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Click on your preferred podcast player link to listen where you enjoy podcasts Welcome to the show notes for Episode 92 of the OT Schoolhouse Podcast. In this episode of the OT schoolhouse podcast, we are discussing mindfulness in school-based OT with Dr. Deirdre Azzopardi of TheMindfulSchoolOT.com Deirdre is an experience school-based OT who has been incorporating mindful practices into her life both personally and professionally. She uses mindfulness to support students, teachers, and administrators in her school district and has seen the benefits of doing so. If you are unsure what mindfulness fully entails or are already on board the mindfulness train and want to get some insight into how you can incorporate it into your sessions, be sure to listen to this episode. Links to Show References: The Mindfulness Transformation for School Based Therapists - Dr. Azzopardi’s course on Mindfulness for school based OTPs Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. Science, 330(6006), 932-932. MindfulSchools.org - a deep dive curriculum for doing mindfulness in the schools Dr. Dan Siegel and the 8th sense of Interconnectedness Soles of the Feet in schools: Felver, J. C., Frank, J. L., & McEachern, A. D. (2014). Effectiveness, acceptability, and feasibility of the soles of the feet mindfulness-based intervention with elementary school students. Mindfulness, 5(5), 589-597. Wheeler, M. S., Arnkoff, D. B., & Glass, C. R. (2017). The neuroscience of mindfulness: How mindfulness alters the brain and facilitates emotion regulation. Mindfulness, 8(6), 1471-1487. 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's your host, Jayson Davies. Class is officially in session. Jayson Davies Hello, everyone. Welcome to Episode 92 of the OT Schoolhouse podcast. Thank you so much for being here today. Today, the day that this podcast is actually dropping is Valentine's Day is February 14, 2022. And so before we jump into our topic for today, which is going to be mindfulness, I figured I'd share a little story. You know Valentine's Day is an important date for so many people. And like those people, it is for me as well. My wife and I actually started dating on February 9. So for about five years, I think it was the while we were dating February 9, it was our anniversary day. And so when it came around for February every year, we'd kind of split the difference split the responsibilities, one of us would plan the anniversary, the other would plan, Valentine's Day, or some years we'd get lazy, and we just kind of combine them. And we do our anniversary and Valentine's Day on February 9, that way we could avoid the hassle of trying to go out to dinner on February 14, when the rest of the world was also trying to go out to dinner. Anyways, about five years into our relationship when the time came to propose. I used it to my advantage. That year, I was planning our anniversary on February 9, and she was in charge of planning Valentine's Day. So she knew that a proposal was likely coming soon. And she really thought it was coming on February 9. But I made sure that wasn't the case. And actually I "hijacked" her date night of February 14, and ended up proposing to her on February 14, with her family there, her parents, and her brother and sister. And it was a very happy moment. And you know, now four years later, after our marriage, we are expecting our first child. So it's been a good, good life since that day. And even before then, I just wanted to share that with you real quick. I hope you all are having or had a great Valentine's Day and continue to have good Valentine's Days in the future. All right, so let's go ahead and jump into the purpose of this podcast. You know, maybe you wanna hear a little bit about me, but I know you want to hear about mindfulness today. And that's exactly what we are talking about. We have on a very special guest. Her name is Dr. Deirdre Azzopardi and she is from themindful schoolot.com. That's her website. And Deirdre is an experienced school-based OT who has been incorporating mindful practices into both her personal and professional life for a very long time. She uses mindfulness to support our students, teachers, and even the administrators at her schools. And so she's been doing this, she's seen the benefits. But not only has she seen the benefits, but the people that really have a say in what she does on campus, are also seeing the benefits, which he's going to share with us. And you're going to see how you can use it to your advantage as well. Now, if you're unsure about kind of the definition of mindfulness, don't worry, we are going to go over that today. We're also going to go over some of the research and how Dierdre uses mindfulness in our practice to support all those individuals that I just spoke about. So if you haven't already, go ahead, put that phone in your pocket, stop hitting that button that fasts forward 30 seconds, you don't need it anymore. Please help me to welcome Dr. Dierdre as a party to the OT schoolhouse podcast. Enjoy the rest of the episode. Hey, Dr. Dierdre. Welcome to the OT Schoolhouse podcast. How are you doing today? Right. Dr. Deirdre Azzopardi It's a day off. I had time to do a full yoga practice and meditation before we started. So I'm feeling Jayson Davies Oh, that is wonderful. Yes. And today is Martin Luther King Day as we record this, of course, when it goes out it'll probably be in February sometime. But yes, thank you all for being here with us today. Actually, you know what you just mentioned a little bit about yoga and mindfulness, which is kind of where we're going with this topic today. Why don't you share actually just kind of, to let us get to know you? What is the kind of your morning routine with mindfulness and yoga? Dr. Deirdre Azzopardi Oh, wow, this is good. Cool. So my morning routine is I never miss a meditation practice. I started my meditation practice when I was getting my adult yoga certification. It's kind of part of the deal is that you do that you now start to kind of embody these practices. So that's been about six years that I've done a daily practice. So I never missed my meditation practice in the morning and I always do some kind of movement. It might be I'm doing a tree pose while I'm waiting for my coffee to be made. So it's not necessarily it depends on the day. I'm having a really good day. I usually try to do at least half an hour before I get off to school. Jayson Davies That is amazing. That's kind of my goal is to get up in the morning and get a little movement in. But it doesn't always work out that way. So congratulations, I guess I should say, for you to actually have prioritized that in your life to make sure that you at least get something in the morning. That's awesome. So, Dr. Deirdre Azzopardi yeah, well, I realized that it changed the way that I showed up at work and showed up for kids. So, you know, when I really realized that, I was like, oh, you know, I feel a lot better the days that I do that. So it's real, it's not always so easy. So Jayson Davies absolutely, I understand. Alright, so before we get into mindfulness, I actually want to give you a moment to talk a little bit about your OT career and kind of how you got to where you are today. Dr. Deirdre Azzopardi Okay, so I've been an OT since the dark ages a long time now. So 30 years, the, and when I started, I always you know, was have always worked in pediatrics, doing it in every capacity could do it in. So I've done private practice, I've done a clinic-based, you know, kind of work, and a lot of work in the schools. In the last 15-16 years, I've been full-time in a school district in my own school district, which is really an interesting thing, right? Because you become very connected, you know, to the children, because it's like your own community. And my own son got special education through our school districts. So I take my job very, very personally, whether that's good or bad, I'm not sure. So over the years, what I've noticed through my career, so during this time that I've had my undergraduate and OT because you could do with them, I went back and I got my master's in psychology because the mental health aspect of OT really has always interested me. And somehow, when we get to the schools, a lot of that stuff kind of goes away, because we've gotten very sort of pigeonholed into certain areas. But I really was interested in that. So I went back to school, and I got a psychology degree was contemplating becoming a school psychologist, and then remembered how much I hate paperwork, dropped that I stopped, I didn't go as far as getting the actual certification, but I got a master's in psychology, okay. And then kind of fell in love back was my OT practice. And when and I did get a doctorate in OT, and what my project was bad. And what I realized, in terms of my own job and career is that the things that I did in my own life, in my whole, you know, my home life impacted the way that I was at work. So I really got into exercise as a way to regulate, I started to notice that like, I was just a better human being when I exercise, so straight-up exercise. And I was like, you know, I work with a lot of kids who have regulation challenges, who are anxious and all this other stuff. I bet there's some research out there for straight-up exercise to help kids in school. And there is, and there is, so I really started getting interested in the idea of habits like What habits can we help foster with kids so that they're not just learning these IEP goals right here right now? What can we help them to use for the rest of their life that will help them, you know, in the entirety of their lives, and especially was interested in school because I loved the idea of an even playing ground like they didn't have to go to an SI clinic. This was like the place where any kid could learn these things. So that's really been the focus of my life is things that are really habits that just help people with their mental well-being. Jayson Davies Yeah, and you're definitely in the right field to be able to do that. I mean, occupational therapy habits are so important to everything that we do as OT. So that's great that you're able to use your practice as an OT as well as, your insights and your education from being a psychologist to help foster habit-building within the kids. And like you said, on an even playing field, within the schools, in schools is that place where we get to help everyone doesn't matter what their socio-economic statuses or whatnot, everyone's at school, aside from the people that are at maybe a private school, if something but people the general public is that schools and we get to support them. So that's awesome. Great. Dr. Deirdre Azzopardi Yeah. And I love the idea. Also, I love the idea that school is sort of a microcosm of life. You know, it's the natural social environment for kids. So I just think we should never squander the opportunity that we have as practitioners to help people in their natural social environment. So that's why I don't like when we become so pigeonholed because then we're just sort of like a clinic-based therapist in school or a medically based therapist in school. But we can do much better than that, and broader and bigger. So yeah. Jayson Davies Great. So let's go ahead and talk a little bit about mindfulness then. I guess my first question is really, how do you describe mindfulness to someone who's never really heard that term? Mean? We often kind of think of that elevator pitch right? About like, what is OT? What would we say if someone asked us about OT? But what about mindfulness? What's that kind of elevator pitch you have when someone asks you about mindfulness. Dr. Deirdre Azzopardi So I love to use Jon Kabat Zinn's definition, he's kind of the father of mindfulness here in the West. And that's just paying attention, on purpose, right, purposefully paying attention in the present moment. So right now, and in a non-judgmental or a kind way, sort of not adding any story to what's happening at the moment, just really being aware of what's happening right now, here. And it's so impactful, because, you know, a lot of our lives we're not really present for. And one thing, I really believe the reason that many of us are so attracted to kids, right? Is that, especially when they're really young, that's all they are, they're present. They're open, they're curious, they're available, you know, they're attentive to the moment. And as adults, we kind of screw that up for them. Because we are not all of those things. But mindfulness is the invitation to go back to that place where we, we know we feel good. And we know that that's really where we should be really hard to do all the time. But so it's really a practice. It's a practice. And a lot of the mindfulness that I learned was really through my yoga practice, which I also bring tickets to. Oh, my God. Jayson Davies Yes, yes, that's awesome. And you know, I recently shared, you know, that, that I'm having my first child coming soon, and that's one thing that has been on the forefront of my mind is being present, and getting the phone away. Even now, when I try and work in my office, I leave my phone. Okay, I shouldn't say all the time, but I tried to make sure to leave my phone outside of these four walls because you just lose your presence. And the phone is just so distracting. And the same thing, we end up sharing that with our kids, and we end up using an iPad as a babysitter or something. And just about to be a parent, I'm being trying to be a little bit more mindful of that. And when we bring in life into this world, so absolutely. Dr. Deirdre Azzopardi That's wonderful. I mean, you're bringing in an intention before this baby even gets here, which is just beautiful. I did not do any of those things when I had my children. But my mindfulness practice has helped with the teenage years for sure. And yeah, and so there was a great, great, great study hit by I'm going to think it's called Kilinger, or Kiplinger, I might have gotten that wrong. But anyway, he did this really awesome study, I had this massive amount of data points, I think it was like 250,000 data points because 5,000 people were in the study because it was a very simple study. They just did it through an app on a phone. And they said right now, how are you feeling? Like what's your, emotional state, like, right now? Are you actually present? Are you paying attention? And like, what are you thinking about? And so what they found was basically a wandering mind where when you're not really present in your body is an unhappy mind. And doesn't matter what the person was doing. So that was what was really kind of funny about it. It could be a mundane task. But if you're actually present for it, you tend to be happier. Oh, yeah. So it was kind of a really cool study. So just in general, yeah, we're, we're happier when we're actually present. Jayson Davies Awesome. Yeah, we'll have to grab that resource. So we can post it on the show notes for others to have a look at if they like it, awesome. All right. So we kind of got your little gist on mindfulness. Now, let's take that a step further. How do you follow that up when people ask how do you use mindfulness in the schools? Dr. Deirdre Azzopardi So I use it in a bunch of different ways, the first most important way is actually using it for myself so that I remember to bring it in with kids, and to teach all the adults it's about the adults. Right. So adults are, I don't know about you, but I've heard that schools are a little stressful, right? Jayson Davies Just a bit Dr. Deirdre Azzopardi Just a bit. And especially since the pandemic. Jayson Davies Absolutely. Dr. Deirdre Azzopardi You know, we've brought this enormous level of fear into the schools and kids are just soaking that up. I have never seen anything like the number of kids with very significant anxiety issues. Okay, so so we can just start right there, kids with disabilities, anxiety is in this was a lot of what my doctoral research was on, you know, for an autistic child to say, or to autism, or an autistic child by the time they reach adolescence or adulthood. It's about something like upwards of around 50% Have enough symptomatology to also have an anxiety disorder. So I think, let's work backward. We know that's going to happen. We know that's going to happen that's been happening for years and years and years. How can we help kids to have some tools to deal with anxiety now, as they are younger? So anyway, so it starts for me. First, who do I come in with at school, then the teachers, then the kids. So there are lots of studies to show that if you just work with the teachers, and help them to reduce their levels of stress, help them to model self-regulation help them to be good co-regulators, that kids respond just from that, just from that. And then you bring it to kids. I use it in lots of different ways. And I do tier-one supports where I work with the whole class teaching kids yoga and mindfulness as a community. And then I also do moments of mindfulness in my sessions. So I might start with like, a quick breath. Or I might end a class with a breath, you know, depends on what's happening in the situation. Jayson Davies That's awesome. I love that you have that kind of top-down approach, you know that it starts with the top, not going directly to the students necessarily, but starting with the people that have an impact on the students and the teachers. And I know some people even go as far as working with the administrator, because, gosh, we all know that they are stressed out as well. And sometimes they need a little bit. And then Dr. Deirdre Azzopardi I've done that for sure I've done that I've done like in a whole administrator. Yeah, for sure. And then they understand what it feels like. A lot of like, you know, what we do is very, very cognitive, right? And we think that we actually act from this cognitive place. So we're constantly teaching kids all of this cognitive stuff. But the truth is, we all act from a very emotional place. Jayson Davies Yeah. Dr. Deirdre Azzopardi And then we justify it with, you know, blah, blah, blah, blah. But that's why some of the self-regulation programs don't work. Right. Because if we're teaching self-regulation, or from a cognitive place, we've missed the boat, it has to also be felt, it has to be felt a child's emotion has to be felt in their body, the way to teach a child to use breath, right. So say use breath as a way to regulate is I practice it, I take time to actually be present, understanding how it feels in my body, all of those things have to happen for the child to be able to then bring it in when the brain is not working. Right? When those executive functions are not there when the child is actually being hijacked by stress, you have to have had practice beforehand. So that's why some of these, you know, and you see it over and over on the Facebook groups, right? The kid knows every zone. But they don't use it. Yeah, they don't use it. And that's because you have to have a practice of using these things that you have a groove in your brain. Oh, hold on a second. I can do that. Jayson Davies Yeah. And so actually, I want to kind of continue on, though, you know, we have a lot of questions to get you today. But I want to continue with where you're going. And you're talking about practicing with them. But do you see a difference between when you practice with them in the classroom as a whole class? Versus when you practice with them? Maybe in an individual session? Do you see more carryover and one setting versus the other? Or do you see more impact on the child when you do it in one setting? Or the other setting? Dr. Deirdre Azzopardi Absolutely. If I do it in the classroom, and the teacher buys in it game changer? Well, it's when the teachers because they practice, right, and the teacher keeps going back to it. And the other the peers model it, right. So sometimes when you're teaching these things, kids are like, I'm not doing that, right, especially like we are all so fast. We're all moving, moving, moving, moving, moving, moving. And, you know, thinking about trauma, just which pretty much all kids you know, disabled folks that have had trauma, right? Trauma, just trauma alone. Sometimes things like breath are really scary for a kid. So you explore lots of different ways to use mindfulness. Mindfulness always has to have an anchor, it doesn't have to just be breath, that's when we think about it can be a sensation, listening, seeing, it can be touchback can be where your anchor for your mindfulness practices, that's where you attend something in your body. So feeling my body. I'll just give you a quick example. You can do it right now. So you can feel it. There's a nice practice called the soles of the feet. So if you just take one minute just to take a breath and just kind of feel that breath, just helps to help your belly to just expand. And then relax. Just right now just putting some attention on your feet. Maybe just noticing your toes. Now maybe just note the arch of your foot. Now maybe just noticing your heel Yeah, so just taking a moment just to notice your feet, maybe they splay out, maybe they feel like they're melting a little bit. Okay. So that's just a quick little practice to think about your feet. Right? So thinking about your feet tends to be something that's very neutral. For some kids, if you do breath, and they've had traumatic experiences, that might not be the right place, you know, so we play with different ways to use it. But when teachers use it, and they see their friends using it, and their peers, it's just a different atmosphere. And then kids can breathe. I've seen four-year-olds bring it in, in the moment of upset where they needed it because they've practiced it. Jayson Davies So then, do you see actually those four-year-olds or any kids requesting that their teacher do some mindfulness because they actually feel themselves start to need that? Dr. Deirdre Azzopardi Yes. Yes. Parents have told me. Parents have told me like, the funniest stories are parents who say, I was in the car, I was getting really stressed out. And my kid said to me, you know, Mom, why don't we just do some breaths? Because then we'll feel better when we get to school? Yeah, so I've seen a lot of different things. But what if it's not practiced, just like any kind of thing, right? If we don't practice it, and we keep it all up here as a cognitive thing, and we don't embody it, we have to embody it ourselves. Yeah. So when we embody it ourselves, we send the message that this is a real thing. And that's, you know, with anything, especially want to deal with like a teenager, you know, a teenager can read your BS meter very, very. Jayson Davies Absolutely. And, you know, you kind of mentioned, and this is for all of us, we kind of tend to think with our emotions, as opposed to at a cognitive level. And I think there's something to be said, when these kids teenagers are carrying this over, because, like you said, thinking with emotion versus cognitive. So they must be feeling an emotional response from this mindfulness, in order for them to want to carry it over. Because I doubt they're thinking, you know, this is going to make me calm down. So I want to use it, no, they're not thinking that way. I think they're thinking more of a this is going to make me feel better. So I want to use it, not that it's going to make my head clear, they don't potentially even understand that concept. But they understand how it makes them feel. Dr. Deirdre Azzopardi Exactly. So like just that little practice for the soles of the feet. It's like if somebody so they've done studies on this if somebody is very, very upset, right? Your mind starts to you start to get entangled in it, you know, I'm so upset. The last time I was upset, blah, blah, blah, and like, you know, they just start to go down the hamster wheel, if we can quickly help kids to just bring their attention to their feet, we can neutralize the situation a little bit. Right. So that's, again, something you have to practice, you have to practice. And usually and I don't know if you noticed it when you put your attention into something like just your feet or your breath, you have a natural relaxation response. When we focus our attention, and maybe at that moment, you didn't, and that's okay, too. So we talk to kids about like, all feelings are really actually okay. We're just exploring. We're being curious. We're being curious. So that's the curiosity is the most important aspect, really, of mindfulness, is being curious about your experience. Jayson Davies Yeah, and you know, it's you mentioned breathing. And that's one thing that I really focus on before I even understood the concept of mindfulness. Well, mindfulness was, when I would go to sleep, you know, my head would be racing. And I found that if I just focus on my breathing a little bit, that would help me to actually fall asleep. And that was something that worked for me, you know, I'd be lying in bed. And as soon as I started to focus on my breathing, but then a few minutes, I can pass out. And so it's a very powerful experience that you just focus on one thing. And so I want to ask you, what are some of the things that you focus on? You mentioned breathing, you mentioned kind of focusing on one part of your body, but are there particular areas that you tend to focus on when it comes to mindfulness. Dr. Deirdre Azzopardi So I definitely do the breath a lot. And I use visuals to use the breath. So I might use my body like bringing my hands up, bringing my hands down to show like inhaling and exhaling so that kids understand and you could do it so that you really slow it down. Right? Now, you don't always have to slow down your breath, you can quickly new breath, you can change the way because not all the time. Do you want to be slow, right? Actually, like after lunch? Maybe you want to wake up? How can you use a mindfulness practice to wake up there are lots of ways to use the breath to wake up. So I definitely use the breath. I use a lot of movement practices. Just a quick one like opening and closing your hand opening and closing your hand opening and closing your hands, feeling those prepositions to close your eyes, notice a difference between two sides of your body. You know, things like that. So you can use proprioception, vestibular, you can move, notice what it feels like to have that little bit of dizziness, like what does that feel like? pleasant, unpleasant, not good, bad, but just feeling it. So anytime we just felt so many of the sensations, what a really great one that most kids are very, it's easily accessible. It's so simple, is one minute of listening, you just put the time around, you sit quietly, and just listen to what's happening around the environment. That's it, you could just say, listen to something that's happening outside of the classroom outside the window. It's so simple. It's so powerful. It's like because we're all living in virtual reality, we live inside our thoughts. And we think we are those thoughts. And we're just kind of going and going and going and going and going. And it's like, oh, I'm actually a human being in a body, hearing something, and it's one minute and the whole room changes. And that's the other thing I do with kids is just talking about, what just did anyone notice what happened in this room? Just by one minute of just settling and listening? Like what happened in your body? What happened in the room? What do you know? So it's really it can be so simple, like one minute? Jayson Davies Yeah, I mean, even in the what you had me breathe and pay attention to my feet, you had us all do it for, what, 20 seconds or so maybe 30 seconds. And I was able to, you know, focus my energy on the toes that the arch in the sole. And as I did that, I realized that half my foot is on my standing mat and half my foot off my standing mat. And I actually at one point started to almost lose my balance a little bit because I was actually focusing so much. And so yeah, you really do start to feel just your body in space and to understand your body a little bit more. So thank you. Dr. Deirdre Azzopardi And that's why I started a lot of this because I started, you know, creating some courses around this kind of stuff. Because just what you just said, we talked about body awareness, right? And we teach it a lot of times through sensory integration, right? We teach it through a bottom-up approach. But what if we put all of it together? So we teach it? And then we're saying, think about it? What just happened? What just happened in your body? Then the insula, right, they've done studies on this, they look at the insula, which is our body awareness part of our brain, that's part of body awareness. When we do those embodied practices where we actually pay attention to your body in space in time, that insula lights up. So that's body awareness, the part of our brain that creates body awareness. interoception. So interoception, that's very hot right now, the interoception stuff, which is great. interoception is the one way to really the evidence-based way to have improved interoception. is mindfulness. An extra big way. Jayson Davies Yeah. to understanding your body. Dr. Deirdre Azzopardi Yes. So bring it all together, you have the bottom-up approach from sensory integration, thinking about, you know, giving lots of sensory information to a child, and at the same time, we take a minute to be aware of it. So we bring in this other part that just adds like all that mind, body, and spirit. So I think that's what OTs are the experts in mind, body, and spirit. We're experts in all three, and how those integrate together. Oh, can't just leave all that just, you know, some of our body stuff is over here. And our mind-stuff is over here. But it's that spirit to all three together. Jayson Davies Gotcha. Great. Thank you for sharing that as well. You're just dropping knowledge bombs like crazy today. I love it. All right. So you've already mentioned a little bit of research, and I was going to ask you, I hate putting people on the spot, because I know if someone asked me, What's the research for something? Like I don't know, I don't keep I have 20 articles in a binder that I can refer to at any point. But you've already mentioned a few. Are there any other particular pieces of research out there that you'd like to share? Dr. Deirdre Azzopardi Yeah, oh, there's so much though. It's a mindfulness practice. There's a lot of research, which is really nice, you know, 20 years now of research with adults, then, you know, going towards disabled population and adults. Now a lot with kids, neurotypical kids. Now starting with more disabled kids, which is really, really exciting for our field. There's a lot of adult research where parents of autistic kids when we give them these practices, it help them to learn how to parent a little bit differently or even just take care of themselves. And then things like kids' behavior improves, which is just crazy without even not doing anything to the child. But there's no there's a lot of nice research, there's Mindful Schools did a nice research project with kids out there in California Mindful Schools with some of the California School Districts, some of the urban districts, and things like improved attention, increased empathy, improvement in behavior, improvement in their stress levels. So lots of lots of different research things coming out. So pretty exciting. Pretty exciting stuff. Jayson Davies Awesome. And I have a feeling that it's not all OTs looking at mindfulness, because, well, I just don't think there's no, as far as I know, there's no degree in mindfulness, maybe there is, or there's no specific one profession that's looking at mindfulness. So when you're looking through these articles, who do you see is actually doing the research? I'm sure there are in fact, I know there's some from OTs, but who else do you see completing this research? Dr. Deirdre Azzopardi So OT is pretty limited. Not too many OTs are doing it, but OTs definitely are involved in it. For sure. Most of the research comes out of the psychological community, right? Because I think psychologists have realized that you know, only talk therapy is not enough that we have to bring embodiment into therapy. So for sure, psychologists are probably the number one area neurologists are doing it umm, certainly physicians are doing it. So I just think as OTs we have to get out of our own practice because not enough OTs are doing research, right? So we have to really look at other professions to see a lot of the research teachers are doing it. There are a lot of different professions doing it because it really touches on everything. Yeah, like pain management. You know, there's a lot of research and mindfulness and pain management. You know, there's it touches on so many different areas. Jayson Davies Absolutely. Great. Well, thank you for sharing a little bit about the research. Moving on to our next little, I guess the topic we wanted to discuss is mindfulness and executive function. You've already talked a little bit about how you're seeing improved attention a little bit. But can you talk a little bit about how they interact more, maybe even specifically, in the brain? You talked a little bit about the insula. But yeah, what else do you know about that? Dr. Deirdre Azzopardi Mindfulness impacts the prefrontal cortex. And so the prefrontal cortex is the seat of executive functioning. Right? So the prefrontal cortex is what grows as we get older, especially big rapid growth in the adolescent years through 25. And what executive functioning is thinking about our thinking, so it just makes sense that because mindfulness is stopping to notice what's happening in the present moment, it's really thinking about your thinking. So practicing mindfulness is practicing attention, practicing emotional regulation, practicing flexibility, all of those things are executive function, you know, and that's what the research shows, the research shows that especially they've done a lot of research on, like, you know, expert meditators, you know, like, Buddhist monks and stuff like that. Yeah, they have extremely well-developed prefrontal cortexes. Yeah, so very, very important. Because a lot of times, we also again, go to this very, like, thinking place about how we're going to improve executive functioning. But really, a lot of it is about our feelings. And a lot of it is about that space, the space between, you know, something happens, and our reaction. And what we want to help kids to do is increase and put a space in there. Because what we see, right, what is ADHD, impulse, impulse, impulse, we just react. We want to help kids to learn how to respond. So responding means you have to have a little space to teach kids that there's a space. But you have to embody that because a lot of us don't have space. Right? A lot of times, we're just in this place where we're always reacting, reacting, reacting. So yeah, so we just teach it. But yeah, it's really nice research on that. And it could just simply, simply be that you just do one breath practice that you remember every day. And that's it. You don't have to do 1000 different things. And that's what I love about mindfulness, too. It's simple. It's not necessary to go to 75 classes and learn it. You know, you could just learn some simple techniques that you if you practice them enough, they'll become part of your routine, and then you bring it together. Jayson Davies Yeah, you know, and with that real quick, what would you say like the top two practices that you like to teach teachers to help them in their classrooms are? Dr. Deirdre Azzopardi For sure, that the one that I was just talking about the listening, that's such a simple one. It's such an easy one. Jayson Davies You're talking about, like, listening to the silence for a minute or so. Right? Dr. Deirdre Azzopardi Yeah, just one minute. We're just gonna listen. That's a great one. Another one is to count out 10 breaths. Counting out 10 breaths. You just have a kid Kids do a little like a turtle shell on their desk, or they could do it on the floor depending on the age of the kids. So you just like, you know, take away the visual stimulation, and you count out every exhale for 10 breaths, which is one minute. If you do the counting, you don't want the kid. Yeah, so if the kids do the counting, they tend to count much quicker. But yeah, it's so simple. I do that a lot. The other one I do a lot is visuals, I might very, very simple. I have here, you know, the tip of a pencil is not a pencil, but just, you're gonna have kids just look at the tip of the pencil. And just keep their eyes focused on the tip of the pencil. And you just play around them, do lots of things, clap, jump around all the stuff and just have them keep paying attention to this tip of the pencil. And they'll notice quickly that your body becomes really centered and focused. And it's really fun. But again, it's just keeping our point of focus instead of everywhere in just one place. So that's a nice simple practice that teachers can do as well. Jayson Davies Awesome. Great. Now, obviously, mindfulness is a pretty big trend right now. It's been incorporated a lot more it is kind of a, it's a buzzword for good reason. But that hasn't always been the case. Where do you see that districts started to realize that they need to start incorporating mindfulness? And what do you think that they were doing before that? If anything? Dr. Deirdre Azzopardi What a great question. Yeah, I think what they started to realize is that heads were Yeah, there was just this enormous amount of stress in the schools. And you know, there was just a lot of stress teachers, and just, I think some of it was, you know, self-imposed because I think schools started really putting all of this extra pressure on teachers to fill up every second of every day, with more content, and more testing and more judgments. I mean, poor teachers are being judged every second. And I think so I think they created the situation for everyone to be really stressed. And then they were like, Oh, we got to do something about this. So there's the conundrum. We don't want to just put a mindfulness bandaid on something when there's a gaping hole of you know, these poor teachers, like what are we doing to these kids? Yeah, so I think, I think that people do understand now, I think that's where the social-emotional learning curriculums, you know, started to be mandatory, right, didn't use to be mandatory. didn't use to be mandatory. But now it's mandatory, right, that that, like kids have to have some exposure to social-emotional learning curriculum. Because you know, that we realize that the mental health of children impacts how they learn. Yeah, yeah. So I think all of that came out of needing some tools to help kids. But again, we have a lot of work to do. It can't just be a mindfulness tool. It has to be, you know, we're looking at why Why are kids so stressed out, to begin with? Jayson Davies Yeah. And so as an occupational therapist in the schools, I do know, especially here in California, we do have that SEL component that is mandatory. At least I'm pretty sure it's mandatory has been in the districts that I've been in for a while now. But SEL and mindfulness are two very different terms. So I guess I want to ask you because I know very little about the SEL programs is, do all SEL programs include some sort of mindfulness, is mindfulness inherently built into SEL programs? Or are they two completely opposing? Even ideas? Potentially, I just don't know what those look like. Dr. Deirdre Azzopardi Awesome. I'm glad you asked me that question. So I really became super involved in the social-emotional learning curriculum in my district, because I wanted to know, right, so I actually did the training or social-emotional learning for is the one that we used like I was the only therapist, there were all teachers, and most of them do now. They didn't always. Yeah, right. They've also come to realize, again, that just like the self-regulation programs, if we don't add an embodied experiential component, they just become another piece of curriculum that's very cognitive. So a lot of them actually do now is the short answer. And I think OTs need another social-emotional learning curriculum, because the STL curriculums what the studies have shown, this is what I learned when I went to, you know, take these classes is that if not everybody does it. Like the bus driver needs to know what you know what it is. Everybody needs to know what the curriculum is. And when everybody does it, and we use the same language, then actually, kids can use it experientially, but what we do we tend to do in schools, and this is what we do in our own lives. Like everything that we do as adults. We just jump on to kids. We overcomplicate everything. We're so distracted ourselves that teachers bring in 20 different socio-emotional learning programs. Like, it's the school one, and then the one I brought in, and then somebody brought it down the street. And it's like, it doesn't matter necessarily which one I think a lot of them have. So Castle is big where, you know, warehouse, I should say, I don't know, like a governing body over SEL. And basically, there's like 100-200 of curriculums been, and they all have these, you know, basic components. So it doesn't necessarily matter. It's just that we have to keep it consistent. Because nobody again, is going to be able to bring this into the moment unless they've practiced it. And everybody talks, the same talk, but I just see everybody overcomplicating it. And yeah, and then we just make everybody crazy and more stressed. So the SEL program becomes another thing to be stressed about. Jayson Davies Yeah, so I think if there's an OT or an OTA listening right now, I think that's an important concept that you just mentioned, good to know, whatever your district's SEL program is because the last thing you want to do, and this was something kind of said by the bed, Moscow is in a previous episode, and I've said it, too. If we bring more work to teachers, they're going to say, No, thanks. And so we need to get on board. And you know, what, maybe that SEL program is the greatest program in the world, it might not be, but it's better than three or four different programs happening at the same time. And so I need to get on board with it. And we can make it better by being a part of it. Dr. Deirdre Azzopardi That's right. 100%, no, 100% Because then, then, like, so what I did with this particular SEL program is I said to one teaching, I mean, listen, because we're all so busy, you know, and so we're all crazy. I said can I was only like 15 minutes, twice a week, I think that's when they did this SEL program. So just think about like, you know, how much time they're putting into it. But 30 minutes twice a week, I said, Can I do it? Is it can do your SEL? Can I do this one thing? Like I would love to do it? And then maybe incorporate? And she was like, yes, yes, you can. Yes, please, anything to take something off my plate? Yeah. So then you take something off a teacher's plate, and they feel like wow, and then if you add some fun pieces to it, because you're an OT, and you like to use movement, and you add that piece to it, instead of making it very like, again, as a script, a lot of them are a script. And the kids give the right answer just like our SEL. I mean, just like a lot of our self-regulation programs give the right answer, spit back to the adult what they want. But when you make it more fun, and kids start to really get connected to their bodies, you know, and then through that, you can connect to the social-emotional learning. But yeah, it's really important that you know what, the program is not inside and out. But just know some of the lingoes. Yeah, you know, like our District uses on uses thing they call like, dangerous. Is it dangerous? Oh, gosh, dangerous, like, like telling each other, you know, like, the whole telling on each other thing, you know, like kids are always telling each other. Yeah, right. So that tattletale, it's like, if it's not dangerous or destructive, you're not supposed to tell. But like, I need to know that dangerous. So that's a language I can use. Like, if I'm with kids, and they're telling each other is dangerous and destructive, it's not dangerous, destructive, I don't want to know. Jayson Davies Yeah, and I mean, I know, we're not necessarily talking about the zones of regulation today. But I do know that the zones of regulation have like a one-sheet, a one-pager that the very first thing you're supposed to do is send that one page or out to the teachers and the parents when you use it because it has some of that lingo that we're going to use. And my guess is that most SEL programs have something like that. And that needs to go out to the OT to the PT to the speech therapist, to the parents. So that, as you said, we're all using that same lingo, and kind of at least know, some of the concepts so that we can reinforce and, and use those when we're working with the students. So absolutely. Dr. Deirdre Azzopardi And especially for our disabled students, because a lot of times the times that they're being pulled for all their stuff is during the social-emotional learning curriculum time. And the other thing is, is that a lot of our kids, you know, the majority of the kids that we work with have language challenges. And so what is the language because we don't want to be adding a new language? Yeah, because the language that they're using is already so challenging. True? Yeah. So but you know, for all the above reasons, we want to kind of know, what the program is. Jayson Davies So you mentioned using a kind of starting small with one teacher, and kind of getting in there that way, mind sharing a little bit more about that maybe what grade it was and how it worked out for you. Dr. Deirdre Azzopardi Yeah, so I've done a lot of different things. I did this one thing where I said to the superintendent, can I go to every kindergarten in the entire district and teach them 10 lessons? And then I'll go away. I'll do it by lunchtime. I'll do it. So you know, I killed myself. It was really hard. Because we have a big district we have six elementaries and so six elementaries. And there were like, three or four kindergartens and every elementary so you do the math was a lot of classes, a lot of kids. But the most joyful experience I've ever had was so amazing. You know, I only had to do 10 lessons. So it was like I did like two schools at a time. And then I did it over time. Yeah, it was really no, I did it twice a week, I did it twice a week. So it's five weeks, five weeks in each school. So it took me like a whole, I don't even know how long maybe a year or something to do it. But it was really wonderful, really getting to know the kids getting to know, getting to know what kindergarten was, like, getting to know what different classrooms were like, and what different was just really a fascinating experience. And you know, I haven't been able to do it since because it was, it was like, I don't have enough time anymore to do it. But yeah, if you can get a teacher, you know, go for the low-hanging fruit. For the teachers already interested in it. I do a lot of professional development, who shows up to so we can pick you can pick like I do a lot of professional development in my district, they can pick my class, my class, Jayson Davies Is that something like the district provides at the beginning of the school year before kids come back or? Dr. Deirdre Azzopardi Yeah, both like they've done everything like we've done, like PD days, you know, professional development days, and my system superintendent asked if I wanted to do some presenting? Sure. And yeah, so the teachers who actually show up to my class must be somewhat interested because they have like, say, 25 choices of classes they can go to. Jayson Davies Great. Dr. Deirdre Azzopardi So they just showed up. So like them, yeah, then that those, those are the ones that we can practice with. Jayson Davies Yeah, and you know, I just want to speak to that real quick, because districts have no idea what to do with us on professional development days. Sometimes they might try and just tell us to get some busy work done, then get caught up on stuff. But I do advocate for every occupational therapist and OTA out there, to not just use a PD day when teachers are going to PD, just to catch up on an IEP or two, that applies to you too. And either, you know, speak up and ask if you can sign up for a professional development course online or whatever it might be? Or do you like what you just said, and offer your experiences and offer your ability to actually be one of the teachers of professional development, I've done that as well? And it is great for the profession is great for you as a person within the district because you're going to get to know so many of the teachers just buy that really quick one-hour professional development that you do. And you're going to have contacts and like, Deirdre was just saying, you know, that tells you who's interested in what you're doing. And from there, you can make your next moves. Like what she was just saying, you know, finding that one teacher that's going to let you come into the classroom. So that's awesome. Good for you. Dr. Deirdre Azzopardi Yeah, no, so fun. Yeah, it's really, really fun. I really enjoy actually doing that. Jayson Davies Yeah. Awesome. So you talked a little bit about the kindergarten level, I get a lot of questions about what to do at the middle and high school level, have you been able to incorporate mindfulness at those levels? And what does it look like? A little bit? Dr. Deirdre Azzopardi Yes. When you do mindfulness training, when you take the classes, it's really a deep dive to really think about your own stuff, and your own emotions and your own practices and how you think about things and how you think about children. The first thing that I had to be really cognizant of is that, you know, teenagers are going to be maybe a little embarrassed by these practices, they might feel a little bit vulnerable, which is a tough place to be when you're a teenager, that the practice is when you take the training is really like making sure that you don't take it any of it personally, it's not really about you and you presenting this is supposed to be about them. Okay, well, caveat there. You might have a class where there's a lot of giggling and that kind of stuff. Buy-in for a class, if you're going to teach mindfulness is to tell them all of the rich and famous people that are major meditators. Yeah, LeBron James has like a whole like now he's doing tons of meditation practices that he's online, you can do with him, LeBron James, Steve Jobs, people that have said that they are mindfulness meditation practice is like influential is the basis of their success. Howard Stern, Katy Perry, Lady Gaga, you know. So that's like a great way you get kids to buy in when they see like, there are these famous people that have used meditation practices to help them to learn how to be better at focusing, and better at their jobs, and better people in general. So that's like one of the best ways to do it. A lot of times, you'll get, you know, just a few kids who will do, and then you'll get a bunch of giggles but I always tell this quick story about middle school just to let people know that it doesn't matter what they're doing in the class at the time, they're still taking it in. I had a student I did a whole group, I did like a 10 lesson thing very similar. I did a 10 lesson thing with, like a learning-based language disability class. So it was a self-contained class. And, you know, it was rough. You know, some of the kids were really having a hard time doing the practices. And you know, again, I tried not to take any of it personally, it had nothing to do with me. And so I went off into the sunset and I was walking down the hallway one day The teacher was standing there with this particular student who did not say one word during the whole time, acted like he was being tortured out of his mind, and did nothing right did not like did not anything during this time. So I thought he got absolutely nothing. I felt bad about it. This is when I was teaching whole lessons. This is not necessarily like something that you might do when you're brand new at all this. But so the teacher said, Oh, tell Mrs. Azzopardi, what happened. And he's like, Oh, I was taking a really high stakes test. I remember the things that you taught us, I use the techniques, and I got through the test because I was really anxious and getting nervous. And I didn't think I'd get through the test. But I used what you taught us and I was like, what I ever heard ever in my life. The kids are taking it in, kids are taking it in. So, embody the practices. If you learn these things you can in again, you can just do a simple, two-minute breath practice at the beginning of a thing like, listen, people use this to help them to attend. Have you ever been told, to pay attention? Yes, every kid will raise their hand. This is how you learn how to pay attention. Jayson Davies That's great. You know, I really love your idea that where you kind of started with is, is getting the students to realize that other people are using it. And because you know, they don't want to be told that their teachers using mindfulness, they don't want to be told that their OT is using mindfulness, they want to know that the people that they really look up to and want to be in the future are using it. And so I could think that that could be great if you do a 10, 10 session whatever lesson right over 10 weeks, or five weeks, whatever it is. And Lesson number one could be to find someone who uses mindfulness online, someone that you look up to. And I can imagine that being a great first experience and getting them interested. And because then they're probably going to go home. And they're going to look up what LeBron James actually does. And what Katy Perry actually does in their mindfulness practice. And then instead of just learning from 10 sessions from you, they're going to learn forever from LeBron James and forever, from Katy Perry. Which that's pretty awesome. That's a great thing. Yeah, we're gonna Dr. Deirdre Azzopardi Yeah, well, even I think like the Chicago Bulls, I think, you know, when they had Michael jet, I mean, Michael Jackson, Michael, Michael Jordan. But when they had like, their winning, winning this winning, Jayson Davies yeah, winning, Phil Jackson's Phil Jackson was really big on like, huge. Dr. Deirdre Azzopardi He was a huge meditator. And he taught all of them. And I know, you know, the late Kobe Bryant was a big meditator also. And they, they said it was a big part of their success. They felt like they changed things up a lot when they started to use mindfulness practices. Jayson Davies Yeah, and for anyone who's not a basketball person, Phil Jackson was the coach of the bulls when they were winning. And then he was also the coach of the Lakers with Kobe Bryant when they were winning. And I do believe that is Phil Jackson that really introduced many of those players to mindfulness and really attributes that a lot to the championships that they won. I think Phil Jackson has like 11 championships or something like that is crazy as a coach. But yeah, that's awesome. I love that I do. Alright, so I can't leave out the rest of OT, in this conversation. Because OT cannot just be about mindfulness, there are other needs that kids have. And so I want to ask you when you're working on other skills, you know, some of the more traditional fine motor visual motor skills? Do you incorporate mindfulness into those? Or do you kind of separate it out? Or how do you work on both a little bit? I guess. Dr. Deirdre Azzopardi Yeah, so simple ways to do it is if you're going to be doing something like was with an older child who's doing some kind of writing, anything, you know, you can incorporate, like a minute of doing a mindfulness practice, and then bringing in some of these, like social-emotional learning themes into the writing, you know, which could be about, you know, making friends or about things like you know, how your body feels, or whatever you can, there's a lot of different ways to kind of just bring in some of this stuff, instead of talking about it, they could do writing about it, right? Typing about it, whatever you want to do. Yeah, for sure I use so like I use, like the little visual thing as I did before, you could do that with something that you're using, you're going to use as a fine motor skill. So I work with a lot of preschoolers, I use these little fuzzy ball things. So we first we just watched them, we might blow them like using them, right to do a breath practice. And then we might use our tongue and put them in something. So those are simple ways that you can bring both in at the same time. A lot of my mindfulness practices just take one or two minutes. So it might be like the beginning of the session and the end of the session. Jayson Davies Great. Dr. Deirdre Azzopardi So the mindfulness is in the session, the session, the goal of the session isn't the mindfulness. The goal is whatever the goal is, Jayson Davies yeah, whatever their IEP goals are, yeah, great. And you know what, I think that's also another reason to better understand the SEL program that the schools use because that will also give you ideas about how you can incorporate it into your sessions. So, as we did earlier, Dr. Deirdre Azzopardi I mean, like friendship, just think about friendship. Think about how many of the students that we work with are extremely lonely. Right? It's really sad. But a lot of you know, kids disabled kids are really lonely. Like you can bring in some of those friendship things, talking about friendship, about how to be a friend how to make a friend into your work as an OT, like why not? You writing about? Jayson Davies And you jumped the gun on my next question actually was talking about inclusion? I know you're a big advocate for inclusion. So I'll let you continue on, like, how does mindfulness lead to the inclusion of students? Dr. Deirdre Azzopardi Wow, so inclusion? You know, I, so I'm going to back up a little bit. Yeah, and just think about, and this is, you know, something that I think about a lot as I get older, and being somebody like who's, you know, thinking about the intersection of like, Special Education And Spirituality, and thinking about like, just by virtue of separating a child and putting them into a separate classroom? What is the inherent message that we're sending about their worthiness? You know, like being in the deficit game, we're kind of in the deficit game, as therapists, we know, our evaluations are deficit-based schools are deficit, like getting into special education is a deficit game. So just thinking about that always that we're part of that system that says to kids that you know, and it's all unconscious, we don't mean to say this, but that they're sort of less than the others. Here's the mainstream, you're over there. Why are you over there wiring on the mainstream? So I just think, we have to think about that, as therapists and a lot of therapists, a lot of there and me for a long time, I've changed my mind over time, and we can all change over time. A lot of therapists are gatekeepers to kids getting into the mainstream, a lot of therapists say things like kids aren't ready. Kids aren't ready. And so like this idea that kids aren't ready, and they have to do something to get into the mainstream. Yeah, is a big issue that we have to really think about. Because you know, people live in society, and we all belong. And when we do mindfulness practices, especially when we do with a class, and we do it in an inclusive way, there's something called Dan Siegel talks about the eighth sense, he doesn't talk about interoception. But he says the eighth sense is interconnectedness, right? That feeling of connection with each other. And you can really foster that feeling through mindfulness practice when you're with a whole class together. So if you have, you know, an integrated class with disabled and neurotypical kids, that sense of connection really is palpable, really can be quite beautiful. Jayson Davies Can you say that name one more time for the interconnectedness, Dr. Deirdre Azzopardi interconnectedness, interconnectedness? Jayson Davies And who was the or did you say the author, Dr. Deirdre Azzopardi Dr. Dan Siegel? Jayson Davies Okay. I've heard the name okay. Dr. Deirdre Azzopardi Yeah, he's a psychologist, or he's a doctor. I'm not even really sure. But he's a tremendous amount. He's written a tremendous amount about the brain. He's the one who does the hand model of the brain, you know, with the prefrontal. I don't know if you've ever seen that. Jayson Davies Yes, yes. I have Dr. Deirdre Azzopardi the hand model of the brain. Yeah. So he, yeah, he talks about that felt sense of connection and ideal that very, very much when I do whole class, especially, there's this like, feeling of family in a classroom, that is really quite beautiful that we don't get if we're doing this pullout stuff all the time. Yeah, Jayson Davies agree. Well, Deirdre, I want to say thank you so much for coming to the show. This has been a very insightful conversation. And I know it's going to help everyone because you have helped me today to better understand mindfulness. So thank you so much. I really do feel like I have a better understanding of mindfulness than I did one hour ago. So thank you for that. And I want to ask you, where can people who want to learn more about you and mindfulness find more? Dr. Deirdre Azzopardi I have a website called themindfulschoolot.com. And, yeah, I have some courses. I have one specifically for school-based therapists, that is, you know, just bringing some simple practices into your work, and hopefully into your life. I hope I convinced one or two people to bring more of this into our busy lives because we impact children greatly. We have a lot of power over children, so we have to use it for them. Jayson Davies Awesome. I love it. Well, everyone head on over to the mindful school. ot.com If you want to learn more about Deirdre and more about mindfulness, it is a great place to start, I believe. And I really, I think that's going to be great for you because you are a skull base OT both you as the person listening right now and Deirdre. And you know, it's one thing to learn mindfulness. It's another thing Well, anything It's one thing to learn anything. And then so it's another to learn about that specifically as it relates to school-based OT. And I think that's what Deidre's just going to be able to offer you over at the mindful school ot.com. So be sure to check that out. So yeah, one last time. Thank you so much, Deirdre, for joining us on the podcast. I appreciate it Dr. Deirdre Azzopardi was super fun, Jason. Jayson Davies Thank you. And we'll definitely keep in touch. All right. Take care and have a great rest of your day. Bye. Alright, thank you all so much for listening in on this episode about mindfulness with Dr. Azzopardi, I learned so much from this episode, this conversation that I had with her and I hope you did as well. Thank you for sticking in there with me when I shared a few minutes about my personal life. Hope you enjoyed learning a little bit about me, my wife, and even more so I hope you enjoyed learning about mindfulness. Let me know in the comments, or down below where you rate the podcast on Apple podcast, what you learned from this episode, and maybe also a little bit about how you are using mindfulness in your schools, or maybe how you plan to use mindfulness in your schools. I'd love to hear that. All right. Take care. Have a rest of your Have a great rest of your Valentine's Day or any other day that you're listening to this podcast. 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! 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

