But now she specializes in supporting individuals of all ages who have dyslexia. Today, Penny is here to help us understand the complexity of dysgraphia as a learning disorder, the importance of a proper evaluation and strategies for supporting students who have dysgraphia, as well as strategies for the teachers who help support those students. And before we jump into our chat with Penny, I wanted to let you know that members of the OT schoolhouse collaborative can earn one hour of professional development by listening to this episode, just after listening head into the podcast base and take the episode quiz for this episode. If you're not yet an OG schoolhouse collaborative member, I invite you to check it out at OTSchoolHouse.com slash collab. As a member you get access to live and recorded professional development. In addition to resources, research, live group mentorship hours with myself and a supportive community of school based OT practitioners. You also of course, get access to professional development by listening to the OT schoolhouse podcast. Learn more about OT school house collaborative at OTSchoolHouse.com slash collab or by checking out the link in the show notes. All right, now let's go ahead and Cue the intro. And when we come back, it's all about dyslexia with Penny stack.    Amazing Narrator     Hello, and welcome to the OT schoolhouse podcast, your source for school based occupational therapy, tips, interviews and professional development. Now to get the conversation started. Here's your host, Jayson Davies, glass is officially in session.    Jayson Davies     Penny, welcome to the OT SchoolHouse podcast. How are you doing today?     Penny Stack     I'm doing great, Jayson, thanks for having me.     Jayson Davies     Yeah, wonderful. It is such a pleasure to have you. You know, when it comes to occupational therapy, a lot of people think about dysgraphia. But there's another learning disability that OTs can support. And that is dyslexia. And that's what we're here to talk about today. And as we dive into that, I just want to give you a moment to first kind of share a little bit about your background as an occupational therapist, and how you got to where you are today.     Penny Stack     Sure, I appreciate that. So I've been an OT for about a little over 33 years, give or take. And when I started out in practice, I did not even know what dyslexia was, and certainly was not my area of expertise, my areas of expertise was working with traumatic brain injury. And then just like many other OTs, I've worked in a variety of settings, including school systems. So it wasn't until I had my daughter, and we started realizing that she had dyslexia and again, never thought I heard of the word until she was diagnosed. To be honest. I started asking my colleagues speech therapist OTs, hey, what do you do to treat dyslexia? And the number one? Well, two, number two answers, I got the most frequent answers were we don't? And I said, Well, who do you refer to? I don't know, like they had, there was no context. And so I did what a lot of moms do, and just brought her to a variety of after school, academic programs, tutoring, things of that nature. And when I realized that her changes weren't permanent, and I was spending 1000s of dollars. I mean, I was taking out loans at this point to provide sparring for her, I remembered that I was an OT. And I say that tongue in cheek, because I think as parents, we focus on being the mom or the dad or the caregiver. And sometimes we forget what we do for a living.  Yeah.  And we're in panic mode, right? We just don't want to see your child suffer. So I thought, well, let me try something. I have an area of expertise in traumatic brain injury, let me kind of think about it in that context. And I in my head, I had to take away the dyslexia diagnosis. And I thought, what if she came to me with a traumatic brain injury? What would I do? And so I just turned into OT mode and start looking at her executive cognitive function. I started treating that and lo and behold, I saw progress. Why? Because the brain has plasticity and is huge lightbulb moment. So that's how it all started. I am the founder of dyslexia center of Tulsa and the Educate to advocate podcast which I successfully sold last year. And during that time, during those 12 ish years, I worked with individuals, the youngest was four oldest was 64, and helping them with dyslexia and no one really thinks of OT when they think of dyslexia, they think of teachers or reading specialists, or dyslexia specialists and I know we're going to get more into the role of Ota in a little bit. So that's what I was doing. And then after I sold, I was like just riding the wave of having some free time thinking, Oh, this is great, you know, and but then I had this nagging thought and that was that whole mental health side of dyslexia, and the prevalence rate of suicide, anxiety and depression, and then I launched dyslexia RX, because now that is what I am addressing. And so that's kind of I think it found me more than I found it.    Jayson Davies     Yeah, definitely sounds like it. So how's your daughter doing? I'm assuming she's thriving in the world today.    Penny Stack     That is a great question. And I do want to say this, because I knew this is going out as a podcast. But when my daughter was growing up, I never spoke about her or put her on social media or referenced her. But now that she is an adult, I do have her permission to share her story. And I just, I always feel like obligated to let people know I'm just not talking to my daughter, like she's aware. So I remember I think my when I hit rock bottom, sitting at the bottom of my stairs, crying, wondering if she was ever going to be able to take care of herself. I'm talking minimum wage job. Just getting by I was in sheer panic. And I say that because a lot of parents feel that but will not express that because they feel like a failure. Now I can honestly say she's a junior in college. She is majoring let me see if I get the major she changes all the time. So let's see if I can get this right. Something, I think, a minor in Religion, organizational leadership and Women's Studies, she'd like to work for profit. That's really where her heart is. And I am really a proud mom to say she's never failed a college class. And I say that because I have failed many college classes, right? So I just like I, I have so much respect for her. She's done really well on our society sorority working volunteer hours. I don't know whose kid she is. But I am just so pleasantly pleased. And as much as I'm proud of her, I also share that story because it is possible, it is possible to have dyslexia and be very successful.     