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It is well established that fine motor skills are crucial in students' school activities and academic performance. In 2020, Caramia et al. established that "Students spent between 37.1% and 60.2% of the school day performing fine motor activities, with handwriting accounting for 3.4%–18.0% of the day." This data comes from a study where the researchers observed kindergarten, second, and fourth-grade classrooms. They also found that transitions accounted for about 20% of the day, but we'll save that for another time. As school-based OT practitioners, we know that there is more to the occupation of education than handwriting, but it is also fair to say that fine motor and handwriting concerns make up a large part of our referrals. Since there is such a high rate of referrals for fine motor and handwriting concerns, you will likely need a few assessment tools on hand to assess these skills. This blog post provides an overview of common fine motor assessment tools used by school-based OT practitioners, categorized into tools that assess handwriting skills and those with a broader focus on fine motor skills. Let's start with handwriting-specific tools. Fine Motor Assessment Tools for Handwriting Assessing handwriting skills is a vital aspect of school-based occupational therapy, as proficient handwriting (or a reasonable and effective accommodation for handwriting) is essential for students' written expression and academic success. Several assessment tools have been specifically designed to evaluate handwriting skills, providing therapists with valuable insights into a student's legibility, speed, pencil grasp, and letter formation. The Minnesota Handwriting Assessment (MHA), Print Tool, Evaluation Tool of Children's Handwriting (ETCH), and Test of Handwriting Skills-Revised (THS-R) are widely recognized tools that assist OT practitioners in assessing and addressing handwriting difficulties in students. Here are some of each tool's characteristics, along with some pros and cons of each tool. Test of Handwriting Skills-Revised (THS-R): Completion time: Approximately 25 minutes Age range: 6 years to 18 years 11 months Pros: Assesses both manuscript and cursive handwriting skills (although I never used the cursive tool) Provides norm-referenced scores for legibility, form, alignment, and size Tests writing without lines so you can get an idea of the student's ability to maintain level writing Cons: Limited age range - may not be suitable for older students. Does not assess fluency of handwriting Scoring of each letter can be tedious until you understand the patterns (like gaps = a score of 1, and overshoots = a score of 2) Pro Tip: The THS-R is identified as a test of "neurosensory skills," not as an assessment of handwriting. However, it does function as a functional writing assessment and national norms for scoring. Minnesota Handwriting Assessment (MHA): Completion time: Around 15 minutes Age range: Grades 1 and 2 Pros: Norm-referenced tool Evaluates letter formation, legibility, speed, and pencil grasp Provides a comprehensive analysis of handwriting skills Cons: Extremely limited age range Easy to administer, difficult and time-consuming to score Pro Tip: Check the desk height and other environmental factors prior to starting. That goes for all of these tools. Print Tool: Completion time: A few minutes to administer & 10 minutes to score Age range: Preschool through 6th grade Pros: Assesses letter formation, sizing, spacing, and overall legibility Provides a clear profile of a student's handwriting strengths and areas for improvement Ties in with the Handwriting Without Tears writing curriculum Cons: Does not assess the speed or fluency of handwriting Pro Tip: Learning Without Tears offers free handwriting screening printouts on their website at LWTears.com Evaluation Tool of Children's Handwriting (ETCH): Completion time: Around 15 minutes Age range: 6-12 years Pros: Evaluates multiple components of handwriting, including letter and number formation, alignment, spacing, and pencil grip Offers specific guidelines for intervention based on identified areas of difficulty No cost to purchase scoring handbooks - They allow you to make copies when you purchase the tool. Assess both individual letter legibility AND word legibility Cons: Takes a moment to learn the scoring, but is on par with other handwriting assessment tools. Pro Tip: Jayson's preferred handwriting assessment Fine Motor Assessment Tools with a Broader Focus While handwriting is crucial, occupational therapists also recognize the importance of assessing overall fine motor skills beyond just handwriting proficiency. Fine motor skills encompass a range of abilities, including hand-eye coordination, dexterity, and motor planning, which significantly influence students' functional independence in various school-related tasks. That is why I will often pair one of the handwriting tools above with one of the tools below. When I do that, I can draw more conclusions as to whether it is fine motor skills or something else impacting a student's handwriting. Assessment tools such as the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI), Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), Peabody Developmental Motor Scales, Second Edition (PDMS-2), and Miller Function & Participation Scales (M-FUN) provide a broader perspective on fine motor development and offer valuable insights into a student's fine motor skills and other skills such as gross motor skills, visual-motor integration, and motor planning abilities. Here is some info on each of those: Miller Function & Participation Scales (M-FUN): Completion time: Approximately 30-45 minutes Age range: 2 years through 7 years 11 months Pros: (Jayson's preferred tool for this age range) Assesses fine motor skills, visual perception, visual-motor integration, and motor planning Provides a comprehensive profile of a child's functional motor abilities Scoring tools that help you guide treatment planning. Cons: Limited age range Longer administration (and set-up) time compared to some other assessment tools The test books and scoring books can get expensive Pro Tip Make lots of copies of the origami fish and dog The pros outweigh the cons, in my opinion Want to hear why I prefer the M-FUN over the BOT-2? Check out this episode of the OT Schoolhouse Podcast! Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2): Completion time: Varies depending on the subtests administered Age range: 4 through 21 years Pros: Evaluates fine motor skills along with other motor abilities Provides a comprehensive assessment of fine motor proficiency Cons: Lengthy administration time for the complete test Pro Tips: The recommended minimum interval for reassessment is three months. I typically administer the Fine Motor Precision, Fine Motor Integration, Manual Dexterity, and Bilateral Coordination subtests. The Upper-Limb Coordination subtest can also be helpful at times. Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI): Completion time: 10-15 minutes Age range: 2 years through adulthood Pros: Assesses the integration of visual and motor skills Provides norm-referenced scores for visual-motor integration abilities Cons: Has been shown to not necessarily correlate with handwriting skills Pro Tip: The VMI is sometimes used by non-OT professionals, so ask your school psychologist if they are using the VMI before you both attend the IEP with the same assessment. Peabody Developmental Motor Scales, Second Edition (PDMS-2): Completion time: Varies depending on the age of the child and the areas being assessed Age range: Birth through 5 years Pros: Assesses fine and gross motor skills Provides a comprehensive assessment of fine motor skills, including grasping, manipulation, and visual-motor integration Offers both standardized scores and age equivalents Cons: Limited to the age range of birth through 5 years Will soon need to upgrade to the Third Edition Pro Tip: Take some time to familiarize yourself with the scoring booklet and tasks. There are many materials, and it takes some time to get used to knowing which task to start with due to the need to find the student's baseline. You've assessed the student. Now what? Sign up for the A-Z School-Based OT Course to help you better understand how to complete an OT evaluation. You'll get access to my evaluation document template to improve your evaluation write-ups! Assessing Beyond Fine Motor Skill While fine motor skills are an essential focus of school-based occupational therapy, it's important to note that occupational therapists address a wide range of areas that contribute to students' overall success and participation in the school environment. While the previously discussed assessment tools provide valuable insights into fine motor development, they do not capture the full scope of an OT's expertise and intervention strategies. Here are a few additional areas in which school-based OTs assess and intervene: Sensory Processing: Evaluating how students perceive and respond to sensory information to develop strategies for managing sensory challenges and promoting engagement in school activities. Self-Care and Independence: Assessing students' ability to perform daily living tasks, such as dressing and grooming, to enhance independence and functional participation. Visual Perception and Visual-Motor Skills: Evaluating how students interpret and use visual information for motor planning and coordination, supporting academic performance. Executive Functioning: Assessing skills related to organization, time management, planning, and self-regulation to address challenges that impact task initiation, focus, time management, and assignment completion. Social-Emotional Skills: Assessing students' social interactions, emotional regulation, self-awareness, and coping strategies to enhance social skills, self-esteem, and emotional well-being, fostering positive relationships and school engagement. By considering these additional areas and employing comprehensive assessment approaches, school-based OT practitioners can address the diverse needs of students and support their holistic development, functional participation, and overall well-being in the school environment. We will soon post blogs about tools you can use to assess these other areas in school-based OT, so stay tuned. The Final Word These fine motor assessment tools are important resources for school-based OT practitioners to evaluate and address students' fine motor skill needs. Using the standardized assessment tools mentioned above, practitioners can obtain valuable information about students' handwriting and fine motor abilities. It is always important to note that standardized assessment tools only give you a snapshot of data in a controlled environment. Always pair standardized assessment tools with observations and other assessment data to form a comprehensive evaluation and treatment plan. What are your preferred fine motor and handwriting assessment tools? Share this post on social media, and let me know which assessment tools you prefer to use when assessing students with fine motor concerns. See ya next time, 👋 Jayson Get my Evaluation Report Template and start feeling confident, knowing you conducted a solid OT evaluation. Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best. 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 Sierra Caramia, Amanpreet Gill, Alisha Ohl, David Schelly; Fine Motor Activities in Elementary School Children: A Replication Study. Am J Occup Ther March/April 2020, Vol. 74(2), 7402345010p1–7402345010p7. doi: https://doi.org/10.5014/ajot.2020.035014

As occupational therapy practitioners working in schools, we are always searching for the best methods of intervention to provide our students with the highest quality care. One of the most debated topics in school-based OT is the question of whether to implement push-in or pull-out services. However, this question oversimplifies the complex needs of each student and assumes that one approach is superior to the other. In reality, the best approach depends on a variety of factors, such as the student's individual needs, the IEP goals, and the resources available. Today, we will explore the pros and cons of both push-in and pull-out services, discuss the importance of collaboration and flexibility, and highlight the benefits of combining these two methods to create a comprehensive intervention plan. The Fallacy of All-or-Nothing Thinking Before we dive into the pros and cons of push-in and pull-out services, let's take a moment to discuss the all-or-nothing fallacy here. This type of thinking assumes that there is only one right answer and overlooks the potential benefits of multiple solutions. In the case of push-in vs. pull-out services, this fallacy assumes that one method is inherently better than the other. However, the reality is that each method has its own benefits and limitations, and the decision of which one to use should be based on our evaluation, student progress, and the priorities of the IEP team. The Problem with Research When it comes to research in school-based occupational therapy, it's important to be aware of the potential for misleading guides. Studies often use particular inclusion criteria, such as focusing only on general education students or exclusively on autistic children. While these studies can provide valuable insights into the effectiveness of particular interventions within specific populations, it's crucial to consider how their findings apply to our own caseload and decision-making processes. For example, if a study only looked at the effectiveness of push-in therapy sessions for students with autism, it may not be applicable to students with other disabilities or those in different educational settings. Similarly, if a study only included general education students, it may not provide insight into the needs and challenges of students in special education programs. Therefore, it's important to carefully read and evaluate research in the context of our own caseload and consider how it may or may not be relevant to our specific situation. There is no question that research can provide useful insights for our practice. However, to be evidence-based, we must also critically evaluate its relevance to our specific caseload and decision-making procedures. By doing so, you can ensure that you are providing the most effective and appropriate interventions for your students. Benefits and Limitations of Push-In Services Push-in services refer to interventions that occur within the student's classroom or natural environment. The primary benefit of push-in services is that they promote developing and generalizing skills in the context where they will be used. Additionally, push-in services can improve collaboration with teachers by providing opportunities for modeling and coaching. However, there are also limitations to push-in services. One of the main limitations is the limited privacy that students have when working in a classroom setting. This is especially important to note as students get older and become more self-aware. Additionally, push-in services can potentially disrupt classroom routines and make it difficult for the student to focus on classroom tasks when there are other distractions in the environment. When it comes to implementing a push-in therapy model, there are a few key considerations to keep in mind. First and foremost, it's important to establish clear goals, expectations, and times for the therapy sessions. This can help ensure that everyone involved is on the same page and working towards the same outcomes. It also ensures that the teacher knows when to expect us, and we know what to expect when we go into the classroom. Additionally, it's important to be flexible and adaptable. Unlike in a pull-out session, during push-in sessions, you have limited resources and control over the environment. Finally, it's crucial to communicate regularly and openly with teachers, parents, and other members of the student's support team to ensure that everyone is informed and involved in the therapy process. With these tips in mind, a push-in therapy model can be a highly effective tool for supporting students in reaching their full potential. Benefits and Limitations of Pull-Out Services Pull-out services refer to interventions that occur outside of the student's classroom or natural environment, such as in a therapy room, stage, closet, or hallway (just to name a few). The primary benefit of pull-out services is that they provide a more focused and controlled approach to intervention, allowing the therapist to target specific areas of need that may not be possible while in a classroom. Pull-out sessions may be offered individually or in small groups with students with similar needs. However, there are also limitations to pull-out services. One of the main limitations is that students may feel stigmatized or embarrassed by being pulled out of the classroom. Additionally, pull-out services may provide limited opportunities for generalization, as the student may struggle to transfer skills learned in the therapy room to the classroom setting. We must remember that every moment a student spends in a pull-out therapy session, they miss crucial educational content in their classroom. You and the IEP team must weigh if the pull-out therapy session is worth the missed educational content. Want to learn more about push-in and pull-out services? Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best. Using a Combined Push-In/Pull-Out Model While push-in and pull-out services both have benefits and limitations, it is important to remember that we are not limited to using one method exclusively. In fact, using a combined push-in/pull-out model can provide the best of both worlds. By using a combined model, you can provide individualized and focused therapy sessions in a quiet and private environment while also promoting generalization by working on skills within the student's natural environment. After years of working in the schools, I found myself recommending and using this type of service model more frequently. For example, I would write on the IEP that the student would be seen twice a month in a pull-out model and twice a month in a push-in model. I then collaborated with the teacher to determine the best time for me to come into the classroom. From there, every week, I switched off where I saw the student - from in the OT room to in the student's classroom. One potential challenge of using a combined push-in/pull-out model like this is that it requires a great deal of flexibility and collaboration with teachers and the IEP team. You must be willing to adjust your approach based on student progress and evolving needs and work closely with teachers to ensure that therapy goals are aligned with the student's academic goals. The Importance of Collaboration and Flexibility Regardless of which service delivery method is used, it is important to prioritize collaboration and flexibility. As school-based occupational therapy practitioners, we are part of a team that includes teachers, administrators, parents, and other service providers. It is important to communicate and collaborate with all members of the team to ensure that therapy goals are aligned with academic goals. We must also be willing to adjust our approach as things change. This may mean shifting from pull-out to push-in services, or vice versa, as well as adjusting therapy goals and interventions based on changing classroom routines or priorities. Remember, an IEP is a living document that can be amended at any time. More than once, I have called a parent to share with them that my plan was not working. We discussed why I thought that was, potential solutions, and how we would move forward with the changes we felt would best support the student. The Wrapup Push-in and pull-out services are both valuable tools for us as school-based OT practitioners. The decision of which method to use should be based on our evaluation, research, experiences, student progress, and the priorities of the IEP team. It is important to remember that neither method is inherently better than the other and that using a combined push-in/pull-out model may provide the best of both worlds. Collaboration and flexibility are key to effective intervention, regardless of which service delivery method is used. By working closely with teachers and the IEP team, we can ensure that therapy goals are aligned with academic goals and that interventions are consistent across school environments. As we strive to provide the best possible support for our students, we must be willing to adapt and adjust our approach based on student progress and evolving needs. See ya next time, 👋 Jayson Learn more about when to choose push-in and pull-out services. Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best.

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 123 of the OT Schoolhouse Podcast. Ready to talk All Things Sensory? In this episode of the OT Schoolhouse podcast, Jayson interviews Rachel Harrington, COTA/L AC, and Jessica Hill, COTA/L, about incorporating movement and sensory activities in the classroom and at home. We discuss sensory diets, fidgets, primitive reflexes, and other strategies for supporting children with sensory needs. Jessica and Rachel also share practical tips for teachers, parents, and caregivers on how to create a sensory-friendly environment and promote self-regulation. Tune in to learn more! Listen now to learn the following objectives: Learn how sensory diets can help children regulate their sensory input throughout the day. Learn how fidgets can be a helpful tool for children who need to move or have tactile stimulation. Identify how primitive reflexes can impact a child's development and should be addressed through movement activities. Learn how you can help teachers to incorporate movement breaks into their lessons to help students stay focused. Resources: The All Things Sensory Podcast Harkla.co The Out-of-Sync Child by Carol Kranowitz (Affiliate link) Primitive Reflex Integration Course by Rachel Harrington Impactful Quotes From the Episode "Kids need to move more. So we always recommend that if they are sitting in the classroom or sitting down for a focus task for 30 minutes, then after 30 minutes, they get up and move for between five and fifteen minutes" -Jessica Hill, COTA/L "We like to teach practitioners and teachers and parents to incorporate these functional movements, that not only wake up the brain and facilitate that sensory break, but they're also rhythmic, and they're also beneficial for working towards integrating those reflexes" -Rachel Harrington, COTA/L AC “When it comes to educating our teachers, we need to recognize the limited time that they have, and they just want the strategies that they can use right now” -Jayson Davies, M.A, OTR/L "75% of a classroom has retained primitive reflexes" -Rachel Harrington, COTA/L AC "W e're all sensory beings, and so all students can benefit from these sensory activities that the therapists are providing to the teachers, and so just teaching them how to do it with the entire class is important" -Jessica Hill, COTA/L Guest Bio Rachel Harrington and Jessica Hill are Harkla's in-house Certified Occupational Therapy Assistants (COTA). They have worked with children for over seven years in outpatient pediatric settings. They specialize in sensory integration, primitive reflexes, teaching regulation strategies, and child development. They are the hosts of the All Things Sensory Podcast and have created several digital courses for parents, therapists, and educators. 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! Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey there. Welcome to Episode 123, of the OT Schoolhouse podcast, I appreciate you listening in today. If you love supporting your students with sensory strategies, with movement, with potentially even some primitive reflexes, you are going to love our guests today, Jessica Hill and Rachel Harrington are both certified occupational therapy assistants, and together, they host the All Things sensory podcast by harkloe. Today, Jessica and Rachel are joining us to talk about how school based otschoolhouse com, incorporate movement into the classroom to support both individual students as well as groups of students. We discuss things like sensory diets, fidgets versus toys, primitive reflexes and more. So sit back, relax and enjoy the episode as we welcome to the show. Jessica Hill and Rachel Harrington.    Amazing Narrator     Hello and welcome to the otschoolhouse. Comcast, your source for school based occupational therapy, tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.    Jayson Davies     Rachel and Jessica, welcome to the OTS podcast. Thank you so much for joining us today.     Jessica Hill     Thank you for having us.     Rachel Harrington     We're excited to be here.     Jayson Davies     Awesome. Well, I really appreciate you both being here. You both run the All Things sensory podcast, which I know has been around for a while. How many episodes do you have now?     Jessica Hill     250 something.     Rachel Harrington     Yeah.    Jessica Hill     Yeah.    Jayson Davies     Congratulations. I mean, we're at like 120 ish or so. So I can just, I know how much work goes in to have 250 episodes. That's crazy.     Jessica Hill     Yeah, it's been a it's been a labor of love. It's honestly just been a journey. And it's fun. It has some fun. I feel like we started before podcasts, like really became popular. We just kind of got in at the right time. But it's, it's been awesome.     Jayson Davies     Yeah, yeah. And, I mean the perfect topic, especially for occupational therapists, even though I know that all things sensory goes way beyond just OTS listening, but let's kind of just start there really quickly, all things sensory. What made you dive in with all things sensory?    Jessica Hill     You know? We I think, you know, taking it way back, we started the podcast initially, just because, as clinicians, we were struggling to have the amount of time to talk to our clients, parents and caregivers after each session. And we're like, how can we reach these parents and teach them everything that we know in a way that's easy for them to digest, and that way, they're they're understanding, oh, they're working on this, you know, swinging activity, and this is why. And so, really, it started there, and then we both just are so passionate about sensory system and just spreading the word and making it more of a normal thing, because everyone has a sensory system, and everyone needs to know about these tools to help it stay regulated.     Rachel Harrington     And what's really cool is that the podcast has expanded, and we have a lot of therapists and educators teachers who listen to us as well, and we'll get messages from them, and we'll get messages from therapists. And it's just really cool that our audience has grown to just encompass everyone who has a child or who was working with a child, and it's just been really amazing.     Jayson Davies     That's awesome. That's great. And of course, in addition to being podcast host, so they'll all think sensory podcast, you are actually yourselves occupational therapy practitioners. And so I Love You know, when we have multiple guests on, it's kind of hard to know who's who for those listening. So I want to give you each a moment to kind of introduce a little bit about yourself and who you are in the world of occupational therapy. So Jessica, would you like to get us started?     Jessica Hill     Sure, yeah, I'm Jessica Hill. I'm a certified occupational therapy assistant. I've been in the world for over nine years, just, well, just about nine years, I think, is what it is. My son is nine, and so that's how I keep track. But yeah, worked in outpatient clinics for several years. I have a love for early intervention. I love that birth to three or four years, and then kind of taking through our journey about two years ago, we joined harkla and have become a part of the harkla team for the last couple of years,    Rachel Harrington     and I'm Rachel, and I am also an occupational therapy assistant, and it's funny, because Jessica and I went to school together and worked together, and in school, we really weren't friends. We just like, were partners here and there, and it wasn't until we were working in the clinic together that we really just kind of became friends and decided to kind of go on the entrepreneurial route in the clinic. And I I also am. I have two little kiddos, and once I had my son, who's two and a half, I I stopped working in the clinic, and I own another ot related business. It's called sensational brain, and it's all continuing education for occupational therapy practitioners. And so I just love talking.    Jessica Hill     About this clearly podcast.     Rachel Harrington     But it's just really fun just taking what we know from OT and just putting it into real life, and I use it with my kiddos. You know, obviously every day you're immersed in it. So it's been fun.     Jayson Davies     Yeah, yeah, absolutely. Well, thank you for introducing a little bit about yourselves and kind of going one step further to learn a little bit more about each of you. What is one thing as we transition into talking about movement and sensory What is one thing that you both do to kind of get your brain waking up, whether it be in the morning, in the middle of the day, or what is one thing you like to do to to just to wake that brain up?    Jessica Hill      I don't do this first thing in the morning, but I usually do it early in the day, and I'll work out. And for me, I prefer to lift weights, and so if I can get in a good workout early in the day, that kind of sets my day up, right? I do try to go outside and go for a walk at some point during the day, whether it's earlier in the day or later in the afternoon, just to get outside and get that fresh air as well. Those are my two go tos.     Jayson Davies     Awesome. And what about you Rach?    Rachel Harrington     Mine would be, you know, our mornings in this season of life are a little chaotic, and I generally try to get outside for a walk in the morning with the kiddos. I will put a drop of essential oil, like an alerting essential oil in the shower in the morning for some olfactory input and a nice hot cup of decaf coffee.    Jayson Davies     That doesn't work. Just kidding. Here I am drinking Starbucks at what time is it 1pm in the afternoon,but no, I'm right there with you. I enjoy working out two to three times a week. I'm waking up early and getting to the gym. And same thing with the walks. You know, I've got my one year old and around 8am after we've had some breakfast or so, we kind of get our little tricycle out and we go for a walk. So right there with you, with those two ideas.    Jessica Hill     Makes a big difference.     Jayson Davies     Yeah, exactly. And that kind of segues perfectly into our next question. Here is, what can you tell us about that connection between movement and learning, and why is it that movement actually helps us with getting our day started and learning?     Rachel Harrington     Well, so as humans, we are designed to move and in today's day and age, people just aren't getting enough movement. And we see that in sleep. We see that in just sensory output, sensory input. We just see so many challenges come from not only adults not moving enough, but kids not moving enough. And I'm not talking about, you know, from a from a health standpoint, because obviously, it's healthy to move, but it's just so important to regulate your sensory system by movement.     Jessica Hill     Yeah, and research shows that movement does have an impact on learning. And in fact, what we've seen is that for adults who are sitting at a desk working the best ratio of sitting and working to movement is about 45 to 50 minutes of sitting. And you know, if you're on a screen, working and then getting up and moving for five to 10 minutes, and that that actually increases productivity, focus and attention. The same goes for our kids. However, our kids need to move more. So we always recommend that if they are sitting in like the classroom or sitting down for a focus task for 30 minutes, then after 30 minutes, they get it up and move for between five and 15 minutes. And getting outside for movement is even more beneficial than any movement outside or inside, because you get the natural light, you get the grounding from the earth. So if your movement breaks, can be outside. It's even better.     Jayson Davies     Yeah, getting it's vitamin D, right? That the sun gives you, I think, I mean, you got to get your vitamin D in so.    Jessica Hill     Well, especially if you're, if you're indoors and you have fluorescent lights shining down on you. Or if you're looking at a screen for long periods of time, it actually affects your brain. And so getting outside and making sure you're getting that natural light is very important.     Jayson Davies     You know, you say that as I have like, two bright lights shining in my face as we record a podcast.    Jessica Hill     not always the best in following our what to do. It's all about it's all about moderation, right?    Jayson Davies      Yep, yep, absolutely great. Well, in addition to talking all things sensory, I know you also like to talk about primitive reflexes on your show frequently. And so my question is, is, when we're talking about movement in the classroom, do you also try to work in some of those motor reflexes at the same time, or are you primarily focused on the sensory input that the movement provides? Does that make sense?     Rachel Harrington     Ideally, if you can kill two birds with one stone, that's the perfect world, because in the classroom, there isn't a lot of time to be incorporating this beautiful reflex and Integration Plan and sensory diets. It's just kind of a just kind of a jumble of, let's see what we can get when we can get it right. And so I think the the cool thing that we like to teach practitioners and teachers and parents is is to incorporate these functional movements that not only wake up the brain and facilitate that sensory break, but they're also rhythmic, and they're also beneficial for working towards integrating those reflexes. I just feel like our kids would be at such a such an advantage if we could get ahead of the reflexes. Because some of the research that we're finding is, you know, 75% of a classroom has retained primitive reflexes at least one and if we can incorporate these exercises into every classroom, how often are we going to see learning disabilities? You know, I feel like ADHD is another thing that isn't going to be seen quite as much, if we can work on these reflexes and get them integrated. And the cool thing is, is that most of the activities or exercises that promote primitive reflex integration also provide great sensory integration and sensory input as well. So you know, one of our favorites is the windmill where you're standing. You look up and you reach down and touch your toes with your opposite hand, and then you look back up, and then you look down and touch your other foot with your opposite hand. Not only are you getting some really great vestibular input, some alerting input, but you're also working on the moral reflex with that head position change and looking up and down. So you're really killing two birds with one stone in that sense.     Jayson Davies     All right, good to know. Now you talked a lot about, you know, getting this information out to parents, getting this information out to teachers, talking specifically about being in the educational setting. What do you find most helpful for a therapist, giving these type of recommendations to a teacher? I mean, we can work with a student one time a week for 30 minutes, but in reality, right? These students need it every single day. So what have you found to help the therapist, help the teachers?     Rachel Harrington     Yes, I think the biggest part is education. I think, you know, and I have never personally worked in a school before, but I think if we can get, you know, lunch and learns, and if we can get those trainings to teachers two therapists, so that way everyone's on the same page. And it's not just one therapist trying to help one child, but actually trying to help the whole classroom. It's, you know, training the entire staff to recognize these are, this is the sensory system. These are the primitive reflexes. You can help foster that integration and sensory diet by doing these activities. So I think it really comes down to educating everyone and getting everyone on the same page and recognizing the benefits of it.     Jessica Hill     Yeah, and I think providing some simple movement strategies for transitions and sensory breaks can be helpful, because all classrooms have to transition throughout the day. So if the therapist can give the teacher three activity ideas to help with transitions that the teacher can do with the entire classroom, and maybe, you know, help one or two students specifically, while the rest of the class is also doing it on their own. Then that can be helpful. Because, you know, I think Rachel already mentioned this, but we're all sensory beings, and so all students can benefit from these sensory activities that the therapists are providing to the teachers, and so just teaching them how to do it with the entire class is important.     Jayson Davies     Absolutely, yeah, totally agree. We need to get more in with the teachers so that they can do a lot more of this. You know, as you were speaking, there something came to my mind, and that's go noodle. Are you familiar with goat noodle?    Jessica Hill     My son uses that in his class,     Jayson Davies     Awesome, awesome. So I have a love, hate relationship with goat noodle. I love the idea that it is out there. You know, there's a lot of movement stuff out there, but a lot of the students, especially the students that we might be working with, one on one small group, they have a real tough time with following along. You know, some of those kids who have Praxis issues, they they struggle with it. And so I just want to ask you, have you experienced this at all? And what might you recommend to an educator who is seeing that, you know, they got one or two kids that are struggling a little bit?    Rachel Harrington     Yeah, I'm thinking like, if the whole classroom is doing the Go noodle activity and you're working with one or two kiddos, I wish that that they could go through it and practice the motions, you know, stop it every I don't know, 10 seconds, and practice the motions. And, you know, if it's a repetitive dance, just to practice the the motions, or I would have maybe the other students teach the kiddos who maybe you were working on on it with your caseload, almost like a buddy system. Like, Hey, these are how we do the dance moves. Or, I haven't watched goonao in a long time. So crazy to me. I think the buddy system is cool because then you're also teaching the students how to work together and how to help each other, right? So you're facilitating that social engagement at the same time. So I think that's a great idea.     Jayson Davies     Yeah, I like that one too. And I mean, after you do the same go noodle video, you know, five times, 10 times in a row, you do have some kids that have memorized it, so why not just turn off the screen and let those kids hop in front of the class and kind of run it, and then you can go at whatever speed you want to go at,     Rachel Harrington     Yeah, like, yeah. I think slowing it down is it will be huge, and videos and mirrors. Oh, there's so many things now.    Jayson Davies     So many things. All right, very cool. All right, back to our regularly scheduled program here. I want to go kind of through different things. You know, we have kids that need more alerting strategies. We have kids who maybe need less alerting strategies. And Jessica, I think it was you that already mentioned, kind of the windmills. But if you see a student or a group of student appearing a little tired, understimulated, what are some of your go to strategies?    Jessica Hill     I think getting up out of the desk is important, even if it's just having the student get up and go get a drink of water from the water fountain. Just that simple, getting up and moving and changing the visual area where they are for just a minute, getting a cold drink of water and then coming back. Can be, I mean, it can be as simple as that. If you want to make it more complex, you can have maybe the entire classroom stand up and do couple of windmills, couple of wall or chair push ups, maybe some sort of, like mouth Imitation Game, where they all where the whole class makes popping noises with their mouth. I think just getting the entire class involved is huge, though, because you know, if you see one student who's appearing lethargic and losing focus, chances are there's a couple of other students who are probably also experiencing that. And so again, just that movement helps everyone so get the entire class involved.     Rachel Harrington     Yeah, I'm kind of thinking about if a teacher doesn't want to take a break from the entire lesson plan and, you know, round everybody up and try to corral everybody a really simple way to just get a head position change, which that head position change is very alerting to the nervous system we could and for criminal reflexes, just tipping back in the seat and tipping the head back and looking up at the sky, and getting our arms in extension, and our legs and extension, basically doing like a starfish, and then folding down into like a little pretzel and doing that, that motion just five times. Everyone stays in their seat. They're getting that head position change. It's fun. You can turn on a metronome and have them do it with the metronome at 60 beats per minute. So really trying to encompass that multi sensory learning environment, that's when kids are going to thrive, not just sitting in their chairs and not focusing. So I think just modifications are huge.     