Let’s face it. Writing school-based OT evaluation Reports in today’s public education climate can be hard, hard, hard…. I was personally inspired to take a more proactive approach to report writing after a parent went through one of my assessments with a red pen. Talk about getting my butt handed to me. I was not only blind-sided, I was immediately thrown into a defensive and anxious state of mind. I felt my professional opinion was being hijacked by my anxiousness. If you have ever had this happen, having a report that is clear, concise, and well written can be your saving grace. Assessing any student in “all areas of suspected need” can be daunting and confusing. Prioritizing and interpreting those findings can take us down a rabbit hole of possibilities. In this post I’m going to review my personal process that I have improved upon since experiencing this tuff meeting. I want all of us (Teachers, OTs, and all other providers) to go into IEP meetings confident and with reports that serve the student. May we all be able to review our report findings with confidence and make recommendations to the IEP team that can be clearly implemented with fidelity. So, you've received that referral, gotten signed permission from the parent and that 60 day timeline is ticking down....what do you do first? 1. First thing is first Start at the beginning. Getting a strong developmental history and background for the student is essential to understanding the student’s suspected areas of need. As OTs, we call this an Occupational Profile. I have often found IEP teams and parents requesting OT, PT, or other services are not entirely certain of why it is they are requesting the evaluation. In developing my occupational profile, I make sure to include: A) Student Interview- what are the student’s interests? Do they enjoy school? Why or why not? What are the student’s favorite classes? Why? What are their least favorite? Do they have friends? B) Priorities from the perspective of both the parents and the classroom teacher(s). You may also want to check in with other service providers. C) Review both previous educational and medical assessments if available, including psycho-educational, occupational therapy, speech therapy, etc​. D) Educational background (grades, time in special education, behaviors, attendance, etc. E) Developmental History and medical diagnosis. 2. Identify why the student referred for occupational therapy assessment? Find out what has been tried with the student as part of Response to Intervention (if anything has been tried?). In our district, I have instructed teachers and personnel to invite me to IEP meetings whenever there is a concern related to occupational therapy (i.e. low VMI scores, poor handwriting, possible behavior related to sensory processing difficulty etc.). This way I can hear first hand what the problems are. If I am unable to attend, I ask that they thoroughly fill out a referral form. At the IEP, you may be able to suggest strategies for the teacher to try and begin collecting data on at this point. This step and the first step should be conducted as soon as possible in the assessment process if possible. 3. Collaborate! If you’re lucky enough (as I am) to have an amazing Special Education team and department, I have found collaborating with the school psychologists and any other service providers prior to writing the report can be a huge benefit to present accurate and relevant findings to the IEP team! I think back to a middle school student who was demonstrating difficulty with behavior and self-regulation during writing/reading tasks. Speaking with the school psychologist and speech therapist proved invaluable as the student had both auditory and visual processing deficits. Therefore, using tools to help access in these areas would prove to be more beneficial than say a chew tool! Remember we are looking at the whole child not just the deficits. 4. Observe! Observe the student in their natural learning environments! I feel student observation is probably the most valuable part of your assessment. Observing in multiple settings during times which the student is performing in areas of strengths, as well as those times in areas of weakness. How do they do with transitions and unforeseen changes in their schedule? This all can be looked at through observation. What are your observations of the main classroom environment? What could the teacher easily implement in this environment for the student? (a correctly sized chair?) Observations can tell us what could potentially be barriers to implementation of strategies for this student. How often have you become frustrated with the lack of follow through and carry over? Did you observe the natural setting to see if what you were recommending was able to be implemented with fidelity? These are important things to ask yourself and these will come up in the IEP. So best be prepared now! 5. Assess the student Assess the student in “all suspected areas of disability” related to occupational therapy services. Do not leave any stone unturned and follow the rabbit hole should you find one. Be thorough! I utilize both functional skills observations as well as standardized assessments. Neither one by itself is sufficient in justification of service level recommendation and both provide valuable information that can inform your assessment. Remember occupational therapy is a wonderfully gray field. It was built on the “art and science” of occupation. Embrace that concept when you look at your assessment. It’s both the challenge and the grace of our profession. Then look to the guidelines of your state. Be sure you can adequately defend your reasoning behind your recommendation. 6. Make it School-based! Be prepared to explain medically based services versus educational based occupational therapy services. (Have a pre-planned speech that sites state guidelines and of course the main difference being access to education!) 7. Speaking of state guidelines, add them into your report. They will be the most objective means of determining the need for occupational therapy services or in some cases not needing OT services. Site them in your interpretation of findings. Remember you are needing to have the student access education in the Least Restrictive Environment. The purpose of school is EDUCATION not occupational therapy. If your state guidelines are like mine there is a great deal up for interpretation. I focus on function and access to academics. 8. Intervention Plan Develop an evidence-based treatment plan or intervention plan based on your assessment report and findings. This should reflect the needs and strengths of the student which you will likely also list in the IEP. Your goal in your plan should be clear and concise (Check out our post on writing S.M.A.R.T. IEP goals). Because our IEP writing software does not allow it; I write my short term objectives on my remediation plan. I may also list treatment strategies and collaboration/consultation plans. This is also where you will develop your progress monitoring strategy for your proposed IEP goal. 9. Evidence-based! Look up and maintain relevant research to support your treatment/remediation strategy. You may find articles on self-regulation/handwriting/visual motor skills to prove valuable in supporting your recommendations. It could be useful to create and keep a binder of relevant research articles in your office and update it often. Evidence –based practices in schools is required by law this is any easy way to ensure you are doing so and have easy references for meetings. 10. Plan for discharge! I have found that exiting students from occupational therapy services is DIFFICULT! Often parents and/or the IEP team do not want to let go of the services they perceive as benefiting their child. OT services are not meant to remain on an IEP indefinitely. Creating a remediation plan with clear objectives is going to lead to a recommendation of exiting the student from service once they no longer need the support. The IEP team determines the need for occupational therapy services and is a team decision and that decision is based on our evaluation, treatment, and progress reporting. I also exit a student with an assessment but its good to have those conversations up front even if discharge does not happen for 3-6 years. Hopefully we can work together to get our students thoroughly and accurately assessed. I know that this list may seem overwhelming; however in a world of due process and standards I think its best to take the time to complete a thorough OT assessment. It will save you trouble in the long run and give a great foundation for treatment and progress monitoring! Let us know in the comments and on Facebook what you're doing to assess your students! Whats on your OT evaluation checklist? Have you had a meeting where you've had your cage rattled? How did you handle it? Thanks for checking in! Subscribe to our mailing list below. If you you liked this article please share! Abby

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 24 of the OT Schoolhouse Podcast. In this episode, Jayson interviews occupational therapist, Cara Koscinski, OTR/L. Cara is the amazing OT that runs one of our favorite blogs, PocketOT.com. In this episode, Cara discusses her new book, "Interoception" also dubbed "the 8th sense." On her website, you will find not only frequent blog posts, but also several books she has authored, CDs she has recorded, and professional development webinars geared toward pediatric and school-based therapists. We highly recommend that you check out her website. Listen in to learn more about Cara and all of the fantastic knowledge she has to share. Listen all the way through for a special discount code you can use to purchase any items from PocketOT.com Links to Show References: Quick reminder: Links below may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you The below references were mentioned throughout Episode 24 Books: The Out-of-Sync Child by Carol Kranowits (Amazon) The Out-of-Sync Child Has Fun by Carol Kranowits (Amazon) 52 weeks of OT "Interoception: How I Feel" Book on Amazon Other Books by Cara Webinars (Use this link to view all of the below webinars) Is It Sensory or Is It Behavior? Pediatric OT Primer Executive Function Disorder Learning Disabilities and ADHD Trauma-Informed Care Building Healthy Brains Business of OT 101 Other mentioned links "School-Eaze" & "Sound-Eaze" CDs by Cara Koscinski Cara's Favorite Pocket OT blog post - Scary Sleeves Mentoring by Cara (Available at select times) Pediatric Occupational Therapists Facebook Page Sonia Story's (Move Play Thrive) Brain & Sensory Foundations Level 1 online course 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! 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

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 9 of the OT Schoolhouse Podcast. In this episode, guest Leah Hiller, OTR/L, and Jayson dive into Response to Intervention (RTI) a bit and discuss several ways OTs can have an impact on students without ever completing an evaluation. RTI is a growing model in schools and as OTs, it opens the door for us to help more students in less time. It also provides opportunities for OTs to provide in-services for teachers and recommend curriculums that will benefit the social and motor aspects of student roles. Have a listen if you would like to hear how Leah and Jayson are providing RTI in schools. Links to Show References: Contact Leah Hiller, OTR/L at Hillertherapy.com Learning Without Tears (LWTears.com): Formally known as Handwriting Without Tears, LWT is a leader in developing handwriting and keyboarding curriculums. Want to hear from them on the podcast? Shoot them an email and let them know about us. We Thinkers! from SocialThinking.com: This program uses music and plays to teach early learners how to manage everyday social situations. Personal Space Camp by Julia Cook Use this Amazon affiliate link to check out the book used by Leah to help her young students understand personal space in the school. AOTA's FAQ On Response To Intervention (RTI) Use this link to view AOTA's description and understanding of what RTI is and how OT/COTA can use RTI in schools. 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! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the otschoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.    Jayson Davies     Hey there. And welcome to the otschoolhouse podcast, I hope you're all having a wonderful summer. Today, I wanted to let you in on a special announcement we have been working on here at the otschoolhouse  and that is that you can now earn professional development units by listening to our episodes and then visiting our website at otschoolhouse.com , forward slash P D. That's the letters p d, as in professional development. I won't go into all the details as I want to get into today's content, but there are currently three episodes that we're offering for units right now for professional development, and those are episode number three on smart eagles, episode six on the comparison between the bot two and the M fun assessment, and episode seven on mental health and mindfulness with Dr Rochelle Murphy, but for any of you wondering, the podcast will continue to be free. We're just adding extra value by giving you the ability to earn professional development for episodes that you've already listened to. So don't worry, the podcast isn't going anywhere. Everyone will still have access to it, and not every episode will be a potential professional development opportunity, but we'll let you know when something is a professional development opportunity. So today's episode is not a professional development opportunity. Leah made it very difficult for us to decide whether or not we should do it or should not do it. She provided a lot of value, but in the end, we just weren't sure that it was enough to provide professional development. So rest assured that there will be some that you can earn professional development and others that you will not be able to earn professional development for all right. So getting into today's content, I'm excited to introduce to you all our guests today. Her name is Leah Hiller, and Leah and I met a few months ago when we both were asked to sit on a panel at the University of Southern California to talk to OT students about ready to graduate with their masters in OT it was a great panel, and I'm so glad I was able to attend. Not only did I enjoy the experience sharing with students, but it also gave me a chance to meet Leah as well as a few other OTS. And that day, Leah shared with me, you know, she has a private practice that she actually runs out of her house. But more than that, she blew me away, because she actually consults with a private preschool once a week, and so that's what we wanted to key in on today a little bit. So you're going to hear a lot about how she works with not only kids, but also the teachers, the administration and even some of the parents. So with that, please have a listen to my interview with Leah right now of Hiller therapy, and remember to visit otschoolhouse com, forward slash episode nine for today's show notes. Hey, Leah, thanks for joining the otschoolhouse podcast. I just finished a short introduction to our listeners about you, but I wanted to give you a second to share about who you are with everyone, maybe share us your ot story about how you became an OT.    Leah Hiller     Yes. So thank you for having me. Occupational Therapy is actually my second career, because when I was in college, I don't think I'd actually ever heard of OT. Yeah. So when I studied history, I studied communication, and then I became an elementary school teacher, and I taught for about 10 years. And so I really loved it. It was great, but I always liked kind of those kids that didn't fit in the mold Exactly. And I found that when I was in the classroom, I didn't necessarily get that much time with them, right. If there was a kid who wasn't just sort of the middle of the road, I could either refer them out or get them support somewhere, or in my spare moments, I could work with them if I had time, but it just wasn't a focus. So I worked with some really good OTS who were in my classroom, helping those kids, and I just kind of realized that that was exactly what I wanted to be doing. So I taught for almost 10 years, and then I left the classroom and went back to school myself.     Jayson Davies     Wow, so you went back full time? You're just in school for the entire time, or were you able to teach and go to school at the same time?    Leah Hiller     So I think my last year teaching, I did all the prereqs at night, and that was just about the hardest thing I've ever done. It was harder than being a full time student or a full time teacher. So I did that because it had been so many years since I'd been in college, and that kind of got me warmed up, and I did it. And then, yeah, I basically it was actually funny. I basically joked around that I was retiring, like I stopped working. I, you know, said my goodbyes, had a cake and a send off. And then I think, like, a week later. I started at USC.    Jayson Davies     Wow, very cool. So you're in a very interesting, unique position, and it's kind of cool that you came from schools, because you're kind of back in school somewhat. But more so than being in schools, you run your own private practice right out of your house. So can you tell us a little about, a little bit about how that came to be. Why are you working in your house and not somewhere else? Or How'd that work out?    Leah Hiller     Yeah, so I most of my time is spent in private practice. So I'm seeing kids to one, one to one in my clinic, which my clinic is my backyard and then my back house, and I think that part of my job probably looks like a lot of other small pediatric practices, but I can, of course, tell you all the things that makes my practice and special and wonderful. It's definitely individual. I love doing it. My commute is amazing. But I actually think that the time I spend outside of my practice, which is in my school based role, is what makes me a good I think it makes me a better OT, basically, and that's what you and I started talking about, was that one or two mornings a week during the school year, I am at school. I'm a school based, ot based pretty much, and my role there is completely different. I'm in a small private preschool. I do 01 to one intervention, so it's completely different than what I do in my private practice. I basically spend time doing things that help everyone at the school. I yeah, I get to talk with administrators, teachers, parents, definitely kids, but every day is different. I love it.    Jayson Davies     Very cool. And so how did that come to be? How did you go from because you had the private practice first, correct? Yes. And so you do not work in the traditional sense for the school, yet you still work in the school. So how did that come to be?    Leah Hiller     So I'm considered a consultant by the school, so I don't, yeah, while I'm working for the school, I'm not like an employee of the school, and my, yeah, my private practice is my employer. So the way I got this job, it was completely an accident. But as you know, as part of my job as a private practice, OT is assessment. So I guess maybe because of my teaching background, or just because assessment involves observing a child, I always go into the school if the child's enrolled in school or camp or daycare, whatever it is. I make sure that part of my assessment includes that visit. I just don't it doesn't cut it for me to just see them in action in my clinic or just get a report from the teacher to be like, here's what I think is going on. So I'm in and out of these preschools and elementary schools all the time, and I always try to kind of check in with the director and say hello if they have a minute. And so one of those times I had a client at this particular preschool, I checked in with the director, and we had maybe a 10 minute conversation. Of course, we started talking about this child, but we just kind of the conversation expanded and expanded. And she said, Hey, why don't you do an in service for my teachers? So we talked about what that would look like we did. And then after the in service, she basically was, like, we really should have an OT. Like, come do it.     Jayson Davies     They did not have an OT or anything on campus.    Leah Hiller     So they did not have an OT on campus. They had in the past, and I think that they'd had more than one. They had different OTs, and I think that it was not necessarily like a negative relationship. It just was kind of seen as like a luxury upgrade, like when we have money in the budget, we might be able to have an OT here or.    Jayson Davies     Gotcha.    Leah Hiller     You know, it would be like a cool thing to have, and sometimes they did, and sometimes they didn't. But it just wasn't kind of like part of the fabric of the school, it was, like, it was like an extra like, oh, wouldn't it be cool if we had, like, you know, Spanish class for the kids on Tuesdays. Wouldn't it be cool if there was a gymnastics teacher here? Wouldn't it be nice if, like, an OT came and did whatever it is OTS do? So I think that that was sort of the my. Mindset, but based on our conversation, I worked really hard to shift that mindset.    Jayson Davies     So did they get the gymnast teacher first or you first?    Leah Hiller     They have a pretty awesome coach. She's great.    Jayson Davies     Well, just to make sure, to clarify for everyone out there you are working in a private setting, a private preschool in California. So with a whole with IDA, it's a little bit different because it's the private preschool. So you do have a different experience than most school based OTS. And I think you understand that,    Leah Hiller     yes, I spend some time, and I've spent some time in the public school in my area, which is LAUSD, so I do see what what they do in a public preschool setting versus what I do, and I'm also in and out of public and private schools. So this model is a little different, but it's a pretty common model. There's a lot of private preschools, and the way they're getting served is honestly just inconsistent.    Jayson Davies     Gotcha, okay. Well, that kind of leads us into, I think, the model you were just kind of referring to, which is RTI model Response to Instruction and Intervention, if I can say it correctly. So you were kind of introduced to it at LAUSD. How much of RTI Did you know, before you took on this opportunity at the private preschool, were you already exposed to that, or was that something you kind of had to research a little bit going into this.    Leah Hiller     So figuring out what exactly I would do was like one of the most interesting parts of the job I knew about RTI vaguely from my conversation and or from my time in LAUSD and from my graduate school time. And I knew that during the course of my conversation with this particular preschool director, I knew that's what we were talking about, right? I knew that's what I wanted to be talking about. I knew that she was saying, Oh, the OT can come in and make sure my kids don't need ot, or tell me if they do need ot, right? That was the model that she wanted, she expected the OT to do, and I think historically, the OT had done. But I knew in my head I wanted it to be RTI, so I kind of, I was asked to write up a proposal. That's just how this particular school hires consultants. So I saw that as my opportunity. So that became my research time. And I was like, pulling out my pediatrics textbook. I was I was actually the aota website had some helpful resources. And I also looked back at some materials I had from LAUSD about their classroom based interventions.     Jayson Davies     Okay.    Leah Hiller     And so I kind of looked at all these things, and I wrote up a really short proposal, like maybe a page and a half.     Jayson Davies     Oh, that is short.     Leah Hiller     And I said, this is my plan for ot support, and it will focus on prevention and universal early intervention, perfect. And I like underline universal, and I underline prevention. And that, of course, is very vague, but I wanted to make sure that I wasn't just thinking my role would be different, but like, this was out there, right? And so then in looking at it, I was like, these are nice words, but what does it really mean? So I actually made a checklist of what I would do with my time, because as a consultant, I bill hourly, and actually I think I bill to the like, 15 minutes or half hour now, like I'm very specific with how I use my time, because I know they have a tight budget, and I want to respect that, and I have a checklist. I say, here's what I'll do for parent education, here's how I'm going to help you with curriculum. Here's what I could do for classroom supplies. And it was just like, this list of everything I thought I could do for them as an OT and I brought it, and I was so excited. And she kind of like, looked at it and was like, okay, cool. And I was like, no, no, no. Like, we're gonna go through this list. We're gonna do these things. And she looked at the list, and she was like, You're you're here, like, four hours a week, three hours. This is a lot of things. So I said, Okay, you're right. These are the things we potentially could do. And that's just the director was like, I love it. You're gonna write, you're gonna do some parent education, you're going to do Teacher Education. You're going to educate me like this is going to be so much fun. So I really, I just had an ally, and I loved that I actually had it in writing. And I think I even showed her a diagram of what the RTI model looked like with each tier, so that she could so I could say. Like, here's what you think OTS should be doing, you know, the one to one intervention. And I said, but here is the level where I work with everyone, and that's where I'm gonna be spending my time.     Jayson Davies     I love that.    Leah Hiller     Yeah. So it was, it was great. It was, it was good, and and it's actually worked out really, really well.    Jayson Davies     Because I think a lot of well, not just OTs, but also, like you said, administrators, when you go into a school, they expect the one to one pull out. That's what teachers, administrators, many OTS certified ot assistants, even the aides, the parents, they all expect occupational therapy to be a one to one, pull out, maybe a small group pull out. They're never expecting and they're always shocked when I say, You know what? I'm not going to pull your kid out. I'm going to go into their classroom and I'm going to work with the teacher so that the teacher can better support your student for five days a week instead of one day for 30 minutes a week. And so that's awesome. So tell me more. How are you helping the teachers at that school?    Leah Hiller     So I love, I love that you mentioned that, um, that thing with like, Oh, is that what you're doing? Because I do get those questions, even from the teachers who I kind of said, like, Oh, I was a teacher. And so when I'm in the classrooms, you know, I've gotten comments like, oh, but you're in here more as a teacher right now, right? You're more like, teacher trainer, right? And I'm like, No, I am the OT who is like, I guess both of me, I can't separate those parts, but I really said, like, OTs are teachers too. Like we are, even if you don't have a teaching credential, like I do, I am. I am a teaching. I'm teaching. I'm modeling. Like everything I'm doing is as an OT    Jayson Davies     everyone that works with a kid as a teacher, whether you want to be a teacher or not, if you're working with a kid, you're a teacher.    Leah Hiller     Um, yeah. So how I spend my time. So again, every day is different, but I might start out doing a mini lesson in the transitional kindergarten classroom, which I made sure to visit. Every time I was on campus, I would spend time with them. We started there we noticed that there were some fine motor challenges. And at first the idea was, oh, maybe one or two kids need a referral to OT. And then it was like, Oh, wait, maybe, like, three or four kids need a referral to OT. Oh, wait, maybe the whole class should probably have some bilateral coordination and fine motor and all these activities just embedded as part of their school day. And so it was an easy sell to get them to start using Handwriting Without Tears. They actually had already purchased some of the materials in years gone by, and really weren't using them, or were using them for other purposes, like all those lines and curves were in a big bin, and they were using them to build things, but not necessarily Batman or letters.     Jayson Davies     Yeah.     Leah Hiller     So, yeah. So we so I started doing that, and I was always, I really tried to be explicit with the teachers that I'm here for 20 minutes right now. Sit with me during the lesson, jump in when you need and then you're going to choose a lesson to do. I can help you pick it, and you're going to do it sometime this week, and we'll talk about it when I come back next time, and I'll do another lesson. So we kind of went back and forth. The kids loved it, and I just felt like a lot of flexibility to sort of do what needed to get done. If the teacher, if I walked into a classroom and the teacher said, Oh my gosh, they're killing each other out on the yard, we have to do something. I could think about what, you know, maybe do an observation for a few minutes, watch the kids in action and say, oh, here are the elements that I think are at play. Let's figure out how to address that. So I had a lot of flexibility.    Jayson Davies     That's cool, because, I mean, that shows your value, though you're there for four hours a week, and this program handwriting, Handwriting Without Tears, going back to that, it's an evident, evidence based program, and without you taking the initiative to work with them, even though they had the program on campus, they would never have implemented it without you being there to kind of guide them along. And they could have hired a physical therapist, a psychologist, they could have hired a gym instructor, and that would never have came about. But because an OT, that's what they went with, an OT who also has previous experience as a teacher, which is awesome, but because you were there, they were able to implement a program now that's going to help kids. Far after you may or may not still be working at that school.    Leah Hiller     And I love it, and I liked how not all schools are this open, but this school was one with that culture of like, Yeah, show me. Like, let's do this together. I think it clearly came from a director who felt that way too, who absolutely said, Yeah, show me, let's do that like I'm willing to to learn how to do this, and the teachers were just absolutely the same way. But I said we adopted two new curriculums this year that I'm really proud that that was done, but I think their total buy in cost for those two curriculums was like $250 Handwriting Without Tears. They already had all the materials, and I had gone to a Handwriting Without Tears workshop in years gone by, and so they actually provide a lot of the handouts and things like that for you to go into your school and do you know, share what you learn. So I had things readily available, and they had everything already. We also adopted the social thinking curriculum that's called we thinkers for preschool aged children, and that was, I mean, a teacher's guide and a couple books. It was so accessible, and the teachers, a couple of the teachers, ran with it and decided to integrate it into their Conscious Discipline program that they've already been using and have been using for years. So they basically took that and said, Oh, we see where this ties in with something we're already doing. And I really, completely took a step back with that. It was, like, my suggestion, I did a few model lessons, but then those few teachers, like, just made it their own.    Jayson Davies     That's cool, because you have to get them to buy in, like, you can go and do a few courses, but unless they're taking it on for themselves, it's a waste of everybody's time honestly and faced the time and money, but that's cool that you were able to somehow. I mean, you say that they're so nice and ready to take on anything, but I'm sure there's something that you must have done to help them, because I know you as a Your personality is awesome. So somehow they they liked you, and they liked what you were recommending and the way that you were teaching it that made it easy for them to continue on, which is, it's hard to do sometimes.    Leah Hiller     Well, I That's really nice of you to say, and I think that it's not necessarily. Of course, I think I'm super nice and approachable, but I don't think, I think there's two things at play. One was I was aware of when I was a teacher of how sometimes specialists or experts or whoever could kind of come in my classroom and just tell me how it was going to be, and sometimes it felt like a burden, like I remember reading psychologist reports, and it would just be This random laundry list of like 25 recommendations that I had to implement for the kid yesterday, and they didn't necessarily, they felt copied and pasted. Yeah? And so it just was, instead of being like, excited as a teacher that I was getting all these tools and this was going to really help the kid, it often just felt like a burden. So I never wanted to feel like a burden. Of course, no one wants to feel like a burden, but that was kind of at the front of my mind when I show up at the school, I want to be like a friendly face. And if I walk into a classroom and a teacher looks like she has had it. And, you know, I can tell that the kids are having a hard time. I can either say, like, Hey, can I help? Can I take them outside and do this, you know, body awareness game with them really quick, or, Hey, can I back up slowly and come back and see you next week? Like, I really that is above all. My goal is to just not be seen as someone who's just adding to their workload.    Jayson Davies     Yeah, I mean, and that's what teachers really want. You're right, I mean, I have felt both ways going into the classroom, and that's why now I make it a point to go in there, and I'm not going to give recommendations without going in and really looking at the classroom, but you have to take in the entire dynamic. You know. You have to know the teacher as well as the students, as well as even the aides, because a lot of times, the aides have a huge influence. And even if you can get buy in from the teacher, if the aides don't buy into it, then it typically ends up failing. But no that getting that buy in, it's it can be tricky, and somehow you have mastered it. So thank you. Later.     Leah Hiller     Oh, I think one thing that's really important is, especially when you go into a school setting, like you said, there's a lot of people there that just that aren't just the lead teacher, and a lot of times, especially in person. Schools, the the assistants are often the ones working with those kids with individual challenges, or like they're often the ones who are going to be refereeing that, like, you know, sports activity, or helping kids solve a problem during free play like they're often the ones doing that, like they're your audience too. I find that the school secretary at this school like she knows everything that's going on. She knows, oh yeah, this, you know, if there's a kid who's having an unexpectedly difficult day, she knows, oh yeah, well, grandma's sick or so and so is out of town, or this, like, that's a person who has so much to offer, and so it's like you have to make, kind of make those relationships. And you and I had talked about whether this was kind of, like a, is this a scalable model, like, is this something you could do at 10 different schools? And I kind of have a hard time envisioning how I could possibly do this at 10 different schools, because it's so much based on the individual relationships and me getting the time to chat with these people and getting the and just keeping it all in the back of my mind. As much as I take notes and do all of those things, I kind of need to remember, like, oh, which teaching team are you on, and which kid's parent just had a new sibling? Or, you know, you kind of have to have that stuff.    Jayson Davies     Definitely. I mean, yeah. And I'm transitioning right now from a job where I was working nine schools plus home hospital kids, and you're right, so I know exactly what you're talking about, and I was never able to build the rapport. You know, there's a handful of teachers that those special day classrooms that I was in regularly. I had a great rapport with those teachers, if something came up, I was there and but that helped me, because they trusted me when I made recommendations for something, they trusted me. You know, even though they thought it was going to cause chaos in their in their classroom, they trusted me when I told them, hey, we need to talk with the aides and have them back off a little bit to not do the project for the kids. And so they trusted me and allowed me to come in and kind of work with the A's to bring them back a little bit, versus if I went into a lot of times, like a general ed classroom that I didn't see them once every five months, because out of nine different schools, it's hard to build that rapport unless you're there every day, at least at weekly. I mean, you gotta be on campus. Otherwise it's just, every time you go, you're spent just building rapport, rather than really focusing on the kids. Because OT and teaching, it's a very personal thing, like you have to have that trust, otherwise nothing's gonna work really so, but yeah, so we can move on to the next one. But yes, props to you, Leah, for being so awesome with your preschool. So Handwriting Without Tears. The What did you call it, the we thinkers program? Those are things that you put into the entire school at A and that would be kind of like an RTI level one type of thing you're helping the entire school doing like an RTI level two thing. Now this is a little bit more intimate. You're working on the classroom level, and I know you do implement the handwriting without tears and the we thinkers in individual classrooms. But is there something else that you can think of, maybe even an example of how you did something differently based upon the classroom? Maybe they were even the same level of class, but because the dynamics were slightly different. You may have changed it up a little bit.    Leah Hiller     With those individual classes all the time. Sometimes you would go in the basis of the social thinking adoption was really looking at again, like conflicts on the play yard. We are in the middle of Los Angeles, there is not a lot of space, and many of the schools in this area don't have a ton of space, right? So it's a commodity. And if you're at a play based school, these kids need space to play, and so sometimes when there isn't huge fields to run and jump and play like conflicts happen, although I'll say, even when there is a huge amount of space to play, conflicts still happen. But So I noticed, or I didn't notice, the teachers brought this very much to my attention, that it was a challenge. So we and they have an excellent discipline, or not a they call it something Conscious Discipline. They have an excellent program. I really enjoyed learning about it, and these conflicts were still happening. And the behaviorist and I were like brainstorming, thinking about it, and I decided, Okay. The behaviors has his approach. That's what they do, and it is tried and true. And I was like, what is the OT approach to a problem and or a or a activity? It's task analysis. So I really kind of thought about the task analysis like, that's what makes my training different, yes, so I kind of pitched that to the teachers, like, I can be the problem solver. Let's take this apart. It's not just kids who are banging into each other on the yard. It's not that they're just too rough, like, every few minutes someone's getting hurt, it seems. And of course, as a teacher, your job is to keep them safe, so we need a solution other than they can't go out on the yard right because they right. That doesn't work. So I used the task analysis, and I was like, Okay, we need to break apart what's happening. Let's all watch, not just me observing, but Let's all watch and see what happens. And we looked at play skills, and I really talked about like, okay, these are the play skills we're working towards. We're gonna watch how they enter play. Are these kids doing a good job of entering play functionally? How about body awareness? Are they physically banging into each other, and that's what's causing all these, like, bumps and bruises. Like, what is it? Are they having trouble, like, modulating the volume? Is it that they are, you know, just exhausted. They're getting to school to like, what is it that's going on? Like, what is it the basis? And honestly, what we found was all of the above, right? Of course, for some kids, it's body awareness. For some kids, it's grading force, right? They're using things. They're just, you know, playing too rough. And for other kids, it's not being sure how to enter play. It's running up to a group of kids and just bulldozing their way into it. So you have all these things going on at once. Of course, individually, these kids are all typical. It's fine. None of them would qualify for an OT referral. Nobody needs to go home and like nothing to write home about. This is typical preschool behavior. Yet we're having melees on the yard, so we kind of use that piece to say, Okay, now what are we going to do about it? So with a little group or with a class, we started using the we thinkers stories, and we used like personal space camp, which is a lovely little book, and we did these different activities for everybody to learn about personal space, and we did different games where we learned about how hard you squeezing, too hard, squeezing too rough. We kind of did all these little mini lessons with the kids, and a lot of them were just kind of planning the seeds with the teachers. And I could hear it later. It was like, later on, like, Oh, he's, you know, he's just having trouble entering the group. And so it became the teachers, kind of were labeling their own problem, their own things, and kind of coming up with their own solutions. And now they have a curriculum, but they also kind of looked at challenges, or it was my goal for us to kind of like look at challenges as maybe with their component parts.    Jayson Davies     yeah, I mean, and you gave them basically a frame to look at these quote, unquote behaviors that were occurring, because they might look at it without your help and just see chaos. And you were able to come and kind of task analysis this entire system that is a classroom on the playground, and kind of break it down into different areas. These group of kids are one or seeking something. These groups of kids need more, maybe even social skills. Or these kids need to know how to ask, Can I play? And so you're able to come in there, and now it's analysis. Wow, I can't talk analyze. You're able to come in there and analyze an entire classroom and kind of break it down to where the where the teachers now feel that they can do it, which is even cool, like, even cooler, because you just not only helped the classroom, but you helped the teachers as well. So I don't know, I love everything you say.    Leah Hiller     I like it. And what I'll say is by no means did we quote, solve the problem like it is not perfect. It is far from perfect. Every preschool class has this typical behavior. What was exciting to see was sort of like a shift in how we talked about it. Yes, it was no longer like, oh, the kid, they're just, you know, battling each other on the yard. It became like it just was sort of a different lens to look at what was happening. And I really feel strongly that that's sort of step one in helping them, helping the kids and the parents and teachers, like how. Going to address it, like, once we kind of look at it a little differently, like, maybe we can approach it a little differently and also just like, see that it is approachable. It's not just like, Oh, why are they doing that? It's like, oh, here, here are the tools we have to help.    Jayson Davies     Yeah, and I think sometimes adults, teachers, aides, even OTs and everyone you know, sometimes we get stuck on seeing one kid doing one thing, and we forget to kind of take a step back and see that that kid's in a context, and that kid is not only acting on the playground, but they're also reacting to everything going around them. And so you really have to step back and see a whole picture thing. You can't see just one kid seeing what that kid's doing in a moment of time, because you don't know what happened to that kid 10 minutes ago, five minutes ago, or two hours ago, or what they're thinking about. But sometimes, when you take a step back and look at the entire play from all 20 kids that are out there, you kind of get a better dynamic, a better feel for how that play is flowing, and how you can adjust that a little bit so.    Leah Hiller     And I tried really hard to like, again, my job is to help the teachers like I am, like they are the experts. Yes, they are the experts in these kids. And I will tell you I said, my like, I'm here as part of a guess and check system. And I tried to be as transparent as possible. I would go in and be like, Okay, we've got this problem. Here are four things we're going to do about it. And I would check back in two weeks later. And the teachers would be like, those were some terrible ideas you have there. Or, like, those ideas did fourth, you know, here are the four consequences of those ideas or so it I was by no means like, this was not perfect, but the teachers were so willing to, like, go on the journey with me, like, we're gonna try this. And they would say to like, there isn't, there's no problem being like, Yeah, that does not work, and it does, you know, it doesn't always work and again, like they are the experts, and but it was, like, really exciting, just that we were really we were able to try stuff, like we had the space to try. And, yeah, it was great.    Jayson Davies     Alright, so getting on to again, we kind of started off big picture in service. We kind of narrowed it down a little bit now to one class at a time. What about groups? Are you doing any small groups? Kind of that tier two, kind of on the verge of tier three, ish, small group interactions in class?    Leah Hiller     So I do. I got to go into the classrooms, and I could kind of come up with some of these ideas that either the teachers were already doing. They often have little groups running in the classroom, so sometimes I could go in and just lead that group. They're already doing an activity. These teachers are awesome. So they're already doing an activity where the kids are making their own putty, and then another station they're like, getting to cut the putty up or build things with the putty, or, you know, all these different things that it's like, oh, if I had made a list of what I would love to see in a preschool, it's really already happening. So sometimes I would just get to be there to offer up cues for grass. Like, maybe we would help with grass. So maybe I would join a station where the kids are already cutting and doing all these things, and I would just kind of go in and, like, add a layer of support to it. Maybe I would try to grade the activity. If I see a kid who's already able to cut all the little snakes he rolled into all these little beads, then maybe we figure out how to punch holes and string those beads onto something like, maybe there's different levels, like, we can expand it in different in different ways. Other times, I came in with my own thing, and those mini lessons were a really good opportunity for me to follow up on some of the social thinking activities, or let the kids, like, build their own Matt man and play around with wet dry try in making letters. It was really kind of that opportunity to just expand whatever things we've introduced.    Jayson Davies     I can just imagine myself when I'm working in in a small group or in a class with a kid a lot of times, and you kind of referenced through this earlier is parents and or teachers wanting more services. So you made it very clear in your proposal. You know you're not there to really do one on one services. So what do you do when someone comes up and says, Hey, I think Little Jimmy over here could benefit from going to your clinic on Friday afternoons for some ot service.    Leah Hiller     Right? So that. One of those interesting fine lines that I am trying so hard to, like, you know, just walk the line, make sure that I don't cross those barriers. Because, of course, I do have private practice clients that are at the school. Like that was my introduction to the school, was that I saw clients there, and I continue to do so, and so I have to be careful. At times, I had even been able to see a client in my private practice at the school. So that's always an interesting thing. And sometimes I'll have to, you know, the teacher, of course, will know I'm here working with this particular kid. But obviously I blend in. The teachers are used to being able to grab me and ask questions here and there, so sometimes I have to say, like, Oh, I'm going to check in with you later on today, when I'm available for that. I have to be careful with confidentiality. I can't say I'm working with this individual because that's not another teacher in another class. Doesn't need to know that, so I do have to be careful on that, and I have to make sure that I honor my time in both ways, but yes, in general, it is my hope that by my being at the school, it will actually lead to fewer inappropriate referrals, and maybe, yeah, and maybe even fewer referrals in general, right? If we can get into the schools and manage and recognize some of the challenges and then address them in a class wide way or in a small group way, then maybe they'll not need to come my way at the and I think the other part of what I get to do is a lot of times parents or teachers will come in with exactly that question, hey, my kid needs to come to OT or the teacher will say, Oh, so and so definitely needs to come to OT so we put in place a process for that, and that was a conversation with the director. Also, again, the school has a behaviorist who's so knowledgeable, and is there more than I am, and so he really kind of knows the way things work. And so we really tried to be thoughtful about this process. So if a teacher suggests a challenge, I think this kid would benefit from ot I have them because they are the connection to the parent. I say, Okay, well, let's chat with the director. Let's see what what they think, and then let's ask the parent. They need to know what's happening. It makes I recognize that I have little kids. I as a parent, I don't want just to think that like there's some professional, like Lurker, right? Keeping it, keeping track of my child without my knowledge. So if there is a concern, the teacher needs to go to that parent and say, hey, here that I'm concerned. And I'm thinking, Leah should come in and observe this child like I think that they should come in. And so I'll help the teacher kind of frame it in a way that's based on skills, like we can kind of hash out, like, what is it you're seeing? I really encourage teachers. I emphasize the fact, like, I'm an OT I'm not a diagnostician, you're a teacher, you're not a diagnostician. Let's be objective. Let's leave this objective up, like, let's put that away. Yeah, tell let's talk about what you're seeing, and then share that with the parent. And of course, it can go one of two ways. Sometimes the parents like, oh my gosh, yeah, I see that too. What is going on with that? Or sometimes parents will say, Oh, that's not just typical four year old. Oh, okay. Then Then let's look into it. And other times parents will say, No, that's not something I'm comfortable with, and that is their prerogative. And then a lot of times parents will say, I said it would go one of two ways. This is way more many, many ways. But sometimes parents will say, You know what, let me talk to the OT. And so I'm also available if a parent wants to give me a call, and I can tell them, of course, at this point, I haven't screened their child, but I can talk to them just generally about what I do as an OT and what a what these little observations look like. And so then I'll go in. I'll set a time with the teacher. Usually, I try to peek in at a time where they're inside the classroom, a time where they are outside, a time where they are maybe having snack or lunch, I kind of just peek in. I do a what I consider like an initial screening, and I do mind. Notes as objectively as possible. I say what I see, and then I kind of put down, oh, we saw this. It could be related to fine motor challenges, or it could be related to core strength. And of course, I say, like, we don't know this. This is just a screening. We might want to look more into this. And sometimes, for some things, I'll just give general strategies, like, sometimes I get a call, Hey, my kids, there's a kid who's drooling, there's a kid who's W sitting, there's a kid who's doing this, you know, these very specific things. And I have just some kind of general strategies that we can sort of implement at home and at school. Here's here are the next steps. So I offer all that, and then again, the teacher is the one to share that information. They have my notes, but they are the one who can have that thoughtful conversation with a parent.    Jayson Davies     I think that's the right way to do that, because, like you said, you don't I wouldn't want to get a call about my kid from, I mean, I don't have kids yet, but I wouldn't want to get a call about my kid from an OT that I didn't even know knew my kid like that's not how the system is designed to work. You have your, you know your routes of communication, so that's good. All right, you touched briefly upon parents just there. How do you help parents other than you know, helping their kids often in the classroom through RTI, but you said earlier, I think too, that you might provide some training or something, or how do you get your word out to parents at a more general knowledge base.    Leah Hiller     So this school is already set up. They have a weekly email, a newsletter that goes out to the families and I could kind of just slide into place like the every once in a while, the behaviorist will write a little article about what's going on and offer some strategies. It's like these wonderful just little tidbits that are there for the parents. Sometimes the coach will present some ideas about promoting play. There's all these different people in the community and in the school that already are set up. So that's really my forum right now, is that couple times a year I get to write a little blurb about, here's what I do, and then I think this year I got to I wrote a little something about travel over spring break. A lot of the OTS over winter break, a lot of the families were going to go away. And so I got to write some strategies for making trips, car trips, maybe making those a little more engaging for the family. I gave some executive functioning strategies, little things here and there. And I kind of just try to pop those in in a way where hopefully parents will read that the other way, I didn't necessarily do a formal teacher educate or parent education program, because, again, I'm the background, yeah, I want the teachers to do that. So basically, I went to a parent meeting, which is again, a forum the school already has set up, but I can introduce myself say, kind of what my role is at the school. And also, the biggest thing is that I'm around. I'm there once a week, that parents know when I'm there. And occasionally one will stop me in the hall and say, Hey, I'm concerned about this. Is this a thing like, Should I, should I ask the teacher about my child's pencil grasp? Or should I worry about which shoes my kid is wearing if they're falling down a lot? So again, these are really easy questions that I can quickly give a general response, or I can say, you know, that's a more involved question. Here's the process, like, go ask your teacher. They can find me if they think it's a concern. And I'm also available to the director too. If there's like, something kind of going on at times, she'll just sort of pull me in and say, What do you think? How could we help in this particular way? And so I can kind of be like a sounding board for that.    Jayson Davies     Great, cool All right? Well, I don't want to take up too much of your time. I know we could probably talk all night long, but I do want to give you a chance to let people know where they can get a hold of you, where they can reach out to you, because I know on your website you have a few things. You have your research article that you did on there, or at least a link to that, and it also gives a little bit about your your clinic that you run from home. So go ahead and give a shout out to yourself. I guess, where people can get a hold of you from?    Leah Hiller     I will give. A shout out to myself. So I'm Leah Hiller and my clinic is Hiller therapy. Hillertherapy.com is my website, and yeah, they can absolutely you can reach me through there, if OTS are preparing in services, if you're looking to do these kinds of things with schools in your community, I'm happy to talk more about it. I know for me, the process of becoming a school consultant has been such a fun learning experience, and I really feel like I'm making a big difference. My private practice is small, and I really feel like I'm helping those kids and their families at the same time. When I'm at the school, it's so many kids and families that I get to interact with, and so I think it's great. I really enjoy it, and I hope other people will maybe see it as an avenue that they can pursue too.    Jayson Davies     Great. Sounds good? Well, thank you again for coming on. I enjoyed even more talking to you today than I did. We were kind of preparing this a few weeks or a week ago or whatever, but that's really cool. I'm so glad I had had an opportunity to meet you a few weeks ago and that you're able to come on and share your experience with us. So thank you.    Leah Hiller     Thank you so much.    Jayson Davies     Definitely take care. I'll talk to you later.    Leah Hiller     All right, bye, bye.    Jayson Davies     All right. Well, that was Leah Hiller of Hiller therapy. I once more, want to say thank you to everyone listening to the otschoolhouse com podcast, and, of course, a huge thank you to Leah from all of us for joining today on the podcast. It was sure great having her on. So be sure to check out otschoolhouse com, forward slash episode nine for today's show notes and the links to Leah's website. Have a great day and enjoy the rest of your summer. Bye, bye.    Amazing Narrator      Thank you for listening to the otschoolhouse podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed.  Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 5 of the OT Schoolhouse Podcast. In this episode, host Abby Parana has a discussion with Board Certified Behavioral Analyst (BCBA), Steven Troyer. Steven and Abby have previously worked together and collaborated to help many of the same students meet their IEP goals. Listen in to hear Abby and Steven discuss behavior from both OT and BCBA perspectives. Links to Show References: Connect with Steven - This is a link to Steven's linked-in profile page in case you would like to contact him. ​ Rising Star Autism Center - RSAC is where Steven currently works as a program director. It is a center-based early intervention program designed specifically to address the needs of young children with Autism. The center is located in Bellevue, Washington 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! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the otschoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.    Abby Parana     Welcome to the OTschoolhouse Podcast. I'm Abby, and today on the podcast, we're having a conversation with Steven Troyer. He's a board certified behavior analyst and director at rising star Autism Center in Seattle, Washington. I personally know Stephen because I've had the pleasure of working with Steven at a school district in Southern California. He and I collaborated in order to address the needs of students in our setting, and he provided me with valuable tools and insight at that time, so I invited him on the podcast today in order to provide us with strategies for all of us to help us with our student behavior. Well, let's get into the conversation. Hey, Steven.    Steven Troyer     Hi Abby. How are you?    Abby Parana     Good! I know Steven from working with him in a school district here in California, so I've had a personal experience of working with him as a behavior analyst in the school setting, and so that's why I invited him on the show. Today, we're going to discuss just his background and your practice areas of expertise and what you like doing, or why you got into being a behavior analyst. So why don't you tell us a little bit about your background?    Steven Troyer     Well, I start I've been in the field for about 15 years now. I started out in an undergrad program in applied behavior analysis, where they kind of told us, in five years, you'll work with kids with autism. And being, you know, in my early 20s, I didn't honestly, really know what that meant, and I believe that the statistics were about one in 180 kids that were born at that time, according to the CDC, were affected by autism. And now we know that those numbers have drastically changed. It's like one in 60 or even the higher now, so the need for behavior analysts working with children with autism has greatly increased. So where I kind of started out, I worked for the Johns Hopkins Medical Institute doing research on language development for older learners with autism. So we had kids that were in their teenage years, so they did an alternative school placement, and that's what they went to school in our programs, as opposed to going to public schools. So that's kind of where I started out. I was there for about two years, and then I realized, since it was such a small program, I'm like, I want to work in schools, and I want to be able to work with other practitioners, and I want to be able to, you know, help more kids than what I was really doing in that program, although research, obviously, is very important, and it was really great to work for Johns Hopkins. So I moved to California. I worked in the Bay Area. I received my master's degree in special education from San Francisco State University, and so I got the teaching element of, you know, the education piece of it, and really knowing what classrooms look like, and putting in the family component into that as well. So there I was doing more consultation for middle school and elementary school aged children. I did that for about three years, and then I moved down to Los Angeles, and I was there, working for an agency, working primarily, again, in homes and in schools. I developed a school consultation division, where I had about 15 staff underneath me, working in school districts such as Inglewood, Lawndale, Redondo Beach, just various schools in the LA area. And I did that for about five years, and then when I met you, I got a job at the Ontario Montclair School District where I had worked with the special education director previously, when he was the director of Inglewood unified. So when I went out there, I was a BCBA program specialist. So I oversaw about 16 to 18, I don't quite remember, but classrooms of children with were considered to be moderate to severe and those were developmental disabilities across the board, medically fragile individuals. I was exposed to a lot more developmental disabilities than just autism. Autism, actually, there weren't that many kids with autism in our programs, which is a little bit different for a school program, especially for behavior analysts. So it really required working with PTS, otschoolhouse, com, and then also administrators, because, you know, as you know in that, in that arena, a lot of administrators aren't quite sure how to manage a lot of these problem behaviors and a lot of these. Students. And as you know idea, you can't just suspend students with disabilities because their behaviors are really disruptive. And in a mod super program, you have a lot of kiddos that can have some pretty disruptive behaviors. So that's where I you know, that's where I was at. And now I'm in Seattle. I have a private practice. I also had started my private practice in the LA area as well just providing consultation to different ABA based programs, or programs that wanted to be more behavior analytic in nature. So I carried a caseload of kids in home, you know, in the San Bernardino County areas, as well as different programs throughout school districts and things like that. And here now in Seattle, I am the director of an Autism Center, and so we provide intensive ABA, full and half day programs for children with autism. And I also have a private practice up here. So I do see clients in home in different school districts and that sort of thing. So that's kind of my background.     Abby Parana     Yeah. Oh, not a short background at all. That's just super extensive. It sounds like you've had a ton of experience working with kids on their behavior management skills.     Steven Troyer     Yes, I would say so.    Abby Parana     Yes, I would say so as well. And I personally had the opportunity to work with you, so I know you've done incredible things with schools and within the districts. Thank you. So when you're looking at behavior, you had mentioned just that you've had experience working particularly in the school setting as well as in the home setting. But when you're looking to assess behavior somebody, does that referral come from somebody having a specific need, or does a teacher just approach you and say, Oh, we're having trouble with this student in the class? How do you then go about getting more information or kind of what is your process for that?    Steven Troyer     Well, in the school district and in the home, it's a little bit different. So let's start in the home. So mostly now, with insurance kicking in, it is a medically necessary service, so you have a referral coming in from a doctor that this child has autism spectrum disorder and needs the support of a board certified behavior analyst or a registered behavior technician to work with the family. So that's kind of how that referral process works in the school, it would usually be a recommendation for an assessment plan. So an assessment plan comes through an IEP is held, and that's how ot services and speech services are all kind of determined, right? It comes from that referral process. So when I was working in the school district, you know, a lot of those referrals were triggered more from there was some type of legal binding situation happening, and so I would do the functional behavior assessment, where I would go into the classroom and observe behavior, do file reviews, that sort of thing, and make recommendations from that standpoint, but it was more, you know, the referral comes through the IEP process versus through a medically necessary service, like if you needed to go to the doctor and you needed a referral for some type of treatment, you get that through the same referral process. ABA is no different now.    Abby Parana     Right, So then, did you ever provide strategies like in the classroom for with the teachers, or just where you could go in, and maybe it's not a specific student, but maybe just general classroom management strategies for them, or coaching.    Steven Troyer     Yeah, I mean, that's mostly what it is. So my philosophy is kind of building capacity within the team. So oftentimes we think behavior is very isolated to the individual, which is mostly completely off. So if you're going to go in and just try to treat that student. When you walk into a classroom that is completely chaotic, well, that students, reactions or behaviors are often a product of what is happening within the environment. So when you have better systems in place, just with any neurotypical classroom, when it is organized, it is structured. There are clear expectations. People are trained. Then obviously behaviors are at a minimum, versus when you walk into a classroom where there aren't behavior management systems in place, it often gets very difficult. So I will always know kind of the level of capacity from that team if they are giving me all of these behaviors and reactively, reactively, how do we manage this? What do we do when this happens? What do we do when that happens? That lets me know that team is not in the right mindset. Because the first thing I will say is you need to spend more time being proactive. You need to plan. You need to set this environment up for success. So one. Behaviors are occurring at a lower rate, the team is actually able to teach, and more productive things are happening, so you have more positive behaviors to reinforce, versus, oh, this kid is doing that, and this kid is doing that, and this could, it's just like, you know, it's like, whack a mole, you know, like you're just trying to put all of these things out. And the team is frustrated and the kids are frustrated, and it's just this super reactive situation, which we see over and over and over. So you have to front load and put the time and invest the time in to prevent behaviors, because lots of times what we would call as like that classroom for that child becomes the signal for chaos. When I walk through those doors, I already know I'm gonna get tons of tension for this behavior, or if every time the teacher assigns me something, I just tip over my desk, and now I don't have to do it. So those patterns of behavior are reinforced. And so if we just continue to do the same old thing. The behaviors never get better, and so you have to proactively approach those behaviors from a different from a different standpoint for success.    Abby Parana     Oh, definitely. Oh my gosh, that is probably the key to successful, having the students be more successful in the classroom. I'm so glad you touched on that, because that's part of that whole when you gave I used to notice that you would give teachers and staff data collection for filling out forms or chart of ABC data. Would you mind touching on just what ABC data looks like? And that seems to kind of, that's a great segue into that, that whole description of, kind of analyzing what the behavior is, and maybe not analyzing, but looking at what the behavior is and what the staff is doing in the classroom, how important that collection is.    