Jayson Davies     That's great. That's great to hear. Thank you for sharing that story. It's so nice to hear those good stories. So as I kind of alluded to a moment ago, we're here to talk about dyslexia. And when it comes to an IEP, there's a specific learning disability. That's what most of our kids have as their primary qualification for for an IEP, especially with dyslexia. But before we dive into those specifics of the IEP, I just want to ask you for kind of that working definition for dyslexia, as we're going to talk about it today. And this could be the DSM version, this could be your version, I just want to hear how you kind of put together dyslexia.    Penny Stack     So I know this is audio only, but you can see me smiling, almost breaking out into laughter because that is the golden question. There is no standardized definition for dyslexia. With that said, there's also no standardization for what needs to be tested or how it needs to be tested, which I think leads to a lot of confusion, the International Dyslexia Association, and Dr. Sally Shaywitz, with Nielsen her for creativity and dyslexia, they both referenced dyslexia to be a language processing disorder. So then what the heck is OTs doing in the mix? Right? And we'll get back to that, because I know that's the big question here. And my definition of dyslexia, it's a, it's a snowflake, it is different, and everybody characteristics are very different. But to me, dyslexia is not about reading. And I want everybody to just sit with that uncomfortableness for a minute. Dyslexia is not about reading. And I used to be terrified to say that out loud, to be honest with you. And I say that, because when you look at all the dyslexia programs that are out there, they are mostly developed by educators. And none of them address executive cognitive function or everything else that goes into dyslexia. But yet, when you look at the research behind it, it's in there. And so the question we ask ourselves is, why is that not addressed? Why? Because educators are the first ones to really see that children are having difficulty with reading. So they're staying in their wheelhouse in their lane, and they're specializing programs that will accentuate reading, which is the exact thing to do. However, it's really important to understand that when we have a child coming to us with dyslexia, if we assume it's just about reading, we miss 90% of what we can do to treat. And so to me, when I think about dyslexia, what is dyslexia? I think about the whole person, I think about dyslexia as being something that defines a path someone might take it Is this big reason why people make choices about occupations they engaged in, and I'm not talking about a job, but maybe leisure activities they want to do or hobbies, they will steer away from one thing because maybe of shame or feeling that they can't do something. And to me, that's what dyslexia is. If we think dyslexia, it's just about reading, and we only treat reading, and we make the assumption that reading will make everything better, we have really missed servicing the person.    Jayson Davies     Wow, thank you for sharing that I actually want to kind of chime in with my own little story. Now, I'm not going to self diagnose myself as having dyslexia dysgraphia. Anything else, but part of the reason that I actually have a podcast as opposed to, you know, writing a blog every week or every other week is because for me, writing, typing, putting my words onto paper, or some sort of, you know, visual system is hard for me, I'm much better at talking, I prefer talking. And so that's kind of why I went the route of a podcast as opposed to a blog several years ago. And when I think about that, and what you just said, it almost sounds like dyslexia is a symptom of a problem, not the actual problem itself. And I'd love to let you chime in on that?    Penny Stack     Bingo, I could not have said that better, myself. So it's an iceberg. We've all seen that image of an iceberg. difficulty reading on top, you look below the water, and there's like a gazillion things under the water. And that's exactly what's happening. So challenges with reading or spelling, those are symptoms. That is not the why, let me give you a really easy example. So some people with dyslexia may have difficulty putting letters in the correct order when they spell a sight word. Or they may have difficulty remembering what they're reading. More times than not. If you peel that onion layer back, you may find deficits and visual memory, or spatial awareness. Or you may find sensory issues that they have going on, or lack of integration of primitive reflexes. There's always a why. And what many of the reading programs do is instead of addressing the why they get right into the phonics of it all, which is a very high level executive cognitive function. But if we don't peel that onion, layer back and look at visual memory, all the different visual perceptual skills, auditory processing, are they integrated, other reflexes? Do they have sensory issues? Is their core strength, okay? Like all these things need to our ability to do this high level function? If we do not look into that, then we're leaving a lot on the table that absolute should be getting addressed.     Jayson Davies     Wow. So then when you have a teacher, a parent, someone who cares for a child coming to you? What are some of those key things you're you're looking for when they're describing their child? You know, and they think that their child has dyslexia? What are you trying to tease out a little bit? What are you trying to hear from them?    Penny Stack     Great, great question. So I think that's where the list of symptoms come into play or the list of characteristics. It's almost like a checklist. So you think about somebody that may have a fractured bone, you look at their x ray, you see the fracture, you see the swelling, you see the deformity of the bone, lack of ability to move a lack of strength. So with dyslexia, it's not that clear cut. And you can have two people with this with the same, the same, they present the same meaning their grades are low, and they have difficulty spelling, but their characteristics could be completely different. So what I am looking for the most no matter what story the parents shares with us, is the fact that it doesn't connect. For example, you can have difficulty with word retrieval, but that doesn't say that you will have difficulty spelling. You could have difficulty with processing speed, but it doesn't say you'll have difficulty with reading comprehension. You can have difficulty with writing, but it doesn't say you'll have difficulty with written expression. So one doesn't lead to another and then the other thing you will always hear is when somebody has dyslexia, after a parent goes down the list of all their concerns. 