Jayson Davies     Yeah, yeah. And so that was some things that might be a little understimulating. Do you find that if a student may be overstimulated. Do you find yourself using similar strategies, or are you customizing it throughout the day?    Jessica Hill     It depends. It definitely depends, and it depends on the kids. So I think, yeah, you do have to kind of customize it sometimes for some of the students, you know, we want to look at the different types of sensory input and what they do to the body right? So that vestibular input is typically more alerting, proprioception is more calming. So if you have a student who's overstimulated and losing focus, then we want to do something that's more proprioceptive based to try to help bring their nervous system back down to a more regulated state. And sometimes that looks like chair push ups or self hubs, maybe big squeezes, arm, squeezes, hand squeezes, maybe some deep breaths, something that's simple in their seat.     Jayson Davies     Very cool, awesome. You know, our primary audience here at otschoolhouse podcast is OTs, and I know many of them are listening to you just like, yes, yes, yes, exactly. And so I actually want to take a step back to that question that we talked a little bit earlier about, like, you know, convincing the teachers to to do some of this. And you both are in a very particular situation in the sense that you speak to parents within your podcast, within your courses and whatnot. And so I want to actually ask you all, what are you hearing back from teachers and parents. Are they asking you for evidence? Are they asking you for what type of resources, I guess, or what are their questions when you're trying to tell them this?    Jessica Hill     Yeah, I think parents and teachers don't ask for, like, research. Like, where's the research on this? Show me that evidence, right? They're kind of in a different area than we are as clinicians. It's mostly just like, What can I do for this specific child? It's usually a specific case by case scenario when they're asking us questions versus like, what can I do for the whole class? We don't really get that, and then parents oftentimes are asking us my you know, my child's melting down in class, my child's having trouble with social social situations. What can I do? How can I talk to the teacher? So those are usually the questions we get.     Rachel Harrington     We did actually have a PE teacher. A couple of PE teachers actually reach out to us and say that they had taken like our from a reflex course and our classroom course, and they had been implementing those activities into just PE, and they were seeing huge differences, and they said it was just so helpful. And I was like, that's one area of the school environment that can be so impactful. I mean, every kid goes to PE, and most kids are enjoying it while they're there. So if the teachers there can say, hey, what functionally can we incorporate to help these kiddos just thrive? I mean, done easy. Let's do it.    Jayson Davies     100% you actually mentioned two things that both of you mentioned one thing, I guess, that I love and Adapted PE teachers are one of my favorite people on campus. I get so close with my ape teachers for that exact reason. They like. They may not understand sensory but as soon as you start to explain it to them, they're like, that makes total sense. And then they'll come to me and they'll ask, like, hey, you know, Jacob, what do you suggest for him? You know, does he need crossing midline? Does he need, you know, different type of exercises? What can I do with him? And so, yeah, I absolutely love our PE and ape teachers, they are fantastic. And then really quickly, the other thing Jessica, you mentioned was, you know, teachers don't necessarily want the research, and that is something that we need to keep in mind when we're trying to educate them. We go to conferences. We're used to sitting down in our two hour, three hour courses, getting all the information. And I think when it comes to educating our teachers, we need to recognize the limited time that they have, and they just want the strategies that they can use right now.     Jessica Hill     Yes, for sure, that's kind of what we found as well, is they're like, just tell me what to do.    Jayson Davies     Yeah, yeah. All right now talking about, you know, discussing with teachers sensory diets and working with sensory diets in the classroom. Do you recommend sensory diets? And if so, what might a sensory diet look like?     Rachel Harrington     Yeah, we love sensory diets. We love sensory lifestyles and sensory just, just making sensory input normal in the classroom. And so I think it's difficult as practitioners to say this is what a sensory diet looks like, because they're so customized to each individual person. But generally, in the classroom, we like to incorporate movement activities, first to help kids reach their threshold, then we follow them with some proprioceptive activities that are grounding and organizing, and then we'll include some more specific things, like a visual tracking activity or an oral motor activity, like Jessica mentioned, with the popping. A visual activity could be something like bubbles for our younger kiddos or for older kiddos, just some like simple ocular motor tracking activities while they're sitting at the desk, and then our aura motor activities, just keeping it simple and structured and repetitive. And if we can get everybody up out of their seats, great. If not, then what can we do at the seat chair? Push ups, mouth bubbles and blowing and have like Velcro under the desk for a tactile pigeon?     Jessica Hill     Yes, yeah. So I think really customizing it to what the classroom looks like and what's feasible, because I just feel like time is the biggest barrier, and teachers just don't have the time to to break it down and say, This is what we're going to implement today, and it's going to take 30 minutes. Well, a 10 minute sensory diet with the whole class is really all we need. A couple of times a day during transitions. Typically,     Jayson Davies     Yeah, I love it, and I think I already know your answer to this, but I'm gonna ask it anyway. Sensory diets, do you see them as being a proactive measure or a reactive measure? Do we use it before you know a student may need it, or are we waiting to see a certain behavior before you implement it? Or both?     Rachel Harrington     Our goal with sensory diets is to be proactive, right? The goal of a sensory diet is to provide sensory activities that are unique to the individual to meet their sensory needs and help them feel regulated and ready to go. But then we do need those other sensory strategies in place for when a child does get get dysregulated? Because, I mean, you can have the perfect sensory diet in place, and the child is still going to have their moments when it's hard the fire alarm goes off. Yes, right? Everyone's dysregulated or they didn't get sleep the night before, so their sensory diets just not quite fitting for them today. So we also want to have those strategies available to them  in the classroom for when they do get dysregulated for whatever reason.    Jayson Davies     Awesome. Now, I think it was Jessica, again, that mentioned fidgets a little bit ago, the little tactile fidget Velcro, whatever it might be, one of the questions I get both, well, mostly from occupational therapy practitioners, because teachers are coming to them, is teachers think everything is a fidget. And so how do you explain to someone, I guess, the difference between a toy and a fidget, to someone who isn't an occupational therapy practitioner?     Jessica Hill     I think for a fidget, for me, it's anything that we do while we are listening or learning, and so I always have adults stop and think about, what are they doing while I'm talking to you, or what are you doing when you're in a seminar or in class? Are you bouncing your leg? Are you clicking your pen? Are you fidgeting with your ring? Are you chewing gum? Yeah, so I think really a fidget is anything that helps, helps you focus? Are you doodling? That's another big one. And I think that that teaching students how to appropriately and efficiently use fidgets is really helpful in teaching them that they're great. You should use them. But when it gets to the point where you're flinging it across the room and it's hitting Sammy in the face, you know, that's definitely not being used as a fidget. So really, the education comes in in the classroom.    Jayson Davies     Great. And, you know, while we're still on this sensory diet, little area right here, I have found that you can't just give a teacher a piece of paper that has a sensory diet on it, right? Like we need to somehow make sure that it's actually going to be incorporated into the classroom. What are some strategies you already mentioned education a little bit, but, yeah, just build upon that. If you're giving a sensory strategy or sensory diet to a teacher, what more should you be doing to make sure it actually gets used?    Jessica Hill     I think talking to them about when they can actually use it and do it. You know, I've mentioned this already, but transitions are a go to place to implement sensory strategies. You know, the students are going from one place to another. There's a lot of noise, a lot of visual input, a lot of movement, so there's a lot of chaos, essentially. And so showing the teachers some of those sensory diet activities to use after a transition. And say, just try this three step activity with their classroom. It takes five minutes, and you'll do it as soon as your students come in from recess. And you'll do that, you know, once a day for a week. And then let's reassess and see if it's helping.     Rachel Harrington     My thought was, could you, as the therapist coming in, working with one student, or in a small group, take the classroom through the sensory diet? So that way you're demonstrating what it looks like, and you're almost running like a full group with the entire classroom when they have a five minute break with the teacher there exactly teaching the teacher, but you're actually taking the whole class through an inclusive sensory guide. Is that something that's feasible?     Jayson Davies     Yeah. And actually, as you're saying that I'm thinking of a research paper that came out is actually, I believe, some educational students, not ot students, that did this research, and they wanted to see how OTs and educators could work more closely together. And through their surveys, they found that teachers wanted more modeling, not just telling. They wanted us to actually come into the classroom and show them how to do it. They really appreciated that. So I think that's right on with what you're saying. Rachel, going into the classroom and actually, you know, showing the teacher what it looks like.    Jessica Hill     that's I just feel like, if it were me, that's what I would want. I'd want someone to come in and say, Alright, let's do it and just take, take the rain, take the bull, by the rain, and just show, show the teacher, like, this is what we're doing, but we're actually doing it while we're learning. So I think that'd be cool.    Jayson Davies     Yeah. And I think that just takes away so many of the hesitations the teacher might have right, like, they don't know if they're doing it right, or they don't know if it's going to work. And if we go into the classroom, we can actually show them exactly what it looks like. We can even record ourselves doing it so that we can just upload it to them and they can watch it whenever they want, and that way they don't have to wonder, what if I'm not doing it right, or am I getting an appropriate reception in it doesn't matter, because they've seen you do it, and they know what to expect. So yeah.    Rachel Harrington     It can be very scary and overwhelming when we start talking about all these different senses, the vestibular system and the proprioceptive system. But don't do too much, because if you do too much, you're going to rile up, and then it's going to be out of control. Like, it's very overwhelming, you know, for someone who has no background in sensory integration, and so I they probably just feel like they don't want to mess up. And, you know, I think just just giving them a simple breakdown, making it as easy as possible.    Jayson Davies     Yeah, yeah. And, you know, they have a lot of other things on their plate. My wife's an assistant principal. I mean, they have common core to worry about they've got certain amount of minutes that they have to reach for different areas of math and language arts and whatnot. So if we can give them just that quick five minute thing, we can show it to them and then let them know when to do it. I think that's a great idea. So thank you for that idea. All right, now we have mostly been talking about an individual student or an individual classroom for the last, you know, 20 minutes or so. I want to broaden that out a little bit. And if we want to, you know, get everyone on campus moving. How can we develop that school wide culture of of movement, supporting learning?    Rachel Harrington     That's a great question.    Jessica Hill     It is the question of the year,    Jayson Davies     Any ideas?     Jessica Hill     My gosh, I think, you know, we, we created a course, kind of with this goal, in mind of education, of, you know, teaching sensory integration to schools so that, yeah, it's not just one classroom, but it's the entire school, and having teachers go through that training to just learn what sensory integration is and why it's important.     Rachel Harrington     I think that teaching students about their own sensory needs and teaching them the benefits of movement From a sensory perspective, from like an arousal level perspective, like, Hey, if you want to wake up, go upside down, do a somersault, teaching them that they're in control over their own nervous system and that this even exists. And I feel like we get more buy in when the students are like, whoa. I feel good when I spend three times in each direction, you know. So I think shameless plug, our course does teach that, but I'm just trying to think of a way that the entire school could be on board with that, and I think it just takes a lot of the education from the top down and trickling down so that everyone's kind of on the same page. I mean, it would be my absolute dream, Jessica, I'm sure your dream too, to have, you know, every classroom learning this material, and just having some background in the sensory system and sensory integration. I just feel like it would make such a huge impact. Well, and two, like, if one teacher figures out this, these sensory strategies are helping my classroom, then ideally, that teacher could go teach their other teacher friends about it, and then it would be like a ripple effect of teachers teaching other teachers about it throughout the entire school. Yeah, and I don't think there's a there's a quick fix at all. I think it's gonna just take time. Unfortunately.    Jayson Davies     Yeah, you know, and I think we're halfway there. It's just getting over the hump. Because a lot of people, a lot of teachers, they're already using go noodle. But they may not necessarily be thinking, you know, my kids need a little bit more probe. This is the type of go noodle I'm going to look for vestibular I'm going to look for this go noodle. So they're already trying to incorporate that movement, but they need that extra little knowledge, that extra little support, to better understand how to gage what to use based upon what their students are, are looking like at that point. Does that make sense?     Rachel Harrington     Or even schools that don't have go noodle, right? Like maybe the old students who aren't into go noodle anymore, because it's for younger kids. So even those different types of strategies for the older students too, is go noodle kind of like the go to for movement right now in the classroom.     Jayson Davies     I think there's a few other programs that have been up and coming, but it's still either go noodle, or some people are just, you know, just YouTubing whatever, you know, movement activities on YouTube, and looking for it well.    Rachel Harrington      And I think go noodle became super popular during covid when lots of schools were on virtual, because my son did first grade all virtual during covid, and he had go noodle almost probably every day as part of like, their virtual class.     Jayson Davies     Yeah, yeah. I we were using it a little bit before covid, but absolutely during covid, it was the easiest way to get everyone doing it. And let's be honest, teachers were just trying to keep their their kids engaged during covid. And so maybe even more covid was or not more covid More go noodle might have been used because the kids were just, you know, if they weren't focused on you, then there are many other things to distract them around the house.     Jessica Hill     For sure. Yeah.    Jayson Davies     All right, so I want to talk a little bit more about the parents from the school based otschoolhouse. Perspective, because as school based OTs, you know, or OT practitioners in general, we are focused primarily on that classroom, that educational setting. But do you think there's any reason for or against ot practitioners, school based ot practitioners sending things? Home or getting parents involved with this movement and learning process.    Jessica Hill      I mean, I think there's certain challenges because the school based OTS don't typically have direct contact with the parents. So the little I mean, I did one of my fieldworks in the schools, and I don't I never met a single parent. I never talked to a single parent when I was doing my fieldwork in the schools. And so I think there is that added challenge of being able to connect with the parent.     Rachel Harrington     Yeah, I feel like, you know, handouts are great, they provide some information, but do they actually make it home into the hands of the parents? Also, side note, my nine year old comes home with 10 papers a day. Let's be real. Like sending these students home with papers is so challenging because, you know, as working parents, we don't have time to look through every single handout. Unfortunately, yeah.     Jayson Davies     Why not? Why not? Why don't you have time Jessica?    Jessica Hill     I know it's so tricky. I think, you know, sharing podcasts and videos in if there's a way to maybe through the teacher, or maybe the teacher can help facilitate that communication with the parents of the students you're working with, and sharing podcasts or videos that the parents can watch or listen to when they're driving or on the weekends, you know, I think that can be helpful.    Jayson Davies     Yeah, I agree. I know during covid Again, something that emerged from the craziness that was covid was videos, and I was sending home videos to Parents, and so I might create two, maybe three different iterations or versions of the same therapy activity based upon student levels. And so I'd send this group, you know, video, a this group, video, too. And so, you know, like, if you're thinking about the windmills, right, maybe one group is getting the full windmill, and then the other two groups are getting kind of accommodated or adapted versions of the windmills. So I think that's something that we can continue to do to an extent. But, yeah, use technology. I feel like we need to start using technology. Teachers are using programs that they can like instantly text to parents. So I think OTS should kind of be getting on board with that as well.     Jessica Hill     Do you feel like the carryover was there when you're sending videos?    Jayson Davies     During that time. Yes, I do think during covid, because that was the expectation, right? And not to mention, most parents were at home more than they are now. My guess is now it's probably a little bit less, but at that point we had the carryover. So I think there's ways to do it. I think you have to, you know, be a little you're always fighting for attention, right? And so there's ways to do it, but yeah, you're probably right. The carryover is going to be hit or miss. So yeah.    Rachel Harrington     In any field, though, honestly.    Jayson Davies     Yeah, yeah, you know. And I always tell people, right? Find the one person who wants to do that with you, like, you know, for some kids, it will work, because their parent wants that. And for other kids, you might have to do something different. You know, it might need to be more on campus, because, like you said, right, you've got 10 papers coming home. You're recording 18 podcast episodes a day, and you just don't have time to to do that. But, you know, I mean, some parents are ready for it, some others aren't for aren't ready for it, but you might be able to address that in a different way. You know, we're all trying to find which way will work for that one student. So yeah, all right, we got a few questions left, and I think this could be a fun, interesting one. Are there any misconceptions or myths about the role of movement within learning that you'd like to debunk? Is there anything out there that you hear from other people that you're like, Hold up a second.    Jessica Hill     It's a good one.    Rachel Harrington     I think I don't know if it's like a myth to debunk, but just understanding that kids need to move to learn, right? I think, I think a lot of people do know that, but I think there's still this idea that children should be able to sit and be quiet and keep their hands to themselves at all times, and it's like no these kids need to move. And you know, their brains work better through movement, so we need to figure out how to help them do that more, versus trying to force them into a little box.     Jessica Hill     Yeah, I don't know if mine's like a myth, but just like, just really, how important getting outside is? I just, I think that, you know, when I think back to my childhood, I was outside, you know, at the neighbor's house, playing, and we were just outside of climbing trees, and I just feel like risky play nowadays, like getting outside and climbing a tree. Parents are just like, Don't boil, be careful. Ah, you're climbing the log. You might nurture your mean, oh my gosh. You know, I just feel like we're just anxious as parents right now, whereas my parents were like, oh, kid. Laughter. Fine. You know, I don't know if there's a myth, but I just feel like we just need to give our kids the opportunity to learn to move and make mistakes, and most of the time they'll be okay.    Jayson Davies     Yeah, you know, I am seeing a trend of outdoor equipment starting to get back to being a little more risky. You know, for a while there, everything had to be like, just, here's a slide, here's a ladder, that's it. But now we're starting to get some of those merry go rounds in a different format back, right? Like, instead of sitting on or instead of standing on the merry go round, they have merry go rounds where you actually sit. So, you know, it's still the vestibular, but maybe it's a little bit more safe. And we're getting some of those rock climbing walls back. We're getting some of those zip lines in parks back. And so I think that's that is fantastic. And hopefully, I mean, it's obviously a shift in the right direction, but hopefully we continue to see, see that shift going.     Rachel Harrington     Are we getting swings back on the school playgrounds?     Jayson Davies     I don't know. You got to ask the insurance adjuster about that, from my understanding, like.    Rachel Harrington     I don't know. Man.     Jayson Davies     I agree. I agree. I mean, but again, even with that, even with swings, there are ways to make swings that are safe if you want to still give a student the vestibular motion of a swing. Well, then create a swing. Not well. I mean, OTs can get on board with whoever makes all the equipment, but create a swing that is safer. You know, I remember, gosh, they're mostly on, like, preschool playgrounds, but it was like a swing, but it was like a fire truck, and you're like, completely enclosed, right? So something like that. I'm sure you can get people out there who designed play equipment have to be creative people, so they got to come up with something I think.     Rachel Harrington     Somebody will share this episode with somebody who does that. They'll hear it.     Jessica Hill     I think there we go. I wonder about kids like their ocular motor skills when they're when they used to swing, and you were like, navigating the environment safely, I mean you'd like run in between. We work on all those underlying skills in OT but it's like timing and sequencing and safety awareness and the visual processing, like all of those skills that are imperative, those underlying skills that we need to develop. Are they getting developed in different ways now, or are they just not getting as developed because they aren't being as challenged with those, you know, dangerous, risky activities like locking in front of a swing.    Jayson Davies     Yeah, things that there's a reason that ot practitioners work in the schools. These are things that we can talk about with teachers, with administrators, with parents who sometimes take things beyond our control, even you know. So yeah, you know, there's a reason that we're there, and hopefully we can start to move this stuff in the right direction and incorporate more movement within the classroom. All right, I got two more questions before we we wrap things up. And the first is, how can school based ot practitioners continue to stay up to date with this knowledge, with this research on best practices for movement and learning, obviously they're already listening to this podcast. But what else?     Rachel Harrington     Just seek out those continuing ed courses that are geared towards the most recent research of, how does movement affect learning? How does nature affect learning? Getting outside, that kind of stuff. There's a lot out there.     Jayson Davies     Yeah, and you mentioned, like, a topic that could be a whole another episode. Hopefully it will be soon, and that's nature and learning, and, you know, being outside, and I know there's a lot of people doing a lot of good stuff with that, Laura Park, Figaro and others, that would be great to talk more about that and how we can take learning outside to make learning even better.     Jessica Hill     Well, we just we recently interviewed an OT her name's Danielle, and she's local here, and she talked about how when she was in the schools, she found ways to take the kids outside and run her school based ot sessions outside in any way that she could. And it was, I mean, it was very eye opening, you know, because you think about school OT or either in the classroom or you're in your little office, or maybe you're in the hallway or the gym, but like, can you take your kids outside to the playground when no one else is there because they're in class right now and run your ot session on the playground instead of in the school.    Jayson Davies     Absolutely. More info on that coming. Maybe in episode 145 I don't know. We'll see. But all right. Final question is, where can anyone interested in learning more about using movement to ready the brain for learning go to find more info, whether it be you know, specific cores, obviously you have your podcast. But where would you where's the best place for people to go to learn more about movement and learning?    Jessica Hill     I would send them to our website. Harkla.co we've got courses there. We have courses for the classroom from reflex courses. Send three diet courses, really everything that we're passionate about. And then we have a YouTube channel where we chat about the same things on YouTube, our podcast, our blog.    Jayson Davies     all the places.     Jessica Hill     All the places, we just try to make all this information as digestible as possible and fun. And just, yeah, I'll plug one more sensational brain provides some really great tools. And you know, it's a continuing education platform as well, so there's a lot of really great courses there.     Jayson Davies     Awesome. Well, thank you both so much for sharing. Thank you for coming on the otschoolhouse com podcast. I really appreciate it. And, yeah, definitely keep in touch about all things sensory.     Jessica Hill     Yeah, thanks for having us.     Rachel Harrington     Thanks, Jayson, see you later.     Jayson Davies     Bye. Bye. All right. I hope you enjoyed that episode with Rachel and Jessica. They are both really awesome and really insightful when it comes to all things sensory, as you might guess, with the name of their podcast, as well as primitive reflexes. And you know, I hope you really enjoyed this and saw that all three of us kind of let our guard down today. You know, I felt almost a little more silly today. But despite the silliness, I feel like we got into some deep conversations that ot practitioners don't always want to talk about, like a fidget versus a toy, and the difficulties behind some of the popular movement programs out there, and a lot of other things. So I hope you found this episode super helpful. I appreciate you being here and all the show notes for this episode you can find at otschoolhouse com slash episode 123, so check out the show notes for all the resources that we discussed today. And yeah, that's about it. Thank you again. So much for tuning in today, 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 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 122 of the OT Schoolhouse Podcast. Welcome to a special episode of the OT Schoolhouse Podcast, where we celebrate OT Month and the anniversary of the OT Schoolhouse Podcast! We're excited to bring you an episode packed with valuable insights as Jayson answers questions submitted by our listeners. Tune in as we cover various topics related to OT, such as creative contests for school-aged students, strategies to help parents prepare for changes in their child's OT services, sensory checklists, and tips for becoming a more confident OT practitioner. We'd like to extend a big thank you to all those who submitted their questions and helped make this episode possible. So sit back, relax, and let's dive in! Listen now to learn the following objectives: Learners will identify how to help build confidence as a new practitioner Learners will identify strategies to help parents prepare for dismissal from OT services Learners will identify how to utilize The Sensational Brain Sensory Checklist with a general Ed classroom Guest Bio In 2017, Jayson founded the OT Schoolhouse website and now supports school-based OT practitioners via courses, conferences, and the OTS Collaborative community. With experience as both a contracted therapist and an "in-house" employee for two distinctly different districts, Jayson has had the opportunity to appreciate the differences between both small-rural and large-suburban districts. Recently, Jayson has put forth his efforts toward supporting therapists interested in tiered intervention, collaborative programming, and managing their workloads. Quotes “Start with one student and one teacher and build from there - find a student who is mastering skills in the OT room but needs to generalize” - Jayson Davies, M.A. OTR/L “Don't fake it till you make it. Instead, believe it till you achieve it” -Jayson Davies, M.A. OTR/L “If you have a student focusing on handwriting, try to find a way to incorporate daily support…even a 5 minutes check-in could have better outcomes” -Jayson Davies, M.A. OTR/L Resources The Sensational Brain Sensory Checklist Effects of Weighted Vests on the Engagement of Children With Developmental Delays and Autism Systematic Review- ADHD & Autism Efficacy of Weighted Vests Choosing wisely- AOTA List- Sensory-Based Intervention STAR for School Course OT Schoolhouse Podcast Episode 26 Article on Self Regulation & ACEs Handwriting and Beyond in School-Based OT Podcast Episode Challenging Typical Handwriting Traditions Podcast Episode Episode Transcript Expand to view the full episode transcript. 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     Hello, fellow occupational therapy practitioner, welcome to episode 122 of the otschoolhouse com podcast. So happy to have you here. I'm your host and fellow school based OTP Jayson Davies, and today you are tuning into a special ot month edition of the otschoolhouse com podcast. Ot month and the anniversary of the otschoolhouse podcast occur right around the same time each year. So to celebrate, I like to host a special Q and A session where I answer some questions directly from you, the listener. So this episode is that special episode. Today, we have about 10 listener submitted questions that I'm going to do my best to answer, and we have questions from Meredith, from Ruth, Amy and more. We also have a special audio question about sensory screenings and checklists that I'm going to play for you from Lori and give my best answer for that one. Just one more thing before I dive into the questions. You may hear me mention the otschoolhouse com collaborative today, or OTS collab, for short. So I just wanted to let you know what that is. In case you haven't heard of it yet, the otschoolhouse com collaborative is our brand new community for school based ot practitioners. Here at the OT school house, inside the collaborative, we host live aota approved professional development courses. We collaborate with one another during team meetings, and we host a research and resource library directly in the community specific to school based OT. If that sounds like something you could benefit from in your career, be sure to check out the community at otschoolhouse com slash collab with that said, let's go ahead and dive into our first question of the day. This one comes from Meredith and is a great first question for ot month. Meredith wants to know if I have any fun contest for school age students during ot month. Apparently, she was thinking of maybe a shoe tying game or something like that, but she just wanted to get my ideas on the matter. So first of all, Meredith, I'm sorry this episode's coming out a little bit later in OT month, but maybe you still have time to fit it in, or maybe save it for next year. So first off, I love this idea. I love this question, and to be brutally honest, I had never thought about doing something like this before, but I really love the idea. And you know, you could do this just for the classes that you frequent most, or you could take your own time, if you have any, of course, and go out during lunch or go out during recess and host a little competition out during that time. I'm thinking something along the lines of Minute to Win It. You know, whether it's like little short one minute games that several people can play at a single time. For example, I remember at, I believe it was an OT of California Association event that we played Minute to Win It, and we had people that had, like, tissue boxes that were strapped around their their waist with a rope or whatever, with a bunch of ping pong balls in the tissue box, and they had to, you know, shake and groove and to try and get the ping pong balls out of their their tissue box, another little minute to win it game. And again, each of these games is just a one minute long, or typically one minute long game, though, so they're very short. You know, you don't have to have a lot of attention to do them. Another one was basically who could wrap up their partner in TP the fastest and so these don't have to be very, you know, super structured games per se. Now, before you go ahead and pick out a game, what I might do is actually reach out to your teachers, reach out to your administrators, and maybe bounce some ideas off of them, because they might give you some things that their students are struggling with that they would like you to incorporate. You know. They might say, Yeah, you know, shoe tines kind of tricky for some of our kids. It'd be great if we gamified it and made it fun for them. Or they might say, you know, we have a bunch of kids that are struggling with opening a milk box, and you could somehow work that into it or something. So, so, yeah, you know, talk to the teachers, you may find that mental health concerns or social skills are some of the concerns, and maybe you can work some of that in there as well. But I think it would be great to kind of collaborate with the administrators with the teachers on this because it is also kind of opening up yourself to that team and letting them know that you want to support them as much as you want to support the kids in what you're doing for this little ot month Shindig. So again. Meredith, fun question. Thank you so much for submitting that and yeah. Keep on going for question number two, Ruth has a question about changing services for a student. More specifically, she wants to know what are some steps to take or strategies to use to help a parent prepare for changes in their child's ot services. Specifically, she wants to know more information about dismissing a student from ot services. Now this is always a I was going to use the word tricky, but I think the right word is actually more it's a sensitive time, and we have to be mindful of not only what we are thinking in the moment at this IEP or before the IEP and after the IEP, but also what the other people on that IEP team are thinking or have beliefs about during that time. When we're trying to dismiss the student, we need to think about the teacher's feelings and thoughts toward the student, the administrator's feelings and thoughts the district as a whole. But also the parents, right? This parent has a huge emotional attachment to the student, and everything, everything that surrounds that student, and that includes the IEP, the services within IEP, the goals within the IEP, everything that makes up an IEP. So when it comes to time to change services, to redo, services to terminate, dismiss, whatever you want to use, but to remove those services from a student's IEP, we need to be sensitive to all of that, and I'd like to say that that process starts way before the IEP is even coming up where you want to dismiss students. In fact, I will often tell people. In fact, I tell people this in my A to Z school based ot course, that dismissal of a student should actually start on day one, when you are reporting your evaluation results for the very first time for that student. So at their initial onset of occupational therapy, you should already be talking about dismissal. Be talking about how we are hoping to be able to dismiss the student from ot services after maybe one, two or three years, and talking about the purpose of OT to support education, and that at some point that student's education will no longer need OTS to support that education. So dismissing shouldn't just be something that sprung up on a on a parent in the IEP meeting when they're expecting. You know, for things just to continue on the status quo, we need to almost eliminate that status quo, like staying on ot services. Maybe that shouldn't be the status quo, and how can you go about changing that? Well, one I just mentioned right starting dismissal, way back when you first even onboard a student to occupational therapy services, but then at all the other IEPs between those two, the onboarding and the dismissal IEP so every year you're kind of bringing that back up. And you can even kind of phrase it like, Hey, Mrs. Smith, you know, whenever I do an evaluation or at all these annual meetings, I always have to weigh, you know, where the student is and should they be dismissed? Should they continue on? Should we change things up a little bit? And this is what I ultimately came across. That way, every time that they're meeting with you, they see that you are actively considering all the different options and that you're not just going with All right, time to continue, time to continue, or just when that meeting comes up for dismissal, all of a sudden, it's time for dismissal, right? So we want to, we want to leave option on the table. I guess you could call it now, of course, maybe you haven't been doing that, maybe you haven't been talking about dismissal from the onset of services. So what can you do from from now on? I would say, start slowly. When it comes to these IEP meetings, it is not usual that you decide the day of the day before, maybe not even the week before that, you're thinking about dismissing a student from ot services. So as soon as you start to think, hey, this student might be ready for dismissal from OT, I would communicate that with the team, both the parent as well as other team members, like the teacher, the administrator and whoever else, maybe even the speech pathologist that communication could be in the form of a phone call, which it probably should be. But you can also use other opportunities to to share this information. In fact, one opportunity that you have about every three or four months is the progress on goals. Now, if you're doing progress on goals which you should be, and you're taking data which you should be, then you can use those progress on goals to actually show the parent. Hey, this is the data that I'm seeing in OT we are making progress to goals two, three and five, or whatever it might be. Here's the data. Data. And you know what Johnny's doing? Great if he continues at this rate, we may be discussing dismissal from ot services at the upcoming IEP. Now I get it. Some people are going to say, Wait, Jayson, you want me to actually, like, give them the heads up so they can go get a lawyer and advocate to come to the meeting to fight me on this. I mean, if you want to take it that way, sure, but I take it as the way as you are kind of leading them, you're scaffolding the parent up to understanding that their parent or that their child no longer will need ot services, and that that is a good thing, not a bad thing. Now, what you will need to make sure of as you lead up to the IEP is that you fully understand all the concerns from all parties on the IEP team, so you can make sure that they have been fully addressed. Then you also want to make sure that any accommodations that are on the IEP or that need to be on the IEP are ready to go, and that the teacher and any other support staff can implement those accommodations without you needing to be there. That way, when you walk away, when you are dismissing yourself from that student's IEP, everything is in place for the student. And I think the last thing that I will add to this topic is that remind the parent that ot can always be added back onto an IEP, if need be, be straight with them. Let them know that it will likely need to be an evaluation to add the student back on. Right? You just don't add services back on. But let them know you know the IEP is a living document, and that at any moment, a teacher, a parent, anyone can make a referral for an OT evaluation. Hopefully, if you do all of those, or at least some of those, it should lessen the quote, unquote blow for the parent and make life a little bit easier for everyone you, the student, the parent, the entire IEP team. So Ruth, thank you for the question. I really hope that helps you, as well as everyone else that is listening today to this special ot month edition of the OTS podcast. All right, next up, we are diving into the topic of sensory we had several sensory questions, so we're going to kind of go through this. We have questions about a sensory checklist, about sensory fidgets, about just general sensory and so we're going to dive through these. There's three or four of them, but we're going to start with an audio question. Laurie was so kind to leave me an audio question, so I'm going to play that for you right now and come back and answer it in just a moment. So have a listen.    