Steven Troyer     Yeah, well, the first thing that you want to know, even aside from ABC data, that's very important in trying to figure out the function or the motivation of the student and why they are doing that, you need to have baselines. So oftentimes, if you go into a frustrated staff, they're like, I'm like, they will use be we'll use tipping over the desk as a behavior. And you ask the team, oh, it happens all the time. Every second. It never stops. Well, we need to actually have information. So what I will do, as opposed to having staff collect data the whole time, the whole day, all of the time, I'll say in a 15 minute window, give me the frequency of times that it occurs, and take five different 15 minute samples, time interval samples, so then we can average it out, and five samples of behavior occurs on average four times in that 15 minute window. Okay, that's pretty frequent, but it's way more accurate than it just happens all the time, and I just never stops, and I'm super frustrated the ABC component. The ABC stands for antecedent behavior in consequence. So the antecedent is what happens right before, and this isn't, oh, well, Mom said he wasn't feeling well last night. So you know that that's why he's doing it. No, it's not, um, you need to what did you deliver a demand. Did was the kid playing, and the other student took something away from that individual, you know, was the individual looking for attention? Were they attention? And then you also have the sensory component. If the child's alone, no demands are placed, nothing but the behaviors happening. That could be a sensory component, but oftentimes we add all of this other information, and it's not truly what it is. An antecedent is typically, demand is placed. A child is denied access to something. They're seeking attention. They didn't get it. But I flipped the desk over, and now someone tells me to stop. Oh, I got the attention right? So you really want to look at what those key components are, and then the consequences. How did we react? Did we give them attention? Did we tell them? No, and this is a very powerful tool, because as a behavior analyst, I already know in a very brief observation of what's happening, but you also have to build capacity with that team for them to see what is happening. So I go, I'll often go in, I'll kind of know what the patterns of behavior are. And once the individuals from the team start collecting the data, and you start talking to them, I remember one classroom that you and I both worked in very extensively, and I had them collect the data, but I didn't really explain what, because I knew that that would then give drift to what they were actually trying to say. And so when we went in, it was like, Oh, we never give attention. And out of 30 intervals, 27 out of 2033 27 out of 30 someone were. Responded with an attention component. So that's a really strong reinforcer. So at that point, you can't now say you're not giving them attention, and that the behavior is not maintained by attention. So now our treatment is going to look very different than, you know, than what they have been doing. You've got, you've got to stop that attention component for it, or in denied access, meaning the student isn't given something that they want right at that moment, you might have to do some front loading. You might have to say, Hey, you're not going to be able to have this right now. But first we're going to work on this worksheet, and then right after, you can earn it, versus just saying, Nope, you can't have it. And then the desk gets flipped over. So the antecedent gives you, how do I plan differently? The consequence component is, how do I respond differently? And you know, based on function, the way you respond, it always that you know. The saying is, is behavior goes where reinforcement flows. So if you're going to reinforce that behavior, then you already know that that behavior is going to continue to occur. So it is a choice by practitioners, too. And sometimes, I always say, we don't make it about you. Don't make it about the staff. It's about the student. And if you really want to treat that behavior, and I've had spitting behavior, you know, where kids spit and the cheers like, I'm not going to condone that. I'm going to tell them to stop every time we're doing it for attention. So you need to think outside of the box and treat that behavior based on the function, not on your personal views of spitting, because if you three months down the road, we're still going to be having the same conversation. And that gets tougher with teachers that have been in the field for a long time, because oftentimes you get why I'm going to do it this way. Well, you can do it that way, but I'm coming from it. I'm approaching it from a scientific way. So scientifically, I'm going to tell you how to better manage that behavior. At that point, it becomes a choice on whether or not you want to handle it that way. But I will give you the scientific approach and what you should do.    Abby Parana     So sort of taking out that subjective like, kind of removing yourself emotionally when you're collecting that data, trying to remove, like, what you feel as the professional, you feel like, oh, they should be doing it this way. They shouldn't do that. And kind of removing yourself from that and just looking at it totally objectively and saying, No, this is what the data is showing. This is what they're doing it for continuously, and then trying to make sure that you understand that component. So that's you build capacity in that respect, saying, like, Oh, don't so much. Look at it from your feeling on the subject, but looking at it from, do you want the behavior to stop? Do you want to change the behavior? And then taking more that approach, and this is how you do it, versus Oh, that's not right, and I'm going to handle it this way.    Steven Troyer     Absolutely. I mean, as behavior analysts, we only make database decisions, which makes us a little bit different than some of the professions. Oh, definitely. You know, you have to remove yourself from that and the date. There's no arguing the data. And so if you see those patterns of behavior, then you I always say knowledge is power, and so you make a database decision, you make an informed decision, and you do what's right for that student, not what you feel, because you'll also see an ABC data like I will have already went in and made my observations, and people will write down in The consequence, what should they should have done?     Abby Parana     Mm, hmm.    Steven Troyer     Okay, know what you should have done, but that's not what's happening. So you have to record it from a very objective standpoint and what actually is happening, because that's true data that's going to make that's going to make better change, it's going to make stronger, more durable change.    Abby Parana     Right? Because I think the other thing I've seen a lot is they'll record the behavior like people record the behavior consistently, but not the antecedent or the consequence, and it seems like just this tracking of what the behavior is over time, but there's nothing to show what was done before or after, or what the consequence was, or what the antecedent to the behavior was. So getting all those A, B, C, seems really important.     Steven Troyer     It's very important, yeah, because otherwise, then you're just really taking a frequency and you know the behaviors happening, because we're all seeing it so great. You know what's happening. Yes, you need to know the frequency or the duration or the rate of the behavior. Those are all very important. But the antecedent and the consequence is going to give you, and I'm not going to get too technical, but that operant conditioning, or those variables that are going to make. Maintain the reinforcement history of that behavior.    Abby Parana     Right? And I mean, I've been guilty of it too, even when I've been in OT I will jot down like, oh, this student did this. But if I don't cue into my mind and think, Oh, what was I doing right before, or what did I do right after, that behavior occurred, and then I see it show up again during therapy sessions. Then I kind of know, Oh, I gotta check myself. What am I doing before and what's happening right after?    Steven Troyer     Absolutely, because behavior is an interaction with the environment, right and you are a part of that environment as the teacher or the practitioner, you are a direct, direct result of how that behavior is maintained through reinforcement. So you have to be very mindful, and you can't do the same thing with every student because of students behavior, even if it looks the same, the topography, topography is the same and it looks the same may have a different function. You may be doing, if you're the student, you may be doing it for attention, but I may be doing it to get out of work. So you can't approach it from the same standpoint. It's whatever the data reveals for that student. So it's very individualized, which, in special education, we're supposed to be providing individualized education and programs, right? So you can't cookie powder it, you can't blanket it. You really have to make sure that it's individualized.     Abby Parana     Oh, definitely. So what I'm thinking to myself, what are like I know some of my mistakes that I've made when I've come to behavior management with students that I've made, or that I've pulled from classes, or that I've worked with in occupational therapy, and, like I said, sometimes it comes into that self check where I have to take a step back and be like, Okay, I've seen this behavior a couple of times, and I self check myself and then look at it. Try to look at it objectively. What mistakes you see when we're managing classroom behavior, or when we're managing behavior when we're working with a student, what would you say? Like, maybe, like, one or two of the biggest areas that you see most commonly.    Steven Troyer     I think one of the biggest things is just not really having the information as to why. You know, as behavior analysts, everyone's like, Oh, it's like the F word data. You know what I mean? Like, just knowing what in any behavior analyst, any good behavior analyst, is going to say, you really have to show me the data like you really have to have the information. I think that's really the number one standpoint, because otherwise, you're looking through it from a subjective lens, and you're so close to it, right? If you're the teacher, you're dealing with it every time. By the time the behavior analyst gets there, you're like, oh my god, get this kid out of here. I've dealt with it long enough so you have to have that level of objective information to really approach it. And then I think the other second piece is, so many people approach everything from a reactive standpoint, how do I deal with it when the behavior happens? Versus what do I need to be doing to prevent the behavior from happening? Because when you are in that reactive state, the team is way more likely to error. You're more way more likely to deliver reinforcement when you shouldn't. You're way more likely to let a kid escape when you shouldn't, versus like, oh, well, the behavior has reduced. Now I'm able to teach. Now I'm able to get opportunities for reinforcement. Now I'm creating way more positive interactions for the student, between myself and them, and them and their other, their other, the other students. So from a social standpoint, you're also just creating a better environment, a more reinforcing environment, research and statistics will show over and over and over that environment to provide more positive reinforcement, have higher outcomes, have better outcomes. That's not even debatable, that's the research. So even if you go into a neurotypical classroom and you have a teacher that never gives any positive praise, you're more likely to have kids acting out, because, well, if I act out, you're going to give me attention, right? Versus if that teacher is just doling out reinforcement here and there, and it's contingent on appropriate responses, I mean you, reinforcement is increasing positive behaviors. When you provide reinforcement, those behaviors are going to increase or maintain, and that's what you should be doing if you're only using punishment procedures and you're trying to reduce behaviors that can be really problematic.    Abby Parana     Right? Oh, absolutely. Those are that's actually amazing tips. That's fantastic. Thank you for sharing that and so well, actually, that's a really great so what are some of the simple positive behavior? What's an example of some positive behavior supports, I guess, or if you have time for a couple examples, but just giving kind of what that. Scenario might look like.     Steven Troyer     Well, when you're looking at a proactive standpoint, you my biggest things is it's a lot environmental. So if you think about it for yourself, if you go into a work environment and things are chaotic and you don't know when you're supposed to be working, where you're supposed to be working, what you're supposed to be doing, when transitions are happening, you're probably not going to produce the behaviors that you're capable of doing, right? So one of the big things is it's just having a structured environment, you know, knowing, working with children with autism that visual supports are helpful. A lot of us are visual learners. You know, I've had people that said, Well, I'm not going to do a visual schedule for a kid, and I say, Well, let me take away your calendar then, which owe all of the your daily planner of all of the things are happening, it's no different. So really, having supports in place that promote appropriate behavior, and a big piece of it is as a behavior analyst, one of the key things that I always look at is what is the student's level and ability to communicate. So many of our kids do not have communication systems in place that are functional for them. Some of our kids are non talkers, and so if you can't communicate and you get frustrated, what happens a behavior access happens, meaning I flip a desk, I yell, I scream, I hit somebody. So communication systems are important, whether that be sign, whether that be spoken word, whether that be an augmentative, you know, an augmentative system for that child, you really need to that's one of the key things that you need to look at is, what is this student's ability to communicate with the world around them? And then, you know, I think it's really important too. And what I see a lot in school systems is we really overshoot the individual's ability to do something. So again, when we go back to baseline data, if you've never seen a kid do it, you have to teach them, yes, if it's 0% that child doesn't know how to do it, yeah. So, oh, I thought it was a classroom. I thought we were teachers. I thought we were teaching here. So you have to teach them and reinforce that behavior so that they're actually able to accomplish the things that you want to accomplish so many times they see frustrates, oh, I just can't do it. He won't do it. You know, I always say, if you if you've never seen a kid do it, it's a can't do they can't do it. If you've seen a student do it once or twice or a few times, it's a motivation issue. So you really need to look into the fact of that individual getting reinforcement for actually engaging in that behavior. If the kid does it and you don't reinforcement, it's not going to increase. I mean, that's science.    Abby Parana     Well, and we call, I mean in occupational therapy and probably in teaching too, I would think we look at like the just right challenge. So finding, you know, a task that's motivating for the student to perform, but also that's within their let their independent level, that's it's a challenge to them, where it's motive motivating, and they're gaining a skill, but also that they're able to accomplish it, because that's when I've seen a lot of behaviors come out, as well as when they're presented with something like, for instance, a child doesn't understand that a marker makes marks on paper, but they're forcing the kid to hold it and put a mark on the paper, and suddenly they're flipping a desk or throwing the marker and running out of the room. Well, they don't understand exactly what that utensils used for, and that's part of teaching. Is that kind of what I mean? Am I hitting that part?    Steven Troyer      Yeah, yeah. And you want to think about the approach for that. So, like that, that example that you gave from a mark, you know, using a marker. So they're going to use this utensil, you probably don't want to start them using a utensil doing math problems. You might want to start from the approach of, it's something fun. I learned that this will make a mark on the page, and then slowly you shape that behavior in whatever that trajectory is. Okay. Now we're going to sit down and we're going to do this. I think of it a lot on very basic things, and I see this with really young children coming into my center that have no learning readiness skills. Never really been in a learning environment. They don't know. And we, just my staff, expect them just to sit down and start doing things, yeah, and it's like, okay, well, you know, we're gonna start a goal of just sitting, and that means sitting at a table with preferred items. And we reinforce and we reinforce. So we reinforce now, okay, well, first you can do some playing. Then we're going to move to something else that's maybe not as accurate or not as fun, and then we sandwich it with something else, and we make sure that clinically, those amounts of times change to the point where now we can have that individual sitting and working longer. So when. Think about remediating problem behaviors. You You don't start, you don't go run a marathon with never even getting on a treadmill or even ever running a few miles, right? So you've got to put that practice in before you're going to get your terminal result. And so many times, practitioners try to start in the terminal. I'm going to get to the finish line this week, and it's like, well, you've got a lot of legwork to do, and you really need to think about that developmentally. When you're working with really young children. You know, you don't have two and three year olds sitting for long periods of time at a table or marking with a marker, doing tracing and writing their name and things like that. So you really have to think developmentally, and then you need to individualize it for that kid, because that kid develop, you know, chronologically, maybe four, but developmentally might be one, you know. So then you have to scale back and really just gage it on a daily basis. That kid may come in, and some days he can do it, and some days he can't. But if you've seen him do it a few times, you know, then it's a motivation. It's not a skill deficit. He can do it. You just have to think strategically how you're going to get them to do that. And that's what makes people good teachers and makes them good clinicians. And so when you're able to do that, you're able to do it from more of a clinical standpoint versus just this is how it's done. This is how everybody does it. This is how you know you teach, and I think in classrooms, that's people get to the traditional standpoint, or how they how teachers feel kids should learn. Where we have kids are very different than they were 2030, years ago, you know, and have more intensive behavioral issues, and not to say that they didn't used to but you know, 2030, years ago, we didn't manage behavior like we do now, either. You know, very true. There's some pretty horrendous stories out there of how behaviors were managed and hopefully not still in that way. But in the past, people did a lot of really crazy things in managing behavior, where now, as clinicians, we know we're way better than that. We know that, you know, we shouldn't be using force. We shouldn't be using, you know, just really only punishment procedures and things like that. We want to use motivation, and we want to get the kid a part of the process. So it's a learning it's not a forced situation, right?     Abby Parana     Right, More self directed.    Steven Troyer     Absolutely. Yeah, because generality and generalization is a huge part of applied behavior analysis. So if it only happens when I'm there, it only happens when you're there, and you'll hear it a lot in classrooms, right? You'll have a paraprofessional, oh, well, he'll only do it with me. He'll only, you know I'm the only one, and when I hear that and like, if you were truly trained and you were clinician, that's a bad thing, because you have not taught that student to generalize those behaviors, and that is not a good thing, because guess what? Five years down the road, you are not going to most likely be with that kid. When that kid is 20, you're definitely not going to be with that kid. So that kid is not able to engage in those behaviors in the natural environment. You haven't done anything. You've done a disservice to that student.    Abby Parana     Behavior. It kind of fading. So like building capacity with the staff and then building have them starting to learn how to build capacity within the child themselves.    Steven Troyer     Absolutely, absolutely and the spirit of supporting that piece at home. So this is what we do in the classroom, because that child also needs to be reinforced for that behavior at home as well. So that's another setting that they're able to do it, and then when they're in the community, you know? So that way they're fully able to access their world, right? Because that's, that's what we're here for, and not just, oh well, when they sit in Miss Betty's class at this table with this book, he can sit and read for 20 minutes, but he can't do it anywhere else. Well, that's that's not good either.      Right? And I've made that mistake as an OT having them be able to do something in occupational therapy, and they do great, and then in the classroom they're not doing it's not the carryover skill that I'd like to see. And then that tells me kind of the same thing, I have certain supports that I should be collaborating more with the teacher on or other staff on that I've been providing an OT that should be in the classroom and then should be reinforced throughout.    Steven Troyer     Absolutely and like from the behavior analytics standpoint, we call that stimulus control. So you have that stimulus control with clients. How you do stimulus control transfer is you pair reinforcement with other people, other objects, other settings, other materials. So when you're able to do that, then that child is getting reinforcement from all modalities in all, all different areas. So then that. Behavior is durable across settings, and that's when you're a good behavior analyst or you're a good practitioner, you realize that.    Abby Parana     Oh well, that makes sense, because now I have a term to go with, what?    Steven Troyer     Signals control.    Abby Parana     There's, there's always like, that terminology. I'm like, Oh well, when I'm doing something.    Steven Troyer     When we talked about, when we spoke about the classroom, that's always chaotic, and that's almost the trigger. That's also that that classroom has control over that client, that student's behavior, that I can do whatever I want in here, and it's wild and crazy. Where the teacher that when you walk in, I remember the teachers I grew up with, you knew when you walked through those doors, you stand up straight, you sit down, you quiet, because that teacher has stimulus control over that classroom, and there's patterns of reinforcement and punishment. It's not to say that we never use punishment, because the technical term of punishment is decreasing behavior. Do we decrease behavior? Absolutely, we do. Punishment isn't in just what we think, Oh, spanking or sending the kid to the office, punishment is really any procedure that reduces behavior. So that's part of it too. Is like really knowing the terminology everybody calls negative reinforcement, and they think that that's punishment. Well, I, as a behavior analyst, I always kind of laugh people like, Oh, they're using negative reinforcements. Like, no, that's, that's straight up punishment. They're, they're trying to reduce the behavior. It has nothing to do with reinforcements. Right? And I think what is negative reinforcements? When you take something away from the child? Increase the behavior? Yeah, So I would say negative reinforcement is your unsung hero, because everybody thinks, oh, well, ABA, that's giving stickers and high fives, and that's your positive reinforcement. But we know those kids that they don't want to do work, they they want to work for a break. I will remove the work to increase the amount of time that you will stay on task. So you do this for five minutes, you get a five minute I will remove this, and you get a five minute break. That is negative reinforcement. You're typically it's something that the individual views as aversive. Typically. Work for kids with disabilities is not fun, and that's why you get a lot of escape maintained behaviors like, well, if I flip the desk, then I'm not doing my work anymore, right, right? So negative reinforcement, I always say, is the unsung hero of reinforcement, and people like there's no reinforcers, this kid won't work for anything. Heck, yeah, you will. He'll work for a break, right? Right? All he's trying to do is break all day. You're letting him break all day, so your outwork for a break, reinforcing his behavior over and over and over. Just set it up in a contingency that's more effective. Even if the kid works for 15 seconds, you can reinforce that, oh, now you can go because 15 seconds can be 30, then a minute, then five minutes, then 10 minutes, then a half an hour, and before you know it, the kids right back on track, working for breaks, great.    Abby Parana     And sometimes I'll even work for a break.     Steven Troyer     Oh, yeah, we all work for breaks.    Abby Parana     Yeah. Well, Steven, I have kept you past the time I said I was going to, but I really appreciate it you've given I just feel like this has been super beneficial, not just for me, but for anybody that would want to listen to it. I think that this has, I don't know, it just it's great to talk to you about behavior, because it seems that a lot of the difficulties that we experience working with students who have behavior difficulties in the classroom or in school or during occupational therapy, speech, PT, whatever it is that you put it in such a way that it seems highly manageable, where we can, if we remove ourselves, and we can just take a step back and take a deep breath and look at the situation, it's easy to kind of see those little markers in the behaviors.    Steven Troyer     Yeah, I would say so. And I think, you know, from the school district standpoint, you know, like, at like, what I would see a lot with you guys is, OTs, a lot of behaviors are thrown at you guys because they're like, everyone's like, Oh, it's sensory where, yes, very few times, in my opinion, is it sensory oriented, and patterns of behavior get formed through how we react to the behavior, right? So it's that reinforcement. So even if it started out as a sensory behavior, but we started managing it in a certain way, it's no longer maintained through a sensory standpoint. Often it's how we've shaped that behavior up. And if we feel like every time the kid wants attention and we tell them to stop it, it's not a sensory issue, it's an attention issue, and we to make the change. Oftentimes, we'll, you know, I'll go into classrooms and it's all about the student changing their behavior when often, that's not where we need to start. We need to start on how stat we need to change staff behavior and attitudes to. Towards that behavior, and once you can make that change, and people realize that you're able to have way more success.    Abby Parana     Oh, for sure. And that's where I think, like OTS collaborating with behavior analysts and really looking at the behavior part, because I noticed sometimes I've made the mistake as an occupational therapist of coming at it from that, oh, I need to work on the self regulation. They need this in order to maintain their regulation for the classroom. But then I end up providing almost a reinforcement for the behavior that we don't want to perpetuate. And I think that that collaboration between the behavior or the behavior analyst and an OT could be really beneficial to the child, because the last thing I'd want to do is provide a support to the classroom that's ultimately not a support necessarily, but reinforcing behaviors in a child.    Steven Troyer     Yeah, and it's not to say that they may not necessarily need that, but it's the timing of it. So if I start flipping desks, and then contingently, I get to go play on a scooter board out in the hallway, then I am teaching that kid, all I have to do is flip a desk, and now I'm out in the classroom or outside in the hallway on a scooter board, having a great time, right? My understanding of sensory in sensory strategies is that the student should be somewhat able to if they're not seeking that out, if they're not requesting that, or they're not really asking for it as a support, then you might want to take a look at that, you know, so it may be okay. First off, it doesn't mean you can't go get that sensory input, but first you need to complete that, contingent on completing that, even if it's a very short period of time, then you can go access that support. But if you just start flipping desks, and then you go out and you get to get on your scooter board. Is that is the flipping desk going to continue to happen? Sure it is, of course it is.    Abby Parana     Right, because we're taking and sometimes it's like, oh, the scooter board is a great fun activity. I mean, a lot of what we do is play, so I think definitely getting sensory breaks in, but not making them, you know, contingent on, oh, we saw this behavior happen, but it's built in throughout their school day, whether it's after they do work or after they've completed an assignment. Then they get to take that break, and if they want to seek sensory input during that break, that's fine.    Steven Troyer     Yeah, and it, you know, if they request it. And, you know, I've worked with a lot of kids that would be consider, you know, that were non talkers or not, what people would say, oh, you know, a lower functioning on the autism spectrum where they absolutely, they have those sensory needs. It's not to deny that at all, but it's contingent on, hey, on this amount of work and slowly increasing it to where teachers are, like, oh my gosh, this kid will sit and work for 45 minutes, and then he actually earns his break. And he can engage. He can grab whatever sensory tools that he needs, and he can use those for 10 minutes, you know? And now that behavior no longer impedes His instruction, right? It's just a planned break that he's well aware of. You need to make sure that he is or she is able to access it. So it's not to say that those things aren't needed, but it needs to be done in a planful way so that it's not like, well, I flipped desk to get scooter board.    Abby Parana     Right. And I think that almost teaches self regulation in a way where they have to maintain their attention. And they are taught that, like, there's a time frame that they have to maintain their intention, and then, oh, I get to get out, you know, my wiggles, or my, you know, the the bottled up kind of self regulation difficulty, and they can have an outlet for that, where they get to get that input or or in those cases, just release that excess energy and then come back to work, and it's almost teaching them to keep that kind of in check on a schedule.    Steven Troyer     Yeah. And the thing about it is, is when you have that more in check, especially when you're dealing with kids that are a little bit older, is that socially stigmatizing piece of it a lot of things, you know, if you have a ninth grader out on the scooter board going down the hallway, what does that look like to his peers, his neurotypical peers, you know, but if it's planful and it's like, oh, at 1pm you go to the multi purpose room and you do that, and they know that then that also is a time for them to be able to engage in that without any judgment, without any other kids looking at them and that sort of thing. And we really need to, we need to recognize that, because even though this may be a freshman with a developmental disability, when you think of it from an inclusion standpoint. You also want to make sure that you're being mindful, that you're not, you know, providing supports that could be viewed as socially stigmatizing and off. I mean, when you get into that level of talk with classrooms, it's like when, you know, we would go into sixth grade classrooms and everything is like Blues Clues. And it's like, well, our six go into the gen ed sixth grade classroom are, is there Blues Clues all over the billboards? Right? Not at all. No. And so that's where we have to make sure that our supports also come from a standpoint where we're not having that individual stick out like a sore thumb, especially when they have behaviors and things that already kind of put them on that level. As practitioners, again, we need to be better than that.    Abby Parana     Right? And that like, and I would say even when we're looking at because sometimes OTS will recommend, you know, an oral chew, where they can chew on something, and kind of being mindful of that, that that might be difficult. So recommending other things, like sports bottles or chewing gum or something like that, to get the same input without being or making sure that we're age appropriate. So Exactly, yeah, but I really, I think that it's important to for OTS to collaborate with behavior analysts 100% definitely, because just working with you had given me so much insight into behavior and how it played into my practice as an OT working in schools, and I've become much more aware of trying to figure out what is the cause of the behavior, versus just assuming it's always a sensory difficulty, or it's always something related to sensory and making sure that I talk to all players on the team, including if we're so blessed to have one a behavior analyst, or somebody who's looking at the behavior, or even just taking a time out to collect ABC data myself to make sure that I'm not reinforcing that behavior, if that's what it is. So I really appreciate you coming on the podcast, and you've given me a great insight, and hopefully we'll get to chat again soon, while we chat.    Steven Troyer     Anyways, yeah, I can talk about behavior all day, every day. So yeah, anytime, anytime you need anything, just let me know.    Abby Parana     Thank you so much, Steven.    Steven Troyer     You're very welcome.    Abby Parana     Thanks for listening to the otschoolhouse com podcast, and thanks to Steven for stopping by to discuss behavior with me. If you like what you're hearing and want to follow us on social media, go ahead and check out our Instagram and Facebook at otschoolhouse com, and be sure to hit subscribe if you're enjoying listening to the podcast.    Amazing Narrator     Thank you for listening to the otschoolhouse com for more ways to help you and your students succeed right now, head on over to otschoolhouse com Until next time class is dismissed.    Abby Parana     and I'm gonna let you go, because we are over by like, 20 minutes. I think I told you, I was like, Oh, it'll just be 30 minutes, but now it's going on three hour minutes. Yeah, almost an hour.  Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Click on your preferred podcast player link to listen where you enjoy podcasts Welcome to the show notes for Episode 90 of the OT Schoolhouse Podcast. During the pandemic, teletherapy found its foothold as the world shut down and continues to now reopen. However, despite schools and businesses reopening, this is just the beginning of the story for occupational therapy and the doors that have opened in the world of teletherapy. In today’s episode, we are talking with Occupational Therapist, Tasha Holmes, and Speech Pathologist, Kristin Martinez, from PresenceLearning. PresenceLearning is one of the largest providers of teletherapy services and in this episode, we are going to learn how they adapted during the pandemic and where they see teletherapy headed as the world continues to become more emerged in technology. Join us and we explore the future of teletherapy with Kristin Martinez, M.A., CCC-SLP & Tasha Holmes, MOT, OTR/L Links to Show References: Learn more about Presence Learning at https://www.presencelearning.com Transcript SUMMARY KEYWORDS students, tasha, support, services, telehealth, ot, therapists, therapy, kids, kristin, platform, ots, activities, piece, pandemic, working, people, helping, learning, slp 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, everyone, and welcome to this week's episode of the OT schoolhouse podcast. Thank you so much for being here today. My name is Jayson Davies, and I'm here with you every other week, if not every week, sometimes to discuss occupational therapy in the schools. So today, we are here to discuss how teletherapy has evolved over the past few years, especially with the pandemic in the past two years, everything has changed. I think just about everyone listening right now has experienced telehealth or teletherapy in the past two years, and I cannot believe we're coming up on that two-year, March 13 date if I remember right when things started to shut down. But aside from looking at the past, we're also going to look into the future a little bit and how teletherapy is going to move forward, how it fits into occupational therapy right now, and also moving forward into the future. In fact, one of my favorite questions you're going to hear in a little bit is how the world is changing. You know, Facebook changed its name to Meta this past few months. And well, I just can't wait to see what teletherapy brings within the next few years, it's gonna take a little while to advance that much. But it's going to get crazy where we go. So to get some of these insights I'm excited to have occupational therapist, Tasha Holmes and speech and language pathologist, Kristin Martinez joins us for this episode. Tasha and Kristen are both employed at a company called Presence Learning where they do provide occupational therapy online teletherapy, as well as speech, and a few other services. Kristin and Tasha are not practicing for presence learning at this moment. But they do support other occupational therapists who do practice through teletherapy. And so they are going to have several insights as to what therapists have difficulties with and how they are helping them get past those difficulties and get past some of those, those mind thoughts that might be limiting their ability to progress. They're also going to share with us a little bit about the presence learning platform that they use, which is different from zoom or Google meet, and it allows them to do more things and be more interactive with the clients that they serve. So now that there is a light at the end of the tunnel with a pandemic, hopefully, I know Omicron is kind of poking its head out. But hopefully, we can get beyond that. We do want to see how teletherapy is going to continue to move forward. So please help me in welcoming Tasha and Kristin to the OT Schoolhouse podcast. I hope you enjoy this interview. Hello, and welcome to the podcast. Thank you so much, Tasha, thank you so much, Kristin for being here today. I want to let you all kind of get started and just talk about your role at presencelearning and kind of where you fit into the therapy world. And so I'll actually go ahead and start with Kristin, let us know a little bit about yourself. Kristin Martinez Okay. Thanks, Jayson, thanks so much for having us today. So I'm Kristin Martinez, I am an SLP by trade. And so I have been an SLP now for over 20 years, which feels a bit shocking. But here we are. So I was an on-site, school-based therapist and in private practice here in my local area for about 13 years before starting with presence learning in 2013. So I first started in teletherapy, not knowing any single another person who was doing teletherapy I knew nothing about it. But I was at a point where I was taking a leave of absence from my district physician needed some more time to support some family needs for a bit. And presence learning reached out to me because they were needing therapists in Colorado. So I thought, Okay, I'll try it. And about a month in just realized how much I loved it. It was a really great fit for me. And so I made the permanent transition. So I was a provider who provided teletherapy services, therapy evaluations, you know, it's really supporting all the full scope of work for SLPs for a couple of years, and then came over as an employee for the company and spent a few years managing the clinical side of accounts working really closely with school districts supporting our providers. And then the last couple of years, I've been clinical director for SLP and OT services. Right that's, that's my, my, my journey. Jayson Davies So that means all the OTs and SLPs. They kind of get to work with you a little bit to hone their teletherapy skills. Kristin Martinez So my role now is not as much day-to-day direct. You know, we've been lucky enough to have quite a bit of growth in our company. And so we have whole teams of clinical account managers who really support day to day needs for our therapists and Tasha and I, well, we do engage with providers, we also do a lot to support resources and bringing in programs and, you know, some of the high-level clinical pieces in order to, you know, expand what we're doing is a teletherapy company and to expand what is available to our therapist, but I'll let Tasha speak a bit more to her role and how she engages with our services and therapists. Jayson Davies Yeah, absolutely. So Tasha, yeah, go ahead, introduce yourself a little bit and share your role within presence learning. Tasha Holmes Sure, so I am Tasha Holmes, I am an Occupational Therapist, I've been an OT for almost 18 years. I've done pretty much at all hospitals, nursing homes, home health, pediatrics, geriatrics, the ages in between. So I've, you know, had a pretty well-rounded career, my husband used to be active duty in the Marine Corps prior to retiring. And so with the moving around, I've done traveling therapy as well. But you know, once we got married, and we started a family, it became a little bit tricky to keep moving and continue with my career, you know, I loved being able to work somewhere, but then you're there, you're invested, and then it's time to go. And so when I, you know, found out about presence learning, it was an excellent fit for me. At this point, I've worked with presence learning in three different states. And I've been able to, you know, just that continuity of having a place where I can, you know, hone my skills, learn something new, but continue to do that have that work-life balance, is the reason why this has been the longest company that I've been with, in my 18 years as an OT, like Kristin, I started out as a provider, so you know, doing evaluations and assessments, working with families and schools. I did that for about six years. And then this past year, in October of 2020, I became an employee. And so as Kristin was stating, we do have account managers that are licensed therapists, and they work directly with the districts and make sure that the day-to-day needs are met via the providers. I did that for a year along with another position where I was able to support providers directly through office hours and workshops. And now my position has changed a little bit more. I'm a Clinical Quality and Resource Manager. That's my official title. But I'm also the subject matter expert for OT, for telehealth at the company. And I think that's a really important role. Something that really sets you to know, us apart is that not only do I get to help support providers, but I also helped to give input as to how things are being shaped on the OT end to support providers. So that way, they're delivering the highest level most ethical services that they can provide for their students. Jayson Davies That's amazing. And I must admit, you know, it's not very often that I get to sit down and have a call with either an OT or speech granted, we have both today that have gone into a role of leadership, it's very hard within the schools, even outside and other settings, clinical practices, and, and in a hospital, for OTs and speech therapists to get into a leadership role. It just doesn't happen, especially in the schools, you know, we don't have a credential in most states. And so we're not even able to, but I just want to congratulate both of you for being in a role where you have had that opportunity to really grow as a leader. So that's, that's really awesome. Kristin Martinez Yeah, thank you. Yeah, it is really exciting. And it is one of the other pieces that really drew me, kept me with presence learning once I learned about the company, and is that I did see opportunities where I could still be involved with what I loved as a speech-language pathologist, but also work as a mentor and as a coach and working with other, you know, people who are from completely different disciplines than myself outside of education outside of, you know, a clinical world. But really, all of that works to shape services for students. So it has been a really great opportunity. Jayson Davies Yeah, that's just awesome. All right. So I want to, Tasha I have a question for you. Obviously, as an occupational therapist, we always have some difficulty explaining our role as an OT, no one knows what we do. I think even fewer people know what we do when it comes to teletherapy. And so I want to ask you if you're at a party or at a gathering, whatever it might be, and someone asks you, what do you do as an occupational therapist for presence learning? How do you respond to that? Tasha Holmes So I like to explain first because you do always have to start with that OTPs and I explained to them, occupation is everything that you do in your life from the time you wake up in the morning until the time you go to bed at night. So if you're having a problem with doing any of those activities, then OTs are there to assist and we assist based on what is limiting you from being able to complete those activities, so then I narrow it down to telehealth for pediatrics, we're looking at what does it look like for the day in the life for the student and so everything that that student needs to do from the time that they arrive at school until it's time for them to go home, we're taking a look at those different activities, and those activities that are keeping them from being able to participate in their academic program. We're addressing those needs, you know, within our huge scope of expertise. And that usually helps people a little bit better because they're like, Oh, well, so then kids, right, and they cut and they socialize, and they do all of these different activities and like, exactly. And then in the telehealth realm, not only are we looking at those particular activities, we're adding in the technological piece of helping the students access the help that they need. So whereas maybe they can access an OT on-site, that can help address their needs. That may not be the case for their particular district, for their particular medical situation, or their particular needs. And so telehealth helps to marry that access to be able to complete your academic program by addressing those deficits. Jayson Davies Definitely. And I love how you tie it in that technology piece. Obviously, we're sitting here at the end of 2021, which has been a crazy time for many schools, basically every school across the entire world. And so that leads kind of into the very next question that I wanted to ask you about is how things have changed or maybe not changed. I don't know, at presencelearning over the past two years since the pandemic started. And I don't know maybe Kristin, you want to share a little bit about how presence learning has adapted over the last few years? Kristin Martinez Sure, absolutely. So, you know, of course, as a teletherapy company, we were founded in 2009. So we were around and providing remote services long before, you know, there was a pandemic, clearly. So we felt fortunate that we were in a position to provide help to be able to share expertise, share services because everybody was having to turn to teletherapy. During that time, of course, and, you know, and not because they wanted to not because they made a choice in their careers or for their students where they said, Oh, I'm going to consider this, get training and become a teletherapist, where, you know, that's how Tasha and I joined we, you know, it was our choice. It was we wanted to learn, we had resources, we had time, all of those pieces that didn't exist, you know, in March of 2020. So, of course, we were available to provide direct services, we do contract we have about over 1500 therapists in our network SLPs OTs, school psychologists, mental, licensed clinical social workers. So we could help with direct services. But what districts most needed just helped. They had the staff, in many cases already, they had their on-site, OTs SLPs. But they had just never done teletherapy before. And so of course, there were options out there, and just in terms of a piece of technology. But there were very few training supports or platforms that were actually designed for this. So the biggest thing that changed for us as a company, the entire time, since we started, we had had our own platform, our platform was designed by our product and engineering team over the past decade and specifically designed for therapy. So it's not based on zoom. It's not based in you know, another platform, it was built from the ground up. And everything included in the platform is designed to provide therapy services, either SLP OT or another, another discipline. So we realized that this was really an opportunity for us to help in another way was to make our platform available. So that was a significant pivot for us as a company is we did make our platform available to school districts to private clinicians, who wanted something better. And we also provided training on the platform. And that's something we've continued to do and continue to expand on. So it's actually called our therapy Essentials program. So that's another way that individuals, you know, university programs, clinics, school districts, if they are needing, you know, a really strong platform in order to provide therapy services, and are also looking for the tech support piece, which we also integrate and also training. We've made that available. So that was absolutely a new, a new piece for us and something that we are continuing to support. Jayson Davies Absolutely. Wow. I didn't realize that you had made that available. So I think I might ask us a little bit later. But how is that program different from Zoom or Google meet? Kristin Martinez Yeah, so good question. And there's I could go on for quite a while about what are some of the highlights thankful. Essentially, you know, as I said, I mean, those are amazing platforms, we're using one right now, as a business tool as a way to connect with each other, I think we were all using those platforms just to stay connected with family and friends, and, you know, business meetings. But there's a lot of if you're trying to provide therapy services, you're having to also bring in other resources, you're having to layer in, you know, the screen-sharing and trying to show another screen at the same time. And, you know, there's just, it's not built for therapy, they're just they just aren't, that wasn't the primary purpose. Our platform was, it was built for therapy. So everything is integrated. For instance, we partner with publishers to have integrated assessments in our platform. And so as an SLP, for instance, you know, I'm not if I'm administering something like the self, I'm not having to take my visual stimulus and hold it up to the camera for the student to see, it's built-in, I can integrate a second camera, which Tasha can speak to very important for OT services. Again, it's really just, it's a one-stop-shop. As a therapist, everything is there. I don't have to we have an activities library. I can upload my own activities to the library. It's interactive. There are built-in reward systems. So it's just, it's engaging and fun for kids. You know, we work in early intervention all the way through transition age, so really a pretty broad range of age levels. So it's just it is a meaningful and intentional tool for therapists. Jayson Davies Very cool. Kristin Martinez Yeah. And Tasha, I'll let you add anything else you want. I was going to the OT side. Jayson Davies Well, Tasha, let me ask you a question. You can answer a little bit of that, too. But, you know, Kristin just mentioned some of the technology sides, but she did mention you kind of talking about potentially having that second camera. So in addition to talking a little bit about the platform, also talk a little bit about some of the tools that are very helpful for teletherapists. Tasha Holmes Absolutely. And I would say that the second camera really does make a difference. I, you know, at the time, when the pandemic hit my two kids were home and, you know, everybody was trying to make there, you know, work their way around it. And so my kids, you know, they've seen me do therapy through the platform. So to them, that's what teletherapy was, or, you know, just doing their schooling online. And I realized that when I'm in the presence learning platform, and I have my second camera, and I'm just hitting a button to turn the second camera on, that frees up my brain for so many other things. Then when I was trying to set my kids up, like, let me get you set up, you know, this is my thing. And I'm like, Alright, I need a hack to figure out how to set up a second camera, so your teacher can see your hands. And you know, and there was a lot of thinking involved. And you know, and I'm sure that you can attest to this, Jayson, you know, burnout is really high as a therapist. And so the extra brainpower that you're taking to figure out hacks, or workarounds, really takes its toll on you throughout the day. And so I found with using the presence learning platform, I'm able to use tools to demonstrate things on the screen. So we have whiteboard tools, where you know, you can demonstrate letter formation, but I can easily pop out a YouTube video at the same time while watching the second camera, seeing what my students actually write on their desktop. But I can run a camera second camera too. So if you have two people in the room, you can be running four cameras, they can watch me I can watch them but I can simultaneously have a letter formation video on the screen or a drawing video on the screen. Or if I have a student who's working on typing, I can place an activity on the screen, have them open up a chatbox, have them angle the camera towards, their keyboard, I can see their finger placement also while seeing what they're typing. I can flip to we have something called team right where it's a collaborative typing activity. Have my students practice typing there, you can also save documents. So for those kiddos, one of the big things that people are always concerned about behaviors are kids who have sensory needs. The platform allows for that too where I'm not trying to bring in other things where okay, I know the student needs a timer. We have widgets, you can pull out a time or I can pull out pictures for a visual schedule that mimics what the student may have in the classroom. I can pull out you know paper special paper that maybe my students working on and they can write on the screen but also right on their desk and I can see what they're doing. So those features really help with you know, providing OT services, being able to I always told my kids that when you're small in the corner and we have something else larger on the screen. You are a TV star but I can make you a movie star by having you know put you on the big screen and so I can put them on the big screen their movie star I can see really well what's going on on their desk. If they get that movie star status and they're looking at themselves they can their door I can hide their pictures so that way, they're not distracted. And I can still see what's on their desk, they're focusing a little bit better. So all of those tools really helped with supporting services. But they also helped me as a clinician, because I'm not in the back of my head. Okay, how am I going to do this, I just do it seamlessly. So this on screen, I can do all of these different things. I'm not trying to figure out how I'm going to piece something together, which allows me to be more creative during my sessions. Jayson Davies I think that's spot on. Because it does take a lot of brainpower just to figure out how to share screen and whatnot. I remember I'm pretty technologically savvy. And so I was helping my AP teacher, I was helping my speech therapists, I was helping everyone learn how to use Zoom. And we were actually in the process of going through my first A-Z school-based OT course, with, I had about 30 therapists. And we were going through how to be a school-based OT all the ins and outs of evaluations and treatment. And when the pandemic hit, we were about four weeks into using zoom as our platform for that course. And so everyone that was in my course, like, oh, I already know how to use zoom a little bit. They're feeling so much better. But it's still a huge learning curve. One thing that you kind of mentioned in there was that you are able to hide the student's video from their screen. Is that true? Tasha Holmes Absolutely. So being able to hide the camera works for those kiddos who were either distracted by seeing themselves because it's a one-way camera, they just see a silhouette, or for those kiddos, you do have kids who they don't want to see themselves on screen, it's very jarring for them. And so to be able to hide that and allow them to work without feeling like they're being displayed really goes a long way for helping build that therapeutic rapport because then they trust you, they know that you're not forcing them into something that they're not comfortable with. And you can focus on what you're doing this session. Jayson Davies That's awesome. I can think of two specific cases where this would have come in handy because I had one kid who would be fixated on his view. And so he had figured out, I mean, just like most kids better technology than the adults. And anytime the mom tried to hide his video anyway, on Zoom, he knew how to get it back. And he would just stare at his own video, it was just like he was just looking at a book and he didn't want to move didn't want to do anything except stare at his own video, I had another student who didn't want to see my video at all. And so as long as my video was up, they weren't going to do anything. So that's great that the platform allows you to be very versatile, like that. Awesome. All right. So we're talking a lot here. And I want to make sure we get through everything. So we might have to go through some rapid-fire stuff. But if you had to think of one thing that therapists struggle the most with when it comes to moving from traditional in-person therapy to teletherapy, could you each give me that one big struggle that you see most therapists having? Kristin, do you want to go ahead and start? Kristin Martinez Sure. So I think one of the biggest pieces, at least for SLPs is, you know, for some I hear a lot from SLPs that they say they're very hands-on that they want to, you know, they're doing articulation, you know, and they want to be able to do tactile stimulation, or, you know, how do you do prompt therapy? Like, how do you do these things, if you can't be physically in the same space? You know, and there's a lot of related questions to that. How do you you know, possibly work with preschoolers or, you know, a lot of those things? So I, you know, first of all, I think it's really important for people to understand that teletherapy is not a new kind of therapy, you are taking your skills, your experience, and translating those skills to a different modality. So what we help with and help therapists learn and develop is how to just translate those skills. And so you're still addressing the single areas, you're not modifying goals for teletherapy, you're not taking goals off and saying, Nope, we just can't do that. You are learning how to still address those goals in an effective benefactor, efficacious way. So sometimes that means, you know, it can sometimes shift your technique potentially. But more often than not, you are engaging with, of course, the tools in the platform, sometimes leveraging that in person support. And so in presence learning, we call that person a primary support person, especially when you're working with kids, there needs to be an adult in the room. As you know, a staff member does not need to be a trained clinician in any way. But somebody who can you know, at the I think of it as a spectrum on one that spectrum, you have just line of sight supervision for kids who are very independent, they engage on the computer all day long, just somebody in the room in case something comes up a tech issue they can help with really quickly all the way over to our students who, you know, they might require one on one support throughout their school day to Access General Education. That same level of support is required if they're working in teletherapy. So really, that's one of the most efficient pieces we do when we come on with schools is to help them understand that so they have appropriate staffing to support that piece. So understanding as an SLP that, you know, yes, you might need to sometimes, of course, you're it's coaching, they are not providing they're not deciding on therapy, they are doing what you asked them to do. So there may be some facilitation, there may be somebody who is helping to support AAC devices or some of that tactile cueing as an SLP. But it can all be done. And so it really is, we really love to work with new teletherapists, to help them understand that and kind of, it's a little bit of a shift, I think, in thinking about your therapy services. But once you realize that, yes, you still can provide that full scope of service and address all goal areas. That's pretty powerful, and really, I think empowers therapists to realize that they are adding, they're adding tools to their toolkit, as opposed to just doing something completely different. Jayson Davies Absolutely. And that coaching was a big new thing, because all of a sudden, we went from working with a student, one on one with no one else in the room, especially for those who you know, we're working in the school districts, and all of a sudden, now we're working one on one, but we have a teacher or sorry, not a teacher, oftentimes, it was a parent, or a Big Brother or Big Sister. Kristin Martinez Right. Jayson Davies And they had to be our what was the term you use primary Kristin Martinez primary support person? That's our lingo. Yeah, yeah. Jayson Davies And so they were our support person, and you had to learn to trust each other and really learn to communicate well. And so, yeah, if you know, what I while you're on that, it's required that a district has a primary support person with the student at all times with presence learning, or how does that work? Kristin Martinez Well, I mean, I would, if I, if I were the school district side, I mean, I would think that anytime a student is engaging with another adult online, that there should be a staff member in the room, I think it's just common sense, safety, all of those pieces. Yeah. But, you know, if we're talking about high school students, if we're talking about that makes sense. You know, kids were very independent. They don't necessarily need somebody who's right there. But we still recommend it, we still think you know, we, at that age, we're actually sometimes the support person is more just to make sure the high schoolers make it to the therapy session from their classroom, and they didn't get lost somewhere in the way. So it's more about attendance at that age. But it's just we want to always make sure we are setting expectations with schools and helping them to understand that, you know, and I tend to use the analogy of the level of support, students need to engage and be successful in general education. So that's a pretty familiar concept for anybody working in special education is, you know, if a student is having to engage in a computer activity, which of course happens throughout students' day, what kind of support do they need? Surely, you know, there's a level of support already being provided for these students to some degree. And so giving them that framework can help and, you know, there's a lot of different ways it can look, we talk about different ways to set it up. Sometimes it's in you know, a few computers in the back of a resource room and maybe a paraprofessional can support both activities, or, you know, we've had SLP assistants or occupational therapy assistants do kind of dual roles is maybe running small groups, but also maybe supporting a couple of students. It just depends on the need of the student. But it is absolutely important, it's just a really important piece to making sure you're discussing and thinking through so that therapy services are successful for students. Jayson Davies Great, thanks. And Tasha then what do you see OT struggling with when they transition from an in-person type of role to more than a teletherapy role? Tasha Holmes I agree with Kristin, it's the hands-on and a lot of times, it's hands-on in terms of sensory processing for the students because they're used to helping facilitate those different activities for students to be able to attend to, you know, whatever fine motor tasks they may be doing for OT. And I always like to say, you know, the kids that are running away from the computer, were probably the kids that were going to be running around the room when you were on site. And so we don't have that expectation that in order to receive services, you have to be in a chair, in front of the computer sitting at the desk, the whole entire session. Because it's not realistic, we wouldn't do that. If we were on site, we would allow the student to move we would incorporate movement activities. And so that's where you know, your activity analysis comes into play. What skills are we actually working on? Okay, so now let me be creative and figure out how we're going to work on it. So for example, when I was working in virtual schools, and I would have students seen at home, we would plug the laptop up to the television, the student would watch me on the television, I would watch them from the laptop, and we would do our sessions that way because that way if the students pacing or the students running around, there's something about things being on time Television that really draws the kids attention. Or maybe the first couple of sessions, we position a laptop or the computer in a certain area. And then I have them walk, you know, to the left to the right into the back of the room, we put a marker and I can say, Okay, I'm still in a visual shot of the student, while there, you know, between those socks or something like that. And then we do our sessions that way. And so that's where you just become creative. And you have to figure those things out. But I think, initially, that's a really hard thing to wrap your head around a student who's going to run around, they're not, you know, they need that sensory input. You know, just thinking about the fact that, well, hey, put the laptop on the floor, have them in prone prop under the desk, they can feel like they're in a cave, you know, so they're getting the different type of sensory input that they need. I've had kids where they're runners, so I'm like, hey, if we put them in prone prop, every single time they stand up to run, they're giving themselves proprioceptive input. And so that's what we do. They're in prone prop, they get up to run, they're pushing through, run away, wheelbarrow, walk them back, we're back in that position again, so that way, you know, you can use your environment to help with those therapy services. Jayson Davies Awesome. It sounds like you've really had to kind of accommodate for some of those difficult situations that we all find ourselves whether or not we're in person, or in teletherapy, we all have to figure out how how to manage those experiences. I want to follow up on that a little bit. What do you tell either potentially new therapists or even districts who are concerned with, hey, you know, we have some tough kids, and I don't know if teletherapy is really going to be right for all of our kids? What do you tell them? Or maybe you've been in a situation where you've had a therapist come to you and say, hey, you know what, I think this kid, just teletherapy isn't going to work? What do you kind of walk me through what that might look like, or what accommodations you might make? Tasha Holmes And I have to say, that's usually exactly what they say, Hey, we have