100% every single parent or caregiver, this is what will come next. But Sally's really smart. That sentence will always be in there. It's not bright. It's not genius. It's not gifted, they use the word smart. And then they will tell you in great detail all the things their child does ever Be Well, and that's when your light bulb goes off and the bell rings, you're like ding, ding, ding, ding, ding. So as occupational therapists and teachers and people who support and work with children, we have something that really is unique to us. And that is the skill of observation. And it's powerful, and being able to pull that out. Because if we have a student who's really, really good at something, but yet this one thing over here, whether it's reading or spelling or comprehending or following directions, but you've got like this little pocket that they are struggling, and they have younger siblings surpassing them. What that tells you is, they have the ability, but their performance is much lower than their ability, that gap. That's the dyslexia and Dr. Sally Shaywitz. Like I cited earlier, she really speaks to this. And there's a lot of research out there that speaks to that. There's also new research coming out saying that may or may not be true, but there's not enough for me to say, Yeah, let's go with that research. It's just I think that research is just emerging, but it's when there's a gap. Now, how is this different from somebody who doesn't have dyslexia? Somebody that doesn't have dyslexia, their story is going to be very different. And what I mean by that, is they're going to be whatever performance level, they they are demonstrating, they are like that across the board. There's nothing in contrast, exceptional to where they're struggling, if they're struggling in one area if they're struggling at all.     Jayson Davies     Gotcha.     Penny Stack     And I think that's when you think about what am I listening for? I'm looking for that difference that that big contrast of ability versus performance.     Jayson Davies     Okay, great. And so now, you know, you're doing a lot with with dyslexia, you're doing evaluations, you're, you have a whole team that works with plenty of kids and adults, it sounds like that have dyslexia. You're an OT, but in a lot of parts of the world. You mentioned right, like teachers are oftentimes the first one is to kind of get that concern. But are there other professionals that are looking into this school psychologist, clinical psychologist, whatever it might be? And then a second part of that question, I guess is, how are they even attempting to diagnose this? Are there tests out there that they use? Or what does that look like?    Penny Stack     First of all, I love that you think I can remember a two part question? I will do my best. Okay.     Jayson Davies     The first part is the people who's who is evaluating dyslexia, that was my fault.     Penny Stack     That's, that's, it's all in good humor, right. And so only a psychologist, clinical psychologist, neuropsychologist can diagnose and I think that's really important, because there are a lot of providers out there such as myself, who can do evaluations, and can screen for dyslexia. But as an occupational therapist, as you know, we cannot provide a medical diagnosis, we can do a treatment diagnosis, but not a medical diagnosis. And clarifying that with parents or families, I think is first and foremost and know what the difference is. So what I always share with parents is I do an in depth evaluation, but I do it to identify areas of concern for treatment, not necessarily for diagnosis. So with that being said, when I started looking at dyslexia, there was not at the time, there was not a lot of research on occupational therapy and dyslexia. And the research I did find, which is pretty much the research I'm finding now as well, is more on the visual perceptual visual motor side. Okay, right. So if you have somebody who has difficulty with letter reversals, testing their spatial awareness, or testing their, like the Jordan left, right, test reversals, those are all really important assessments to do. So. I use a lot of standardized testing. I also have a screener on my website that lists I mean, there's a gazillion questions, there's probably 50 or 60 questions there. And it's looking at their lived experience, because their story, especially with older children, or adults is super important. Because if you have somebody that's had a higher education, they will do well on all your testing. That's true, but it doesn't mean they don't have dyslexia. So I digress, you asked me about testing. Okay. So let me go back. Okay. So for example, I will administer the barre visual motor integration because I want to see how much control they have over their pencil and can they copy? I use the test for visual motor tbps tests for visual motor processing skills TVP.    Jayson Davies     Processing or Yeah, something like that    Penny Stack     short perceptual There we go, sir. Visual tbps for whatever that is, Google it, look it up. Not remember the long name of it. But there's a lot of discussion about that because I know that Barry has a visual perceptual test as well. And the motor and the MVP T is also a visual perceptual test, I've used all of them, let me tell you the why and why not because this is where we get into the weeds with. So I don't use the berry, visual perceptual test, because in my mind, it's a spatial awareness test.     Jayson Davies     Okay.    Penny Stack     When you think about, you're looking at shapes, and you're doing those designs. But what I and I am the MVP at the motor, free visual perceptual test, I think that's what that stands for. It only gives you one overall score, and it doesn't break out each each sub test from a statistical standpoint. So you're having to guess let's say, there's 10, slides on, I don't know, visual closure, you would have to count, they got five out of 10, they got 50%. So it's not very statistically sound to do it that way. I prefer the tbps. Because it looks at visual closure, visual perceptual skill, spatial awareness, visual memory, for your ground, it looks at all of these, and I believe there's a few more, and they give percentile ranks on each of them. So the difference is, let's say, you did the berry, spatial awareness tests, and they scored Fine. How do you know what their visual closure is? Ya know, how do you know your ground is down. And on the MVP T, they have an overall score, let's say they scored in the 30th percentile rank, which is well, with an average check. They're great, no problem. But on the tbps, what if they score in the 30th percentile rank, and maybe their visual closure was in the fourth percentile rank, and their spatial awareness was in the 98th percentile rank. So when you add up all the sub tests, sure, it comes to 30. But you've got this visual closure in the fifth percentile ranks, you could tweet that out. And you can treat just that. I think that's what's so very important when you are looking at evaluation. What's the utility of it? How can you use it, I also use the tests for information processing skills, this looks at short term working memory wanting to and delayed recall, I use the cetop, the Comprehensive