Lori Flynn     Hey, I've been, I'm an OT in the schools as well, and I've been, recently been asked, actually, more and more, I'm being asked to look at kids with sensory concerns in the gen ed classroom. And I started using the sensational brain sensory checklist, which makes it really easy to see if this is an over responder, an under responder, sensory seeker. And I wondered if that is sufficient. And your thoughts on that.     Jayson Davies     Lori, thank you so much for your question. Thank you for leaving us a voicemail so we could play it here on the podcast. And also, thank you for kicking off. What is going to be the sensory section of this podcast episode? We have three, I think, questions about sensory and we're going to start by talking about this sensory checklist and my thoughts on that. So let's dive into it. When I first heard your voicemail about a sensory checklist, it reminded me of a conversation that myself, Leanne and a few others in the otschoolhouse com collaborative have been having about the sensory profile, the SPM and all the different sensory checklists and standardized assessment tools that we commonly use as school based OTS. And this conversation actually revolved around the psychologist using a sensory profile before the occupational therapist even comes on board. And so when I heard you asking about this sensory checklist and using it kind of as a screening tool, it kind of clicked with me a little bit, and I wanted to share kind of our conversation that we were having there, and what I might do here. Now I'm going to talk first about that other conversation inside our collaborative and that is that the psychologist is actually using the SPM to gather some data to determine if the OT needs to be more involved. Now if that's going to happen, the psychologist should definitely be more trained in understanding the SPM and how to actually grade it, and what those outcomes of the SPM actually mean, so they can pass it off to the OT, or choose not to pass it off to the OT. Now in this case, where you're talking about using the sensational brain sensory checklist, which we'll link to in the in the comments or in the show notes, so that you. And I'll find that here, but using that kind of as a screening tool, per se, before a student even has an IEP, or at least has ot on on the IEP, if they already have an IEP. Now, if that's the case, this is the way I would go about it. I would actually provide that questionnaire to the teacher, and I would say, Hey, Mrs. Jones, can you please fill this questionnaire out in relationship to the student you have in mind? I don't need to know the student's name. I don't need to know all the different concerns. I just want you to kind of fill this out in relationship to the teacher so I can provide you some general guidelines. All right, that's how you can get potentially around this without having to do a full evaluation. This is, in a way, tier three RTI. You're getting some specific information about a child, but it's not leading to the point where you necessarily need to do a full evaluation. So after the teacher completes that form for you and they give that back to you, you can kind of look at it right. This sensory checklist isn't standardized. It's simply designed to provide you with information or behaviors that the teacher is seeing the student exhibit. Now, based upon the sensory checklist, you can provide the teacher with some general strategies, and when you provide those general strategies, you should also provide some sort of data sheet that the teacher can use to track if those those strategies, those sensory strategies, behavioral strategies, whatever strategies that you are asking the teacher to implement if they work now, if they work within, you know, the next full or six, eight weeks, then there is no Need to move forward with an evaluation. However, if they don't work, then you may need to do a evaluation to really identify what areas of sensory processing skills are impacting those behaviors, or whatever type of sensory behaviors we are seeing. Okay, so again, I would identify this as a tier three strategy. You don't necessarily need to know who the student is. You are simply providing general strategies based upon the checklist form the teacher has filled out. Now if it doesn't work, then you would go beyond that to do a more comprehensive evaluation so you can actually identify what areas within sensory is impacting that student's behavior and functional skills, but with this checklist, you're not going to be able to really get that. You need more standardized assessment tools, more observations, more pulling the student out and working with them one to one to really understand the sensory processing skills or the deficits that the student needs specific, targeted intervention with to actually implement that type of occupational therapy beyond what we can do with this skills checklist. All right. Cool. Now that brings us to Amy's questions. So you got three in there, three in one here, most of them, or two of them pertain to sensory at least that's the way that I'm I'm taking it, and I'll explain in just a moment. And the other is about push in versus pull out. So let's start with the two sensory questions, and then we'll go into the push in model versus pull out model. Her first question is, how do we prevent us from becoming the quote, unquote stuff people? And I'm taking this as we provide a lot of sensory stuff to the teachers, or at least, I think that is where Amy's going with this question. Now the straightforward, blunt part of my brain is just saying, Well, don't give the teachers stuff then, right? But obviously it's not that simple. What I mean is, don't make it as easy. When teachers come to you asking for something, for example, they may come ask you for a weighted vest or a yoga ball that a student can sit on, or a sensory fidget item, right? They may come with all different types of things, and typically, they're coming to you because this is a hot topic. Of course, sensory is a hot topic. It continues to be a hot topic, but just because it is a hot topic doesn't necessarily mean that the teacher understands the research behind it and the strategies behind how it is supposed to work, or what limitations it might have, or how not to use it, because it could potentially harm the student in the future. Now, Amy's second half, or, I guess, second third of her question is, what's the real T on the use of weighted vests for sensory issues? And that's important here. There is research that goes both ways on weighted vests. There's research that is being put out by OTS per se that kind of shows either no significant improvement with the use of weighted vest for sleep and attention. And then there's others that are saying, yes, there is some benefit to using a weighted vest for sleep and attention. Then there's other research put out by, you know, psychologists, ABA, therapists, that are saying, No, you know what? Some. Sensory vest, there's no change in behavior, and some of them have even linked a negative change in behavior with the use of sensory vest. So unfortunately, I can't give you just like a straightforward answer yes sensory vest or no sensory vest. What I can do is point you in the direction of the aota choosing wisely campaign, where they do actually state this, and I really do appreciate that they did this. They have a statement that says, don't provide sensory based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information. So what does that mean? When we break that apart, it means that we shouldn't actually be providing sensory strategies, whether it be sensory integration treatment or a weighted vest or yoga ball or anything kind of simplistic like that, the stuff, right, without doing any valuation. So that's how we can get away from just giving teachers stuff, sensory stuff, right? We say, okay, Mrs. Jones, or Mr. Jones comes to us and says, Hey, I need a sensory vest for Jason. You seen him in the classroom? You know, he needs a sensory vest, a weighted vest, whatever it might be. And your response can then be, okay, okay, Mr. Jones, I hear you. I understand what you're saying. Unfortunately, you know, the governing body of occupational therapy says, I need to do an evaluation before I can provide this sensory based intervention for that student. Now, yes, you are giving yourself more work. You have to do an evaluation, but to be honest, that's a good thing. We need to stop trying to eliminate work by doing interventions without any evaluation. Instead, we need to advocate for ourselves to have more time to do those evaluations and treatment, to make sure that we're implementing good evaluations and treatment. So the next time that a teacher comes to you and just says, Hey, I need sensory stuff. Say, hold on. You know what? It's one thing if you want to provide your student with something, and you can call it a toy, you can call it a fidget, you can call it whatever you want to call it. That's okay, but it's not going to come from me until I do an evaluation to actually determine if the student is going to need this. Is this the most appropriate sensory item to work for your student? Yeah, I'm taking a long pause there, because we should really think hard about that. We shouldn't just be handing out stuff. We need to be doing an evaluation, especially when it pertains to a single student. Now, again, we can kind of potentially say, Okay, some of these things might work with some of your students. Here are a few things, you know, just kind of try and see what works as a general strategy. But when we're talking about one particular student, we need to do that evaluation. And that now brings me to the final question that Amy had, and that was how we can start to move from a pull out model to a push in model. And I'm gonna give you the same tips that I give all the school based ot practitioners that take my A to Z school based ot course. And that is to start small, find one student that is currently on a pull out model service that you know is doing pretty well. They're meeting their goals in that pull out model environment, and now talk to the teacher and say, hey, you know what Johnny's doing so well with improving his executive functioning skills, for taking notes, for handwriting, whatever the goal is. You know, Johnny's doing super well with that in the pullout model. But I'm hearing from you that we're not quite getting that into the classroom yet, and that right there is your opportunity to say, All right, we're going to move Johnny from a pull out model to a push in model, and just do it with one kid, just Johnny. Don't Don't worry about Sarah, don't worry about Elise, don't worry about Brian, just worry about Johnny first. And getting into the classroom with Johnny, that's going to be your opportunity to learn a little bit what it feels like, the planning that it might take to do that push in. And it's also going to give the teacher an opportunity to see what you can do, what progress you make with the child, being in the classroom, being in their academic setting with the student and the teacher. From there, you might be surprised, because if the teacher sees you doing great work in the classroom, you're gonna have other teachers starting to come to you and asking you if you can go into the classroom with Brian, with Sarah, with Elise, because they're gonna see that progress that you make. The other thing that I would also potentially recommend is that, if you have the time and the opportunity to do it, is to do an in service, do an in service for maybe grades K through two, the teachers on their professional development day, and share with them what a push in model might look like, and how you know during a push in model. So it might not just be beneficial for the student that you're there to see, but maybe all the other students that the teacher has some concerns about, and how you can provide co teaching with the teacher to maybe implement some handwriting instruction, or how you can come into the classroom and provide some generalized sensory strategies and introduce them to go noodle or some other type of video that they can use in the classroom to promote sensory regulation or even mental well being. All right, so start small. Start with one student and one teacher, and then grow from there. Don't try and just say, You know what, I'm going to move my entire caseload to push in. That is an easy way to fail. Don't do that unless you're really confident. Yeah, I recommend starting small and growing from there. So Amy, thank you for your trio of questions. I hope I was able to weave those all in together for you, and I hope that makes sense, if not, you know, reach out to me. I'd love to help you out some more. All right, so this next question comes from Tiffany. And Tiffany, thank you for your question. I'm going to synthesize it a little bit. It is a little on the long side, but I got the general feel, and I'm going to share that, and then we'll dive into an answer. So Tiffany shares that she is a relatively new occupational therapy practitioner. She's got about one year of experience as a school based OT. And you know she has some days where she's feeling great and others days where she's just not feeling so confident. A lot of us have those days. You have those days beyond your first year. It does happen. Don't worry about it. Like I'll get more into that in a moment, but just know that everyone has those days going a little bit further, Tiffany shares that sensory seems to be that area that most gets her feeling less confident, right? Maybe imposter syndrome creeps up on her when there's a student that needs some sensory intervention or some sensory supports, and that's kind of what her question revolves around. Hence why it's kind of in our sensory segment of this podcast. She really loves working in the schools. She loves working with the teachers, the parents. She loves the otschoolhouse podcast. Thanks for sharing that, Tiffany. But she needs some support within sensory so that she can feel more confident in her role. So the first thing that I want to say is, don't use the saying, fake it until you make it. Instead, use the saying, believe it until you achieve it, because you do have a lot of great skills. Maybe you're not feeling so great in the area of sensory, but you understand sensory a little bit. If you don't fully understand it, there's places to get more training in that. And eventually you will get to a point where you do feel like you pretty much understand sensory now, as soon as you start to understand sensory, things will change, and you'll have to get more education. You know, that's why we have to get 12 hours or so of professional development every year. But don't beat yourself up, you know, 10 years in, and sometimes I still feel like, wait a second, this just changed. You know, like, what was common practice 10 years ago is not common practice anymore because there has been new research, new growth. So I would definitely recommend that you look out for either a mentor in your district that understands sensory that you look into other forms of education, like at the otschoolhouse com collaborative, where we have professional development every month, and in fact, just, you know, shameless pitch here in May, we're having a course from Kelly altright all about sensory perception in the schools and how sensory reactivity and sensory perception impacts school participation. So something like that might be a great idea. I would also recommend that you find a course, if not the one I just mentioned, a course that revolves around school based practice, because you can go and take a long certification program like the class C or the full STAR program, and yeah, you'll get a lot of information, but maybe only 25% of it will be super relevant to what you're doing in the schools. Or you can go and take one piece of their course, one piece that is specifically relevant to school based OT and that's where I would start. I know the star Institute in Colorado has actually one particular sensory course geared towards school based OTPs that might be worth looking into. One type of course that I would actually avoid is any course that pits sensory versus behavior. I would avoid that like the plague, unless within the description it clearly says, haha, sensory versus behavior. That's a joke. Of course, sensory and behavior go together. Because, you know, you can't weed out sensory and behavior fully. They, of course, interact and they impact one another. So anyone who tells you that you can completely weed out sensory versus behavior, just I recommend, don't believe in them. So yeah, definitely find a course that addresses sensory. It relates to school based OT, you know, the last 10 minutes of this podcast have probably helped you already tremendously, and the next question is probably going to help you as well, but find something that's a little bit more structured. Again, we have a course coming up in May, all about sensory in the schools, and there are other courses available to you. And then again, just believe it, until you achieve it, you have so much education. One year into your profession, you are not supposed to know everything. That's why we have professional development and continuing education. You will continue to learn, and you will continue to feel like you don't know everything, because things change, and then you will learn some more. So just be confident you're doing great, and yeah, we'll continue to support you here on the otschoolhouse com podcast. All right, this final sensory question comes from an anonymous certified occupational therapy assistant, and she wants to know how she can support her OTRS to address sensory and self regulation. In addition, she asked for any guidance and Data Research published information stating that a child needs to be able to self regulate before being able to learn and decrease behavior. So I actually had to kind of dive into this a little bit. I wasn't too familiar with any particular research that you know, kind of blatantly said, Yes, you need to be able to regulate before you can learn and behavior. Now, I think the OT side of us, you know, kind of understands, right. We're trying to find that optimal arousal level, as we often call it, for a student to learn, right? If their engine is running too high, or if their engine's running too low, then it's not a great place to learn. So I did a little bit of research into it, and as I say, engine high, engine low. We did an episode a few weeks ago with one of the creators of the Alert program, and they keyed into a lot of research. So you might want to go back and listen to that episode and view the show notes, because they shared a lot of a lot of research related to self regulation. Now, I did do my own little homework into this, and I did find an article in the Open Journal of Occupational Therapy from Rhonda Lynn Whitney, and it's titled, self regulation as a key factor in protection against the harmful effects of adverse childhood experiences, critical role for ot effects of adverse child experiences. Anyways. So it's looking at the adverse experiences of aces, or the adverse effects of aces, and we often include that one of the adverse effects of aces, often is behavior and self regulation and the ability to learn, and if we're using self regulation or CO regulation to offset those adverse effects of adverse childhood experiences, then that is kind of in a way, saying, Yeah, we do need to address the self regulation in order to Address behavior and and learning itself. So I would definitely check out that article. I will post a link to that as well as all the other research that I mentioned so far in the show notes. But I would, you know, download that, keep it in your file, keep it available, so that way you can have it when you need to explain something to your OTR. You know, I would also show or share with your OTRS, what other ot practitioners are doing. Share with them different school based OTs, whether it be on Instagram or research articles or the otschoolhouse com podcast or other places where sensory is a key feature within the school based occupational therapy realm. Now, I know there is a lot of kickback. When you bring up the word sensory integration, people like to claim one of two things. They either say a there's no research behind it, which is complete nonsense, because there's probably more research into sensory integration, whether it's good or bad, there's more research into sensory integration in the field of OT than most other areas within OT. You know, that used to be a case for concern back in the 90s, but there has been so much research since gene airs all the way up to, you know, this year. So there is research related to sensory integration and sensory practices in general that you can find. The other concern that's often brought up is that, okay, there's research, but it doesn't pertain to school based OT, and that one's hard to argue with a little bit, because most of the research that is done is so much more than one time a week for 30 minutes like the protocol that they use is more than likely three to five days a week for one hour sessions, and we can't match that in school based OT. So that is often a hard part to combat when people use that argument because they're kind of correct and. Sensory integration hasn't really been studied in a school based setting. There have been some research, you know, like we talked about weighted vest earlier, as to whether or not weighted vest work within a school setting. But there hasn't really been a lot related to sensory integration, and actually using more that clinic style model with swings and whatnot in the schools, and there we go. There's another situation that people often bring up is we don't have swings, we don't have bolsters, we don't have all the stuff that you often see in a clinic in a school based setting. And to be fair, you know you can't expect every single school to have a sensory integration clinic. I have seen school districts where sometimes they will actually bus a student from one campus to another campus after school for a sensory integration style treatment that they have a lab kind of at that school site. But we can't even expect that like that's really a lot, especially for smaller districts, districts where schools are spread out by, you know, 20 plus miles and stuff like that. So it's hard to, you know, get some people to come around, but I would continue to talk about it, make sure that you're noting it within your notes when you do sensory interventions, and how you are seeing that your sensory intervention interventions are impacting the students. And, you know, sometimes sensory can be like a four letter word to some people, and it's often because the research that has developed, it's developed slowly. It hasn't always been consistent. The protocols haven't been administered consistent. And I know the people that are within Si, you know that has been a pain in their side for years, and so much so that they now have a fidelity measure to say whether or not you are actually implementing sensory integration or not. And so now the research that's coming out now follows that fidelity measure. So the research is getting better. So keep, keep you know, finding that research, sharing that research, and then implementing what you know to be best practices within sensory and documenting that for your OTRS. One other resource that may be helpful for you is actually episode 26 of the otschoolhouse com podcast, if you haven't listened to it already, and that is with Olivia Martinez Hauge, and we talked about the polyvagal theory and how sensory and behavior are just really linked together. So I would definitely check that one out as well. Now we have a question from Joan, and Joan has a question about handwriting, so we're kind of moving away from the sensory part of this episode, and moving toward the handwriting part, of course, there had to be a handwriting section, and she's asking about handwriting strategies for students within third grade or above, you know, those outside, I guess, of that typical K through two handwriting kind of focus group. And she wants to know, you know, once you get to third grade, can you still work on handwriting? And you know, if a student is still showing mixtures of uppercase and lowercase letters, should we continue to work on it or not? So here's my simple answer to that, no. There's no research that says a student cannot make progress on handwriting after the third grade, or after the second grade, after the fifth grade, whatever it may be. And I've had a lot of handwriting specialists on the otschoolhouse com, like Dr Beverly Moskowitz and Cheryl Bragman. And you know, these people have handwriting programs, and they all tell me the same thing, that, yes, a student who is older can still learn to improve their handwriting skills. And I truly believe this, mostly because I believe in the growth mindset. I never believe that we can stop learning something, even if a student has a disability. I believe that they have the ability to continue to learn something, it might take longer. They might need to do it in a different way, to learn it in a different way. But yes, they can learn it, and that is what the specialists that I've talked to are telling me. And if we are going to work on handwriting, we might need to reframe our thoughts about it, because, again, the research, just like the sensory research when it comes to handwriting, the research isn't usually a handwriting program once a week for 30 minutes. It's usually a handwriting program four times a week for 1520, minutes. And unfortunately, we often default to one time a week for 30 minutes for OT and then we say it doesn't work. Well, maybe, instead of saying it's not working, maybe we need to say it's not working because I'm only seeing the student one time a week for 30 minutes, or it's not working because the student's only practicing handwriting one time a week for 30 minutes. And when you reframe it that way, whether it be in an IEP or to a teacher to a parent, then you can start to. Think about, okay, well, what if we change what our handwriting instruction looks like, and that's where you get to be creative. That's where you get to say, You know what? Instead of me pulling out this student for 30 minutes one time a week, what if instead I meet with the teacher 15 minutes a week to provide the teacher with some strategies that they can do all week long with the student for handwriting, or what if I work with the student five minutes in the morning, three days a week? Now I know that's like chaotic, right? You may not even be at a school three days a week, I get that, but I'm just saying this is where we need to be creative a little bit. If you're in an IEP, you might have parents that are open to working on handwriting at home, and so you're more like a teacher giving homework out to a parent, and that is okay, too, as long as the IEP team agrees on it, you can give out a home program now, getting the parent to actually make sure that they follow through with it, that's a Different story, but you can try it. You know, it may work better than one time a week for 30 minutes, even if they're only doing it a few times a week. And that is kind of the point here. You got to get creative about how we are implementing programs when it's not working one time a week for 30 minutes. All right? So, yes, I definitely think that students can improve upon their handwriting at later ages. I think we just need to get creative in the way that we are implementing said programs. And now for question number eight, I believe we are on from Laura. And Laura wants to know, can a diagnosis of dysgraphia only be given by a OTR in the school special education team, or outside ot clinician, or who is the one that is giving a dysgraphia diagnosis? To answer this question, I'm actually going to tease an upcoming episode that I had with Penny stack. Penny is actually the founder of dyslexia RX, not dysgraphia, but dyslexia RX, and she made a good point during that episode. And like dyslexia, dysgraphia is a specific learning disability, and that's where it actually falls within the DSM. And so as you know, specific learning disability is a qualifying criteria within special education that said special education, whether it be an OT, an educational psychologist, the speech therapist, we are not making diagnoses. Neither is any ot outside of a school based realm. We might make a treating diagnosis, you know, kind of a theory that we have that we want to work with, but technically, it would be someone like a neurologist, who would make that diagnosis of a specific learning disability, and they might tag onto that an area of dysgraphia within specific learning disability or dyslexia under a specific learning disability. So no, OTs are not making diagnoses. Neither is anyone on the special education team that would be coming from a medical doctor. We are making kind of a treatment diagnosis or a treatment theory, and we're working with that, but we're not making the actual diagnosis. Okay, we are now down to our final three questions for today's special episode, and this one comes all the way from India, from B santoshini, and she has a question about, if an autistic child receives early intervention or special education services, is it possible for them to be involved in normal school for their higher studies, and the answer is just 100% true. Now not every student will get to that point, but it is absolutely possible for a student to receive special education services early on in the career, or even later on in their educational career in high school, and then go on to college and be successful in college. Or, you know, they could even have special education from grades one through three, then exit from special education for grades four, five and six, and then they're back on special education for the rest of their, you know, educational career that is totally possible. Everything on an IEP is up for changing, and even then, an IEP only goes up until a student either graduates or exits out of the educational system at age 22 so at that point they would no longer have an IEP. They could potentially still have a 504 because five oh fours are not tied directly to public education. They're tied to any program that receives federal funding, which often includes colleges. So a college could put a 504 plan in place for a student. That's not out of the realm. So yeah, to answer your question in the most simple terms, yes, it is possible for a autistic student. To receive early intervention, special education services, and then go on to participate in regular education for the rest of their educational career and beyond, all right? And that brings up Gina's question. Gina, thank you for submitting a question. Gina asks, Can you please go over RTI ideas now? RTI, if you know me, is one of my favorite things within education, because it allows us to be more proactive, as opposed to reactionary when it comes to supporting students. And it's so important to me that I dedicated an entire episode to RTI and occupational therapy that is back in episode 42 of the otschoolhouse com podcast. So I definitely recommend checking that out. Now RTI, sometimes people will refer to RTI as MTSS, they are slightly different, but they're both tiered intervention models, and they have three different tiers, tier one, tier two and tier three. Tier one is often referred to as whole district or whole school or even whole grade level support training, providing teachers with the first best instruction. So tier one examples could be providing an in service for an entire school on proper body mechanics, for sitting in a chair while doing work. That could be something that is supporting teachers so that they can support all of their students. Or it could be something about handwriting. It could be something about self regulation, and how you can, you can get students moving to improve their self regulation and improve their ability to work on schoolwork like that. Could be an in service and a tier one intervention. When you get to tier two, I like to say that tier two is about supporting individual classrooms. So even though you just did an in service about how all the teachers need to make sure that their students have, you know, good posture in the classroom, well, maybe one teacher is still having difficulty with that. So they might come to you and say, Hey, I know you just did this in service, but I'm still having some difficulties with, you know, a handful of my students sitting in their chairs. Can you just come take a look? And then you go, you take a look, and then you provide strategies, not to the individual students, but to the teacher then to implement. So maybe you tell the teacher, well, hey, you have some kids who their chairs too big. I recommend reaching out to the custodian to find some smaller chairs. Or you have some students that are rocking back and forth in their chair, you can even provide them with a idea for a rocker chair. And you and the teacher together can propose to the principal, hey, can we get some rocker chairs? It will benefit some of our students without necessarily needing an evaluation, and it would be then up for the teachers to ultimately decide who gets that rocker chair, not you. Once you go beyond that, you go to tier three, which is often supporting either a small group of students identified by the teacher or possibly an individual student through what is commonly referred to in Southern California as an SST, a student study team. It might be called something else in your area. It's almost like an informal IEP, and the team being the teacher and maybe the parent and maybe the administrator might just be those three people come together to discuss ideas and how they're going to take data to see if the student's improving within educational standards and what to do if the student doesn't actually make improvements. So as far as the OT, you could potentially sit on that team meeting as a consultant. So you're not evaluating the student, but you're listening in to say, You know what? Here's some general strategies that you could try and then, kind of like what we referred to earlier in this episode, if the student doesn't make improvements with those general strategies, then maybe you need to do something more specific, and that's where an evaluation might come into play. So yeah, that's RTI at tier one in services, and you can do an in service on just about anything. I would definitely talk to your teachers and ask them what they need help with, and then create an in service about that. At tier two, you're going to listen to one, maybe two specific teachers and ask them or listen for how they need additional support. And you're going to support them by providing them with strategies, or maybe even co teaching something like a handwriting lesson or a self regulation lesson per se. So that would be tier two, and tier three gets more specific, individualized and or with a small group. So you could kind of do a center in a kindergarten classroom where all the kids rotate through your center to work on fine motor skills or whatever it is that they need support with, thanks again, Gina for the question, and best of luck with RTI. And that brings us to our final question in this special ot month Q and A edition of the OTS podcast. And this question comes from Natalie. Natalie actually wants to ask. If I can do a full podcast on something, but I'll see what I can do here. She wants to know if I can do a podcast on how to work in stressful classroom environments, particularly with teachers that aren't collaborative or open to learning. Could you discuss behavioral management in classrooms and schools and the OT role? Now, I think we've already kind of hit this a little harder earlier in this podcast episode, but a few other things that I want to add is that teachers don't just want to be told what to do. They want to be shown what to do. And this has actually been shown in research. I think I even did an episode on this a few months ago, but it was all about modeling and how teachers actually want to see you model what you are recommending that they do in the classroom. So getting into the classroom actually modeling, showing them the strategies that might work, as opposed to just telling them that can help with getting into the classroom and supporting the students in there in a collaborative way, in services I just mentioned those that's a good way to kind of building rapport with the teachers, so that they might be more interested in having you come into the classroom within the otschoolhouse com collaborative, we actually just had a wonderful course from the occupational therapy practitioners behind mindfulness in motion, and they talked about helping the staff to better understand their own sensory preferences and triggers, and that way they can self identify when something is triggering them in the classroom, and so that they may not overreact when something is going on within the class, right? The last thing we need is a student triggering an adult, and in response, that adult triggering the student, and it just goes back and forth, back and forth, so the better the adults understand their triggers, the better that they can respond and calm down and use those co regulation type of strategies within that presentation, from mindfulness in motion, Danielle and me also explained the Four main functions of behavior, being sensory escape avoidance, attention and access. And I think that is something that you know, ABA therapists understand. OTs, I think are starting to better understand it, but teachers may not fully understand that yet, and so helping them to understand the sensory escape, attention and access type of causes for behavior. Again, you're going to further build your rapport with that teacher. You're giving them education that will support them and they might see how beneficial you are to their program and become more open to learning and collaborating with you. So to wrap that up, I would definitely recommend the course that we have within ot school house collaborative. You can access that if you become a member today, or anytime it is a replay within the OT school house collaborative, and we'd be happy to have you there. And yeah, you can, you can learn from there today with the registration in the OT school house collaborative. All right, well, that is going to wrap up this very special ot month edition of the otschoolhouse com podcast. Thank you so much for listening. I really appreciate every single person who, well, not only you know, submitted a question, but all of you for listening today. You know, we get 1000s of OT practitioners that listen to the otschoolhouse com podcast every single week, every month, and it just blows my mind that you want to be a better ot practitioner, that you want to better serve the students that you work with. And I just, you know, applaud you. I appreciate you for doing everything you can to support the students and the teachers that you serve. So thank you so much for being here. Thank you so much for listening to this. You know, 5455 minute long podcast on your commute while you're at the gym, whatever it is, I appreciate you. You know, I just love that we get to come together every other week to learn together. So I appreciate you. I love you. Have a great rest of your ot month. Celebrate advocate and yeah, just enjoy your month. I will see you next time on Episode 123 of the otschoolhouse podcast, take care. Bye.    Amazing Narrator     Thank you for listening to the OT Schoolhouse podcast, for more ways to help you and your students succeed right now, head on over to otschoolhouse com Until next time class is dismissed.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast! 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