some, that's almost verbatim what they say. And so that's one of those things where, you know, I'm completely honest, teletherapy is not going to work for every student, however, you can't, you know, you don't really know if teletherapy is going to work unless you try it. Because some of those students that you would think are oh, this is just not going to work for them. You know, just something about being on the computer really resonates with them, they thrive, they do a wonderful job. And then you have may have some kids where you're like, Oh, I would have thought this would have been perfect for them. And those are the students that you find that okay, this probably was not the best fit. And so I always like to suggest that people would just give it a try. And that's when you talk about okay, well, this is Plan A, we're going to try this, you know, these few times, we're going to set up a plan. And then we have a plan B if it looks like it's not working. And that's where it comes into play, having those supports that are really going to help you with your sessions. So if you're trying to piecemeal and put things together and try to figure out, okay, how am I going to make this work, it makes it much more difficult than having those resources already there. And those resources, I mean, by your choice and platform, if you do have a choice for what platform you use for therapy services, the location of your therapy services, so you know, maybe the student will be better in a smaller room because they like to run around, versus a larger room where now they've runoff. And it takes us so long to get back to the computer, you know, things that are less distracting. And so whereas if we were on-site, we would look around the room, and we would decide, is this a good area? Is this not a good area? Same thing you're going to do during teletherapy services? I've had it where I've had my primary support person, give me a tour before we even start services? Can you turn the laptop around? Can you take your external camera and show me what you have on your shelves? What's in the room? And that way I can know, you know, are there any hazards there? If the students you know, runoff? What things can I use in that environment that's going to support that student? Does that student need to be pushed in? Should that student be pulled out? How does your WiFi hold up outside all of those different things? And so you really have to take a good look at your environment and your resources to determine if it's really going to support that student. So it's going to be more than just, you know, do well with grandma over FaceTime that you know, that's not going to be the determining factor of whether they're going to do well with OT and telehealth services. Jayson Davies Yeah, every kid's unique and you don't know until you try. So definitely. Now you mentioned a term in their push out versus push-in type of services. As a teletherapy therapy provider, are you able to do some of those push-in services? I know when I think of teletherapy I do typically think of that student who is going to leave the classroom sit in another room with the PSP the helper and sit in front of a computer. But is it possible to do some of those push-in types of services through teletherapy? Tasha Holmes Absolutely. And it's another one of those things that we've teletherapy it does take a little bit of planning But the way I reconcile that is, when I was on-site, it usually took some planning as to where we actually going to do these services because you don't have a room. Whereas for pushing services for teletherapy, you're thinking about how are we going to do this? Is this going to be best where I have my primary support person, and they have the headphones on? And I'm coaching them, and they're, you know, pointing as to where those students should put there, you know, letters on the line? Would it work better for the student to have the headphones on and I'm giving direct instructions to the student? Would it work better for me to be on a laptop and do some observation first, and figure out okay, this is the classroom flow. I've done things where I've contacted the teacher beforehand, which is what you would do on-site. Hey, what's your lesson plan for next week? Because I'd like to come into the classroom to work. Oh, that's great. You guys are working that, you know, on that writing activity? Now, is this going to be individual is this going to be a small group are you going to do it in a large group. And so finding out those different types of things, so that way, you can plan accordingly for your session. Other kids, sometimes other students think it's so cool when you get to be in the group with the person on camera, and you know, you just have that your student in the visual shot, you're giving those directions, and you know, that students still interacting with their group. So really just figuring out what the plan needs to be for providing those services, and certainly pushing services, observations in classrooms, consultation for the classroom, co-teaching with the teacher. Very, I mean, it's all very appropriate. Jayson Davies Yeah, well, I gotta admit, you just open my eyes, like, the first thing you said was, you know, having either the PSP or the student wearing headphones in the classroom. I was like, that fixes so many problems that some therapists have when pushing in physically to a classroom, because the therapist wants to say something, but doesn't in fear that it's going to be distracting, or whatever the case might be. But if the student has headphones on or the helper has the headphones on, then the rest of the classroom doesn't hear you. And they can silently make the little corrections. So that's awesome. I never thought about that. Great idea. All right. Now, when I browse through the Presence Learning website a little bit, I do see some articles about research. And you know, whenever we have new models forming, and let's be honest, technology has evolved so much over the past, say 20 years, but really, it's been closer to 30 years now that we've really had the internet at least available, what research is out there that has kind of led to teletherapy really being an established model of therapy. Tasha Holmes I will say on the OT end, we're a bit behind what this research for speech therapists like Kristin speaks to that. But what I will say is that you know, our occupational therapy practice framework has been updated to include telehealth, you know, the AOTA does have a position paper where they support telehealth. And if you look at some of the more recent journal research articles, if you go into the AJOT, and you're looking at ones from I'd say maybe from like the past even like three or four years, it's discussing the effectiveness of using the telehealth service delivery model for different populations. There's for autism, there's, you know, several other different occupation-based coaching services for you know, students or children or even adults. And so I think that as telehealth continues to evolve, our research will, you know, start to bridge that gap. But as you know, telehealth is, you know, evolving so much faster than research. And even with research, there's always that lag between the day the research has been completed, when it's published when someone reads it when someone implements it. And then by that time, you know, it's you're already kind of behind the ball in terms of that. But everything that exists at this point, does support telehealth as a viable service delivery model on its own, not something to be used. Well, it's the next best thing. If you can't do on-site services. It's viable, it's viable and comparable to providing services on site. Jayson Davies Yeah, Kristin Martinez yeah, I echo Tasha's note on that, you know, there is more research on the speech side, I think, you know, teletherapy services started first, first, really on the medical front and then with speech and OT and little psychology and mental health. So there's been this, you know, order of things. There is growing research, it tends to be I would say, I don't know of one just Silver Bullet study that says, absolutely no matter what student you're working with teletherapy is effective, you know, that that's just not realistic. Anyway, there are studies that are, you know, specific to this goal area students with This disability this age group, I, you know, I know your audience is generally OTs, probably. So I won't get into too many details on this side. But I will say there are some really interesting studies that support the effectiveness with some populations of students that really potentially the opposite of what many might think in terms of effectiveness. So for instance, in early intervention, there's some good research that shows that teletherapy can be highly effective in early intervention services, and also with populations of students who are on the more severe end of the spectrum. And with both sides, part of the reason for that is that, you know, when you're thinking about early intervention, of course, the most important piece is the caregivers, you know, that coaching model. And so oftentimes, I think people have had the experience of doing in-home early intervention services, where you come in as a therapist to, you know, your hour, and sometimes that becomes the parents moment to go catch up on laundry, or which they desperately need to do it, all these pieces, and then you do the five-minute catch up at the end of the session. teletherapy, they can't do that when you're working with 14 months old, they need to be present the entire time. And so they're learning they are really learning from you as the therapist, how to support their child, the rest of the week, until you're back working with them again, the same is true for students who you know, for instance, are nonverbal. With AAC devices, the most powerful thing that you can do is to really train that person who supports them throughout their day, because you're as the SLP, you're in and out, and you might get 15 minutes, 30 minutes with them once a week. So the power of that through teletherapy is really amplified, I think, as opposed to sometimes in-person services where you don't always get that person who's really with you through the whole session and learning. So there's no, I'm hoping, I think we're always looking for anything positive may be to come out of the pandemic, I'm hopeful that there will be much more funding toward research in the area of teletherapy. Because of course, it really is impacting all of us and children across, you know, all kinds of areas of support. So I really look forward to seeing the future of research. Jayson Davies Absolutely. And I, I'm not in research, I don't know the answers, but I'm sure that there were some studies that went digital, and they're probably already has been some funding that has gone into it. And people couldn't research in person. So maybe they decided to do their research on Zoom or on another platform. And I think Tasha, you acknowledge, you know, it does take time, they say there's a 17-year gap between the research and things getting into practice. And you know, that's not the time it takes for a research study to be published. But still, it does take time from when the data is collected, to going through all the analysis, the writing, and to publish date. And so some of those research that might have happened in 2020 2021, we might not get to actually see it until 2024, potentially, because it does take that time to do all the analysis and write up so yeah, that's great. I'm really looking forward to it. Kristin, you mentioned both of you actually mentioned the coaching model. And that's the one research article that I'm most familiar with, I think it was coaching with children with ASD, I believe. And yeah, they did find success. And that primary piece was really coaching the parents. And that moves us from a position of one to one therapy to one to two in a week, because we're now talking to both the student and the primary care provider, which agree with everything you say, Kristin, because now that primary care provider is going to be using those strategies that we give them every hour of every day, not just for one hour of therapy. So 100% agree, and hopefully, we do see more research that comes out backing that up. That'd be great. All right. So one talk about teletherapy. Going forward, we kind of talked about some research, and we talked a little bit about what we're hoping to see but I want to get your take on where you see teletherapy going. Obviously, the internet is changing. We have Facebook changing their name to Meta because they believe in the meta-universe. We have Nike going to start selling shoes that are digital for characters and video games. How do you see all of this virtual reality augmented reality potentially changing teletherapy as we move into the future? I don't know who wants to take this one first? Kristin Martinez Well, I will I will start and I'll let Tasha speak to it. Yeah, I think I think there's no going back. I think we know though, those who may have thought that this was a fad of some sort. I think we've pretty much dispelled that. And yes, the need is there. And also because when it's done when teletherapy has done well with fidelity, it is effective. And students, our students, adults, you know, are getting the services that they need, you know, teletherapy was born because of out of a need for access and equity, and that is still a significant problem across our country, in the world. But, you know, our focus as a company is in the United States, k 12 services. And there are significant differences in the services students are receiving depending on their geography, and that just shouldn't be. So that is the initial reason. That's why we are passionate about teletherapy, Tasha, and me because we have the opportunity to affect that and to reach students. So, fortunately, the technology is just getting better. I did you mentioned virtual reality, we did a brief partnership, kind of a pilot with a VR company that's doing some awesome stuff with kids with autism. So I think there's going to just be incredible things on that front, integrating virtual reality for some students. And, you know, I think that it's just going to be a hybrid approach, there will always be a place for, you know, in-person services. But there also needs to be an equal place for teletherapy support. And the more you know, we have some really incredible school partners, special education directors who are just incredibly innovative, they have been pushing teletherapy, and the integration to solve so many problems, you know, anywhere from again, students who were underserved because of where they lived, all the way over to just the time that their staff is spending driving, you know, in some of these rural areas, driving hours and hours each week, just trying to reach to students who might be in, you know, one building. So there are so many areas where, again, if we are using the knowledge we have accessing the experience of those of us who've been now doing this for a number of years, it's just going to expand and we're going to see, you know, I think the the the implementation being just standard, where it's not, you know, people ask me a lot, well, this is just for rural schools, right, or this is just for now, we're everywhere, we are in very large districts where they just they don't have enough staff to cover, they can never keep enough people on staff, rural areas, suburban, charter schools, private schools, virtual schools. So the need is just well established. So I think it is, you know, Tasha, and I get to be part of a company that is looking to be innovative, and really on the cutting edge of what we can provide to support students and in reality everyone who can benefit from teletherapy. Jayson Davies Absolutely. And Tasha, do you want to add anything to that about where you see teletherapy going? Tasha Holmes Sure, I think that not only will teletherapy, because right now we're looking at using teletherapy, for skill acquisition, and for rehabilitation, I think that it will be used more for wellness, there seems to be a very big mental shift, where people are realizing that wellness is a thing. And we need to be preventative versus reactive. So I think that that's really teletherapy is going to assist with that. I think teletherapy will be a specialty, think it will not just because it is a service modality, but it is also a specialty and I think that it will be more recognized as a specialty, versus just one of the other tools that we pull out of our tool bag. But more importantly, the sociologist in me is very excited about what this is going to do. I feel like for the world because if you think about it, telehealth is connecting people who might not other I mean, these are people who don't live in your community, these are people you probably wouldn't have run into at the grocery store, people you would have never had a reason to interact with. And so you know, it's really, um, transcending cultural boundaries, racial boundaries, religious boundaries, a lot of different things where I think that certainly in this, you know, time and age, we need those things. And then I also really think that in terms of just our profession, I think it's really going to help with the OT profession. You know, we do get pigeonholed a lot for the handwriting teachers, or we're the people who help people get dressed. But I think that you know, OT and mental health, I think that people are going to really realize that not only are we qualified for mental health, but we can deliver those things to telehealth services. And I think that as the world shifts more into technology, for us, as OTs, we're really going to be the ones where we're saying, hey, telehealth is excellent. But let me connect some of these dots for you. These are the things that you're missing because you're using technology for these different, you know, activities. And this is how we can bridge the gap. And we can also bridge this gap by using telehealth. And so I think that that kind of ironic line of thinking will really help our profession because we know those components skills that you need in order to be successful in other occupations. Whereas you know, tech Knology is replacing the acquisition of some of those components skills. But we can certainly use telehealth to help with that skill acquisition and to bridge those skill gaps. So I'm very excited for that about what it's going to do, you know, for our profession as well. Jayson Davies Yeah, I agree, I think there's going to be a lot of great news coming out of the teletherapy. side, and a lot of like, we talked about earlier research. Alright, I want to ask you a question. I don't know, one of you, I probably only need an answer from one of you. But there is a shift right now, as you know, I think both speech therapy and I know OT, you have to be licensed right now in the state that you are living in, as well as the state that the client is in. Now, I know, there's some change on that front. And I don't know exactly how speech pathology works. But Tasha, what do you know about that? And what updates are there? Do you know those? Tasha Holmes Yes, so during the pandemic, there were several different states or even just, you know, DC, which is not a state, which maybe will be you know, and sometime in the future, where they became a little bit more lacks in terms of being licensed in that particular state in order to provide services. And that was temporary due to the pandemic. However, you know, speech is also trying to, you know, pass their compact license legislature, as well as what we are trying to do for OTs, which will help people to get services faster. And so with having to have licenses for where you are located, and also where you're providing services, that legislation with the compact licenses certainly will make it easier and will propel further propel telehealth, you know, forward, there are also states that do recognize so you know, you have the military clause in some states where if you are a military spouse, or you are in the military, you can have your licenses expedited. So that way you're able to practice in another particular state, and you know, myself who was a military wife, that is definitely going those laws there to looking at those they assist, but they don't necessarily help if you're in transition between two different states. So certainly the legislature being supported by practitioners is really what's going to help us, you know, for both professions overall, but specifically telehealth. Jayson Davies Yeah. And it sounds like an OTs is making decent progress on that. I feel like a few states have already jumped on to the compact and only need to find out more, nine out of 10, Tasha Holmes nine out of 10. And ironically, DC has not signed on, so I'm an hour. So like I always thought I'm like, I need to just drive to there, you know, DC OT meeting and say, hey, look, I'm supporting you being a state. Let's, you know, let's get this in there. So you know, if there's anybody in your listeners who are, you know, in the DC chapter of T, like, let's get this question. Maryland's on board, Virginia's on board, so we have both, you know, bordering the bordering states. Jayson Davies Awesome. Alright. So before we wrap up today, we have two more questions, I think. And the first one is a really light-hearted fun one, I would like you each to share one big success story that you've had with teletherapy with a kid that you've had, maybe it's even a provider that you had a success story with or a parent, but I'd love for you each to share a success story that you have that that's a good memory for you. Tasha Holmes So I have this one student who was completely adorable when I first met her, she would bark at me. She's very poor. She was on the spectrum, very poor social skills, anxiety, very poor, fine motor skills, double vision, a lot of different things. And so fast forward to like three years later, and she's building like Lego firehouses, you know, without a model structure because her visual perceptual skills or visual-motor or fine motor is better. She told her grandmother Finally she liked to write, she started writing in a journal, she said, finally I can write about my life. And she's writing in her journal, she's writing on the line with correct spacing, it's legible. And she's not only gone from working at me through every session, to texting me on the weekend, hey, look what I did in karate. They're sending me pictures. They like knitted me socks and mailed to my house. And, you know, they lived you, you know, very far up in Washington. And at that point I was living in I was in North Carolina, but then I was also living in Oregon. And so that, you know, was a family I would have never run into and, you know, I had such a close bond with them. And it's, you know, they're texting me on, you know, the holidays and different things like that. And so that was a huge success story for me, to see her from the point of evaluation to the point of discharge and to see not only how well she was doing in school, but the fact that she had more confidence that she started to make friends outside the home and different things like that and that just so heartwarming to me. Jayson Davies That's awesome. It's always nice to have good stories that just make us feel better to get us through those tough days. So, Kristin, what about you? Kristin Martinez Yeah, so, you know, I would not have stayed the teletherapy. If I didn't feel that I was being effective I was able to address goals. So I, you know, I have lots of students I can think of where, you know, they just made great progress. And it was so exciting. But I have to say one of the first experiences I had that, again, kind of hooked me, was with a kindergartener, and again, I'm in Colorado, I was unlicensed, was licensed in Oregon. So I was working for school districts in Oregon. And I think my first my first concern, I think, starting in teletherapy, is that I would not have those connections with my students, I wouldn't have that same. Just we get to know each other, we feel, you know, because that's so much of that effectiveness is, of course, your skill as a clinician, but also just that buy-in, and then, you know, being motivated to work do work for you. So again, a kindergartener, he was pretty severely Praxis. And so it was, it was challenging, but you know, it was really wonderful working with him. But it really hit me that after working together for about three months, he invited me to his birthday party, which, you know, we had to talk about the fact that we were 1500 miles apart. But it was just, you know, I felt like, I can still, I can still have that peace, I'm still able to connect, even though there's this screen, but it really wasn't a divide. So that was just meaningful, not a clinical story. But just more about, I think the effectiveness and the ability to still connect with whoever you're working with. On the other side, Jayson Davies I completely will second that, because I did a short stint of teletherapy. And I completed it at the end of the school year, and I didn't come back at the beginning of the next school year. And part of the reason I didn't come back, was I had a whole new caseload. And I had built connections with some of those students. And I kind of missed some of the students that I was working with. And even though they were hundreds of miles away, I was only working with kids in California. But even though they're 100 miles away, like you still build that bond was not just not with just the kid, but with the family. And you really do build that bond. So I agree with you that that's very, it's very awesome that we're able to do that. And not even just do teletherapy. I mean, we can have conversations. I don't even know Tasha, you said you're an hour outside of DC. Kristin, I don't even know where you're calling in from. Kristin Martinez I'm in Colorado, Jayson Davies Colorado. Okay. But yeah, so it's just amazing that we can do this with technology. Well, I want to say thank you so much for coming on here. And I also want to ask Kristin, where can people go to either a learn more about potentially being a clinician for presidents learning, or even if they're thinking, hey, you know, what, my district might really need this, you know, we're struggling, and we're still doing teletherapy, or even, they're just doing great, but maybe they need a little more support? Where can they go to learn more? Kristin Martinez So the best place is just to go to our website presencelearning.com. And you can if, regardless of whether you're an individual therapist looking potentially for work, or if you're interested in a platform that you need to use, or if it's a district, yes, looking for services, all the links are there. So it's pretty easy to navigate the website. And, you know, you can request to speak with the recruiter, if you're interested in working with us, or talk with one of our, you know, sales representatives, if you're, you know, looking for services for a school district. And we do live demos, and you know, there's just a lot of great information. There's also just a ton of information on our website, there's a lot of videos that you can watch, you know, kind of services and activities. You know, there's a whole blog section that both Tasha and I have contributed to so lots of information, even just on the website itself. Jayson Davies Yeah, I think you guys even have some, like professional development type of videos, I don't know if you actually get professional development for watching them. But you have videos with specialists and whatnot, that really, that really share some great information. So be sure to check out presencelearning.com, the link will be in the show notes. So be sure to check that out and go over there if you're interested in learning more. Well, Tasha and Kristin, thank you so much for coming to the show. I really appreciate having you here. And we will definitely have to keep in touch about the future of teletherapy. Tasha Holmes Absolutely. Kristin Martinez All right. Thank you, Jayson. Great talking to you. Jayson Davies Take care. Bye-bye. Tasha Holmes All right, bye. Kristin Martinez Bye. Jayson Davies Oh, right. And that is going to wrap up our episode for today. Thank you so much to Kristin Martinez and Tasha Holmes for coming on and sharing all their knowledge and experiences with teletherapy and presencelearning.com Especially when they shared their biggest wins and their biggest, biggest success stories right there at the end. It's always nice to see how people can make a big change to go from traditional in-person therapy to a more I don't want to call it modern but a new way with teletherapy and as they call it a new model and potential Even a specialization in the future, how they made that transition and were able to succeed in that. I think they are spot on with using more of a coaching model potentially going forward. That is going to be a big game-changer when we are able to support especially the guardians and the parents and working with their child, big success stories whenever you're able to use that type of model in my opinion. Thank you everyone for listening. I hope this has been a great commute for you or a great workout, whatever you've been doing while listening to this episode, even if it is just cleaning the house. I hope you had a good time listening in and I'll 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! 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 where you enjoy podcasts Welcome to the show notes for Episode 89 of the OT Schoolhouse Podcast. In this episode of the OT Schoolhouse Podcast, we have a very special guest with decades of experience in helping therapists, teachers, and adults around the world to support students with handwriting difficulties. Dr. Bev is a nationally recognized speaker with 43+ years of experience as an Occupational Therapist. As a school therapist, she serviced more than fifteen school districts, visiting over 60 individual schools. She has experienced the shift of practice in the schools over the years and shares her knowledge with us in this interview. A creative entrepreneur, determined researcher, and tireless professional, she is also the author of The Size Matters Handwriting Program. Currently used in every state and 5 continents, its concept-driven approach to teaching and remediating handwriting has been proven effective at a .001 level of significance in the largest research study ever done on handwriting. I am excited to have Dr. Moskowitz joining us to talk about all things School-Based OT. You can listen to the audio version above or on your preferred podcast player. Or you may watch the interview below. Either way, I hope you enjoy this episode of the OT School House Podcast! Links to Show References: Learn more about Dr. Moskowitz and her programs at RealOTSolutions.com Transcript Download the Transcript or read the episode below! Jayson Davies Hello there, and welcome to the very first episode of 2022. I cannot believe that I am saying that. But welcome to 2022 Thank you so much for taking the time out of your early week or maybe the second week, or maybe you're listening to this a lot later. But thank you for taking the opportunity to listen to this podcast. Today we have a very special guest who in the world of school-based occupational therapy probably needs no introduction, but I'm going to give her one anyway, we have on the wonderful the talented, the evidence-based Dr. Beverly Moskowitz of the Size Matters handwriting program and the realotsolutions.com website. I'm so excited to have Beverly on today. Many of you have probably seen her in the halls of the AOTA conference, or maybe your state associations, she just has so much energy, so much passion for occupational therapy, and also a passion for the research behind occupational therapy. So I'm excited to have her on this day. We are not only going to talk about her size matters handwriting program, but also a future endeavor that she is working on. But we're also going to have Beverley talk a little bit about her experiences as a school-based occupational therapist. She has been a school-based occupational therapist for several decades. And so she's kind of seen our profession evolve over the years back when we didn't even really participate in IEPs and IEPs were very unofficial to where we are today where an IEP is the backbone of every single student that we see for the most part unless we're doing five-oh fours and RTIs or students study teams, SST's or whatnot. So be sure to put that phone away, put it in your pocket, and just enjoy this episode. It is so much fun. This is actually a recording of a live episode that Beverly and I did together on YouTube. And if you'd like to watch the video, the recording of the video that we did, you can do that at otschoolhouse.com/episode 89. Or you can just continue to listen and you will get the audio version of that right here right now. So stay tuned. Enjoy the episode, and I like to welcome to the OT Schoolhouse podcast, Dr. Beverly Moskowitz. Enjoy the episode. Hello, hello, everyone, and welcome to a very special edition of the OT Schoolhouse podcast. Thank you so much for being here this afternoon and evening with us today. I am your host, Jayson Davies. And if you are here, please just type into the chat, let me know that you're here. Maybe type in there where you're from, or if you're an occupational therapist, or an occupational therapy assistant just helps us to feel a little bit more involved and engaged when we see that chat going on. And we really appreciate that. So if you can take a moment to go ahead and let us know that you are on in the chat. We really appreciate that. Awesome. We have Andres here from an occupational therapist from Illinois. Thank you so much for being here. I'm just thanking you for typing into the chat. I'm just making sure we've got everything set up for our questions. Thank you all. We already have 10 likes here have, I believe Around 20 people or so watching live. So we really appreciate you being here this evening, this afternoon with us and we're actually going to go ahead and get started. We have a very special guest today. Her name is Dr. Beverly Moskowitz, and she is an OT a doctor of occupational therapy. She is a fellow of the AOTA Association. She has done the research. And as many of you probably know, she is the creator of the Size Matters handwriting program, and also the owner at realotsolutions.com. So I'm very excited to welcome to our show, Dr. Beverly Moskowitz. So there you see her right there. Before I dive in and say hello to Beverly real quickly. Thank you, Tanya. Thank you, Jennifer. Thank you, Debbie, Aaron. All these showing up really appreciate you being here. So let's go ahead and let's dive right into it. Welcome to the show. Dr. Beverly Moskowitz. How are you doing today? Beverly Moskowitz I'm great. I'm excited to be here too. I have to share with everybody. This is my first podcast. So I'm a little nervous on my end that I speak all the time. But honestly, when I'm in front of a camera or a microphone, sometimes it's like I don't even know English. So I hope that this is coherent and fun for you. I am excited to go forward. Jayson Davies Absolutely. And as I mentioned, you know this is very different. Usually when we record a podcast simply for the OT Schoolhouse podcast. We do it without an audience but today we have a live audience As everyone here from all over the country, and it's just it's going to be an exciting show. If we have some time, in the end, we'll do some Q&A, which will be even more fun. We don't usually get to do that on a podcast on all audio podcasts. So, yeah, I'm excited to get right into this. And, you know, the first thing I wanted to ask you actually is about your early career and how you found your way into pediatrics and working as an occupational therapist with kids in schools. Beverly Moskowitz Well, first, I have to share, I'm doing this for 46 years, I can't even believe that much time went by it goes by in a blink. So I graduated in the 70s. In the 70s, you could practice with a bachelor's degree. So I got a BS from the University of Pennsylvania no longer even has a program anymore. And back then you had two rotations, you did adult rehab you did or rehab and psychiatry if you want to do pediatrics, you had to do an extra three months. I always knew I wanted to work with kids. And so I chose to pursue the third rotation. We call them internships back then. Their fieldwork right now. But I always knew that I wanted to work in peds only this big, to begin with, so bigger than the kids. Jayson Davies That's funny. Yeah. And so what was your first job, actually? Did you end up directly into a school? Or were you in a clinic? Or what did that look like? Beverly Moskowitz Okay, so, first of all, there weren't a whole bunch of jobs out there. Hospitals, or odd children's clinics, their school practice wasn't a thing. So you really had to be created if you want to work with kids. And ultimately, you had lots of little contracts. My first contract was in a residential facility. And no back. This is the 70s that kids were kind of warehouse and I hate to say it, but that was a reality of life. If you had a severe disability you were put into an institution. So I worked in an institution for a few months, I didn't love it. And then I got an opportunity to go to the St. Edmund's home for Crippled Children. And that's what they called it back then they use that language because they wanted to get the donations and the sympathy money. And they needed a department head, I had only been working two months, I became the department head. I was at the department of one. So I worked at St. Edmund's for two years, I will share with you my career just took off. The church was very generous in sending me to every single course that I ever got a flyer for. And I do encourage everybody, if there are new graduates out there amongst you, every time that you can read something, take a course listen to a podcast, apparently they're educational. Do it, do it, I took everything out there. And I really felt like my learning curve had been expedited. And then after that, I got involved with a consulting group. So get back in the 70s, there was an institution called Pennhurst that had all of these disabled adults, and it had been decided that was inhumane. So different agencies were bringing these disabled adults into the community in group homes. I became the coordinating consultant for and I'm talking to you from Philadelphia, right now, Philadelphia and the surrounding counties. I went to all of these group homes and created programs for the staff to do with the people that were living in these homes. And I traveled the entire city I put a lot of mileage on. But again, in terms of could you work in pediatrics, you could work in related developmental disability fields. So I would do that for a few hours. But then I would also work in a preschool center, and then I would do a sheltered workshop. And I would do some other residential facilities or home care like I worked 15 different contracts. I, when I started to work in schools, was still juggling a whole bunch of contracts. But none of it was ever a full-time job. If you got a few hours in a school, that was that day, Tuesday mornings, I'm in this particular school district, then I got one that was an hour and a half. I mean a day and a half of work. So you, you stitched all of your contracts together to make a living. Now, of course, schools have multiple therapists, but I was the only one for around 15 different school districts. I visited more than 60 different schools, sometimes as many as seven in a day. Jayson Davies Wow. Wow, that's a lot. Wow. Yeah. And you know, as you mentioned now it's very different whether you work for a district in itself or even a contractor. You're primarily going to be in the schools. There are some contractors that will still have you maybe come back to the clinic and the Afternoon or something like that. But for the most part, we kind of stick to either clinic-based or school-based, which is very different than what you were doing where you'd have so many different contracts at a time. So yeah, that's pretty crazy. You mentioned that you had to go and get some training. At that point in your career very early in your career, what was concerning to you? Or what did you feel like you needed to learn in order to do your job? And what did you reach out for? Beverly Moskowitz So um, I learned a lot of stuff in school, but I wasn't really sure if I was being effective. I, I've always had the drive to know that my time was worth it. It was worth it to me, it was worth it to the person I was working with. And I made a difference. So there was a lot of back then we were not an evidence-based profession. But because I had this internal drive, I was always testing myself to see if I could make a difference. Was I being effective in school? Was I being effective at home? Did people really enjoy the fact that I had been there? Did I make a difference there? So I was reading, I was learning I was taking courses, I was trying everything, you could play around a lot more than that actually was kind of nice. Now, evidence-based practice is definitely the way to go. But when we had no evidence, you were doing your own experimentation all the time. And I was always creative and always trying things out. And that's kind of how they have already played around back then. Jayson Davies Yeah. Beverly Moskowitz But I Yeah, it was more loosey-goosey. And I had to be resourceful. We didn't have any internet. You know, you had to go to conferences and learn from your colleagues. Jayson Davies Yeah. And you mentioned how and before we got on here, you actually just mentioned how you didn't even have to do paperwork back then. And just helping somebody. Beverly Moskowitz So don't shoot me, anybody. This is what so what was school-based OT like back in the western working in schools in the late 80s, early 90s. And there was no requirement for paperwork. I'm not sure that IEPS had reared its head yet. But all notetaking was a little bit looser. And nobody knew what I was doing. Now I had been recruited. It was very interesting my reputation as somebody that understood why I was there, it was never supposed to be about me, it really is about everybody else. And listen, friends, it's probably like alike attention. I'm standing in front of you, podcasting right now. But I know when I'm in a school, I'm really there to serve. I'm there to serve the teachers and the kids and the parents and make sure everyone gets along. So I knew that and I was recruited by the district in which I lived, which was fantastic as my kids went there. And just the same, I wanted them to invite me back. So I created paperwork, I, I created what I call the summary of Service Report, at the end of the year, I wanted them to know, everything I worked on so that they thought you know, we should have that back. She does all that stuff. Now, of course, we're drowning in paperwork. But when I didn't have to go to any meetings, we had, no, there were no IEPs, there was news data collection, I will tell you, there was no security. So when I was covering all of those schools, I could drive up to the back door run in do my little magic. Of course, I had no office. So you have to do your math in the hallway. And the closet, literally in the closet, on the stage, the cafeteria, you had no budget, you are buying your own stuff. Teachers still buy their own stuff. It's called investment in your in yourself. Lots of changes that you know that over time, some good and not some not so good. Jayson Davies Right? And so do you remember when there was a large shift and when you really started to get invited to IEPs? And they're starting to ask you maybe for progress on goals? I mean, does that even, or did it just kind of gradually happen over time. Beverly Moskowitz So a little bit gradually. But yeah, there was a period of time where this thing called the IEP reared its head. And putting this in perspective, it wasn't clear even to the administrators who were training us on how these things worked. They were always opening up their manuals to try and like get a little bit more clarity on what OT service should be. And, you know, we were a line item related service was a line item next to transportation. That's, you know, where they put related services. So everybody was figuring out but language started to populate the day FAPE free and appropriate public education was not always a thing. Least restrictive environment. So that was interesting. And I had really good intuitions I really felt way back when that you want me in the classroom. You don't want me pulling kids out? How? How am I going to know what you need kids to do? How are you going to know what I did if I can show you? So from the very beginning, even before this collaborative model evolved, before the least restrictive environment was more fleshed out a, as a concept as a strategy. I was pushing into classrooms, and I was learning from them. And that was something that later evolved. But it wasn't always the case that I'll share with you also, there was a period of time, for better or for worse, that the teachers, the therapists, you wrote through what their dream plan was going to be the education plan. And then during the 90s, I forget which President which act it was, but parents got a lot more power. And that's a good thing. It actually is good that parents have a seat. I know that that wasn't always the case, there was a very long period that parents had to accept whatever their school said was the right thing, even if it meant shipping them off their kids off to a different school, not their home schools. So that happened where I was. And then when they started bringing home these kids into our home district, we had to figure out how we're going to accommodate them. So I saw a lot of changes, parents having a voice, bringing in advocates, lots of paperwork, those procedural safeguards. They didn't always use to be a thing. Okay, now, just recycled it. But yeah, a lot of changes. At this point, right. I do think the pendulum might have swung a little bit too far to the side of deferring to parents. And listen, I'm a parent too. But sometimes you want the professionals to weigh in and give you some guidance there. I observed a Facebook discussion today where an advocate had apparently vetoed all the OT's goals. I'm like, Oh, I believe that's overstepping. So, okay, so it has to swing back a little bit. Jayson Davies Yeah. And it's hard to find that balance. But you're right. It used to be a team decision, not a parent decision, not an advocate decision, not an OT decision, a team decision. And so we all have to kind of agree. So yeah, right there with you. Alright, I do want to step into the present. But I have one more thing that I want to talk about or ask you about how things have changed. And that's evaluations. How have you seen evaluations change over time? Beverly Moskowitz So, um, I want to talk about valuations and treatment. Okay, we really didn't have a big repertoire of avails back, then we had some developmentally. And that's what we did. Now, I'm gonna be honest with you, I'm a really good therapist, I have never cured somebody who has an intellectual disability. Okay, so I, I felt all along. Why are you asking me to do developmental vows, the child's always going to not measure up, I get there, so functional, and you really don't need OT services if the teacher can fully include them in all the activities, and they're participatory. So that was back then the evals, the evals have evolved, we have more criterion-referenced, we still have standardized assessments, I get it, you need to have some kind of barometer. So you can measure change. Not a big fan of a lot of standardized assessments, I'll be honest with you, they typically never speak to what I was working on. So I'm more a fan of what we call now performance-based assessments. I think that was a smart move in evaluations, moving away from a deficit-based evaluation process, I don't want to know all the things that kids can't do, I want to know what they can do. And if that's still problematic, that's where I'm starting. So that's been a lovely evolution in our services moving away from the deficit-based to what we call the strength-based assessment, in terms of up treatment, pushing into the classrooms, I think is the right thing to do. Now, I've been in schools where they have these gorgeous OT departments, I was invited to one of those schools with a gorgeous OT department. And I said to them, so I think this is really mixed messaging. Like, I don't think you want me to have a medical model. And when parents see this, they want that pull-out service. You want me to go into your classroom. And in terms of all that stuff that you have, that's in the cabinets that you allowed the previous OT to buy, that's lovely, but I think you want to use that either. You won't be using this stuff that's already in the classroom because isn't that the stuff that kids actually have to use during the course of the day? So I'm very practical and my straight talk appeal to a lot of administrators, as I said, my reputation as somebody who got it was out there and I never looked for job districts always sought me out because they knew that I would do the right thing by the district, by the kids, the teachers, and the parents. Jayson Davies And that's interesting because you know, we do have this clinic model school model. And to kind of go back and forth, you really don't see the education model going into the clinic, but you do see the clinic model going into education a lot. And you're right, I've worked at districts where we do have a, maybe it's one clinic at one of the schools where more of the autism classrooms are based, or there might even be a few motor labs or whatever we might want to call them. And that does, it's moving into the classrooms more, it's moving into the schools more I should say. And so that's, that is a very interesting talk. And we have that talk a lot with all OTs that I talked to about, you know, what's clinic-based? What's educational based? Should we be pulling kids out of a classroom to provide 30 minutes of some sort of sensory type of therapy? And I, as someone asked me earlier, like, Is their research to back some sort of sensory in schools, and there really isn't most sensory research that's out there are three times a week, for an hour for 10 weeks, I've never seen a school-based occupational therapist have three hours a week with a student, that just isn't going to happen. On the flip side, you're saying, well, that kids now miss three hours of education every week, who would agree to that? Beverly Moskowitz So also, Jayson, our charge when we go into schools is to promote function and participation, their research, and if you look up, Helen Pola Tyco, there's a whole bunch of other articles out there, sensory integration, and I got certified way back in the 70s, the original Southern California sensory integration tests, I got certified and all that. But the research on using sensory integration therapy has not shown that it facilitates function. That's a problem. That's what we're supposed to be doing in school, and you're gonna tell me I'm doing all this swinging, it's not promoting that child's ability to actually work within the classroom? No, it's not. Does it impact the quality of life? All that's valuable. But when we're in school, we really have to get down to how can I give that child the movement experiences I read today on Facebook about how do I stop a child from tilting his chair back? Well, don't stop him from fooling. But think of a safer chair, because the child's telling you, he needs that movement. So that's the kind of sensory stuff that we can do in school, we should not be doing sensory integration therapy. Now, Lucy Jane Miller, at the star Institute is doing research on how to better measure the effectiveness of sensory treatment on function. Those are the things that we need to be measuring. Because when you administer, those SIP tests, and you go through all your fancy treatments, we administer those sub-tests, there's no significant difference. Jayson Davies Interesting. Interesting. Yeah, I know, that's going to continue to go on. And I know we need more research because there just hasn't I don't think there's been a sensory-based program that has been studied or researched using any sort of a school-based model. And until we get some sort of research where the sensory model can somehow be integrated into a school model, then I don't even think we can truly compare what could happen at a school versus what can happen in a clinic. There's a lot of research out there. We need more research in both sensory Beverly Moskowitz respectful, Jean Ayres, is it a she's like, whoa, brilliant, we are also indebted to the body of knowledge that she gave our profession. But as, as I read today, hey, listen, Facebook is awesome. And I resisted Facebook. Okay, not as long as I resisted podcasting, but I resisted Facebook. And then I discovered these wonderful discussion groups that OTs are having on Facebook. So there was something about the weighted vest today. And you know, how what's the protocol for a weighted vest is no research supporting weighted vest weighted blankets. Now, that's not to say, we haven't found the right variable to measure exactly. Cause we all know how nice it feels to get a nice hug. You know, when our children are upset how that is what they need. So we need to measure there are some neurochemicals we have to kind of hook up with some lab and make their something but the evidence isn't there right now. It's not there with sensory integration treatment in terms of translating into function, so keep your eye on the board. When you're in school, you are a major problem solver looking for ways to promote function? Jayson Davies Absolutely. Speaking of function, I think one thing that has evolved over the last 20 years is tiered intervention and RTI. And so I would love to know your experiences with RTI, obviously, you've been talking about how you push into the classroom already. So how have you used RTI over the years? Beverly Moskowitz By coming across as pushy? Because I guess I am? I don't know. Jayson Davies No, no, not at all. Not at all. Beverly Moskowitz No, I say that, jokingly, it always struck me as the right thing to do. So way back, even in the 90s, when they were having discussions about kids that were struggling regular ed kids, I would inject myself into the conversation out because I would say, "Listen, it's such a better use of me now to help him to help anybody, then to then wait until he gets you to know, you have to make a referral." Now you commit me to do an evaluation. Now I've got to write score tests and write a report and go to a meeting. "Listen, if you let me come into your classrooms and speak with you now. And, and actually, I bet there are a few other kids who I could hope also, we can intercept these at-risk kids". I have this feeling way back when before RTI ever became an acronym. That's the way I wanted to practice. And apparently, I convinced enough people that that's how I built my practice and my reputation, I was somebody, I am not standing on ceremony, I'm going to help everybody, you can talk to me in the hallway, you can invite me into your classroom. Now, we have, you know, more bureaucracy now. And I get that too. But I always was pushing limits to see how much I would be able to avoid having to get into a lot of red tapes. So I sent you my message, here's what I want to do. I'm never gonna lie, I'm never gonna hide it from you, this is what I want to do. I want you to be okay with it. And they would say, okay, so sounds okay. So if that is something that sounds comfortable to you, if you feel like, you know what, I could see myself doing it, do it level with your administrators, I will share Iran handwriting clubs. And we call them handwriting clubs. They just happen to be facilitated by the OT, but we can call them OT, because if we call it OT, then we wouldn't need to have a referral. I don't want to do referral paperwork. It's not just being honest with you. We call it handwriting club. Jayson Davies It's true. It's true. Beverly Moskowitz Right? By running it by the administrators. Here's what I want to do. And they said, sounds fantastic. And then all those at-risk regular ed kids, who, you know, if you just had a few sessions with them, you tweaked a few things, gave them some adapted writing paper, taught them the rules on letter size, I'll get to that. You can make a difference. And so I was playing a kind of play fast and loose. I was making my own rules up as we went along. They were there were no really strict boundaries. Jayson Davies Yeah. And you know, sometimes I will say that it is better to ask for forgiveness than permission. Sometimes, you know, you go into a classroom, you get something working with one teacher, that one teacher, it's amazing how three other teachers come and ask for your help because you kind of stuck your neck, your neck out there, and got a group going with that one teacher. So I absolutely am right on the same page with you when it comes to RTI. Beverly Moskowitz Absolutely, I think that should be our motto. Jayson Davies Let's do it. Alright, so what have you found to be the most helpful when attempting to collaborate with teachers? We obviously just kind of talked about how you collaborated with the principal, but what about the teachers? Beverly Moskowitz Okay, so you got to be real, you got to connect with them. And you have to recognize they're professionals. They went to school thinking, you know, whether they're new grads, or they've been doing it for a really long time that they would be teaching, not sitting in the hallway themselves collecting data all day. They have so many layers upon layers of mandates. Differentiated Instruction is the right thing to do. Just the same. They are lesson planning for different groups for their classroom every single day. And they have to like juggling their and making sure that everybody is active. If you go into the classrooms, and they perceive that you're about to give them more to do. They're going to say, I'm good, thanks. Okay. And believe it or not, I did that because I have so many ideas to share, and they basically say, Okay, thanks, you know, any, okay, so yes, I have been known to overwhelm people, but I learned that the best use of my time is to listen to them to recognize we are on their turf. It is not about you and me. And I said that earlier, it's you know, listen, I'm getting plenty of attention right now. It really has that mindset. Well, you are there to serve in school, you are on teacher turf, you have to learn what they need to cover. So have those real conversations with them. Tell me about your curriculum. How are you assessing learning? What's your homework look like? How do you set up your assignments? Your room? May I play around? I've been known to Fench way a few rooms because I do that. But I asked permission first. I do before I forgiveness because I am moving furniture. But I also move furniture around I'm going to bring things I bring them gifts. It's a joke. It's not like I'm buying them an outfit or anything. But I will adapt the test for them. Can I try my hand at your test? Because I saw their test. It's visually overwhelming. Maybe I could make it much more linear on an adapted writing paper? Or could I move some desks around so that the child who really needs to be front and center it doesn't have to crane his neck to see the board moving away from the radiator because it makes a whole bunch of noise? That's a gift, you give a teacher. So if you want to have those connections with the teachers, let them know that personally, you come in peace. I say that to them. I'm not a spy. I'm not here to judge, right? I'm here to help. How can I help you? Yeah, I want to learn with you. And honestly, that kind of attitude will go such a long way in getting those teachers to open up. The ones that are overwhelmed. They have a whole new curriculum, they're in a master's program, their kids are sick at home, everybody has a life. They'll share that with you. And you'll say no worries, would you like me to create that test for you or to work in this in this center with you? They will be so grateful. So I don't know being human? Jayson Davies Yeah, you know, and some of my best experiences of school as a school-based OT come from working with the teachers. You know, we have great experiences when we work directly with the students, but you get such reward from working with the teachers as well. And also knowing that your knowledge of one teacher could potentially help 30 kids this year, and then even more kids throughout the lifetime of that teacher once they understand something so absolutely. So I want to dive into the Size Matters handwriting program that you so cleverly created. But I think this question might actually lead you there. I mentioned how I love working with teachers and that can be rewarding. What has been a super rewarding part of being a school-based OT for you? Beverly Moskowitz Wow. Well, what has been so rewarding of the connections, the connections with the teachers, the kids, to have people excited to see you in the hallway, I created a little gizmo we called it the budget, there was a device that attached to it, legs of a desk that kids would bounce on. This is before the bouncy band I had a model that I put in 30 seconds I had installed in their principal with saying the bed I need six more. And that room went on every desk in the classroom and the kids would stop me in the hall and say, Can I have one of those things? And I'm like, Who are you? I don't even know these kids. But I love that they recognize that I brought something into the classroom and they wanted it. I love it. The teachers sought me out they really only wanted my opinion that I had said something done something that stayed with them. And so that feels really good. And there's one story I wanted to share. And I'm sure you all have stories like this right now. But how do I know that I was on the right track? How do I know this inclusion part was going to be working very early in the beginning in the late 80s, early 90s. A parent knew her right she was having her severely cognitively impaired daughter in regular kindergarten cutest little thing, but she had Angel mints anyone have angel has to do with Angel mints you're pretty impaired. But those children were lovely to her daughter. And I sat in a meeting with his parents said for the very first time. She got to go to a birthday party. Her daughter was invited to a birthday party. And she was able to sit with the adults because the kids played with her daughter. And if I tell you that story is like 40 years old now. It still makes me cry. That's the right we're doing the right thing. It's the right thing to do. Jayson Davies Oh, yeah, I've had a pair of brothers with Angel mints and you're right very, they need a lot of support. And so that's so kind to some other students, some other kids were able to come and support. You know, I think it takes a certain type of person, to be an occupational therapist, to be an educator to be anyone that's going to come in and work with kids, especially kids with disabilities. And I think all of us as occupational therapists, working for those schools, we kind of have that heart that it requires, you know, the special education teachers have it too. And so Beverly Moskowitz not our kids, whether they ever grow up to be teachers or OTs, we want our kids to grow up to be kind. Yeah, to be able to see somebody with a disability and not be afraid of them to occlude them to talk to them. Jayson Davies Absolutely. Beverly Moskowitz You make such a difference to that parent. Maybe the child doesn't even know what that parent is most grateful for. Jayson Davies Absolutely. All right. Well, I know a lot of people know you for the size matters handwriting program, this program has helped 1000s if not more, tons of 1000s of kids and adults around the world to understand. So I want to ask you starting what is the size matters handwriting program? Beverly Moskowitz So as I said to you, way back when we could play around a lot. And I was getting all these handwriting referrals. And doing everything I had ever learned should be impactful. I'm working on my core strength by enhancing manipulation skills, perceptual skills, so they had done those assessments and the kids did really poorly. And using the prevailing handwriting program out there. And I'm not making a difference. I'm not nobody is any better. They're still printing the same way. This probably like 25 years ago, I started to play around with variables I thought might have more impact. And that's what I discovered that when I focused on letter size, the kids caught on really quickly to that that was really, you know, touching here. And what started to happen if you were have taken my course I tell this story. The special ed kids became the neatest printers in the school. And you know, it was always hanging there work in the hallway, not go by my classrooms, and it looks so beautiful. And the regular classrooms were horrible. So I asked a first-grade teacher, friend, could I try something in her classroom, I wondered if these ideas would translate. And I gave a 20-minute half-hour lesson in her room in first grade. That's it. Later the day, she flagged me down but you walked out of the room and everybody's printing changed. One parent later in the week, said to me, that the teacher caught up with me and said, a parent called to confess that she scolded her daughter for being so irresponsible, bringing home somebody else's assignment book. I was there once. So I had the sense that I thought I'm onto something. And I started to develop it and play with it a little bit. And then I went back to school for my doctorate. And I wanted to know what everybody is doing about handwriting in the country and in the world. So you're welcome to read my doctoral work. And I stayed connected with Temple University because I wanted to test my premises. And that's when we did and I'll, I'll get into the research, we designed the largest research study ever done on handwriting. And my methods were proven effective change scores were significant at a point, 001 level. That is massive. Jayson Davies Yeah. Yep. Absolutely. Actually, go ahead and explain that research a little bit. How was that put together? We had Beth Pfeiffer on the podcast not too long ago. And she talked about the program is this that the researcher was different research? Beverly Moskowitz So Beth, Beth Pfeiffer, everybody checks her out. She is beyond awesome. She's faculty at Temple University in Philadelphia. So after I finished my doctoral program, I did stay connected with Temple and I said to them, if you ever have a student looking for a study, bring it on. Later to doctoral candidates came forward. And in what turned out to be this first study. Now at this point, I was traveling around the country teaching and I would always say if you're interested in being a site for research, let me know, we had around 678 therapists say, Yeah, I want to participate. Let me share with you when you read the literature and you see the size of a study, be impressed. It doesn't matter how small definitely if it's big, you have to jump through such hoops to get to that point where your school is approved for participating in a research study. You got to write the IRB, which if you've done that, it's a pretty lengthy thing. By the time we finally were ready to launch, the eight schools dwindled to six to five. Ultimately, we had two school districts. That said, three grades, kindergarten first and second. Control and intervention in both grades. Over 200 students, three different standardized or criterion-referenced assessments. We had to our scores We had 15 scores in six different states because