Test of phonological processing skills to tease out phonological awareness, phonological memory. And this is a great assessment for speech therapy as well. I do the scan three auditory screener. What I love about it is it's a standardized screener. Anybody can do teachers can do this OTs, any discipline. Now, just to be clear, only an audiologist can diagnose auditory processing disorder and speech therapist, it's in their domain of practice to treat it. But as OTs we can screen for it. And so why do we screen for it? Because when we have a client that and we're student and I'm sure you guys, you know, everyone's listening to this can relate to it, you ask a child, you know, go pet the cat, and you look around, and they're grabbing their hat. They're just not processing the sound, it's not auditory acuity, can they hear it, they may not be able to process blending sounds correctly. And, and so screening for that auditory processing is really important. I will say with that, though, it is very rare auditory processing is only two to 3% of the population. And if you have dyslexia can go up to 5%. But boy, if you miss it, that kid can be on years of services without any progress or very limited progress and be very frustrated. So it is really important to catch even though it's its prevalence rate is very low.    Jayson Davies     Gotcha. Gotcha. You know, I loved how you talk about finding evaluations that are actually looking at what we want to look at, you know, when I use the Rab Mo, which is similar to the VMI. You know, I try and look at the visual motor integration part. And compare that to the visual spatial part. Yeah, but that one's very similar to the VMI. In the sense that, like you said, you're not looking at closure, you're not looking at some of the other fine tuned, I guess you could call it skills that are really involved with visual processing. And that's why I tend to like the D TVP, developmental test of visual processing skills. And they have one for adults, one for adolescents and kids. But that one, like you kind of mentioned, it gave me more information than just overall processing. I really liked when my school psychologists use the VMI, because then they're kind of able to say, Okay, thanks, something's up. Now, I'm going to pass this over to the OT to do a little bit more go more in depth with some of those. Those tests that can be a little bit more specialized, I guess you can call it so. Yeah, that that's great. Thanks for sharing so many of the actual assessments that you use.    Penny Stack     You're welcome. i There are a few more but one other one I want to make sure I mentioned is the sensory profile measure. Because it's really important that we consider what's going on in their environment especially. I mean Kids are not the same as kids were 2030 years ago, we have COVID, which really changed how children develop. We have children, we have technology, which really changes how much children spend time outside and playing. And so I really take a look at that to see if it's an issue of sensory issues or just lack of opportunity. Because again, if we don't address these core foundational skills, that higher expectation of reading will be pretty challenging.    Jayson Davies     Absolutely, thanks. Thanks for sharing that. There's always we always have to be sure to look at that sensory profile. For every I don't know, if really, for just about everyone, you know, we all have different sensory profiles. Just the other day, we were talking about how there needs to be a screener if there isn't one already, to give to like teachers so that they can even better understand their own sensory preferences and whatnot. So yeah. Now, staying kind of on the lines of sensory integration, sensory processing. I know from my training within sensory integration, that there tends to be profiles, like there's Vbi, s, vestibular bilateral integration, and there's a few others within just Lexia, do you tend to see some of those patterns kind of emerge? Through all the evaluations that you've done? Are there few particular skill sets that you tend to kind of see maybe even paired with another one?     Penny Stack     Okay, you're gonna love this answer, why did not prepare you for this answer? Okay. So my area of expertise of clinical expertise is dyslexia. I do know that all of these other components make us up to be able to perform. However, I am not a pediatric therapist, to me, they're very different. And so I administer the sensory profile measure. And if they if the child's indicating that they have deficits in any of the areas, I immediately turn the parent around and refer them to a pediatric outpatient clinic or somebody that specializes in treating sensory processing, because that's about as far as my skill set can go. It's just, it's just something that I've chosen to really dive into dyslexia and understand it well. And I think that leads me into the other part that I know we're getting to, but we may, we might just jump into it is the team.     Jayson Davies     Yeah.     Penny Stack     So I do what I do, and I do it well, but that's all I can do. And I've done that with intention. And so if I have a child who needs help with phonological awareness, or associating sound with a letter, I don't even try to address that we have a speech therapist on our team who will work with them. Or if they aren't on my team, I'll refer out for example, I have a play therapist that I collaborate with, that helps me with a lot of behaviors, and just that communication between parent and child. So even though I may test or screen for something, and I think this is really important to share. I think as OTs we tend to think we have to do it all or be experts in it all, because that's we're taught as generalist, but I really believe it's okay. To say you don't know, like, it is totally a and preferred if you really don't know. And in that case, if you know it's not an area of interest of yours, or that it's not your area of expertise, then the best thing to do is develop that team around you in your community. Who can you refer to? Who can you connect with? And so that's pretty much how I've set that up. So back to your sensory question. I don't even know the phrase that you use, like, I don't even know what that is. So that's how.    Jayson Davies     I think what I was trying to I was trying to use that as an example a little bit, but just in when you've done hundreds, if not more evaluations and therapy for students who have dyslexia? Are there certain patterns that you see within dyslexia even like yes, you know, sometimes you might see high visual motor, low visual processing or increased fine motor low, something else. Are there any patterns that you come across?    