Introduction As school-based occupational therapy practitioners (OTPs), we are often asked to support teachers in addressing sensory concerns. The teachers sometimes do not know how sensory is impacting the student. But they know the student likes certain toys, seeks out sensory stimuli, and will sometimes have "behaviors" without an apparent cause. Unfortunately, for the past decade (or more), teachers, ABA therapists, other professionals, and yes - even OTPs - have been seeking to weed out what is sensory and what is behavior. I have yet to run across a therapist who can explain "sensory vs. behavior" well. And I think I know why - because deep down, we know that sensory processing always has an impact on behavior. Just as our behavior always has an impact on our sensory systems. So, the traditional approach of attempting to separate sensory and behavior may not be the most effective. In this blog post, we will explore why sensory vs. behavior thinking is a fallacy and how school-based OT practitioners can create a holistic plan to address student behavioral concerns. The Limitations of Sensory vs. Behavior Thinking Sensory vs. behavior thinking is a common approach in many OT courses, but it is a fallacy. While it may be helpful to identify the differences between sensory processing and behavior, it is important to remember that sensory always impacts behavior to some extent. Focusing solely on behavior without addressing the sensory component may lead us to miss how sensory stimuli have a unique impact on the student. For example, a student who has difficulty with auditory processing may become easily overwhelmed and agitated in a noisy classroom environment. This may lead to behaviors such as avoidance, agitation, or acting out. If we only focus on addressing the behavior without addressing the underlying sensory component, we may miss the opportunity to create a more supportive environment that meets the student's needs. Using ABC (antecedent, behavior, consequence) data and committing to address the sensory components to assess our student, we may identify the following: Antecedent - The student is given a writing assignment Behavior - Student acts out and refuses to complete the assignment Consequence - The student is told to calm down. Recess is taken. And now, the student has to complete the assignment for homework. But what if the antecedent was actually the noisy classroom or the inability to hear the teacher's instructions? Or something completely unrelated to the writing assignment or the student's auditory processing difficulty. That is why believe that it is irresponsible for us to separate sensory from behavior. The Holistic Approach to Addressing Student Behavior To create a comprehensive plan to address student behavioral concerns, we can use the Person-Environment-Occupation (PEO) model. This model helps us to evaluate the causes of behaviors through observations and assessment to look not only at the individual but also everything around the individual. With the PEO model, we can address the student's preferences, abilities, struggles, and more. Then we can address the environment (including the classroom dynamics - such as personnel) and the expectations for the student in the classroom. Using this model, we may identify any single, or combination of PEO factors that could be the "antecedent" of a behavior. By addressing the interwoven interactions of person, environment, and occupation, we can create a plan that meets the student's unique needs and supports their success in the classroom. Here are some practical tips and strategies for implementing a holistic approach to addressing student behavior: Understand the student's sensory processing needs: Conduct assessments and observations to gain a better understanding of how the student processes sensory information. This may include auditory, visual, tactile, vestibular, and proprioceptive processing. Once you have a better understanding of the student's sensory processing needs AND behavioral concerns, you can work with the teacher and other school staff to create a more supportive environment. Collaborate with the teacher and other school staff: Creating a plan to address student behavior requires collaboration and communication with the teacher and other school staff. Together, you can identify the student's strengths, preferences, and challenges, as well as the environmental factors that may impact their behavior. By working together, you can create, implement, and collect data on a plan that meets the student's unique needs and supports their success in the classroom. Use a variety of strategies and interventions: There is no one-size-fits-all approach to addressing student behavior. Instead, use a variety of strategies and interventions to create a comprehensive plan. This may include environmental modifications, sensory integration strategies, behavioral interventions, and social-emotional learning programs. By using a variety of strategies, you can address the underlying causes of behavior and create a supportive environment for the student. Benefits of Holistic Approach to Addressing Student Behavior A holistic approach to addressing student behavior has several benefits. One of the most significant benefits is that it allows school-based OT practitioners to address the underlying causes of behavior rather than just treating the symptoms. By focusing on the whole child and evaluating their physical, emotional, and social needs, OT practitioners can develop more effective intervention plans to help students develop the skills they need to manage their own behavior, rather than relying on external consequences. In addition, a holistic approach can lead to better outcomes for students. By addressing the sensory component of behavior, OT practitioners can create a more supportive environment that allows students to thrive. This approach can also help to promote positive behavior and reduce the likelihood of negative behaviors occurring in the future. Examples of how a holistic approach can lead to better outcomes for students include: A student with attention deficit hyperactivity disorder (ADHD) may struggle with staying focused and completing tasks. By addressing the sensory component of their behavior, such as providing a structured and organized environment and using visual aids, the student may be better able to manage their attention and complete tasks more effectively. An autistic student may struggle with processing sensory stimuli in a busy classroom environment. By providing support to the teacher to reduce stimuli in the classroom, the student may be better able to regulate their behavior and engage more fully in learning activities. Proactive and Reactive Sensory Strategies When it comes to supporting student behavior through sensory means. I like to use both proactive and reactive strategies to support students' sensory needs. Proactive sensory strategies may include modifying the classroom environment to minimize sensory overload or providing sensory input that is calming or organizing for the student. For example, you may suggest using a compression vest or offering a quiet space for a student to take breaks before an activity that sometimes leads to the student feeling overwhelmed. These strategies can help prevent sensory overload and reduce the likelihood of behaviors that limit participation. Reactive sensory strategies may include providing sensory input in response to a student's needs. For example, a student who is becoming dysregulated may benefit from deep breathing exercises, heavy work activities, or repetitive actions. By providing appropriate sensory input in the moment, the therapist or teacher can help the student regulate their arousal level and return to a state of optimal functioning. Something I created and use for my students to address reactive strategies is a Personalized Sensory Plan. If you're interested in developing an Individualized Sensory Program for your students, I've created a free template that you can use as a starting point. Simply insert your info below to download your free template today! By using both proactive and reactive sensory strategies, school-based occupational therapists can support students' sensory needs in a comprehensive and individualized way. This can lead to better outcomes such as improved attention and participation in classroom activities, reduced stress and anxiety, and improved self-regulation skills. Get your free copy of our Individualized Sensory Program Template to use with your students Individualize this Google Document to meet the needs of your students. Enter your info below to grab this free resource! Challenges and Pitfalls of Holistic Approach to Addressing Student Behavior While there are many benefits to taking a holistic approach to addressing student behavior, there are also some challenges and potential pitfalls to consider. One challenge is that addressing one area of life may impact another area - for better or for worse. For example, making changes to a student's environment may have unintended consequences for their social interactions. It is important to always take data and adjust plans accordingly. Another challenge is that taking a holistic approach requires collaboration and communication among all members of the student's support team. This can be difficult to achieve in a busy school setting where teachers, OT practitioners, and other support staff may have different schedules and priorities. To overcome this challenge, it is important to establish clear lines of communication and set regular meetings to discuss student progress and intervention plans. Conclusion In conclusion, taking a holistic approach to address student behavior is essential for promoting positive outcomes for students. By using the PEO model and other holistic approaches, school-based OT practitioners can evaluate the causes of behavior through observation and assessment tools, create a comprehensive plan that does not rely on limited ABC data, and address the student's personal factors, the environment, and the occupational demands of the classroom. So, the next time behaviors are being addressed in an IEP or staff meeting, raise your hand or your voice and share with your staff how you can support them and their students. You got this! Thanks for reading all the way to the end of this post. I hope you found it helpful in your practice. If you did, be sure to subscribe to our email list, where we send out helpful tips for school-based OT practitioners every week! See ya next time, 👋 Jayson Want to further your understanding of how Sensory & Behaviors are connected? Join us at the Back to School Conference this year, where Greg Santucci, MS, OTR, will be discussing the interconnectedness of the two & how OTPs can support students on campus. Click here to learn more about the Back to School Conference! I hope to see you there! The OT schoolhouse is proud to be an AOTA Approved Provider of professional development.

As occupational therapy practitioners in the school setting, we don't just work directly with the students. Often, we find ourselves working on behalf of the students by supporting teachers and paraprofessionals. This happens frequently when teachers and paraprofessionals are faced with the challenge of managing difficult behaviors in their students. Managing difficult behaviors can be a daunting task, but as experts in the areas of functional behavior, sensory integration, and motor skills, we can provide valuable support and resources to help teachers and paraprofessionals succeed in this aspect of their job. Below, I have compiled four sets of strategies and techniques that occupational therapy practitioners like us can use to support teachers and paraprofessionals who work with children who demonstrate difficult behaviors. Each of these strategies can be used to support an individual student, but the nice part is that most of them can be used in a tiered intervention program to support teachers before behaviors may present in a classroom. Let's dive in. Want to earn professional development & be part of a supportive school-based occupational therapy community? Join us in the OT Schoolhouse Collaborative, where you can earn AOTA-Approved professional development and get individualized support from Jayson and other school-based OT practitioners. Promote Sensory Modulation Surprise! Sensory made the list! Sensory modulation is an area where occupational therapy practitioners can provide valuable support and resources to teachers and paraprofessionals. By identifying and addressing sensory concerns that may be contributing to difficult behaviors, we can help students feel more comfortable and confident in the classroom. For example, if a student has difficulty modulating sensory input, you could support the teachers by sharing with them what to look for. Programs like the Zones of Regulation or the Alert Program are as much about providing adults with an understanding of behavior as it is about teaching students to understand their own feelings. One thing I have created in the past is an individual sensory preference sheet for students. It was essentially a "When you notice a student ______ , try one of these sensory strategies" chart. On the chart, I would identify what a teacher or paraprofessional may observe when a student is presenting as under, over, or within an optimal learning arousal level. I never liked time-based sensory diets, so this was my slight adaptation to that. Some things you may recommend based on what the student directly or indirectly communicates to the teacher could include providing sensory breaks, using pressure vests, or incorporating sensory-based activities into the curriculum. The example I provided was geared more toward an individualized program, but this could also work for an entire classroom. How great would it be for a class of students to identify their sensory level at the moment and decide on an appropriate follow-up activity? Incorporate Mindfulness Techniques Mindfulness techniques can also be a powerful tool for managing difficult behaviors and promoting emotional regulation in students. As occupational therapy practitioners, we can work with teachers and paraprofessionals to incorporate mindfulness practices into their daily routines and behavior management plans. Trust me. It wouldn't just be the kids that benefit from some mindful activities in the classroom. Now I wouldn't exactly say that incorporating mindful strategies into classrooms is my strong point, but Danielle Delorenzo and My Bui-Lewis at Mindulnes in mOTion are all about this. Danielle and My are occupational therapists turned educational consultants and they work with districts to develop mindful programs in schools. Some of the strategies they teach include breathing techniques, guided imagery, and progressive muscle relaxation exercises that students can use to calm themselves when they feel overwhelmed or stressed. By incorporating mindfulness techniques into the classroom environment, we can help students (and adults) develop greater self-awareness, emotional regulation, and overall well-being. Want to learn more about supporting behaviors using a Mindful Approach? Join us in the OT Schoolhouse Collaborative, where Danielle and My will be presenting on March 23, 2023 Watch it live, or catch the replay. Develop Individualized Behavior Plans Oh wait... Did you think only Psychologists and ABA therapists could develop behavior plans? Absolutely not. One of the most effective ways to manage difficult behaviors is to develop individualized behavior plans that are tailored to each student's specific needs and challenges. Unfortunately, behavior plans have become synonymous with discrete trial training and taking ABC data without considering other student factors. As OTs, not only can we work with teachers and paraprofessionals to identify triggers and antecedents that are possibly leading to challenging behaviors, but we can also identify other factors like task demands, the environment, the people involved, the emotional status of the student, and more. Behavior is not as simple as an IFTTT (If This, Then That) computer application. Behavior is dynamic and requires the keen eye of an OT practitioner who can analyze the task with various frameworks in mind. By developing individualized behavior plans that take into account the unique needs and challenges of each student, we can help teachers and paraprofessionals effectively manage difficult behaviors and create a positive learning environment. Provide Training and Education Finally, occupational therapy practitioners can provide training and education to teachers and paraprofessionals on best practices for behavior management and sensory modulation. I've said it a million times and will say it a million times more. OT practitioners need to conduct more trainings for teachers at their school sites! By sharing our expertise and knowledge, we can help build the capacity of the entire school community to effectively manage difficult behaviors and promote positive learning outcomes for all students. And not only that, but you will also become more ingrained in your school culture by becoming more involved! This will give co-workers an opportunity to learn your name and how awesome you are at supporting students! If you are new to providing inservices for colleagues, start small. I first started supporting teachers by meeting with one special education teacher. That turned into a meeting with one general education teacher, which then grew to a meeting with the "first-grade team" The next thing I knew, I was being asked to speak to entire schools, parent-teacher associations, and special education staff. When you start small, you get to "grow in" to and learn how to present to the larger groups where you can have even more impact. And now, it is easier than ever to create a video that can be shared with an entire district. So team up with another OT or a school psychologist and put a piece of training together. You'll be surprised by the impact you can have. The Final Word As occupational therapy practitioners, we have a unique set of skills and expertise that can be invaluable in supporting teachers and paraprofessionals who work with children who demonstrate difficult behaviors. By developing individualized behavior plans, incorporating mindfulness techniques, promoting sensory modulation, and providing training and education, we can help create a positive and supportive learning environment for all students and maybe even remove some stress from the teachers. And they can really use some of that right about now. Resources American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001 Dunn, W. (2007). Supporting Children to Participate Successfully in Everyday Life by Using Sensory Processing Knowledge. Infants & Young Children, 20(2), 84–101. https://doi.org/10.1097/01.IYC.0000264379.20368.61 Perrier, MF., Gurgel-Juarez, N., Flowers, H.L. et al. Mindfulness-based interventions for children and adolescents across all settings: a scoping review protocol. Syst Rev 9, 286 (2020). https://doi.org/10.1186/s13643-020-01548-7 Watling, Renee, PhD, OTR/L, FAOTA; Miller Kuhaneck, Heather, PhD, OTR/L, FAOTA; Parham, L. Diane, PhD, OTR/L, FAOTA; Schaaf, Roseann C., PhD, OTR/L, FAOTA. (2018). Occupational Therapy Practice Guidelines for Children and Adolescents with Challenges in Sensory Processing and Sensory Integration. Bethesda, MD: AOTA Press.

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 121 of the OT Schoolhouse Podcast. Do you ever wonder how much our early reflexes impact our physical, cognitive, and emotional development? What about the importance of reflex integration and rhythmic movements in shaping these abilities? In this episode, Sonia Story sheds light on these intriguing connections and explains why reflex integration is critical for a child's growth and development. Get ready to rethink the role of reflexes and discover the fascinating world of neurological soft signs and sensory integration. Listen now to learn the following objectives: Learners will identify neurological soft signs and what happens when they are inhibited Learners will identify how sensory integration and retained reflexes are connected Learners will identify why reflex integration is such a fundamental foundational system of movements Guest(s) Bio Sonia Story earned a Bachelor of Science degree with a combined major in biology and psychology. She studied two bodywork systems—Orthobionomy and Hanna Somatics—which influenced her later application of neurodevelopmental movement tools. Sonia extensively studied innate neurodevelopmental movements with Harald Blomberg, MD; Moira Dempsey; Svetlana Masgutova; Mary Kawar, OT; and other instructors. While earning certifications to teach Rhythmic Movement Training (RMTi) and other movement courses, Sonia maintained a private practice effectively using these tools—first to overcome her own challenges with sensory issues and anxiety—then for helping individuals of all ages. The majority of Sonia’s clients are school-age children. Sonia Story taught the RMTi curriculum for 10 years and has been teaching the Brain and Sensory Foundations curriculum since 2008. Quotes “The more you know about the stimulus and the motor response, the more you can see that reflexes could be hindering functional skills” -Sonia Story “Reflex integration as a modality is basically trying to boost, innate development through, using the patterns and the ways that nature itself has designed human beings to develop” - Sonia Story “There are very compelling studies showing that, when we give the tools for reflex integration, we boost function and occupational functions” Sonia Story “It's also about going through the scientific steps to see if what we are doing is working with our clients. And… at the end of the plan, we are able to say, this created occupational outcomes, then we have created data for our program” Jayson Davies, M.A., OTR/L “There is a sensory component that is stimulating the reflex” Jayson Davies, M.A., OTR/L Resources (Affiliate links) Episode streamed on Youtube E-Book Unintegrated Infant Reflexes Chart Brain & Sensory Foundation Course - Use discount code: OTSH30OFF by April 30, 2023 Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey there, and welcome to a very special episode and a unique episode of the OT Schoolhouse podcast, special because of the topic and unique because of how it was recorded. More on that in just a second. Today, I am sharing with you a conversation I had with Sonia Story from move playthrive.com Sonia is the creator and instructor of the brain and sensory foundations course, where she supports individuals and better understanding innate rhythmic movement and targeted reflex integration. Full disclosure, I am an affiliate for Sonia's course, meaning that I may earn a commission if you decide to take her course. But I want to let you know that that's not the reason I'm here today. I'm not here to convince you to take her course instead. Sonia and I are here today to address a very hot topic in the world of occupational therapy and reflex integration. We're here to talk about how to link reflex integration to occupational outcomes. If this sounds familiar to you, it's probably because AOTA has addressed this in a choosing wisely campaign where they stated, don't use reflex integration programs for individuals with delayed primary motor reflexes without clear length to occupational outcomes. Now unfortunately, this statement has led to some confusion and misunderstanding. Many therapists have read it and believed or thought to themselves, don't use reflex integration, but that's not what it says. There are two parts to this statement, so let's dive more into the statement and reflex integration as a whole with Sonia story. But before that, I almost forgot to tell you why this conversation is unique. Sonia and I actually recorded this interview live on YouTube, so you can actually listen to the edited version here, or you can use the links in the show notes to catch the full chat on YouTube. Either way, it's worth the listen, and there are several resources in the show notes for this episode. Sonia provided us with several links to give you several handouts that are very helpful, so be sure to check those out in the show notes at otschoolhouse com, slash episode 121, so let's go ahead Cue the intro, and when we come back, I will let Sonia actually introduce a little bit more about herself. 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     Welcome Sonya. How are you doing this evening?    Sonia Story     I'm very well. Thank you so much. It's super cold here too, but super delighted to be here with our virtual fires, sitting by our virtual fires. But I'm so thankful that ones are interested and looking forward to talking    Jayson Davies     absolutely and I, as you're talking, I can hear the rain starting to come down again. Here it comes. And you know what? Today we are here. Well, because you and I, we've we've had conversations together. You've been on the podcast before, but since you were on the podcast, actually something new came out back in 2021 and that was AOTAs collaboration with choosing wisely.org their campaign and within this campaign, aota asserted, don't use reflex integration programs for individuals with delayed primary motor reflexes without clear length to occupational outcomes. So that's what we're here to talk about today, and I'm excited to have you as we get started before we dive into that statement, why don't you just give us a quick background of your history within reflex integration and move playthrive.com .    Sonia Story     Sure. Well, I was somebody who got introduced to reflex integration, went to a reflex Integration Course. As a result of having done many courses within the brain gym curriculum, I took all the courses to become an instructor, and that's what I thought I was going to be doing. And I took those courses because I felt like I needed something for my own functioning I was a mother of two young children who both had challenges, not super severe challenges, but one was tended to be hypersensitive. One was hyperactive, and together, the two of them were it was like putting gasoline on a fire, because they kept triggering each other, but I felt like I wasn't the most steady, and I was really kind of scattered as a mom. So I when I had the chance, I took courses in brain gym, and I thought it was the most fun and engaging and remarkable set of tools, because you could make changes in things that were. Were very deep and profound, like things I'd been working on a long time, and I could make changes very quickly with movement, and so that was exciting to me, but then I learned about reflexes, and I couldn't believe it, because I have a background in biology, and that's what I took in undergrad. I had a combined major of biology and psychology. But I was so stunned to find out about these reflexes, because they have so much to do. I learned with how we function, and I also could tell, just by being in that one class that I had reflexes that weren't fully developed and integrated. And I thought, Oh my goodness. So then I did many, many courses. After that, I took over 50 courses from various mentors, and I realized about halfway through it, I was being taught by some of the best people in the world in this field. And it was such a joy. And I just, I kept using it for myself, my children. I started seeing private clients, and I am still, 17 years later, in awe of what these movements can do. And so here we are. That's how that's how I got started.    Jayson Davies     Awesome. And you know, we're going to be talking a lot about reflex integration. So before we get too far into the weeds. For anyone who's unfamiliar with Reflex integration as a modality to support individuals, can you share just a little bit about the premise behind it and what it looks like?    Sonia Story     Sure, well, it's a modality because it's needed part of development, but I want to, and there are various ways of approaching it. And they've been in use for a very long time, several decades. And they were first used for individuals with cerebral palsy, at least that I know of, at least going back in the literature. But then within the educational field or psychological field, they started to notice that children with learning challenges had remnants of these reflexes that were unintegrated. But basically, this is really, really what we're doing in a simple form. Is not any one modality, but it's an attempt to recreate development that was either missed or hindered, or somehow development that went awry later on due to trauma or something like that. So I guess reflex integration as a modality is basically trying to boost innate development through using the patterns and the ways that nature itself has designed human beings to develop.    Jayson Davies     Great thank you for sharing that. And as we go down that route, you were talking, you know, understanding the signs a little bit. You talked a little bit about how trauma could potentially be a reason for maybe something doesn't become integrated completely. There's a common term that is used alongside reflex integration, and that is neurological soft signs. That's something I hear a lot in relationship to maybe seeing a soft sign of a delayed, integrated, primitive reflex. So could you share what that means? Neurological soft sign.    Sonia Story     Sure. Well, yeah, and this is something that's well known by pediatricians, and they when they're giving infants exams, they look at these primitive reflexes to make sure that they're there and present, because they should be there as part of our proper development. But if they stay past the age of certain there's certain time frames when they should do their jobs, which means repeating over and over. So basically you have a certain stimulus, you have a motor response. So basically input a motor response, and that constitute, constitutes a primitive reflex. And there's all there's many different ones, all different kinds. They help us, in many, many ways, to develop the brain, the body and the sensory system. But they're supposed to do their jobs, and then, by virtue of that, the brain gets mature. And actually, it's not just reflexes. There are innate rhythmic movements that are working hand in hand with reflexes and development. So anyway, the whole if the whole thing is working together in healthy development the way it should, then there's a synergistic maturing that happens. And then the body, with its innate intelligence, and the brain knows to let go of that primitive reflex so that we can move on to more intentional, voluntary movement that's more refined. But if that does not happen, and the reflexes are retained, or they're still active, they haven't become dormant, and. Another word is that they're uninhibited. So if they're still in that stage where they're active, even though this individual is no longer an infant, then it causes problems. And the problems are neurological in nature, and that's why they're called neurological soft signs. So it means like, it's not actually like hard damage to the neurology, but there's definitely a soft meaning, a partial neurological abnormality going on. Yeah, and I put that in the slides also, if we want to look at some slides.    Jayson Davies     All right, yeah. And I think we'll get into those slides in just a bit as you, as you were speaking, there one thing that as OTs, we're very familiar with the term reflex integration, primitive reflexes, but you're also using the word innate rhythmic movements. I know this wasn't a question I had actually planned to ask you, but what is that word, innate rhythmic movement? What does that mean in comparison to the reflex integration?    Sonia Story     Yeah. So the way that I understand development is that there are groups or categories of innate movements. These are movements that all healthy babies do, as long as they're not stressed, as long as they have room to move, they will go through these very stereotypical movements, some of which are rhythmic in nature, some of which are reflexive in nature, and we're sucking is one that everyone's familiar With. Sucking is a rhythmic movement, and it obviously has purposes, because it calms ensues, and it's also necessary for survival and feeding. And another thing about the rhythmic movements is that they precede huge bursts and development. They precede bursts in speech, and they literally grow the brain, and they make connections within the brain, and they're very supportive and work hand in hand with primitive reflexes. So they're a whole category unto themselves, and they were studied in depth by Esther Thelen, who some of some people might recognize because she she wrote a lot about dynamical systems theory and movement. So she was a PT who did phenomenal work on what she called spontaneous rhythmic movements. And she her papers amazing, and she I really would love to get her original footage, because she studied healthy babies, and she documented what they were doing, and she described all these various rhythmic movements that they did. One that I'm sure everyone's familiar with is when a baby's on all fours and rocking on hands and knees. But these so other researchers have gone on, and they found out that when these rhythmic movements are hindered, just like reflexes, that it becomes problematic, like, Oh, we didn't get a big piece of development that we should have gotten, or something went awry, and the system didn't really get fully used the way it should have been. And that can result in brain immaturity, where the brain stem and the cerebellum are not as mature as would be optimal, and it can also result in the primitive reflexes not also being able to mature. So the two go hand in hand. And then the other category that everyone's familiar with would be developmental movements. So those are things like rolling writing and that the baby the whole trajectory from the baby being pretty helpless to being up and walking by the end of the.    Jayson Davies     gotcha. Yeah, and I don't know if this is one of them, but I as you're talking about rhythmic movements, I'm just thinking of my 11 month old shaking his hips every time we put music on. He says all the time he's shaking his hips.    Sonia Story     Isn't that fun. So and we are designed to function with rhythm, so we're, you know, that's how our bodies work the best. That's why we that sort of the end of the road in infant development is being up and walking, and ideally, the child is up and walking in a way that's aligned, free attention, without compensations, without, you know, imbalances in the muscle tone and things like that. So, yeah, we're meant to be rhythmic, and that's why we come with innate rhythmic movements. They're super important.     Jayson Davies     Awesome. Thanks for, thanks for adding on to that. Every time I go out there, man, he's he's always shaking his hips, so it's always fun to see. Now, yeah, now I know you're an aota approved provider, and when I'm an aota approved provider as well. And one thing that I know that that means is that you have to have research that supports everything that you're saying. And so I want to ask you just a little bit about what research is out there that showing retained primitive reflexes interfere with functions and occupation?    Sonia Story     Yeah, there's actually a lot, and I am right now in a master's program in Movement Science. And one of the wonderful things about it is I get to study what I'm really interested in. So I had to do a literature review last semester, and it was perfect timing, because I needed to address the choosing wisely initiative in my annual renewal to be an AOT provider aota. And so I got to do this literature review and really delve into what's out there. And I should say that there are a lot of recent studies, but there are studies going back decades and decades showing that retained, rhythmic, retained, primitive reflexes are connected with all kinds of dysfunction and in children, they're connected with, well, we already mentioned cerebral palsy, but learning challenges, things like dyspraxia, postural disorders, handwriting, that's more one of the more recent ones. ADHD is a big one. There's quite a bit of research connecting retained or unintegrated primitive reflexes with ADHD symptoms and sensory disorders, and even some researchers looked at how they were correlated with changes in gait. So there were anomalies in the PEL the way the pelvis is situated, which affects the gait. And then there were also recent research that was really well done, and it came out in 2020 where they connected retained primitive reflexes with emotional and behavioral challenges, which I thought was fascinating, because when you really got into the study, they were the authors of the study took into account things like past trauma that the child had and family upset, and things like the ACES score. And they took into account ADHD type symptoms and socio and economic factors, and still, even factoring in all those different things, they still found a predictive relationship between primitive reflexes and emotional behavioral disorders, and that kind of goes right along with what We see when we give children these any movements, we can actually pull them out of a more vulnerable state where they're they've got, like, a lot of sensory issues going on, a lot of emotional behavior challenges. And I think those stem a lot or are related with fighting, flight states, because, for example, that's what it's the same physiological response as what would be in a moral reflex. So once we can mature that and calm those fight and flight states, there isn't a need for the child to be disruptive and to have behavior challenges. And there's a lot more to it than just emotions and behavior, because we're actually really making the body much more comfortable and functional and so, so that's the idea behind that. But there, there's a lot of research connecting the retained primitive reflexes with dysfunction, and they've actually done research, not only in children, but in adults. And in adults, it's connected with things like schizophrenia, unfortunately, Parkinson's disease dementia, and even when they checked like some of the Oral Facial reflexes, they found that adults in nursing homes, when they have those retained, they weren't chewing well, and they were way more likely to suffer from malnutrition. So there's a lot.    Jayson Davies     Interesting that's, it's, it's amazing when you're able to just link a few things like that across the lifespan. And you talked about so many different populations, that was actually going to be my next question is to talk about some of about some of the different populations, but you already dove into that, so I'm going to skip that question. As we continue on, I will just say that in the chat I have just dropped a link a little while ago. Sonia all this information that she's sharing about evidence she has put so much of this into an E. Book, and you can grab that ebook. It's a free download that you can grab it talking about or showing how the primitive reflexes can link to occupation. So you can grab that. And as she mentioned, she had to really study this and document this for her aota approved provider application. And that's where this came from. She didn't just put this together for no reason. This is something that she put together, and it has gone to aota. And kind of, I don't want to say it's been approved by aota, because I know that's not the way that they use things, but it went through and it was approved by their approved Provider Program. So absolutely, check it out.    Sonia Story     Yeah, honestly, I don't know if they like officially approved this document, but the courses that I teach are aota approved, at least at this point, you know. And they have been since 2015 every year we get approved, and every year we show the evidence basis. So it wasn't, it was pretty much the same this year, except that I just did a whole lot more because of the choosing wisely initiative.    Jayson Davies     Yeah. And you know what I want to ask you one more question before we dive into that initiative, and that is the link between reflex integration and sensory integration that often, that often comes up. And so I just want to ask, from your standpoint, do these two frameworks and treatment models have similarities? Do they overlap? What do you think?    Sonia Story     All right, so Well, I want to just first tell a story. You know, when I was first starting out learning about reflexes, I was so fascinated and just dumbstruck, because I really couldn't remember talking about them much in college, I remember I had one physiology professor saying, well, the baby's born, and the baby knows how to suck, and the baby has a rooting reflex to find nourishment. And that's all I could remember. And I don't think it was much more than that, but then when I find out much later in life how impactful these were with our functioning, for our functioning, I was so hooked on that. And I just thought that, you know, we've got to get the word out about this, because I can clearly see them inhibiting the function. And I can clearly see them needing to be addressed, and I can clearly see when we address them, we see huge gains in functioning. So it was really OTs, who came back and said to me and parents, they said, This is the best thing we found for sensory processing issues. And they were specifically talking about the rhythmic movements in combination with the reflex integration. But I can tell you that I've had so many students who are OTS who have taken the brain and sensory foundations training, and that's why sensory is in the title, but they've taken it and said, You know, I'm trained in sips and, you know, high level sensory integration, and this is definitely a missing piece of it. And so if you think about it, our primitive reflexes are all stimulated by sensory input. They're all they've all got sensory, some kind of sensory stimulus that triggers the motor response. And so you can't really separate sensory from reflex integration, and that's what I came to learn. And then now that there's, there's research showing that when children have reflexes that are retained. They have sensory disorders, all kinds of different ones. Sometimes it's dyspraxia, sometimes it's postural disorders, sometimes it's ocular motor disorders, many different things. So you can't really separate the two, and I think it's a missing piece in terms of how to get the sensory system to be mature and calm and organized. So hopefully that's helpful.    