there were 1800 assessments to score and they had to sit through training videos and score samples and earn a reliability coefficient of 0.8, to qualify, all of that. I wrote, has anybody ever wants to replicate by study, a Fidelity manual, so exactly what was happening on day 15 In first grade, and Massachusetts, was happening in day 15, in first grade in New York, and so on. It was an eight weeks study, they did it every day. And again, being impressed with research makes it into literature, these people work hard. You need to get in, I needed to get out because you're gonna have to school. So it was a very brief period of time. That study was Beth was the lead investigator on it. Tammy, Mary, and Jillian Ray were also part of that study that got published in the OT Journal of Research in 2015. The second study was the one that you get Cheryl Zylstra. Cheryl was a doctoral candidate temple. And she did the second study with Beth Pfeiffer again, hers was smaller, but they correlated handwriting also with reading. So it kind of reading Facebook, you might think that's my it's like Wikipedia. Every it's Facebook. I don't know is that horrible? But I wonder what some of you are talking about so yeah, there was this advocate who wants technology, no handwriting. And I said, Well, what do they want the kids to learn how to read this. Handwriting supports reading technology does not problem-solving creativity. So anyway, Cheryl's study showed a very strong correlation between handwriting, and letter-sound and letter name recognition. That was that study, we had another study off, and Leigh and Leigh Akasha. And I hope that you're watching, she wanted to look at the self-monitoring component that we're very proud of. One of the unique features of size matters is that kids can score themselves. If they want to score each other, they can score each other do some peer monitoring, there is evidence on the benefit of giving kids that power. So she went to church to see whether there you know how powerful that is. So she looked at our second graders and wanted to ascertain the benefit of the self-monitoring, they rolled dice to determine practice. How silly is that? But we got to defer to it. They roll a five they're gonna make five-star worthy. Yeah, there's no they wrote one. We only have to make one but better Three Star Wars a year, you're making another one. The kids love that. And next thing, you know, kids are like, give me a six. Wait, you know, this game works, right? They love the power. They love the power so there's the buy-in. We had another study, this was thrilling. This was at the University of Wisconsin-Madison. I didn't even know it was happening to I saw it published in a journal I do my agents, they did a comparison of effect sizes of nine different handwriting programs. Some of those maybe I saw that one among your favorites. And they conclude when it came to legibility Size Matters are best. Now they did conclude we're not as good for speed Jayson Davies speed. I was gonna ask you about that. What's your reasoning on that? And do you think it's a problem? Beverly Moskowitz So that was funny. In that very first research study that kids did measurably slower, the intervention group kids were measurably slower when it came to writing. That said, the site managers in both locations said to me, that was so funny. When it came time for the post-testing. The kids were so careful to touch their pencils to the writing lines in all the right places that they were slower. Listen, we're looking for a longitudinal study. Does anybody out there want to do that? I believe. Yeah. So this was only an eight-week study. If we had a semester, the year I think you're gonna see it even out but okay, you have to report. That's what happened. Yeah. And here's my response. If the kids are writing fast, but you can't read it. Who cares? Jayson Davies Yeah. And to that point, what is one of the main things I think teachers say, in a classroom, they, their kids slow down, whether kids running across the room, or if they're going through math problems too fast if they're writing too fast. I mean, to your point, everything we need to slow down in a lot of time for kids, you know, reading to, they're not going to comprehend what they're reading, if they're going through it at the pace of a jackrabbit. They need to slow down and do the same thing with writing and everything else. I agree. Beverly Moskowitz In the beginning, let's get it right, and as you develop that automaticity? Yeah, the speeds gonna come. Jayson Davies Absolutely. Alright, what are the main cornerstones that you would say the Size Matters Handwriting Program is based on, obviously, size, it's in the name. But are there one, two, maybe even three other like Cornerstone blocks of information that you really focus on? Beverly Moskowitz So yeah, letter size is the biggie. But Size Matters is very responsive to the realities in school, you have to empower kids and these kids. First of all, if the kids have been on your caseload for a while, a few years, they're not happy about it. They want to, you know, there's something about always having to go to therapy, it makes them feel like there's something very wrong with them. We want we don't want that messaging, this program works quickly. It's amazing. If you're not using size matters yet, I'm going to suggest it is in your future, because I do believe it's the future, because it works so easily. Once you correct errors in letter size. That's what makes an immediate difference in the consistency, and therefore the readability of the page. And it is so easy to teach because there are only three sizes in the manuscript. So I can't undervalue that when you look at format, every other program is focusing on form, there are 62 of those your uppercase or lowercase numbers. And individually, if you looked at that your kids writing letter one that you could figure out what those letters are. It's in the context of the whole that it's a mess. And that's how you know it's not about form. It's also not about a workbook. So Size Matters is a concept-driven approach, I often say that you can get started right away with your knowledge alone, you don't need any material. Now we haven't here to make your own can make it faster, make it easier to use. But if you don't have anything, you can get started just by teaching the concepts that make it affordable for all those districts that have budgetary issues. And who doesn't? You can get started right away, just using your concepts. I also share with you stuff that you can make, that's the kind of therapist I am. I mean, we have stuff that's beautiful, and you know, nicely finished. But I didn't have stuff when I was figuring this out, I made stuff. And I'm going to share with you how you can make your make stuff to share in your classrooms. It's embeddable across the curriculum, that's another thing that no other program can say. Because it's not about 15 minutes of practice in a workbook a week, that's not going to get you anywhere. You have to have concepts and strategies that are that remind kids to think handwriting letter-size during science, social studies, they're writing word problems in math. And it can be as simple as just having the teacher walk around with dice. When the kids hear the dice, their ears perk up, because they know, at any moment, the teacher could stop by and say, Hey, Beth, a veteran is a star worthy. So in so many ways, it is a realistic program. And I'm not done with the research. We just finished a study up in Florida. That was lovely. They're pursuing publication there that talked about how teachers feel about bringing size matters into their classroom, what the perception is, we had another study that finished in I want to say Norristown, Pennsylvania, with kids on the spectrum. We have another study, listen, there's more and more, I just say bring it on, I am going to be the most heavily researched program out there. That's how confident we are. Jayson Davies That's great. Beverly Moskowitz How well it goes. Jayson Davies that's great. We need more research in the field of occupational therapy. So yes, go for it as much as you can. So you go around the world, or at least around you talked about you might be going around the world soon. But you definitely go around the country and teach others. What is your hope for the occupational therapist sitting at the middle desk in the third row of your training? What is your hope that they're going back to their school? And do Beverly Moskowitz I want them to get excited? As I said, I'm doing this for a long time. 46 years, and I'm still excited. I am odd when I go to conferences, and I hope that all of you join your state organization, join AOTA go to conferences. Our profession continues to evolve. We're so very grounded in the way we approach situations. I said to somebody today, I don't think there's ever a problem that OT can solve. We just haven't figured it out yet. But give it to an OT because we are so creative. There are so many different avenues to go in there. So I want that therapists coming to my conferences to feel my energy to feel excitement about this awesome profession. In that you have spent a lot of time and money becoming a part of the possibilities are endless, but do protect this wonderful profession. Because there are people, professions, I should say, who are jumping on the bandwagon. And we kind of have taken our eye off the ball by not joining our state organizations, people say I don't have to, so I'm going to save the dues. Listen, I call it the cost to do a business, recreation therapists are doing ADLs they are doing handwriting they're doing, you know, they say they own recreation. Actually, recreation was always part of an... So no, Pts are being more functional. They're recognizing that just standing or walking is not nearly as important as when you have to put your bookbag in the locker. So they're being more function-oriented. And the ABA therapists don't get me started. They have somehow moved to the front of the desk, the conference table, and they're telling us how to practice and they are not science-based. They're not evidence-based. How did that happen? Well, how it happened is that OT stop representing, and when you see a practice infringement, and you want to nip it in the bud, the lobbyists, the legislators in your state say well, how many people in your state? Are you representing how many people feel that way? And the sad fact is that only around 10% of practicing OTs are members of their state organization. So they say, Well, how do we know that the other 90% exists is important. That's a point. By contrast, recreation therapists are 90% of those practicing are members of their state organization. Jayson Davies Oh my gosh. Beverly Moskowitz I would word for word from the OT practice framework here in Pennsylvania and drop it into their licensure bill. And amazingly, there was somebody on Capitol Hill in Harrisburg, capital, Pennsylvania, who caught it. And so you can't say that, that's what OTs do. It is happening in your state. So listen, you don't have to be politically active unless you want to be. But you must pay your dues to protect your future. Jayson Davies Yeah, Beverly Moskowitz and then go to the conference be awed by the many ways that your colleagues have taken this body of knowledge and are applying it. That's thrilling. Jayson Davies Absolutely. All right, great. Well, I want to leave a little bit of time for some Q&A, because we do have about 50 to 60 people here with us tonight. But I do want to give you an opportunity to kind of transition because you're working on a new project. Obviously, you have the manuscript to size matters, handwriting program. That works all on uppercase, lowercase manuscript, but I think you're working on something in the future, right? Go ahead and explain that. Beverly Moskowitz So thanks, Jayson. This is a labor of love. For years, people have asked me for a Spanish edition, a cursive edition. Personally, I don't speak Spanish. So that was a big stumbling block right there. I didn't even know how I would attempt that. And in terms of cursive, I wasn't inspired. I didn't know how I was going to make my approach different, better than anybody else's. And then two summers ago, when the country looks like, like what happened, you know, we're like, can't we all just get along? I got it. I got my inspiration. Unlike the manuscript book, which is there's only one workbook and it practices a single letter at a time teachers are instructed, open up their literacy, social studies, pluck out words that are meaningful to your curriculum. That's what you want to write. Unlike a manuscript, cursive is all about connectedness. So I actually needed to identify words for kids to be writing. And, the words I chose to use were words of kindness, participation, inclusion, disability awareness, things that I think are so sorely missing nowadays, what happened to civility, and us learning how to have a polite discourse. So I have an advisory board. And we have built on the Size Matters principles, there's now a size four-letter. There are lots of motor learning opportunities where you practice making the movements of the letters. And then there are narratives and the narratives are written at grade level, second, third grade on these themes of acceptance and awareness and fineness with discussion questions. The words that the kids practice writing are extracted from the narrative. So they're a little contrived, because I've always tried to use the featured letter of the page on it, but the kids practice writing words that are meaningful reading words and having these lovely discussions about how they might include somebody who does Just make it simple. Suppose your arm is in a cast, how are you going to write. So it doesn't have to always be heavy-handed, but it gets the kids thinking about the challenges that are out there. So that's part of the beauty of this book, I will share too. It's illustrated by children. Beyond proud of that my own son did illustrate the cover. So it's dedicated to him. And I can just be a little bit personal here, he has a traumatic brain injury. So he qualifies as an artist in this book, but all of the children are exceptional. And the artwork is exciting, and I'm so so honored at the opportunity to celebrate these talented children. And then that's not all, that's the lowercase pages. I wanted to be authentic when it came to the uppercase pages. And to be authentic, you want to have a proper noun, which is a person place, or thing. I chose places because these are themes that are relevant, every place everywhere in the world. And so the uppercase pages actually have maps, different parts of the US different parts of the world, Europe and Africa and Russia, and China and Southeast Asia. And honest to goodness, I think this book is going to be a keeper because you're gonna love it. You're, I'm planning a vacation, I had, like, oh, well, I got a book as a map of them. It's a beautiful book, we have been working on a year and a half my advisory board, and I had a seven-hour meeting last Friday because they are so dedicated to this book, I believe that you'll love it, you will keep it you'll treasure it. And your kids are going to learn how to write in cursive, and how to be part of a kinder, more humane society. Jayson Davies I love that because I think as occupational therapists, sometimes we forget that, especially in the schools that were part of the education, and the idea that you're putting that geography in there. And you're using principles from the curriculum, and you're and you're throwing that in there. That's so important. So I think that's fantastic. Awesome. Looking forward to Beverly Moskowitz Worthing that the teacher amongst us suggested that we have additional STEM activities, which has now been expanded to steam science, technology, engineering, art, and math. So for those teachers that want to build a curriculum, there's a whole bunch of ways to expand on the lessons here are things to learn about, for instance, the AP age talks about accommodations and adaptations. And I think we talked about Temple Grandin under the steam pages Google her we tell the kids pretty, pretty fascinating lady, so much learning in this book, I'm just so as I said, so proud, so proud. This is a labor of love. I hope that you are interested in seeing it. Jayson Davies Absolutely. And you know, some people are already talking about just about the size matters handwriting program. So I'm going to actually bring up our first question from Jennifer, I can bring that right up here on the screen for us, and says, I've really enjoyed this. Thank you. If I would like to start the size matters in my schools, where should I start? Beverly Moskowitz So, Jennifer, there are a few ways to get started. You want to learn more about it. And to learn we have a so my website is called realotsolutions.com, you can take the three parts self-study webinar series, I am an approved provider of continuing through AOTA so you earn points seven CEUs. That's a self-study, or teaching a two-day live course in February on East Coast time. I should probably know those dates and I don't. But depending on where you are, you could do that in April. I'm teaching a two-day course on West Coast time, two days. Day one is the intro course, it's comparable to the webinar series. If you take the webinar, you can just take day two, day two is a therapist certification course if you would like to be certified as an SMHP therapist, all you want to take the day two course. And I send you, I send you a gift. I'm going to send you your handbooks, your lab materials, scoring kits, a few little extra goodies in there, pre SMHP materials. So that would be a good way to start. Educate yourself. If you want to get a proposal for your school, I'd be honored, I'm happy to craft a proposal. I always say this is the beginning of a conversation. I want to learn more about you. Whenever schools districts adopt size matters, they get a free hour of me I'm going to do training on the use of the materials. If you want a CEU course I'm happy to bring that also to you. But I always want to learn what is your budget what I don't want to tell you to get something if you can't afford this. Don't get it. We'll make it we'll make something that's going to be okay. Hey, maybe next year, you'll buy the MRB, the magnetic rec to square board. But in the meantime, a dental practice scoreboard, it's a big whiteboard that has lines on pink, a yellow-blue marker is very cute. Or you can make lines on your board and use pink, yellow and blue, a dry erase board. Anyway, so I'm going to share with you how you can get started, whether you want to propose, whether you want to pilot it. Another option, pilot studies, I can help you design one of those, I always suggest asking your administrator, that's okay as parents to have that there. Okay, teachers, you want to control in treatment. So you can say that differences and take pictures before and after? Because a picture is worth 10,000 words, I promise you. You're going to say, as I still say, wait, that was the beginning of the session? The end of the same session? Jayson Davies Wow. Yep. All right. This next question kind of leads into where I think you're going anyway. So what are some of your methods for providing push-in services with the Size Matters program? Would you provide instruction to the entire class? Beverly Moskowitz Yeah, yeah. Jayson Davies So how would you pilot that? Or how would you pilot that then for the administrator to see? Beverly Moskowitz So So pilot studies can be as detailed as you want, or as long as you want, or as short as you want. We've done four-week pilot studies, three-month pilot studies, full-year pilot studies. So first, it's going to start with a conversation about what do you envision? What permissions? Do you need parent administrators? And how many classes do you want? How many, you know, grades per classroom Do you want so let's flesh all that out. We talk about what the training is going to be like. And I like to empower you as I want you to be trained and you get me you get to talk to me, I'm happy to talk to you. So shy, I know it's gonna be hard. I'm going to support you make sure that you feel like you know how to launch it. So you want to get bit collects baseline samples, which could be as simple as the kids writing the alphabet, and a grade-level sentence, date it, initial it, so maybe, you know, we keep it a little bit blindly, we don't want to or your number. And so you really don't know who the child is. And then at the end of whatever interval, you decide, you want that pilot period to be the child's gonna write the alphabet, upper and lowercase, and that same grade level sentence and you're going to compare it, I always suggest buying one of those flipbooks, like at Staples Office Depot that has those proposal sheets in it, and you assemble it. When you present that to your administrators, I promise you they're going to go they will. Jayson Davies Yeah, I've seen that happen. I've done something similar. And sure enough, the next year, the principal set aside money in their budget to get a handwriting program. And so definitely it does work. I wanted to go a little bit further on Caitlin's question. She asked about doing this in the classroom, I want to be asked you a question that I don't know everyone's a little bit different. What does it require of you to do with the teacher? Do you think that we can just walk in and do this on our own? Or do we need to plan with the teacher ahead of time, collaborate a little bit before we go in, and do an entire classroom program? Beverly Moskowitz Well, you always want to collaborate with teachers, because I'll go back to where I said they were on their turf. I'm Yes, I'm there to support you. I certainly don't want to be pushy. So first, when I asked, may I come in? Would you like a policy? Would you be receptive to it? And you might have teachers say to you, yes, not this year, I'm overwhelmed, ah, blah, blah, blah, whatever is going on in their life, and they love you. So first get you to know, you have that relationship, that rapport building wasn't that like OT one on one, establish rapport, you want to have that rapport? And you want to ask for teachers, what would be a good time to come in? They may say I am, we are so far behind in our math curriculum that I need to add extra time on that. So listen, life, find out when that block of time is, and ask for some regularity. So if this is the block of time, can I come in every day? Can I come in three days a week? Do I have 20 minutes, you can get a lot done in 20 minutes if you're organized. So there are lots of questions to ask an answer before you launch a pilot study. And that said, I tell you this from experience, had a therapist love, love, love size matters. They have I want to do a research study. And by administrators, my everybody's ready to go and I'm like, I think that this is going a little bit too fast. But she was so enthusiastic. The bottom line was we didn't ask enough questions. And when the study was finishing, it was the end of the school year. And it was field day. Well, who wanted to be in class doing a post-test when it was Field Day. And even when they sat there, they were really distracted. So we didn't realize it was gonna be a vacation overlapping that the time here. Ultimately, all that hard work ended up not being a good study. So Jayson Davies yeah, we always got to look at the calendar. All right, we'll do one last question. This is kind of a question about your course, you already explained this a little bit, but just a little confusion on the difference between the three-part self-study and the two-day course. Beverly Moskowitz Ah, okay. So if you want to become a certified SMHP therapist, that's an intermediate level course, you have to take a qualifying prerequisite an intro course, to be eligible for the certification course. Now, if you've followed me at all, you may know that I have taught our long courses on ot.com, a marvelous site, those do not count as qualifying prerequisites, look at them as like a little preview a little supplement to what you're learning, but it's not sufficient in itself, still, definitely, you know, take them they you get to see you if you want to do that. The three parts of self-study, and that day one course essentially have the same content. Here's the difference. The self-study, self study your, your pacing yourself, you get to backup, if you want to listen to me again, you can watch it a two in the morning, if that's the only time that you're free, you do have to take a post-test. As I said, I am AOTA approved provider. And when you do distance education, there has to be proof that you paid attention that you took the course you just go to movies. So of there are three different post-tests that you have to take, I send you the links to the slideshow, the handout, the post-test link, and the course evaluation link, you have to download the handout. I talked about the lab materials, you don't actually do them. In the live course, it's me in real-time. I'm going to send you the handbooks, I'm going to send you the lab materials because I believe in fun, so we're gonna have fun together doing center time activity, you get to ask questions in real-time, the day one course is six hours versus the three-part webinar, which is seven hours. So there's a supplemental course, if you want that extra stuff that I just couldn't have you sitting there for seven hours, I can't sit there for seven hours either. So there's a little less content, but essentially the same content in the day one course as the self-study. Now we do the lab materials in the day one course, which we use the next day during the certification course. So it's fun. Because you get to play the games, a lot of games that you play in certification. If you took the self-study, you can still play the games, when you're just not gonna have the materials to submit one of your samples. But you're certainly welcome. A little bit of a budgetary issue difference too. So you get to decide this, this works for my budget, this works for my time. And if you can't take two days off in a row, I'm gonna tell you to take the self-study. And then just join me for the live course. Jayson Davies There you go. Beverly Moskowitz Get a certification. Jayson Davies All right. Well, Dr. Beverly Moskowitz, thank you so much for joining us today. It's been a real pleasure. We've been going on for about an hour, almost an hour and 15 minutes, we've had 50 to 60 people here consistently, just loving what you're saying. Thank you. Everyone who has joined us this afternoon. Really appreciate you being here. And I look forward to staying in touch with you, Beverly, and maybe taking that course alongside some of the people that are here today. So maybe. Beverly Moskowitz Listen, this has been hard for me to read the chat and like, look at you all to see that. But I am, you inform me and I would be honored. If you wanted to write to me, bev@realotsolutions.com. I would love to problem-solve with you. Certainly, if its size matters. I'm thrilled about that pick-up anything in school-based practice. So please don't hesitate. I always hope that above all that people feel connected. Sometimes we are so isolated out there. And I want people to know that I am. It would be my pleasure. You honor me by reaching out and allowing me to learn about your life and your practice. Jayson Davies Absolutely. Everyone takes that and uses it because it's very amazing to be able to collaborate with another therapist, just to get a little bit of event really appreciate you offering your assistance there. So thank you, Beverly. Thank you, everyone, for tuning in. Really appreciate you and we'll see you next time on the OT schoolhouse podcast. Take care. Bye. Beverly Moskowitz Bye, everyone. Jayson Davies All right, that was such a fun episode. I'm excited about that. When I'm excited to keep in touch with Dr. Moskowitz, she just has so much going on. Her passion for occupational therapy is off the charts. I love everything that she has to say. And I'm excited to keep in touch with her. Maybe we'll have her back on the podcast again in the future. Thank you. Huge shout out to Beverly for coming on taking the time to do this for us. And I really appreciate you for being here. Whether this was your commute your workout, your ADLs for the day just listening to a podcast, whatever it might have been. Thank you so much for being here and I will see you again on the very next episode of 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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Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 88 of the OT Schoolhouse Podcast. School-based Occupational therapists have been a part of public education since legislation was initially enacted in the 1970’s. Contrary to this, school-based OT practitioners often do not have pathways to educational leadership. OT practitioners are unable to serve as administrators within a school system in 46 states in the United States. In this special episode of the OTS Podcast, we will explore the unique qualities that OT practitioners possess that support leadership roles within a school system. Barriers to advancing into leadership positions (e.g., policy) OT practitioners’ face will be identified, and solutions will be discussed. The Audio in this episode comes from a 2021 presentation prepared for the Occupational Therapy Association of California Annual Conference. It is presented by Jayson Davies, MA, OTR/L, & Jaime Spencer, MS, OTR/L. You can listen to the audio version above or on your preferred podcast player. You may watch the presentation below. Links to Show References: Download the slides for this presentation directly below. CA School-Based OTs Looking for Change (Facebook group) USA School-Based OTs Looking for Change (Facebook Group) Transcript Download the Transcript or read the episode below! Jayson Davies Hey there, and welcome back to another episode of the OT Schoolhouse podcast. This is the final episode of 2021. And I cannot be more excited to have you here with me today. This is episode 88. And like I said, it's the final episode of 2021. I can't wait to come back in 2022 refreshed after a little winter break and come back hitting the ground running again, with the OT Schoolhouse podcast. It's been so much fun over the last few years putting this podcast together, we've had so many great guests, we've shared so many good stories together. And I'm just excited to continue this down the road. But for today in Episode 88, I am actually going to share with you a very special presentation that I and Jaime Spencer, from missjaimeot.com, put together for a recent conference here in California. It was the Occupational Therapy Association of California annual conference. And she and I put this presentation again about why they've put this presentation together about why occupational therapists should be credentialed within the schools. Some people think it's only because it would give us an opportunity to advance our leadership within the school system. But that is not the only benefit. In fact, there are benefits beyond that that will support the students that we work with. And so it's very important that at least again, myself and Jamie believe that we should be credentialed in the schools. Some states have already done this, but not every state. So if you're ready to kind of stick around and hear our reasoning about it, and potentially how to move forward with doing this, I encourage you to stick around and listen in. Jaime comes to us from New York, and obviously, I'm in California, we presented this in California. So it is somewhat California-specific. But she adds in some New York components. And we also tried to make sure that we add in some national components that it doesn't matter what state you're in, you're going to benefit from this as well. If you'd like to see the full visual presentation of this, we actually did record it and you can watch it at otschoolhouse.com/episode88. You're going to hear that same content, it's going to be a little more edited here. But you will see the same content at otchoolhouse.com/episode88. You'll just see all the slides and whatnot. As we are presenting so you can listen here or go watch it over there. Either way works or you can do both whatever complements your learning style. So stick around or head over to otschoolhouse.com/episode88 to hear this presentation that I and Jaime Spencer from Miss Jaime OT did together to promote occupational therapy within the schools. I hope you enjoy this special presentation Jaime Spencer Changing the face of school OT in California. Today we're going to talk about what's going on in the California Department of Education and how it's impacting school-based occupational therapy practitioners. My name is Jaime Spencer and I'm presenting today with my friend Jayson Davies. I've been a school-based occupational therapist for 22 years. I have a bachelor's in occupational therapy and a master's in special ed. I am a passionate advocate for school-based occupational therapists. I have a website and a blog at Miss Jaime OT where I help other therapists and other grownups to help their kids. It's really important to me to advocate for the value of school-based occupational therapy practitioners. I'm also doing research at Toro College of Health Sciences about occupational therapists and advocacy and leadership. Jayson Davies All right, and that brings me to me, my name is Jayson Davies and I am an Occupational Therapist here in Southern California. And I'd like to say that I am a school-based occupational therapist. I've been in the schools for about nine years now ever since I graduated from occupational therapy school at USC in 2012. And I just happened to fall into school-based OT and yeah, I just love being a part of that role. I did get my master's in occupational or occupational therapy at USC, and I am the host of the OT Schoolhouse podcast, where we talk about all things school-based occupational therapy. I'm also an adjunct thesis advisor for Stanford University and a mentor to OT practitioners. Today, we're going to go over three very specific items. We're going to summarize how the structure of California Department of Education systems impacts parity for school-based OTs. We're also going to identify three opportunities for school-based OT practitioners to showcase leadership, and then we're going to talk about how to apply these concepts to advocacy for school-based occupational therapists. So to get started, we have a question for you. If you had the power to change one thing at your school sites, what would it be? What about money? Would you like more pay or maybe a budget for your therapy supplies? That could be one of those things that you might want? Jaime Spencer Definitely. Jayson Davies Would you like to have more collaboration and a sense of belonging on campus to feel like you actually are part of the teachers union maybe or that you feel like you can go into the lunchroom and sit there and talk with everyone and be a part of that and have friends there? I mean, I'm not saying you can't do that. But maybe that's something that you might want. Some people just want to be a part of the Parent-Teacher Association and feel welcome there, that's perfectly fine. Maybe you don't want to be known as the handwriting teacher. Oftentimes, as school-based occupational therapists, we do work on fine motor skills. But sometimes it goes further than that. And we start to get referrals only for handwriting. And we're only known as the handwriting teacher, or the handwriting coach, maybe you want to be more than that. Maybe you want to be a leader on your campus, whether it is an official title of being a leader, or even in a commodity sense, you know, just being a leader, being able to coach the teachers provide professional development for the teachers, that's something that you might want. And then finally, maybe you just want to climb the ladder, and you want more opportunities to increase your pay, but also increase your leadership and your role within your school district. Jaime Spencer So Jayson, in my school, all of the teachers wear red on Thursdays, they're all on the same Union. But I don't get the shirt, because I'm not included in the teachers union. So while all of my colleagues are wonderful, and you know, we have a great rapport, I've been in the building for 22 years, there are a lot of things that I'm excluded from because I'm not in that union. So for example, I'm not included, or I'm not actually forced, or expected to be at their professional development meeting. And, you know, I've heard before leaders will say to me, "Oh, well, you're welcome to attend." Okay, but I'm not being paid to attend, and the teachers are being paid to a time. So I can't, I don't feel that I should be volunteering my time when everybody else is being paid for that time. So I'm a little bit of a stickler about it, because I think that leaders need to recognize that we need to be included in these things. And so I made this faculty picture because I don't have the red shirt. And it's something that is really important to me, I feel excluded at my school. And it's very easy to become cynical or frustrated in situations like that. But you have to ask yourself, rather than getting angry, and really being frustrated by the slow pace of change in things, we have to look at it in a positive light of how can we help? Jayson Davies Absolutely. And if I can just add to that really quickly. You know, in California, we're oftentimes we're considered classified management, certificated, management, whatever it might be. And that kind of puts us in a weird spot, because we don't really have people that work under us that we manage. We work alongside our certified occupational therapy assistants, but we definitely don't manage them. We are not the ones who evaluate our certified OT assistants. But at the same time, we're also not really being managed like a teacher would be. They're not managers, they're teachers. And so as occupational therapists in the schools as a classified or certificated management, we're kind of in this weird spot. So I definitely agree with you, Jaime. Jaime Spencer Yeah, I mean, everybody in this faculty picture, speech, social work, psychologist guidance, they're all in the same unit. So they have all of these similar opportunities that I don't have, and it is frustrating. Jayson Davies Alright, so this is our first objective, and we're going to go over that we're going to summarize how the structure of the California Department of Education system impacts parity for school-based OT. So let's go. The first big question is what is educational credentialing? Well, educational credentialing is exactly what it sounds like those teachers, anyone who I shouldn't say anyone, because obviously, we don't have one. But most people on campus have some sort of education credentialing. And we have another slide that's going to list all those out for you. So I won't get into too much detail yet. I don't want to skip ahead of myself. But you have to have a teaching certificate or teaching credential in order to be a teacher in school. Being categorized as certificated also opens more doors for you as far as moving up to potentially be an administrator or whatnot. And we'll talk about that in a second. So who is educationally credentialed? Here, there are three different types of credentials within the state of California. We have our services credential, our classroom teachers, or just a teacher's credential, and then we have our school administrators. To get that school administrator credential, you actually have to have one of the two other credentials. So under your services credential, you see school counselors, school, social work, school sites, child welfare and attendance, speech pathologists, teachers, librarian, school nurses, clinical rehab services. That Clinical Rehabilitation Services is a really interesting one to me. I don't know how we don't fall into that. It's really funny how things work out. It's kind of like in Hamilton, you know, I want to be in the room where it happens. It's just like, OTs weren't at the table that day that they're discussing who should be a credential provider, I guess. But then under the classroom teachers, this is more what people are familiar with, right? You have your single subject and multiple subject teachers. Single-subject refers to those teachers that work in middle school or high school where they specifically teach English or they specifically teach math or history or whatever that might be multiple subjects, teachers are your general education, elementary school teachers, right? They teach everything the entire day that with the same group of kids, and they teach it all. An education specialist is actually broken down into different levels. So your RSP, your resource specialist teacher, they have an Education Specialist credential for mild to moderate students. And then you have your mild to moderate STC teacher. But then when you get to your severe to mod classification, that's a different credential for that specific population. But it's still an Education Specialist credential. You have Career Technical and Adult Education, as well as adapted physical education teachers, they are also credentialed under that classroom teachers. That moves over to the school administrator's credential. And again, this is a separate credential that tries to word this the best way possible. My wife actually just got this, she's now an assistant principal, but she had to be a teacher first, for about five years before she could even apply to get her school administrator credential. And so she actually had to have that teaching credential. And a fun fact here, actually, because while she was applying for this, you know, I've been to School-Based OT for nine years at the time, I had been a school-based OT for about five years. And just for the fun of it, I was actually asking questions while she was applying. I was asking the college I was like, "Hey, can I can I go through the program with you?" And actually, asked them this? Because they're like, "do you have potential?" Like, "No, but I've worked in the schools for five years, I'm a licensed occupational therapist." And they're like, "No, you don't have a teaching credential." And I wasn't really planning on going through with it. But I just wanted to see what they would say. And if there's any roundabout way to do it, it wasn't the case. Jaime Spencer I actually had the same exact experience. Jayson, I wanted to when I was going back to get my master's, I wanted to get my Master's in School Administration. And when I started applying to all the programs, I couldn't believe when I was getting rejection letters, I was like, I was just shocked. And I wrote a letter to the New York State Education Department. And they wrote me back and said, "You're not considered pedagogical, which basically means you're not a teacher, your all of your time in the school doesn't count." And I even had people say to me, "Well, you're not in the classroom." And I want to say, "Okay, well, the gym teacher is not in the classroom. The social worker is not in the classroom, the psychologist is not in the classroom. But they're all eligible to advance, but not me because I'm an OT." And that, I think, is how this whole advocacy passion of mine started. So these are the people that are not educationally credentialed in California. And it's very, very similar to where I'm from in New York, updates to federal law, the Every Student Succeeds Act, states that OTs and physical therapists should be involved in the multi-tier system supports, RTI programs, and positive behavior support programs. But what the law has recommended hasn't really caught up to what's going on. So we could ask ourselves why. And it's because the decision-makers don't really know how valuable we are, we haven't had the chance to show them because we're very often not at the table. We are now in this category with bus drivers and paraprofessionals, cafeteria workers, and school clerks. And all of those people are crucial to the school running smoothly and keeping our children safe and getting them to and from their education. But these non-instructional staff members, don't work on the child's education, they don't work on the child's educational goals. They're not a part of educating the students and helping them access their curriculum. And I hate to say it, but being in the same category as people who don't need the education to do their job gives us a stigma of inferiority. So we're almost treated as less them which is why probably we're often not in the same unions and not included in the continuing education programs that are provided for what they call teachers. So in California, instructional staff like occupational therapy professionals, physical therapists, BCBAs, and vision therapists, even though we are instructional, we are not considered educationally credentialed. Jayson Davies So Jaime, before we move on, I actually want to ask you a question because in your about me slide you had your master's in special education, right? Jaime Spencer Yes. Jayson Davies So why did you do that? And did that help you at all? Jaime Spencer Well, when I graduated from occupational therapy school, I was like one of the very last classes that were permitted to get a bachelor's. So as soon as I was in the field, everyone else was coming out with a master's degree. And I thought that, in my journey at the school district, I was working that we would eventually be hiring more occupational therapists. So I wanted to have a Master's so that if an opportunity came up, I could be the supervisor and have a supervisory position. And I felt that if new therapists were coming on, and they had more education than me, it might not like automatically be my position. So I just thought, you know, I want to get I love to learn, I want to get my master's, I wanted to get it in school administration, but I was not allowed. So I chose special education because I thought that it would, at least, you know, supplement what I'm doing with the schools. And no, it didn't help me. It gave me a lot of student loans. And I received a teeny tiny stipend from my school district, if I was in the teachers union, my pay increase would have been very substantial. But because I am not in the teachers union, I'm in the CSEA. In New York, we are called the CSEA more civil service employees. And I'm in the same union with the bus drivers and the lunch ladies and administrative assistants. So I got my master's in special ed, but I'm still paying it off, to be honest with you, Jason, and it hasn't done anything for me, which is a shame, because I got my master's in special ed. But I didn't go a little bit further to do the student teaching and become a teacher, because it wouldn't really have helped me I would have had to leave the field of occupational therapy and be a classroom teacher for three years. And then I would be allowed to be an administrator. And I was I said, Absolutely not. I want to be an administrator as an OT, not as a classroom teacher. Jayson Davies Absolutely. Jaime Spencer And that's a position. That's what a lot of us are in that position, unfortunately, Jayson Davies Yeah, I've considered doing the same thing. But I've come to the same conclusion that you ultimately did was that you know, it would take me about eight years to eventually get to the point where I could go and get an administrative credential after starting the initial special education program, I just, and you have to work for free like you're saying, you have to be you when you do your student teaching, you're basically working for free. And yeah, I can't afford that. Jaime Spencer So it's just silly, it's backward. And Federal law says that we should be involved on a school level SS says, OTs and PTs should be involved, just like everybody else, but we're not. And it's because of this categorical exclusion of us from the educational category. Jayson Davies Alright, and that brings us to the next slide, which I think we've kind of gone over. But Jamie, if you want to add a little bit more, go for it. Jaime Spencer Right. So in order to become an administrator, you can either be a pupil personnel provider, which is listed here speech and language counselors, librarians, you could be considered a pupil personnel employee, or you could be considered a classroom teacher, either one of those categories is allowed to take the coursework to get their school building leader certificate, which would be a principal might be an assistant principal, or a chair, person, any kind of administrative position on the first level would be a school building leader. And you have to be a school building leader in order to then go on and get your school district leader certificate, which would be an assistant superintendent or a superintendent position high up. So you can see that all of the people on the left are eligible if they wish to move forward and to progress to a superintendent position. But occupational therapy practitioners and physical therapists are not even on the list. We have no way of really influencing the entire school district with all of the wonderful knowledge that we have, we really do have a unique knowledge base and background and a way of thinking outside the box to help people and we can't use that to influence the school districts. Jayson Davies Yeah, in California, just to clarify, for those watching, I know most of you are in California, there are not two separate certificates for the school building, and then school district leader. It's all just under that administrative credential. But either way, we can't. Can't get it here in California. So Jaime Spencer right and but also in general, you wouldn't go from being a classroom teacher to being the superintendent you need, you know, it's a stepping stone. Jayson Davies Yes. Jaime Spencer Yeah, that experience for sure. Jayson Davies Speaking of stepping stones, we've got a ladder picture for you. Jaime Spencer So this is one of my favorite cartoons. And it just really showcases the career path that's available for occupational therapy practitioners within the school setting. All of the educationally credentialed professionals that we just spoke about have the opportunity to advance themselves if they wish. But if we occupational therapy practitioners desire to move up the career ladder, we really don't have the opportunity, and it's just a shame. They have these opportunities which grant them the ability to create new programs that would benefit the staff, the children, the entire school community. And as they take the coursework to be an administrator or a leader, they move up in salary as well. And today, occupational and physical therapists do not have this opportunity. Because we don't have a teaching certificate, we are not allowed to take the coursework. This means that we are not permitted to become leaders. So the lead administrators in a school district have a lot of important decisions to meet. They meet to discuss the needs of the children, the staff, the whole community, they have to find how to fill weaknesses and fill voids that the district is experiencing. They have to decide about programs, curriculums budgets, the admins might be former teachers, social workers, or psychologists. And they're using their background knowledge and experience to do what's best for the school in their experience and their knowledge background. But right now, there's no occupational therapist at that table. So this is an enormous disservice to the school. And it really impacts therapists in many, many ways. There's no OT to offer solutions that showcase our training and our qualifications. We don't have the opportunity to contribute our opinions or ideas to earn the respect of other administrators and our colleagues. And this impacts the way we are viewed and valued by school administrators. And that means it impacts our parity. In a not-so-subtle way, we are often viewed and treated as inferior to other school professionals. OTs may be contracted instead of being hired directly, they report that they're not included in the professional development that the rest of the staff get, including the safety training, which is definitely a concern when it comes to the kids. We are separated from the rest of the professional staff and it creates a stigma of inferiority. OTs in California are retiring with fewer benefits than the rest of the staff. why? It's because there are no OTs at the leadership table. There's no OT to say, "Oh, don't forget to give the OTs and PTs a room to work in when you're adding on a hallway, maybe we can get them out of the hole or off the stage to do their job. Let's hire our own staff and include them in the collaboration meetings, so they know what's going on. Let's give the therapists time in their schedules to collaborate with the teachers. According to best practice, let's treat the therapist fairly." All of the complaints that OTPs have about inferior inferiority or inequality would be challenged by an OT seated at that table. Jayson Davies So back in wasn't too long ago, 2020. I know they updated every now and then. But this data is directly from the AOTA salary and workforce survey that they did. And they collect this data, you might have been part of this data collection. And they found that 23% of occupational therapy practitioners working in the USA work in school. So that's almost one in four OTs report, working in the schools, along with that 1/4 of occupational therapists also report working a second job. And, you know, that was kind of news to me, but I totally see it. I mean, a lot of OTs, work their school-based OT jobs, six, eight hours a day or whatever it might be. And then they hop over to a clinic, or they stop by a student's house or not a student but a child's house on the way home to provide some early intervention, or on the weekends, they're going into a clinic, or they're providing teletherapy services at another time. It's quite amazing. I know I've done that. I worked in the skilled nursing facility on the weekends. What about you? Jaime Spencer I've never had just one job. And it's actually really funny, Jayson and I presented at a conference last weekend about OT entrepreneurs, and I had all my badges ready. So I have a badge of working in a hospital and being a per diem, and I have a badge of working as a faculty member at a college, and I have a badge of being a contract therapist. And I'm missing two badges because I have the one from my first contract job as well as the one that I wear every day to my real job. But yes, you know, in order to feel stable financially, I needed to always have more than one job. And I think that that's sad because OTs work really hard for their degrees. And they work just as hard as the rest of the education, educational staff. So why don't we have the same opportunities for advancement? It's just not right. Jayson Davies And, you know, that is a perfect segway to maybe that is why 16% of occupational therapists are considering leaving the field of occupational therapy 30, or sorry, leaving the field, but 31% of that 16% I believe it was, are even just thinking about looking for a different field. They're not ready to retire. They're just considering moving out of occupational therapy. And you know, this is reflected in the data from AOTA but I know many of you that are watching this presentation, you're also in the Facebook groups, the school-based OT Facebook group, the resource Facebook group, all those. And I feel like it's once a week I see someone that just says, you know, I'm overwhelmed. I want to get out. What other career can I do with a master's in occupational therapy, they just want to get out. And they don't even want to consider potentially going to another occupational therapy site, you know, going to a hospital, or skilled nursing facility or something like that. They just don't feel like OT is right for them. And that's just really sad to see, you know, we're always trying to lift them up when we see something like that. Jaime Spencer Yeah, it really is a big cause of stress and burnout for people when you've consistently felt like you are not valued, or you're less than it's demeaning, you know, you feel disheartened. And again, for all your hard work and how you go to work every day, and you're you put in everything you've got for those kids, which is great. And you want to but you just want the respect. Jayson Davies Yeah. And I'm going to go over this. But I also want to ask Jaime, her numbers. The median salary in California is 88,000 and 60000, respectively, for certified occupational therapy assistants. So 88, for OTs. 60, for OTAs. Jaime, why don't you share with us in New York, you know about what that split is? Jaime Spencer I'm not 100% positive of it. But I think it was about 75,000, which I know in California and New York, the cost of living here is is very extensive. And the problem for us in New York, and I know it's not exactly the same in California, but we make significantly less than the classroom teachers like, I'll just talk for my own example. I'm very, very lucky that I have a job as an employee within a school district, I'm not contracted. So I do have benefits and retirement and in summers off, and I'm very grateful about that. But what I'm very upset about is that the classroom teacher next to me, who started way after I did make $30,000 more than me. And that's because she's in that other union, where she's able to take courses and bump up herself on the salary scale. And if she wants to be an administrator, she can. But meanwhile, I'm the one providing. I'm actually one of the presenters at the new teacher in-service, I teach about special education. So here I am educating them, and they get credit for it, which gives them more money, but I am not allowed. And it makes me very much feel like a hamster on a wheel. Jayson Davies Yeah, if you've ever seen a teacher salary schedule, it takes up an entire page. Because there are columns, there are rows, and for OT, it tends to be five short rows, or maybe seven. So yeah, definitely some, Jaime Spencer which really means that you're you've hit your top pay at the age of 30. And you've got another 30 or 35 years to go. You know, and we'll think about how much the cat the cost of a home goes up, or the cost of milk or the cost of gas. But our salaries do not go up. In fact, fun facts for you. When I graduated in 1999, the half-hour pay rate when I, my first job I was a contract therapist, was $29 a half-hour. Or you know, one half-hour 30-minute session is $29. Today, 22 years later, it's like $34 a half-hour that the therapist Yes. I mean, it has barely inched up at all. But when I think like my, the price of gas, when I first bought my first car was like nothing, it was like suit $7 to fill my tank. And now it's $30. So just those little things. I mean, that impacts us, why aren't we having a nice big retirement fund so we can buy an extra house? You know, Jayson Davies Exactly. And so we do want to talk about how that those numbers that AOTA revealed? How does that impact the schools? And you know, it impacts the education system, it impacts the future of OT practitioners, it impacts teachers, how we are able to support our teachers. And of course, it impacts our students, our colleagues, and our profession. One of the things that I was thinking about, as Jaime was speaking a moment ago, was because we only have those five tiers, you know, we move up and after five years or seven years, we're already at our max pay. I went through this. And you know what, as soon as I got to that top, what did I start doing, I started looking for other jobs where I can move up. And so what does that mean? That means that I moved to a new position, and that district only has an OT for three or four years, right? And you know what's going to happen, whoever takes my job is going to be there for the five years, get to the top, and they're going to do the same thing because they're going to want to make more money. And so over time, you're going to end up having a new person to fill that position every four to five years. Jaime Spencer When you compare that to a classroom teacher, most of the time I'm gonna say 90% of the time when a classroom teacher gets a job in a district. That's it. They are there until they retire and they those people become their best friends and they're their family that they go through all the hardships and blessings of life with. But for us, we're very often in and out. And it's, it causes a high turnover, which not only impacts our ability to make changes on the system level but also to have a fulfilling job. Everyone wants to have friends at work and the ability to be respected by their colleagues. But if you're not there that long, it's hard to develop that. Jayson Davies Yeah. And it also hurts the students as well, the teachers, because we all know it takes at least a year to kind of start building rapport with people. And then it takes another year to kind of go to the next level and start to build a rapport maybe with your, your administrator, your assistant principals across places, multiply that times, you know, you're at four different school sites, and you're trying to remember 80 Teachers names, and three or four administrators names that right, it takes time. And oftentimes, you know, we get to that point where we can actually make a change. And then we're like, hey, more money over there. Let me go over there. Jaime Spencer Yeah. Jayson Davies And so it impacts it trickles down and impacts the students all the way at the bottom because you're getting a new OT every four to five years, versus having someone consistently with them. Jaime Spencer And investing in someone, when they hire their teachers, they look at this person a little bit like a blank slate, and they train them they give them a mentor. In New York, I'm not sure if it's the same in California. But in New York, a new teacher is assigned an experienced teacher to mentor them. And the experienced teacher gets paid to do it. OTs, I mean often don't have another OT to even talk to much less someone to train them and supervise them. But the school looks at that teacher as a worthwhile investment, because they're going to be there for a long time. So they train them in the topics that are important so that they just are better and better and better highly qualified to teach the kids. Jayson Davies That's a very important point, actually, because teachers have to go through a program, I don't know if it's still called, I think they changed the name, but it used to be called Bitsa. And that's exactly what you were just referring to where they have to have a mentor. And I believe it's a year year and a half long, where they have to have a mentor. And they still have to do basically coursework. And they have to learn how to manage their classroom, while in the classroom, they have to do this program in order to clear their credential. And if they don't clear their credential, then they just went to school for two and a half years, or nothing. And so you have to go through that program where you clear your credential. Even administrators have to do that as well, once they get an administrative credential, they have to then clear that credential by working and going through a program while working. We don't have that as OTs, like Jaime was saying, you're lucky if you work in a district that has 5,6,7 OTs, and you have the opportunity to maybe go shadow them for your first day or two, before being thrown in all on your own at a school site, or for school sites. So absolutely. Jaime Spencer And with this high turnover, like you were saying it takes a long time to build a rapport and with all of the different buildings to see what kind of changes would really benefit the school district. But if you're not there for very long, if you haven't established respect and a rapport with the administrators, you can't make changes at the system's level, you can't make changes that would have an impact and benefit the entire school district because no one maybe knows who you are, or the big waves don't know who you are. And they haven't had the opportunity to value occupational therapy and our amazing input. They really don't know what it is that they're missing. Jayson Davies Absolutely. And so this brings us to why now is the time for a change. Because there is a teacher shortage, there is an administrator shortage, and occupational therapists could help fill that void. And it's 2021. And 2019 is that resource that you see there under the teacher shortage, California State Teachers Retirement System, or CALSTERS, report a 26% increase in the number of teacher retirements in the second half of 2020. Compared with that same period in 2019. Obviously, 2020 was a very interesting year with COVID. And we know that COVID forced out a lot of teachers and forced out my mother-in-law. For some a lot of teachers, they just said, "Hey, I don't want to deal with technology. I don't have data for OTs, but I would imagine that there were some OTs that probably did the same thing. Because zoom was hard to navigate. Google Maps was hard to navigate. It was definitely hard to navigate when districts couldn't make up their mind of what platform they wanted us to use." And so I'm sure people did leave both teachers and occupational therapists, the administrator shortage, expected teaching staff shortage will increase the lack of administrators in the future. So because there is a chief teacher shortage, there will be an administrator shortage. Jaime Spencer Right because the pool of candidates is getting smaller and smaller. So if they were to allow occupational therapy practitioners and physical therapists to be in that category, they're expanding that pool. Another thing about why now is the time for change is the culture, there's a very big focus on equality and parity and treating, giving everybody equal opportunities not to be opportunistic. But we can kind of capitalize on that and show it's really almost discrimination discriminatory practices that we are now excluded. And maybe years and years ago before the laws evolved to treat us as equal. Maybe it was appropriate that we were kind of considered medical and we were in a different category. But now under the, Every Student Succeeds Act, we are educators and should be treated as such, therefore, we deserve parity. So parity basically means fairness, justice, being equitable, not being discriminated against not being treated as less than, and the words that you can use to go opposite, it would be bias prejudice, if you don't have parity, someone else has partiality. You are not having equity, and it's not okay. This cartoon is one of my favorites. So you see, the Occupational Therapy practitioner and the physical therapist are trying to get on the elevator and everybody else on that elevator is going up to the sixth floor, up up up to become an administrator, but OT and PT are not welcome. This is definitely not equity, this is not parity. All of the other school professionals are able to become leaders if they wish, if they desire, not that they have to, but they may. This furthers their career, their pay, and their ability to have an impact, they are able to showcase their skills in a way that impacts the whole school district. But OTs and PTs are excluded. So when we talk about discrimination, there is a history of discrimination in education. Back in the day, racial segregation of children in public schools was commonly accepted. Children with disabilities were not receiving the free and appropriate education. And children with disabilities were segregated. They were they, you know, there was no least restrictive environment, they were put totally in other schools, they didn't get to the mainstream with typically developing children at all. And there were limited funds, resources, and opportunities for females to play sports. So these are all instances of discrimination that were very, very