Penny Stack     Yes. Yes. And thank you for reframing that. So years ago, I started collecting data just for my own understanding of what's going on and how things tie together. And when I was testing the primitive survival reflexes, the number one reflex if they were gonna pop positive, was the spinal galon. And what I thought was interesting about that reflex was if your spinal reflex is not integrated, sometimes it can cause issues with with memory, or, you know, bedwetting or you know, a few other things. And what I found interesting was, when I would look at that and on my chart, I kind of kept track of all the things that would be impaired if they tested positive responded law and then I would compare it like cross reference it with a standardized tests that tested that. And lo and behold, every child that was positive on spawnable, on reflex also had impaired visual memory. 100%.     Jayson Davies     Wow.     Penny Stack     So there is a correlation. And I'm going to throw something out there. And it's just this is I really like to make clear what's research, what's my personal bias? And what's my clinical observation. And so I want to be very transparent and share that this is coming from my clinical observation and maybe my personal bias. i Right now, they say the prevalence of dyslexia is one in five. And I'm starting to question that for a couple of reasons. I'm not quite sure if all cases are being tested. Dr. Shaywitz says that 80% of children with a specific learning disability in the school system actually has dyslexia which is undiagnosed. Okay, I don't know how over under its diagnosed, for example, in Texas dyslexia is very recognized. So dyslexia is a prevalent diagnosis in Oklahoma, it's just emerging to be recognized. So most everybody there has ADHD. What with all that aside, when I take a look, when you talk about themes and prevalence and patterns, when I reflect on all the testing I've done, and the test results and the treatment, and I'm so grateful, I don't diagnose because I probably would have misdiagnosed because Lillian kiss, right? I'm grateful, it's not my responsibility. But let's say we have two kids. And they both are behind in their reading, and their spelling and their scores are very low. And I work on both kids because I work on their executive cognitive function, because maybe they're having difficulties with memory or visual perceptual skills or whatever, one child, after I do all that work with executive cognitive function skills may still struggle. But the other child, I work on all their executive cognitive function skills, and they're fine. The readings always I haven't addressed reading at all, and they're fine. So I'm wondering how many of these children are being tested for reading and tested for dyslexia? And because we're only looking at that higher level skill, they're showing a deficit. And no one's really addressing their executive cognitive function, their sensory, their core, their reflexes? No one's addressing all of that. But if that were addressed, how many of them would be fine? Because dyslexia is not curable? Right? And would we have a more accurate number? So that's the question that research or pardon me that I asked that I can't, I can't seem to shake?    Jayson Davies     Yeah, and, you know, research just continues to advance. And I really, I mean, just with time research advance, and with new research becomes or comes new terminology. And, you know, who knows, so many of our diagnoses could be spider web spiderweb, down into several other potential diagnosis and further that we can better understand better explain better given name and, you know, a behavior to that specific diagnosis, the better that we can treat it, you know, in the long term, like you said, to kids same diagnosis, but need a different treatment methodology, potentially. And maybe they just have a complete different diagnosis. So     Penny Stack     Exactly, and when you think about that, this also comes to mind as therapists diagnosis often don't matter, in terms of what we're doing. I remember working in skilled nursing facilities years ago, when everybody had generalized weakness, when one just had a triple bypass, and the other had a total knee replacement, right? And what do we do we treat what we say? Yeah. And I think is OTs, we just really need to come back to some of the fundamentals that we learned in school, and we're just treating the characteristics that we see.    Jayson Davies     Yeah, you know what, let's stay on that because you just kind of talked a little bit about what it might look like in a older population. All of us have school based OTs, we work with IEPs. And, you know, there are 13, if I'm getting this right criteria, that students can qualify for an IEP, that might be slightly different depending on the state that you're in. But dyslexia is not one of them. dysgraphia is not one of them, right? specific learning disability is right. So I'm assuming that dyslexia would fall under that specific learning disability, and just kind of what maybe an OT a school based OT, should they look for something in the IEP to kind of give them an idea that a student has dyslexia or what what should be in an IEP or what should they look for?     Penny Stack     Right, so just to start off, just to clarify the 2015, the assistant secretary of the US Department of Education Office of Special Education and Rehabilitation, wrote a letter. And he went on to say there's nothing in the IDI a that would prohibit the use of the term dyslexia, dyscalculia and dysgraphia. In the IDA evaluation, eligibility determinations, or IEP documents, all right, I'm just throwing that out there because I get a lot of questions. Why don't they say dyslexia? And I have no idea why, because there's nothing written saying they can't, but they won't, is more happening. And so when you're looking at an IEP, I would look for the diagnosis of specific learning disability. Yeah, and I would specifically look at that, because Dr. Sally Shea, which is research shows that 80% of those with that designation have dyslexia. So it's like a swing and a mess, you'll you're probably going to hit the nail on the head more often than not thinking that way. Yes. And if they have a specific learning disability, they fall under an IEP with that category, the likelihood of them having dyslexia is most likely pretty high.    Jayson Davies     That is a great takeaway. Those are two really big tidbits, I had never heard that language from the assistant secretary of US Department of Ed, that's, that's awesome. I love and the type of person who I love, like finding those little details, because those aren't things that like, are in IDA, the law itself. These are things that come out after the fact and they're little tidbits, I always loved those. So thanks for sharing that. And yeah, I think spot on, if you see the specific learning disability in there, that should cue you in to potentially looking more into dyslexia Great. Now, let's dive more into the therapy side of it. I love talking about both therapy for an individual student, as well as more of that communal type of team therapy that you even kind of alluded to before. And so if we are seeing a student individually, and maybe you have to give us a little background on a student before you dive into the therapy, but what does that potentially look like for you for therapy?     