Jayson Davies     Yeah, yeah, absolutely. I, I like Especially that last part that you mentioned, right, that there is a sensory component that is stimulating the reflex. And so I think when you think of it that way, they're very closely linked. So yeah, absolutely.    Sonia Story     Can I say just a couple other things about this? First of all, one of the things that Dr Blomberg, he's a psychiatrist, he was one of my mentors, and he used these movements quite a lot with children, and helped them overcome ADHD symptoms and learning challenges all kinds of things. And he said that what you're really doing with rhythmic movements and reflexes is you're maturing the brainstem and cerebellum. We. What is normal and natural in our development. But when you start maturing the brainstem, especially, it has one of its the functions of the brainstem is to filter sensory input. That's one of its jobs. It can't do its job unless it's mature. So you've got to have these movements to mature the brainstem so that your sensory functioning can be calm, mature and organized and integrated. So hopefully, that's another piece that makes sense to everybody. And then yet another piece, which is also something I learned from Dr Blomberg, is that you cannot fully help somebody get to an optimal sensory integration place until you deal with the moral reflex, which is the startle. So the startle, we know, if that is retained, it really should be inhibited or dormant, unless there's some kind of emergency, it should be dormant at the age of about two months, four months, probably at the most. And if that continues on, then sensory input, like a vestibular input or a sudden tactile input, a sudden movement, a sudden visual stimulus that can trigger a sudden loud noise, something like that can trigger this startle response. And instead of it just being a normal startle, which wouldn't trigger the fight or flight, it triggers the Moro startle, which is adrenaline, cortisol, the whole fight in flight, you know you have. The breathing rate goes up, the heart rate goes up, the blood goes to the limbs, just it's the exact same physiological response. And when that happens over time, because the adrenaline and cortisol are there, that makes us more sensitive, which would be good in an emergency, because you want to be hyper vigilant. You want to know where's the threat coming. Do I need to fight or flee? What do I need to do? But in a normal, everyday circumstance, when you have that much adrenaline, you're making yourself more sensitive over time, because that's the nature of the way our bodies are wired and so calming that fight or flight through maturing of the reflexes is is super important. So hopefully that's another piece for sensory specifically.    Jayson Davies     Yeah, I mean, you talk about the the old brain, as they often call it, that brain stem, and how that's where you know everything originally originated from, and everything beyond that, you have to kind of things have to mature in that old, old brain before you can start to use the rest of the brain. And so yeah, all right. Now, I know we titled this right Choose wisely, talking about the linking of reflex integration to occupation, and that's we're going to dive into for the rest of the evening, and I just want to read that verbatim. Aota, choose wisely. Campaign really quickly. And then as I do that, I'm going to ask Sonia what her first thoughts were, but I also want to ask everyone listening what your first thoughts were. And go ahead, either, just think about it in your head, type it in the chat, do whatever, but this is what they said, don't use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes. So I would love to hear Sonia, what your first thoughts were when this came through your email or you read this online, what were some of your first thoughts?    Sonia Story     Oh gosh. All right, so if I'm going to be really honest, I was very upset. I'm continue to be upset, but I'm I'm really upset by it. I think it is misleading. I do understand that as an occupational therapist, there needs to be a connection to occupations. But the way, you know, reflux integration is, is development. It's a part of development. And so I was shocked when I read it. I was really upset. I was sad. I was, gosh, frustrated, I think anger got in there. I was just like, Wow, are you kidding me? I couldn't believe it, and I I didn't, I still don't understand what the motivation is behind it. But you know, when I really dug deep into, like I have the whole aota Choosing Wisely thing here in front of me, and it lists the sources for that initiative. They list only two sources, and the one I read thoroughly, many, many times, and it's, it's they're citing. Research erroneously. I actually put it toward my one of my research professors going to school right now, and I said, Am I interpreting this correctly? And he writes back and says, As far as I can see, yes, you're interpreting it correctly. I said, because they're not saying the same thing in this article. And so I felt like, Okay, I'm just gonna stick with what I know and what the research actually says, and I'm gonna continue forward, and I'm gonna, you know, I've read over 1500 case studies. I'm pretty sure it's closer to 1600 or more, and they're so these are case studies that are written by students of the brain and sensory foundations. Course, they're remarkably consistent, remarkably positive and remarkably showing transformation and showing that they're making an impact that's really hugely positive. And so at some point. You know, we know that case studies are anecdotal, but when you've read 1500 of them, I mean, they become data. And actually, I would like to analyze the data. It's just a lot of work, and I'm not sure exactly how to do it yet, but I'd like to figure out how to do that and put it together into like a qualitative study. But, but the thing is, is that if the thing that upset me about it is that if you are a new OT, then you could read that initiative, and you could think, Oh, well, reflex integration, I don't have to worry about that, but you wouldn't know how important it is for sensory processing. You wouldn't know how important it is to help a child out of flight, fight or flight. You wouldn't know how important it is to help a child with handwriting or with reading or with walking even, or with sleeping or with all these occupations that are so important, with playing, socializing, it's really such a fundamental, foundational system of movements, because it comes from development, that it it should not be cast there should be no casting of doubt on it, and there should be more exploration, In my opinion, there should be more funding for research. In my opinion, it's a tough thing to research, absolutely, because there are so many factors, and it's really hard and standard research to to, you know, take, what's the word I'm looking at when you have all these different Yeah, like, it's hard to control for the variables. So research is not easy, but if we're well funded, we could do so much. It's also hard to standardize assessments, because everybody has their individual ways in which they compensate for reflexes. And so it's challenging, but I tell you, I have heard from so many occupational therapists over the years, hundreds and hundreds who have all said, we learn what a primitive reflex is. We learn how to test for them. We learn that they're soft neurological signs, but we don't learn what to do about them and that whole thing, if we had more of an emphasis on that, we could help so many children with their occupations, as we've seen over and over and over again, so you know. And I talked to some really seasoned OTS who have said that they were really upset by it. They said, Wow, this makes us so frustrated, because young OTs, who don't know, you know what we know, would just tend to write this off. And so to me, that's a problem, because we're writing off a chunk of development, or possibly writing it off. So I appreciate you like taking this head on, Jason, when you know, and talking about it. You know, we should be having conversations about this, and we should be, we should be talking about it and diving into what literature there is, you know, I do wish there was more. I do wish we had funding and proper more studies. But there are very compelling studies showing that when we give the tools for reflex integration, we boost function and occupational functions. So that is out there. It's just, I wish we had more of it.    Jayson Davies     Yeah, and I'm going to just chime in here with what Melinda said in the chat. She says it reminds me of a time when history, or in history, when people were not as accepting of sensory integration because we didn't have the research to back it up. And it's, in a way, it's similar, and because it takes funding now, something that has, well, we've been talking. A lot about it on the podcast recently, is creating your own evidence, and I think that that is something that we do. As far as evidence based practice, evidence based practice, it's not just about going out and finding the research. It's also about going through the scientific steps to see if what we are doing is working with our clients, and if what we do, if we assess our our student, our client, we put a plan in place, we follow that plan, and at the end of the plan, we are able to say, this created occupational outcomes, then we have created data for our program. Now, again, just like everything else in the world, what works with one student may not work with another student, but that doesn't mean that it's maybe not worth trying, and especially if you are doing an assessment to figure that out, and that kind of leads into where I wanted to go next, which is asking you about that assessment tool you just mentioned. There's no standardized assessment tool, per se. But how might you assess to see okay, this student is having difficulty with an occupational task, such as you've already talked a little bit about functional mobility, walking, or maybe they're having difficulty with writing. Maybe they're having difficulty with unzipping, unzipping their backpack, whatever it might be, how do you go about assessing that and then linking it back to a specific, retained reflex.    Sonia Story     Right, okay, so that's a great question. And what I would say about that is, it really helps to know what the stimulus is and the motor response and where in the body the reflex expresses and one of the huge eye openers for me was when Dr Blomberg explained that when reflexes are retained, it not only ties body parts together, but it interferes with the function of the muscles in that region or possibly interferes. So, for example, when the reflexes of the hands are not integrated, we see, oftentimes children with really weak hands or immature grasp, and you know, the children who have the dagger grasp and things like that. And when we start to integrate reflexes, then we help the muscles of the hand to develop, and then the child is able to have a tripod grasp. They're able to do writing that's way more comfortable, it looks nicer, it's more legible. And they say things like, Oh, my hands aren't getting as tired, and things like that. You know, the asymmetrical tonic neck reflex is probably involved quite a bit in handwriting, also when that's retained. But yes, you know, the more you know about the stimulus and the motor response, the more you can see that reflexes could be hindering functional skills.     Jayson Davies     Okay, so I have a question then, kind of going off of that, because as occupational therapy practitioners, we're taught to start with the big picture and work our way down, and so we really have to start with this student is not able to functionally write out a sentence. Let's just go with that one, and then we kind of work backwards to determine if it's a fine motor skill, if it's sensory motor processing, whatever it might be that leads us there. Now, if you're seeing and we can kind of even maybe walk through this a little bit, but if you're seeing a student that has difficulty with handwriting, you mentioned some of those. You know reflexes within the hand. Do you just kind of say, I see difficulties with handwriting? Immediately you're going to go to those more hand reflexes, or are you going to look at several reflexes? How are you going to determine which reflexes to work on, per se? Does that make sense?    Sonia Story     Yeah it does. So what I personally do and what I actually teach students, because after years of experience, I realized, like, wow, and I talked to many other therapists and they were seeing the same thing was that we actually have a lot easier time integrating reflexes if we begin with the rhythmic movements. And that's true with almost everybody. So that I kind of, after a lot of experience, that came to be sort of a general rule, like, let's start here, because they're so calming and organizing. And when a child has unintegrated reflexes, they unconsciously are compensating for the underlying muscle weakness and or the body parts being tied together and or different ways of holding tension, or different compensations that they've held. And. For a long time, since infancy. So I actually start with the rhythmic movements, because then when you go to stimulate the primitive reflexes, there's a more stable foundation, and you're not dysregulating the child as much, because when you go right in and stimulate reflexes, it can be uncomfortable for a lot of children, especially the tactile reflexes. They're uncomfortable because the nervous system is in like a less mature, more raw, more vulnerable state, and so having that foundation of rhythmic movements makes things so much easier and and faster also, and deeper. So faster, easier, deeper. And I'm like, let's go with this. It works way better. And kids are getting huge benefits just from the rhythmic movements where they're sleeping better. They're calmer. Their emotional regulation is better. They they even start, some of them even, will start having much better reading fluency and speech even before we get to reflexes. So we see that quite a lot. And so that would be my first thing. And then, you know, I like to look at, okay, what area, what? What areas this child having the most challenge with and then I look for reflexes that might be related. So for example, if it's anxiety, well, you know, the rhythmic movements impact that quite a bit. But then I would think, okay, possibly more. And fear paralysis reflex could be really helpful. And then if it's something like handwriting, then we talked about the hand reflexes and asymmetrical tonic neck. If it's balance issues, I always go for tonic labyrinthine reflex, because that seems to be very good for helping with balance. That and more motion sickness, those kinds of things would be rhythmic movements, Moro, tonic, labyrinthine reflex. Sometimes kids have a big challenge with the spinal gallant reflex, where they're they're just fidgety all the time, and clothes are uncomfortable, and they're constantly squirming. So that can be helpful for that. And then, if you have things like ADHD or an inability to focus, you know, usually any kind of functional thing that you see, there are several reflexes involved. And also, you know, there's research about if a child has a rhythmic impairment and they can't produce a smooth rhythmic movement from within that is associated with ADHD, dyslexia, speech and language challenges and something now, so I can't remember the other one, but it's in the literature, and I have slides too. I should share    Jayson Davies     this. You can go ahead and share the slides.    Sonia Story     I mean, I just hot. Well, we don't have too much time left, but let me show us one or two that works. Sure, I'll find that on the slides so well, okay, so let me just go to the the research that I was just talking about.    Jayson Davies     Yeah, and as you do that, I'm going to go ahead and post in the comments one more time that link to where they can get the ebook on supporting evidence for the brain and sensory foundations, course. And then one thing as you bring that up that I was thinking about too, is you also have a chart. Because you really, I think right there you dove into exactly what I was trying to get was like, what reflexes might you focus on when you see this? And that reminded me that you also have a chart, and I think I'm going to put that in the in the chat as well, because you have a chart that shows kind of what reflexes may lead to long term difficulties, right?    Sonia Story     Yes, for sure, and that's actually a really good guide, because, like I said, the children are so different in how they present, because they've all their bodies have sort of found these individual ways of compensating, and so it's very helpful to have the chart to see where there might be gaps in development.    Jayson Davies     Did you want to bring up the slides or,    Sonia Story     I mean, I have, oh wait, I got a screen share, right? Let me put    Jayson Davies     them up really quickly. There you go. Now everyone should be able to There we go. Now everyone can see them.    Sonia Story     Okay, great. So this is the research I was referring to, where they they took a group of children and found out if they had a rhythmic impairment, that it was associated with all these different things that you see. So I had three out of the four. The other one was Developmental Coordination Disorder, which is related to dyspraxia. So yeah, so there, there's so many things I could share. You know that you guys already know about the a lot of these things we talked about, the neurological. Yeah, but here's a one that I really love to share, and I've shared it before because it's so illustrative of the fact that a lot of the functional challenges we see in children are related to what did or did not happen in infancy, and so all of these kinds of skills that we want to see our children have, which is proper alignment, posture, core strength, our integrated sensory development, focus, speech, social emotional skills, executive function type things, they're all related, and they all depend on infant movements, and we can't fully develop our brain, our body and our sensory systems without them. So that's just a way of showing that what else can here's a related research about how retained reflexes are related to sensory issues. We see the difference between a healthy baby and compromised baby with in terms of core strength, and that's related as like that's definitely associated with autism later on. I like this one because you can see like, these changes don't go away when we get older. So here's a seven year old boy who had scoliosis, and he was unable to fully lay prone on the floor, and after doing the spinal gallant reflex and rhythmic movements, he was able to, within a few months, able to maintain prone position comfortably. So this is the these are different challenges that are all associated with retained, primitive reflex, reflexes and peer reviewed research. So you guys can get the evidence book that Jason's putting the link up. So you asked about sensory and one thing we didn't talk about Jason was how they're linked, how retained reflexes are linked with sensory issues, but then sensory issues and sensory processing disorders are linked with anxiety, which I think is really an important connection, because so many Children are suffering from anxiety these days. Anyway, I can send you the link to the slides if people want them, but I think it's really important to make this connection. We talked about this already and and basically what we're doing is we're using these movements to boost development. And, oh, here's a case study. I know. I know that that was going to be the next question too. Are we? I can't I don't want to take up too much of time going on and on.    Jayson Davies     No, that actually was going to be exactly where I was going with next. So I'm going to let you share the case study, but also, as you go into that for everyone out there watching, listening, go ahead and drop any questions you might have. We have about 10 minutes left. So after she shares this case study, we can dive into some questions that you might want to ask. So I'll keep an eye on the chat while Sonia goes ahead and shares the case study.    Sonia Story     Okay, great. Thanks, Jason. So I like this case study. I love this case study because this mom who is also a occupation, comcupational therapy assistant, she documented how much they were doing of these movements, and actually they're so the movements are so powerful and our brain recognizes them and takes them in, like super food, and then really can work with them. And so even a small amount, such as they did one to 15 minutes per day, three to five times a week, and they got phenomenal results. So the first thing they did was, for a couple months, they did just the rhythmic movements, and they found that instead of being fearful in public places, she was able to go at a public restaurant, able to go visit the restroom on her own, which was a huge thing for this girl. She was 12 at the age of this case study, and at the time, she was also struggling with balance, skipping, hopping and toe walking. And after they did a combination of rhythmic movements and reflexes, she was much less clumsy and even had improved gait and stronger heel strikes. She had much better writing fluency. She scored a on a math test for the first time, and she had been in speech therapy since the age of three, and she was dismissed after they started doing these movements at the age of 12, and then she just was able to study more on her own, and started getting all A's and B's on her report card. So she. She graduated right out of her IEP and her speech therapy. So, yeah, I and, you know, that that's really, I think, showing a clear connection to to functional outcomes and being able to participate in what's meaningful. And that's the, you know, that's the heart of OT is to be able to participate in meaningful activities.    Jayson Davies     Absolutely. Um, I really like, how on that slide, you put them side by side, you know, the before and after, and then you also show down in the corner, kind of what it took to get there. And As occupational therapists, we're, if we're not using reflex, we're doing the same thing, right? We're evaluating the students, seeing where they are. We're implementing a program, and then we are taking data to see where where the student eventually gets to. Now we have a few questions coming in, and as I continue to kind of gather them up, why don't you just go ahead and share a little bit about the brain and sensory course. And then we'll dive into these questions.    Sonia Story     Sure, well the course is doing. So what my goal was with this course was to give somebody as complete and comprehensive set of activities that are child friendly, first of all, and that really work. And so I really synthesized a lot of different training into one package of what I found were the best of the best, most useful tools. And what I really wanted to do is I wanted to go deep, and I also wanted to go broad, because with the broad, you're getting more components of development. So we included things like the rhythmic movements, developmental movements, play and games, and very targeted, specific reflex integration. And also i There were some processes and things that I learned in my initial brain gym courses that I found were very helpful, specifically for taking stress out of goals. Because we know that, like a child who's been struggling with reading, for example, every time they open a book, that stress pattern comes up, and then, like their their nervous system learns like, this is super uncomfortable, super stressful. And so that becomes, like a ingrained nervous system response if they're really nervous about reading. And so I use some of the processes that don't necessarily come from development, but they're very effective for taking the stress out of goals specifically, and I wove those in to help children reach their goals. And adults, it works for adults, too, to reach their goals with more enjoyment and much less stress. And we could also use that process to help reflexes integrate more quickly. So it's a it's a very good combination, and I'm just super thankful for how well it's working. And that's, I think that's it in a nutshell.     Jayson Davies     And we're going to go ahead and post a link right now, just in the chat for anyone who might be interested.    Sonia Story     I stopped sharing my slides.    Jayson Davies     I've already moved it on to you, so we are good to go. I did go ahead and just put in a link in the chat for anyone who wants to learn more about the course. This is an affiliate link, meaning that if you do decide to purchase the course at no additional cost to you. Sonia's is super grateful, and she actually provides a slight compensation to myself for hosting this conversation and bringing us all together tonight. So with that, there are a few questions, and I want to start with Kristen, she asks, and I'm going to go ahead and put this on the screen. Do you have advice for using reflex integration or rhythmic movements in school based practice where we are at most, seen a child one time a week for 30 minutes.    Sonia Story     Yeah. You know what I would love to see happen is that all the children in the classroom get these movements that would be ideal somehow. And what I would say is, within these limitations, that these movements are incredibly powerful, so if you only have limited time in from my perspective and my experience, it's important to really use them so that you can boost function and promote those skills that you're looking for. And I'll give you a little story that an OTS actually an OT assistant. And she said in their school district, there was a teacher who said, Look, my kids really need this. Can you help me? And between her and another OT, they had 96 kids, and she said there was no way we. Could get to them all. And so she said what we did was we gave them each I have to check back with her, it was either five minutes a day or 10 minutes a day of rhythmic movement. And she said we couldn't even specifically address their ot goal. She said, I'm kind of embarrassed to say this, because it's not the way we're supposed to do things as an OT she said, but we had such a big caseload, she goes. But you know what happened when they got those rhythmic movements even just a tiny amount on a daily basis? She said, they made progress on all their ot goals. And so that's the kind of thing where, you know, after all these years of hearing these things, I'm not I'm not surprised at all, but I just wish that somehow we could, we could get this out there to more children, and they're really delightful. Most children really love, especially the rhythmic movements. And, you know, somebody wrote a comment about play and leisure, which being an occupation, I think that's really important. It really needs to be fun for children and and having that connection and fun, you know, is really ideal. So that's a part of integration. It's a part of development. But anyway, I know it's hard when you're limited to once a week. And the other thing I would say would be to if you can is try to teach the parents. Ask the parent to come in, give them some rhythmic movement. Get training first, because there there are specific things, because some children respond uncomfortably to them. You have to know what to do, even though most children love them and will ask for more. But some children don't what their their system is way too underdeveloped to to take the stimulus in comfortably. But anyway, if you can get the parents to experience them and then do them even for three to five minutes on a daily basis, you're going to be doing some huge help with that. And also, if you cannot get the parents to do it, try to teach the child himself or herself how to do it. And if you can get them to a place where they can produce a smooth, rhythmic movement and do this on their own, you can say, hey, this is good for whenever you feel like you need a little break, or a little wake up, or a little thing to calm down, or something that just makes you feel better. You know, you can go and do this. So if you can plant that seed for them, even though you can't, you know, maybe see them multiple times a week. But we have seen OTs, who do apply this. They apply the rhythmic movements and the reflexes, and they just see kids once a week for 30 minutes, and they see measurable progress. So So I would still encourage you to do it even within limitations, yeah.    Jayson Davies     Absolutely. Thank you. And yeah, we did have Holly. I put it up on the screen. She said that she was able to get a teacher assistant and parents on board to work on reflex integration daily. So, yeah, you know, I think we come across this issue with everything, I mean, from handwriting to sensory to reflex integration, right? Like we talk about, we could spend 30 minutes working on a student's grasp, working on the letter formation, their sizing, whatever it might be, and then they go back to the classroom, and for the next week they do it all wrong until they come back to our class. And so that's the same type of thing, right? We have this problem across the board. It's not specific to reflex integration. Wouldn't it be great if every morning a student could get five minutes of handwriting instruction? That's what we would love to so, you know, it's it really does take time. Anything takes that concerted effort, that daily practice, if you will. You know, to make changes. So absolutely, there was another question here from Jeanette. And Jeanette wants to a fairly, you know, a short, short question that might have a not so short answer. How long does it take to see results on average? And let's just assume that we're going with, you know that that student who maybe is getting the three to five times a week.    Sonia Story     Yeah, so it's so variable, you know, development is so complex, and then when development has gaps in it, everybody seems to be different in terms of how much of a foundation they got versus, you know, how, how compromised was the foundation, you know, if you're talking about a child with something like severe autism or severe cerebral palsy, you know, it may take longer, but in general, what we usually see is that Within a month, almost everybody is showing positive, noticeable changes. I'm not saying you're done in a month, by any means, but you're seeing things going in the right direction within a month, some people see changes right away, like they'll see children. They get the rhythmic movements and they they're much calmer. They're. Much more present they can then focus on, you know, a tabletop activity or something like that. So sometimes you'll see changes right there in one session. And that's not uncommon, but to see really substantial changes in the foundation and substantial changes in how that child or individual actually functions throughout the day, usually about a month. It's very rare to see it taking longer than that to see things going in a positive direction, but sometimes that happens. But yeah, everybody's really different, but hopefully that helps. Yeah, absolutely. I just want to say, you know, this is a process. Development is a process. You have a baby developing that entire time in the womb, which is nine months, and ideally, they're getting a lot of good movement in the womb, with the mother moving a lot. Mothers tend to be more sedentary in this day and age, and that that leaves the baby less developed, but you've got the whole womb life, and you've got the whole entire infancy. Well, the birth is important too, but the birth and the infancy through toddlerhood, that's a long time to be developing. And so when there are gaps in development, you have to take into account that this may take some time, and we want to be in it for the long haul, and really give children a broad and deep and you know, foundation of the movements from development.    Jayson Davies     Absolutely All right. Well, Sonia, thank you so much for coming on today, I apologize for my production muting airs, but I'm glad that we were able to talk about reflex integration. And again, I posted some links in the comments for anyone who wants to learn more. Sonia is so nice and that she is offering a few different freebies. So you can use those links to grab those freebies. And of course, there is no pressure to take a course on reflex, on reflex integration with Sonia, but if it is something that you're interested in, be sure to also use the link that we posted as well. If you want to. Maybe you caught the second half of this, but not the first half. We'll be sending out a replay tomorrow morning in an email, so you all have the replay to this. So come back, watch it when you have the time and catch all the good things that we talked about. So one more time, Sonia, thank you so much for being here. I really appreciate it, and be sure to check her out at move playthrive.com and learn all about it. So thank you so much, Sonia.    Sonia Story     Thank you Jayson, and thanks to everyone listening.    Jayson Davies     Take care.    Sonia Story     Take care.    Jayson Davies     All right. Thank you so much for listening to this episode of the otschoolhouse podcast. Again. You can catch all the show notes, all the resources that we shared at otschoolhouse com, slash episode 121, there are many resources there. You can also catch the live unedited YouTube chat, if you'd like over there. And yeah, I just want to really quickly say thank you to Sonia one more time for coming on the show. If you would like to learn more about her courses. The links are in the show notes. And yeah, I hope this episode just got you thinking a little bit more about reflex integration and occupational outcomes. Take care. Have a great rest of your week, and I will see you next time bye bye.    Amazing Narrator     Thank you for listening to the OT Schoolhouse podcast, for more ways to help you and your students succeed right now, head on over to otschoolhouse com, until next time class is dismissed.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast! 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

Welcome to the final post in our three-part series on developing present levels, goals, accommodations, and determining service frequency. In our previous posts, we discussed the importance of writing effective Present Levels of Performance (PLOPs) and using them to develop effective accommodations and therapy goals for our students. In this post, we will focus on using those PLOPs, accommodations, and therapy goals to determine an appropriate occupational therapy service frequency for each student. Occupational therapy service frequency refers to how often a student receives occupational therapy services, and it's a critical factor in ensuring that students receive the support they need to achieve their goals. We'll provide practical tips and an exercise you can use for determining an appropriate occupational therapy service frequency for each student based on their unique needs and goals. By the end of this post, you'll have a clear understanding of how to use PLOPs, accommodations, and therapy goals to determine an appropriate occupational therapy service frequency for each student, which will help ensure that they receive the support they need to succeed. So let's dive in and learn how to determine the appropriate occupational therapy service frequency for your students! Part Three: Frequency of Services One of the most challenging parts of being a school-based OT is deciding the frequency at which we should see a student. As much as we want to make the determination of service frequency a black-and-white process by using a magic calculator or formula, this process is very subjective and complex. One goal does not equal once-a-month consults, and having three IEP goals does not automatically mean a student requires weekly services. With that said, more complex goals may warrant more frequent therapy sessions. There are many factors to consider, such as: How many goals does the student have? How old is the student? Who is the teachers, and can I collaborate with them? Will there be carryover from the team? And more... And we are just talking about frequency, not where the service will take place or what tools we will use during therapy. I have found the best way to determine the frequency for each student is to use the student's Present Levels of Performance (PLOPs), accommodations and modifications, and therapy goals as a guide. In the last email, I shared how we can use the PLOPs to lead to goals and accommodations, so we will start there in this email. Remember, areas of concern often lead to goals, while areas of strength may lead you to think of some reasonable accommodations to support those goals. Once you have your goals and accommodations in place, it is time to determine how you will implement the accommodations and support the student in reaching the goals. Starting with the accommodations, ask yourself these questions: How complex is the accommodation to learn? Who will I need to train in the use of the accommodations? Will you train the teacher, and the teacher teaches the student? Or will you have to train everyone? Will you have to order the tool? How will you know when training is no longer needed, and the tool is being used adequately? Based on the answers to these questions, you may only need to meet with the teacher once a month to implement the tool. Or you may need to see the teacher and student every week for several weeks. Want to learn more about developing strong present levels, goals, and services? Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best. Goals to Services Moving on to services, it gets more tricky - especially if you do not yet know the student well. Every child develops uniquely and learning what they can accomplish in what time frame takes time. Ideally, we are supposed to determine services in a way that keeps the student in their educational environment as much as possible while also making "meaningful progress" (as referenced in many court cases) toward the student's IEP goals. We may be experts in child development, but we aren't Tarot Card reads. We can't predict what the student will accomplish one year from today. At least, I can't. So when it comes to determining services, this is the exercise I use. Feel free to use it for yourself. I ask myself a series of questions starting with the least restrictive service frequency. Is the student likely to meet their goals (or make meaningful progress toward their goals) if I meet with them or their teacher only once a month? If so, that is where I start - with a once-a-month service or consult. But if not, I ask: Is the student likely to meet their goals (or make meaningful progress toward them) if I meet with them or their teacher twice a month? If not... Is the student likely to meet their goals (or make meaningful progress toward their goals) if I meet with them or their teacher 3 or 4 times a month? Three questions. That's not too bad, yeah? From there, if the answer is still "No, I do not think the child will meet the goals with services once a week." Then there are a few things you can do. Before asking if twice a week is required (don't scream at me, I know you don't even want to hear that... well, most of you), first ask if just one additional consult a month would make a difference. I have found that when I see a student weekly, some things don't carry over into the classroom. But good things seem to happen when I add one consult a month to my weekly services. So, maybe start there. You may also ask yourself if the goals you and the IEP team are putting in place are over the top - either in their quantity or in the student's ability range. When a single service provider has more than three goals they are responsible for, I find that they don't always get worked on. There are always other goals to work on, but the IEP team must determine what is most important this year. It's okay to say to the IEP team, "I was considering a goal to _____, but the goal I wrote is most important now. Maybe next year we can focus on _____." I know we did not dive into the topics of consult vs. collaboration and how long sessions should be. We can do that another time. Or, if you'd like to learn more about that and more with me right now, check out my course - A-Z School-Based OT Course. The A-Z School-Based OT Course is perfect for you if you're headed into a position as a school-based OT practitioner or if you have been there awhile and feel like you need some support being the confident therapist you want to be. I've supported nearly 1000 OT practitioners via this course and would love to help you, as well. See ya next time, 👋 Jayson Learn more about developing strong present levels, goals, and services. Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best.