common in the past, of course. So some of the discriminatory educational practices that need to be abolished now are that the California Department of Education does not consider school occupational physical therapists to be teachers or to be considered pedagogical, we are prohibited from taking the coursework to become a leader. So back in the day, it would be crazy to consider that. So nowadays, I'm sorry, nowadays, it would be crazy to consider that children with disabilities or children who are considered minorities would be separate. That would be, you know, out of the unbelievable. Okay. Campbell, it's unbelievable that that used to be commonly accepted. And that's how it was, we are hoping that it's going to be considered unbelievable, that OTs and PTs were once not allowed to be leaders. Jayson Davies And as I mentioned earlier, you know, we just want to see that the table, we want to be in the room where it happens. And AOTA’s 2025 vision states that we envision that occupational therapy is a powerful, widely recognized science-driven, and evidence-based profession with a globally connected and diverse workforce. Meeting society's occupational needs, this is from surely Chris Holm. And as part of that whole vision, that 2025 vision from AOTA and just shows how much that we have the ability to be impactful. All we need to do is step up to the plate or be allowed to step up to the plate. And so we need to advocate for ourselves. And that's what we're going to talk about here as we move forward. But we need to advocate for ourselves so that we can earn that spot at the table. Well, I mean, I wouldn't say we've already earned it. But now we have to actually get it Jaime Spencer To actually and we have to, we have to push for it, ask for it and take it instead of you know, just holding back. There was an amazing TED Talk by the CEO of Facebook. I can't remember her name, but I like, love her. And she did a whole podcast about taking a seat at the table and advancing yourself in your career. And it was just so inspiring. And it really made that saying, stick in my head, take a seat at the table. We have to we do deserve it and it's important. Jayson Davies Absolutely. So some of you may already know about this letter, some of you. I see most of you probably have never seen this in your life or know about it. But AOTA drafted up this letter back in 2017 talking about why OTs should be able to have a seat at the table why OTs should be able to take the coursework to become an administrator and it outlines some great areas such as you know we have the knowledge and skills and mental health positions to address personal issues, to support parents and to promote social-emotional learning that we have the knowledge and the training to, in transitioning, so helping people transition and improve graduation rates, to improve attendance to reduce dropout rates. So this letter was actually sent out to every single Department of Education in every single state. And AOTA did not hear back from any of the states related or regarding this letter. And so who knows where it ended up probably in a shredder somewhere, but this is something that we can have an impact on, as well. Jaime Spencer It just goes to show the lack of respect, I mean, to not answer a state association is a big deal. Jayson Davies Yeah. And I agree. And the other thing about this too, is, correct me if I'm wrong, Jaime, does New York, have OT/PT practice guidelines for therapists in the schools right now? Jaime Spencer We are currently developing one. Jayson Davies Okay, well, here in California, we have one, but it's from 2012, I believe. So it's very old. But it's actually for 2012. I think it was pretty progressive to the point that it still holds up pretty well today, okay. And I had an experience where I brought that practice guideline to my supervisor, and I highlighted something and I showed it to him, I can't remember exactly what it was today. But they're saying, well, is that from CDE? California Department of Education as a part of the ed code, education code in California. No, but it's practice guidelines that were published by the California Department of Education. Right. And it holds no weight, though, because they're guidelines, they're not laws. And basically, it's not IDEA, it's not California law, it's just guidelines. And so while it talks about moving to that workload model, while it talks about participating in RTI and Multi-Tiered Systems of Supports, it's not something that is required. Alright. So the next phase of our presentation here is to list three unique opportunities for school-based OT practitioners to showcase leadership. So what makes a leader? I think we've talked a lot about this already. So I'll just list a few here. You know, we make decisions. We already do that we're role models, we keep data, we set goals, we're effective, we attract personnel, we take action, we're organized, we're responsible, and we are especially dedicated, at least if you asked me. So, Jaime Spencer I agree. Jayson Davies How can you become a leader, there are two different types of leadership, you have informal leadership, and then you have formal leadership. I think many of us already take action in this informal leadership, we volunteer, especially hours every day that we still have to work, right? Personal personality, we get out there and we help other people. Maybe you're a social influencer, maybe you actually know a lot, and people come to you. And so you actually are able to direct some of those teachers, even though you're not officially their supervisor, they may come to you for advice. I know I've had that experience in the past. And you are probably pretty clear on your vision, whether or not you are, I don't want to throw out any specific examples. But you likely believe in something like an occupational therapist, whether it's neurodiversity, sensory integration, something, whatever area that you really believe in, you have a clearer vision on that. And you have done the research, you know, that it can help your students and you have a clearer vision of how you can get there. So you are an informal leader, leader. Now, formal leadership is what we've been kind of talking about, for the last 20 minutes or so having that that official job title of being an assistant principal being a principal being something higher than that, and that is where we can not get at this point. Jaime Spencer Right. If you're not a formal leader, you don't have the opportunity to put big changes into place, you can't set up new programs or put new systems in place that would benefit everybody that has an OT, twist, or an OT feel, you, you can make suggestions, but your boss might take them, but they would get the credit for putting them into place, you know. So that brings us to another problem. OTs are, I mean, I don't know any OT that's not totally busy and kind of like running all around everywhere, usually, in multiple buildings, you know, we need to show our value. And in order to do that, we've got to be able to volunteer for school-wide initiatives beyond committees influence other people who aren't in our OT bubble, about our value, but we really don't have time. We are we're not often provided the time to be on these committees. We don't get paid for that extra stuff like teachers might. But because of that, we can't really show our influence. We often have second jobs as Jayson said before. And because we can't show our influence we kind of maybe zoom into a building and see our kids and zoom to the next building. And because of that, we might not be valued within the school system. So it's kind of like a hamster on a wheel. Like I said before, which problem came first the chicken or the egg. In order for us to show our value, we've got a put out a little more. And I was in I think it actually was with you, Jayson, where we did a presentation during COVID. And the other guest presenter said, you know, now is the time for OTs to step up, they need to give more. And I felt like, I don't know any OTs who have any more to give, I mean, we're already stretched so thin. I know, so many OTs who don't eat lunch, they, you know, they wait until 3:35, when that bell rings so they can run to the bathroom. And you know, there's no time for the extra stuff of coming up with a new program or sharing a great idea with your principal and helping put it into place from start to finish. We just don't have that extra time. But when you do have the extra time, here's the thing I say, you know, if you can, that's awesome. But I don't think it should be expected because we are already stretched so thin. But I've found that if I create one resource and share it multiple times in multiple ways, I'm able to reach more and more people to try to have an impact. So I've provided continuing education at you know, the staff meetings, I volunteered for the flexible seating committee, and it wasn't a giant commitment. But I did do it because I felt like goodness, if OT is not on the flexible seating committee. I mean, I don't know who should be, you know, you can join committees, you can put together a presentation that would be appropriate to be addressed at the PTA, or addressed at a faculty meeting, just to give everybody the influence. We are not handwriting teachers, we treat the entire child. And it's important to influence. Everybody else is thinking about occupational therapy in general, we need to be our own advocates. And we can influence the general I mean, the administrators as well as the staff to let them know that, you know, it's not just about handwriting, Jaime is the one who knows about strength. And Jaime is the one who knows about vision, and sensory strategies, and all these other things that my kids need help with. And I'm not equipped with but OT is, so as much as you can do, that's great. I mean, every little bit helps, I just find that we're often kind of expected to give this extra stuff for free. While teachers may be, it might be a part of their job. One thing that I have found really helpful is I've printed out handouts from like my own blog, or the Inspire Treehouse or you Jayson that I thought teachers would really benefit from and I make a bulletin board and I just put little folders on the bulletin board with the handouts in there. And it would be like "Do your students struggle with hamstring with a handout of activities", and the teacher consented home? And it says from occupational therapy on it is important that we kind of take ownership of those things that we do because it's, you know, hard to find the time to do that. So as we said, we need to make our own seat at the table, we've got to ask for the things we need. I've had OTs complain to me like I don't even have any pencil grips. I don't even have paper, I have to buy everything for myself. And I said, you know, I was in that position when I first got hired. But years later, I kind of learned you know, my principal doesn't even know that I don't have those things. So if I make a meeting, and I introduce myself, and I advocate not only just for me, "Hi, I'm Jaime Spencer, I'm your occupational therapist. I'm working with these students. I was wondering if you possibly had any extra budget for me to invest in pencil grips because it's already October. And I've given all of mine out." I've never had a principal say no to something like that. And I know sometimes people may work for a third party. And that third party might say, you know, don't ask for anything, you're an independent employee, you have to provide everything yourself. But it's not really always the case. And very often there is a little bit of extra money like even the PTA can provide money for things like extra handouts or seat cushions or you know, whatever it is that you need. It is important to make it known that you need it and why you need it. Because there are people who can help you and you only need one, you only need one person who's like, "Yeah, that's really important. I'll get you your seat cushions no problem." Another easy way to promote OT without having to do any work is to distribute the AOTA factsheets, they have a lot of great handouts that are really helpful, that talk about backpack safety, or what the role of OT is within a school setting. I've handed that one out at a few special ed meetings because I've had parents that said OTs just handwriting and I'm like with my factsheet well actually, according to the American Occupational Therapy Association, we treat the entire child so all you have to do is kind of print out or assemble those resources that you can use again and again. And your work is done. But you still have the opportunity to reach so many people, you can promote occupational therapy month. And you don't have to do a lot of work to do that you can find things that other people have promoted. And even on social media, you can just repost something, or share a cute cartoon or a cute handout, I very often leave things on my faculty room tables. One year, I did a whole display of different kinds of adapted scissors, and I labeled them and I put little examples of why certain students would need certain things. And when I was eating my lunch in that faculty room, not one teacher came in and didn't have to stop and take a peek. And they're like, these are cool scissors. I've never seen these, what is this about? And there's my chance while I'm eating my sandwich to be like, "Oh, well, for kids with weak hamstrings, sometimes they need special scissors that have a spring, and then it helps with their motor memory of the position that they need to do with their hands. But it takes away some of that hard work." You can also offer it to present to your PTA if you don't mind public speaking, I know a lot of people don't like it, some people love it. Another great thing is to show new research articles to your school administrators. So my administrator and it's important to know your administrators and what their I don't want to say their pain points, but what their bet what they value. And if you know that your administrator values, the newest evidence-based practice, or the newest research in certain areas, it's a great way to get your end to bring an article about that says, Look, you know, there was a recent article that showed that weighted vests are helpful for children with ADHD, but it's not a cure-all. So let's have a little conversation with all the teachers who are asking for weighted vests and make sure that they understand how a weighted vest is used and what it's really for, and that it's not, you know, the end all and be all of the things. And my administrator was like, "Woohoo, we don't have to buy another 30 weighted vests this year." You know, just to bring that forward and to show research says, I mean, my administrator love that phrase, research says that this is what's going on. And she's like, "Okay, give it to me, give me the article. All right." And that's an easy thing to do. I just have to photocopy something and have it with me, to bring it to the meeting. Jayson Davies Yeah, I could not agree more with that. I mean, it only takes one person to make a change or to get started, at least in making that change. So if you have your administrator on your side, you've got a good team member. Jaime Spencer Definitely. So there are a ton of occupational therapy practitioners who work in the California School System, and most of them want parity and to be valued and to be equal to everybody else. But we can't just wait for someone to do it. So many people have said to me, why hasn't this changed? Why aren't we just included? And it's because we all need to step up, we all need to take part. If you just sit back and lay low, you're gonna stay low, you've got to speak up and stand up and help with the I don't want to say the fight, but the journey and the evolvement of occupational therapy, we really all have a responsibility, not just for ourselves, but for the future generations of practitioners, as well as for the kids, the kids are missing out on all the OT superpowers that we have to offer, if think about the difference of what your school district would look like if your superintendent was an occupational therapist. I mean, I think the trickle-down effect would just be unbelievable. So we have to look at the difference. Are you apathetic? Or are you an advocate, apathy is a lack of concern. If you're not doing anything or saying anything if you're not talking about it, you're not motivated, then you have apathy. Or you could be an advocate, which would mean you know, your rights, you speak up for what you deserve. You speak up for yourself, you know your value, you ask for what you need, and you ask for what you want. If you're not doing anything, and you're not saying anything, then your behavior, Minix and apathetic person. There are many, many ways to showcase your opinion, beliefs, and your values as an OTP. But it all starts with one decision. Will you take action? And at the conference last weekend, Jayson, one of the therapists said to me, you know, I know that you're a very outspoken advocate for occupational therapy, and I just wondered if you ever had any backlash? Did you ever get in trouble for being outspoken? And I'll be very honest, I haven't. I've never, you know when you look at other track other things where people stuck up for themselves, I mean, it's only what's right. What I'm stating is a fact I'm not giving equal things to everyone else, and I do what they do. And you know, I'm actually giving black and white facts when I present to my administrators or if I go to someone asking for more I'm always professional, I'm always confident and I make sure I know my stuff, I'm not going to go in there and say, oh, I need, you know, because I know exactly what I need. And I'll give specific reasons why. And, in general, I mean, I really, I've not ever had anything and I can understand being afraid of, you know, they might not give me my job back, or oh, what's going to happen to me, but then I think of like the bigger picture, think of all the people who stuck their neck out for change, think of the “me too movement”, all those women who spoke up and made so many changes in Hollywood, like, and that's such a different thing. But when you look at the big picture, you're going to be okay, there are OT jobs all over the place. Worst case scenario, if you were to lose your job, you've no one can ever take your education away from you. And the chances of it happening are, you know, minute, and I know it's always in the back of everybody's mind, like, what happens if I stand up for myself? You know, what if, but what if people listen? What if your reason why your school district makes a change? You have to look at both ways. Jayson Davies Yeah, I absolutely agree. In fact, typically advocating for myself, leads to that admin coming to me more, versus the other way around, even though at the moment, they might be like, "Why is Jayson talking about this," it definitely actually lead them to know that I know more, and that I have more to offer, and that the next time they have a question about something, instead of trying to fake it till they make it, they come to me, and they asked me, "Hey, Jayson, what do you know about research? Or what do you know about this?" And so don't be afraid to speak up. Jaime Spencer It's important, and it's part of knowing your worth and knowing your value. They don't know what they're missing, you know, if you do keep quiet, and you don't offer all these wonderful things that you have, everybody's missing out on it. Everybody's missing out on your magic. Jayson Davies Yeah. And you know, we haven't explicitly said this, I think I think it's kind of been described a little bit. But a lot of times we work for people that have no idea what we do. Our Special Education Coordinator, our special education director, whoever oversees you, oftentimes has no idea what you do, they know that you do great work, they see you potentially, maybe in some IEPs, they come they observe you once every three years, or whatever, whenever they get around to it to evaluate you. But even when they evaluate you, they don't know what they're evaluating. Because part of that is we haven't told them, and we have to let them know. Jaime Spencer Yes, I, to be honest with you, in my 22 years, I've never been evaluated. I shouldn't say I've never been evaluated, I've never been observed. I get like you know, a checklist, like Yes, she does her work. But no one I would love for someone to come observe me. And a lot of people don't feel that way. And I get it. But I do make sure. And even the little ways of letting the people in your school know what it is that you do I make an effort. So if I'm, you know, working with a child in the hallway, and we're using the scooter to get back to class, and you know, inevitably somebody is like, Oh, that looks like so much fun. I max my turn, you know, like just being cute. I am always like, Yeah, and look how strong he's getting his arms are our look at those muscles. You know, like, I'm making sure that that grownup knows that we're not, we're not just playing here like we are working on important things. And it's a very easy way to do it. You can do that and go home and be like, I advocated for OT today. You know, you want people to know, we are not just handwriting teachers. Jayson Davies Absolutely. So we have about 15 minutes left, which is going to bring us right to our final section today. And Miss Jaime, she just asked you a question. I called you Miss Jaime. Miss Jaime OT, I can't get it out of my head. She asked you a question a moment ago, she asked are going to take action. And in this section, we want to show you how you can take action, we want to apply these concepts of advocacy or school-based OT leadership at the local and state level. And we want you to take action on this, we're going to show you how. The first thing that we need to do is communicate the need for change. This has a ripple effect. And we've already discussed a little bit you know, it only takes one person and it doesn't necessarily even need to start with your administrator level. I know that's what we talked about a few minutes ago. But it can really start by sharing that one thing with one teacher with who you already have a rapport. And then that teacher might share it with their co-teacher maybe you helped one second grade teacher and the next thing you know all three second grade teachers are coming to you asking for your support. It really only starts with one that's happened to me on multiple occasions. I go to a new school. I provide it can be as simple as a pencil grip to a kindergartener teacher. And a week later, I'm getting an email saying hey, can you come and share with us some techniques during our PLC our learning community time on Wednesday afternoon, we really have some students that are having difficulty with this and this and this and we would love your take on different things. You know Jaime alluded to some of the big changes that have happened recently, you know, the “me too movement”, the Black Lives Matters, movements, all of these we wouldn't know about today unless something started somewhere, you know, it only took one person to really start that movement, and then look how it has grown today. So how can you start that ripple, get involved, communicate with their state and local associations and leaders, it is awesome that you are here right now, you are at an Occupational Therapy Association for California conference? And you chose this specific presentation to go to, which means I already know you're a natural-born leader. So you're in the right spot. Now we need to communicate, we need to go beyond this, we need to communicate with OTAC, which OTAC to be fair, has done so much the last few years, and it hasn't been easy for them. So they need our help. Join the go-to OT OTAC initiative. This is something that was actually started by my friend, Sabrina McNally. And she has just gotten done so much for our profession. And she is now actually the state RA for AOTA which means she is a person that we can talk to. And she's going to take that information over to AOTA and let them know, hey, California needs help with this. So reach out to your RAs, the go-to OT initiative, I want to share that with you really quickly is basically there is a lot of occupational therapist in California. One in four, as we mentioned earlier, is our school-based OT so I don't know the numbers, my license number is 13,000. So I'm assuming there's probably about 15, active, maybe 15,000, active school-based or not school-based but OTs, there are not that many California legislators. So every single one of us should be able to find a legislator, state assembly member that we can have contact with, whether it's an email a phone call, meeting up with them, and tweeting at them Instagramming at them, let them know who you are and what you do. It can be that simple. It's just letting them know who you are. You don't have to have lunch with them. If you want to, by all means, go for it. But it doesn't have to go that far. You can just reach out even voting and understanding who you're voting for is a is advocacy, email your state OT legislative chair and RA. I mentioned RA Sabrina, we have another RA. I don't think I have his name on me right now. But we actually have two RAs in the state of California. And their information can be found on AOTA and I think Miss Jaime might actually have the RA information in a Facebook group called the California School-Based OTs for change, right. Jaime Spencer California school-based OTs looking for Facebook advocacy group, and Jayson and I are the administrators of the group. And we have been for years, it's been a little slow in there. But we created the group just to have a collective place for California-based occupational therapy practitioners to discuss advocacy, what we can do what's going on. And we have some resources in there for you as well, that we'll be talking about. Jayson Davies Yes, and obviously, you're here. So you're already supporting OTAC. Be sure to also support AOTA and I will see you in the Facebook group. Now, here's the reason why it's so important to be willing and open to talk. Because the California Department of Education is a messy spiderweb of people, and you never know who you might actually be talking to. You might be at a cocktail party for your friend's wedding. And you might be standing next to I don't know, the Tony Thurman, do you know the state superintendent of public education? Who knows you never know who you're going to be talking to? And so speak up, let people know who you are and what you do. Jaime Spencer And then Tony says, "Oh, my goodness, my son had OTA. That's amazing. I didn't know that you guys weren't treated equally to OTs and PTs." Jayson Davies Yeah. Yeah. Don't just say you're a teacher. Don't just say you work with students with special education. Let them know what you actually do what your title is, and, and share that with the world. You know, get it out there. Jaime Spencer Or I sometimes will have friends introduce me to someone else and be like, "Oh, she's a teacher?" And I'm like, "no, no, I'm an occupational therapist. And I work with chill, you know, blah, blah, blah," my little elevator speech is short but sweet, but I make sure they know exactly what I do. And I do often say, you know, I'll go into the whole like a hospital setting. The physical therapist works on this and you know, and we'll do the whole thing like a physical therapist might help you to walk down the street, but if you're not wearing your pants, you're in big trouble. OTs are really important in the school district. Jayson Davies Yeah, I really like to describe what I do. I like to ask people a question. You know, let me describe what you do. What is one of your favorite activities that you do? And then they tell me whatever it might be, and then I say, you know, God forbid what happened if you make maybe had a stroke or something and you couldn't do those things that you loved. And this is how an occupational therapist could help you. And you know, it kind of hits home with them, they remember it. And maybe the next time they're out doing whatever their favorite activity is golfing, they think about that OT, who said, "Oh, man, he said he could really help me with my shoulder, whatever might be, you know." And so what the know and who knows, maybe that guy's golfing with Tony Thurman, I don't know. But it can all start with one little ripple and it can grow from there. So Jaime put this little chip on here with I love and she actually had to ask me, I don't know. Maybe she thought I was too young when I saw this. Like, do you know what this is from? I was like, Santa Claus. I couldn't think of the movie. But we got Jaime Spencer cuz I'm a total movie buff. Like, I remember lines from movies. I remember. I'll see movie ones. And I'm like, Oh, yeah. So I refer to movies a lot. But like, my best friend doesn't know anything. And I'll be like, Are you kidding me? You and I have watched that movie together at times. You don't know it? And she's like, what? So I try not to assume that people know a movie. Jayson Davies Yeah. So this is from the miracle on 34th Street. Actually, I think this is the original one. Which I know people always like, No, I don't want to watch the one in color. I don't want to watch the one from whatever you want the original. Yes, yes. So never underestimate the power of a letter or the power of 20,000 letters. OTAC regularly sends out emails and they say hey, can you please send this letter, oftentimes, they give you a template, or they even actually, sometimes it's just a Google form, and you fill out the Google Form, and it magically sends a letter to whoever it might be. That's important in that in that system. But this is who you can send that letter to the California Department of Education, you can send it to even your union if you're part of the Union. You know, unfortunately, with unions, we tend to be if you're part of a union, you are one person in a union of like hundreds. And so sometimes the OTs don't get heard. That doesn't mean that we shouldn't stop trying. In fact, if you can send a monthly email to your union member and just say, "Hey, this is what I do. This is how I help the kid this week," you know, let them know, let Otac know and ask for more. Yes, yes, ask for more. Let OTAC know, they are really trying to change the law in California, it's a messy process that we have to go through in order to get that credential, it really isn't going to be straight up with you. It is a messy process. With a lot of players involved. The unions are involved, the California Department of Education is involved. The State Board of licensing is involved, how much education we have that plays into it, there's so much that goes into that. But we have to let them know that we're interested. And so sending those letters to OTAC, sending them to your AOTA RAs, as we already mentioned earlier, and then the go-to OT advocacy talking to your state assembly members. Even if we get a legislation bill in place. If our state assembly members have no idea what it is, then they're likely not going to vote for it. So we need to let them know, "Hey, we have something coming up." And I really hope that if nothing else, you remember the name of occupational therapy, because we have a bill coming up, it's going to be about occupational therapy, and how we can support our students in schools. Even if it's that something that simple, you can do it. Jaime and I were setting up something to help you out here, we're going to put a template up in this California school-based OTs looking for change Facebook group is going to be kind of a plug and play letter for you that you can send out, you might want to edit it or update it a little bit to be a little more specific to you. But this is going to be a letter that you can send out to your union member, your union rep, or your even your boss. I mean, just send it out to people and let them know who you are what you do. And by the way, it is important for you to have the ability to be an administrator. Jaime, do you want to add to that? Jaime Spencer Yes. So I think in this day and age, people email a lot. And I don't know about you, Jayson, I know you're in the same boat where you work as a school-based OT and you have a business on the side. So my emails are jam-packed millions of emails and I'm like, "oh, goodness, I just can't even start addressing all of them." But when I receive something in the mail, when I receive a letter from someone that's different, I don't get a lot of handwritten mail or typed mail that's sent specifically to me. So I always make sure to read it. And that is something that I really think is important here. So we did create a template, we're going to post it in the California group, it's going to be under Files. So when you join the group, unless you already are in there. Just go to files and it's going to be there for you and you can plug in the important people that you want to address but we do have the meat and potatoes of it there for you. So you don't have to come up with like well what do I ask for? How do I ask It's there for you. Just put in your name where you're from, and anything extra that you want to add is great. And put a stamp on it and address it and mail it out because that is something that's going to be opened and read more thoroughly than just another email in the box. So if you, I just said I was a total movie buff, if you guys remember Shawshank Redemption, one of the best movies ever. And he prayed he wanted more money for the jail library. And he asked his boss, can I please write a letter to get more money and the boss was like you I mean, I don't care. Go ahead. But you know, no one's gonna do anything about it. So he wrote a letter a week. And he ended up getting it because the person who was in charge of it said off with these letters and gave him a nice big check. And he ended up outfitting an entire library for his jail, it just goes to show, if we keep doing it, keep advocating keep sending the letters, you can go to this file and print out 10 copies, and sign them all up and mail them once a week, for the next 10 weeks. And that makes a big difference. If the person didn't know anything about it or knew a little bit about it, they're going to be a lot more aware after they receive 10 letters about it. And if you and the person sitting next to you, does it, then that's 20 letters that they end up receiving, we want to be like a little bee buzzing in their ears that's constantly. I don't want to say annoying, but reminding them of this very, very important need that must be addressed. Jayson Davies So Jamie, how long does it take to move a mountain? Jaime Spencer It takes a long time and it takes a lot of people but it can get done. I can't even begin to tell you the amount of time and work and effort that so many wonderful occupational therapists before us have done Jayson, people like Jan Hollenback and Patti Labrador, and Serena Zeiler. They have written articles, Joan's going Kirsch, there's so much that people have already done that we can build upon, we can take their work and show it to other people or email articles, we need to spread out this information. And we need to make it widely known. Again, with things like me too movement, one person started but little by little it's snowballed. More and more people were talking about it more and more people were saying, "Yeah, I'm not treated fairly. either. I'm this, I'm that." And I'm not remotely trying to compare this to the Mewtwo movement, but just that kind of sticking up for yourself, having those guts to just say, You know what, I'm not going to put my head down anymore, I'm not going to just ignore it and keep working every day. Because in five years, either they'll be changed, or there won't. But if you help, you're much better off. You know, if everyone does something, the time is gonna pass no matter what. But if we do something every day or every week to help it, they'll be a different mountain in five years to address. Jayson Davies Absolutely. And that brings us to our final slide where we get to say thank you so much. And we have our emails here for you. Feel free to email Jaime, feel free to email me our emails are there for you CC as both or whatever you want to do. But let us know we want to help you. We want to answer your question. Please do reach out. And don't forget to sign up for, see a school-based OTs looking for a change Facebook group, you might even find a replay of this video there at some point. So, Jaime Spencer if you're looking for more resources and more information, Jayson has a lot of great podcasts about advocacy. Jayson, I loved the one you did about how important it is to join your membership. Jayson Davies Thanks. Yes with Sarah. Jaime Spencer Yes. I mean, that was really great. And I have some posts on my website as well missjaimeot.com, about advocacy, about sticking up for yourself about how I wish I had the red shirt. Just to start if you're if this is new to you, and this topic is something that you want to learn more about. This is a great way to educate yourself. Jayson and I both have a lot of resources on our websites for you to kind of start that educational journey. Jayson Davies And sorry, one more thing, if you are not in California, but you happen to be here know that Jaime has like a Facebook group for just about I don't know if you have every state but she also has the USA right? Jaime Spencer Yes. So I have the USA school-based OTs looking for Change Group, which is all like anybody if you join California, Please also join the USA. But we've had multiple people, people like you, Jayson who said who stand up and say, I want to do something specific for my state that has branched off and made subgroups. So we have New York, New Jersey, Florida, North Carolina, South Carolina, Connecticut, California, Florida, Pennsylvania, I think, Ohio, Illinois, they have all they all have their own groups. Now there's not always a ton going on in these groups, but they were collecting our people. And we're gathering our crowds so that we can move on things together when it's time. Jayson Davies Perfect. All right. So thank you so much for being here. And we'll see in a moment. Jaime Spencer Thank you, everybody. Jayson Davies Alright, and that is going to wrap up the OT Schoolhouse podcast for 2021. Thank you so much for being here. And a big shout out to Jaime Spencer of missjaimeot.com. For really putting the bulk of this presentation together, she has done this in many states now, or at least a few. And she really helped me to just kind of add in the California-specific content. But as I mentioned in the intro, this is very specific to any state. Yes, some lingo may change, there might be a different education board that you have to reach out to. But we should all be working to get credentialed as occupational therapists within the schools. So one more time, thank you so much to Jaime Spencer, for helping me put this together. And thank you for listening to this episode and every other episode of the OT Schoolhouse podcast. I look forward to coming back in 2022 strong. And actually, I want to share your stories in 2022. So if you're still listening to the very end of this podcast, thank you, but also reach out to me and let me know what worked for you in 2021. I want to share those stories in 2022 about how you thrived through a difficult time. So reach out to me email me at jayson@otschoolhouse.com and let me know what went well and 2021. Who knows maybe you'll be on the OT Schoolhouse podcast sharing your big accomplishments. Alright, everyone, take care to have a great winter break and I will see you and 2022. Bye now. 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 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, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 87 of the OT Schoolhouse Podcast. School-based occupational therapists wear many hats. Sometimes we treat students individually and other times we have to train the teachers in ways they can support students in the classroom. Today, we are focusing on supporting teachers in fostering safe and regulating environments in the classroom for students with sensory differences. Joining me today to discuss this topic is Dr. Jamie Chaves, OTD, OTR/L, SWC. Dr. Chaves is a pediatric occupational therapist and is also the OT Division Leader at the Center For Connection. Along with co-author, Ashley Taylor, Psy.D., Dr. Chaves has written two books to support therapists and educators working with students who have sensory differences. You can find both books on Amazon. They are titled “The Why Behind Behaviors” and “Creating Sensory Smart Classrooms” *Affiliate links included help the OT School House to earn a small commission at no additional cost to you. Links to Show References: Book on Amazon: The Why Behind Behaviors Book on Amazon: Creating Sensory Smart Classrooms Jamie’s Personal Website Instagram: TheWhyBehindBehaviors Transcript Download the Transcript or read the episode below! Jayson Davies Hey, everyone, welcome to the OT Schoolhouse podcast. Thank you for being here really appreciate you being here to listen to this episode of the OT Schoolhouse podcast. And for just being a part of the OT Schoolhouse community. I can't believe that we are almost to the end of 2021. 2020 and 2021 have just gone by so quickly and well, things are changing so much right now within the world. We've got so much going on. And I am just so happy that you have decided to spend a part of your day with me and Dr. Jamie Chaves, who we are having on the podcast today. Dr. Jamie Chaves is a doctor of occupational therapy. She is also a licensed occupational therapist and she actually has a few different roles. So I want to share those with you. She works at the Center for Connection in Pasadena, California. And she is also the author of two books with her colleague, Ashley Taylor, who we will talk about a little bit later as well. The two books that she has written or co-written with Ashley are Creating Sensory Smart Classrooms and The WHY Behind Behaviors. We're actually going to dive into both of those books a little bit today, or at least the contents of those. This is definitely not a sales pitch for the books. But there is a lot of great information from those books that come out in this podcast episode. This interview with Jamie is such a great interviewer, you're going to learn so much about sensory processing, sensory integration, and really fostering safe environments within the classroom. And I cannot wait for you to hear it. So go ahead, put those phones in your pocket. Turn the speakers, put those headphones in to start your jog or your workout, whatever you're doing, driving, and enjoy this episode with myself and Dr. Jamie Chaves. Hey, Jamie, welcome to the OT Schoolhouse podcast. How are you doing this morning? Dr. Jamie Chaves I'm doing really well. Thank you. Thanks for having me. Jayson Davies Yeah, definitely. I'm excited you have a book out, actually, you have two books out. We're talking about one today creating sensory smart classrooms. And that was written by yourself as well as Ashley Taylor. And I do want to allow you to give a moment to give a shout-out to Ashley and talk a little bit about her as well. But first, I want to ask you about your career as an occupational therapist and just share a little bit of background about yourself. Dr. Jamie Chaves Sure, I've been an occupational therapist for nine years now. And I kind of stumbled upon the profession when I was in undergrad and just fell more and more in love with it as I went through grad school, which is always a good thing. I wasn't backpedaling. And I've always been really passionate about children. And one of the areas of research I spent a lot of time on in grad school was children and orphanage-like settings. And as I was doing that research, so much was coming up about sensory and motor development and how those things are impacted in orphanages and foster homes and when a child is adopted, and so that got me down the rabbit hole of sensory processing and sensory integration. And my first job was in a clinic with kids of varying developmental needs. And there were a lot of sensory-motor needs. And so I just continued to learn more and more about it. And that's my area of specialty now is sensory integration. Jayson Davies Awesome. And so you actually do have your doctorate in OT, what was that experience? Like? Did you focus specifically on kids in the orphanage? Is that kind of where you went or sensory integration or what? Dr. Jamie Chaves Yes, my doctoral project was all on looking at the occupation and the occupational performance factors in orphanage-like settings, and I actually did my four-month apprenticeship at an orphanage in Romania. Jayson Davies Oh, wow. Dr. Jamie Chaves And work with caregivers who were at that orphanage. Jayson Davies Wow, that must have been an amazing definitely outside-of-the-box experience. Dr. Jamie Chaves It was one of the most challenging things I've done and also one of the richest learning experiences I've had as well. Jayson Davies And in Romania, then is occupational therapy, even really a thing out there. I know as far as I don't know, I talk to people outside of the country, and like occupational therapy isn't even a profession in some countries. So in Romania, is it a profession, is it something is it similar but called something different? Or? Yeah, Dr. Jamie Chaves There is a profession called occupational therapy, and it shares the same name. But I would say they're about 50 years behind where the United States is. So they're still doing a lot of those like craft-based, leather-based, like leatherworking. Yeah, like a lot of those types of occupational therapy, tactics, and they aren't really a well-recognized profession. And you don't really have to have a degree to get into the profession. It's more of like an associate's degree level. At least it was 10 years ago, I'm not exactly sure how it's progressed. Since then, I haven't really kept up to date on that. And pediatric occupational therapy was pretty much non-existent. It was all working with adults with mental and developmental disabilities. Jayson Davies Gotcha. Okay, that was gonna be my next question. Because historically, you know, occupational therapy in America really seems like it developed based upon a rehabilitative model. You know, after World War One, it was really working with armed services, right, or people that were coming back and were injured in OT was helping them to rehabilitate and get back to, "normal life". So I was wondering how that would look like in Romania. So it's mostly mental health and a little bit of rehabilitation. Dr. Jamie Chaves Yes. And it's very much. It's not an integrative thing. It's not trying to integrate people back into society or back into their families. It's like these. They're basically outcasts. And they, there's these occupational therapists who are working with these people who are who would otherwise be unsupported and not really seen as contributors to society or participants in society. Jayson Davies Yeah, very different. Dr. Jamie Chaves Yes. Jayson Davies Well, thank you for sharing that. So you said that was about 10 years ago, you've been working really, primarily with a pediatric population. And so where are you now then? Dr. Jamie Chaves I'm at the Center for Connection in Pasadena, California. The executive director is Dr. Tina Payne Bryson, who's the author, co-author of the whole brainchild and no Jama discipline, and they have several more books out as well. And she really, she has her Ph.D. in social work. And she really saw how what they were doing in mental health wasn't the whole picture. And there were missing pieces of the puzzle. So she started putting together a team that was more integrative and could put all the pieces together. And she saw occupational therapy as one of the biggest pieces of missing pieces of the puzzle. So she asked me to come on board, and I helped start the OT department there. And I'm at home full time with my two toddlers right now. So I'm not in the clinic full time and haven't been for the past two and a half years. But I'm hoping to get back there in the next couple of years. Jayson Davies Awesome. Yeah, I've heard great things about the center. And you know, we've had Olivia Martinez-Hauge on the show, and she also is a part of that center. And it's just amazing how someone who is not an occupational therapist who started this center really sees the value that occupational therapists can provide for all the people that that come into that center. So it's quite amazing that a social worker, by trade by training, is so invested in occupational therapy and sees our value. So that's just really cool. I really appreciate that. All right, so let's go ahead and dive into our real topic. For today. It was great doing a little introduction. But I want to know and you have written a book about this, along with your colleague, Ashley Taylor, but we want to know about how to support teachers with sensory regulation, self-regulation, and fostering safe regulating environments for students with varying sensory needs. So I think a great place to start would be to start with the current problem. What are you seeing in classrooms that led you to focus on supporting teachers within with regulating environments? Dr. Jamie Chaves Well, one of the things is that I've seen how empowered teachers feel, even when they just have this information. So many teachers don't get information. I mean, it's not taught in their classes in school, and so they don't get information about what does it mean to be regulated in order to learn and what is sensory processing? And what does it mean to feel safe in your environment? So empowering teachers to be able to ask different questions and see behaviors in a different light, and also empowering teachers to examine themselves and how they might not feel safe or regulated, or have their sensory needs met in the classroom, either, and how can they examine that to say, hey, I need to find support in this area, so I can support my students better. And also just seeing how empowered students feel when teachers are actually hearing them and responding to their needs for being regulated, or their sensory needs, which are also needs for being regulated. But yeah, I've just seen the trickle-down effect and how students participate more and feel more engaged in the learning process. Jayson Davies Gotcha. And so when you develop this book before it was a book, were you providing training to teachers in some capacity. Dr. Jamie Chaves That's basically what this book came out of, I had started doing some training a handful of years ago for teachers, just during lunch hours. And then it evolved into a 10-hour course, that I put together on sensory processing. And I thought, hey, this could be a book if put this down on paper. And so that's what we did. Jayson Davies Wow, that's amazing. So it really just started with a little lunchtime, you know, conversations with the teachers. And it's amazing what that can turn into. I know right now, you know, it's a big focus for occupational therapy within the schools, to not just see students individually in a pull-up model, you know, the more that we educate teachers on things that they can do within the classroom, the more that those teachers can then implement, just like what you're trying to do with his book. And I often like to say, you know, I could spend 30 minutes helping one student and a pullout session, or I could spend 30 minutes, I shouldn't say, or it's more of an and, and I can spend 30 minutes working with a teacher, and that teacher can then support. However many kids are in their classroom for the entire week, for the entire year. And then for the kids that they have next year and the kids that they have the year after that in the year after that. So knowledge is so powerful. And so I just love that you're spreading your knowledge and not keeping it all into yourself and only using it during your one on one sessions. Right. It's great that we're able to actually share that knowledge. That's so cool. So what have you found in regards to common misconceptions that teachers often have about sensory and regulating environments? I'm sure that when you're providing those training to them, you might get some pushback or just questions. And what are some of those questions or misconceptions you often hear? Dr. Jamie Chaves I think one of the things that frustrations that teachers face, and it's not just teachers, its parents, it's also therapists is that the sensory strategies, or the regulation strategies, the co-regulation strategies, they should work all the time, every time, and it's just not true. We change from day to day, we change from hour to hour, and what works one time might not work the next time. But that doesn't mean that it's not going to work again, or that it's a failed strategy. And so having multiple tools in your tool belt is something that's really important. And going along with that setbacks are normal, like, we don't progress, none of us progress. But we certainly don't develop or learn in a linear fashion. It's kind of two or three steps forward, and then maybe one or two steps back. And it's this push-pull process. And that's true of meeting kids' regulatory needs in the classroom as well. I think also, what I've seen, and we'll talk about some more of the sensory nook suggestions, but I've seen a lot of classes where teachers have self or CO regulation strategies or sensory strategies in the classroom. And they allow the child five minutes or 10 minutes or three minutes or whatever the time limit is. And I think there's a big misconception that regulation should happen within a confined period of time. And it could be that one day a child needs three minutes to step away, or the next day they might need 10 or 25. And I think it's important to not put those time limitations because ultimately it is going to negatively impact how they're participating or how engaged they are. And if you just allow them that extra 10 or 15 minutes, even if it seems like a waste of time to you are a waste of class or a waste of instruction. Are they missing out on a big piece? Ultimately, they're going to feel safer and more regulated in the classroom. So the next time they do come in, they are at a better place to be more focused and engaged, rather than feeling like, "Oh, man, if I get dysregulated, I only get five minutes. And if I'm not regulated again in five minutes, what's going to happen? I have to pull it together." So yeah, I would say those are some of them. Jayson Davies That's exactly what I see, too. And going to the next step, because I see this as well as you know, sensory processing sensory integration. It's a difficult concept to understand. And so I wanted to ask you, like, what is kind of your go-to blurb? You know, when you're explaining very quickly to a teacher, what sensory processing is, what sensory integration is, and how it will impact the students that they work with? Dr. Jamie Chaves Yeah, my line is really sensory processing is how we make sense of our own bodies, how we make sense of what's happening in the environment, and how we relate to other people. And this all sets the foundation for our regulation, and regulation is the foundation for being engaged and being able to access your higher-level cognitive skills, which are what you typically are doing in the classroom. Jayson Davies Great. And that actually leads right into my next question, because you and I, haven't been in the traditional classroom and a few years, nine years, it sounds like we're both been practicing occupational therapists. And so we haven't taken an anatomy class or physio class in a while. But in your book, near the beginning chapter, I know you guys kind of dive into the anatomy a little bit, and more so about how the amygdala and how the oh gosh, the hypothalamus, and how they all work a little bit to create a response, whether it be the parasympathetic or sympathetic nervous system. And so if you wouldn't mind just kind of explaining that route that a sensory stimuli kind of goes up through the brain a little bit and where that sympathetic or parasympathetic nervous system kicks in of it. Dr. Jamie Chaves So when we talk about the system, particularly involved with the amygdala, we're talking about sensory modulation, which is one of the three branches of sensory integration. And sensory modulation is really important for our sense of regulation and determining what is safe and unsafe in our environment. So when we have some sort of sensory stimulus come in, all of the sensory systems passed through the thalamus, except one, I think it's olfactory, maybe it's either the olfactory, or gustatory, doesn't pass through the thalamus, which is then passed to the amygdala, the amygdala is really the center that determines what is safe and unsafe, because should I be fearful of this or not fearful of this, and if the amygdala is saying, "Hey, you should be fearful of this. That's really what triggers your fight flight or freeze response." If the amygdala says, "Hey, this is safe, you don't need to worry, you've already paid attention to it, and it's not a big deal", then the parasympathetic nervous system kicks in and says, "Hey, you can call him back down and you can carry on with your life." And the example that I like to give is, if you're in a cafe and you hear a dog barking, for example, you are likely, if you have a typically functioning auditory system, you're going to respond to that dog and you're going to turn and attend to it and your amygdala, your brain is going to be like, "Hey, whoa, I need like, that was a really loud sound. And I need to assess is this something I need to pay more attention to and act on? Or is it something where I can just remain calm and go back to reading my book?" And so most of us would turn and see like, oh, okay, the dogs on a leash and the owners got the dog under control. I don't have to be worried. The next time the dog barks because our brain hopes to habituate to the responses. Our brain isn't activated in the same way. Because our brain already knows I'm in a safe context. That dog isn't a threat to me. And we don't have to be constantly triggered. But kids who do have difficulty processing auditory input if they are overstimulated, would turn every single time and have that same sympathetic response of "oh, oh my gosh, that dogs barking again. Whoa, do an" If they couldn't focus on reading their book, they'd get a half a page read and a half an hour where we could finish a whole chapter because our, our system is regulated, and we can engage in something else. Jayson Davies Yeah, and the brain really is amazing, I don't know, organism, I guess, you know, it's quite amazing what it can do, and how it uses past experiences to also help us regulate because, you know, the brain would not be very functional if every time we got a new sensory stimulus, we weren't able to relate it to something that we had heard or seen or smelled in the past. And so it's amazing how it can work so quickly, and how it can recall all those past experiences so quickly. But like you're mentioning, if the brain can't do that, then you're going to have that same experience over and over again, where it's trying to figure out, am I in a safe environment. And if it doesn't have any past experiences to reference to, you're going to kind of go through that flight, fight, flight or freeze every single time as opposed to already having a reference point. And knowing Yes, I'm in that safe spot. So Wow, pretty, it's pretty crazy how the brain works, I got to give it that one of the words that you have really keyed on is safe. And you mentioned that students have to feel safe in their classrooms to feel safe in the cafeteria. What do you mean by safe in relation to a student's classroom setting? Dr. Jamie Chaves Yeah, so really, when I'm talking about safety, and well, Ashley and I are talking about safety, particularly in our books, we're talking about nervous system regulation. And going back to the amygdala, is the amygdala feeling safe and calm, is the nervous system imbalance where the sympathetic nervous system isn't taking over for the brain, and the student can feel like, they can just operate as usual through life, which is what most of us do, where we are in a calm, alert state. That's really what safety is for our nervous system. And it's really rooted in the positive, trusting relationships that we have through co-regulation. It's based on a sense of control over your own body over the environment, you know, what to anticipate out of your body, you know, what to anticipate out of the environment, and you can trust in those things. And you can trust the people who are also around you. Jayson Davies Yeah. And so then how do you teach teachers a way for them to facilitate that safety? Is there a specific strategy or set of strategies that you're able to help them with? Dr. Jamie Chaves I think the first thing is teachers' understanding, we call it the teacher-student response cycle. And teacher's understanding, how their responses and how their own regulation can impact a student's regulation. And thus, a student's response is really a foundational point, because that's how we can get to a co-regulation state, that if a student is feeling really frustrated about doing something and throws a book across the room, and the teacher comes up and says, "Hey, you can't do that you need to go pick up that book right now", then that might trigger the student even more, and then their behavior is going to be reflective of that. But if the teacher can get into a better state of regulation, himself, approach the child and say, "Hey, it sounds like you're getting really frustrated. Let's try to figure out what we can do differently here." The teachers in a regulated state, the student is going to match that regulation, and then they can move forward with the problem-solving stage, and it might not happen that fluidly. But that's the general concept of it. Because co-regulation is really the foundation of self-regulation. And you have to have that established first. And there are so many self-regulation strategies out there. But really, it's co-regulation strategies, shared moments of joy, seeing songs together, taking pictures together, talking about what happened over the weekend together. I think those can be really powerful co-regulation experiences between teachers and students. Jayson Davies Yeah, that leads into another question that I have then, based upon your response, you know, you mentioned co-regulation, and I think that really is an occupational therapy term. I think that or maybe not Occupational Therapy specific but more of mental health, medical term per se. And I don't think it's a term that teachers would really associate with. And I don't know if they have a term for that. Maybe it's school culture, potentially. But how can an occupational therapist working in a school help teachers to understand that term co-regulation? Do you think that trainings are the best way? Or do you think potentially getting into the classroom and maybe modeling it? How can an OT who's working in a school help teachers to understand the concept of co-regulation? Dr. Jamie Chaves I think it's both ends. I think understanding the underlying concepts around it, and how the nervous system works, and how self-regulation does develop out of co-regulation. What are the zones of regulation, all of that terminology is a really important foundation. But then seeing done and in action is also just such a powerful method of learning. I just wrote a blog post about multi-sensory learning. And that's what that is, I mean, you're like experiencing, it's more of this kinesthetic experience. And then you can step in and or the teacher can step in and say, Okay, let me take over from here and see how I can do it, and model it for the student in the same way that you are modeling it for that teacher. But yeah, I think I mean, it's a process and I, as a parent too like, I use co-regulation so much as a parent. And it's a process, I know all of the things, and I've seen it modeled before, and I've done it myself before. And it still is, it just takes practice. And so just encouraging teachers to start somewhere and start with something and build off of that, knowing that it's never too late to change. And you don't have to be afraid to do things differently and think differently because it is kind of countercultural to what a lot of the behavioral strategies are out there. Jayson Davies Exactly. Yeah. And that's where I was gonna go with the next question, a little off-script. But talking about that behavioral change, you know, so much for the last 100 years, or more, I don't know, schools have been so focused on behavior. And we think how much progress public education has made, you know, you can't walk around and hit a kid sand with a ruler any more, like you used to be able to do back in the 40s, or whatever it was, but there is still a very much a behavioral approach from teachers. And it can be difficult to change that mindset. And I think by bringing in that co-regulation idea, you are in a roundabout way, changing the shift from behavior to regulation. And so I think that's an important context. You know, we moved from potentially having clip charts to being more in tune with the child and meeting them where they are. And so I don't even know if this is leading to a question, honestly. But I know that's a big shift right now. But it is also a very difficult shift for teachers because that is what they learn. And, you know, Dr. Jamie Chaves and it's not just teachers, Jayson Davies True Dr. Jamie Chaves it's parents, it's, I mean, it's society culture as a whole. I mean, I don't, it's kind of a trickle-down effect. And I don't want to totally call them out. But pediatricians like that's how they're guiding parents in behavioral-based strategies because they're not getting this information in school. But they're the ones that parents pass through when their kids are toddlers, and they're first acting out. And a lot of teachers are parents. And so they've gotten that information from the pediatrician. And they've used that as parents, and then they're enacting it in their classroom because, and it's like this huge cultural shift of like, we need to educate so many people on this shit like, it's the pediatricians, as well as all of us therapists and teachers and parents. And but yeah, I mean, it is a really hard shift when it has been so embedded in our culture that, well, if a child keeps doing this, they're going to learn that that's okay. Well, if you keep attending to a child's regulation needs, then they're not going to keep doing it because they are going to feel safe and they are going to feel like they have their needs met and that you can problem-solve together and find a different pathway forward. Jayson Davies Yeah, and or Earlier you talked about and this ties right into it, I wanted to talk about it when you mentioned it earlier, you talked about how sometimes a teacher or even a therapist or parent, we say you have five minutes to go get regulated? And well, there's a problem in the whole sense with that, because you're saying, I'm going to use a behavioral approach for an hour, and then now go get regulated in five minutes. Versus what if we turn that into instead of a behavioral approach for an hour, five minutes for regulation? What if we spent that entire hour with the regulation approach and co-regulating with the students and saying, all right, yes, you're frustrated at the minute, number one. But let's start there with co-regulation, not wait 60 minutes later, to let you have a break and potentially go get regulated. And so changing that mindset, we can't just change that mindset for five minutes a day or five minutes every hour, there really needs to be a whole paradigm, you know, full-day, every minute of everyday shift. And so I think that's very important. And that's awesome, that, that you're