Penny Stack     Right. So just like all all of our care, we it's very client centered. And we always need to start there. And I say that because when we see a child that comes to us with dyslexia, we always assume, Oh, we need to teach them to read, here's the new phonics program. But meanwhile, the child's really dealing with anxiety, depression, potentially suicide ideation, self talk, I'm not good enough, I'm a failure, I can't they think I'm stupid, why bother trying. And if we just glaze over that, that's a huge mess. And so I think with school therapist, this puts you in a tricky wiki, because you have dates and milestones you have to hit when you work in, in school, and you may and often may not have time to address these needs. But if you don't address these needs, the likelihood of progress being long lasting, and the likelihood of that person being open to receive services, when they move on from your care are really slim. So I think what it looks like for the child is really doing more asking and listening than telling, finding out how it feels for the child to be asked to do something, finding out what's important to the child. Up until this point, he's been done, or she's been done on to the parent, the teacher, everyone else knows what's good. And this is what the child needs to do. But as anyone asked the child or explained to the child, what's about to happen, and how interested are they. And a lot of times, when it's just very human nature, when we are working on things that are hard for us, our willingness to work on them and are is really low and our frustration tolerance is really high. So doing them in small chunks, and relating it to things that they enjoy doing. So if their visual perceptual skills are poor, but they love Legos related to Legos, you know, again, that's keeping it client centered, it's meaningful to the child and acknowledging effort, which is different than giving a ribbon just for showing up. It's really acknowledging, I can see that you're working hard, and I can see you're frustrated, that what you're working on, it's not coming out to reflect how much effort you're putting in, but I see your effort. Just having those moments with the child and making the activities fun, I think are the most important things you can do for a child as far as supporting the team. There's a few things to think about. And I don't know if I'm going off your question, if I am just redirect.    Jayson Davies     You're totally fine. That's exactly what the next question was.    Penny Stack     So if you're supporting the team, you have to keep in mind that the parent or the kid caregiver are part of that team. And if this child is a biological child of that parent, the likelihood of the parent having dyslexia or learning difference is pretty high. So think about the deficits the child has, the parents probably have the same deficit, but are better at masking it. So think about how you're interacting with the parent and make those adjustments, it's usually really helpful pictures are great. And then I remember when I first went into practice, and it doesn't matter what setting you're in, you're all gung ho and you want to go show the world how smart you are, because you just pass boards, and you just graduated. And you give them this big, huge long program to do at home. And then you wonder why it doesn't get done? Well, you and speech therapy and the teacher, and their ballet instructor, and everybody gave them things to do at home. And now the list is too big. So when you're giving suggestions for things to be done at home, because the we should, you know, working with a therapist once a week for 30 minutes in a group is not going to make a significant impact we have to follow through. And I would either give a variety of things, let them choose and rotate throughout the day, and limited five minutes a day, 10 minutes a day, just make it achievable. And I think that will be really helpful in working with the team when especially with a parent, when working with the teacher, I can't imagine being a teacher in a classroom of 10 to 30 kids. And if one and five have dyslexia, and then other children with other learning needs having to implement every single accommodation for every single kid and remembering all that I think my heart goes out to teachers, I think that's a huge ask, but it's something we have to ask them to do. So I would frame it in the context of let me help you make your classroom experience easier for you make it all about the teacher, and not necessarily about the student. Because some of the some of the accommodations or strategies they can implement for this one child will impact 20% of their class. Or maybe if on activity for everybody, or your teaching or skills that he or she that the teacher can do. That will not take any more time. But can address everything. For example. Maybe the teacher you want the teacher to work on memory with with the child. And so the teacher in the morning goes over announcements. Five seconds later, what are we doing today, and then the children have to repeat it back? Or you're working on increasing memory in terms of length. And she gives two instructions maybe the next time she's given three instructions, maybe four instructions? And can the children hold on to it. And she's kind of keying into who and who cannot hold on to it. So really coming really working with the teacher to find out how does their day flow? What time do they have to do things and then hearing what they have going on? Can you come up with a plan that the teacher can implement that will not take much time out of her day or shift from what they're doing that will still positively impact her students?    Jayson Davies     Yeah, and I mean, some of those just sound like good educational strategies, I mean, that a teacher would want to use anyways, I like to talk about that quick win for teachers, a lot of us, you know, we struggled to get teachers on our sides at some of our school sites. And sometimes that quick when something like what you just mentioned, can can be that thing that just flips the switch from no one knowing you at the school to every single teacher wanting to you to come in and support them in their classroom, right?    Penny Stack     Yes. And the funny thing is, ironically, funny is that teachers can be an OTs best friend, because a lot of what they have in the classroom is what we have for treatment intervention activities. And they can really help us help the child.    