Welcome to the second post in our three-part series on effective school-based occupational therapy. In our previous post, we discussed the importance of writing effective Present Levels of Performance (PLOPs) for each student we work with, and how they can be used to guide the development of individualized education programs (IEPs). In this post, we will focus on using PLOPs to develop effective accommodations and therapy goals for our students. Accommodations are changes to the learning environment or materials that help students access the curriculum and demonstrate their knowledge, while therapy goals are specific objectives that the student will work on with the occupational therapist to improve their skills and abilities. We'll provide practical tips and examples for developing accommodations and therapy goals that are individualized, measurable, and relevant to each student's needs. By the end of this post, you'll have a clear understanding of how to use PLOPs to guide the development of effective accommodations and therapy goals, which will help you to help your students succeed in the classroom and beyond. So let's dive in! Part Two: Accommodations & Goals I like to say the student's strengths lead to accommodations, while the areas of concern can lead to goals. For example, we have a few potential options if a student struggles with producing legible writing but excels in verbal communication. From a goal standpoint, we could recommend something along the lines of the student producing more legible written language. Or we could introduce typing and write a goal for that. Alternatively (or in tandem with a goal from above), we could recommend that the team allow the student to record his responses verbally or use a speech-to-text system to complete academic tasks. My preference is to implement a combination of these options. There is no reason to prevent this student from accessing his curriculum in the short term because it will take time to meet the legibility goal. To prevent that situation, we can put accommodations in place so the student can continue progressing academically while we work on the area of concern. When making such recommendations, it is important to consider the student's environment and how it may impact their ability to access the curriculum. For example, if the student is going to respond to questions verbally, the team must factor in what this may look like during a test when the expectation is to remain quiet. Will the student be assessed separately, or is there another way the student's learning could be assessed while eliminating the task demand of writing? You might have to get creative. Want to learn more about developing proven present levels, goals, and services? Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best. Remember that the IEP is a team effort. Collaborate with other members of the team, such as the student's teacher, to ensure that your recommendations are appropriate and feasible within the classroom setting. Working with the IEP team can lead to more effective and comprehensive recommendations. When setting therapy goals, use data from the PLOPs and other assessments to ensure that the goals are specific, measurable, and achievable. By using data to inform goals, you can make sure that the goals are appropriately challenging and that progress can be accurately measured. You can learn more about smart goals in this blog post or this episode of the OT Schoolhouse Podcast. By following these tips, you can effectively use the PLOPs to inform recommendations for accommodations and therapy goals that will help the student succeed in the classroom. Remember to approach this process from a strengths-based perspective and collaborate with the IEP team to ensure the student receives the support they need to succeed. Next time, we will talk about how to decide what your services should look like based on the goals and recommendations you developed. See you next time, 👋 Jayson PS - Did you miss the first article in this series? Click here to learn more about writing your PLOPs. Learn more about developing strong present levels, goals, and services. Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best.

Welcome to the first post in our three-part series on effective school-based occupational therapy. As school-based occupational therapy practitioners, one of our most important responsibilities is to develop Present Levels of Performance (PLOPs) for each student we work with. The PLOPs provide a snapshot of the student's current skills, abilities, and challenges, and are used to guide the development of individualized education programs (IEPs) for each student. In this post, we will focus on the importance of writing effective PLOPs, and provide practical tips for doing so. We'll also discuss how PLOPs can be used to develop effective accommodations and therapy goals, which will be the focus of our second post. In our final post, we'll discuss how to determine an appropriate service frequency for school-based occupational therapy, using PLOPs and therapy goals as a guide. By the end of this three-part series, you'll have a clear understanding of how to use PLOPs to guide effective occupational therapy services in the school setting. So let's get started! Part one: The PLOPs The present levels of performance section is a substantial piece of every Individualized Education Program (IEP). The PLOPs are the foundation of an IEP, and they provide the team with a clear and comprehensive description of the student's current abilities, needs, and challenges. With a good set of PLOPs, the rest of the IEP often flows with ease. However, with a poor and unclear set of PLOPs, the IEP team may struggle to create meaningful goals for the student, misidentify appropriate modifications and accommodations, and over (or under) recommend service frequencies. So, how can you be sure to set a proper baseline for the student's performance that will guide the development of appropriate goals and objectives? Using a strength-based approach to the PLOPs, we can focus on the student's strengths and abilities while still providing a comprehensive picture of their needs and challenges. Here are some ways you can keep the PLOPs strengths-based and still provide value to the IEP team: Use positive and descriptive language: Use positive and descriptive language to highlight the student's strengths and abilities. For example, instead of saying "the student struggles with fine motor skills," say "the student demonstrates strength in gross motor skills during PE and at recess and is working to improve fine motor skills to allow for increased independence in completing writing assignments." Emphasize what the student can do: Focus on what the student can do, rather than what they cannot do. This approach reinforces a positive self-image for the student, and encourages them to continue to build on their strengths. It also gives the parents the opportunity to hear what wonderful things their child is doing. The IEP does not need to be traumatizing for the parents. Include the student's interests and preferences: Incorporate the student's interests and preferences into the PLOP section, and identify how these strengths can be used to support their academic and functional goals. Highlight progress and achievements: Include information about the student's progress and achievements, and celebrate their successes. This reinforces a strengths-based approach and encourages the student to continue to build on their progress. Include the Data: Just because we are using a strengths-based approach doesn't mean you can omit the data. Share data points that show the progression the student has made. If the data doesn't show progression, what can be gathered from that? Collaborate with the student, teachers, and the family: Involve the teachers, student, and their family in the development of the PLOP section, and ask for their input regarding the student's strengths and needs. The IEP is a collaborative document, and it is beneficial to include the family's beliefs, opinions, and observations in the document. Here is an example of a PLOPs section using these guidelines: Brad is a bright and enthusiastic 2nd grade student who demonstrates strengths in reading and physical activity. He has a learning disorder and requires support to achieve his academic and functional goals. Brad loves reading, and he excels at citing text from a story. However, he struggles with writing and requires assistance documenting his ideas. Brad is an active and engaged learner, but has difficulty attending to his teacher for extended periods of time. ​ During recess, Brad struggles to engage with his peers and requires support to initiate play. However, he is very physically active and enjoys running and playing games. Brad is highly motivated by his interest in Pokemon, and this can be used to engage him in therapy activities. He engages better in play with peers when there is structure. Brads parents have noted to observe this as well at church and at the park. ​ Last year, Brad had a goal to independently write a three-sentence summary after reading a short story. He has achieved this goal with support, using a worksheet that prompts Brad to write three important points about the story. When he writes out his points, his teacher sometimes struggles to read what he has written, which impacts his ability to demonstrate his comprehension of the story. ​ Overall, Brad is a hard-working and motivated student who benefits from strengths-based support focusing on his interests and abilities. By building on his strengths and providing appropriate support, Brad can continue to make progress toward his academic and functional goals. This is an example of a PLOP in an IEP where the OT practitioner is provided a space to write a narrative section of their own. In some IEP programs, you may need to split this up into various areas. You may add pieces of it under the fine motor, sensory processing, behavior, and daily living sections. There may be other sections that you can add to as well. No one section is only for one individual provider. Completing the PLOPs is the first step in the IEP process for related services providers, and they create the baseline for the rest of the IEP. If you think of an IEP as a story, the PLOPs is the first chapter. It sets the scene, introduces the main character, and even alludes to what may be coming in the next few chapters. If you read the PLOP above carefully, you may just see where I may be headed with the goals and services I plan to recommend. That story is by design. It helps parents, other team members, and potentially even advocates see how to link the PLOPS to the goals, accommodations, and services. Click here to check out the next article in this three-part series on developing strong present levels, goals and accommodations, and service recommendations. See ya next time, 👋 Jayson Want to learn more about developing strong present levels, goals, and services? Sign up for the A-Z School-Based OT Course to help you better understand school-based OT and to create systems to ensure you are giving each student your absolute best.

Press play below to listen to the podcast Or click on your preferred podcast player link! Want to learn more about sensory, stress, and behavior from Olivia Martinez-Hauge? Learn more about the OT School House: Back to School Conference Here! Welcome to the show notes for the Episode 64 of the OT School House Podcast. Today, I am welcoming Olivia Martinez-Hauge, MFTA, OTR/L, back to the podcast . Olivia is a school-based OT, a parent of a child with special needs, and a soon to be licensed marriage and family therapist as she furthers her education to support children with special needs. In this episode, Olivia and I are going to provide updates as to how this year has gone compared to our expectations back in August. We will then dive into some pressing issues like person first versus disability first language, ableism, non-preferred activity goals, how OTs address behavior, and how stress plays a role in behavior. You are going to love these discussions Links to Show References: OT School House Podcast Episode 54 - Back To School During a Pandemic Polyvagal Chart referred to in the podcast Olivia's website Olivia's Facebook Page Olivia's Instagram Transcript Now you can read the transcript here or download it to read later! Amazing Narrator 00:01 Hello and welcome to the OT schoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here's your host, Jayson Davies. Class is officially in session. Jayson Davies 00:19 Hello OT schoolhouse crew and welcome to Episode 64 of the OT schoolhouse podcast. My name is Jayson Davies and it is a pleasure to be here with you right now. Wherever you are, whatever time of the day or night it might be. Thank you for listening in to this episode. Today we have another special occupational therapy guest on to talk about how she is handling this crazy 2020/2021 school year. And this is actually going to be somewhat of a follow up episode to I believe it was Episode 54 where we talked about plans to start the school year during a pandemic. So today I am welcoming back to the podcast the energetic and passionate Olivia Martinez-Hauge. Olivia is a school based occupational therapist, a parent of a child with special needs and a soon to be licensed Marriage and Family Therapist, as she furthers her education to support children with special needs and just want to give her a quick shout out and nudge I know she's trying to get through her hours that she needs and the pandemic is not helping but she will soon be licensed you will get done with her hours. And she will get there. in this episode, Olivia and I are going to provide updates as to how this year is going as compared to what we kind of thought it might go back in August and September. I'm sure all of you are experiencing differences from what you might have expected to where we are now. After we catch up with Olivia on how the school year is going, we're also going to dive into some pressing issues like using person first versus disability first language ableism non preferred activity goals and how OTS adjust behavior and how stress plays a role in behavior. You are going to love these discussions, I guarantee it, her energy, just like make some topics that can sometimes be a little draining. She just brings the energy in and we have a great time talking about some good stuff. So now before I want to get into this interview with Olivia, I have to reveal a secret with you all. And that is that Olivia is not only a guest on this show, but she is also going to be one of the five guest speakers along with myself at the back to school conference in August that I am preparing right now. At the back to school conference, Olivia will be presenting her topic titled it's not sensory, it's stress. And this presentation she plans to focus on current research on stress and the brain. She's going to help us unpack challenging behaviors and examine why they are occurring, the power of being trauma informed and what we can do about it. This presentation will give you tangible information you can apply to your caseload right now and you will gain knowledge to help you lead IEP teams and meaningful conversations, develop whole team interventions and provide the families with valuable information. And she's going to help us better understand trauma and aces or adverse childhood experiences, chronic stress, the polyvagal theory, top down versus bottom up behaviors, emotional regulation, intervention strategies and more in her two hour engaging discussion. Be sure to check out all the OT schoolhouse back to school conference has to offer and sign up at otschoolhouse.com/backtoschool or grab the registration flyer and ask your employer or district to allow you to attend. I will be announcing the remainder of the speakers for the conference all month long. So stay tuned to emails and the podcast. We have less than six months to go before the conference and I am super excited to interact with all of you in this first ever OT schoolhouse back to school conference. Again, the theme if you don't remember it, I think I mentioned it last time is promoting independence in education. So all the speakers will be talking about how we can make our students as independent as possible in the educational environment they are in. And just one last time remember to check out otschoolhouse.com/backtoschool to learn all that the conference has to offer to you. Alright, so without any further weight or anticipation, please help me to welcome to the show. Olivia Martinez Howdy. Hey, Olivia, welcome to the OT school house podcast. How are you this morning? Olivia Martinez-Hauge 04:22 Good. Thanks for having me. Jayson Davies 04:24 Yeah, definitely. You actually were on the podcast once before also in our lives back to school. It was just a video that we talked about. Olivia Martinez-Hauge 04:33 That's right. That was I feel like that was a year ago, two years ago. And it was only what four or five months ago is a school year. Jayson Davies 04:41 We got on with a few people and we just talked about what the plans were going forward with COVID Olivia Martinez-Hauge 04:47 Yeah, that was fun. And also, I don't know, did any of that stuff work? Okay, I was just gonna ask you might have thrown all that stuff out the window and just survive each day. I agree. You know? Jayson Davies 05:00 Let's start there actually, because you are a school based occupational therapist, we'll get a little bit into your background. But while we're on this, I want to talk about it. Yeah, I think we were talking about how we would do evaluations would kids be coming in? Or would we be doing that on on zoom? How to do treatments where we're going to send packets home? What were we going to do? So, you know what, let's start right there. It is January, something, what have you been doing the last six months for your virtual, whatever it might be therapy sessions, Olivia Martinez-Hauge 05:30 holy cow. Okay. So it's just, it's been a little of everything. And just in in pure, you know, in our pure OT profession, it's, it seems like, you've got a treatment plan, you've got these ideas. And then you've got to be flexible, and throw those things out the window when they don't work, or, you know, whatever. And so, it's been a little bit of everything. So we send we send home packets, which has been nice to have, you know, tools and things that you know, the student has right off the bat. So you can just say, Hey, take out your potty or take out whatever, this is what we're doing today. So that's been really nice. A lot of a lot of actually push into the class put quote, unquote, push into the classroom, observing the students within their classroom setting on their their Google classroom setting, and then giving the teacher some strategies and some ideas and talking about, you know, what I'm seeing and what I'm observing with the student at home. Yeah, it's just been a lot of different things. Jayson Davies 06:43 That is great that you bring that up. I have a lot of people asking me on Instagram. So for all of you that have asked me this question on Instagram, I'm going to ask Olivia right now. Always have the answer. But Olivia, Olivia Martinez-Hauge 06:57 break it down. Uh huh. Jayson Davies 06:59 How does that specifically look like when you observe a child? I want to know the process of how are you planning for that? And then how do you follow up after you observe a child in the classroom? Because you just said you're kind of observing them in their Google Classroom, their zoom classroom? Yeah. What goes into that process? Are you reaching out to the teacher or the parent beforehand? Or, or walk me through the three or four steps that that takes? Olivia Martinez-Hauge 07:24 Yeah, so you know, what, you know, what's interesting is I think this COVID thing has really open things wide open in terms of what, what is working and what is not working. And so I'm seeing a lot of students transition from, you know, non COVID times into home, and getting lost and not really knowing what to do. And we get to start to see like, Oh, this kid's really dependent on on a lot of prompts, you know, that we're giving in school. So it's giving us an opportunity to really look at what the kids are, are able to do and what supports they need, and what supports maybe haven't been working the way that we think they're working. Yeah. But OTS are master observers, right? We see everything. And so I just have my little handy dandy Notepad, and I drop into class, and depending on the teacher, depending on the class, I might keep my camera off. Certainly, my microphone off. And, you know, I'm just watching that student, like, how much movement or how much sensory input is that student needing in order to attend and engage in that, in that learning process? Is the student looking at the screen? Are they are they more comfortable not looking at the screen? And so I'm doing a lot of consultation like, hey, let the kid sit on the floor. If he wants to sit on the floor, don't call him back to his seat. That's okay. The main one of the biggest things that it seems to be sort of depending on what your how, you know, Richard, you're going to be his camera on or camera off, or students. And so a lot of students are having a really hard time with camera on and it makes sense. Because if our kids are in a classroom, what are they doing? They're sitting in, let's say, Johnny's three rows back and he's sitting, he's looking at kid the back of kids heads. He's not looking at 24 sets of eyes staring back at him, which is what's happening on Google Classroom. And so and, and depending on a student's perspective, that student may think every one of those eyes are looking at him. And so I'm allowing the student to tell me There camera up. So maybe it's just the top of their forehead and up or even higher. And the way you get that child engaged or know that they're still there is a is a high thumbs up, you know, or, or a raising of the hand. Yeah, I'm still here, encouraging the child to use the chat function. And so, you know, some of my teachers are like, they're not turning on their camera. Okay, but they're there. And they're participating. And, you know, so yeah, that's sort of my take on that. Jayson Davies 10:30 Yeah. And I've had some, I mean, I'm sure we've all had our stories. I've had kids that I can see in the reflection of their glasses. They're watching a YouTube video. I've had kids where you know that they're sitting at a table, like a dining room table, and their toys are just spread out all over the table? Olivia Martinez-Hauge 10:47 Are there 16 other people in the room and four of them are also on a distance learning and you're hearing 16 different ones? Yeah, it's Jayson Davies 10:57 My favorite is when I can hear I can hear the sibling. Like, I have two kids, right. I had two kids and their brothers and I had both of them. And I could hear one speaking to the teacher over the air. And yeah, funny. But it's a challenge. Olivia Martinez-Hauge 11:12 If we're feeling challenged, what about our little guys, you know, our kids? And no one, no one said, Hey, is distance learning developmentally appropriate for you know, for a six year old, a seven year old or whatever, it's, it takes a lot of organization, it takes a lot of sequencing. And some of our adults took, you know, a huge learning curve to even figure this out. I did I can I can I say that I can land a plane with zoom. But with Google Classroom? I am. I mean, you might as well, it's just Yeah, I don't know. I don't know how to do. Classroom. Jayson Davies 11:48 Yeah. Much, much better with the zoom as well. Yeah. So let's move forward, then. So you just observed the kid, you saw some of these things? What do you do now? Olivia Martinez-Hauge 11:59 Oh, you know, and this gives me an opportunity to talk about the stuff that I see if I know that student well, that I can correlate that or show teachers the difference between what is happening in the physical classroom, and what is happening in a virtual setting. And what I'm hearing is a lot of a lot of our kids, and, you know, some of our kids are really, really struggling and this platform is not good for them. Some of them are thriving, and their focus is is better, and they're whatever. So this gives us otas the opportunity to say, hey, you want to know why? Because it's there was a sensory issue in that classroom, that student now at home, it's quiet, it's predictable, there's less social stress, there's less just stress in general. That's why we're seeing this increase. So we can begin the conversation of well, what can What do we need to change when the child comes back to our classrooms, but also, you know, having teacher noticed that, but then also, you know, just sort of more of the physical, logistical parts of it, if, if a teacher pulls up something with like, a lot of words, or a lot of writing, and I know my student has trouble with visual perception or, or pairing auditory with, with watching with visual, then I help that teacher set, you know, take everything off that page, use a highlighter and circle what you're talking about. It's, you know, increased the cursor, make that really huge and big and colorful. So it's so bizarre that I'm giving strategies about how to change up their Google Classroom. But that's, that's where we are right now. Jayson Davies 13:56 Yeah. All of us became technology specialists very quickly. Yeah. Well, Olivia Martinez-Hauge 14:01 yeah. And my accommodations are has to do with increasing the cursor, so my students can see what you're pointing at. Jayson Davies 14:10 Oh, man, that's great. So you talked a little bit about working with the teacher on there? And what about working with the parents? Are you also working with the parents at all? Olivia Martinez-Hauge 14:19 Yeah, it's, it's difficult because it's a fine line. Because, you know, I have three kids at home distance learning and parents are under quite a bit of stress. And so it's a fine line of supporting the parent, but also not making them feel like they have to step into the role of a therapist or a teacher or whatever. And so it is, here's some, here's some information and I'm going to be real gentle about it. And it's not like you have to do this or you have to do that. But rather like where are you seeing Where you can support? You know, me asking the parent, like, Where are you feeling where you need, where you need a little bit extra support, I can help kind of build that in for you. But it is hard because it's parents are stressed. And this is not something that they typically do. You know, Jayson Davies 15:20 definitely you get that deer in the headlights look on parents sometimes. Olivia Martinez-Hauge 15:24 I don't blame them. I don't blame them. It's like, wow, what do you want me to do? And you know, for me, I don't want to change up the dynamic of my of my household. And so my relationship with my children is so important that I don't want to engage in an argument with my kids every single day about whatever. And so you know, it's, we still have to download that we're within a worldwide pandemic. And we'll just, you know, we'll come out of this and we'll figure we'll figure it out. Jayson Davies 15:55 Yeah, and so I think that's probably a good time for me now to, to let you actually introduce yourself a little bit, we just like dove right in. We want to let you share a little bit about your background as an OT how you decided to become an OT and where you are in your OT career right now. Olivia Martinez-Hauge 16:14 Okay, so you're asking me to recall ancient times. So I've been in I've been an OT since 1999. And all within the school setting. by choice. I just felt found school setting and I I haven't moved from from there. And so why did I choose OT I mean, I was pre veterinarian, which some people can say like, you know, animals, kids. But yeah, I just thought that is not for me, but I loved science. And I loved being creative and inventive. And I although I've gone on to graduate school and get a degree in clinical psychology, and I'm trying to finish my license for marriage and family therapy, I'm almost there. Um, I still have a passion and a heart and my first career and and loved part of my profession is going to be ot. And I think it comes down to there's no other profession that just mixes in a relationship and empathy and creativity and science and just mashes it all together. And that, that I think that was the perfect formula for me. And so what else did you ask me? Where am I at now? Jayson Davies 17:45 Wherecare you at right now? And you started to kind of go down that road with lmft. Yeah, yeah. Olivia Martinez-Hauge 17:51 So yeah, so I still work in a school district 40 hours a week, because let's face it, I have to pay a mortgage. And I'm working towards my, my marriage and family therapy license, but I still have a full caseload, you have to do 3000 hours. And so I've carried a full caseload and my passion in that part of my life has been to work with parents of children with special needs, or neuro differences. I'm a parent of three kids, two with neuro differences. And so I bring a unique experience to that. And then I've started seeing autistic children slash adults. And I, I love that I love that focus, and it just and everything, my OT and my MFT life just informs each other. They're just constantly talking back and forth to each other. And so I'm, I'm, I'm learning so much. I'm always learning. I'm always making mistakes. And so yeah, I just I love. I love everything about both professions. Jayson Davies 19:14 Yeah, and I'm sure you're able to kind of blend those and are actually want to talk more in a minute about how you're working with autistic persons. But I actually want to dive back because I know people really want to just hear how me how you how we're all surviving right now. And so we talked about observing in the classroom. How much would you say IEP goals? And now we're coming out to the point where most IEP goals now were developed after March 13 of last year, but were you struggling with trying to figure out how to work on IEP goals in a virtual setting? Or are you trying to work on IEP goals still, or is that kind of almost out the window now because Think that Olivia Martinez-Hauge 20:01 You are asking you are asking possibly the wrong person? Because I'm constantly going to these IPS and saying to myself, Wait, am I writing this goal? Where am I writing this goal for? I could not conceivably. And right. Okay. I will just say this, this is my like, lean into the microphone. Oh, cheese. Do you ever feel like Pete, like, things don't apply to you? And you're asking questions that people just don't understand. But you're like, but I'm the OT, I need these answers. And, you know, it's like, the psychology the teachers, the speech servers, everybody goes, they it makes sense to them. But I'm like, this doesn't apply to Oh, this is weird. How do you want me to think about this? So yeah, I'm always asking like, well, I see. So the student is under significant stress and sensory overload in their classroom. But I'm observing the student who is full on doing their activity, participating in the class, and doing their work at home. So am I supposed to write a goal for home? Or am I supposed to write a goal for school? So legally, I understand that we that the IEP is written as though they're going to be in school tomorrow. Yeah. So but I think that just stretches ourselves to look at the bigger picture and say, Okay, this child, then if the child has issues at school, but not at home, then this is a sensory regulation goal that we can write. And we're going to have to be creative and write it so that it addresses the academic portion, but also is general enough to address now? I don't know if that's an answer at all for you Jayson Davies 22:06 And you started with that with I'm asking the wrong person this question, but I do not agree with that premise. Because I am right there with you. You are right here in Southern California. You're in Southern California, too. We have been told and I don't know if this is a nationwide thing, but we have been told right goals as if the kid is going to be in class tomorrow. And that that's not the case. Have you have you have any of your kids come back to classes? Olivia Martinez-Hauge 22:31 No, we are we're completely virtual. We started to we've started to dabble in, in person assessments, but with the uptick, um, I think they're still saying we can do but it's if you can do an online assessment, do it. I think that's where we are because our numbers have skyrocketed. December and now into January. Jayson Davies 23:00 Okay. Yeah. And the district that I was in previously, they were doing assessments in person already, they've been doing that since even the end of last No, the beginning of the school year is when they kind of started doing that. And we have or they have brought back moderate to severe classrooms. Okay, so they have done that now. But there are all your RSP students, they're still learning online. And that really applies for what you're talking about observing in the classroom. Because those kiddos are seeing them virtually working potentially on a fine motor skill. They're not doing any fine motor activities at home right now. They're not any writing at home right now. Everything is basically online, Watch and learn. And then a little bit of typing to show that you can do something, right. And that's really they're not using scissors at home, they're not doing writing, it's all it's all computer based. So Olivia Martinez-Hauge 23:55 and that's when you go and you ask somebody and it's the end that, you know, like administration or whatever it's like I don't know, an agenda, right, a general goal that will address things when you return. Jayson Davies 24:09 Exactly. No, that that's exactly what's going on right now. And I think everyone's kind of struggling with with at least part of this. anywhere really across the nation. Some kids are some kids are back, some are not. And we're expected to write goals as those school is in session in the classroom tomorrow, without social distancing without wearing face masks without wearing any pp. Yeah, this is crazy. So yeah. All right. I want to move forward. Something you said earlier. You use the phrase that you are working with autistic persons now. Yeah. And before we dive into what that might look like, I want to ask you I don't even know how to ask this question person first language. When we were in school. When I graduated from OT school in 2012. Everything was used person first language use person first language that is changing in the world as well. The last few years. Yeah, don't worry about that. Olivia Martinez-Hauge 25:03 Yes, I'm so glad you asked this because I'm in my, in my quest to learn everything and want to just make sure that I'm honoring and respecting the kiddos and the people that I see. I'm learning a lot about ableism. And which is, you know, I'm a terrible definition giver. So it's, it's just the neuro typical, assuming that neuro typical is best. And assuming that those who are neuro diverse or new nor neuro different, want to be neuro typical want to be fixed, or that neurotypical is, is a goal to achieve. And so I think when we went to school, particularly when I went to school, we were told that we use a person with autism. And so what the autistic community is teaching us, and by no means am I a spokesperson. So go to go to like Facebook page, autism level up is a fantastic Facebook page, every OT needs to be hooked into that. And then the therapist, oh, neurodiversity collective, Oh, my gosh, the infographics and the stuff that they have, there is fantastic. But basically, what autistic individuals are teaching us and telling us is, we that is our identity. And to put that as, as a second, you know, as person first and then and then my autism, that that isn't working for them. And that's not respectful. And so I but I still catch myself person, you know, a child with a with autism. But now I have to say, autistic child. And so I'm so glad that, um, that social media is being used for some good in that area. Jayson Davies 27:16 Yeah. And you know, it's interesting that just as you're talking about that, I always hear this in reference to autism, we never really hear this in reference to people with other disabilities. Like, I don't know, I can't even imagine you say autistic child, Down syndrome child or child with Down syndrome, like you never hear about it. In other communities, there seems to always be within the autistic community, that people talk about it. But I don't know if it's different from one community to another community, does someone with a different type of developmental disability or any disability? Do they prefer it the other way? I don't, I don't expect you to have the answers I'm just kind of thinking about. The autistic community is a very connected community. And I don't think that you can necessarily generalize the autistic community, with people with schizophrenia community, or something like that. And so I'm sure it also varies from different from community, to community. Olivia Martinez-Hauge 28:13 I, I think we, because in school, in the school setting, the majority, at least for me, the majority of my caseload is autistic children. That's where sort of my my attention goes. But certainly, there is a conversation to be had about any disabled person and, and, but it as and this totally goes back to our profession, and the why I love it is we must listen to their story. And we must glean from their story, what are their meaningful activities. And it is not for us to change those meaningful activities. And I think in school, in school setting, you know, we look at a child with mercy, I was gonna do it, we look at an autistic child and their act, their activities, and we go, Well, those aren't meaningful, or those aren't functional, or those aren't purposeful. It's not for us to define those are meaningful activities for them. And so we need to support them in, in in their school setting, but also support them in their meaningful activities. Jayson Davies 29:34 