working on that shift with so many other people, too. Dr. Jamie Chaves Yeah, and it's a shift from what we typically do as like rewards punishment, even in terms of like, oh, well, I know, playing outside is really regulating for you, or I know this, the sensory nook is really regulating for you. So finish these finish writing these two sentences, and then you can go to the sensory nook and calm down, like, no, go to the sensory nook, and calm down, and then come back and finish writing these two sentences. And it'll go faster, the child will be in a better cognitive state because they won't be so triggered in their lower levels of the brain that they can access those higher levels of the brain. And that writing experience will be wired more positively in their brain rather than negatively. And, yeah, I mean, we want to, we want to hurry things along and say just write these two sentences, and then you can go off and do your thing. But really, it's the opposite that we need to be focused on. And like you're saying, it could be that the child spends 20 minutes and that sensory nook rather than 20 minutes at the desk, struggling to write those two sentences. Jayson Davies Yeah, and I want to talk more about the environment in the note, but based upon what you're just saying, one of the things that OTs I don't think have been the best at and our counterpart with behavior lists are really good at is documenting, and documenting how things are working. And they sit there with a notepad, and they marked down every single thing that works and doesn't work. And then they're able to present these very detailed charts that show you know, progress, potentially, because the student is learning over time, hey, if I write those two sentences, I get to go to the nook a little bit faster. And so the time goes down 20 minutes, Monday, 19 minutes, Tuesday, whatever. But how do we document that doing the opposite using a co-regulation approach works in a way that we can kind of show the parents that it's working because we see it working? But how do we document that it's working? Dr. Jamie Chaves Yeah, I think that's a good question. And I, I know that's a struggle for public health, too, when you're doing these, like preventative things, how you how do you show that it's actually preventing something from happening when it doesn't actually happen. And when you're a behavior analyst, you're looking at behaviors. And that's what we're doing as OTs too. We're just looking at the behaviors in a different way. And so you can still track those behaviors and the frequency of the behavior and the duration of the behavior. But the approach to the decrease of that is so different. It's not that you are you're moving a clip or you're giving them an incentive every time like, oh, he only needs five incentives now like, no, he only needs five minutes of being in a sensory nook or he only accessed a fidget toy three times today instead of eight times today. So I think we're still looking at those same behaviors, and we can document those behaviors in the same way. But the way that we're getting to the decrease in behaviors is really different. Jayson Davies Yeah, no, that makes sense. And I want to throw this out there too, is that the way that behavioral list their structure of practice is laid out? They are given the time to actually track data. When we think about a BCBA model. They have the BCBA who is kind of in a way the occupational therapist per se, right? We're the person doing the evaluation but then they have someone who is often sitting with a child for hours at a time. And they are marking down every single thing that happens. And as occupational therapists, we typically don't have that opportunity, even an occupational therapy assistant is not going to be one to sit with a child for three hours. And document every single time a student throws a book, or throws a pencil or refuses to do a task, or on a different side positively says, Hey, I need to go to the sensory nook, or hey, I need a break. So it's kind of difficult for us, to take data. And I know often a school-based occupational therapist, we are inclined. And we're, we're very polite about it when we try our best to get help from a teacher or help from a classroom aide to take that data for us. But to be fair, they have their own jobs to be doing. And it is very difficult for them to also take data on that when they're trying to. I mean, they're trying to teach that that's what their job is they're trying to teach. And it's hard for them to take data. And so I do kind of wish, and I'm almost jealous of these behavioral technicians that get to spend two hours, three hours, or even all day with a student. And I'm just like, man, what if I had one day that I could spend with one kid the entire day? Oh, and by the way, I'm in their natural context with the teacher there who I can also explain what I'm doing. And yeah, you know, I get a little jealous of that, because they do have that time with a child that we just don't have, we typically have a half-hour, maybe an hour, at best a week with a student. And I know there are studies going on right now to try and figure out dosages a little bit and compare that. But yeah, I just think it'd be awesome. If we could have just one opportunity to spend an entire day with a kid and how much progress we could potentially make. I don't know. Do you have any thoughts on that? Dr. Jamie Chaves No, I think it's true. And I mean, I honestly hope the model is shifting not only for the sake of OTs, for the sake of kids, I hope that the model is shifting away from ABA. And maybe it's more time like DIR floor time specialists who are spending the three hours a day in the classroom with them. And then they are getting these co-regulation techniques rather than behavior techniques. And floor time specialists can also measure data really well too I mean, in a different way. But yeah, I just hope the model is shifting away from so much of the ABA in the classroom and more of these co-regulation… Jayson Davies Strategies. Dr. Jamie Chaves Yeah, strategy. Yeah. approaches. Jayson Davies Yeah. All right. It's so easy to get off topic when we start going down that route. But let's go back and get on the topic a little bit. Talking about the classroom environment, how do you support teachers in understanding that the environment can have an impact on a student's performance and the child feeling safe? We've talked a little bit about safety. And you've also discussed a little bit about the nooks. So maybe you can expand a little bit more on that? Dr. Jamie Chaves Sure. Well, I would say one of the most enlightening things for teachers is two of them, actually, are one examining their own sensory preferences. I think a lot of people think of sensory and they think of sensory processing differences. But we all have sensory preferences. And once teachers realize, like, wow, I do have these sensory preferences, and they're inputs I lean into, and they're inputs that I stay away from and when I can't avoid those inputs, I feel more dysregulated. Or if I can't lean into the inputs, I need to I feel more dysregulated like I'm a sensory being too. I think that's really enlightening and helps them see all of their students in a different light and realize why someone might have different sensory needs on one day versus another day because teachers are realizing, hey, I have different sensory needs on a daily basis as well. And also, what I like to do with teachers is have them experience what different sensory processing differences might feel like. And that's something we put into our book as well. In each of the sensory chapters, we have an experience it box, and that's something that anyone reading the book could guide teachers through, just pick it up and say, Hey, teachers, we're going to go through this experience, and it really makes teachers step back and say, "Whoa, I can understand how a child would have a really hard time learning in this environment when this is what they might be experiencing" Jayson Davies Absolutely. So you've mentioned the nook a little bit during this hour so that we that we're talking and so what do you look for in a nook? Or when teachers are trying to develop a nook? What do you kind of recommend? Dr. Jamie Chaves Yeah, so a sensory nook is really a place where kids can go and access different sensory inputs that would have a calming impact on their bodies. And it's not something that every student might access. And it might not be something that students access, even on a regular basis. And they might need different like one day, they might need body brakes versus going to the sensory knock, but it is, again, a tool in a teacher's tool belt. And so I like a place that has pillows, something soft, I like heavier pillows because they can give more appropriate receptive input, calming visual input, they have some of those fish tanks, those light-up fish tanks that kind of scroll around or like a lava lamp, but not one that plugs in, there's just like these things where the bubbles move in the water, something like that's really calming, there might be some noise-canceling headphones, there might be access to music, that's calming, they can put on headphones, and access calming music, fidgets might be like a basket of fidgets back there. And then I usually recommend having some sort of zones of a regulation chart with the green and red and blue zones, or different pictures of emotions, so that kids can communicate by pointing to different pictures because language is a higher-level cognitive skill that might drop out when kids are dysregulated. But so that they can communicate where they might be at in the process. And I think a lot of sensory notes have timers, and I really, really don't recommend having a timer in the sensory neck. I know you're asking what I do recommend, but I don't recommend putting a timer back there because it puts more pressure on the child and can make them feel anxious, which is a state of dysregulation about whether or not they're going to meet that time. Jayson Davies Yeah. And you know, I think I already know the answer to this question. But what would you say to the teacher, the parent administrator, who says, "well, then what's going to happen while that one student is in the nook and is missing out on the instruction that the teacher is providing?" What's your response to that? Dr. Jamie Chaves Well, I would say, particularly in younger years, I feel like this answer is easier because so much of the material is repeated. A lot of the instruction, like when you're learning to tell time, you don't just learn that in one, one instruction period, like you're doing it over multiple instruction periods. So I think it's easier to say, like, "Well, hey, they, they miss some of that, and they'll pick up where they left off the other day." But I think it's really important for people to see that regulation is just as important as taking in some of that cognitive information. And when kids are in a regulated state, they're going to be able to take it in faster, more likely, they'll be able to take it in faster, and they'll be able to integrate it a lot more, as well. So it might be that they just pick up where they left off. And then whatever the teacher needs to fill in, in a quick, quick lesson, it might just be that they kind of pick up there. But yeah, like I said, in the younger years, there's so much repetition that happens that I feel like it can naturally be folded into how the child's learning. Jayson Davies Yeah, and I think it's also a little, it's difficult to have the conversation, but it leads to an understanding of sensory processing. When we let the parent the teacher administrator, understand and let them know that that child isn't missing anything that they might have been already missing anyways because they were dysregulated. And so I could let them sit in that chair dysregulated for 20 minutes, not learning anything. Or I could let them go to the nook and become regulated in less than 20 minutes and get back to the task and potentially miss less instruction. And who knows while they're in the nook, regulating. They're still listening in in a little bit. And as they become more regulated, the more they might take in and so maybe instead of missing 20 minutes, they're missing five minutes, but they're in the note for an extra five to 10 minutes really getting to the point of regulation. And so they're still keying in on what's being said, maybe they're not seeing the board where the teachers writing down one plus one or whatever, but they're still potentially taking that in auditorily. So, yeah, I think it's really key that we let teachers know that part of it. Dr. Jamie Chaves I would agree. Jayson Davies Yeah. So we talked about a nook. But what about a sensory lab or motor lab? What are your thoughts on a motor lab within a classroom? That kind of looks more like a traditional sensory integration type of gym? Dr. Jamie Chaves Yeah, I mean, I think it's great for school sites to have that it's great, particularly for kids who have sensory processing differences, who do need more of that because I see it written a lot, which is true to a degree, but I see it written that kids know their own sensory needs, and they will meet their needs. And then they will, like, kind of move on, which is, like I said, true for a lot of kids. But for sensory kids with sensory processing differences, that's not true. Their typical environments are not meeting their sensory needs, and they're not able to meet their own sensory needs, which is why they have sensory processing differences. So yeah, having a space to be able to access inputs that are more intense or less intense, or different than what their typical environment provides, I think is really helpful. The direction that Ashley and I really push for in our books is multi-sensory learning, where it's just folded into the curriculum and folded into the classroom engagement where kids are learning more through play and through experience and through Yeah, different ways of learning and doing and being and explicitly exploring with students how some students have strengths in some areas and vulnerabilities in some areas, and then other students, it's, it might be reversed, and how can those things complement each other? And how can we create a learning environment where everybody can learn, regardless of their strengths and vulnerabilities, rather than always leaning into the strengths of auditory and visual learners, which I think is what traditionally classrooms have done? Jayson Davies Yeah, I think you're right. And again, this kind of leads right into an area that I think is not well understood within sensory integration. And that's praxis. You know, when we think of sensory, we don't think of praxis, it's not a true sense. It's not a sense at all. It's a combination of how we act on our senses, along with the environment. And so I want to ask you a little bit about praxis and how you explain that to teachers, in the sense of learning, how does praxis impact learning? And how do you explain that to teachers? Dr. Jamie Chaves Yeah, so what I've learned through the years is that praxis is really the foundation for executive functioning skills. And I think teachers know a lot more about executive function and how executive function impacts learning. And basically, if we can't organize our bodies and organize our body movements, and how we're moving through space, then organizing materials and objects, and thoughts within the environment are going to be even more difficult. So I think that's something that teachers can really relate to, in particular with praxis. Jayson Davies And then do you feel that praxis can have an impact on child safety and child regulation as well? Dr. Jamie Chaves It's one of the biggest factors I think I see with kids with sensory processing differences. I mean, the confidence that we gain through our movements and being able to depend on our movements and depend on our motor responses, and when we can't rely on that. It's so frustrating and it just becomes us a space where you're like, I don't want to try anymore, or I just want to be goofy because it hides the fact that this is challenging or, and so kids with praxis, I would say are one of the biggest group with dyspraxia, I should say, are one of the biggest groups who need co-regulation and who really need safe environments where they can trust what's going to happen and have things more in their sense of control and build their resilience more so that they can take steps to be more independent in some of the things that are really just so challenging and take up so much cognitive space that they don't have anything left to actually learn the math problem because they're taking up so much cognitive space just on figuring out how to hold the pencil. Jayson Davies Exactly. I agree. And, you know, that's one of the things that I find myself explaining within IEP meetings so often. It's just that, you know, handwriting we make it look simple. But there are so many factors that go into handwriting. And of course, praxis is one of them. And then you add on the demand of putting a sentence together, or you add on the demand of putting multiple sentences together, and you're just adding demand on demand on demand when something hasn't been perfected. And they're trying to relearn every single time how to make a letter R. And we're trying to get them to spell a word that has two R's in it, or whatever it might be. And so we're just adding demands before the student has kind of moved beyond that motor learning or beyond that praxis ability to muscle memory. And so yeah, that's, that's very difficult. I'll never, I'll never forget this one time, I was working with a kid. And she just threw her book and her pencil on the floor, I think we were coloring and it was something very simple, like just coloring in and shapes. And she became so distraught that she just threw everything off the table onto the floor. And immediately, she felt so sad and started apologizing, and went to go pick everything up. And I was like, that's not frustration. That's not a behavior of, I don't want to do this. That's a behavior of I can't do this, I need help. I don't want to do this, because it's difficult for me. And I think that just shows the praxis. And I think that shows how dyspraxia, like you're talking about, can lead to dysregulation so yeah, I'm right there with them I feel like practice is 100%, something that needs to be intact, in order for learning to occur in the classroom. Dr. Jamie Chaves And we actually wrote a whole chapter in our book, the why behind classroom behaviors, which is the first book we published, we wrote a whole chapter on handwriting, because we thought, this is an area that causes so much dysregulation, not only for students but also for teachers and helping teachers understand, like you said, what goes into handwriting and how many layers are present and that it's not a developmental skill, it's something that you truly have to learn through so many integrations through the integration of so many areas of the brain. So yeah, Jayson Davies so I think that's going to kind of wrap up what we're talking about. But I do want to dive into your book a little bit, I was reading it the other day. And I really love how you guys organized the chapters, and actually want to give you a second to kind of talk about that organization a little bit because you kind of talked about knowledge first, and then what a teacher may see and then kind of what they can do based upon that. And so I want to let you share how you and Ashley kind of developed the book and came to organize it. Dr. Jamie Chaves Yeah, as I said, it was really developed out of the trainings that I was doing. And that just happened to be how I was organizing the trainings. And it was working for the educators with who I was doing the trainings. And they liked the flow of that. So I just kept it as the flow in the chapters. And I wanted to make it accessible, while at the same time, make it informative. And I want educators to have all of that information background, but then also not have to connect all the dots as to okay, how might I see this in the classroom? How might it be impacting kids' behaviors the most in the classroom? And then what might I see? And then how specifically, might I address this? And then, like I said, earlier, we wanted those experience, experiential learning things to be part of the picture as well so that teachers could take a step back and really feel like what sensory processing differences might be. Jayson Davies That's awesome. Yeah, I really love it. It's super affordable. I was telling you that earlier, I really expected this book to be more like the price of a textbook. And I love that you guys have made it right around that $29-30 price range. So it's actually accessible for both occupational therapists, teachers, any educator, which I love about that because the last thing anyone wants to do is to spend 120 bucks on a book and I know that's difficult. But at the $30 price range. This is information that's so valuable, that teachers can pick up and read a chapter a week and it's going to help them better understand their students that have sensory processing. differences. So that is awesome. Dr. Jamie Chaves And OTs too Jayson Davies and OT Dr. Jamie Chaves OT like OTs who are just starting off or even OTs been in the field for a while. I mean, I had OTs in mind when we were writing this as well because we all get different levels of training. Jayson Davies Yeah, and we all can't afford a $600 level one course from any of the sensory processing. Big. Yes, $30 You can't beat that for getting a very good start with sensory processing and understanding all of the senses from the five typical senses and then also into vestibular proprioception. I think you even wrote a little bit about interoception on the right. Yes, yeah. So it's a great place to start. I told you, I was gonna give you an opportunity to shout out to Ashley and I completely missed that part. So if you can share with us a little bit about Ashley, how you guys came to work together? Dr. Jamie Chaves Yeah. So Ashley Taylor is a PhRSID. She has a specialty in early childhood development. She's a practicing clinical psychologist, she does a lot of neuro-psych neuropsychological testing, I met her at the Center for Connection. And we just really hit it off. And we shared a lot of clients together. And we've learned so much from each other throughout the years. And I would really highly recommend all OTs to buddy up with somebody who does really good work on neuropsychological or psychoeducational testing and really understand those assessments and how they overlap with OT, and then vice versa, being able to share as an OT how what we are seeing in the kids and students that we work with, how that might inform the neuro-psych and psycho Ed assessments as well. Jayson Davies Yeah, and you know, I know, if you're not within a big city, like myself, and you are in Pasadena, a subset of a large city, then you're often left to work on your own as an occupational therapist, and you may not have another occupational therapist, within your city or sometimes within your county that you get to work with. And, you know, we have to remember that we can get knowledge from people who are not always occupational therapists, and our mentors can be people who are psychologists, speech and language pathologists, physical therapists, you know, we don't always have to have an occupational therapist, I recommend you do find occupational therapists. And that's probably why you're listening to this podcast right now. But at the same time, learn from people who are outside of the field of OT, because they have so much to teach us as well. And we also have so much to teach them. And so working together, using that interaction approach, we can support students from all sides, and not just from an OT lens, but from a PT, a speech, a teaching lens. So definitely agree with you there. So yeah, where can people learn a little bit more about you, if they want to buy the book? If they want to just get in touch with you? Where can they learn about you? Dr. Jamie Chaves Yeah, so we are on Instagram at the @whybehindbehaviors. My personal website is jamiechaves.otd.webstarts.com. And then our books, the why behind classroom behaviors. And creating sensory smart classrooms are both available on Amazon. Jayson Davies Great, and we will be sure to link all of those in the show notes. So be sure to head on over to the show notes for this page. You can find that in your podcast player and all of the links to her website to the Instagram pages, and the books will be there for you all to find super easily. So Jamie, thank you so much for coming on the show really appreciate having you on. And I know this specific, this topic, the knowledge that you've shared today is going to help so many occupational therapists, I mean the occupational therapy assistants, and in turn, hundreds 1000s Maybe of teachers and the students that they serve. So thank you so much for being here today. Dr. Jamie Chaves Yeah, thanks for the conversation. That was great. Jayson Davies Definitely take care and have a great rest of your day. Dr. Jamie Chaves Thank you too. Bye-bye. Jayson Davies One more time. Thank you so much to Jamie for coming on the podcast and sharing all that information about sensory processing, sensory integration, and self-regulation, and safety within our students. She really obviously knows everything that she is talking about. And if you want to learn more about everything related to this topic, be sure to check out her book on Amazon. It's got a lot of great information and it is a pretty easy and also cheap read so be sure to check that out. Thank you so much for hanging in there and listening to this entire episode. I appreciate you being a part of the OT schoolhouse community. And I look forward to our next episode together. Take care. Have a great rest of your day and I'll see you next time. 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 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, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast

The world of school-based occupational therapy is unique and different than any other setting. We are medical professionals in a world of education. You could say that we are “the odd man out”. As occupational therapists, we are educated to support a medical model. However, when we cross over to school-based therapy, our framework and foundation must shift to an education model. Because of this, I feel like school-based OTs spend an insane amount of time educating parents, faculty, and staff about our role in the school system. Since we are initially trained in the medical model, if a therapist is just starting in the school system as a brand new graduate, or if an OT practitioner is transitioning into the schools after 20 years in inpatient rehab, the simple idea of starting in a school-based model can be daunting and terrifying all at the same time. So, when Jayson prompted the community to share a tip for new practitioners on Instagram, there were almost a hundred helpful comments from experienced school-based OT practitioners. Clearly, therapists are more than willing to give advice, especially related to areas and situations where they wish someone would have told them how to (you can fill in the blank). As we dove into the comments more, several themes surfaced and we wanted to take some time to share and expand on these words of wisdom. Tip #1: Build relationships with everyone on campus “Make sure your admin know who you are” @Theaccommodationstation (Alexandra)​ “Make friends with the custodian! You never know when you’ll need to borrow tools/hardware or have them rig something up for you!” @Theeverydayot (Sarah)​ “In addition to making friends with the building secretaries and janitor, befriend the gym teacher…Also, don’t forget to provide support to the ‘specials’ teachers (art, gym, music, and computer). These teachers a lot of time get little support and aren’t quite sure how to meet students’ needs. Art and gym are often great classes to push in to for OTs.” - @Raejean84 (Raejean) Each school you walk into is a family. Each member has its role and place, and no one wants to be left out. In all the years I have been in the schools, I cannot count the number of times I have borrowed the janitor’s hammer to “fix-up” a student’s locker to increase accessibility, or the number of adapted scissors (usually the loop scissors) I have given to art teachers for our students in special education classrooms to use while in their classroom. These are all things that can help build relationships within each of your campuses. No one is too great or too small to be involved. When you ask for that hammer, be genuine while you ask how their day is going. Take a second to see what the cafeteria monitor’s favorite TV show is. When you take the time to build these relationships across the entire campus, you can bet that they are going to reciprocate that relationship and take an interest in you. Tip #2: Take time to build rapport “Always start with building rapport with your clients, you’ll be able to more effectively meet your goals once your students have a solid trust in you and your relationship!” - @Kidscopinglab (Dr. Meryl & Shae) The phrase “It takes a village to raise a child” can definitely apply here. Taking some time to build rapport with each of those individuals can help bring the entire team together. It can be simple things, like asking about their day, or offering to check supplies of adapted paper so they never run out. It could mean taking some time to sit in on the IEP meeting they told you about last minute, or adapting and integrating parent strategies into the classroom setting. Once you take this time to build rapport with the team, it becomes easier for them to help you as well if you get into a difficult situation. Tip #3: Do not be afraid to ask questions “Don’t be afraid to ask questions #yr2schoolCOTA” - @Haepi_ft (Elisha)​​ “Ask questions! Ask where the bathroom/gym/nurse’s office is rather than wandering around until you find it…Ask for help, Ask what people mean by acronyms- you get smarter and better at your job when you ask clarifying questions than when you pretend to know what people are talking about” @Michellemarie5 (Michelle) This is where the previous rapport building and building relationships can come in handy. If you have taken the time to build rapport and relationships on your campuses, they are going to be more likely to help you. It can be embarrassing to ask simple questions about the location of the bathroom or where room 204 is. If you take time to build relationships, the teachers and staff are going to be more than willing to help you. They know you care. Tip #4: Reach out for training and in turn, train others “Take advantage of all the mentorship you can get. Watch and learn” @Tarradp (Tarra)​ “Do a lot of training. Train those teachers, push in, and present, present, present. You have too many kids to see all alone so instill help in the staff. Collaborate constantly.” - @Kidsviewtherapy (Theresa) “Collaborate and create alliances with your case carriers and specialized academic instruction teachers, They will be your eyes and ears for your students everyday even if you physically can’t be on the school campus.” @Mamawells329 (Christine) “Push in to the classroom, let the teachers see you working with the students. It will help create rapport with the teachers and buy-in for interventions you want to implement. Also makes sure what you might be working on in a pull out session transfer into their everyday environment” @Ashmenzies (Ashley) Take a second to think back to your entry-level OT curriculum. What was one of the tools your professors or instructors would use to help teach concepts? Teaching others! Once you have received some training or some correction, take the time to turn around and apply it. This could be through training a teacher on a strategy you are using with a student or discussing a new strategy with a coworker or colleague. This can also help you build collaborative teams and alliances within your different campuses. If you have access to other OTs, maybe see if they can come and observe you or sit with you through your first IEP meeting. They can help you point out things about yourself that you may not pick up on. It could be little things like “your posture appeared very closed and uninviting” to “when you are talking with the parent, a different way to phrase that would be…”. Do not look at it as a colleague trying to pick apart everything little thing you do, but as an opportunity to grow and learn as a therapist. Listen to Episode 45 of the OT School House Podcast for even more tips! Tip #5: Find your own organization strategy so you can be flexible “1. Using electronic documentation as much as possible and find some sort of way to keep track of IEP dates. 2. Try to avoid bouncing back and forth between schools.” - @Yoursch00lot (Amanda) “I recommend making yourself a checklist of all the things that need to be completed before/after IEPs (data collection, teacher consult, scoring goals, drafting goals, documentation, etc.).” - @Sarahbeeot (Sarah) “Before IEP meetings observe the child in class, talk to the teacher, and call the parents." - @Wootherapy (Meghan) “Be kind to yourself. Figure out a schedule that allows you to spend the most time with your kiddos and supporting staff.” - @Mornings.with.an.ot.mom (Danielle) “Be flexible! Write everything in pencil because it will change. Also, give yourself some grace to make mistakes and take long on things. The first year is DIFFICULT and so you need that year to learn the rhythm and routine of the school year.” - @hopemccarroll (Hope) Everyone is going to have their own way to keep organized. Jayson, for instance, keeps items electronically. He even offers you resources for free to help with organization when you subscribe to the OTschoolhouse.com email list. I, however, do not keep up with items well if I keep them online or electronically. I have forms that I keep in one binder and have dividers for each campus. I have had systems in the past where I had a binder or folder for each campus. I think you need to figure out a system that works best for you that is going to help you stay organized. Also, I keep a paper planner and write out a schedule every single week. I take it as an opportunity to cluster treatment sessions on the same campus and look at moving sessions if I have an IEP meeting or additional staff meeting on the campus a different day of the week. I do this knowing that my schedule will change during the week, but I can easily keep track of the sessions I need to move and reschedule when changes come. And that is not an “if changes come” but “when they come”. Tip #6: Document everything “If it’s not documented, It never happened!” -Elisa Wern Documentation is everything. Documentation is not just for treatment sessions but, it is also for everyday tasks and conversations as well. If an incident happens, document it. A consultation with a teacher or conversation with the parent, document it. If you attended an IEP meeting or staffing, document it. You really should do this for a number of reasons: First, It becomes part of the child’s running record and chart. Even IEP meetings can help document recommendations made about service time so another therapist could look at it and see the progression over time. Second, this can also really show the time it takes to be part of a child’s case. Districts are always looking for documentation related to how you spend your time during the day. This is a great way to document that. It is hard to quantify a conversation with a parent or how long consultation meetings with teachers actually take. This is a way to keep track of that. And finally, if you are ever questioned about how you spend your time, you are able to pull your own documentation records and see exactly what you did because you documented it. Tip #7: Advocate for yourself “Advocate for the children but most importantly YOURSELF.” @OTwithKenzie (Kenzie) “Change takes time. You will see many things you are not ok with. Focus on the things you can change.” - @mornings.with.an.ot.mom (Danielle) In the school system, advocating as an occupational therapist could look many different ways. Maybe it is advocating for additional OT staff or for help on a campus or two because you are behind on treatment sessions or piled with evaluations. You may also choose to advocate for additional programming on a campus because of a trend you are seeing related to the mental health and anxiety in the children on that campus. You may also advocate for additional training and help on a particular case. Do not be afraid to be honest with yourself and others about your needs. Many of the educational service centers and AOTA have tons of resources, but you may not always know how to access those. It never hurts to ask! Although you may feel alone in this endeavor of school-based therapy, know that you have access to a plethora of other school-based therapists virtually that you can also rely on for additional advice. There are many Facebook groups, podcasts (such as the OT School House Podcast), blogs, and Instagram accounts (including all the people who are quoted in this article) that can all be used as resources to build your own therapy community. Do not be afraid to put yourself out there and to build that community! Have a great first year! Author Bio: Hope McCarroll has been an occupational therapist since 2011. Her primary area of focus has been school-based occupational therapy services. She recently made the leap to academia and is currently core faculty at University of St. Augustine for Health Sciences. Hope continues to practice as a pediatric occupational therapist while teaching occupational therapy students.

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 86 of the OT School House Podcast. In this journal club edition of the OT School House Podcast, we are examining the 2020 Seruya & Garfinkle article about the current workload trends in school-based OT. We will discuss the findings from a survey of 571 OT Practitioners working in the schools just like you and talk about the real-life implications your caseload can have on your practice. Spoiler alert: Your Caseload is likely holding you back, but listen in to hear how you are not alone and what steps you can take to move forward. Also, stay tuned until the end for a special announcement and giveaway from Jayson. Links to Show References: Get access to the Making the Shift: Caseload to Workload Workshop! Article Citation: Seruya, F. M., & Garfinkel, M. (2020). Caseload and workload: Current trends in school-based practice across the United States. American Journal of Occupational Therapy, 74, 7405205090. https://doi.org/10.5014/ajot.2020.039818 Transcript Download the Transcript or read the episode below! Jayson Davies Hey there, and welcome to this journal club episode of the OT School House podcast. My name is Jayson Davies. And I am so happy to have you here joining me from wherever you are. As you might have noticed, we're starting this podcast off like we have a few in the past where we do the intro first. And then we're going to cue that intro to the music that we all love so much in just a moment. But first, I just wanted to let you all in that this episode is a very important episode because we're talking about something called a caseload and a workload and how those differ how they're similar a little bit. And we're actually bringing in an article from the American Journal of Occupational Therapy to kind of show where we're at today, or actually where we were at in 2020, right before the shutdown of everything. But anyway, that's a different story for another time. So I'm excited to have you here this entire, this entire episode is going to lead to something bigger I have an announcement as well as a giveaway at the end of this episode. But I really want you, to listen in to this entire episode because it all comes together at the end for one big announcement that I'm super excited about and cannot wait to share with you. So let's go ahead and cue the intro. And when we come back, we're going to talk about an article titled caseload and workload current trends and school-based practices across the United States. Alright, I will see you in just a moment right after this intro. Amazing Narrator Hello, and welcome to the OT School House podcast, your source for school-based occupational therapy, tips, interviews, and professional development. Now to get the conversation started. Here's your host, Jayson Davies, class is officially in session. Jayson Davies Alright, welcome back. Thank you again so much for being here. I want to start off by sharing a little bit of the demographics I guess you can call it the information about this article that we're discussing today. The title is "Caseload and Workload: Current trends in School-Based practice across the United States". It was published in the AJOT, the American Journal of Occupational Therapy back in 2020. So it is relatively new. And the authors who I just admire so much are Francine Seruya and Mindy Garfinkel, more on them in just a bit. The full citation can be found down in the show notes or at otschoolhouse.com/episode 86. I cannot believe we're on episode 86. This has just been a whole blur from episode one to Episode 86. And thank you so much for being along for the ride. So I want to talk to a moment about Seruya and Garfinkel, Mindy, and Francine they had been so instrumental in supporting occupational therapy practitioners working in the schools. This article as well as some of their other articles have been my go-to Resources. When it comes to thinking about what the next step in occupational therapy within the schools is. They have published articles about workload and caseloads and where we're at and maybe where we could be in the future. They've also looked at the three to one model, which some of you might know as being a model where you provide direct therapy services for three weeks and then you have that fourth week of the month to kind of do other things like maybe get into the classrooms to observe those students that you would regularly pull out and see also to maybe complete those evaluations maybe participate in some RTI or MTSS tiered intervention. So that is the type of thing that Seruya and Garfinkel have been pushing forward, almost kind of the next step for occupational therapy, how we can move from where we are today to where we can be in the future to support more students, more teachers with potential even less time. So I want to get into that. But first one last time, I want to give a huge shout-out to Francine Seruya and Mindy Garfinkel just for all the work that they have done for occupational therapy practitioners working in the schools. So let's go ahead and dive into some of the key terms some of the background information that this research article actually starts with. They identify a few things that we really need to know about in the first is caseload versus workload. They do define caseload as basically the students that are on your list of students that you have to serve. So the students that you serve, whether they're on an IEP or 504, the students that you are directly responsible for that is your caseload. We'll talk about the average caseload in a little bit. Now they define the workload as going beyond that more than just your caseload. But all the responsibilities and the time that those responsibilities take throughout your week or throughout your month, that's your workload. How many hours do you put toward RTI, toward driving, toward seeing the students on your caseload, toward maybe training teachers and working with staff, all of that is part of your workload. And as we get further into this study, you're going to see how many are using caseload but they're not using a workload approach. And when you're not using a workload approach that could potentially kind of skews what the numbers look like your caseload just simply doesn't tell the whole picture. And then they go on to talk about how this is really a paradigm shift. And switching from a caseload model to a workload model would in theory allow for occupational therapy providers to provide occupation-based interventions within the natural environments such as within the classroom. As you'll see in a little bit, most occupational therapists are using a pullout model, partially because that's what we have kind of schedule for us, you know, it's very easy to control a pullout model service, it's a little more difficult to control that push in. And therefore, it does take a little bit more time in order to actually prepare and complete that push-in model. In fact, we discussed this a little bit in the most recent episode, Episode 85, at OT School House podcast with Megan, right, we talked about how the struggles are so real when it comes to moving from that pullout model to more of a collaborative type of push-in model. And there are a lot of barriers involved in moving from that pullout, traditional pullout model to a push-in model. And one of those is that we are using a caseload-based model, that really just assumes that every student needs 30 minutes of services. And that's not always the case. And it does take a little bit more time when you have to plan to go into the classroom. And you have to figure out what time to go into the classroom. All those barriers that we talked about in episode 85, with Megan, are all relevant to what we're going to be talking about right here within episode 86. And moving from that caseload context to a workload approach. And then there's one last thing before we jump into our goals and hypothesis, and that is that the researchers know within their background of this article that while there are state guidelines, and even some district guidelines that have been published related to caseload and workload approaches, some states have even gone as far as putting a soft cap in place. But there have been no general standards implemented at the national level. And even at the state level, many of those guidelines, they're not law, and so they're not enforceable. And so you have districts kind of using them when possible feature with a cap, you know, a cap might be 55 kids, but then it says at the end of that when possible. Well, what does that mean? When possible? I mean, does that mean Oh, right. You know what, we have four therapists and we have 300. Kids? Sorry, it's not possible to keep your caseload at 55. So you all have to take on 70 kids? Well, no, that means you should be hiring someone, right? The district should be hiring. But because it's not a national law, or because it's not really enforced at even the state level, that isn't happening. And that is what is leading to some of our caseloads, continuously expanding, or maybe your caseload isn't growing, but your workload is growing, because you're getting more duties such as tiered intervention than your team wants you to be a part of. Or maybe you're being asked to be in more IEP meetings or longer IEP meetings. Well, that includes your workload, without actually increasing your caseload. Your caseload might still be 55 kids, but your workload, the time that you actually need to complete your job is growing. And so nothing related to national guidelines for that really exists. There are guidelines from AOTA and even ASHA, the American Speech and Hearing Association that say we should be moving to a workload approach. But again, they're just guidelines. There's nothing forcing that we do that. And there's nothing forcing the school districts to make us do that or allow us to do that. And so that brings us to our goals of this, this research and what the purpose of this research was by Seruya and Garfinkel, well, they wanted to reach out to occupational therapy practitioners working in the schools and find out what their caseloads were, and what activities were a part of their workloads. They didn't necessarily ask, Hey, how many hours of student direct therapy time do you have? But they did ask what do you have to do other than direct therapy time? And you know, documentation and evaluations writing up evals but also tiered intervention, all that is part of the workload. So they ask them what is a part of your workload? They also wanted to know the why behind who was using a case of the model and who was using a workload model. Why were therapists using the caseload model versus their workload model? Or vice versa? Why were they using a workload approach as opposed to a caseload model? So we'll talk about some of the data that came as a result of that. So then, let's have a look at the participants who completed the survey who participated in this. Well, there were actually 541 Occupational Therapy practitioners that started this survey. I am proud to say that I was one of them. Many of you probably also completed this. They did have therapists from all over the country participate in this of the 541 Occupational Therapy practitioners that started the survey 371 completed the survey. So what We kind of round-up, that's four out of six therapists that completed it. So that's about 66% of the therapists who started the survey also completed the survey. And in case you're wondering if the 541, occupational therapy practitioners that started the survey 479, were occupational therapists and 44 were occupational therapy assistants. There were a handful of others who are not US based, or they're not currently working, and they were excluded from the survey results. Demographics from this participation group showed that most of the therapists were working in a full-time job, meaning that they were working either 30 hours or more per week as an occupational therapist, going even a little deeper than those therapists who participated came from all over the country and had various levels of experience, if I remember, right, the most therapists came from the northeast, I think it was around 20%. And then about 20% also were within the one to five-year range. Within experience. However, there were therapists who had many more years of experience than those, who also participated in the study. So that covers the demographics of the participants. And of course, this is a survey so the word no interventions used, and the results are directly related to the survey conducted. So let's go ahead and take a look at the results. We're going to start with some key results here, and that is that therapists reported working in anywhere from one to 10 schools, and the average caseload was identified as 41-50 students, there's actually only one therapist, I think, that reported working at 10 schools, most of the therapists reported working in one to four schools. And despite having schools across the gamut from elementary to middle and high school, a majority of the therapist did work within the elementary range. Diving a little bit deeper into the caseload, I mentioned that the average caseload was 41 to 50 students. However, as we know, the average is not always what everyone has. So I want to share a little bit of the extreme. Looking at the graphs in the article, it's actually a little shocking, because you see that 10 therapists reported as having a caseload of greater than 120 kids. So 10 therapists, and more than 120 kids on their caseload, it does not identify as to whether or not they had an occupational therapy assistant, working to help them with that 120. But still, 120 is a lot, even if you do have an occupational therapy assistant working with you. Maybe if you have two or three OTAs working alongside you, then maybe that's a little bit more manageable. But that wasn't identified here. Going a little bit deeper, because we all know that 120 is a lot, but so is 80. And if we look at any other therapists who had 81 students or more on their caseload, 35 therapists or almost 9% of all respondents had 81 or more kids on their caseload. That's a lot of kids, I've been there, I've done that. That is a lot of kids, especially if you are trying to do that by yourself, it almost makes it impossible to see kids on a weekly basis, you can only see them on a console, maybe on a twice a month basis. Now, again, if you have an occupational therapy assistant, it does make it a little bit more manageable. But that is what was identified here in the research. Now with such a high caseload size, it's not difficult to understand this, but 60% of the surveyed therapist reported that their caseload was not manageable. And 55% of all of those who were surveyed noted that they were not always able to meet the mandated IEP minutes for the students on their caseload. That means that over half of us are not able to see the students that we need to see every week. That's pretty crazy. Because we are, that's our sole purpose. Even if you're going by a caseload number and you don't have any RTI going on on the side, your sole purpose of being on campus, is to evaluate students, and provide them the minutes of therapy that they need, right? That's like the basics of IDEA. And so to say that 55% of us are not even meeting the minutes that we are, "prescribing or recommending", if you want to say that, that's kind of a scary thought because we're saying these students need services, and we're not meeting those services. That's also a liability for the district. If parents knew that half of us were unable to see all of our students, can you imagine the uproar that would be happening among the parents, they'd be questioning whether or not their students actually getting the services that the occupational therapist recommended, and it might extend beyond occupational therapy might extend to speech therapy, physical therapy, adaptive physical education, who knows? Now getting beyond the average caseload, when asked to rate their most frequently used model of service delivery, 63 and a half of us occupational therapists who work in Schools rated non-integrated pullout as their most frequently used treatment model. The second most used model was integrated pushing services. So I think that was kind of expected. I think, at this point in 2021, where we're at or even 2019-2020, when this survey was conducted, I think that's the case most of us are using a pullout service as our primary model that we use as the students. Now, I do think that it is a bright point in the research though, that about 70% of therapists rated push in collaborative pushing services as being their most or second most used treatment model. That means that most of us are using a push-in service, in addition to a non-integrated pullout service, which is kind of cool, right? That means we're kind of choosing one of those two, as you get into collaboration, consultation, those numbers really start to drop, I have a lot of data. So I'm not going to go over all the data. But you can obviously check it out in your AJOT, the American Journal of Occupational Therapy, access that and you can find all the data, all the tables, and whatnot. Now, what we didn't get here that I would have liked to see is how many of those who are using a push-in model, or really any model for that case, felt comfortable using that model because I hear a lot from therapists on Instagram and in my email inbox that people aren't quite comfortable with that push and model. They don't know how to do that and be effective. They know how to go in and observe, but they don't necessarily know how to go in and actually provide therapy to the students within that context. So I would actually like to see another survey where we're able to see, do they feel comfortable with doing that. Now, another bright side to this research, in my opinion, was that about 50% of therapists reported being a part of 504 and servicing students that were on a 504 plan. I think that is awesome. I was actually a little surprised by how high that number was, I did not expect it to be at a 50% clip. Also, about 38% of therapists noted participating in some form of tiered intervention, which as you know, I'm a huge advocate for so that is also great to see. In the next section that we're about to discuss, I really consider this the bread and butter of this article. It just really shows where we're at and where we are going. And so about 46% of the therapist reported using some form of blended workload and caseload model, and 1/3 reported using only a caseload approach, about 20% noted using a workload-only approach. Now, this kind of didn't bother me. But I was a little left wanting more because I don't know what a blended program looks like. And I don't know that. Let's say Johnny over in San Demas. And Christine over in Glendora knows that their blended program looks the same. And so I think that if we're going to give an option of saying we use a blended approach, that needs to be a little bit more identified as to what that is because they kind of said that some therapists were using a blended approach, meaning that they had time for a workload, but they didn't really incorporate it. And it was, it was a little tricky to understand. But one thing that was very easy to understand is that only 1/5 20% of therapists had made the move to a full workload model. Not only that, but more than 60% of therapists reported attempting to make a shift to a workload model, but we're not successful. Despite that 77% of therapists reported being satisfied with their job and salary benefits and the therapist relationship with stakeholders was identified as the reason why therapists were satisfied with their job. So let's take a pause right there. Because I think that's a big number 60% of therapists have reported, hey, you know what, we want to make this shift to a workload. And we tried, we talked to our administrators, maybe we showed them some research, maybe you showed them this very article, but for whatever reason, the administrator said, No, we're not making the shift to a workload approach. Maybe you didn't even get that far. Maybe you just kind of wondered about it. And you're just like, Nope, I can't do it. There's no way the administration is going to go with this. I'm not going to go with it. I know that in the past, I have been just plain out shut down by an administrator saying No, I don't want to hear the term workload. We're not making the shift to a workload. We give you a caseload. You're expected to meet that caseload. Then they're also surprised when halfway through the year we're asking for help. So you know, it is hard, and I've been there done that. I've gotten through it with a few people and I've tried with others and I haven't gotten through it and I know many of you are experiencing that same exact thing. Now, as I kind of went on to say, it is nice to see that despite people still being on that caseload model 77% of therapists that reported here are happy with their job or generally satisfied with their job. And as I mentioned, the salary, the benefits, and therapist relationships with stakeholders, meaning like the teachers, administrators, were why therapists were satisfied. However, when they were asked to rank what would increase their job satisfaction. So even if you're happy, what would make you happier, or if you're not happy, what would make you happy, lower caseload numbers with the top selected option. So yes, people are happy because they have a decent salary, because they have good benefits, and they like who they work with. But they'd be even more satisfied if they had lower caseload numbers. And that information actually directly correlates with another article that I'm familiar with about where burnout is directly correlated with our workload. And the higher our workload, the more likely we are to be burnt out. But here in the schools, less than 20% of us are really even calculating our workload, because we're on a caseload model. And so we don't know what our workload is. Part of our role as an occupational therapy department is to really understand whether or not what we are doing is having an impact and who it's having an impact on, is what we are doing impacting student performance and increasing outcomes, or is it not? And also, what effect does it have on us and the entire district as a whole. Now, if we are only measuring by the number of students that we serve, that we're not measuring the impact that it has on the students, and if we're not measuring workload, then we don't know if what we're doing is actually effective with our time, maybe our time is going to IEPs for 18 hours a week. And is that really effective use of our time when we could be doing that with students. And so that's where a workload approach really can come into play because it can help us to evaluate our program internally. Likewise, if we think about that burnout rate, if we have high workloads, and we're getting burned out all the time, it's not only impacting us, but it's also impacting the district. It's really expensive for a district to hire a new occupational therapist when one leaves because they're burnt out. And so we can convey that to our administrators and say, hey, you know what, we can actually save money by decreasing our workload because that's going to save the district money in the long term because every year you're having to hire a new OT because the previous OT quit and was burned out and decided to go start a podcast or whatever it might be. So there is a reason to, to measure our workload. And it's not just for us, but it's for the entire district. Before we move into talking about some of the conclusions that the authors had related to this article, I want to let you in on some of the things that the researchers did not find because what they don't find is also just as important as what they do find the authors in this case, they tried to cross-reference some of the survey responses. And when they did that, it did not result in relationships developing between the use of a workload model and other factors such as the employment model region of the country and years of experience. I was kind of wondering if maybe the workload model would correlate with job satisfaction or even the caseload and they didn't provide that information within the survey. So I'm assuming when they made those cross-connections, nothing of significance popped up. Later in the article in the limitation section, they actually do mention that they wish they might have asked the questions a little bit differently and maybe formatted the questions a little bit because some of the questions did not lend themselves to being cross-referenced with another question. For instance, they did some ratings, right? Rate this from one to five or rate your top five reasons for being satisfied in your job. And some of those are hard to cross-reference to another question. And so that was one of the things that they think maybe they would do differently next time. And that leads us right to the author's conclusions. What did they take away from this? What do they want us to take away from this? Well, Seruya and Garfinkel, felt that OT showed that they have some control in the role, but primarily only during IEP meetings. They actually did ask a question, you know, do you feel like you have control in your role as an occupational therapist? And everyone said, Yes, or a large percentage of people said yes. But then when it came to moving to a workload, everyone said, Yeah, we tried, but it didn't work out. And so what they really gained from that was that yes, people feel occupational therapist, they feel like they have some, some authority when they're in an IEP, and they're providing the recommendation for goals and services. But outside of that IEP, they kind of feel like they don't have control, and they don't really have a role in the direction of the OT department, or the special education department as a whole, even potentially. Seruya and Garfinkel also noted that caseloads appear to be tied to job satisfaction, and because of this, they should be some form of effort from higher associations such as AOTA or maybe state organizations to advocate for national caseload or workload cap that may actually be enforced. As I mentioned earlier, we talked about this, they just were seeing that the caps that were put in place weren't really being enforced. And they thought maybe if it happens on a national level, that maybe it'd be a little bit easier to call out districts when they're not enforcing that cap. One of the barriers often identified for moving to a workload model from a caseload model is the funding. And they noted in their conclusions that therapists you know, if they are interacting, and they are participating in tiered interventions, such as RTI or MTS s, this could qualify a district for additional funding through IDE-IA of 2004. And going even further than that, this is my own part after I've learned a little bit from Dr. Bazyk, and so many others who are working in the role of the Every Student Succeeds Act, which didn't come out till 2015, and is still being a little interpreted to figure out how it really works. But maybe you would also get funding from ESSA, Every Student Succeeds Act, if you're doing more of those tiered interventions in the general education realm. Remember, IDEA is really specific to special education. But ESSA is really general, it's for all education, not special education. And so if we're supporting students, not in special education, then there are additional funding sources potentially, such as through grants from ESSA. And finally, what I think they felt like the largest outcome from this study is that therapists have a high level of interest in moving to a workload approach. Remember, 60% of therapists have tried and failed, and 20% have actually tried and made that switch to a workload model. That's 80% right there. And based on the high rate of therapists who have tried to make that shift, and were unsuccessful, they feel that more resources and training are needed to make that shift. And with that outcome, that is where I start to get really excited because I do see that happening, I do see the need to move from a caseload to a workload model. And I really have heard from you, the occupational therapist, that is working in your schools that you need help and that you want to make that shift. And so yeah, I'm just going to kind of forewarn you that the giveaway at the end of this and my announcement has something to do related to a caseload and workload shift. But before I get there, I do want to add that there were some limitations to this article. And the authors know that they pointed that out, they do have a limitation section, and the main flaw that they point out, and they knew it was that this was a researcher design study. And they knew that that could skew results. They did take measures to ensure the quality of the questions such as reaching out to colleagues before they sent it out to kind of have it proofread and check for understanding. But without using a standardized tool, there's always a question around validity and reliability. Likewise, they would like to see additional stakeholders such as parents, teachers, and administrators surveyed about similar topics, to compare that with the occupational therapist results. And now that brings us to my takeaways, which I'm kind of peppered a few in here and there. But I just first want to say I love what Seruya and Garfinkel have done here. There is something to be said about the perceptions of occupational therapists working in the schools, not just you know, how effective are we, but also what are our perceived notions about working in the schools. And what I'm hearing from all of you on Instagram and in my inbox is that you too are feeling overwhelmed by your caseload. And you want to know how you can change that you want to change and you want to know how to change. In fact, just this morning, I was messaging, an occupational therapist on Instagram. Hi, Alison, I know you listen to the podcast, and Alison and I were talking and she shared with me that she and nine other occupational therapy practitioners are responsible for more than 26 school districts and charter schools, herself has four different schools that she has to be a part of. Now four schools aren’t unheard of, but it's really difficult. I've worked at six different schools. Well, I had 12, we had two therapists, anyways, it's really hard to keep track of who everyone is, who the teachers are, who your kids are, even when you have so many schools that you're bouncing around from. And I think that by moving from a caseload approach to a workload approach, we'll start to see, you know, all that time that we spent driving, how can we decrease that time, all that time that we spend jumping around to an IEP, and then the therapist or sorry, not that therapist, the teacher or a parent isn't ready for that IEP, and we just wasted time. Now, a lot of that is changing, because we have zoom IEPs now. But still, there's a lot of things that go into a workload that just isn't accounted for in a caseload. And when you have a caseload consisting of four schools, six schools, one person 10 schools or more, that wears you down, and it's really hard to participate to your full extent, when you're trying to figure out what to do at four different school sites. I think there are two things that I can say here to kind of maybe help raise your spirits and the first is that you're not alone. 