Jayson Davies     Yeah, absolutely. And there's been more and more research, mostly surveys that have been done by OTD students, and a few by also educational doctorate students, but they're finding that that teachers want more support from OTs. They don't want to just to tell them things, they want us to come in and show them, you know, model how we can make some of these, these strategies work within their classroom. So definitely, you use the term a moment ago, and you actually used it talking about the adults and that term was masking. And I think we're all pretty familiar with what masking means. But it led me to think how some of our students might be masking for their teachers. Now, when it comes to dyslexia, we'll just kind of key in on the traditional idea of dyslexia difficulty with reading, how might students mask their difficulty with reading? Is that a fair question?    Penny Stack     Yes. And I want to start with something that's really missed a lot. You can work with an eighth grader for example, that is a fluent A beautiful reader and they can absolutely have dyslexia. And the way you know is they can't remember a thing that they've read. And people don't think about that. But because the student is a people pleaser, super friendly, everyone likes the student goes home spends four, four times the amount of time they need to on their homework, and as great grades, no one notices. So that's, that's one masking. Another one is fatigue, you'll, you'll see students get tired rub their eyes fall asleep, the class clown. My favorite probably because that was me talked a lot got in trouble. There's also the child who will be very disruptive. And this is something really important to think about. Maybe we have a child who throws a pencil, or kicks the kid next home, or whatever behavior is a negative behavior. And our first reaction as the adult is to stop that behavior and discipline. And I know this might be hard to do, but to take a moment and take a breath. And just think for a second, what were we just asking that child to do? Or what were they doing? If it's tying to something that's really hard for them? They made a conscious choice to act in that particular way. Because being reprimanded was a far better consequence than having to maybe read out loud. Yeah. And when you think about, I mean, that just breaks my heart saying it. But when you think about where is that student's self concept at that moment, for them to think that that's the better option? That's a whole different way of dealing with that child, then you're going to the principal's office, and we're sending you home with your mom. So those I think are the top ones.    Jayson Davies     It's unfortunate, but I mean, it is it's happening. And I know another another aspect of dyslexia that's close to your heart. And it sounds like it's actually what led you to dyslexia RX is understanding and supporting mental health within our students. And I think what you were just mentioning, right, like the fear of embarrassment, is causing students to potentially mask something else. And so I want to ask you about the ties between dyslexia and mental health. What are you seeing what trends are you noticing    Penny Stack     high prevalence rate in anxiety, and depression, you know, it's the chicken in the egg sometimes. And suicide ideation. If you take a look at some suicide notes, there's significant research, where they've looked at suicide notes and words have been spelled phonetically. And so the anticipation that this person had dyslexia is pretty high. That's what's noted in the research. I've seen children as young as first grade, tell me they hate school, which is terrifying. I've had children, I had an eighth grader once come in and ask me, Why am I here? This is just another place, it's not going to help me. They kind of just give up and feel like they have no control and what's what's the point? And I think, giving them that space, to acknowledge their feelings, working with them on good coping skills, appropriately sure activities. And that dialogue among the family is huge. And I'm glad you brought up the mental health side of it. Because typically, when we work with an individual with dyslexia, we work with one person, and we work with that person on reading. But then we have parents at home where one parent totally gets it, and the other parent does not. And I've seen this a lot, and it's either the parent, there's there's two sides I've seen to this. I've seen a parent who has been very successful, has dyslexia, and just wants their kid to buck up. If I did it, you can grind through it. Yeah. And I've seen I've seen horrible, I mean, just horrible things. And then I've seen the other parent who is very successful, very bright, never had a learning disability and just can't fathom what the problem is. They just need to work harder. So there's this inability to empathize, that these children are not our many means. And they are their own personality. And yes, we are raising them but so is their environment, and they're being bullied, which falls into the depression and anxiety. They may have younger siblings at home that are surpassing them. They may have parents saying, why can't you be more like so and so? There are homes where you have children who are gifted and talented. And you will have another child that has dyslexia. Like, I don't envy that parent, because both are challenged. And so yeah, I really think it just goes back to, and I keep coming back here is really looking into that lived experience asking them how they feel, how does it make them feel? You know, how does it make them feel when they're asked to read out loud? How does that make them feel when we ask them to do an activity that's hard for them? What do they want to be able to do? Why don't they like this, and some kids, some kids are scared to ask their teachers, you know, they get up in the classroom, and they go up to the desk master teacher, their teacher gives the answer by the time they go sit down, they forgot, again, they go back up, I just told you. So I really believe that we need to be intentional about what we say and how we say it. Because just the smallest thing can be the difference between a spark a spark or putting up a flame in the curiosity of a child and their willingness to be thirsty to learn. And if we can just cultivate that, above all, I tell this to parents all the time, let everybody else do the heavy lifting. No one else can be the parent. Just be that soft place for them to land. And I think if we did that we came together as a community around that child and we supported them, I think we'd see a big difference. And we might be able to end generational poverty. And we could put a big dent into generational illiteracy, and that seeping into adult social justice systems that we have to provide support for them.    Jayson Davies     Yeah, wow. Those are, you know, when when you think about something one specific, you know, diagnosis of dyslexia. It's hard to fathom all the other impacts that that can have beyond what most people consider to be the difficulty of reading. And I think we've all had that student that you kind of alluded to where they just don't want to come to school. And I have sat in plenty of IEP is where everyone wants to put in place three goals for this student. You know, the speech therapist wants three goals, the teacher wants three goals, the counselor wants three goals. And I've sat there and I've said, you know, like, the students having a hard time he's every day, he's saying, I don't want to come to school, are we really going to meet 12 goals, when the student doesn't even want to be here? Do we need to take a step back and just get the student to actually want to come to school and not cry when they get out of the out of the car?     Penny Stack     Jayson, you bring up a really good point, we've been very tunnel vision in our conversation today on dyslexia, because that's the topic at hand, and I understand. And you talk about coming to school. And when we think about dyslexia, we need to think about, they may have parents at home that are illiterate, they may have come from poverty or issues of not having access. And so what did it take for them to even show up to school? Did they have a good night's sleep? Do they have food? Do they have support at home, I mean, the list goes on and on. And so it goes back to that team and bringing community resources together to give them as much support as they can. And being realistic. I try when I when I do public speaking to tell the audience, if really all you do at the end of the school year is leave this kid in good spirits with openness to learn. You've done your job.    Jayson Davies     Yeah, that openness to learn is     Penny Stack     Yeah, I know, that's not a benchmark of an IEP, but my gosh, that's the best thing we can do for humanity, for sure.    Jayson Davies     Yeah, yeah, I agree that, especially in today's world, if you have that desire to learn, there is the World Wide Web out there. And we don't have to learn everything in school school is definitely a starting point, right? It's not the end of our learning. And I think you're right on with that openness to learn. If a child has an openness to learn, once they get that spark of what they want to learn about. Just watch out, just look out because they're gonna learn everything, whether it be on YouTube, Google Chat, GPT, something's gonna teach them it.    Penny Stack     So here's the interesting statistic for you. Most entrepreneurs have dyslexia. I've heard that one before. Yeah, there's the research out on that. Because when you look at somebody who is an entrepreneur on their resume, they will have a significant amount of startups sold startup sold, and somebody that does not have dyslexia will typically be somebody who worked for very few companies, but for longer periods of time each. So it's kind of an interesting, fun fact that ties into what you just said one.    Jayson Davies     Yeah, you know, we're all different. And we all find the things that tie into our strengths. And I love it. That's awesome. All righty Penny. Well, our where our conversation today has been such a pleasure learned so much about dyslexia. And we have ventured into a little bit more beyond the dyslexia RX and going into mental health, I really love it. And before we kind of conclude our episode, today, I want to kind of let you share what you're doing exactly at just like CR X. I know this is a very much a passion project, a passion startup for you. And I want to let you share kind of what you're doing with it, and how the OTs who are listening today might be able to get involved.     Penny Stack     Sure, thank you. I appreciate the opportunity. Jason said dyslexia RX is really taking this telescope and pulling it back and taking a look at the whole family to really support the core of the person who might have dyslexia. So we have dyslexia RX community in which people can join. And this can be therapists, teachers, parents, we do webinars weekly, and provide a community of support. We also provide resources where I may have a client come to me, they're not sure if they even have dyslexia, or where to go. And I'll just visit with them for a little bit, and try to create for them resources within their community that they can access. So no matter where they are in United States, they just really don't know where to start, I can help put that together for them. We do in depth screening on executive cognitive functions, and set up activities that children can do at home or, you know, adults, whoever can do at home. In the interim, between, oh, I'm not sure what to do. And here are community resources that I can directly access, but it just provides that gap and support. And so my vision for our for our clients at dyslexia RX, is to just address that mental health and that wellness and that family unit. So there's more peace and harmony in the home, children are excited to go to school, they start enjoying reading, and their journeys in school and their journeys with their teachers are more exciting and enjoyable.    Jayson Davies     Absolutely, that sounds wonderful. And it sounds like you have the skills to do just that. And now you're, you're creating that place to do it. So I really love it. Community is a great place to be not only to learn, but to be able to find that support that you may need. Whether you are a person you know, who has dyslexia, you know, someone in your personal space, who has dyslexia, or if you're a therapist, who is working with, with clients or with students who has dyslexia, so that is awesome. Well, Penny, thank you so much. It has been a true pleasure. I really appreciate diving into dyslexia and all the other places we went today, but definitely dyslexia and if you would like to learn more about dyslexia, RX and Penny, we will be sure to share the link to dyslexia RX to that community where you can learn more in the show notes. So Penny, thank you so much, and I really appreciate it.    Penny Stack     Thank you, Jayson. I appreciate being invited.    Jayson Davies     Alright, and that is going to wrap up episode 125 of the OT schoolhouse podcast. Thank you so much for tuning in. And remember, if you are a member of the OT schoolhouse collaborative, just hop on into OT school house collaborative community, click on the podcast PD space and take your quiz to earn your certificate of completion. If you're not yet a member, and you would like to learn more about it, head on over to OTSchoolHouse.com slash collab and I hope to see you in the community very soon. Take care everyone have a great week and I'll see you next time on the OT school health podcast.    Amazing Narrator     Thank you for listening to the OT schoolhouse podcast. For more ways to help you and your students succeed right now. Head on over to OT school house.com Until next time, class is dismissed.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. 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