Yeah, and you know what, that is perfect to just continue to move on that side. We actually, because we wanted to talk about sensory behavior a little bit about that. But let's start there. Occupational therapists, we look at meaningful activities. And who is who is to decide what is a meaningful activity or an individual in an IEP? Do you feel like you really have to explain or how do you think Explain that to either someone who is on the team, a district employee, or to a parent, you know what, this is why I'm making this goal? How do you explain what a meaningful activity is? And why you're why you're developing or why you're choosing this type of goal? Olivia Martinez-Hauge 30:18 So, um, Jayson Davies 30:23 I know the is a hard question. Yeah, Olivia Martinez-Hauge 30:25 it's a hard question. Because you know, it, there's so many layers to it. And I think that for, for me, like, I would say, in the last two to three years, my my practice has been up ended, but in a good way. And I have completely shifted my paradigm, and completely shifted the way I treat, and I'll tell you, and, and parent, and it is, and it has really changed my life, I am no longer, you know, I'm not stressed as a parent. And in terms of being a therapist, I don't stress about things as much as I used to. Because I felt like, in the back of my mind, I had to fix. And now I just am I'm, I am part of that child's team, what and that child is my coach. And so I am taking that child's lead, no matter how young No matter how much support that child needs. But and so I try to bring that into an IEP setting. Now, I think I've said this, and maybe some courses that I've taught or whatever, but I just want to like Control Alt Delete, and the IEP process is so it is so hard to really establish a relationship with this very legalistic IEP document sort of situation. And so I just engage in a conversation in terms of what is what is the child telling me is meaningful? And how can we how can I use a strengths based approach to a write my report, and B, write those goals? And then C helps the team in collaboration, utilize those strengths to develop the child's academic skills even further? Jayson Davies 32:36 Yeah, definitely. No, I think that's a fantastic answer. You know, there is no one size fits all answer for what is meaningful activity and how you develop those. But I think you hit it on the nail, and I liked your analogy that you use there about you being on the same team as a kid and in the student being your coach. Actually, I think that's amazing. Because really, that, in a way, basically, you're saying that those observations are super important, and understanding where a kid is and what they prefer. Olivia Martinez-Hauge 33:04 Totally, totally. And, you know, I think I think it along the way, OTS have been sort of quieted by, by other professions, not purposefully and not, you know, I respect other professions, but I think, OTS in general, we were not great at collecting data. And, and so and some other professions have come in and are like, you know, this is science, and this is data driven research. And somehow, at least for me, I will, I will speak for myself, somehow I thought, well, then my observations must not be valid or valid enough or whatever. But the fact of the matter is, just because there's data doesn't make that approach, right, or ethical. And so, I've really, really gone back and shored up what I know about what I know about what I know, and that my observations are real and valid. And, and I can and I can connect those observations to science and what I know and what I know about sensory and what I know about, you know, stress and all of that stuff. Jayson Davies 34:32 Yep, we're headed there. Okay, so, you talked about different types of goals and other professions and something that comes up in IEP is a lot is a certain type of goal. A goal for a student to complete a non preferred activity. Olivia Martinez-Hauge 34:49 Oh, oh, yeah. Haha. Jayson Davies 34:51 So tell me about Olivia Martinez-Hauge 34:53 You said the words, you said words. So, so I for the longest time SAT, and these are PS, and I, you know, didn't I paid no attention to, to those kinds of goals, and I was also using that language and non-preferred or, you know, compliance driven language or, you know, those kinds of terms. And I thought nothing of it. But as I have sort of turned this corner and adopted this new paradigm, and under a new understanding, and by the way, I can sit in a whole bunch of shame, about, you know, the, the, you know, not doing certain things prior in my career, and I can, I can sit there and I can go on, but rather, I will channel that shame into getting on my soapbox and talking to as many OTS as I can about how we don't have to, we don't have to accept that language. And so, yeah, I mean, using the using the non-preferred term. As OTS, we should be sitting there and saying, Well, why is that activity non preferred, if you're talking about a writing activity, then I can tell you all about why Johnny does not like that activity, or that it's, quote, unquote, non-preferred, it's because there's learning gaps there, there's huge skills missing. And so the, the, the problem or the or the, the potential, um, dare I say, damage that we do, by by saying that so and so will, will participate or will comply with a non-preferred activity, that we as OTS and the team, and the child suffer, because we lose the opportunity to identify a the need, that's missing the, the, the support that's missing and, and be, we lose the opportunity of addressing that. And then also, we lose the opportunity for that kid to advocate for themselves about what is hard, or what is what, what is happening. So if you have Johnny, who, who, in whatever way, he's choosing to do this, whether it is a PE, teacher, this is hard, or, you know, banging on that table or throwing the pencil, if we're not recognizing that that is a way for Johnny to communicate to us, then Johnny will stop communicating to us. If he knows, well, hold on, I've been doing this stuff and no one is paying attention to me or there's planned ignoring of my behavior, then Johnny's gonna stop raising his hands, right, we stopped, then we stopped reaching out to the people and then, you know, in high school, then we start writing goals, like Johnny will advocate for himself. Well, we didn't do that we didn't help him do that back in third grade. And so I'm, I as an OT, I'm done thinking of kids as manipulative or trying to get out of something or non-compliant or whatever, I'm done with that. And so instead, Yeah, go ahead. Jayson Davies 38:41 I was just gonna say, I love the quote, I can't recall off the top of my head who said it, but kids will do well, when they can. Olivia Martinez-Hauge 38:46 That's Ross Greene. Yeah, Jayson Davies 38:48 Yeah. Okay. So you know, it's he will do well when they can and when they can't, that's when you're going to see behaviors, you're gonna see noncompliance, you're gonna see, they're trying to tell you, I can't do it. Olivia Martinez-Hauge 38:58 I can't do it. This is hard. This is hard. And here we go back to sort of the ableism stuff as we hold our most vulnerable population, our most the population that we need to come alongside most, we hold them to a different standard. And that's just not right. That just simply isn't correct. And so we, if, if a student needs help, then we need to help them and it isn't, you know, if you have I forget where the quote was, either on Facebook or Instagram stuff. I'm not I'm not on tik tok. So I don't know. But someone said, and excuse my language, but like, if I have a shitty day, no one says you're having behaviors and you're saying I had a bad day because I don't feel well. You know, my dad is sick, I'm stressed out or Whatever. But as soon as one of our autistic children or just you know, someone on our caseload is reaching out, then all of a sudden, it's behaviors. And so that's why I like to say it's not, you know, it's not behaviors, it's stress. It's something finding the why. Jayson Davies 40:23 Yeah. And I love that behaviors is always used as a negative connotation, even though every single thing is a behavior. But, yeah, Olivia Martinez-Hauge 40:32 Also, and also, you know, the, the part and forgive me for also, you know, stepping onto the soapbox for a moment, but the fact that I get frustrated when, when, you know, maybe the IEP team is talking about behaviors, and we're not part of the discussion. I'm, I'm a behavioral specialist as well. So are you. Yep. So is every so is anybody OT that is listening. I don't know who else listens to the podcast, but I'll just talk to the OTS to you awesome. Okay, hi, everybody, you are behaving, you are a behavioral specialist. And you know, whether or not you want to take home or not, but we know about behaviors, and we know why they are happening. And so that's where we need to come to these IEP meetings and say, This is why this skill or this this activity, quote, unquote, is non compliant. This is why that child is eloping. It's not good enough to me to say, you know, so and so is eloping. Why? Why is Jayson Davies 41:44 That, everyone listening?, Rermember what she just said? Because that is your question in an IEP, when someone says that the goal is for the child not to elope or Yeah, you just need to ask, why is the child eloping and the team you can have a discussion about that? Olivia Martinez-Hauge 42:02 Yeah, and we shouldn't be stopping meetings when when the goal is for eye contact. Jayson Davies 42:09 I mean, I haven't had one with eye contact in a long time, but I'm sure other people are still having those Olivia Martinez-Hauge 42:15 eye contact, and then don't get me started about appropriate, you know, appropriate play or appropriate, whatever or functional, whatever. Because our kids are talking about adaptive responses. You know, a lot of the terminology I hear is, quote, unquote, maladaptive. There's nothing maladaptive about my student having a meltdown, when the bell rings, you know, that's an adaptive response. That is that is that child's, you know, sensory system and, and stress signals, and that that brain is working correctly saying to that child, you're and this is this is danger. You know, and so we should be having conversations about those things. And it but it's hard, because these are, we're, we're in meetings, with colleagues and with parents, and so trying to have those conversations, you know, in different areas, in consultation with teachers and that sort of thing. Jayson Davies 43:28 Yeah, and I want to challenge you, for the sake of everyone listening here, just a little bit, I want to, I want to ask you for a storytime or an example, of maybe a goal that you had, maybe let's use your kids, because it's a little less outside the realm, but have a goal that maybe you had a few years ago, and how that has changed to now with your changing. Olivia Martinez-Hauge 43:54 Yeah, I mean, that's that kind of is easy. I mean, I would, I would put myself on a goal. And I might do it now. But I changed the wording or I'm changing the modality that I'm using. And so you know, a student will demonstrate Oh, gosh, now you really put me on the spot. Improved, like sensory regulation to participate in a in a imitation song situation, right? Like you wanting the child to imitate the song, whatever appropriately. And so what that has changed too. Well, what about that scenario, that scenario where where Johnny is sitting in a seat and have and being asked to follow you know, the classroom directions or invitations or whatever, I am doing a terrible job. Bringing this home. So I guess what I'm saying is I'm really going way down deep finding out what is the what are the the Jayson Davies 45:11 task analysis? Yeah, what's the analysis? Olivia Martinez-Hauge 45:14 Right? What is the skill that's missing? And people are like you weren't doing that Olivia? Well, it gets hard, you know. And then, and then also, there's that fear, too, of, oh my gosh, and I'm gonna write seven goals, or I'm gonna, you know, or, or maybe this isn't quite, maybe this isn't quite the sensory processing, or the sensory integration, stuff that that is under my scope. But this is something else. So like, if you've ever said, and I used to say this, maybe this is bringing it home for you. If I used to say, I used to do an assessment and go, wow, this is not a sensory issue. This is behavior. Okay. And I have stopped saying that, because the, the message there is that, Oh, this is behavior, I'm going to hand this off to someone else that knows behavior. And instead, I'm saying no, no, no, I know behavior. And, and there is a, there's a stress component here, there is something going on, that is related. I may not be the main interventionalist on the case for this, but I can help the team understand why this is happening. If that makes any sense. I feel like I totally skirted your goal. Jayson Davies 46:50 Talk about the assessment, which is even more important. I think that that is and it led to this this question now. Okay, how do you work on behaviors differently than a different professional might? Olivia Martinez-Hauge 47:03 Okay, so it starts with that assessment. And so, I look at I, we, we still are as OTS are going to be detectives, when we're doing that assessment. And if, if everything that we're looking at, we're saying, well, this is this is interesting, this is not a fine motor thing, this is not a visual motor thing, this is not a gross motor thing, where, but but you're still seeing issues with attention or focus, or behaviors in the classroom. Um, I do a really strong sensory processing assessment. I utilize that that and I know that sometimes as OTS we fear using, like a an assessment, like the sensory profile or the SPM. Because we're like, oh, man, we don't want to uncover anything that that might, you know, keep us keep us here longer. But I really utilize those tools to help build that profile of that student, because that's what it is, it's a profile of that student, it's giving the whole team information that is so vital and important. And so then I use that information, and I break down for the team. And a lot of times it's in a chart form. So if the team is saying, This kid gets up and leaves the circle, time, that I'm looking at that sensory profile, and what I know about this child's ability to process sensory information, touch, vision, auditory, whatever, and I go, Hmm, there's an issue here with auditory. And so then I so then in that in that chart, I say, here's what you see the child get up and leave. This is what this is the why this is why this is happening. And here's an intervention for you. Here's a strategy. And I break that all down for the for the teachers and, and so then I say, try it. So if that student is auditory, whatever, maybe call that child a little bit in front of his peers a little bit in back of his peers, to keep that auditory, let's use some headphones or whatever. And so let's look at those at those things. If it's, if I feel like it, this is a not so much just sensory issue but more of an issue of anxiety and stress that is coming from something To the child and the child's parents are not in the house, they just got a divorce, the child is not, doesn't have any food, there's concern about where the next meal is, or, you know, or simply put the child is, you know, maybe he doesn't have a great relationship with his parents, and, you know, the stress and anxiety are coming from some other realm. And I still am part of that, that conversation, and I'm like, you guys, that stress, anxiety is going to have our child more sensitive to sensory input. And it's going to make it difficult for them to learn that child, if you guys are familiar with the zones of regulation, that child is not living in the green zone, they're living in yellow, blue, or red. And if we know that the child is living and yellow, blue and red, and they're not ready to learn, and so how can we help the team? And maybe that is the psychologists coming in and helping with that part of it, or the teacher just changing things up? And so it's not always me providing intervention, but rather, how can I help the other team members look at what is going on differently? Jayson Davies 51:21 Yeah, and that gets all into the was I gonna say, Knowledge Translation and doing consultations collaborations with other professionals, just to provide your expertise? Yeah, no, definitely right on, and just wait, you haven't had kids come back yet? Wait till the kids start coming back on the campus, trust me, we've have behaved. I mean, I really is it's it's behaviors that they had gotten over a few years ago, from all the therapy sessions that they have been receiving all the difficulties that we had kind of been getting past, a lot of them are now returning. So Olivia Martinez-Hauge 51:59 I don't I don't doubt it, because it's, it all comes down to relationship and feeling secure and safe. And not just do not just do I think they feel secure and safe, secure, and safety and, and, you know, all of those things. That's, that's subjective. That's for them to decide not for us to decide. And so, you know, all of those therapeutic interventions where someone would say, you know, oh, I'm, I'm doing this, you know, I'm doing this on planned ignoring or whatever. It's, the child has no idea what you're doing. But are they perceiving what you're doing as something safe and secure? And, you know, are and regulating and that sort of thing? It makes no difference if you just think that? Jayson Davies 52:54 Absolutely. All right. Well, we've actually been on longer than I actually would be. And that no, that's perfectly fine. You and I, I won't go into the specifics. But you and I are going to be working kind of closely together over the next few months, maybe a year. And one of the things that I know you are completely passionate about, and you kind of teased it a little bit here and there in this talk. But I know you could go on for hours about this is sensory stress and the polyvagal theory. And so I actually want to give you just a quick minute, not even a quick minute, feel free to go on. But tell us about the polyvagal theory and kind of how you use that or Yeah, or does it fit on forever? Olivia Martinez-Hauge 53:37 Okay. Um, so I and I just got the dreaded message that my connection is unstable. Are we still okay, we're gonna sound fine. Jayson Davies 53:45 Yeah. Okay. Olivia Martinez-Hauge 53:46 So I by no means and this is where I get stressed, talking about the polyvagal theory. Because I by no means I'm just the conduit of, of, of getting the information out. So people you want to follow are like Steven Porges, who's the father of the polyvagal theory, and Mona Delahooke, who I'm lucky enough to call a friend and a mentor, wrote the book, beyond behaviors, which is, by the way, OTS, that is the book that I, my work wife, and I make our interns read before coming to intern with us now. And so if we go way back into biology, or whatever class this was, so the, the vagal nerve, the vagus nerve is the 10th cranial nerve, and it is the only nerve that leaves the brain. And so I used to say it's the only nerve that leaves the body but that was not it just like came out and that's not correct. And that's really creepy. So It's the only nerve that leaves the brain. And it branches all in it innervates all kinds of things, all kinds of organs, and most importantly, it innervates the heart and the lungs and the stomach. And so what does this all mean? That when, okay, so, so the one branch of the vagus nerve, which is the, the ventral part of it, I won't go into too much beyond that is the parasympathetic. So we know that parasympathetic keeps us regulated keeps us calm. If we're, if we're color coding it, this would be the green zone, this would be the ready to learn, this would be the the, you know, ready to make social connections. And, and when we're regulated, that's the parasympathetic nervous system, the sympathetic nervous system, and if we're color coding this, this would be red. So the red zone fight or flight, this is the so yeah, so the red zone sympathetic. There's also another parasympathetic portion of the Vegas nerve. And will color code this as blue. And this is the freeze. So this is just like Blue Zone freeze shut down. And, and that kind of Blue Zone situation. So when we're under stress, when we come under stress, the parasympathetic releases the break, and we go streaming down the hill, into either the red zone or the Blue Zone. And it happens without our knowledge, and it's something that we cannot control. And so this then goes back to all of those goals that we talked about, like the eloping and the compliance goals, and whatever those goals assume control. And what we know of like, the, the, the polyvagal theory, and also just what what happens under stress is we're not in control. And so that brake releases and all kinds of things happen, our heart starts speeding, everything starts happening. And so, um, you know, that's where I said that it's quite adaptive to flee the scene. And so I'll give you just this one little analogy that I use that. Okay, so everybody knows the ring doorbell, right? Oh, yeah. Jayson Davies 57:49 Yeah. I just got a notification for one. Olivia Martinez-Hauge 57:52 Did you? Is it Amazon? Or is it Jayson Davies 57:54 Who is it? It's at the cabin? And so my parents are there. So every time they walk in and out? Yeah, anyways. Olivia Martinez-Hauge 58:02 Right. So well, this is a great, great analogy. So the ring doorbell does not have discretion, it goes off, right? Whether it's Amazon or where that whether or not it's masked intruders. ring goes, Jayson Davies 58:18 Yeah, if it's a person, Olivia Martinez-Hauge 58:20 if it's a person, it goes. And so that's, that is what happens. And so with our with our autistic kids who are at baseline really stressed right at baseline, a stress happens. And that stress could be a math quiz. Or it could be, you know, someone just brushing up against them and the ring doorbell goes off. And, and, and the brake releases, and now we're careening into fight or flight or freeze and shutdown. Now, as OTS Our job is to help with regulation and help with CO reg. So, so OTS, you come alongside you co regulate, you connect, and you help that child or person, you know, reregulate and or or learn how to regulate. And so yeah, so that's how we, we can help. We can help our community and that in those kids that we see. identify what's going on. And so what I do sometimes is say, you know, don't let the train leave the station and help narrate what's going on and help walk through this very stressful event. But some of some of our kids their default setting is releasing that break and immediately going red or blue. And so, um, yeah, just helping With regulation and that, in that scenario, I don't know if that even answered your question Jayson Davies 1:00:08 I think you answered it so thoroughly that you got to a point where, Olivia Martinez-Hauge 1:00:12 okay, Jayson Davies 1:00:13 but that is right on Olivia Martinez-Hauge 1:00:14 Period. There you go. Yeah, Jayson Davies 1:00:17 it was funny. Actually, I am a techie person. So as you're saying that in making the ring analogy, in my head, I went beyond that, actually, because the ring doorbell a lot of people actually connect the ring doorbell with other things. And so what happens is, yes, the ring doorbell it sees that person. And the same thing happens in our bodies. The ring doorbell says sees that person. And then it sends a message to every other camera, hey, start recording, and it sends a message to the door to lock. And it sends a message to potentially like an alarm system, maybe it's sending a message to downtown at the sheriff's station, say, hey, come look at my house. Olivia Martinez-Hauge 1:00:53 So you're describing then the kids that I use the term hyper vigilance, I use that often when describing our kids. Because if you're right, if your ring doorbell, and your now brain is trained to everything's a threat, and everything's a, you know, whatever, then you are now sitting in a classroom. And you're, you're supposed to be learning math. But instead you're hypo, you're hyper vigilant for what's coming, what is going to come next what's happening next. And, and chronic stress is so unhealthy, not only for adults, but for our kids to sit in chronic stress that I asked other professionals like when you take when you're thinking of that one kid on your caseload, how often do you think that child is in a stress response? And if the if the person is, you know, honest with themselves and that the child is in chronic stress, a majority of the day? Jayson Davies 1:02:05 Mm hmm. Yeah, absolutely. And you know what, as you're talking, I also remembered that you shared with me a very useful polyvagal chart. And I will be sure to post a link to that you can get it really easily just by googling polybags. Olivia Martinez-Hauge 1:02:18 You haven't read readily. Jayson Davies 1:02:19 I have it, and I will add it to the show notes. So I'll put a link to probably find one of the Steven Porges or something I'll just link directly to I think he has it on his website. So I'll just probably link straight to there. But all right, well, I think I have to cut us both. I know you and I could talk forever. Sure. I want to thank you for sharing so much value. This. Well now it's afternoon. Yeah, so much. I really appreciate it. Is there anything else you'd like to share today with everyone who's still listening? Which I think a lot of people are probably still listening because well, you have given so much. Is there anything else you wanted to share? Maybe contact information or anything else like that? Yeah, Olivia Martinez-Hauge 1:02:59 I mean, people can find me on I'm, I'm so not text, not social media savvy. So you people can find me on Facebook, under Olivia Martinez-Hauge. And then you'll find like, I guess I'm OTR whatever that Facebook page, you can you're more than happy to, to ask to be invited to my personal Facebook page. But I don't think you want to see you know, grandma's 90th birthday party but my other my professional one. Jayson Davies 1:03:30 People may want to see your watermelon eating. Olivia Martinez-Hauge 1:03:34 Well, that's on Instagram, which is totally public too. Basically what Jayson's referring to is that my my children are addicted to watermelon. And so each year we try to top our watermelon consumption, which is on average a watermelon a day, from June 1 to like when we see pumpkins arrived at Vons. Jayson Davies 1:03:58 And to the point that like they actually have like news outlets like contacting them about this. It's not just like, Oh, we eat a watermelon a day. It's like we eat a watermelon every day to the point that abc news wants to come. Olivia Martinez-Hauge 1:04:12 We love watermelons what can we say? But people can find me on on? Yeah, on Facebook, and then on Instagram, which I will do better at posting professional stuff. But um, yeah, and I look forward to doing more stuff with you, Jayson. Jayson Davies 1:04:30 Yeah, definitely. And check out the link. If you're listening, check out the link to the show notes. We'll have links to all of those things that you just pointed out to make it easy for you so well. Olivia, thank you so much. I really appreciate you joining me today. And I'm looking forward to working with you in the future. Olivia Martinez-Hauge 1:04:45 Yeah, yeah. Jayson Davies 1:04:47 All right. Well, take care. Thank you, everyone. Olivia Martinez-Hauge 1:04:49 Thanks. Jayson Davies 1:04:55 Alright, everyone. I hope you enjoyed that chat with Olivia and yeah, she's just amazing. She's got all the energy in the world a bunch of information and I cannot wait for her presentation about stress and sensory coming up in August. If you enjoyed this conversation and you would like to hear more from Olivia, be sure to check out otschoolhouse.com/backtoschool and sign up for the OT schoolhouse back to school conference in August. Until next time, keep being awesome. All right, take care. Bye. Amazing Narrator 1:05:24 Thank you for listening to the OT schoolhouse podcast. For more ways to help you and your students succeed right now head on over to OTschoolhouse.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, thank you for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast

Click on your preferred podcast player link to listen where you enjoy podcasts Welcome to the show notes for Episode 91 of the OT Schoolhouse Podcast. Our role in special education was established in 1775 with the passing of The Education for All Handicapped Children Act. A lot has changed since then and we now have what is called the Every Student Succeeds Act, or ESSA. In this episode of the OT Schoolhouse Podcast, we are welcoming Abe Saffer, MPM. Abe is the Senior Legislative Representative for AOTA and I asked him to come on the show to share with us how laws created and updated in Washington D.C. impact us as practicing school-based OTs. Specifically, we will be discussing how IDEA differs from the Every Student Succeeds Act and what it means for us as OTPs, both now and in the coming years. Listen in to better understand your role as a school-based OT. Links to Show References: Contact Abe Saffer, MPM via email School-based OT resources from the American Occupational Therapy Associations National Alliance of Specialized Instructional Support Personnel Transcript Amazing Narrator Hello and welcome to the OT Schoolhouse podcast, your source for school-based occupational therapy tips, interviews, and professional development. Now to get the conversation started, here is your host Jayson Davies, class is officially in session. Jayson Davies Hello, hello, everyone. Welcome to Episode 91 of the OT Schoolhouse podcast. So excited for you to be here today. I'm so excited about today's interview. In previous episodes, you might have heard me use the term ESSA or ESSA and that stands for Every Student Succeeds Act, and that act was actually passed in 2015. It wasn't an amendment or replacement to the No Child Left Behind Act that was passed in the early 2000s. Well, we're gonna dive in deeper into that with a very special person today from AOTA the American Occupational Therapy Association to share more about what ESSA is. And also what AOTA is doing, not just in regards to ESSA, but also for school-based practice in general. Today, we have on Abe Saffer. And He is the senior legislative representative for AOTA I don't want to dive too much into what he does because he's going to share so much with us. Right upfront. He is the sole legislative representative that we have in AOTA and trust me, he is tasked with so much. It's one of the big reasons that I always advocate for you to be an AOTA member. In fact, they have multiple tiers coming out soon, so will be even easier for you to be an AOTA member. I really hope that you enjoy this episode, but even more, so I hope you're inspired a little bit by what he has to say today. So without any further ado, here is Abe Saffer, from AOTA. Hello, and welcome to the show Abe. How are you doing today? Abe Saffer I'm great. Thanks so much for having me. Jayson Davies Yeah, definitely. So, it's been a while since we've had a non-occupational therapist as the main guest the sole guest here. But as I know, and everyone is soon to find out, you are very connected to the world of OT. So I actually want to give you a second just to kind of share how you're connected to occupational therapy. Abe Saffer Well, I appreciate that. And it's a huge honor to be one of the few non-OTs to be on here. So I am one of the American Occupational Therapy Association's congressional lobbyists. So I do federal lobbying, in terms of a lot of issues, basically everything but health, traditional health stuff. And I do that with Congress, as well as the White House, the Department of Education. And I consider myself an education, disability, lobbyist, and advocate. And that's something that I love to be able to do. But then with AOTA now for a little over five years. And it's been absolutely fantastic. And so I'm glad you mentioned I wasn't an OT because I don't want people to get the wrong idea when I started talking about certain OT-specific practice areas or interventions or anything along those lines. Jayson Davies Yeah, and people who know the OT Schoolhouse podcast have listened before, they know that I'm a huge advocate for everyone being a part of AOTA paying your dues, or 18 or $19 a month or whatever it comes out to a year. That's kind of what pays your salary. And we're just appreciative of you doing that, and, and advocating for us, you know, without AOTA and all the work that they do and as well as our state organizations, I don't know where OT the profession would be today. So thank you. And going forward, I actually, let's stay on this a little bit is what does your day-to-day activity actually look at? You know, we're used to an occupational therapist, day-to-day activity, what does your day-to-day work look like for AOTA? Abe Saffer So I obviously work every day, I don't have what I would consider day-to-day activities I could have, I could have a day where I spend it. I mean, now they're having these virtual back-to-back zoom calls with Hill staff talking about a specific issue, whether that is education or workforce recruitment and shortages. I could have a day where I just spend it writing and I'm working on, you know, either writing articles or just resources for practitioners to understand or something in the mix where I'm just doing a little bit of everything. There's really no consistency to my days, whatever it is, I live my life entirely by my calendar, based on what it says I just do. It is all-powerful. And I listened to that above all else. And it's exciting to be able to see what comes up every day of doing different things. You know, say today, I'm working on a lot of you know, I worked on prep for this podcast as well, just making sure I had resources. I am planning a week of action, which I think will have already taken place related to another bill, a workforce diversity bill. And I'm actually following up with the White House on guidance documents related to how a SISP can be used in schools in general, I can talk a little bit more about that later. But it's I mean, day-to-day is a different hour to hour can be different. It is the perfect environment, I think for someone with ADHD. So it is fantastic that I get paid for probably the only thing I'm really good at and my market. Jayson Davies Great. Yeah. And, you know, I think as we go through this podcast, we're gonna get a better understanding of what you're actually doing specifically in relation to what we're talking about today, which is the ESSA Act, the Every Student Succeeds Act, and how you are trying to make sure that occupational therapy is talked about in that act, making sure that that act is actually being followed up on I think, a little bit. So I guess the next point that we want to discuss then is the ESSA Every Student Succeeds Act, and what that is, how it came to be, and kind of where OT fits into that. Abe Saffer Yeah, no, that's exactly where I think you should be starting. So the largest legislation that has to deal with Public Schools is the Elementary and Secondary Education Act. So if you've ever heard of Title One schools or funding for low income, that's where it comes. So it's also called ESCA has the largest single source of federal funding for education in the country, or out of all the other bills. And any bill that provides funding, whether it's ESSA or anything else, needs to be reauthorized regularly by Congress. And that just gives them a chance to sort of seeing how things are working, is it still necessary to have you know, all those things and so, the Elementary Secondary Education Act was reauthorized in the early 2000s by and was named No Child Left Behind. So a lot of people know, NCLB. And then in 2015, at the end of that year, President Obama signed the Every Student Succeeds Act or ESSA to reauthorize the Elementary and Secondary Education Act and update it with a whole lot of different changes and get rid of things that didn't work. So No Child Left Behind is, for all intents and purposes, dead and ESSA is the new king of education law. And so that's where we are sort of now in the general education space, but ESSA included a lot of updates, including I talked about Title One that remains, but then they're under No Child Left Behind. They're about 80 to 85 competitive grants that schools could go to a no sorry, there were 50 that provided about 85 million in funding to different schools and programs. And those were eliminated and replaced with a larger grant called the title for a grant which is the student support and enrichment Grant students award success and enrichment grant. And that was authorized at 1.2 billion, so just a huge amount of money more and every year since we've been fighting to the crease that but ESSA is, is due soon for a reauthorization. And so we'll start to see some standalone bills floated and then when there's momentum enough for Congress to actually decide they wanted to act on it, then that's when they'll, that's when they'll update the law and reauthorize it. Jayson Davies Wow, that's a lot. So basically, ESSA is an amendment or an addendum to pre-existing law, correct? Abe Saffer Yep. Jayson Davies It gets reauthorized every like, I don't know, I think No Child Left Behind was in the early 2000s. So about every 10 years or so. Abe Saffer Yep. Different bills could have different years between them. But yeah, so you know, if someone says ESSA or if someone says ESCA, it's talking about the exact same thing, ESCA sort of the statute, that the law as it is, and ESSA amended the statute to make the changes that have existed since late 2015. Jayson Davies Gotcha. Okay. So now, I want to just delineate the difference between ESSA and IDEA, you said ESSA was the largest general education bill, I think it's kind of how you worded it. And IDEA, as we know, is more special education is that the main difference between those two is explained. Abe Saffer Yeah, yeah, for that's pretty a pretty good way of thinking about it. So ESSA is the number one source of federal funding for any education. I think it's like 16 and a half billion, maybe 17. a spin-off that actually looks at the numbers. IDEA is the second-largest source of funding for education, and it's about 13 or 14 billion, and it's intended specifically for students with disabilities and providing service for them. And so ESCA has been around since the 60s and IDEA while it started in 75. As the education for Handicapped Children Act IDEA was born as the reauthorization of the education of Handicapped Children Act to become the Individuals with Disability Education Act. And so the biggest difference is that ESSA is not as prescriptive. If it's funding for low income, there are some other grants in there and different laws that mandate. But overall, it's mostly just a money bill, for lack of a more nuanced way of saying it, IDEA is completely voluntary. States actually don't have to participate in IDEA. But if they do participate, then it becomes extremely prescriptive. So the reason that every state so every state does participate, and that's because the way to think about it is IDEA is an education funding bill. And section 504 of the Rehabilitation Act of 1973 is an unfunded civil rights bill. And so all of the rights that are guaranteed under Section 504 of the Rehabilitation Act can be funded through IDEA if that makes any sense. Yeah. So states don't have to participate in IDEA if they don't want to, but they're mandated to do everything anyway, under the Rehab Act. So every state participates in IDEA funding. Jayson Davies Yeah, cuz correct me if I'm wrong, but 504, section 504. I mean, it really doesn't have anything to do with education. It simply says that if you want federal funding, you have to provide accommodations, is that correct? Abe Saffer Yeah. And you don't need so you don't need a specific, IDEA is more for disabilities that will impact on your education, your instructional, your career, being able to access the curriculum. So for example, in my previous job, one of my responsibilities was making sure that students with type one diabetes had access to insulin at their schools. And so that's where a 504, IEP would come into play. So there was some academic, but for the most part, it was just making sure that they had that right to like, go to either go to the nurse's office or administer themselves, all those things. So IDEA is really meant to be for students that have a disability that impacts their ability to participate in the general education curriculum. Jayson Davies Sounds good, perfect. Thanks. And so I think most occupational therapists get into our first job as a school-based occupational therapist, and IDEA is what we hear all the time IEP needs to follow IDEA, we have to make sure that all of our services are compliant with IDEA. But we very rarely hear the term ESSA and how OTs fit into ESSA. And so I want to give you an opportunity to share that part. Where does occupational therapy, occupational therapy assistants fit into the Every Student Succeeds Act? Abe Saffer No, I think you're absolutely right. I'll say this is a sort of a teaser. But it's a myth that IDEA is the only way that OTs can be paid, and either at all periods or in federal funding, at least. So when ESSA was created, there was a term prior called pupil service. And that's something that a lot of folks might know it didn't have a large role and no child left behind in the previous iterations of ESCA. And so ESSA was created. And a coalition I can talk a little bit about later naces. Back then, was actually the National Alliance for People Service CCoordinators, they fought hard to add the term specialized instructional support personnel into ESSA. And so this did a couple of things. One, it would provide a different term that OTs fit under essentially the exact same list of professions as related services under IDEA. So it created this new term. And that allowed it to actually use asset funds, those title one funding, and all the other sources to pay for these professionals. So as you can now pay for any specialized instructional support personnel, you can use that funding. Also, what it did was try to promote, although I will say that it fell short because it didn't provide additional funding specifically for this but to promote multi-tiered systems of support in general education, allowing for services to go to students with, you know, without an either without a disability at all, or without a diagnosed disability just to sort of, you know, OTs no much better as their response to intervention model, but like being able to provide those services without having a disability, specifically diagnosed was the intention of ESSA. And so that's sort of where we've been since the end of 2015. And we still have a lot of fights to go with regards to ESSA. Jayson Davies Okay, so it sounds like you're saying ESSA says, Hey, yes, related services. SISP specialized instructional support personnel can support students that don't have an IEP, but at the same time, it didn't go as far to give them a lot of funding in order to do that. Is that what you're saying? Abe Saffer Yeah, so IDEA provides funding above what the actual average cost of a student to educate a student, there's meant to provide funding, in addition to all those services, ESSA didn't do that, there's been a lot of efforts to try to get that get funding through Congress in the next iteration. But there's also we sort of understanding instinctually. But also, we've seen a little bit of evidence that if you provide those services to students, in general, it can have a huge return on investment, it's just the difficulty is that a lot of administrators don't fully know that system exists, that that term exists. And that ability exists. And a lot of practitioners don't really know about it. And so whenever I'm talking with school-based or pediatric OTs, all I do is say, you know, you are assist, you are specialized instructional support personnel and try to just get that to become the, you know, the term that they know, is something that allows them sort of it's their key into the general education setting. Jayson Davies Absolutely. And you know, I've been using it much more since I've gotten in contact with you. I've heard you speak with every moment counts, and with Sue Bazyk a little bit. And, yeah, I'm trying to ingrain that into my vocabulary and use it as much as possible because I really do see occupational therapy as more of a, or I shouldn't say as more of but equally preventative, as opposed to rehabilitative. And I think that's where ESSA really comes into play, having more than that preventative role through the tiered intervention model, as opposed to only working with students who have already been identified as needing support through an IEP. So absolutely. You mentioned a little bit about funding. And you actually even said something about how OTs don't have to just be paid under IDEA funds? What would the alternative look like to that? Because I do talk to OTs, and sometimes they tell me, the reason I'm not doing RTI is that RTI is a general education function, and I'm being paid from special education funds. So you can kind of explain a little bit how those may be different banks of money work and how OTs could potentially be paid otherwise? Abe Saffer Yeah, so first of all, I'll just say I'll do a quick list of our funding sources on the federal level. So ESSA, number one IDEA is number two, Medicaid is actually number three, about four and 5 billion a year, and then title for a round out the group. And so all this federal funding only represents about 8% of education funding in the country. Jayson Davies Wow. Abe Saffer So using that to say, state and local governments are the ones that make up that other 92%. When an OT says, I can only work with students with disabilities, because I'm paid under IDEA, what I'm hearing is my school is coming to me and saying that I have X amount of IEP minutes to accomplish every week or month. And because of that, I can't go into the general ed space, I would bet a lot of money that most OTs don't know the line item that their salaries come from, I mean, IDEA absolutely is used to pay for the salaries of these folks. But there's a lot of ways that you can sort of supplement what you're doing with a student's disability to help other students without disabilities without diagnosis ability, there was a concept called incidental benefit under IDEA, that was sort of that actually prohibited it. And so that said that if you were a related service provider, and you were working with a student for disability, you should not be working with a student without one because the way you said it is they were paid for under IDEA, and you shouldn't be providing that incidental benefit. But it was very quickly that IDEA decided that just wasn't, there was no reason for that, and rocked it. And so now if you're able to complete IEP minutes, in a group setting, or in a whole-class setting, or even, you know, in some cases, a whole school setting, you can use some of those, you know, take in groups of students with disabilities with an IEP and a couple with without an IEP and work on the same issue together, whether that's handwriting or social, emotional or mental health, or any of the huge range of services that OTs can provide, and be able to actually provide those services to any students. And so while even though that and I know that a lot of OTs look at it, and they say, Well, you know, I don't have the ability or the rights to do it. A lot of it stems from the fact that school administrators don't know about ESSA like they don't fully know ESSA and that's sort of has a lot to do with sort of how it was rolled out when it was signed into law in the first place. Jayson Davies Yeah, and that was kind of a question I also had is, these bills are massive, but they're all happening in Washington, DC, and What happens when a bill actually gets passed? How does that trickle down to the local district where I work? And what is the processor that? Abe Saffer I will say how a bill becomes a law sort of idealistic process, and then I'll talk about the reality. So Congress comes together decides to create a law and the law is, has certain things in it. But if you were a school administrator, first of all, it's not the easiest thing to read. I mean, it's a lot of like, refers to clause A and Section B, you know, you have to be sort of be trained and experienced in it. And so what happens is, whatever agency the law affects, so obviously, in our case is Department of Education, we'll take the law as passed and release regulations. And regulatory language is just as law binding as a statute because it is passed through a very specific, open, transparent process where you can have time to publicly comment, but it'll be much easier to read. So if you've ever read actually IDEA's regulations, it's a really easy read to look through and understand. It talks about consent and sort of who's on the team and all that. And so then what also the department will do is they produce the regulations, but those can be, you know, I can show you the books, but they can be pretty thick. And so they'll release what's called sub-regulatory guidance or advice. And this can take the form of a letter to school administrators or to anyone in the public saying, Here's what this new law says and what you should do. It can take the form of a Q&A where the questions literally like ask, can you use SF funds to pay for OT services, and it can take a lot of other forms. And now getting into the reality, if you think about just the timeline. ESSA was passed and signed into law in late mid-December of 2015. So by the time the Department of Education, got it and was able to really analyze it and work on the regulations, it was early 2017, which was a new education administration, a new Department of Education staff. And for the guidance was not a top priority, unfortunately. And so I think one of the biggest barriers that we face in the education community and the folks in the field is that ESSA never got the sort of rollout that other legislation has gotten because it just wasn't a high priority. And we're still actually fighting for in a perfect world, ESSA's regulations would have actually literally had guidance documents that said, Hey, sis has a new term. Here's what it means. Here's what we can use, and, and all of that. But that never happened and where we're still asking and advocating for the department to release something along those lines, and they're still getting folks up to in different positions there. But so we're still hopeful, but it's still a process ongoing, even as we're literally, you know, a couple of years away from ESSA being reauthorized again. Jayson Davies Wow. All right. You mentioned Title One funds a little while ago, I know the term. And I'm sure many other OTs out there. We hear the term we hear our administrators use the terms, but we don't necessarily fully understand it. Can you explain what title one means? And also what it means as far as funding? Abe Saffer Yeah, sure. So you know, the most base level, most legislation, especially big legislations, will have different titles and it could be anything from just massively different sort of policy areas. So under ESSA, Title One is meant for students support for low-income students, the wonky way of looking at it is saying it's a formula grant. So every student, that they take all the students that are low income, and they'll, you know, divide the number of money that the government has appropriated for it, and each student gets that so the school gets extra funding for it. If a certain percentage of a school is low-income, they'll call that a low-income school. And then every student in that school is considered low income. So it's a way of providing extra education funds to a school district that has a high population of low-income residents. So you know, I live in a suburb of DC, where the average income is pretty high just because of the government. And so our school districts have a little bit more money than some of DCs inner-city ones. And so they want to make sure that there's some kind of parity when we're looking at title one. That's what that would be providing. And title two would do those like teacher prep and school principal prep, and I'm not an expert by any means, and two or three and then title four is sort of meant to be this catch-all section to sort of help overall school Health and Safety, well being and, and sort of effective use of technology. It's just the different sections. Jayson Davies Okay. And so if an occupational therapist listening right now they're like, Hey, I know I'm at a title one school, what would you encourage them to do? Or is there a way to potentially Like, who do they talk to? To say, hey, you know what? I'm a SISP? Is there a way for me to potentially even get some supplies through title one? Or who distributes title one in my district? How can I be a part of that conversation? Abe Saffer So the way that funding will generally work is that a school will just get the amount that because everything gets funneled in through the state government. So you know, Maryland will get a certain amount of IDEA funding and title one funding based on the different formulas. For the practitioners, as they're looking to try to expand, they should know that. I mean, obviously, one of the biggest challenges they face is that schools are very underfunded, even IDEA is dramatically underfunded, unfortunately, and so that, they're usually utilized just to fulfill these IEP minutes. And that can be a daunting challenge. If you work seven hours a day, and you'd have seven hours a day worth of IEP minutes, you need to get a little bit creative. And so the most important, I think, the takeaway is that, first of all, we hope that OT is wanting to help beyond obviously, I think they do but help beyond just students with IEPs. And so they can use some of that creativity, whether it's, you know, again, using the group model, so that they're, you know, killing two birds with one stone, or whether they're going to their administrator and saying, Hey, RTI can actually save you money in the long run with, you know, the district in the long run. And, you know, legally, you're allowed to do this, that's sort of the best way of doing it because education is extremely state and local control, like, there's a lot we can do in the federal government. But the IDEA, the see is the floor is the bare minimum that schools need to do with sort of students with disabilities. But they can do way more if they want to the state sets the ceiling. And so it's important to work with, you know, every OT just to be able to work with their school administrators and special ed directors and any other principals to be able to say, I want to be able to provide services to students without disabilities, and really talk about what that is. And we're hoping to have some more examples and resources of that, where they're starting to trickle in. And we're starting to get people who are actually doing that, and some of the benefits. But it's something that OTs actually have the legal federally legal right to do it. Now, again, every state is different. And so there literally might be a state that just says, OTs can only work with students with disabilities, but I have not found one that says that. So just talk to your state associations, like they're fantastic resources. We can always also at AOTA help people find to see if there's some state prohibition against it. But talking to your principal and saying, I'm allowed to do this by federal law, and it'll benefit you. Can you please help me get some flexibility? Hopefully, you have, they'll have the support to be able to do that. Jayson Davies Gotcha. Cool. Thank you. From hearing you speak at the last meeting that we're both in. I feel like I recall you saying something about specialized instructional personnel being a part of the team that is supposed to be making money decisions at a district level? Do you recall that? And my offer? Abe Saffer No, no, you're right. So so one of the ways that assist were integrated into the process is, and again, it was an opportunity, I think, last under the previous administration, was that every state had to develop their state plan for under ESSA. And that plan was required to have assessed representative as part of the team to create that plan. And then the Department of Education was required to have an assist representative as part of the team that evaluated that plan. And ideally, it would have been that the department looked at it and said, This is great, but we would like to see X, Y, or Z either changed, increased, or you shouldn't be doing this, whatever the policy may be. And really, that didn't happen. I mean, I'm sure most of the states have great plans. But for more or less, they were just rubber-stamped by the department and there was none that had any feedback that I'm aware of to say this needs to change or you need to relook at this one policy that you're or part of your plan. So that's sort of where the money issue came in. And so it was just an opportunity last, I think, to have the federal government try to show some best practices that might work, you know, a lot that's being done in one or two states to help spread the word a little bit more. Jayson Davies Gotcha. Okay, I do know, at the district level, a lot of times the special education department or whatever department, will convene committees to discuss how they want to spend, oftentimes the Medicare funding, has to go back towards students with disabilities or back to the students in some way. And there often is a team, I know I have fought for my ability to be a part of that team so that I can actually be a little bit of that decision-making process. Now that might not be title one title to whatever funds, but that was Medicare, and being able to be a part of that team to kind of hear what's going on what people are asking for money for, and also to be a part of the team just to help make decisions. I think that's important. I think other occupational therapists should try to be someone who can be on that team, oftentimes, they just want a related service provider or a SISP person on that team. And there are so many of us related service providers, you have so many different providers, you have the OT, you have the PT, the speech therapist, you have the counselors, the nurse, the list goes on and on even transportation as a related service. And so they'll bring in the easiest person, the easiest related service provider to be a part of that team. And with OT speech therapists, oftentimes the therapy providers, we're out at the school sites, we're not at the district office where that's happening. And so we might not get thought of as being a part of that team. And so this isn't a question but just for all the OTs out there listening, you know, try and be a part of that team mentioned, you know, I'm a SISP, and I can be a part of general education, or I'm a related service provider, and I would love to be on that committee where decisions are being made about what to do with the Medicare funds. So be a part of that conversation. Abe Saffer I think you're hitting on another area where just be part of the team as much as possible, like being able to work with the general and special education teachers and the administrators, and just being part, you know, as much as possible. And I understand this can be difficult, especially if it is covering multiple schools or as a part-time contract. Yeah, exactly. Or even districts be part of that team to the most extent you can be because you're going to be able to provide resources and ideas that you're going to be the only one who would be able to suggest that and a lot of our like, my favorite thing about OT is, while it's extremely evidence-based and takes a lot of training, when you hear it, you're like, Oh, that makes complete sense. And you know, you don't really have a whole lot of questions about it just because it just is sort of like, oh, yeah, no, absolutely like sort of model. And so just try to be as part of a team as much as you can, because it'll, it's gonna benefit you in the long run. And it's gonna also benefit the students a great deal. Jayson Davies I absolutely got to be a part of the team. You teased it earlier, and I want to move on to it all the groups that are working to make sure that SIPS and ESSA really get kind of the attention that they deserve and need, who's all part of that group and I believe it's the National Association of SISP, correct? Abe Saffer Yeah, the National Association of Specialized Instructional Support Personnel. And I'm, I'm honored to be one of the co-chairs of the coalition. So it's every major organization that represents every professional association that you can imagine everything from the school sites, the school counselors, OT, PT, speech, the music therapists, dance therapists, they're all part of this because they're all obsessed with the coalition also includes the major education unions, like NEA EFT, and then special. There's the Council for Ministers of Special Education case and the National Association of Special Education directors. And as the and both of them are involved in so this is a huge coalition of a broad coalition of folks that really care about system issues, which is really important, because there are about three and a half million teachers in this in the country, there's a million status. So it's not like we're an inconsequential number of folks in the school. But we are. So I think a lot of the things you touched on. Yeah, a lot of the things you touched on, were just not thought of as much because you know, and OT isn't coming in and providing three or four days a week of service to a class, it's helping kind of in a more sporadic fashion. And so being part of that team is just even more important. And so on the federal level and the national level, we all work very well collaboratively to try to draw as much attention to what assists are who they are, and what they can do. And in April of the next year of 2022, so I guess a couple of months when this is released, there's going to be an assessed week, which we've had every year for the last few. We missed 2020 For reasons but we usually do a whole lot of advocacy and marketing around that So definitely keep watch for AOTA to announce that because we're going to be doing that again in 2022. Jayson Davies Absolutely. That's awesome. So nasisp.org, I believe is that website, correct? For? Abe Saffer Yes, it has a fantastic and this is one of the resources, that there's a fantastic PowerPoint on there that talks about everything that I, you know, in a much more nuanced and accurate way talks about everything that I've talked about today with regards to this. Jayson Davies Absolutely. Alright, I think we've touched on ESSA and SIST so much right now. So thank you for that. I do want to discuss one more topic. I don't know if I put this in the notes for us. But health prevention and occupational therapy within the schools. And, you know, we have a lot going on in our schools now. And if it's not needed because students are returning to school right now, after being home, "homeschool", it's not homeschooled. But being educated from home, you had a lot of that going on. Also, as we are now seeing schools start to open back up, I think we're also starting to see a rise and other unfortunate events, which I hate to even mention, like the school shootings and whatnot, we're starting to see those come back up now seems like some schools are going back in session, is health prevention, a part of that tiered intervention that you kind of mentioned, ESSA could kind of had an influence on but didn't fund is that part of it? health prevention? And can OTs work on that? Abe Saffer Yeah. So I mean, here's what I'll make me, my pitch for AOTA membership. Because if we had, you know, membership is a huge driving factor for our ability to do certain things. And I'm going to advocate for the things that we've talked about plus a lot more, no matter what, but if we had a lot more members, and there were two of me, a lot of the priorities that, you know, I would love to see moving forward and making and make really making progress on would become a reality. And so I think that there is a, I think that there's going to be a big push over the next few years, you know, it's already kind of started, but they'll make, I think there's gonna be some progress made with regards to like, schools being these school-based health centers. And so students would be able to receive, you know, a lot of their services, not just ones that are the ones for academic relevancy, but provided there at the school. And so it's I think it's an issue though, in an area that we can really play a part and really show some improvement in a sort of like what the benefit of school is because if you're, we know how to deal with students with disabilities to an extent, we're catching up, although we're definitely not there, we know how to deal with students are going through a mental health crisis. Now, we need to have increased access to this because it's just, it's not nearly enough. But we sort of knowing what to do. And that the fewer distractions a student has, whether it's through an academic challenge, a disability challenge, or just like a, you know, a much more standard health challenge, you know, could even be just the flu or strep or something along those lines, the fewer distractions that students have, the more they're going to take away from school and be and find that benefit from it. And so my hope is that eventually we're talking about not just how do we integrate OT more into general ed and special ed, but also finding those students that would need an OT but maybe wouldn't have access to it as easily outside of the school. And I've actually heard of OTs that are entirely separate entities from the school. But the school provides them with a room in the school so that they can practice there. And so they'll see students with disabilities, they'll see general ed students, and they can actually even build not just Medicaid, but also private insurance. And so it's sort of a great way to be able to provide students with just the full range of all of their needs, whether it's academic or health. Jayson Davies Yeah, absolutely. And I know the kind of along that point that you're talking about, a lot of us have worked in rural areas. And I don't know about you guys listening, but I have been in a situation where ethically I want to provide as much support that I can for that student because I know that they're not going to get occupational therapy that they need outside. There are just no OTs within a 100-mile radius of them. Now teletherapy is really stepping into that spot, potentially and can help. But sometimes, you know, you just kind of wish that occupational therapy of medical base model could be provided at that school site, whether it be after school, or even potentially, during school because there are so many barriers to access, such as location and transportation. So that sounds like a very interesting model that you're just sharing. Abe Saffer Yeah, absolutely. Jayson Davies All right. Well, I think it's just about time to wrap up but I want to ask you and give you the opportunity to also share what else is AOTA is working on outside of trying to help Bass OTs through ESSA and various other means, what else is AOTA? Working on at this time? Abe Saffer So first of all, I think the biggest thing we're working on right now is in my area is just trying to make that playing field a little easier for OTs to provide services and the general adspace. Because there are very few, I mean, we want for all SISP, but there are very few professions that are as holistic as OTs are. And so that's sort of my priorities in terms of the policy. But when it comes to everything that we're doing, we want to make sure that AOTA is providing the resources that are not just meet the needs of OTs as where they are now. But where they want to grow and really be able to provide those resources to show you know, how would you be able to, like think creatively and double up on a couple of students that allows you to access more in the gen ed space? Or how would you be able to say you're going to provide more mental health support to different students, or we're working together? And so we're always looking to see what the landscape is and what resources are needed. And our practice was fantastic. One of the things they did that, that, for me, as an AOTA employee that I'm the proudest of, and I can say this because I had absolutely nothing to do with it was our back to school resource that we released last August. And I can say, personally, I literally took I printed, I had it printed out, I print out everything, completely analog. But I literally took it out and designed by basement for my son's school during virtual schooling I like to use the OT model of how would you treat your home as your virtual school down to like he was required to wear shoes and no pajamas and how to eat lunch in a specific way. And we even like, had the bell for when school started. And then and all that stuff. And you know, we're always looking to see what resources are actually needed. And so the more folks we have that are part of the process to say like, Oh, hey, as a practitioner, I want to be able to do this, or whatever the service delivery is and say, Can you help me make sure that I can provide that. And then we can say, Yes, we have these four resources that can absolutely support you. And that gives us a great idea that this fifth one should be developed to be able to help you. When the meeting, you're just you're talking about we have a Sue Bazyk and everyone counts. There was a lot of discussion about barriers that OTs are dealing with. And one of the resources that I want to create myself as a policy person is a myth. Resource. I'm saying there's a lot of misinformation and stuff that you might not know. But let's talk about some of the myths of OTs practice in school, like we talked about a couple, it's a myth that only IDEA can you know, resources can fund OTs. It's a myth that OTs can only provide a small part of their service like they can do their full scope of service to a student as long as it's academically relevant. And so like, that's something that I'm working on now. And hopefully, we'll have out soon, we're still trying to figure out the best avenue for but it's something that I love. And so we're just always looking for ways for people to just I'm in telephone for me just to sort of know what's going on on the ground. People are talking to me and saying, these are what we're seeing. But also just to say it'd be really helpful if I had this and it might already exist. And if it doesn't, like we have a whole team that would be excited to be able to produce something like that. I would say out of all of the settings and areas where OTs are currently like I just see as school-based practices that the most fertile ground for a huge expansion of the use of OT, Jayson Davies that's saying something that is Abe Saffer Yeah, Jayson Davies awesome. I love him. And I love hearing that you just set up your basement based upon everything that the school-based OTs that you work with kind of put together and you just ran and ran. And that goes to show for everyone listening like you don't have to work directly with a student to make an impact on a student's life. I've sent home newsletters in the past, I've sent home videos to teachers to parents, and all those little things, they can add up and make a change with many students. I mean, I'm assuming your son doesn't receive OT services. Abe Saffer Now, he did probably tell me where the OT office was in his school when he went back after a year but now he's never received OT services. I mean, other than indirectly by the amount of OTs I work with and giving me advice, but But yeah, but it was just that this is one of the reasons why I do feel like school-based practice has the most potential is because there's not a student in any school who would not benefit at some level to getting OT services. Some are a lot. Some are a little but my son is doing very well in school and thankfully the pandemic was not hard for him like I think he was able to benefit a lot from OT services even though he didn't get through school? Jayson Davies Yes. Abe Saffer Got it because his dad has a connection. Jayson Davies Absolutely. That is awesome. All right, man, before I let you go, where can anyone listening learn a little bit more about everything. You mentioned a few resources. But if you can kind of sum up? Abe Saffer yeah, so I would always recommend naces.org nasisp.org. That's where all the resources for the SISP bar, you can also take a look. I mean, obviously, aota.org has a ton of resources, we can link, you can follow me on Twitter and ask questions if you want. I'm an AOTA, AbeAOTA on Twitter. And my email address, I think in public. And I know it's public in terms of like, federal lobby, regular registration, but it's just astaffer@aota.org. And I encourage anyone to not add me to random listservs. But to email me if you have questions or need a little bit of help with anything, I just got back from the Children and Youth specialty conference in Orlando, which was my first conference in person in two and a half years. And it's just, I can't tell you how much I miss talking with OTs in general, that not just the ones that work for AOTA and they're fantastic. But the ones on the ground, just hearing what they're doing is amazing. And so I am much better at my job if folks email me and say, Hey, I got a problem. And I need your me to fix it. And I do my best. And sometimes when I'm successful, and sometimes I'm not. But I'm always honest, tell you what we're able to do and what the law says. Jayson Davies Awesome. Well, thank you so much, Abe, really appreciate you coming in dropping all this knowledge. I think it's important. I think this is something that OTs don't talk about, and we don't learn about in college. It's not something that you know, is thrown at us. But it's important to know, kind of where we're being funded for what, like you talked about those myths, what are those myths that aren't true? You know, we can provide services outside of IDEA? Yes, we do have to somehow get creative and create time to do that. But it is something and I think if we start to do it in a creative way, we'll start to see it more implemented in a more systematic way when we see the benefits that the creative way, creates, you know, administrators and teachers are watching. And they do see the benefits that we create when we're not just working with those students with disabilities. And you know what, maybe it is a classroom of students with disabilities, but they don't each have services, that still tiered intervention, you don't have to be on their IEP to still help them. So thank you so much. I really appreciate you coming on here. And you know, maybe we'll have to do this again and 2023 for SISP week. Abe Saffer I would love to I'm always happy to come back. Jayson Davies Sounds good, man. Thank you. Appreciate you being here. Take care. Pleasure. All right. Thank you so much for listening in today. And thank you a big thank you to a for coming on and not holding anything back you really told us like it is and he gave us a lot to work with. I hope that you will continue to support AOTA so that you can continue to support Abe and everyone else there that is working on our behalf. Until next time, enjoy your week. Enjoy your month and I will see you next time on the OT Schoolhouse podcast. Take care. Bye. Amazing Narrator Thank you for listening to the OT Schoolhouse podcast. For more ways to help you and your students succeed right now. Head on over to otschoolhouse.com Until next time, class is dismissed. Freebies! 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. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! 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