60% of therapists feel the same way according to this survey, they feel like they have too much on their plate. Remember, 55% of us can't even meet all the IEP minutes that we are responsible for every week for treatment minutes. So if you feel like you're struggling first and foremost, I want you to know that you're not alone. Right? We talked about earlier, 60% of therapists are feeling the same way according to this survey, we're feeling like we have more on our plate than we can manage. That's a lot. And 55% of us feel like we can't even meet the minutes that are required within our IEPs. That's a problem not just for us, but also for the district, as I mentioned earlier, right, the district has an obligation to meet whatever they are putting into the IEP. And if they don't, there are actual real significant outcomes that can come with that. And the districts can get penalized, right through either court or through funding, whatever it might be. So I do think that moving to a workload approach is actually a potential solution here. Likewise, another solution, I think, is that tiered intervention is something that we can provide to our schools that a lot of us are not yet providing. Only about 38% of therapists reported that they are using tiered intervention at their school, we're all using direct pullout, most of us are using pushing services. But very few of us are actually using a tiered intervention that could potentially prevent impairment or loss of function as Ida actually defines occupational therapy in Section 300, point 34, which can then potentially reduce the number of evaluations that we have to do and even lower our caseload, which ultimately, it doesn't necessarily lower our workload, but it allows us to put our time toward other aspects. Now, don't get me wrong, there will always be a need for individual occupational therapy services. I'm not saying that every student needs a push in occupational therapy service, there will be services that need to be in that pullout model. But we know that we can potentially help more kids through an MTSS model, and do that in less time than a pullout individual service. I really do wish that we had some sort of OT intervention research that showed how MTSS actually decreased the number of evaluations that were needed three years down the line or whatever it might be. Unfortunately, we don't have that maybe one of us listening out there, right now I myself can go back, get our doctorate or Ph.D. and do some research in that area. But it just isn't there. And, you know, RTI is picking up because there is research behind it. There's just not a lot of research related to RTI and occupational therapy. So that's one thing to keep in mind. And that brings me to my final takeaway, which is that we need to support each other in the shift from a caseload to a workload approach. I have been a little obsessed with Hamilton recently. And so the line that comes to my mind right now is that this is not a moment, it's a movement. And I think that's true. Right now we are seeing occupational therapists in the schools start to slowly move to that workload approach. And I think it's only going to compound and get more significant over time. And I really want to be there to support that. And that's why I am super excited today to announce that I am hosting a new course it is called Making the Shift: Caseload to Workload. And it really is a three-step process about helping you move from a caseload approach to a workload approach within your district, you yourself or you and your occupational therapy team will be able to go through this and I'm going to give you everything that you need in order to complete a time study to figure out what is going on with your time. And then analyze that and present it to your administrators in a way that hopefully, they can understand. Because we all know administrators think a little differently than we do as occupational therapists. And so I want to help you get into their brain a little bit, see what's important for them, and how we can come to some sort of an agreement that a workload approach is an approach that we need to move to in order to support our students, our teachers, our school and our community as a whole. Because it is not just for us, yes, it will benefit us as occupational therapists, but we want it to benefit everyone involved from the students all the way up to the superintendent of schools or even the county of education. We want to benefit everyone. I have been able to make the shift from a caseload approach to a workload approach. One and a half times in my career as a school-based OT. The first was for an entire small district though, I was able to move myself another occupational therapist and an occupational therapy assistant, we were all able to move to a workload approach and that allowed us to measure our time and it also allowed us to actually hire an additional occupational therapist when we were able to show that our time was really maxed out that we couldn't provide any more therapy service than where we were at. The other half-time. As I like to say that I did this was in my most recent occupational therapy job where I basically showed through a time study to my administrator, that I didn't have time to see all those students. And I was able to get help from a contractor. And then over time, we started to make more changes. Now, this was with an administrator who did not even want to hear the term workload. But through constant, I don't want to say pressuring or anything like that I didn't pressure. But I made my needs known through data, I use data to show that it was impossible to do my job. And by doing that, I was able to get the support that I needed. And that's why right now, I'm super excited to share that later this month in November of 2021, I am releasing my caseload to workload workshop making the shift. And I really just want to help you make that shift. There are so many of you out there that want to make the shift 60% have tried and have not been successful. Well, I want to take that 60% of you that want to do this, and I want to help you be successful. I want to help your district be successful. And so it is not quite ready yet. I will let you all know when it is. But right now, I want to give away access to the caseload to workload workshop for one lucky winner right now. And so all you have to do, yep, this is the giveaway point. If you fast-forward it, you're in the right spot. All you have to do is tag me in an Instagram story with you listening to this podcast. So either take a screenshot of your phone, or take a picture of your car with the OT School House podcast playing whatever it might be, and tag me in a story. And yeah, that's all you have to do. Just do that between now and Sunday, November 21. If it's November 22, or later, and you're just now hearing this, I'm so sorry. But I have to have an end to a giveaway at some point, right? It can't go on forever and ever and ever. So November 21 is the last day that you can enter to win the making the shift caseload to workload workshop by tagging me OT School House in an Instagram story. Okay, do that show me that you're listening to the OT School House podcast. And I will be happy to enter you in to be one of the potential winners for the giveaway. And with that, I'm going to say goodbye to episode 85 of the OT School House podcast. Thank you so much for being here. I always appreciate my time with you. Thank you for allowing me to be a part of your day. And I'm so excited to help you make the shift. Let's make the shift for the OTs make the shift for the students make the shift for the principal to teachers all the way up to the superintendent. Let's make that shift from a caseload model to a workload model to support everyone. I cannot thank you enough for listening. Have a great Thanksgiving. Have a great rest of your week. And I will see you back here for episode 86 Take care. Bye. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now head on over to otschoolhouse.com Until next time, class is dismissed. Jayson Davies Oh and one more thing if you just listen to this episode, and it is beyond November 2021. And you are super excited to make that shift from a caseload to a workload model. I want to help you go ahead and head on over to otschoolhouse.com/maketheshift to learn how you too can make the shift from a caseload to a workload model. See you over there. Bye 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, Thanks for visiting the podcast show notes! 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Press play below to listen to the OT School House Podcast Or click on your preferred podcast player link! In this episode, I am bringing on Meghan Fox, OTR/L, from Wootherapy.com to talk about her transition from providing primarily pull-out OT services, to a more collaborative service approach. Meghan shares with us why she decided to make the move and what those collaborative services look like. Also, she gets very real with us and shares what is (and is not) working during the transition. There will always be students who need pull-out services, but there will also be students who learn best from in-class, contextually relevant services. So let's talk about how we do that. Listen in for more and check out the show notes at otschoolhouse.com/episode85 Links to Show References: Wootherapy.com Get Meghan’s free Desk Check! Episode Transcript Download or read a rough edit of this OT School House Podcast episode Amazing Narrator Hello and welcome to the OT School House podcast, your source for school-based occupational therapy tips, interviews, and professional development. Now to get the conversation started, here is your host, Jayson Davies. Class is officially in session. Jayson Davies Hey there, welcome back to Episode 85 of the OT School House podcast. My name is Jayson Davies, thank you so much for being here with me today. Whether you're in your car, working out at the gym, wherever you might be. Thanks for joining in and listening to this episode of the OT School House podcast. Today we have joining us, Meghan Fox, she is an occupational therapist here in Southern California actually not too far from me. We'll talk about that during the episode. But yeah, I'm excited to have her many of you have probably already interacted in some form with Meghan on Instagram actually, that is her main platform where she does post under the name wootherapy. She is the brilliant mind behind wootherapy and the woo tape that she produces for her company wootherapy. We're not going to talk too much about the woo tape even though it is a fantastic product where you can actually it's taped that has handwriting lines on it. So you can rip off a piece of tape, add it to a piece of paper and you have a handwriting line. So we're not going to talk too much about that, you know, Meghan is just so humble, so kind. And we're not trying to sell anything, but I do want to mention it because it is such a great product. But what we are going to talk about today and I'm super excited, because we're going to be very open, very candid in this episode, and talk about how Meghan has started to shift from a pullout model of services more to a push in collaborative model service. And you know, this isn't something that happens overnight, you can't just flip a switch and turn all of your students from a pullout model into a pushing collaborative model. That's not how it works. But as you will hear from Meghan today, it does happen over time, and you can make a slow, steady shift, she is not to the point where she's at a full 100% of a collaboration pushing model. And you know what, she may never get there and that's okay. Most of us probably never will, because that wouldn't necessarily be ethical. Some kids do need a pullout model of service and that's okay. So without any further ado, let's go ahead and jump into my interview with Meghan Fox from wootherapy and talk about how she's making the shift from a pullout model to a collaborative model. I really do hope that you find our candid conversations really helpful within this interview. Hey, Meghan, welcome to the OT School House podcast. How are you doing this evening? Meghan Fox Hi, Jayson I am good. So happy to be here. I know. We have both been looking forward to this for a while. So excited to finally be on that OT School House. Jayson Davies Yeah, I'm really surprised it took us this long to get you on to the podcast. I mean, we've known each other for a little while. A few years now you live literally like, I mean if there wasn't hell in the way. Baseball? Not quite that far. But not that close. Yeah. But no, I'm so happy to have you here. I mean, you are the mastermind behind wootherapy and woo tape. Don't give me that. Look, you are a mastermind. You are awesome. Every OT, we are all awesome. So yeah, so we're going to talk a little bit about that. But first, I want to give you the opportunity to kind of share your story about how you fell into occupational therapy. And even more specifically, how you fell into school-based occupational therapy. Meghan Fox For sure. So I feel like I've heard this story a lot from other OTs I've heard on podcasts but it's so funny how it happens because I literally thought I was on the path to PT through college and then I get to my junior year and then they want me to take like quantum physics and like all these crazy science courses and I'm like, like pump the brakes, no not going there. And so it just kind of snowballed into talking to my advisor. What other you know, I've taken all these, I was a cornice major. So took all this human movement, all the anatomy physiology courses, like, what other realm or you know, road and path Should I go down? So she's like, oh, have you ever ever thought of occupational therapy? I'm like, No, what's that? Got more information? and funny story. She literally showed me the pamphlet of the top OT Schools and USC was on there. I'm like, I knew before college that I wanted to be out in California. So I'm like, Okay, done. Like, let's just put in the application. Hmm. Yeah, no, that's just another side story. But yeah, so that's kind of how I fell into it is, I wasn't up for taking all the coursework, not because I'm lazy, but just that wasn't my interest. If that wasn't my strength and my skill base come to find out and turns out occupational therapy is the most perfect fit for my creativity, my coping, you know, interaction with people. So, yeah, that's kind of how it happened. And then for as getting into school-based, so I ended up coming to USC, as you know, didn't even apply anywhere else should have, like, looked into it more, but I was kind of like one-track mind, I want to get out to California. So everything has worked out so far. But uh, so while I was there, I took the school-based course with Julie Bissell. And so which was great. And we've maintained a relationship still to this day. She's a great mentor to me. But what happened was, I did two years in a clinical-like sensory clinic on the west side of LA, and then decided I was going to move down to Orange County. So reached out to her for some, you know, I started applying for school-based jobs, and there was like, four available and I was like, What do you think of these? I, you know, I'm not so sure I'm familiar with these districts, and one was like, OCDE... Jayson Davies Orange County Department of Ed. Meghan Fox Yeah, sorry, jargon for those listeners don't know. And so she kind of steered me in a direction where she was collaborating with my current district to actually start an OT-PT department. They had been contracting for so many years, and not being able to keep reliable, consistent therapists in place for all the services that they were needing to provide. So she collaborated did the whole needs assessment, like, this is how many therapists you would need that this is what you would need to pay them, this is what some of your spaces should look like. And they bought, like all this equipment, it was really rad. She was very instrumental in developing our department, and then was very instrumental in helping me get the job because I didn't have any school-based experience. So she was kind of offering them, you know, my personal strengths. And, you know, so anyway, it worked out because, at the time, I think they hired in waves, and in my wave, they hired like, six, and I think I was the only one without school-based experience. So they really took a chance on me, which I'm grateful for. Because now being on some interview panels, it's like, oh, I don't know if I would take someone without experience and not disparage any listeners who are new to school-based or hoping to get into it. But it's, it's challenging. If you don't know, you know, you have to start somewhere. So obviously, Jayson Davies we actually do have a lot of people that listen to this podcast, specifically, because they think they're about to have an interview. And they know they need to learn some of the lingoes. And this is the perfect place for those people to be in my opinion, because we talked about IEPs. We talked about treatment. And we talked about the hard stuff about school-based OT, so I kind of want to lead you right into that you're kind of going there. But tell us about those first few years that first year, even in school-based OT what was it like and what did you learn? Meghan Fox Yeah, so I think I had an experience, unlike others, that I'm extremely grateful for. So because I didn't have any school-based experience, they placed me at two school sites where there was another therapist there. So we kind of I split the caseload at two sites, and another therapist was also there. So we overlapped at least one day where I could watch her treatment plan, I could watch her right IEPs, I think I sat in on a few IEPs that I wasn't a part of to understand, like, you know, kind of speak when spoken to like you know about you the areas that are relevant to you and just the dynamic of the team and how-to, we would have a lot of collaborative meetings with the whole IEP team prop you know, staffing is essentially before big meetings and stuff. So I got mentoring that I don't feel a lot of therapists get. And to me that made a lot of difference in my ability to then feel successful or confident to then keep going because I know school days can be grueling. For those that don't have any mentorship and they're just handed caseloads of 60 plus students, you know, plus, plus. So kind of piece of advice if you can, if there's anyone that you feel like you can trust or reach out to just say, hey, once a month, can I email you some questions and get some feedback, like any sort of opportunity to get some experience from someone else if you're new to school basis, kind of invaluable. Jayson Davies Yeah, and you know, I even found because I was in kind of that position at one point where there wasn't really any other OTs and I kind of reached out to other OTs that weren't in my district, but also to other speech therapists psychologists to, you know, they weren't OT they didn't know that side of it, potentially. But they knew about the IEP, and they knew how to get through tough IEPs and even a little bit that can help you with understanding IDEA and the laws specific to your state, just that kind of material that we don't get necessarily in school-based OT. What about actual therapy? You those first two years? What type of therapy did you actually provide? were you doing collaboration at that point? Or was it a lot of pullout pushing? What did that look like? Meghan Fox So it was a lot of pullouts because that's what I felt comfortable with. I didn't know the teachers, so I didn't know when was appropriate, or if it was okay for me to go into their classrooms. And, you know, it's taken many years for me there still find a rhythm with them, like, sometimes I'll schedule kids, and they're not even working remotely on something that's going to apply to my goals. And so it's just like an ebb and flow. And so yeah, those first few years, I was so comfortable with my clinical kind of experience. So I was pulling them into my room, like, so thankfully, I had a space where I could work with them. And I was kind of pulling a lot of that kind of treatment out and working handwriting in until all these different things. And I felt like I saw tons of progress. And at that time, because my district was transitioning from contracted therapists to district employed. Yeah, we saw, how do we put this kindly. We saw a lot of students getting services, maybe that didn't need the intensity, based on contractors aren't going to get paid unless they have students to service. And I'm saying, I'm trying to get it. Jayson Davies Yeah, no, no, let's have a conversation about that because I think it is a real conversation to be had. And I've seen it go both ways. You know, I've seen, I have worked with contracted therapists, I've been a contracted therapist. And personally, when I was a contracted therapist, the last thing I thought about was, I need to give this student more services so that I get more hours. However, that being said, when I was a contracted therapist, I was almost an in-house provider, because the entire every single person that worked at that district worked for the same contractor. And we were basically hourly employees at the school site. So it didn't matter whether or not we had 50 students on our caseload or 25 students on our caseload, for the most part, we were, it was like we were in the house. And I've seen other therapists too. I just don't think that they feel like they're personally doing that. But I can see maybe where people are independent contractors, they're their own business owners. And that does happen. And I could see that potentially being something that they think about, you know if I see the student three times a week, that's an extra two services to pick up as far as $50 an hour or whatever it might be. So I can see how that could work out. Meghan Fox Yeah. And so I think it was a combination of me just being really green and excited. And like, coming off that sensory type of intervention, that I saw a lot of progress. And then coupled with maybe the students were receiving more services than I thought. So I was able to just decrease the number of kids on my caseload because I felt like I was seeing progress where they were successful in their classroom environments. So So yeah, like I was saying a lot of, what I was doing at the time was pull out because I wasn't sure how to break the ice with the new teachers that, you know, I hadn't built a rapport with them. So a lot of them can be particular about other people coming into their classroom being more disruptive than helpful. So it took me a few years to find my groove with that, and, you know, build up the report. And it's hard for those that travel to different schools, there's not a lot of opportunities to really get to know the teachers on campus. So I would say if you are planted at a certain site, even if you're there for a full day, at the most and then you go somewhere else, do your best to go eat lunch in the lounge and be able to talk to teachers so that they can open up to you and feel comfortable letting you into their space. Jayson Davies Yeah, absolutely. I mean, it's hard when you're at, especially if you're at like more than three sites, you know, you're not at a single site for more than two days a week. I mean, some of us are at a site for half a day, a week, or even half a day, a month for some people who are more in rural areas. And that's tough. And you literally just don't have the ability to sit in the lunchroom and say hello to people. And when it comes to scheduling you, you can't even take into account what's going on in the classroom. Because you can only be there for half a day. And you have to see those six kids while you're there for half that day. And the half that you're there, they're not even doing language arts, and so you can't go in and look at handwriting because that's just not what's going on. So it's tricky. But like Meghan said, Yeah, anyway that we can work to build that rapport. And so Meghan, those first two years, you said most of it was pulled out, was it one time a week, once every other week, for the most part, was a spread out different frequencies, or what? Meghan Fox I had a lot of kids that started at two times 45. And those sessions seem to last forever. Not to mention, many of them were Gen Ed kids that were out of their classrooms for that huge chunk of time. And so obviously, it took me time to learn about like, Oh, well, yeah, I guess if they are with me, they are missing a huge part of academic instruction. And, like, that part seemed obvious, but I was just doing what was on the legal paperwork, like, "Okay, this is the services that I was inherited". So yeah, over time, you know, we evened out the service minutes, and everything seemed more appropriate. Yeah. Jayson Davies And you said earlier, you said sensory? Did you have some training in sensory? And is that primarily what you were doing with the students that you were pulling out? was some, were you in like a sensory-motor lab? Or is that just one of the many things that you... Meghan Fox Yeah, I mean, I am CIP certified and trained. So I did that at the previous job that I was at for two years, just more strategies like, for me, a lot of positive results come from having a good rapport with the student. And so if I'm bringing them in there and setting up some cool obstacle course, and like in this corner, you have found a word in the word search. And then you get all the way over here, and you have to write a sentence about the word, you have to remember it the whole way, like those type of motor learning strategies, but I wasn't in a sensory lab later, when I transferred schools I have, I'm on a site that has something more like that. But at this particular school, where I started, it was just kind of a closet, if you will make the best of it. Jayson Davies Right, do with what we have. Absolutely. All right, well, let's go ahead and move on because you kind of already started to allude to it, and as people know because they clicked on the button to press play. We're talking about collaboration today. And so you have been in the schools for a little while. Do you mind sharing exactly a round number for how long you've been? Meghan Fox On my 12? school year? Yeah. Jayson Davies Okay. So 12 years in the schools, and we talked about how it was very tough to start, or just I'll put it this way, you started off with a lot of pull out sessions, some as many as twice a week for 45 minutes, which, I'm sure there are some people out there listening, like their heads exploding twice, times 45 minutes, like why, but let's move forward to now 12 years later, what do your services look like a lot more now? Meghan Fox Yeah, so I do have a range of needs and ages. So I'd say it's typically anywhere from one times 30 to two times 30. And then quite a bit of consultation, which we can get into later. But so those needs and populations range from like a couple, mild mod SDC classrooms, special day classes that are that I say, preschool age, and then up through Gen Ed as well. I'm kind of going out of order if you look at the continuum of restriction, but I'm just going by like my two primary sites, and then, at another site, I have three moderate-severe classrooms that I work with a lot. And so, what was the question? Jayson Davies We're talking about kind of what your services are looking at these days, maybe in fact, you can even kind of just off the top of your head, what percentage would you say or pull out? What percentage is collaboration? And maybe what percentage is more than consulting? Meghan Fox Yeah, so I would say right now, probably 50% is probably still on a pullout model where they're really needing a lot of direct instruction about what they're learning. But more recently, in the past few weeks, we've transitioned to probably about 25 percent push-in service. So I mean, just today alone I was we have a student that's been having enrollment problems. So the teachers like just for a few sessions, can we see what not transitioning him down the hall will look like. So he can make the most out of his classroom needs and his OT session. And sure enough, it was great, you know, so then I did it for another student in there. And so it's just continuing to see the benefits of the student not having to generalize those, you know, those skills, so, so I'd say about 50%, pull out, still 25% push in, and that number is going up, as you know, the weeks have gone, and then about 25% consult. Jayson Davies Okay. And so I want to pause here, then when I get this question a lot, and I find a way to answer it. And I think there is a right answer to this. How do you answer the question when someone asks you what is the difference between pushing into the classroom and a consult. Meghan Fox So for me pushing really is that collaboration where a teacher and or another staff member that you know, a lot of the classrooms I'm in have aids, where they're working in the near vicinity of what I'm doing with the child, whether most of the time it's with what they're already doing as a whole or a small group, a lot of my special ed kids work in small groups, and we go from center to center, but, versus a consult, I typically will do outside of the school hours or when the child's not there. So they're not seeing what I'm doing with the child, the language I'm using with them, the types of prompting I'm giving them, I've just gotten so much feedback on how helpful that is, so that when I'm not in there during my one or two times a week, that they're really able to implement a lot of those strategies because we've had time to share them too. Whereas, you know, if a student doesn't have a consult on their IEP, in addition to their direct service, a lot of times, there's no time or opportunity to communicate what I've done to those teachers, with those teachers about what I've done with the students and their sessions. So, Jayson Davies absolutely. And how would you go about making a determination for a student to receive that push-in collaboration type of service? Oftentimes, we have students that are a pullout model, how do you make that switch? How do you decide, you know what I want to try seeing the student in the classroom, instead of in a pull-up model, Meghan Fox A couple of different scenarios Go on, where I'm like, Yeah, I think they're ready for that, or no, this needs to happen because I'm actually not getting the results that I'm hoping for during our one-to-one pull-out session. So the first would be that they've pretty much mastered the skills that I'm working on with them in a one-to-one setting. So for instance, say a kid has a goal where they'll write a few sentences, maintaining the spacing between their words, and they can do that when there's not a noisy environment. You know, I'm next to them. So I'm actually a visual cue for them of what's expected. And so they've mastered that, but I can't, I can't in good faith report on that goal as being met, if I don't see that goal met within the classroom consistently. Without me there, you know, samples and all that. So I really, that's like my first cue to, yeah, let's go push in. And let's find a time that works when you're working on writing skills, and show me that you can actually do this in the classroom. When you have your peers around you when the teacher is giving instruction. Maybe when the kid next to you is fidgeting in their desk, can you modulate and tune out all those extraneous things and still execute the skill? successfully? So Jayson Davies Yeah, I 100% agree with that. Man, I've got so much going in my mind. I like I want to ask you so many questions, I want to make sure I get to all of them, but also ask them in a logical sequence. So with that collaboration, now, let's go beyond that to the next step, which is consultation potentially that's less restrictive, right? Because you're no longer even working directly with a student. How do you make that determination from whether it's a student that's on a pullout model or a push-in model? How do you make that jump to the consultation? Meghan Fox Yeah, so that'll come after I've, you know, pretty much ensured that they've been successful in generalizing the skills. You know, there can be a range of skills, it doesn't have to just be handwriting, but that they're being successful in their classroom. They're accessing everything they need, fairly independently, every kid requires a few prompts here and there, right? So, and then at that point, a few things could happen where, you know, I just want to ensure for an, you know, another cycle of an IEP that that's the academics are going to increase in the demands are gonna get harder, can he keep up with that? Or she, whatever, sometimes a parent wants to keep it, you know, I wasn't willing to let go or, you know, a lot of things happen, you legally have to. And for us, we have to do an assessment to discharge, yeah, all those things. But I think it's the right thing to do to keep on as a consult, especially for the transition to a new classroom. So that teacher knows, what are all the supports, you know, they can be outlined in an IEP accommodation page. But what does that look like in real-time? Are those you know, if he requires maybe he required he or she requires a checklist of some sort? You know, is that checklist physically attached to the IEP? Is that kid going to remember after a whole summer, how to implement all those things, so I think it's a nice want to call it a safety net, but just a nice transition to ensure that they're successful all along the way. Jayson Davies Yeah, and you know, that's funny with the OT School House podcast, obviously, I hear from therapists from all over the country. And, you know, the pullout model is pretty straightforward, right? We have a goal, we pull the student out, we work with them on a scale, hopefully, we see it generalized back into the classroom. The Push-in model gets a little bit different. Some people just sit by the student, and it might look like you're almost doing a pull-up model but inside the classroom. Other people are more collaborative, they get the aid or the teacher involved, kind of like what you were talking about. But when it comes to consults, there's a lot of difficulty there that I hear from school-based OTs, and they're done completely differently. You know, some people have goals, other people's don't have that other people don't have to have goals within their schools and districts, maybe they're tagged on a goal, maybe they're not tagged on a goal and, and they're just kind of there to check-in. Sometimes there's a very outlined detailed not rule that they have to follow up a structure that they have to follow. And it might be you know, what, they're incorporating a sensory plan of some sort. And they're making sure that the teacher is able, to implement that sensory plan. So consults are, they change, they have a big variety, from what I, from what I hear from everyone. I personally like to use consults, it's kind of like what you're alluding to, I think, is to make sure that all the accommodations that are in place are actually working, because it's one thing to say, Hey, here's an accommodation, but who's going to introduce that accommodation, who's going to let the child know that they even have access to that accommodation, let alone how to actually use the accommodation. So that's where I think that, that the consult model really, really comes into play. I don't know if you want to add... Meghan Fox No, I was just gonna say, in our district, specifically, we, if we are linked on a goal, we have to be on a service box. So like, we can't just recommend a consultation, if we are part of the success and execution of a specific goal, then we need to be direct service. I mean, that can look like one times 30 per month, you know, whatever. But we should be having some face-to-face time with the child to ensure some success, not just with the teacher. And then the second thing I wanted to say is when we write a consult, it's my preference and my department's preference that you specify like not just say, "consultation between teacher and OT", but to expand on that and say, "What are you specifically consulting for?" Because, like, if it's for consistent pencil grasp and spacing between words, or whatever it is, so that when that I get it all the time, I've had five this year, kids who moved from out of district and you're just given a new IEP, that therapist needs to know. I mean, it's so helpful to know just exactly what they're going to be going in to do. It saves a lot of time, you know, trying to figure everything out. So Jayson Davies yeah, yeah, I'm on the same page with you with trying to almost over-explain on the IEP exactly what's going on. Because you really do want the therapist that that student might move to and we never know when a student is going to move when they move, it would be nice to be able to pick up that IEP and kind of see at least what the OT was thinking. So yeah, over-explain that a little bit. Meghan Fox We got to work together as OTs to like, lessen our workload, because, you know, just make things clear for each other. Got Your Back. Jayson Davies Yeah. Yeah, absolutely. You kind of mentioned a grid box versus not a grid box when it comes to consultations. versus regular services. I, some people will know what that means as far as the grid box. I think most people will kind of get it. But I want to explain that a little bit further and go beyond that, why would a consult beyond or not beyond the grid box? Meghan Fox Okay, so basically, it's just a way that we differentiate the services. So a lot of times, you know, I have a, I have a lot of kids with visual impairments. So we have a visual teacher for the visually impaired, she rarely gives direct service, but she will consult with anyone on the team about what the needs of that child are. So because she's not working directly with the child, that she is not deemed a service provider, which would require minutes to interact with the student. What does that mean? Jayson Davies So that would be if it's on the grid box, then it is a service that's outlined as weekly, monthly, yearly, whatever services are outlined on Meghan Fox With directly working with the student. Jayson Davies Okay, and so then if they're not on the grid, explain that, Meghan Fox then, you know, they just changed us a few years ago, but then you're basically on accommodation, but on our new IEP forms, whatever, there are three different breakdowns. So I used to, if I was proposing a consult, it would just be basically an accommodation to the student's IEP. And that's where it would go under the accommodations. Now it's kind of differentiated as personnel supports. So it is technically still just an accommodation. But there wouldn't be direct, really working with the student on anything, it would be supporting the teacher and the classroom needs and implementing the other accommodations. Does that make sense? Jayson Davies All right, so I'm going to get on my soapbox. Because I have strong feelings about this. Because from my experiences is if it's not on the grid if it's not direct service, A) it either gets lost or B), when the student goes to a new school, they don't, doesn't hold the same weight as being on the grid. And I've had both of those happen. I've had a student come in who kind of had OT, but it wasn't well explained like we were talking a moment ago about it was kind of on there's consult, but it didn't really define what the consult was. And therefore the special education department actually didn't even tell me about the student. And so I didn't find out about the student till later. And now I'm trying to figure out okay, well, what have I missed. So that was an instance where the kid actually came into our school district. But I've also just been completely forgotten about when it comes to IEPs because the student again is not on the grid, they have a consult. I have them down on my caseload, my workload document. But I don't learn about the IEP till the day of or three days after the IEP was held, because I'm not on the grid. And so it almost bothers me that we're not putting consults on the grid, and be it right or wrong. I put my consults on the grid now for that reason for those two reasons, because I don't want to be forgotten. And I will, I will somehow figure out how to attach OT to a goal to make it so that I'm on board. But yeah, I know it happens again, that kind of goes back to what we started with this down this road is consults get done differently everywhere. pullout services look pretty similar no matter where you go. Consults and collaborations, they get a little, they get a little dicey everywhere. But yeah, so sorry, soapbox. Meghan Fox No, I agree with you. I hate getting left off and getting an email in the 11th hour saying, oh, we're having this try next week. Like, excuse me, like, so I get that frustration completely. So yeah, I think it makes sense in my mind when I'm just doing it within my district. But getting a kid and it's not clear. I don't know why. I know we never case carriers. But why is it so hard for a case carrier to look at? Any person that has access to them on whatever computerized? Yeah, the thing that you use? Jayson Davies Yeah. Oh, blame the IEP. The IEP system, it's their fault. Meghan Fox All right. Jayson Davies All right. All right. Well, let's hone in on the collaboration because I know that's kind of you even alluded to it, that you're kind of moving toward a lot more collaboration. You're slowly moving kids over to collaboration sounds like I'm assuming those are kids that were pulled out, you're slowly moving them into a collaboration? Meghan Fox And especially those that I have twice a week. I love one of each, you know, like, one week, one day focus on really instructing the skills that we're working on and the second day, you know, so there's a nice ebb and flow to generalizing, and it's just not all of a sudden I'm, you know, showing up or expecting them to execute something that they've only done in on one to one settings. So Jayson Davies I think you just answered the question that I had earlier that I forgot to ask. So you'll do two services, one will be a pull-out and one will be a push-in. Is that what you're saying? Meghan Fox Yeah. Jayson Davies And do you Okay, so I have another question then is, is that on the grid as two separate services? Or is it one service twice a week, in the class or twice a week? Meghan Fox I, the way I write it is two times 30 minutes. And then in the notes saying push in, or pull out based on student needs. Jayson Davies Okay, gotcha. I've done it both ways in the past. I've done what you just said. And then I've also had people ask me to actually break it up. And so it'll be OT on there twice. Usually, I don't do twice a week, usually, it's every other week, but I'll put twice a month, push in twice a month pull out. But it looks the same as far as Meghan Fox There are people that are particular about how they want things outlined. And so it's clear to everyone. Jayson Davies Right, and by the way, there are so many differences, and literally the districts that I've worked in, and the districts that Meghan works in are literally like two cities over. And so you can hear the differences that we have going on between the districts that we've worked for, and we are so close geographically, and so that's just how different the world is when it comes to IEPs and how things work. So all right, back to collaborations, what has facilitated your move toward this collaborative approach? What are some things that either you've done? Have you done any trainings or other professional development? Or are you just reading learning more, or what is facilitating your move to this collaborative approach? Meghan Fox So it started more with my special ed teachers that were really on board and eager to know what I was doing in my sessions, and how that they could implement that in their classroom. And so it just seemed like the obvious thing to just be in there when they're doing those types of activities, or, you know, sometimes it was as simple as telling the teacher that the student needs left-handed scissors, it's like because they're just little things that we pick up on. And unless they're explicitly told about it, they continue to do things, they're a very certain specific way for years and years and years. So it started off with literally just because my room is so close to my preschool teacher, my preschool special ed classes. And so it's just so easy to hear her see what they're doing in there and want to jump in. And they're doing so many crafts-type things at that age level, that it's so relevant to what I would be doing in a pullout session anyways. So to give them language and demonstration on how I kind of also coach the kids through some of these things. It's been so helpful to them. So I started there, and I'm slowly working into the gen ed population. Jayson Davies Awesome. Awesome. So it started really, it's the preschool. Is that like an It's a special education only preschool? Meghan Fox It's a... Well, yeah, so it's district-run kids students are on IEP is, but it's cool because both so it's to pretty much the same class, they just divide the students and they have reverse mainstreaming. So we have neighborhood buddies that come into the classroom, a couple of days a week so that those students have peer models and exposure. And then you know, it's great for those neighborhood peers to be involved in supporting the special ed kids. So that's really great program. Yeah. Jayson Davies So how is it going with moving into more Gen Ed, with the gen ed teachers and Gen Ed Students? Meghan Fox It's going well, it's a lot easier to do, the younger they are because they're kinda want to say this. Jayson Davies I think it's honestly to me, it's because it's play-based, it's a lot more play-based activities going on. And it leads to occupational therapy, like the activities that they're doing are just so much more similar to the activities that we might traditionally do in a small group pool Meghan Fox And those foundational handwriting skills of Okay, you start your letters at the top like that, just counting and those things that need the repetition that maybe a kindergarten teacher with 30 kids, that's not she's repeating Johnny sit down or, Sam, stop playing with that, you know, rather than being able to focus on the letter formation and all those things that you want to get really solid in the beginning, but I think the challenge with moving as you get a job, it's, the kid is more embarrassed or to you know, have an extra adult next to them in class or, again, they flip their schedules all the time, so they're not always working on something that's going to be related to what I need to address. So then I feel like, Oh, well, that was kind of a bummer of a session that I, you know, I didn't get done what I wanted to with the student. So that's pretty much it. And so that's kind of where I do, like a lot of my booth therapy stuff is, I want to give teacher gen ed teachers little snippets, little micro size, easily digestible information on how the kids’ desk should be set up, or quick tips to adjust a grass, you know, those types of things where it's short, as the training, I think can be valuable. But a lot of the times, you know, it's more of, I guess you could do a volunteer one, but sometimes I've been asked to speak at like staff meetings, and some of the teachers are just checked out. And I don't feel like it's a valuable use of everyone's time if they don't want to be there receiving the information. Plus, if it's too much info, are they gonna even remember half of it to go back and implement it? So that's where I've just found small bite-sized pieces of content are easy for them to be like, Oh, that makes sense. I can go try that with this kid. I, you know, it sends up a little flag-like, Oh, I have a kit, I know exactly who I can use this for. So, yeah. Jayson Davies Gotcha. Okay, I found that training really works for me when I'm able to get to just like, the kindergarten team of teachers, or the first-grade team of teachers, where I can sit down with them during their planning time. And just ask them, Hey, what's going on in your classroom? How can I help? And just let them vent? Almost let them share with me, what are they having? What behaviors? What are they saying? What? What weird pencil grasp? are they seeing what I mean? Who's the kid or what kids are using scissors to cut toward their body or like, and it just leads to, they have a desire to learn about whatever you have to give them at that point? Because they're the ones bringing the concern to you. And they actually want to hear an answer. So that's really helped for me is actually just going in and talking to the three Kinder teachers or the three first grade teachers or whatever. I found that to work out. Meghan Fox Well, that makes a lot of sense. And I like that as well. Because now that you're mentioning it, this was the first year that I reached out to. So my one of my school that's pretty small, but there are only 200 teachers and I just my caseload was a little smaller to start off with there. That's where I have the preschooler. So that caseload will build over the course of the school year. So because I was lowering the beginning, I was like, hey, like, I was super excited to try a new handwriting screener. So I did it with the whole class and like, to just educate them on what really the expectation is for a kindergartener, and, you know, kindergarteners, when they first come in can be a hot mess, I have one of my own, so I can speak freely on that. I think the expectation that the kinder teachers sometimes have is what the end of the year is going to look like. And you know, you those kids have 180 days to make that progress. So within the first few weeks of school, yeah, it might look kind of bad, but the barometer for what they should know is only at about, I use the handwriting without tears screener, and then part of Miss Jamie OTs new handwriting screener, she has out just with a starting spot assessment. And the handwriting without tears screener says like, at the first benchmark, they should only be about 61%. So most of the students were meeting that, and so well, we'll see where they go. So I have collaborated in those smaller settings. But those larger training, I haven't found to be as effective as I would like, for the time I put into them. Jayson Davies Yeah, yeah, they do require more time. And yeah, you're, you're more likely, it's kind of like the whole person on the side of the freeway who needs help, you know, if there's only one person going by that one person is likely to pull over and work with that, or help that person that has a flat tire. But if just cars are going by, the odds of one person stopping are slim or so nil because they think someone else is going to stop. And I think that is kind of the same thing when it comes to large training if you're trying to help everyone. Plus, it's just really hard to give a first-grade teacher and a fifth-grade teacher the same information and expect them to find both find it helpful. So there's some I really do think that that the way to go about it is to be a little bit more specific. Maybe you can do even to grades, kinder first, second and third, but to break it down a little bit. Okay, so what have been, what are three things that you have had to learn in order to make these collaborations with teachers successful? Meghan Fox Okay, so the first one is what I do for, you know, the rapport, making sure that they understand you and respect you. And that's the number one, the number two is like you suggested going in and letting them vent, hear their concerns. Like, what's the point of spouting off all your knowledge, if it's not what they're looking for? So really listening to them? And then the third, to be effective follow-up, Jayson Davies I just came up with a random number, if you have Meghan Fox no following up after you provide your suggestion, like, did what I say work? Like, how long did you try to implement it? You know, how much support did the student require? So and if that didn't work, let's try something also offering other strategies. So that follow-up pieces is super important because it's kind of pointless to offer a strategy, or multiple suggestions if you're not going to bother going back to find out if they worked? Jayson Davies Yeah. In your eyes, what has been one of the top struggles for making this work? Meghan Fox I think mostly the willingness of some of the students, Jayson Davies oh, the students Meghan Fox that are aging up the ones that I'm like, yeah, it's time to, like, get off this IEP. But like I said, I can't do that in good faith, unless I know you can generalize the skill within your classroom. And so they're more resistant to having that additional adult sitting nearby them or any of their friends knowing that I'm particularly there for them. That's kind of a roadblock for me. Jayson Davies What age do you start to see that at? Meghan Fox starts in about third grade? Jayson Davies Okay. Meghan Fox Definitely fourth and fifth. Third, you can sort of get away with it. Jayson Davies And so how do you deal with that? Or how do I mean, you just kind of sorry, kid, we need to, we need to get to this, where do you compromise? Or how do you? How does that go for you? Meghan Fox I pull them out, you know, after the fact or on our next session, maybe we don't push in that time that he pulls up. I mean, I don't really see too much, I guess I kind of does. But if they're leaving the classroom for something special or specific, anyways, then their friends know that they're doing something else. But, you know, I'll just be real with them most of my gen Ed. So this is related to Gen Ed kids, mostly that I'm getting pushed back my special ed kids that they like having Yeah, they do. I know. It's nice to feel loved. But you know, I can be real with them. Because I'll just tell them what the expectation is like you do this, for me show your teachers and your parents all the hard work we've done like, this doesn't have to be hard. And I, I can get off your back sooner than later if you execute. So kind of putting it more back on them if they don't want this, this lady around. Jayson Davies So for those when you go into the classroom, are you specifically working directly with that student? Do you sit near them? Do you try and hover around the classrooms? to kind of make it a little less obvious? Or? And what does that look like? Meghan Fox I guess it depends on what the assignment is that they're working on, and how much direct oversight that they're requiring. But I am trying to pull back a little bit because I'm trying to see what they can do independently. So yeah, I don't need to be exactly next to them. But I need to make sure that, you know, they have the accommodations that I've trained them to use out and available and they're implementing them. You know, I'm hoping I don't have to provide cues for them to pay attention and those types of things or follow along with what step the teachers are on. So, yeah. Jayson Davies Yeah, that makes sense. I want to ask you about goals because we are talking about collaboration, when it comes to if you know, you're going to be collaborating with a teacher, for a student, whether it's Gen Ed or special education. Do you write more collaborative-based goals? Or are you writing separate goals? OT goals, per se? Meghan Fox I would be a huge fan of writing collaborative goals. I just, we're not there yet. With all the teachers, and for some reason it comes down to Okay, like even when we're just staffing like, Okay, well, what goals are you going to write? And I'm like, Well, what, what is the student need to be doing in the class that they're not doing? And how can I support that is how I try to approach it. Um, but yeah, at this point, um, unfortunately, I feel like many of us are still writing our own goals. And I don't necessarily know that's what or think that's what's best for the child. Because if the teacher is also on there, then it gives them some accountability, shared responsibility to, you know, be working on those things. And that's where that push and collaborative collaborative model comes in. Because then the progress and the generalization is going to be greater. Jayson Davies Yeah, no, I completely agree. And it's tough and within the same school, you know, you'll have maybe one teacher who's all up for collaborative goals. And then the other two teachers that you work with primarily are like, Nope, I don't want to do it. And it really comes back down to what you're talking about earlier, that rapport building, oftentimes, you know, it's, it's not that they're against it, it's just that they're kind of, we all get set in our ways, you know, and it's, it's easier to continue down the path that we're on than it is to make a change. And it takes time, and it's hard, and I'm sorry, what's that? Meghan Fox Well, I was sorry to interrupt you, but I feel like that they feel like it's more work for them, you know, like, well, I'm on an OT goal on it's like, No, no, no, this is what the student needs to be doing in class. Yes, it's something that I'm maybe more of the expert in if you want to call it that. But I think we need to work together for them to achieve it. So it's kind of how you reframe what you're looking for, and when goals come up. But I do have some teachers that really dig their heels in and have the separate goals and like, even when you go around in an IEP meeting, and they're like, okay, would you please report on the goal, and I'm like, Okay, here we go again. Jayson Davies I'm right there with you. Meghan Fox My goals were. So Jayson Davies Yeah, and I can't remember who originally started doing this that I caught on with, but it's starting to reframe the idea of you know, what, it's not an OT goal. It's not a speech goal. It's John's goal, it is John's goal. And I'd rather have, you know, five collaborative goals that are going to be addressed, no matter where the student is, than 15 goals, where three of them are going to be addressed only in OT three are only going to be addressed to speech, and then five are going to be addressed in the classroom, and another one's going to be addressed may be in the cafeteria, you know, like what's, we want to help the student make progress. And the only way to do that is to incorporate the goals everywhere, doesn't matter where they are, we all need to be working on similar goals. But we all come from different backgrounds, different expertise. And we have a different way of helping the student to achieve those goals. And if we're lucky, we can share that knowledge with each other, so that we can all make progress from each other's specialties. So yeah, yeah, I know, it can be tricky, but I do think it is the right thing to be doing. And I know a lot of OTs are working on it. And yeah, and just continue on with it. If you're writing collaborative goals, keep going. Meghan Fox Rock on props. Jayson Davies Making this just gave you all right. Well, Meghan, you know, thank you so much for all this information, collaboration consultations, a little bit, pull-out model. Earlier, you mentioned some like mini trainings, is that something that's coming along with wootherapy? Or how's what's going on with wootherapy these days? Meghan Fox Oh, wootherapy. So there's OT brain, you know, there's lots going on out there all the time. As we spoke about before, pre-recording, I don't have a ton of time these days. So I'm working on scheduling more with every time I do have a course in mind that would be for teachers specifically. That's in the like, pre-development stage. So I'm excited about that. But I cannot give you an idea of a launch date. Jayson Davies No worries, no worries. But tell us about what you do have. I know you've got some cool stuff going on? Meghan Fox Yes. So obviously, I think I'm most known for woo tape. And that is my little handwriting, adaptive handwriting tape that helps put visual boundaries anywhere a child is needing to produce handwriting that gives them pretty much I see such a difference just in the sizing and the placement and other take some training like regular paper to work on the proportions. But I see almost an immediate difference when a kid has provided the appropriate visual boundary. So I've just gotten so much joy, seeing direct results, hearing about them from everyone who's used it, I bring it into the classroom every time I'm there because they're typically working in like a science notebook or you know, a Venn diagram that has just no nothing. Just you know, some circles fill in all the blanks, and obviously the kids on our caseload that doesn't work for them. So I created it for my OT brain, but it's really a tool for I'm hoping every classroom because that's where it needs to be. I mean, I think any accommodation needs to be in any place. But the child is required to execute those skills. So at home in the classroom, in OT, I think those need to be consistent but yes, I think, woo tape belongs in every classroom. So I'm working to share that more with teachers. And every time what else do we have going on? I don't know writing some more blog posts and hanging out on Instagram. That's where you'll find me at woo therapy. And I'm kind of embarrassed to say I joined tik tok just today. Oh, I joined tik tok. So I'm gonna see how back Jayson Davies I saw your dance moves. I saw your pencil-breaking dance. Meghan Fox No, the crown break the crown the Jayson Davies crown breaking Yeah, sorry, crown breaking, you got to break those crowns into smaller pieces Meghan Fox every time. Jayson Davies Yes, and you know, I really do like the woo tape for the same reason you just mentioned because it's so easy just to give it to a teacher. And you know, it's like here, here's some tape, this is the tape that your kids need as the right size. And now you have three or four different sizes, three or four or four different sizes. You know, like, you know, kindergarteners, he needs a different size and second graders, but teachers are always giving kids papers that don't have lines on them. And they're expecting them to write and then they write really big because they don't have guidelines on the paper. And then the next thing you know, they ran out of space and well might give them some lines. Yes, so I 100% agree, you know, just handing it to the teacher and showing it one time, you just have to show it to them one time. And then they see Wow, how big of a difference it makes and how easy it is to get that big difference. And what's cool about it too, is that I'm sure the kids love it. I mean, they enjoy it. I mean, it kind of looks like a road. So I'm sure the boys absolutely love that. And then you just kind of put it on there. And they have something, to write on. So yeah. And I have to say thank you also, Meghan, because you actually sponsored the back-to-school conference and gave out 200 rolls of the tape to the first 200 people that signed up for the conference. And then you also gave some away. So thank you so much for that. Meghan Fox Absolutely. Jayson Davies Yeah, so you know what I think we're we talked a lot today, we talked a lot about what services have looked like in the past when you first got started. And we talked about the transition a little bit to collaboration, consultation, and some of the struggles and some of the things that that we have to keep in mind because we know that it's going to be a barrier to building that rapport, especially when we're not on the campus all the time. But it's so important to build that rapport. And so thank you so much for sharing all the wins all the difficulties, all the struggles, because they are real, and how to move forward. I really appreciate that. Meghan Fox Absolutely. And just one last thing, like, I know that I haven't so easy, I won't say easy. Our jobs are very difficult. But I have a lot of things in place that many of the listeners do not. So I want to be available to those who are in, you know, more rural communities or multiple schools. And if they have any questions on how to navigate some of this, please reach out to me at wootherapy on Instagram is or wootherapy@gmail.com. if it's a longer thing you want to email me about so just as a support to newer therapists or those looking to dive more into a collaborative model. So... Jayson Davies absolutely, yeah. And I will be sure to link to your social and your website on the show notes. So everyone will have access to that right there on the show notes. Oh, yes. One more thing. Go for it. No... Meghan Fox No, Okay, I want everyone to get this desk check. Because this is the easiest thing I meant to mention that I give to all my teachers. So if you're just looking for a way to support some teachers, I have this great PDF, it's just like, quick how-to arrange desks and everything like that, that I just it's a kind of an icebreaker, if you will, like you could put it in teachers mailboxes as a way to say, Hey, I'm available as a resource on your campus if you need something. These are some simple strategies to help your classroom and your kids attend the best. So it's just called desk check. We'll put that in the show notes. I'll send you the link, Jayson. That's a really easy way. Jayson Davies Perfect. Well, thank you, Meghan. It's been a pleasure. And yeah, take care. We'll see you soon. Meghan Fox You're welcome. Thanks. Jayson Davies Bye, everyone. Alright, everyone. Thank you so much for sticking around all the way through to hear what Megan had to say about moving from a push-in model to more of a collaborative model for those who it's appropriate for, you know, this isn't designed to be a one size fits all model or approach. You know, we need to still see kids in a pull-up model. We'll never get to that 100% because it wouldn't be ethical. But it is something that many kids will benefit from and so we should start using it a little bit more frequently. Thank you again to Meghan for coming to the show. I really appreciate having her on. I really appreciate all the candid conversations that she was open to having during this episode. Really appreciate it. Be sure to check her out at wootherapy.com And also check out the show notes for all the things that we talked about today. She had a little checklist that she mentioned, and we'll be sure to add that to the show notes. All right. Take care everyone. Have a great rest of your week, and I'll see you next time. Bye. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to otschoolhouse.com. Until next time, class is dismissed. 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, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast