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Press play below to listen to the podcast Or click on your preferred podcast player link! "Help! I was just assigned to a high school & I have no idea what to do!!" Ever had that thought before? It is not uncommon for me to receive an email with something like that in my inbox. Now, I am no specialist in providing OT in high schools, but just like you, I can read some articles and listen to others who have done it before to learn from them. In this episode, I am sharing my experiences from working at the high school level and also what I learned from two recent articles about OTs providing Post Secondary Transitional (PSTP) Services. Press play above to listen, or find it on your favorite podcast app. Links to Show References: Doris Pierce, Amy Spence, Lisa Sakemiller & Celeste Roberts (2021) School-based Transition Readiness Services for Adolescents with Disabilities, Journal of Occupational Therapy, Schools, & Early Intervention, 14:2, 207-224, DOI: 10.1080/19411243.2020.1835601 Pierce D, Sakemiller L, Spence A, LoBianco T. Effectiveness of Transition Readiness Interventions by School-Based Occupational Therapy Personnel. OTJR: Occupation, Participation, and Health. 2020;40(1):27-35. doi:10.1177/1539449219850129 Episode Transcript Download or read a rough edit of this OT School House Podcast episode Jayson Davies Hello, and welcome back to the OT School House podcast for Episode 84 today, so happy to have you here. My name is Jayson Davies and I am a school-based occupational therapist in Southern California. One of the most common questions that I get on social media refers to high school. So today we are going to do just that. We're going to talk about high school. And I'm not talking about, you know, my terrifying and also glorious days in high school, with marching band and animation class and Spanish, all those things that man I just couldn't do today, I couldn't remember half of that stuff. But we're gonna talk about occupational therapy in high schools, also in middle schools because that's kind of that transition period into high school. Traditionally, most occupational therapists work in elementary schools. But one day, we often get the call and say, Hey, you know what, we have services that need to be provided at the high school, and I need you to provide those services. And we look like a deer in the headlights we don't know what to do. And I do get questions on Instagram and in my email box about Hey, what do you do with high school students? What do I do with high school students? How do I support these students? What is educational for high school students, and maybe what about transition or planning, we did have an episode earlier about transition planning with a special guest? But I do want to go a little bit deeper than that. Because, well, I'm not a specialist in high school services, I have provided services at a high school for a total of about two years at two different high schools. That is my total experience within the 10 years that I've been a school-based occupational therapist. So I am by far not a specialist in that area. But just like you, I do have the ability to look up research to find articles to support what I can do. And so that's what we are going to do in today's episode, we are going to dive into a little bit of research. I actually have two articles today that we're going to be discussing. They're both from the same core researchers, but they have different not opinions, but differing visions. I should even say that they do have similar visions. It's the same research, but it's pulled two different ways. And so I want to share this with you because they not only looked at the quantitative data as to whether or not the students made progress and what they did. But they also looked at the other side, the qualitative side of the occupational therapist who provided that service, what their perceptions were, how they experience the services that they provided to students. So let's go ahead and cue the intro. And when we come back, we're going to talk about high school and even those older middle school kids as they transition from high school and out into the real world. So enjoy the music. Stay tuned, and I will be right back. Amazing Narrator Hello, and welcome to the OT School House podcast, your source for school-based occupational therapy, tips, interviews, and professional development. Now to get the conversation started. Here is your host, Jayson Davies. Class is officially in session. Jayson Davies All right. All right. All right. We are back like a Lincoln commercial from Matthew McConaughey. And we are ready to discuss High School and occupational therapy within the high school. I cannot believe I just use All right. All right, all right, in a podcast. Anyways, let's go ahead and get started. We have two articles that we are discussing today. The first is titled "School-based Transition Readiness Services for Adolescents with Disabilities", and the second is actually a very similar title, but it is the "Effectiveness of Transition Readiness Interventions by School-based Occupational Therapy Personnel". Both of these articles have the same primary researcher and the name of that researcher is Doris Pierce. And there are a few other researchers that collaborated with Doris on these articles. The first article is Doris Pierce, Amy Spence, Lisa Sakemiller, and Celeste Roberts. The second article is again, Doris Pierce, Lisa Sakemiller, and Amy Spence. But instead of one of the other therapists, we have Tony LoBianco that also helped out with that second article. These articles are relatively recent, they come from 2019 and 2021 of them come from the Journal of Occupational Therapy, Schools and Early Intervention and the other comes from the OTJ or Occupation, Participation and Health Journal. As I mentioned earlier, one of these is more of a quantitative article and the other is a qualitative article. The quantitative article looks to see if transitional services provided by an occupational therapist would be effective for students in high school, aged 14 to 16. The other article looked at that same exact that's same exact research, but from a different lens, they looked at a qualitative idea. And they actually spoke with the occupational therapist to see what their impact was and what their thoughts were about providing these services to transitional age students. And so we're going to talk a little bit about both, I am really hoping that I can eventually have doors or one of the other researchers on here to go more in-depth with these two articles. I think that'd be awesome. But for now, I really want to share with you what I learned from these articles, as well as some of my experiences from working in high school and how I participated as an OT within a high school setting. So I'm going to go ahead and actually start with sharing some of my experiences in high school. In fact, I don't think I've ever really had experiences in middle school, I've always done either elementary or high school. But with that said, my very first year as a school-based occupational therapist, and actually, as a contracted school-based occupational therapist, a high school was one of my assignments. And my goodness, I had no idea what to expect, and I had no idea what I was doing. Now looking back on that. I really did approach working with those students in high school. Well, actually, all my students at that time, from a very clinical based model, I had had volunteer experience in a clinic, I had also completed a level two build work at a CCS, which is a California Children's Services, which is very much a clinical model as well. And so when I got this job, I knew the thing to say, because people had coached me and what an IEP is. But, when it came to the treatment side of things, all I knew, was very much a clinical model. And I was very much working on performance skills as opposed to functional output for the students. In that sense, I would potentially go into the classroom and work on things like range of motion with students with severe disabilities and, and motor disorders. And I would work on simply pushing a button, but there was really no functional aspect to it. And I had no idea what I was doing. Fast forward about eight years, and I had another round of opportunities to work in high school, and man were things so different. Rather than working with them on the performance skills that they had probably been working on for 12, maybe as little as eight years with their occupational therapist, in K through eight, or even early intervention through eighth grade, I went a different route. I started to have conversations with the students with who I could have conversations, and ask them what was meaningful to them. What did they want to do after high school? How can I facilitate their ability to make that happen? The kids who were in RSP resource, and mostly in general education, for the most part of their day, really were able to tell me what their plans were after high school. And I was able to support that and support them in that opportunity. We talked about jobs, we talked about college, we talked about what might be needed in order to make those things happen. I had the opportunity to work with students that were both in that ninth grade through 12th grade, traditional high school age, but also students who were in post-high school classrooms from that 18 to 21-year-old range. And you know what, I found that they were so similar, especially those classrooms with students who had moderate to severe disabilities, they were no longer focusing on math skills, and history and science, they were now focusing on daily life skills and being able to eventually leave high school and be as independent as possible. And so you know what, that's what myself and my speech therapist that I worked with, there, really tried to do, rather than pulling students out to just working on some simple, meaningless handwriting that they might need to learn. We embedded ourselves into the classroom, where we could teach the aides, the teachers how to actually implement that in the classroom. Not only do we help the teachers and the aides, but we developed a rapport with every single student in that classroom. And they knew who we were. And as many of you know, especially if you have dealt with teenagers, maybe even teenagers of your own, that rapport is so important. They know when to call BS on you, right? And so you have to have that rapport with them. And you start to see where they are not functioning within their community, their community, is their classroom, the school, and the larger community, the city, the county, whatever it might be. And so that was how we saw our role was by helping them be a part of the community. So we got away from those performance tasks that they had been working on for so long with occupational therapy. And we really started to focus on how they can be independent at school and in the community. In regards to the term and idea of post-secondary transition planning or PSDP think I said that right? I had never even heard of this term when I had my first stint in high schools with students with disabilities and as an occupational therapist. I didn't know what a transition plan and I don't even remember hearing the word transition plan. When I was in that first, that first job, that was back in 2012-2013. Fast forward to 2000 and about 18-2019. At a new school asked to work at a high school, I definitely became more familiar with the transition plan. But never did anyone ever asked me to help out with it, I'd be in an IEP, and the teacher would kind of review what was on the transition plan what they had created for the transition plan. But it wasn't really something that I was included in. I guess I knew it existed. But I was not part of the transition plan is how I would best describe my role within the PSDP. So now I have done the research I have learned, and there is so much more that I believe we can do and that we should be doing. And it's really funny that we often are not included in a transition plan because ADL is is like one of the key points to a transition plan, making sure that students can actually live independently in their life skills. And if that's not OT, then I don't know what OT is, right. So I think it's almost comical that we are not embedded in that we should be. And that's going to bring us now back to our research articles that really share how we can and what we can do in order to be a part of that transition plan, and why OT being a part of the transition plan is truly effective. So let's go ahead and dive into a little bit about the articles. So Doris Pierce knew that IDEA mandated post-secondary transitional planning and services. But what they could not find was a lot of research, at least on the occupational therapy side, showing how OT is provided for these PSDP services and planning. And also whether or not that was effective, you know, if you have been in the high schools, you might know about the basics program or other programs that that teachers use in order to facilitate life skills and whatnot. But there isn't really anything out there for occupational therapists. And so they knew that IDEA use language similar to the language that we might use in our OTP at the board. You know, words and phrases like life skills, work skills, self-determination, are all words that are used within IDEA are phrases used within IDEA that we as occupational therapists know, that are meaningful in a patient's life or a student's life because that's what's in our occupational profile. We have research that shows that OT does help with life skills, work skills, and self-determination. And I know a lot of us to get frustrated by those who just think that we help people get jobs. But for these students who are in high school, looking to the future, that's exactly what we do for them. We use both occupations as a means and as an answer to help them to develop the skills that they need to be successful and whatever is meaningful to them, right? I get that we feel slighted when people think we just help people get jobs. But in a roundabout way, that is exactly what we do. And so Doris Pierce and the other researchers that were a part of this wanted to look into what a program might look like in the high school for Post Secondary Transition. And they also wanted to determine whether or not occupational therapy can be effective in helping students in their post-secondary transition planning. So what did they do then? Well, they found some OTs and they found some students and they got busy. They actually found 42 students to participate in this research study, along with 10, occupational therapists and four occupational therapy assistants. So a total of four Occupational Therapy - Occupational Therapy Assistant teams. Now, the students who were a part of this research study were adolescents with IEPs and disabilities who spent at least part of their day in general education. Surprisingly, the funding that they received required that the students did have some form of general education which was mandated by the state who helped to fund the study. They also required that the students had an IQ of 60 or greater. This led to them having a pretty diverse set of students. Some of the identified criteria on an IEP included Asperger's, autism, and learning disabilities. But no matter their identified disability on the IEP, they all spend at least part of their day within a general education classroom. So this is where things get a little interesting now because you know, when you're reading a journal article, you really want to know what the therapist actually did in order to see the progress that was made right? Well, that's not exactly what they did here. The researchers actually pointed out that they wanted this to be as realistic to occupational therapy in the schools as possible. So they actually didn't give the school-based occupational therapist a specific program, because they know that that's just not realistic for most school-based OTs, which I thought was absolutely amazing that they did that. And that they actually included that, because we all want to have this cookie-cutter program to implement. But that is not always the case. And so they actually specifically put it in the article that they didn't do that cookie-cutter program because they knew that therapists wouldn't be able to follow a cookie-cutter program. So instead, what they did was something more like what we might actually do. They had an annual meeting where the therapist got trained in some different ideas in different theories. And then they also had monthly meetings, like many of us also have with our OT team, if you have an OT team, or maybe you go into Facebook once a month to ask a question or whatever that might be. But they use monthly meetings, to then give more ideas, and to also collaborate and see what other therapists were doing, and get ideas and bounce those ideas off of each other, so that they could then use those ideas at their school. I found this very unique and really intriguing because that's what school-based OT actually looks like. It is not a perfect program. And even when we are given a program, we know that those programs don't typically go exactly as they say in the book, right, they have to be accommodated for and adapted in order to meet the needs of our students. So I really appreciated how they use this intervention. Now, because this was a post-secondary transitional planning and research project, they didn't use assessment tools that we might typically use, they weren't going to use the BOT, they weren't going to use the sensory processing measure, they weren't going to use the sipped, obviously, because the students are too old. But just because that was not what they were focusing on. So they ended up using two assessment tools that honestly I had never heard of. The first is the Scales of Independent Behavior Revised. And this was a self-report from the student. In most cases, they were able to get that self-report, although they did mention that in some instances, they had to get help from a teacher or a parent to fill that out. And the SIBR includes four scales, I guess you could call them the motor scale, the social interaction and communication scale, personal living skill, and community living skills. So that was the SIBR and actually, the SIBR had been used in the national longitudinal transition study, which is the largest national study for students going into the workforce from school, and that they use to track whether or not students with special needs are getting jobs at the same rates, which they're not, it's much lower as their typically developing peers. So they did use that same tool that was used in a very large study, which kind of shows that, you know, they, they're using something that is valid and reliable. The second tool that they use with the arcs, the ARCS self-determination scale, and was to assess self-determination, as it implies in the name of the assessment tool. So this was used, it wasn't something that had been used in the national longitudinal transition study, I don't believe, but it is something that gave them some information. Now, in the findings, they ended up finding that the arcs self-determination scale showed some improvement, but nothing that was significantly relevant during the course of the time. Now, something that I forgot to mention earlier is that students participated in this program for two full school years. So from August to June, and then August to June, again, the second year, they started right before they turned 15 for the most part right at 14. And they ended a little bit before they turned 16 because it was about an 18 month-long program. So now that you have that 18-month timeline from 14 to 15 and a half years in your head, let's talk a little bit about the SIBR results. On average students scored in a range that showed that they were at about a nine almost 10-year-old range at the onset of this research. So when they were about 14-14 and a half, they were scoring at the range of a nine to 10-year-old. By the end of the 18 months, almost two years of the study. They were now scoring at what a 14 and a quarter-year-old student would score. So they jumped up almost for almost five years, actually, in this time span of about a year and a half, almost two years. So while they were physically aged about 18 months, their scores on average on the SIBR increased so much that it was like they had gained more than four years of experience related to life skills. That's pretty awesome. That is showing that you know, these students who were on average behind, were able to make up ground by going through this program with occupational therapists. How cool is that? I think that deserves another Matthew McConaughey. All right, all right, all right. All right, for reals though I'm done with that. Anyways, that is really cool though. Doris Pierce and her team showed that therapy can make a huge difference. Over a course of about 18 months, they made almost four actually closer to five years worth of progress in the areas of motor skills, social interaction and communication, personal living, and community living, as shown on the scales of independent behavior revised, or the SIBR. Now, you may not be able to access the qualitative article, the school-based transitional readiness services for adolescents with disabilities article, because that is in the Journal of Occupational Therapy Schools and Early Intervention, which you don't get with your AOTA or NBCOT monthly or yearly dues. But you all should be able to get the other article, the more quantitative article which is titled, "Effectiveness of Transition Readiness Interventions by School-based Occupational Therapy Personnel", because that does come to us from the OTJR, Occupation Participation and Health Journal, which you do get access to if you are an AOTA member, so be sure to check that one out. And I do want to go just a little bit further because you're probably asking, you know, what did those OTs actually work on? From the qualitative article, we actually see that OTs spent a lot of time working on self-determination, groups and group projects, pre-vocational exploration, like what type of jobs are out there, and what jobs they might want. They also heavily relied on life skills, cooking was a big activity, because it was more easily graded than some of the other life skills. Social and communication skills were also a big area as studied organizational, and time management skills. Among those a few things that really stood out to me was the group projects, they really saw students as a group, not individually, they didn't meet with them individually for the actual assessment, and then also to kind of start to build that rapport. But they quickly turn those into groups. And they did long-term projects, these weren't just like, come to OT, we're going to do something for today. And the next week will be totally unrelated. Nothings were long-term. They had to plan this week, they had to plan next week. And then the week after that, they actually had to implement something. And then they had to go further. And further and further until they actually achieved whatever goals that they had actually set out for. The therapists were not the ones that were creating the long-term outcome goals for the students, the students were creating goals themselves. That's that self-determination, part, right? Teaching students that they can have their own ideas and their own goals that they are not just living to please the adults in their life, the therapist really wanted the students to have a sense of autonomy, and to understand their disability, and be aware of their strengths and their concerns and what they have access to as far as accommodations about the internet, how to use the internet to find things. But even going further than that, the students work together in some cases to create their own jobs. They actually created stores and collected money within the high school community, and then donated that money to a foundation, which they were actually then able to attend the foundation award ceremony and be recognized for their contribution. How awesome is that, that they had so much personal, personal investment into this and then also got to be rewarded for it. That is so much learning that can only be done through real occupations. We can't just work with a student one on one on an off-shoot day, I guess, you know, working on one skill, and then working on a new skill a week later and expecting that to make a change. These are real things real activities that the students are engaged in. And that I believe is what's leading to that such large impact that the research shows. So what can we do with this information? First and foremost, I would highly encourage you to go get access to at least one of these articles and read it for yourself. After that, you're going to take a time, take a moment to reflect on what your practice as a high school or even a middle school occupational therapist looks like and how you could potentially change things up over the next year or even two years. It does take time to change. But by reading this article and getting a piece of what is there, you can change the way that you are providing services to be more occupation-based to think about not just tomorrow with a student needs but think about what they need in four years, five years, six years, when they're no longer in school, perhaps. What is meaningful to that student trying to actually have conversations with students to determine what they want to do. Even high schoolers who give the most simple one-word basic answers when given a simple question, even they want to talk about themselves in a positive light, and they want to envision themselves outside of high school, they want to envision themselves succeeding in life. And so if you can give that opportunity to them to share with you what they want to do long term, you're going to learn so much about those students. I think another key aspect from this article that I learned is that groups are so important, and I knew this to some extent, but I think if you get that small group, as opposed to potentially even a whole classroom group, then within that small group, those students can really learn to, to learn from each other to feed off each other to help each other out. And that is then going to be shown to make difference when those students are in the larger picture. One of the things that they did within this, in this study, some of the therapists talked about talking about bullying and talking about social interactions. And, and at least one of the therapists actually uses video modeling. So, they recorded each other having social interactions, and then watch that back to see what they actually did when they were interacting with their peers. And they learned so much, you know, social communication is not all that you say, but also how you say it. And a lot of times you don't get to know what you're doing or what you're saying unless you listen back or look back on it. Trust me, I know from recording podcasts. But you know, that's just really awesome what they were able to do with this study, and I really cannot wait to see what they are able to do next. And Doris or anyone who was a part of this research, I would love to talk more to you about this. So please reach out if you're listening to this. Otherwise, everyone, I think we are done for today, I want to say thank you so much for listening to this. If you are a therapist that's about to start in high school or middle school, or maybe you've been in high school or middle school for a long period. I really hope that this does help. Please feel free to reach out to me on Instagram or via email at jayson@otschoolhouse.com and let me know what you think about this research. What did you learn from this research? And how might you make a difference in your provision of occupational therapy after hearing what we talked about today, I'd love to hear from you. So please, please, please go ahead and reach out anytime, anywhere. With that, I'm going to say goodbye to everyone. Take care and I will see you in Episode 85 of the OT School House podcast. Have a great rest of your week everyone 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. 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 podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 83 of the OT School House Podcast. In this episode, Jayson shares the difference between screenings and evaluations. Using AOTA documents, IDEA references, and court cases, we will discuss when it is and is not appropriate to use screenings in a school-based setting. We will also briefly discuss how to ensure that your using a top-down approach when completing evaluations. Links to Show References: Individuals with Disabilities Education Act, Subpart Occupational Therapy Practice Framework - 4th edition OT School House Evaluation Checklist Tereance D v. School Dist. of Philadelphia Learn more about the A-Z School-Based OT Course 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's your host, Jayson Davies. Class is officially in session. Jayson Davies Hey there and welcome to Episode 83 of the OT School House podcast. Thank you so much for being here. For anyone who has never listened to an episode of the OT School House podcast, maybe you just saw something on Facebook about evaluations and screenings, and you hit play. I just want to thank you so much for being here and also introduce myself. My name is Jayson Davies, and I am an Occupational Therapist in Southern California. I'm the host of this podcast, the OT School House podcast, and I've been practicing as a school-based OT for about nine years now. And well in this episode, I am just super excited to get into the three keys to school-based occupational therapy screenings and evaluations. That's what we are going to talk about today. How screenings are similar, how they are different from evaluations, and also when to use a screening versus an evaluation. So we're going to talk about what IDEA says we're going to talk a little bit about what AOTA says about screenings and evaluations. And then we're going to kind of bring it all together and talk about when to use which one and how they can impact your practice as an occupational therapist working in the schools. All right. So real quickly, usually, this is the moment in the podcast where I get to introduce our guests. But I'm going to take this opportunity since it's just me and you today to share a little bit about myself. I am a school-based occupational therapist as I mentioned in Southern California. And I do have experience as both a contracted occupational therapist and in-house or district employee occupational therapist. In fact, recently, I also had an opportunity to work as an online contracted therapist for a teletherapy company, which was very interesting, I must say, personally, my preference is to work within a school district. I just feel like you have a better connection with all the people involved. The kids, the teachers, the administrators, people up above you, the speech therapist, the other occupational therapist in the district, I just really appreciate that setting. I'm also the creator and owner of otschoolhouse.com and School House education LLC, which is kind of the overarching company that runs OT School House. So at OT School House, we provide professional development opportunities through this podcast their conferences, through recorded CEU or professional development opportunities. And you can learn all about that at otschoolhouse.com and by listening to this podcast, really, this is really a place for school-based OTs to come to learn to be heard, I really like to interact with you. And with every single person that listens to this podcast. If you've ever sent me an email, if you've ever sent me a direct message on Instagram or Facebook, you know that I get back to you. It may be a week or two. But I will get back to you. It's something that I just believe in that we all need to communicate and get in touch. So feel free to hop on Instagram, if you're not driving, and send me a quick message saying “hello, let me know you're listening to Episode 83”. And just that, you're enjoying this, that you appreciate this, and that you want to learn more, you can even drop a message in there and say, Hey, Jayson, I'm really trying to do this at work. I'd really love a podcast about whatever that is that you're working on, I will definitely try to get something in here for you. So if you're here today, listening to this podcast, you saw the title, maybe you just listened to every podcast no matter what the title is. But this particular title, maybe you saw it and it said evaluations and screenings. Well, you're probably just like me, your school-based OT practitioner who wants to do right by the children and the students you serve. And by that I mean, you want to know when should I do an evaluation? Or when should I do a screening? What's the difference between the two? You're right on, you're in the right place. You might also be wondering, you know, how can I make my life as a school-based occupational therapist easier? I've heard of people using screenings. I've heard of people using the evaluations. But sometimes it seems like a screening can be an evaluation or an evaluation is a screening. How does that make my life easier if I screen? Or how does it make my life more difficult if I screen? Well, we're going to talk about that in a little bit. Okay. So, today, we have three overarching key points that we're going to go over. And those three, I'm going to lay them out right here so you know what to expect are, why screening is not an evaluation, how to use screenings as a means to reduce unnecessary evaluations and actually help more students. So how you can help more students even though you're actually going to be evaluating fewer students. And also how to how to produce effective evaluations to support individual students, we're going to go over that just a little bit as well. So we're gonna start with what I think most of you are very familiar with. And that's OT evaluation, not everyone's screens. But I think everyone does occupational therapy evaluations in the schools. I'd like to share with you a direct quote from the Individuals with Disabilities Education Act, also known as IDEA. And well, this is talking about evaluation. So listen really quickly, each public agency must conduct a full and individual initial evaluation in accordance with other parts of IDEA before the initial provision of special education and related services to a child with a disability under this part. So basically, it's saying that we must conduct an evaluation, not screening and evaluation before the initial provision of special education and related services are provided. As an occupational therapist, we are a related service provider under IDEA. And so in order to provide a student with services, under an IEP as a related service, we must have an evaluation. If we are going to provide that service to the student, whether it be an individual or even a small group service, or even consultation on behalf of that specific student, we need to have an evaluation. The fourth and most recent edition of the occupational therapy practice framework published in Asia by AOTA, notes that the evaluation process is focused on finding out what the client wants and needs to do, determining what the client can do or has done, and identifying supports and barriers to health, well being and participation. Participation is the key word there because as school-based OTs, we are really focused on the student's ability to participate and access their curriculum. Within the Individuals with Disabilities Education Act, they don't break down different evaluations like what an OT evaluation should look like, versus a speech evaluation, versus a psychoeducational evaluation. But they do list out in Section 300.304, that we must use a variety of assessment tools and strategies to gather relevant functional, developmental and academic information about the child, including information provided by the parent, that is a key one information provided by the parent, I recently went through a due process. And well, I'm not gonna lie with you, I'm not perfect, I omitted getting parent information. I might have called the parent and left a voicemail, but I never actually got the information that I should have gotten. Usually, I sent home a questionnaire at the very minimum or a Google form in this case, to be honest, I can't remember if I sent it out, but I did not get that information back. And that was something that, fortunately for me, and never went to due process. But that would have been something that I would have had to potentially explain in that due process. So be sure that you do get some parent information. It also requires within IDEA that we use more than one tool to determine the need for services. So we can't just use observations, we can't just use that parent information, we need to use multiple tools, that could be an observation in addition to a standardized assessment tool, but you still need to be sure to get that parent information. And then also laid out in Section 300.304 is actually that we just need to be at the goal that is actually laid out in IDEA. I thought that was almost a little silly that it had to be mentioned there. But it is there that we have to be ethical. While AOTA and the OTPS occupational therapy practice framework don't necessarily mention using a top-down evaluation procedure. I think that's something that we all learned in OT school is kind of starting with that very general top theme that concerns overarching concern, and working our way down. And so that is the evaluation process that I use as well. And what that kind of looks like is starting with that student's occupational profile, getting a good picture of them, their strengths, and their concerns. And then from there branching down to the embedded observations to actually get into the classroom and see or translate almost, if what you were told or what you found out by doing a review of historical records and talking to the parent, if what they told you, you can actually see within the classroom happening from there, going down a little bit further then we can pull out this year. And do some structured observations and our standardized assessments in a controlled environment. You can also within that controlled environment, and actually in the classroom, if you want it to is try some relevant trials, if you have the opportunity, you can say, Hey, we still have a few weeks before the IEP or before that assessments do, let's see what happens if I give that student a pencil grip. Or if I put some Thera band around the chair, or if I try one of those other strategies that can be implemented, right within the classroom, that's okay. And that can go into your evaluation. And maybe at the end of your evaluation, you find that those trials that you completed are actually enough for the student as possible. After you do all of that the profile, the observations, the assessments, any trials that you want to do, then you have to be sure to include two more things, your interpretations. What does everything that you did actually mean? This is really where some reports, I see fall apart, and I've been guilty of that, too. You know, we can't just summarize our findings, we need to actually interpret our findings. What did it mean that the students scored below average on this assessment, but average on this assessment? How does that impact the student's ability to complete classroom activities, that is all part of the evaluation, and then at the end is when we can summarize that up. And even if your district wants you to provide a very specific or general recommendation, some districts even want you to add goals into your evaluation. Again, that's up to the district, it is not required. So I do actually have a tool and I want to offer this to you, you can head over to otschoolhouse.com/checklist. And you will get the checklist that I use during my evaluations. And this is something that just helps you control or not control, I guess it helps you ensure that you are using that top-down approach. If you go down the list in order, you will be completing a top-down evaluation. So that's going to wrap up our discussion on evaluations. But now I would like to take a moment to talk about screening. So let's go ahead and jump into that. Now I want to start off this section of the podcast with a very clear statement. screenings are not evaluations. This is another quote that comes from IDEA section 300.302. The screening of a student by a teacher or specialist to determine appropriate instructional strategies for curriculum implementation shall not be considered to be an evaluation for eligibility for special education or, and related services. So it's saying that screening is not appropriate in order to qualify a student for eligibility for special education and or related services. So it's not exactly identifying what screening is here. But it's saying that screening is not enough. It does say that screening is really for determining appropriate instructional strategies for curriculum and implementation and around about way, again, this is section 300.302. If you'd like to listen, or sorry, not listen, look it up for yourself in IDEA. So this is kind of how I break down evaluations versus screenings, and evaluation is individualized, right, you're going to only look at one student, when you do an evaluation, you're not going to see three students and give them all the bot at the same time. That's not what we do. An evaluation is always individualized. The evaluation also will have implications for an IEP team right? After you complete your evaluation, you're going to go in and you're going to give a report to that IEP team, you're going to let them know what the strengths for the student are, what the weaknesses for the student are. And also you're going to present goals and whether or not you recommend services. It's also 100% required before the provision of related services. And occupational therapy, as it relates to IDEA is a related service. Now there are ways to provide services as an occupational therapist without going through IDEA. And that's where the education or sorry, Every Student Succeeds Act of 2015 comes into play. And that's kind of where we're going to go with the screenings. But for this, if you're going to provide services to a specific student, you're going to need that evaluation. Now, on the flip side, screenings do not have to be individualized. You can maybe not the bot but you can use some tool and provide that screening to an entire classroom or an entire group of kids. It is not necessarily individualized. Screenings are also used to determine appropriate instructional strategies. Whereas the evaluation is used to determine related services and goals. Screenings are used to determine appropriate instructional strategies. Those instructional strategies could be put in place by yourself alongside the teacher, or you can provide the teacher with recommended instructional strategies. And that teacher can then carry out those strategies, you are not providing an individualized strategy, you're providing strategies for the entire instruction. And finally, you can probably already assume this, but screenings do not result in the provision of related services. So now, if screenings don't lead to services, then why would we screen right? As an occupational therapist, you were hired by special education to evaluate and treat students and to go to their IEP is to write goals to write progress on the report. That's what you were hired to do, right. But if you can't do screenings, I shouldn't say if you can't do screenings, because everyone can do screenings. But that's what you're hired for. And so what does it mean to make that shift over to screening and why would we want to do that? Well, that brings us to the second part of this podcast, where screenings as a means to reduce unnecessary evaluations. And to help more students, you may have heard the term RTI, RTI, or MTSS, these are all multi-tiered levels of systems that we put in place to support students before they need special education, and occupational therapy, as specialized instructional support personnel under the Every Student Succeeds Act of 2015. We can absolutely 100% partake in that RTI, which stands for response to instruction and intervention, RTI, or MTSS, which is multi sorry, got to make sure I get that right, multi-tiered support systems. We can participate in those different systems, whether they call it RTI, MTSS, or just multi tiered system. So just to break down RTI, a little bit, there are three tiers, you have tier one, which is strategies for all, a tier-one strategy would be something like, using appropriate posture, we know that's going to help every single person in the classroom, including the teacher, so if we can train teachers about posture, then they're going to translate that into their students, everyone's going to have better posture, therefore, they're going to have more success, or at least that's in theory, right? Well, maybe you provide those postural strategies, and I'm just using an example that doesn't have to be about posture. But maybe you do share these postural strategies with the teachers, the teachers, in turn, do share that with all of their students. Well, you just helped an entire school at that point. Maybe the more if you presented this at a district level? Well, now, say there's a group of students that don't quite or maybe the entire classroom, one of those three classrooms that you presented to, they still need a little bit more support. Well, that's when you get into a tier-two strategy, where you are really providing that it's not individualized, but it's more specific to that entire community of the classroom, the classroom as a community. So now maybe teacher number two comes back to you and says, you know, what, my students are still kind of fidgety. And, you know, it's just I need a little bit more, would you mind coming into my classroom, just observing the student as a whole, not one particular student, but just looking at the student as well, or looking at the community that is the classroom and providing some potential strategies that I could use. So that would be more of tier two, a tier two strategy under RTI or MTSS. Now, tier three is where we get a little bit closer to that line of what is individual services and what is still under that RTI, what's special education versus what is RTI? And some districts will even identify tier three as being a referral to special education. I don't think that's quite right. In my opinion, tier three is for students that are kind of on a student support team sometimes called an SST. It's almost like a mini IEP, except it's really just a consultation between the administrator, the teacher, the principal, and maybe yourself if you're involved. There's not going to be special education teachers involved at this point, but you can still come in and provide general strategies, not student-specific strategies, General strategies. Think about a teacher who's googling for students. is kicking legs on under the desk? sure that student is or that teacher is thinking about a particular student. But you don't need to know all the information in order to answer that Google question, right? You have some general strategies that may support that student without knowing any more about that student. Maybe the teacher tried the strategies that you gave to the entire district, that just the strategies that you gave to her as a classroom. But there are still, maybe two or three kids in her classroom that are still fidgeting without doing any evaluation. Again, you can provide some very general strategies. RTI, two, aims to prevent students from requiring special education through this tiered prevention. So by providing those tier-one strategies, we're helping the entire school, maybe even the entire district. at tier two, I like to think of it as helping either a specific grade level, maybe three teachers that are all third-grade teachers, or at the individual classroom level. When you get to tier three, you may be talking about an individual student, but you're still providing general strategies as opposed to student-specific strategies. So now, where do screenings fall into the whole RTI or MTSS process? Well, I kind of alluded to it a little bit earlier when I talked about tier two. And that's where I feel screenings can have the most impact when it comes to supporting classrooms and supporting students conducting a screening for an entire classroom. Remember, tier two would be an entire classroom, or maybe a group within a classroom, you can then lead to that collaborative intervention with that teacher. So let me lay out what that might look like. We'll get away from the postural example. And we're actually going to move now to a handwriting example, mostly because I feel like this is the area that it's easiest to transition to, to start screening and start that RTI process. It is something that all the teachers recognize us for, and therefore we can use that to start the process. So let's say you just provided some general handwriting strategies through an in-service for all of the kindergarteners and first-grade teachers. Well, now, teacher number two in the first grade comes to you and says, Hey, Mr. or Mrs. so and so I loved those strategies that you gave me, some of them are working. But there's still this going on, maybe it has to do with students writing, like literally on the line versus on top of the line, maybe she has several students that are writing letters. And they don't understand the big small talk, where you place letters either on the line to the top of the line, and so forth, right ground, grass, sky, and dirt letters type of thing. Well, now you can then work with that teacher and maybe set up a time for three weeks in a row where you can go in and co-teach that. And you can bring in your materials, you can bring in your sky grass, dirt, paper, 30 copies of it, and do it with all the students, as opposed to pulling out just that one student that might have a little bit of trouble with it. You also don't have to take the time to evaluate that one, maybe three students that are having trouble, you can go in and support the entire classroom. So odds are that first-grade teacher, especially if it's a kindergarten, kindergarten teacher, they are going to be working on some sort of handwriting. And maybe it's not directly handwriting, if it's in first grade, maybe they're working on sentences. But that doesn't mean that you still can't be a part of that lesson, and kind of focus on the actual act of handwriting while they're working on the act of the grammar of putting a sentence together per se. So that screening can then lead to some intervention within the classroom. Now that I've discussed a little bit about how that screening can help you, let's talk about the steps to a screening. There are three steps that I'm going to lay out here first, and the first one is to determine the need through teacher feedback. So obviously, in the example that I use about handwriting, the teacher came to you and she said or he said, Hey, I have some difficulties with my students writing on the line. Their kind of their G's are on top of the lines, their Q's are hanging down below the line, whatever it might be, that she's giving you or he's giving you some general feedback. Based upon that feedback, you're now going to go into the classroom and either observe the classroom from afar, you're not looking at any one child in specific but you are there to just observe the general setting. However, if you're going to be screening for handwriting concerns, it may actually be more beneficial for you to use a screening tool such as maybe the print tool or the etch, which is the evaluation tool for children's handwriting if I got that, right, etc, ah, and you can go in and it's not an evaluation, because you're going to give it to the entire class at once. The print tool is a pretty simple tool. However, if you want to go even more simple than that, you can have all the students copy a sentence and write a sentence on a piece of paper, they don't need to put their name on it, and they can turn it into you. Now you can look at those 30 papers or 25 papers, whatever it might be. And based upon those, you can develop an idea of what supports those students need, then that can lead to your intervention, which leads to number three, which is collaborating with the teacher to determine potential solutions. So, meet with the teacher after school that same day or that same week, at some point, and say, Hey, this is what I saw based upon your students turning in those papers to me. And you know, I don't know which student had these difficulties. But I saw about five students that had this going on, I saw a few students that had this going on, here's how I can support you, do you have any lessons coming up, where you're going to work on writing, is there a time that I can push in and work with you a little bit, I would love to teach you so that you can, in turn, continue to support them throughout the rest of the school year. So that is one of the potential outcomes of screening, maybe you do end up collaborating with the teacher. But there are also two other potential outcomes from a screening. One is very simple and is literally just providing strategies. Maybe you went in, you observe some postural instability, and you said, Hey, a few things that might work, I can provide you with these tools, and you can easily use them within your classroom. Or maybe I can provide you with some handouts that you can post up and explain to your kids once a week and remind them about postural stability and being able to touch the floor, or the ability to stand while doing work. Instead of sitting if they don't feel comfortable, whatever it might be, there are so many different options to there are so many different solutions to a number of difficulties, and you can work to provide that for your teacher. And then your teacher can implement that. The other potential outcome of screening is a referral. And I know some people will use a screening. And when I say people, some occupational therapists will use screening to determine if an evaluation is necessary. That is not what I'm saying here. By all means, and I will make this as clear as I can, you should not be screening an individual student. As soon as that student is told to you that there is a concern by name and you know that student by name, that is essentially them saying an evaluation is needed, the bar is very low when it comes to when a new evaluation is needed. The reason that I am so persistent on this about screening and not being an evaluation on vice versa. And not using screening as a way to determine whether or not you should complete an evaluation is because there have been lawsuits where that has turned out poorly, where someone completed a screening, but then did not do the evaluation based upon that screening. And so I'm going to share that lawsuit with you in just a few minutes. But I want to continue on first and kind of go through. It'll make more sense if we go through everything first and then go for that lawsuit. So bear with me. However, in the sense that I was talking about a screening where you are determining instructional strategies, there is the possibility that while you are screening the entire classroom, that you do see a student that you really believe needs a referral. And when that happens, you need to work within your school's guidelines for referring a student, you probably need to work with that general education teacher in order to refer that student. After all, it is really the general education teacher that has that concern. Or even if you're in a special education classroom, that special education teacher that has that concern, whether they have an IEP or not, you can still be a part of that referral process. Maybe you're in the classroom and you see a student that has no services at all, no IEP at all. But you see something that is concerning, you probably want to start with a psychoeducational evaluation, or perhaps a speech evaluation. Because those services are kind of the kickoff to special education. Speech can be a standalone service. Occupational Therapy, in most states, cannot be a standalone service. If you can be a standalone service, then maybe you could refer the student to yourself. However, you probably want to start with whatever your district has outlined. When it comes to referrals. The second example is if the student already does have an IEP, maybe the student already is identified as having an IEP and needing additional supports. Well, in that case, maybe you could go to the case carrier, and let them know what you saw and why you think the student may need a referral to yourself or to another special education provider. So to kind of summarize those three outcomes of a screening or the potential outcomes of screening, it could be as simple as providing strategies to a teacher, you may provide strategies and then also help in the implementation of those strategies through a collaboration or co-teaching model. Or you may also decide to submit a referral for a formal evaluation of a student. And again, work with the teacher to do that, it should not just come from you, you should have that discussion with the teacher to make that referral. Just like any occupational therapist, when there is research about something that we're discussing, I want to share it with you. And there are two sides to the research here because RTI MTSS tiered supports are relatively new as his screening when it comes to an occupational therapist, the SSA Every Student Succeeds Act that describes us as specialized instructional support personnel was only passed in 2015. There just isn't a lot of research. In fact, I couldn't find any research related to occupational therapists providing screenings within the school system and the effectiveness of doing that. However, there are many research studies out there about the effectiveness of handwriting programs for an entire classroom or for many at-risk kindergarteners, for instance, the journal club that we had just on episode 82 of the podcast, where Dr. Beth and Dr. Sheryl came on and described how they use the size matters handwriting program to assist several students, not just a single student who had an IEP, they saw all students or not all but a large group of students of kindergarteners that were at risk. At risk, not necessarily meaning that they had an IEP. In that case, it could be called a tier two intervention that the occupational therapists were seeing students not with an IEP, but in a group because of their concerns based upon a teacher screening. Beyond the research, I also have an actual court case that I'd like to share with you. And this is actually the court case titled Terrence Dee versus School District of Philadelphia, and it comes to us from 2008. So it is 12, almost 13 years ago, probably. But it does kind of explain why we need to be sure that we are using screening and an evaluation appropriately. Because if you use one when maybe you should have used the other than, well, it might come back to haunt you, like it did in this case. The lawyers for Terrence Dee argued and correctly I might add, they argued that Terrence actually was not fully evaluated by the occupational therapist, when the district said that they were completing an evaluation. Instead, they quoted that the Occupational Therapist performed only a cursory OT screen and failed entirely to assess tolerances need in the sensory area. Now I know everyone has their own opinion on sensory in the schools or whatnot. But if you say you're going to assess something, then you need to assess it. Or if there's an area of concern within that area of sensory, you need to assess it. Right. So what happened then, based upon those findings that the occupational therapists never fully evaluated, Terrance, well, turns out turns did eventually qualify for Occupational Therapy through a full evaluation at a later time, the court ruled that if any evaluation would have been conducted earlier, a full comprehensive evaluation rather than an "OT screening", then Terrance would have had occupational therapy services potentially for a much longer time and at an earlier period. So the Occupational Therapist did that cursory screen, it went to court at some point and well, the school district did actually lose that argument. And compensatory strategies were required to be provided. The lawsuit doesn't actually state that OT services were part of those compensatory services. But it also doesn't say what services were required. So I'm going to assume that OT was part of that based upon the outcome, however, I could potentially be wrong, so take that with a grain of salt. The court also found that the district actually violated the Americans with Disabilities Act by withholding public services because of this whole debacle for lack of a better term, I guess I can say. So with that, I think I gave you some evidence that shows Yes, we can be efficient within the RTI setting. I think I also shared with you some decent points as to why screening is not an evaluation. And I laid out a little bit about what an evaluation should look like and what screening should look like. Remember, you can get that checklist that I use at otschoolhouse.com/checklist. I'll also make sure I put a link to that in the show notes for this episode. But I just wanted to make sure that you have this overview of screenings versus evaluation and know the difference between the two. I think sometimes those words, those actions of screening versus an evaluation can get misused and confused. And a speech therapist might use one and you might use another and some people might kind of say, well, the speech therapist said screening, you said evaluation, but they sound the same. Well, now this can help you to identify maybe some common language to be used within your school, or even at your district. And you can also use this to share with your administrator the next time they ask you to do a screening and ask them to really define what they mean by screening. Are they really asking you for any evaluation? Or are they asking you to complete screening, all very important things that need to be identified within your role as an occupational therapist in the schools? Alright, well, that is going to wrap up our discussion on evaluations and screenings, when to use them when not to use them and how they can support you. Before I let you go, I do actually want to let you all in on. A lot of this information actually comes directly from my course, the A to Z school-based OT course, the A to Z school-based OT course really is the perfect course for anyone that is either currently or transitioning to a school-based occupational therapy job in the course we really start from scratch and work our way all the way up within the school-based OT realm. We start with understanding what school-based OT the role of school-based OT is in schools, we then move on to the referral process and RTI strategies that you can put in place. I even provide an entire slideshow for you to complete as an in-service for your teachers. I mean, I have a lot of resources in there, so be sure to check it out. From there, we actually talk about evaluations, I give you templates for evaluations. And then we go into actually dealing with IEPs, treatment planning, and even how to exit a student from occupational therapy. That is all included in the A to Z school-based OT course, which you can learn more about at otschoolhouse.com/A-Z. I will definitely put a link to that in the show notes as well. Until next time, take care, and yeah, just enjoy your week. 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

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 80 of the OT School House Podcast. We are kicking off the 2021-22 school year with the perfect topic - Ergonomics. For the better part of 18 months, many of us have been working from home and students have been learning from their couches, beds, & Kitchen table. If you are lucky, you have had a desk in your home to work from. Now, Most of us are heading back into the school buildings and that is going to be a big change on our bodies. So today I am bringing on School-Based OT and Ergonomic Specialist, Kirsten Beshay, to talk a little bit about how ergonomics has and will continue to impact us, the teachers in our schools, and the kids we serve. In this episode, we dive into both her experiences as an ergonomic specialist in the private sector as well as her experiences in the schools. Links to Show References: Kirsten.beshay.net/schoolergo Follow Kirsten on Instagram https://www.aota.org/Conference-Events/Backpack-Safety-Awareness-Day/Handouts.aspx REBA assessment RULA assessment Teaching from Home Ergo Brochure Learning from Home Ergo Brochure Article References: Jacobs, K. (Ed.). (2008) Ergonomics for therapists. Mosby Elsevier. American Occupational Therapy Association. (2020). 2019 workforce & salary survey. Fisher, T. (2019). Occupational therapy’s work and industry area of practice: Content in entry-level professional occupational therapy curricula: A survey. The Open Journal of Occupational Therapy, 7(4), 1-10. Guirado, Terry, Chambonnière, Camille, Chaput, Jean-Philippe, Metz, Lore, Thivel, David, & Duclos, Martine. (2021). Effects of classroom active desks on children and adolescents' physical activity, sedentary behavior, academic achievements and overall health: A systematic review. International Journal of Environmental Research and Public Health, 18(6), 2828. https://doi.org/10.3390/ijerph18062828 Sarafian, A. (2019). Educational participation for children 5-21 years. Systematic review of related literature from 2010 to 2017 [Critically Appraised Topic]. Bethesda, MD: American Occupational Therapy Association. United States Bureau of Labor Statistics. (2021a). Detailed event or exposure by selected natures [Data file]. Retrieved from https://www.bls.gov/iif/soii-data.htm United States Bureau of Labor Statistics. (2021b). Employment status of the civilian noninstitutional population, 1950 to date [Data file]. Retrieved from https://www.bls.gov/cps/tables.htm#annual Wong, C. W., Tsai, A., Jonas, J. B., Ohno-Matsui, K., Chen, J., Ang, M., & Ting, D. S. W. (2020). Digital screen time during COVID-19 pandemic: Risk for a further myopia boom? American Journal of Ophthalmology, 2020-07. https://doi.org/10.1016/j.ajo.2020.07.034 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's your host, Jayson Davies. Class is officially in session. Jayson Davies Hey there, welcome back for what I'm calling is the first episode of the 2021-2022 school year of the OT School House podcast. Thank you so much for joining me today. My name is Jayson Davies, and I am an occupational therapist down in Southern California. But I'm happy to be with you, wherever you are in the world listening today really appreciate you being here. Today, I wanted to have a podcast that really embodied the return to schools. Because right now, you know, some of you got back to school to the physical building at the end of the last school year or some part of last school year. For others of us, we're just going back in person this year. And so I really wanted something that would embody that. You know this is a start to a school year, like none other, there is just so much. I don't want to use the word controversy. But really, there is controversy about everything that's going on right now. And so we're gonna set that controversy aside, and we're going to talk about ergonomics today. And why I think ergonomics is the perfect topic for today is because like I said, we have people who have been learning from their couches, learning from their beds, learning from their home offices, whether you are an adult like you and I probably, or a kid, they've been learning from their bed, you've been maybe working from your bed or couch. And now we're all having to go back into work potentially. And that is going to be a big change in our own bodies. And so today I am bringing on Kirsten Beshay. She is a Doctor of occupational therapy. She studied at the University of Southern California, my own alma mater fight on football season is coming up for all you Trojans out there, and everyone else who's interested in football. And then she ended up getting her OTD at Boston University. And we'll actually talk a little bit about that, as we get started with this interview. She is an ergonomics specialist. And you know, she's actually pretty new to school-based OT. And so she's going to talk to us about ergonomics in school-based OT as well as ergonomics outside of school-based OT for any of you who have ever had an interest and what that might look like. So kick back, relax, put that phone away if you haven't already. And please enjoy this interview with Kirsten Beshay. Hey, Kirsten, welcome to the OT School House podcast. How are you doing today? Kirsten Beshay Hey, Jayson. I'm so happy to be here. I'm doing great. Jayson Davies Awesome. And you know what, I have to start with this because you just said you're going on a trip. And by the time people hear this, you will probably already be back. But tell us where are you going? Kirsten Beshay Yeah, I'm going to Egypt tomorrow. My husband was actually born and raised in Cairo. So we are going to see family. Jayson Davies Oh, wow. So it's not just for I mean, just have fun. I mean, it is to have fun, obviously. But it's also to see some family huh? Kirsten Beshay Yeah, yeah, I've done the pyramids before. I've been on the camel. So I think this one will be a pretty low-key family... family visit. Jayson Davies Not too much sightseeing. Just kind of taking easy eating some good food, I'm sure. Company... Kirsten Beshay Always about the food for me for sure. So yeah, I think that part will absolutely be a big piece of it. Jayson Davies That's awesome. Oh, man. I've never been to Egypt never been to. I mean, I've been to Europe. But that's about I've only been to Europe and Peru as far as outside of the country. Unless you count the Virgin Islands, but whatever. But yeah, that'll be a fun demo now to Egypt. And sounds like you've been there before. So that's gonna be one... Kirsten Beshay Once before. Yeah, I'm still relatively a newbie. But you know, I have a family of experts. I get the insider scoop. Jayson Davies There you go. That's always nice. Right doing some of the local stuff as opposed to some of the tourists. So very cool. Well, we are actually here to talk a lot about ergonomics today, you have done ergonomics, both in the schools, as well as outside of the schools. And we're going to talk all about that. But first, I want to give you an opportunity to share a little bit about yourself and your background as far as occupational therapy. Kirsten Beshay Yeah. So um, this is always kind of a fun question how people got into it. I graduated with my bachelor's degree in psychology and music. And I was initially thinking about studying cognitive psychology, maybe tried to get into a Ph. D program I applied to those, but it just kind of didn't work out. And so I graduated with my bachelor's degree and was like, Well, I don't have a plan now. Am I gonna do and my dad actually mentioned he'd read in US News and World Report that OT was like this up and coming great future job and I was like, Okay, dad, but I ended up shadowing, you know, all sorts of different OT settings to get a sense Because I read the description, and I had no idea what OT was. And then I shadowed and I still really didn't know what OT was because it was so varied. But I said, I think I could do any of these, these look fun. And so I'm in right now. That's kind of what drew me and it's so fun. I just love that we can like do different things on different days of the week that are so different but are still so tied together with our skillset. So I love it. Jayson Davies Absolutely. Man, I love the whole psychology behind when your parents tell you about something. It's like, nothing is ever good. When your parents tell you like your parents could tell you you won the lottery. And you're like, no, that's not I don't want the money. But that's funny. Well, I'm glad you ended up finding occupational therapy. And if I remember right, you are actually relatively new to school-based OT. Right? So how long have you been in OT? How long have you been in the schools? And yeah, we'll start there. Kirsten Beshay Yeah, so I have been an OT for six years now. I just finished my first school year as a school-based OT, and your podcast, I've gone through dozens and dozens of episodes, in this past year learning and growing, and it's been great. So thank you. Um, I also, of course, have been partly seeing kids with teletherapy for most of that time, you know, so I know everybody's a little different regionally, but most of my year has been spent doing that. So coming back for a year or two, and the in-person is, you know, I've done some, but it's gonna be another learning curve. So I guess that's just how it is for everybody right now. Anyway. Uh, yeah, Jayson Davies Yeah. And you know, if you've made it through the last 18 months of the school-based OT, I don't think it can get much more difficult than that. I mean, was teletherapy was tough. I don't know for you. But for me, it was tough. Kirsten Beshay Yeah, absolutely. I think in some ways, it was a lower bar for me because everyone was figuring it out. So people were very, I mean, I have a very supportive team. But I felt especially supportive because everyone kind of felt like we're starting from scratch. So it was Yeah, I learned a lot. I think that it was an interesting time to have witnessed, you know, to see everybody kind of figuring this out and banding together. So I'm glad I was I wouldn't say it was easy, but I think that I was a part of it in some ways. Jayson Davies Yeah. And in me, I mean, it doesn't matter. You could have been an occupational therapist in the schools for 20 years before last year, you were still struggling last year. So it doesn't matter where you were, the whole playing field just got leveled, like everyone was, unless you were already practicing in teletherapy online, you basically had to figure it out. So we were all transitioning right there with you. So you mentioned listening to the OT School House podcasts? What else helped make that school year a little bit easier? Did you have any other resources that were some go-to resources or any mentors? Kirsten Beshay Yeah, um, you know, I've been thinking about, I know, we'll get into my background and what else I've done a little bit, but I've been thinking about making the switch to school-based OT for a while. And I was really holding out to find like a supportive, like team lead or manager or, you know, a team that was going to be really supportive, because I was just going to have a lot of learning to do. So. It took me a little while to find it. But I think like my shout-out to Laura, OT lead, she has been super supportive. So I would definitely call her my mentor. I also have multiple friends that I graduated from USC with back in 2015, who have been very helpful and just, you know, a phone call away when I have questions. And then just digging through, you know, I mentioned the podcast, I bought the e-book of the AOTA school-based practice, textbook and went through a lot of that, and I gotta say, the Facebook groups for some of these pediatric school-based OT communities have just been absolutely wonderful. You know, like, any questions under the sun are probably all in there. And if not, I probably asked them, and it's just an amazing community. So all of those have been a huge help. Jayson Davies 100% Shout out to Laura, shout out to the 2015 USC grads. Whoo, you're doing great. I was a few years before that, but good job. And of course, all the Facebook groups. Yes. Very helpful. I love the Facebook groups. You know I wanted to start one for myself. But then I was like, why there are so many good ones out there already for pediatric in school-based OT And so yeah, I go on there to ask questions, answer questions. I'm there too. Alright, so let's jump into school-based OT and ergonomics. First, we'll start with ergonomics. How did you end up actually kind of getting into economics? You know, we talked about this a little bit in schools, like when we're in OT school, but how did you just kind of end up going full throttle into economics? Kirsten Beshay Yeah, you know, it was always something that I've been a little interested in when I was doing my I guess gap year after my bachelor's degree when I was taking anatomy at night, you know, getting my prerequisites for OT school, doing my shadowing. I was also attempting at a small kind of tech company in the bay area, which is where I live in Northern California. And the HR team there was always kind of very puzzled by what to do if someone had an injury and like, what, what keyboard should they get? Like, should they order a footrest, they just kind of like didn't really know where to go. And I think it was such a small company that it was just a question mark, no one really had a process set up for like how to find this stuff out. So I remember kind of thinking, I think that might be something that I might be able to figure out once I go to OT school. So it was like, kind of in the back of my mind. And then I took an elective in ergonomics at USC, which was really fun, and just kind of gave me a lot more of that information. We had a couple of guest lectures of OTs who were doing ergonomic consulting, so it just kind of planted the seeds. And yeah, I just think the whole time I got exposed to it. I just loved how preventative it was, you know, how you can spend like 20-30 minutes with someone one time and just make a world of difference. And you know, preventing an injury, hopefully, and you can be super creative. You know, a lot of times they're really low budgets for ergonomic services. And so you're not going to go out and get someone that $1,000 deaths, you got to kind of work with, you know, a stack of books and all those, you know, duct tapes and crazy stuff. Um, and it's, it's pretty unique. So that's kind of fun, too, is you know, not many people know that. Well, I shouldn't say many, but it's definitely a unique practice area for OTs. And I think it's a pretty well-kept great secret because it's a pretty low stress. The hours are very good. You know, I used to work in the hospitals too. And so I feel like there were some aspects, I was like, Oh, I feel like I can breathe a little easier in this type of mission. Jayson Davies That's funny that you mentioned the low-key ergonomics ways to fix things because I'm not gonna lie. Yesterday, I was on costco.com and Amazon and looking for one of them, the adjustable standup desks. And I got to the point where I'm even like measuring my office, I'm like, Alright, do I want the 48 inches, so 55, which is like ordering a DV. But then I'm like, I have to get rid of my other desk, which I already like. And then you get into the rabbit hole. It's like, Oh, well, you have the ones that can go on your desk and rise up. And then all yanking, I'm like, dude, I have OT textbooks on my desk that are raising up my monitors. For my kids back when phone books actually existed, you know, I tape up phone books with duct tape and put that under their feet, turn the trashcan on its side so they can put their feet on the trash can try and I mean anything right to kind of try and get them in a position where it's easier for them. So you're right. It's a little bit different than typical traditional per se, occupational therapy. But I can see how it could be a good, a good changeup. Kirsten Beshay Yeah, absolutely. Jayson Davies All right. Before we get too far, though, I do want to give you the opportunity, actually, just to make sure we're on the same page to kind of defined ergonomics, what it is. And sometimes the easiest way to answer this is just like, what is someone who has no idea what ergonomics is, and they ask you, what do you do? How do you explain that? Kirsten Beshay Yeah, I mean, you know, we're all used to that. Right? OT or is like, How do I explain this, but we're gonna have, it's kind of the same. I like there's a quote by Pheasant and Hargrave that I really like that says ergonomics is the science of work of the people who do it and the ways it is done, the tools and equipment they use, the places they work in, and the psychosocial aspects of the working situation. So I mean, obviously a very broad definition. But basically, we're looking at work in, of course, we'll get into this, but that might be you know, children's work might be getting an education. So it doesn't have to be an office setting. But someone doing work and looking at the social aspect, the physical aspect, the mental aspect, and kind of approaching the environment, approaching the person in the occupation, and tackling all of those to ensure that people are healthy, and we're promoting well being. So if that's still a little broad, you can really spend a lot of time doing office ergonomics where you might go into someone's desk, like what you're mentioning, you know, a home office, we're seeing a lot of those and suggest equipment, if it's not fitting them well, in a school, we'll dive into this, but you might look at furniture fit for your students. If someone's working in a factory, you know, standing at a conveyor belt, you might suggest task variation for them. Someone's in a wet lab, you know, you might suggest more automated pipetting equipment, so lots of different things, but the world is your oyster in terms of how you specifically approach that. Jayson Davies Yeah, and you're right that that definition of ergonomics was very, very broad. And one of the key terms or two key terms that you used in that definition was physical, which I think makes sense. We're all used to adapting to the physical environment when it comes to ergonomics. But you also use the term social adaptions, which I don't think of typically when I think of ergonomics. I don't know if you can elaborate on that a little bit more. Have you even really touched upon the social aspect? Kirsten Beshay Yeah, I think it's kind of that mental health piece is a bit too in my mind. So if I'm evaluating someone say, you know, in an office setting, and they are extremely stressed, you know, am I going to completely like, take that out of it and just look at the physical piece and say, Oh, your desk is too high, you know, obviously as OTs were, like, absolutely going to look at that, and I'm probably not going to provide mental health services for the long term. But it's, you know, there are recommendations, if I know, the company's HR department might, you know, have some resources and employee assistance program, you know, I might kind of put that in the kind of write up or depends on the situation. But you know, that or, you know, just co-worker interactions can also if you're sitting in an open office space, and the coworker next to you clips, their toenails in the middle of the day, and that really bother you. Maybe having a slightly further desk space will actually be conducive to your well-being at work. So just some random examples, but it really can look like a lot of different things. Jayson Davies No, that is a great example, then I hadn't thought of that. Because you're right, you can't. You mentioned the PEO model person, environment occupation. And, you know, I love that model. And that's absolutely true. What you're saying though because even though you might give someone a new chair or a new desk, that doesn't mean it's gonna fix the problem. If you don't address maybe some of the other issues. Like what you use the example use high stress Well, I mean, sitting or standing, if you have high stress, that's still going to impact your body one way or the other. So very important, at least consider it. Kirsten Beshay And I have to add, you'd mentioned like the sit-stand desk, which, you know, I like those, but I do find a lot of times people get that, and then they never stand. So there's the behavior aspect, within like, the individual person is like, you know, you'd like to have this but are you actually like, can we work on like a, like a timer, or reminder or some app that will help you remember what motivates you to stay on? So you know, all of those things that we as OTs are looking at with our clients are exactly the same in ergonomics. Jayson Davies That's funny. Yeah. But that's totally true. I mean, all the even the apps that we use on our phone to remind us about things, I mean, all of those once upon a time, were really accommodations, and now their everyday life to remind us to mean, something simple as brushing your teeth in the morning, just a reminder to brush your teeth or reminder to drink water. I mean, how many of us have a reminder every three hours to drink a glass of water? I mean, things that were accommodations, at some point are now just everyday life. And so teaching people how to use even something like their cell phone, which they have on them 24/7. That's one way you can do it. Kirsten Beshay Yeah, cool. Jayson Davies So, ergonomics, you've been an OT for about six years, but you've only been in those schools for about one year. What were you doing during those five years related to ergonomics? Kirsten Beshay Yeah, so I mentioned I had a brief stint working as an inpatient in a hospital. But most of my time for the past five years was spent as an ergonomic consultant for a tech company. So I was a contractor. But I have pretty integrated with the like ergonomics department actually, within environmental health and safety, which is a pretty common way that an ergonomics team or an ergonomic consultant might be integrated. Because you know, there is a safety, health and safety aspect to that. I'm currently also like per diem as an Ergo consultant. But during the bulk of my time, in those five years, I did a lot of office assessments. But I also did some lab assessments, both dry lab, which is more like electronics, and then wet lab, like, you know, I mentioned pipetting. They also had some industrial assessments, awesome kitchen spaces, which was fun, got to use some different standardized ergonomic assessments, and then provide a lot of one on one education, but also did some team education to kind of strike more preventatively. So since the pandemic started, thing, so things shifted a bit. So while I was doing more ergonomics day-to-day, in that role, I really was focusing on working from home. So that has been even outside of schools a big shift and that same creativity element, like working with what people have what space people have totally different than being in the office. So that's been really fun for me. Jayson Davies Wow. And so did you do any? I mean, you mentioned the per diem work and the consulting work. Did you do zoom calls with employees at all in like, look at their workspace at home? Kirsten Beshay Yes, I've been doing virtual evaluations, in various capacities for five years. So that wasn't a big switch for me, but seeing people at home, most of those people might have been, you know, in a different place than I was but in an office and now, I already I should say back at the start of the pandemic, especially people just, you know, in a hotel room that was 300 square feet and like trying to figure out how to work so it's scary. Yeah, just very different than anything I've seen before, which was really fun. And there are a lot of solutions that you can provide in those spaces, that just force you to be a little more creative, which I really like. So not I would say to anybody who has worked from home, you know, as a result of the pandemic, that it doesn't mean that you can't be comfortable, and there aren't solutions. But you might just have to put in a little more effort to kind of look around the house and see what you have. Jayson Davies So I think I might actually have this question later. But I'm gonna ask it now. Because we're kind of on the topic of your previous employment. How did you even come to find a job like this? Like, you know, it's really easy. I don't know you type in school-based OT jobs, and they come up? Do you type in occupational therapy ergonomic jobs on Google? Or how do you even find these? Kirsten Beshay Not at all. Yeah, it's totally different. And I think this is one of the big reasons that many OTs don't really know much about, you know how to how to get into this or what this might look like. Because I don't search for OT related things I search usually, like when I'm keeping an eye on indeed.com, which is where I usually look, I just searched the word ergonomic, or, or ergonomist, or ergonomic specialists, but usually just the word like ergonomic or even ergo. You'll have to sort through a lot, unfortunately, but it's not quite as clean-cut as OT positions where you need a license, because you actually don't need a specific license or background to work in ergonomics. So of course, some backgrounds are more helpful than others, like our background, and Kinesiology and posture and activity analysis, all of those things are great, but you might find people coming from a lot of different backgrounds. And so I actually, when I first got into it and was looking for jobs after I'd kind of been exposed to this, I just started searching on Indeed the word ergonomic. And I also had sent some messages on LinkedIn, like cold messages, very uncomfortable for me to send some messages to people in the Bay Area, who were either OTs or PTs who were doing who seemed to be doing ergonomics for tech companies, because, you know, being from the Bay Area, I was like, that would be so cool. What would that be like? And I just messaged them and said, How did you get into this, but I shadow you, no one really could let me shadow them by someone gave me a manager's email, and then I just kind of periodically would check in with this manager. And then that's kind of one of the times I emailed they had a position. And then that's how I ended up, you know, interviewing for the position that I had for almost five years. So it was a roundabout way. But you know, I would say don't be afraid to just kind of look around for someone who is doing that type of thing, if that's what you're interested in, and often people are happy to help you. But if not, you know, starting with that basic search is good too. Jayson Davies Yeah. Wow. So you mentioned OTs and PTs. Did you notice while you were in the field, any other professions that were kind of gravitating toward ergonomics type of jobs? or What did you see? Where is it just OTs and PTs really applying? Or what type of other positions did you see applying for this type of job? Kirsten Beshay You know, I would say OTs and PTs are actually less common, at least in my personal experience. I don't have any hard, hard data on that. But I actually consulted for install and per diem for a physical therapy company that does some ergonomic consulting. So they have a few OTs in the clinic, too. But they actually have a lot more therapy background people because you know, their primary focus is outpatient therapy. Yeah. But of the other people that I've kind of run into, I've seen a lot of people who come in with maybe an athletic training background, or I don't know bachelors in human resources or kinesiology, or it really, really can vary. I'm trying to think of who else but yeah, it really draws a variety of people who have some sort of interest in like health sciences or movement or engineering, I actually have also met a lot of people in, you know, at conferences and things who are like engineers who focus on like, the ergonomic side, but they might look more at design. But yeah, it's definitely a mix. And I think the fact that you don't explicitly need a certain background or certification also, is a little confusing at first, but I think that also makes us very well qualified because we do have such wonderful training and a lot of relevant aspects. Jayson Davies Yeah, whenever you don't need a license or certificate or something, it definitely opens up the possibilities for other people to apply. But you kind of started to allude to and so I want to go with it is during your interviews during your application processes, do you feel like having that OT degree, supported you and helps you to find a job potentially? Kirsten Beshay Yes, I was huge. They like communicated to me that it was a great background. I think the key thing when I'm talking to OTs who are interested in ergonomics, you know, as a consultant or something like that, outside of school, specifically, that job search term criteria being different as one thing, that's a hurdle. And the other hurdle is when you get an interview, when you're sending in your resume, I have a different resume for that type of work. That is basically it's the same experience, but I don't use our like OT lingo terms, I use terms that a layperson would understand, you know, who doesn't know the OT world. So it's still relevant, but it's slightly different. And same with interviews, I really try to use terms that make sense without talking about oh, you know, I saw, I don't know, just talking about caseload in the hospital didn't wouldn't really make sense to them. Yeah. So I think just thinking about vocabulary was was another big piece. Jayson Davies Gotcha. Those are two great tips for anyone looking for a job. Alright. That leads right into the next question I have is you talked about using different lingo. You know, if you're in an interview for Corporation, a tech Corporation, you're not going to throw out terms like IDA, IEP, like, those are out the window. Vestibular, probably, yeah, you're not gonna use those. But where did you learn this lingo for ergonomics? Did you go out and search for additional training outside of school? You did mention that you had an elective at USC about ergonomics, but I'm sure you've read books, went to conferences, maybe what have you done to further your education in that particular area? Kirsten Beshay Yeah, well, I would say first, like the be day-to-day, I think familiarizing myself with the standardized assessments that I got in the elective was, you know, a crucial piece in the beginning, but working with clients doing education, I need to use simple language anyway. So you know, I'm going out and like learning all the technical terms and things, I'm still going to do exactly the same way we do with like, you know, Family Education, you know, like, I'm really gonna think about the way I present it. So that said, I use the textbook ergonomics for therapists by Karen Jacobs, who was actually my, my academic advisor when I did my OTD, which was really wonderful because it gave me as a therapist, kind of a good perspective on ergonomics. AOTA also has a lot of school-based OT Ergo stuff and some ergonomic things in general. So that is a great resource. And depending on interest, I actually have a course for occupational therapists who want to work in Ergo. And I also will have a free school-based OT ergonomics webinar at some point in the fall. There are also some other online and in-person courses on ergonomic topics. So depending on you know, if you're interested in industrial ergonomics for factories, you know, there's something specific for that. So it kind of depends on what level you're looking for. Jayson Davies Yeah, and you know, we always have show notes, we'll be sure to link your website so that people can find that. The other resources you have, you mentioned, familiarizing yourself with a few assessments. You don't need to go into detail. But are there a few big ones that you would recommend anyone kind of look into if they're interested in this line? Kirsten Beshay Oh, that's a good question. I have just been kind of going through my list for the course. So they're all fresh in my mind. And it's really honestly hard to pick. So there are a few checklists out there that are pretty, pretty standard. And then there are also a few kinds of more standardized assessments. So one that I really like is the Rebbe rapid while I'm thinking of the robot, and the real, actually, anyway, there are a few, but there are a few kinds of one to the page, you kind of take a quick look at posture, and it gives you a score, the ruba and the real, I can send you those links. And those are freely available. And you know, as a school-based OT you might not actually be using those to assess children. But I think that might still be kind of a nice, just gateway into, like, what we're looking for. I mean, we look at posture all the time. So I don't think that's new for anyone. But it's kind of nice to see another aspect of that. Jayson Davies Yeah, absolutely. Great. Yeah, go ahead. And you can send me those resources at any time. And we will add it on here. You also mentioned your mentor, which Karen Jacobs, I love Karen Jacobs. And, Karen, if you are listening to this, let's do a podcast together sometime. If you're listening to gears on this podcast, you need to know that you and I need to jump on a call together into one of these because you just have so much knowledge to share. So I just kind of plugged that in real quick. But that's so awesome that you get to work with her. Did you meet her and start working with her as part of your OTD? Kirsten Beshay You know, I actually met her at the human factors and ergonomics society conference in October. And then I had kind of there weren't any OTs there. And so I had kind of found her on the brochure and was like, I gotta go to everything she's doing. And I went up to her at a poster and in five minutes she convinced me to do the Boston University OTD program, and she was my academic mentor, and she has such a wonderful background in school and ergonomics. So it was a perfect fit. So yes, she has been a huge support and developing that course as my OTD project. She was a huge advocate for that too. Jayson Davies Awesome. Yeah, she's a brilliant mind. She's always Go in. And I just Yeah, she's fantastic. So you mentioned you went there for your OTD. And it sounds like you actually did your OTD in relationship to ergonomics. What was that all about? Kirsten Beshay Yeah. So a lot of people as we kind of touched on earlier who are OT practitioners really don't know how to get started in ergonomics are really totally feel like they know what it is. We do have some questions about the licensing exam. But I think we spend a lot less time talking about ergonomics or at least terming things ergonomics that we look at, as I said, we look at posture all the time, and grasp and things like that, which are kind of overlapping and ergonomics and other areas. But I just felt like we have such a good background and activity analysis and knowledge of Kinesiology and creativity. So I thought that we are such a great fit. But it's strange that under 2% of OT practitioners are in that practice area. But I saw a statistic that about 69% wanted more information on the working industry is under so yes, and also musculoskeletal disorders were the most common non-fatal work-related injury in 2019. So it's just a huge scope, you know, like ergonomics gonna have such an impact. So I felt like we really needed more people, whether they're ergonomics consultants, or whether you know, we're in schools or in hospitals, like, they're aspects of ergonomics, and each, and I really felt like it was an opportunity for us as OT. So that's what led me to start developing that course. Jayson Davies That's awesome. Well, I'm excited. I think a lot of people are going to benefit from what you have to share with them, especially on ergonomics. So that's fantastic. And you said you're doing a webinar specific to school-based OT, so even better for our population at least. Kirsten Beshay Yes, that should be a one-hour webinar. So I will be condensing just the information that I think is most crucial. I won't have you go through all eight to 10 hours. Jayson Davies Yeah, that's cool. Very cool. So before we move on to how ergonomics relates to school-based OT, that's what we're going to get into for like the second you know, half of this episode, I want to ask you one more job as it relates to ergonomics outside of school-based OT and the job and, and all that and would you say it's a growing field, a shrinking field, a steady field? Do you think there's going to be a lot more opportunities for school-based OTs to use to get into this type of area? Kirsten Beshay Yeah. Are you thinking more like consultants? Jayson Davies Yeah, consultant or no? Do I don't even know big businesses? Do they hire their own person just to do ergonomics? Or is it mostly consulting work? Kirsten Beshay Yeah, that's a great question. The very, very large companies will have an internal team, I was at a very large company, as a contractor, and I was still a contractor. So even if you're part of like a team, that's just at one company, you might still be a contractor or a consultant, you might just, you know, have more hours there. But if, if it's not a really, really large company, it might be more of like a quarterly need, or they might want to have someone on hand if Oh, I think there's an issue here. So it depends. But all the need is absolutely there. And it's growing. I mean, especially with all of these changes in what work looks like with people just working from home with, you know, of course, none of us had much morning. And so I've seen a lot of discomfort coming from that. And I want to touch on that, in terms of us as school-based OTs too, because we have to think about ourselves and our own health and well being I'm sure there are people listening who have had some sort of discomfort or re come up of working from home on a laptop without much mourning. But yeah, in transitioning back to the office, things might start looking different. Some people might not be there, you know, people might be rotating desks, or people might be partly working from home. So I think there's a huge need. And as I said that, that musculoskeletal disorder incidence is so high. And we really, if you look at the data, we can save so much money by, you know, providing ergonomic services, whether it's preventative, or we're addressing something that's already going on if you make the case that the company can really save so much money in workers compensation costs, and it's a huge and growing field. So I think we have to kind of think a little bit about how we approach that and present that. So for new people, I found it easier to go with an existing company that had an opening for a consultant, but I think it's it's a wonderful thing to keep an eye on and I do touch on promoting ourselves and making the financial case for services in the course if that's something people are interested into. Jayson Davies Gotcha. You know, sorry, I just keep coming up with new questions. So we're gonna stay here a little bit longer and that is, so you are a consultant. You work for you said at the time or I don't know if it still is but for a physical therapy practice. The company is reaching out to the physical therapy practice asking for a consultant to come in to look at ergonomics. What are they really asking for... Do they even know what they're asking for? Are they saying we have a budget of you know, $20,000 and we want everyone to want to have nice ergonomic desks? Are they asking for one particular person you to come look at? What is that even? What is the referral per se? If we're going to use more OT terms? Kirsten Beshay Yeah, you know, I think you can look really different. And I'm not super privy to that specific company. But in general, I would say, it really, it can be kind of a one-off, or, oh, we've had a couple of injuries. And we're a little worried about this. So we want someone to kind of come and do a report and tell us, you know, what, we should change what equipment we should change, like, give us a list, here's our budget, and then we'll address it. So that could be one thing, I think there is gradually more and more knowledge about ergonomics on the company level, and so on. And sometimes it's seen as a perk, which fundamentally, I don't really believe it is, but it can feel like that, especially at these large tech companies. So I think that it's popular if you offer it, but also I do think that there's a sense that, you know, it will protect the employees and will hopefully save the company money. So I think sometimes you might be approached, or sometimes the consulting company might approach, you know, just companies and say, do you have anybody offering this service? Like this is how much money it might save? And then that might be how that relationship starts? Wow. So it can probably vary quite a bit. Jayson Davies Yeah, of course. I mean, and, you know, it's very different. Once you get out of the public sector of schools, you know, things are so much different once you get out of government-funded entities of any kind. I mean, they can really do anything they want. And so you've got Google wants one thing, Apple wants something completely different. And then any subsidiary of them on something else. So yeah, I can very definitely big time. Alright, so we're gonna kind of as much as I could probably ask you questions about the field of ergonomics outside of school-based OT. Obviously, most of the listeners that listen, to this podcast are school-based OTs, and they want to know, what they can do with their clients, how economics relates to school-based OT. And so I guess my first question is, is how do you feel like having that best knowledge and ergonomics has helped you as a school-based OT? Kirsten Beshay Yeah, so I mentioned posture a lot. So we all know that that's a piece of, you know, an overlapping piece, I would say, looking at grasp is also something that I feel that, you know, my background and ergonomics helps me to do is a little bit stating the obvious, but doing teletherapy I think computer usage, I like I'm very well equipped to look at, you know, what, what is my student using? What am I using that's working for me or not working for me? Specifically, how are my eyes doing? Am I straining them? You know, while I'm using all of these screens? Also, how is the furniture fitting, and you talked about using the trashcan, footrest, that type of thing, you know, like, is the chair too high? What can we do about that a lot of the furniture that we see in schools is just one size? And you know, that might, you know, we might not have, you know, kind of thought about what size that is, or it might obviously not fit every percentile of the student. Also looking at backpacks. I know AOTA has an annual Backpack Awareness Day that Karen Jacobs was very involved in the price. But I think as we come back to schools, especially, it's great to highlight because depending on what area you're in, and how much people are going back in my students, at least most of the year was virtual. And so we haven't thought about how much weight is in a backpack and how a backpack is fitting. And if we're using one from two years ago, it's probably not going to fit anymore. And then just movement, what the same kind of behavior modification, we were talking about what standing at the desk, I think, is a great thing to think about what students and we think about that. But we don't always realize that that's also ergonomic. So some of these things we're all doing. But I do think that having that background and doing it with adults for a long time, I do a lot of the same things with my students. Jayson Davies Yeah. And so over the past, we'll just say the last school year, what have been some very common things that you said to kids that two parents said to teachers, as a result of ergonomics, and kids learning from home, and obviously, people not being in the same room and learning. Kirsten Beshay Yeah, I mean, first off, it's been tough. You know, I think we all have kind of adapted our expectations a bit, you're not going to get like the cleanest, most straightforward therapy session all the time, you know, parents might or might not be able to be there. So, you know, we do the best we can. But I would say I mentioned computers, and that's such a crucial piece of ergonomics, both for us and for our students. And we've seen a huge increase in computer usage for school-aged students over the pandemic, not shocking to anyone, but we really don't know what the long term trends of that will be, especially as it relates to eye care, but also musculoskeletal disorders and posture and all of that. So I developed some handouts on computer usage. I know the human factors and ergonomics society has some too. We'll have some links in there, but you just kind of that basic knowledge of having a screen at eye level, if your students are on a laptop, maybe having a separate keyboard and mouse for them, that's more elbow height, and then fading the screen on some books just to have that basic, you know, looking straight ahead at the screen and also having your elbows kind of at 90 degrees while you're typing and mousing. If you can, I didn't always get there with my students, it's not, um, I know that a big push as some of my Schools has been to have everyone's faces on zoom, you know, to like be able to see the whole face and like actively participating. And for me, I absolutely cannot have my laptop screen angle that way over the course of the day. So personally, I would encourage students to angle it back a little bit more. So I can see the forehead, which is what all my junior highers love to do anyway, just show me the very top of their head, but to have it angled, so you're not looking down quite as hard at the screen, it's kind of coming to you a little bit more. And you know, I know this is diving a little bit into interoception. But also some of our students might not really be paying attention to is my neck aching from looking down all day. So we really have to, like walk them through How are you feeling with this position? So I would ask that a lot. Like, are you noticing your neck is sore? Are you noticing your wrists are sore? You know, do you feel like you're punching down? and usually, they say no, I feel fine. But you know, just kind of helping them walk through that. And that can help us catch any ergonomic risks that are there. I also would encourage having a dedicated space, although again, I definitely didn't have that with all my students. So you got to take what you can get. It's tough, but I think lots of parent collaboration and education, you know, sensory tips, a lot of self-feedback about the organization at home. And really just having a team effort was huge. I had a lot of teachers once I started giving handouts on ergonomics really coming to me with someone asked me specifically about eyestrain so that I made a handout on eyestrain to distribute. I ended up doing a little five-minute online video for the teachers on ergonomics so that they could protect themselves. So I think it really gave us some nice visibility into what OT can do. Apart from handwriting. Jayson Davies Exactly. Trying to get away from just being the handwriting teacher. No, I love that. I mean, I've got my setup here. And yeah, I had to, I've raised up my laptop a little bit. So it's not at eye level, but it's definitely a lot higher than what it would be if it's just sitting on the table. I've got my keyboard, my separate keyboard, and my separate mouse here. And my second monitor is on top of a textbook, will Willard inspections occupational therapy textbook. And so, no, I get that, you know, we're all trying to do that. With kids. It's been difficult. I mean, I've worked with a few sessions with kids. And it's like, they're at their dining room table learning. And I went as far with this student, I knew she was getting distracted, her teachers were telling me she's distracted all the time. And so I was like, Alright, well, no name, what is behind your computer screen. And oh my gosh, she turned around her computer screen, she was so nervous about doing it. And just the entire rest of the dining room table is just filled with toys. And luckily, the mom was kind of in the background listening. And so she was very open when I started because you know, mom has tried to do something. Let's go back to the conversation and think we had earlier about you know, dad tells you something, it means nothing, but someone else tells you something, right? And so the mom was very happy to hear me talk about, hey, we need to have separate areas for play and a separate area for learning. And I know that's not possible for everyone, especially learning at home. But when it is possible I that's huge, because she went from being super distracted in class to actually being able to get some work done. And all it was, was making sure that her toys stayed up in her room as opposed to down in her working area. So yeah, big aspect. Kirsten Beshay Absolutely. Jayson Davies Alright, so going back to your experience in a school-based OT, we have talked so much about ergonomics here. But obviously, you can't just be an ergonomic only occupational therapist in the schools, I like to say that we have to be, we have to know a little bit about everything. Because we could have a kid with autism one day kid with down syndrome the next minute, and we have to know a little bit about all of it. We can't specialize in one thing. And so, while I know you bring the ergonomic side to the table, I mean, I don't even know how to ask this question. I mean, you're not just an ergonomic therapist in the schools, you have to do everything, right. Kirsten Beshay Absolutely. Yes. So I have I do focus a lot on you know, kind of my individual students as I'm working with them one on one, but this is also a great tier one to think about it. I see that so that they make the point that it fits into what I'm doing with them, you know, so it's not I'm usually not doing justice ergonomics session. It's kind of integrated with other things that we're doing. I think also, you know, maybe plugging in self-feedback, if we're working on handwriting, and we're doing some self-feedback, or, you know, putting in a question about ergonomics there. There might be times where I spend the kind of a little bit more of one session, you know, checking in on how's your backpack weigh, you know, or how, you know, organization wise, you know, how many things are you putting in your backpack, and that might be more of like a monthly check-in or something like that. Or, you know, if we're working on typing, the first couple times of the year, we might focus on computer ergonomics, you know, talking through a little bit of that, because I do work with older students junior high in high school. And so talking through that, and then potentially, even if I have cell feedback for typing, maybe making get aware was the keyboard position, or it was I using the mouse or was using the trackpad or something like that. But most of the sessions I do integrate with other things. It's not exclusively ergonomics. I would also say that, if I'm doing an observation, I might spend a lot more time looking at ergonomics, then while I'm observing other things at the same time, yeah, especially you know, I mentioned backpack, so maybe looking at the fit of the backpack. Ideally, a backpack should have a maximum of up to 10% of a child's body weight. So I probably won't have a scale on hand, but I might get a good sense if I pick it up. And I'm like, this feels like 25 pounds, right? They're also observing, you know, if I'm observing, typing, or you know, like, anything like that in the classroom, I'm going to note the ergonomics of that. So are they reaching really far up the desk? Or the keyboard? Are they really are they on the laptop and their screen is just totally upright, and they're just cranking their neck down to look at it? Obviously, we all know to look for other feet dangling or they planted on the floor, is the chair way too big for them do we maybe need to throw a cushion on there is the desk height looking like it's you know, around their elbow height for typing or a little bit higher for writing, we'd look at playing board. So all that to say generally, it's not just an ergonomics day. But if I'm observing, I might spend a little more time thinking about that. Jayson Davies Yeah. And I've told this story many times too, as I've seen kids that are being scolded for moving in their seats. And I was literally watching the kid and the kid was trying to put their foot on the bottom of the table because that's all that they could reach like the, you know how they go down and they tee at the bottom, they were trying to put their feet on that tee because they couldn't reach the floor and got scolded because they were sitting at the edge of their desk because that's where they could actually reach the floor. And with that, this leads into the next question, because I know you do some training. And so in my experience, when I did that, you know, I wasn't gonna say anything to the teacher, right at the moment. I mean, first of all, I'm in there observing in the middle of the day, I'm not just going to go up to the teacher and say something, but I did leader, I sent an email and just then said, I didn't say any specific kid or anything, but just Hey, just so you know, some kids weren't able to reach the floor and went about it that way. How do you go about helping teachers when you see kids not necessarily, maybe not using the best posture not able to reach the seat? Or if you notice something in the classroom? How do you help the teachers? Kirsten Beshay Yeah, I love what you said about, you know, maybe sending an email out, especially if it's not for a specific student, that I think that's, you know, a pretty what's the word, I guess, non-aggressive, you know, it's not in the moment, it's later, so they have time to think about it. I think that's great. And, you know, offering to kind of maybe suggestions for Oh, it looks like a few kids have their feet dangling. You mentioned phone books, and how we never have those. But if there's like something similar that, you know, we can, we might think about having a few in the back of the rooms that you know, if anybody is noticing that, you know, kids can kind of pull same with like cushions and, and keyboards. And also I'd say the same in terms of breaks, which is something I think we do as OTs in schools think about a lot. But if I noticed that it looks like you're doing a little bit more of a stretch break, as opposed to kind of a break seated, doing something slightly different. You know, I might throw that in the email, too. If it's kind of a one-off, and I know that teacher well, I might say it in-person kind of right at the end. But I like to if there's something that I can offer as a resource at the same time, I like to do that. So I might wait until, you know, I have like a stretch handout or I can offer to you know, lead a stretch break, kind of see some of the different stretches. Yeah, that type of thing. Jayson Davies Yeah. And earlier, you mentioned a short, like five-minute training that you did was that for the teachers or for the kids, and how did that come about? Kirsten Beshay Yeah, you know, that's kind of a fun story. It was for the staff and not the students and people had kind of known when I joined this year that I had done ergonomics before. I think you know, it was just kind of the background that I shared when everybody's meeting each other on zoom because we did everything online at the beginning of the year. And so my team lead had asked me to do like a two minute or five minutes, ergo kind of working from home tips for our like staff meeting, you know, one of the first meetings of the year, so just a couple minutes. And then someone there said, Oh, can you maybe give us a handout? And so I made a handout. And then our Director of Special Ed was there. And she really liked it. And so then she said, Oh, wow, could you would you consider making a five to 10-minute video about working from home for everybody, and then our HR team could distribute it. So that's how I ended up doing a five-minute video of myself at my kitchen table with like sitting on a, you know, a couch pillow, and who has my laptop on a bunch of books, you haven't recorded that myself. And then that ended up being distributed to the entire regional team, which was very cool. Jayson Davies Wow, that is impressive. That's cool. And you're right, though, I just want to point out too, is that it is amazing. And I tell therapists in my course, I tell them all the time, one thing can turn into something much bigger. And like for you, it just started with the sound like it started with like a little one school just wanted a little bit, a few tips. And then it ended up and the whole district is now seeing your little video. And so start small, you don't need to change the world all at once. You can help one teacher, which may turn into two teachers, which may turn into an entire school, which may turn into an entire district. And you know, you don't have to start but you don't have to create a video for the entire district to start. Just start with one teacher. And you'll be surprised at how far that really can go. And it sounds like that's exactly what happened with you. Kirsten Beshay Definitely. That's Yeah, I mentioned one of the teachers later said, Oh, well, do you have anything for eye care? And I didn't. So I ended up, you know, a month later when I had some time making something. And then a couple of months later, that same teacher said, Oh, we've had a request from our school to have a presentation on executive function. Oh, what about the OT? And so I ended up co-presenting with the school psychologist. But I really think I probably wouldn't have been thought of first for that unless, you know, they had been like, Oh, well, she's done this. So that was a kind of cool visibility, an opportunity for me. Jayson Davies Yeah, yeah. And you know, the same exact thing happened to me, I presented for our three or four special education teachers at a school and the director of special education happened to be there. And then the next thing I knew she wanted us to present at a much larger meeting. And then you're presenting for paraprofessionals for teachers, for people that you would have never had the chance to introduce occupational therapy and what we can do unless you start with that, that first little thing, so very cool. All right, remind me again, you are now in the schools. Is it a public school, private school charter school? What is it? Kirsten Beshay Yes, thanks for asking. I didn't mention that earlier. So it's probably a little confusing. So I work for KIPP charter schools in Northern California. So it's, it's basically like, you know, a large district. So we have a few schools in San Jose, we have a few schools in Redwood City. Anyway, we're kind of distributed. I couldn't even tell you what the current number of schools is, they're always opening one or two more, but I do work for a charter school system, supporting junior high and high school students. And so I got five or six different schools and kind of do a variety of things. Jayson Davies And so in August, are you going to be returning in person for the most part? Kirsten Beshay As far as I know, right now, I think we're all kind of waiting to see with California what, what changes are happening? I think, for now, we're wearing masks. But you know, the school year hasn't really started. So I don't think I've heard too much official. Jayson Davies Yeah. Okay. And so do you think it's going to be fairly similar in your practice, when you obviously things are going to be in person when that happens, as opposed to online. But do you think your actual practice as an occupational therapist, other than just being on a computer is going to change very much? Or do you think is still going to be pretty similar? Kirsten Beshay You mean, in terms of like, what I'm doing... Jayson Davies Yeah, what you're actually doing? Kirsten Beshay Yeah, you know, when we did get to see some of our students in person, the second half of the school year, not everybody, but it was interesting, because some things I actually kept very much the same, some things I tried to change up. But of course, at that point, you know, some things run boxes, we didn't have all the equipment we would normally have. And so it was actually great because I really was a minimalist, you know, I was like, Okay, I got a piece, I got some printer paper, I've got some markers. This is what I know, I have today, I can do stuff with this. And I know some stretches. So I think it will be I'll have a lot more equipment. I mean, I had it available, but you know, I just really didn't want to have that much on my brain. So I wanted to start really simple, you know, do some, you know, bring in like one toy bring in, you know, one game. And so I think I'll probably be expanding a lot more the types of activities that I'm doing. But I do think that whether we end up having to do it virtually at some point in the future or not, you know, I think it's more there's more awareness about It now. And so having those, that ergonomic knowledge about computer skills, even if we're just working on typing with a student is going to be more and more of an important piece to have. Jayson Davies Absolutely. And you know, you're in a unique position, I didn't realize you're mostly with junior in high school, that's fairly unique. I feel like most of us occupational therapists, tend to at least have one elementary school. And typically, it's, you know, several elementary schools, maybe one junior and maybe one high school. But that's unique, that you're more in that upper grade. Have you had the chance to focus at all on working with kids and their actual cell phone devices? Because you're in that older? I know, a lot of kids now are using their cell phones to take pictures of notes or to even maybe use text to speech. Have you had that come up? Kirsten Beshay Yeah, you know, it's kind of funny, because I've been on campus less than I've been in school, it's possible that I'm not super up to date. But my understanding is that they don't allow cell phones, at least at the schools that were in person if I was there, during the day, unless, of course, there were a special need. So there have been instances where we've used an iPad or a laptop for some of those features, you know, like the PDF to print. I mean, I'm forgetting the names of all those apps where you can write on them. Yeah, but definitely, we definitely do a fair amount of focusing on that. And I know I spent a lot of time kind of talking about Grammarly. This year, we're talking about, you know, looking at reading and write and co-writer and like, which would be appropriate for which kid and word prediction and using the text to speech or sorry, the voice dictation feature on Google Docs and all of that. So I'm still definitely learning one of the other people on my team. It's kind of my go-to for assistive technology recommendations. But I think we do a fair amount of that with the older students for sure. Jayson Davies Gotcha. All right. Well, Kirsten, I want to say thank you so much for coming on the show sharing so much about ergonomics, both in the schools and outside of the schools really appreciate you coming on and just given us so much information about that. It's really awesome to see how things that you learn outside of the school-based world can kind of be brought into the school-based OT world and just make me an even better therapist through all that learning outside. Before I let you go. Are there any resources where people are, maybe not even resources, just where can people learn more about you? Do you have a website or Instagram or do you prefer to have people find you? Kirsten Beshay Yeah, so the best place is my website, which is kirstenbeshay.net/schoolergo, that's where I'm going to have information about my free one-hour webinar on ergonomics for schools, which should be out in the fall. So that's probably the best place to start. I'm also on LinkedIn. So all of that information will also I’m sure be up there at some point. So I'm sure this will be in the show notes. But I would say LinkedIn or that website are my best points of contact. Jayson Davies Sounds great. Well, thank you so much for coming to the show. Really appreciate you doing this. And I'm sure everyone out there listening has just learned so much from you today. So I really appreciate it. Kirsten Beshay Yeah, thank you. It's so much fun to be here. Jayson Davies Thank you. We'll have to catch up more once you got that course out. And I am looking forward. Looking forward to that webinar. That'll be a good one. So I will be checking out kirstenbeshay.net/schoolergo. And we will of course put the links to everything you just mentioned. And, and maybe even some of the resources you mentioned above in the show notes. With that, thank you. I really appreciate you being here. Kirsten Beshay Thanks for having me. Jayson Davies Take care. Bye. Kirsten Beshay Bye. Jayson Davies Thank you all again, so much for checking out the OT School House podcast. I really hope this episode with Kirsten really just opened your eyes to ergonomics and what OTs can do in the field of ergonomics. Even if you are working as a school-based occupational therapist, there is definitely something that you can look at in regards to ergonomics. And for some of you who might be looking to venture out of school-based OT know that there is something you can do out there with ergonomics. All right. With that take care. I really hope you enjoyed this episode and I will see you next time. Bye-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

Press play below to listen to the podcast Or click on your preferred podcast player link! Have you ever wondered if that handwriting intervention you provide is helpful? Or how about what that intervention in the research article actually looked like? In this episode of the OT School House Podcast, we are going beyond the article with the authors of the 2016 AJOT article titled Effectiveness of a Handwriting Intervention With At-Risk Kindergarteners. Join me, along with Sheryl Zylstra, DOT, MS, OTR/L & Beth Pfeiffer, PhD, OTR/L, BCP, as we dive deeper into this journal article that shows how a handwriting intervention can impact at-risk kindergarteners. Links to Show References: Guest(s): Sheryl Zylstra, DOT, MS, OTR/L Beth Pfeiffer, PhD, OTR/L, BCP Article: Title: Effectiveness of a Handwriting Intervention With At-Risk Kindergarteners Journal: AJOT Date Published: April 1, 2016 Full Citation: Sheryl Eckberg Zylstra, Beth Pfeiffer; Effectiveness of a Handwriting Intervention With At-Risk Kindergarteners. Am J Occup Ther 2016;70(3):7003220020. https://doi.org/10.5014/ajot.2016.018820 Additional Resources Hoy, M. M. P., Egan, M. Y., & Feder, K. P. (2011). A systematic review of interventions to improve handwriting. Canadian Journal of Occupational Therapy, 78, 13–25. http://dx.doi.org/10.2182/cjot.2011.78.1.3 [Article] Size Matters Handwriting Program 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, everyone and welcome to another episode of the OT School House podcast. Thank you so much for joining me today. My name is Jayson Davies and I am a School-based Occupational Therapist down in Southern California. But I love interacting here on the podcast with all of you, no matter where you are. We have international listeners. We have listeners from the UK, from Australia, and of course the United States of America, Canada. And I just love. I love knowing that you're out there listening gaining from this experience. But I also love hearing back from you, whether it be on Instagram, Facebook, or even an email at jayson@otschoolhouse.com. I really love hearing from all of you. So please, if you love this episode, let me know. You can also leave a comment down in the comments if you're listening on Apple Podcasts. Really appreciate any review that can be a five-star review, I would love that. But I'd love any review just as much helps me to grow. So, let's get into today's content. Today we have on Dr. Sheryl Zylstra and Dr. Beth Pfeiffer. Sheryl Zylstra is a school-based OT by trade. And she is actually the primary researcher on an article that we're going to be discussing today. And we are so lucky to have her on because she's going to be here talking about her article. We also have on Dr. Beth Pfeiffer who was actually the researcher, the academic behind the article, she helped Sheryl with making sure that everything was going according to plan on this article. And she's going to give us insight as well as Sheryl, on kind of what this whole experience will look like, as well as what we lead to what the outcomes lead to. And so I'm super excited to have both of these amazing occupational therapists on the show today to really give you an idea of how this, this research came together, what the outcomes were, and even maybe what you could do if you would like to dive into research yourself. At the very end, we talk about some of the barriers and facilitators to research and so be sure to stick around for that, as well as everything about the article that is titled "Effectiveness of a Handwriting Intervention with at-risk Kindergartens". This article was published back in 2016, in the American Journal of Occupational Therapists, and the researchers were Dr. Sheryl Zylstra and Dr. Beth Pfeiffer. So enjoy this interview with them talking about their article "Effectiveness of a Handwriting Intervention with at-risk Kindergarteners". Good morning, Beth. Good morning. Sheryl. How are you doing today? You know what, let's go ahead and start with Sheryl, I'll give you a chance to speak first. Sheryl Zylstra Oh, good. Thank you. Thank you for having me. I'm excited to talk about one of my favorite subjects. Jayson Davies Awesome. Yeah. And I'm excited to have you...excited to let you share your research. You know, there are so many school-based OTs out there. And it's hard to find time to read the research. So I'm happy to have you on here to share a little bit about what you did. And over to Beth, how are you doing this morning? Beth Pfeiffer I'm doing well. I'm delighted to be here with both of you today. Jayson Davies Well, thank you. I'm really happy to have both of you on. And we're going to talk about so much today. But first, I want to actually give you both the chance to kind of share a little bit about your OT career, how you got to where you are today. So Sheryl, would you like to go ahead and start? Sheryl Zylstra sure I've been an OT for over 30 years kind of stopped counting at 30. But the majority of it and pediatric practice but not all of it. And then the last six years or so I've been teaching full-time at the University of Puget Sound. Jayson Davies Awesome. And what about you Beth? Beth Pfeiffer I've been in OT for about 25 years, mostly in pediatric practice as well. I'm an associate professor in the Department of Health and Rehabilitation Sciences in the College of Public Health at Temple University. I've been there for about 15 years, most of my time there was spent directing a research lab. So I'm very invested in research, but I also try to keep my hand in clinical practice as well. And that's mostly school-based practice. Jayson Davies Awesome. We are so happy to have you here today. And you mentioned Temple University, correct? And that's outside of Philadelphia? Beth Pfeiffer Yes, it is. Jayson Davies Awesome. Okay. Beth Pfeiffer What else? Jayson Davies Yeah, in Philadelphia. Sorry. You're outside of Philadelphia. But the university is in Philadelphia. Beth Pfeiffer Yeah. Jayson Davies And sure. What about you? Where are you joining us from? Sheryl Zylstra I'm in Washington State near Tacoma, Washington. And I did my doctoral work at Temple University, which is how I met Beth and she was my faculty mentor there. Jayson Davies That makes so much sense now. It's like how do people from two different areas of the country come together and University and Graduate School research that tends to be one keyway so that's awesome that you guys had that opportunity to, to come together in that way. All right. So let's go ahead and jump into the research. That you conducted. Sheryl, it sounds like you did a big part of this research. But how was Beth instrumental in this? Sheryl Zylstra Yeah, great question. So this was my Doctoral Capstone, I wanted to do research. And I wanted to do something surrounding handwriting because that's an area that I'm very interested in. And when I got to Temple, I just started talking to Beth. And she gave me a lot of different ideas, and then really was integral in helping with the design of the project, I had a lot of lofty ideas about what I could do what we do in practice. And she would say, you know, that's great in practice, that sounds like a lot of fun, but we have to streamline it so that we can research it. So that's how that went. Jayson Davies Awesome. And so were you working in a school at that time when you started your doctorate? Sheryl Zylstra Yes, I was. I have almost 15 years of school-based practice. And so I was doing my Doctorate while I was working in the school, School District here in Washington. Jayson Davies Gotcha. All right, perfect. And so you said that you had an interest in handwriting? I mean, can you go a little bit further on that? Why handwriting? And then was there any particular part of handwriting that you're interested in? Sheryl Zylstra Yeah. So as an OT, I love working on handwriting. And I feel like it gets a little bit of a bad rap. And one thing that I've been reading about in recent years is really expanding our discussion of handwriting into talking about literacy. And when I work with children in handwriting, really, we're working on early literacy skills. And we're really promoting a variety of written language skills. And so I really encourage OTs to talk about handwriting in the broader sense of literacy. And one of the reasons I've really loved working in that area is because I see progress. I just see a lot of progress when I'm working with kids in that area. Jayson Davies Absolutely. And feel free to speak. And you know, you're right, we oftentimes are considered the handwriting therapist, the handwriting teacher, the handwriting something. And yes, we do want to have more roles at school-based OT, they really do think that OTs have so much more value to offer. But at the same time, I don't know. Did your research did you figure out what percentage of the day kids spent handwriting? I know that wasn't the whole point of your research, but it's got to be a large part, right? Sheryl Zylstra Yeah, it is. And it is in the research. It needs to be redone. But the most recent numbers set about 25% of the day for young kids. Jayson Davies So 25%? Sheryl Zylstra 25% of the day spit specifically spent handwriting for kindergarten first grade age students. Jayson Davies Wow. So a quarter of our of the child's day is spent basically with a pencil in their hand. That is an occupation itself, right? I mean, that is such an important part of a child's school day. So there is a good reason that we do focus on that handwriting. Definitely Believe me there. All right, well, I have never done any research. But one of the things I always value in a good article is the background information and the research review of the literature that we have to look up. Before we even really get started with our project. As you decided to look into handwriting, what are some of the things you discovered through your literature review? And actually, along with that, how did Beth help you with a literature review? Sheryl Zylstra Great questions, I learned so much from the literature review, there were two to three articles that really stuck out for me. And they were really new at the time. And the first article is Hoy et all. So let me see, it's Hoy Fetter. And I've got it here. It'll come to me in just a second. And they really looked at they did a systematic review of the literature, and really helped determine what works, what's evidence-based, and what isn't really working to improve handwriting outcomes. So that was huge for me because that really taught me that some things that I was doing, weren't necessarily shown to be helpful. Jayson Davies Gotcha. And so Beth, I want to actually yeah, I want to go ahead. And as I know, you weren't the primary researcher on this, but you help a lot of primary researchers. And so what are some of the tips that you give researchers, specifically Sheryl when it comes to that lit review? Beth Pfeiffer Well, Sheryl came in with such incredible experiences, she had this clinical background, and she had a real insight into what kind of questions should we be asking what should we be doing? And then my job is to come in and really narrow that focus because as clinicians, we think big and we think broad and we think very functionally. And then with research, you have to bring that to a specific question and methodology to be able to do that and, and look at that. So. So when looking at the literature, it does go back to what is your question? What are you trying to answer and how can you justify that and I think one of the things that really came out of this and why I really value this article quite a bit in the area of handwriting is because it makes that connection to really functional outcomes, it's not just about getting words down on paper, which I think is really important. That's not to diminish how important that is. And being able to read, those words and then information and to be able to demonstrate that you know the answer and you know the information. So it can be evaluated in a school setting. But there's also this link that was made. And I think Sheryl did a great job of connecting that to the literacy component that she's talking about these pre-reading skills. Not a lot of people really understand that relationship and how substantial it is. So if you take 25% of the time looking at actually physically handwriting in the classroom, but how much more time is spent reading and learning how to read, and being able to obtain information through reading. So that's another big aspect of this. And I feel like that literature review really highlighted that and identified the importance of it. Jayson Davies Wow. And Sheryl, were you able to find actually a number that of the literacy component of the day? You said its 25% was spent in handwriting? Was there also a number for that? If not, no worries, I just wanted to throw it out there. Sheryl Zylstra Yeah, I don't have that number. But what I do know is that researchers are talking a lot about how handwriting itself is being de-emphasized. Because the Common Core is so focused on reading. And so students aren't being taught, specifically taught how to write the same way that they used to be taught. And but if we can go to our administrators and say, Look, there's this direct link between handwriting and early reading skills, then there'll be more likely to allow this time to be spent on handwriting instruction, and not just on what they consider to be reading. So it's all part of literacy. Jayson Davies Absolutely. And you know, handwriting without tears, as well as the size matters handwriting program, which I know we're going to talk about a little bit. I always mess up her last name. So I'm going to call her Dr. Bev, she has done so much. And she continues to emphasize handwriting in the schools. And I really think that is part of the reason not just because of the handwriting like you're saying, but also again like you're saying, you know, there's so much beyond the physical action of getting the letters on paper. There's so much more than that. So absolutely. Before we move on from the literature review part, I actually want to open up a question and you know, what, maybe there's an answer, maybe there's not, but when you were doing your literature review, was there anything shocking? Was there anything like oh, my gosh, I can't believe this exists? Or, on the flip side, wow, this, how come this doesn't exist? Was there anything really shocking to you? Sheryl Zylstra Well, thanks for getting back to that, because I wanted to mention this article, it's white Egan, and Fetter 2011. And the name of the article is a systematic review of interventions to improve handwriting. And that was hugely helpful for me, as I mentioned earlier because it taught me that some of the things I was doing weren't evidence-based in terms of improving outcomes. And another article that was hugely informative to me was the James and Engelhart, in 2012. And what they found, they looked at children were either copying letters, or they were punching the same letter on a keyboard, so they were copying a C, or they were keyboarding, a C. And what they found was when they were copying the letter when they were doing the physical act of handwriting, parts of the brain lit up that were directly related to reading, when they were keyboarding, that letter, those parts of the brain did not light up. And so again, it just showed from a neurological standpoint where the physical act of handwriting was impacting the parts of the brain that are specifically related to supporting reading. So those were huge articles to me. Jayson Davies Wow. Yeah. You know, we always it's funny, you hear something on the news, right? You hear just a quick 22nd clip on the news about something. And I remember, I don't know, maybe about five years ago, it was like handwriting helps you with memory more than keyboarding does, you're actually gonna remember something more, if you write it down versus type it, you know, and it's only like a one minute clip on the news. But you have no idea where that research comes from. They don't mention the author's or what journal it comes from, or anything. But I would imagine that maybe what you're talking about right there might have had an influence on that. And it's something we all hear but I don't think we often really hear how it was conducted and the research behind it. So thank you so much for sharing that. Sheryl Zylstra Yeah. Jayson Davies All right. I have to touch on this because RTI is one of my most favorite ideas within the schools, tiered intervention, MTSS, RTI, PB is all of it. I love it. And you mentioned RTI in your article. And so I just want to ask you, were you able to find RTI articles out there? And if so, what impact has that had on you? Because I know RTI in the grand scheme of things is actually relatively new. It's been probably around 20 years, but it's just now starting to really get embedded. So I just want to ask you, if there's any, what do you know about RTI? Was there any research in relation to occupational therapy, or in general? Sheryl Zylstra Yeah, you know, there wasn't a lot of research, especially related to occupational therapy and RTI. But what happened to me as I worked in two different school districts at the same time, and one of the school districts I worked in was implementing RTI heavily, and the other district wasn't implementing it at all. And that's a choice school districts can make that choice. But what I was seeing in the school district that was implementing the RTI was amazing. And so I was, I became so interested in it, and I could see the impact it was having on the kids. And those are the kids we typically work with as occupational therapists, we don't typically work in general education settings, we're typically working with the at-risk kids or the kids that have already been selected for individualized education plans. Jayson Davies Yeah, yeah. Thank you so much for sharing that. Beth, do you want to add? Beth Pfeiffer Yeah, I think that's what really made this, um, this research study so important was it was really it was looking at a group of students that were receiving either RTI or that did have IEP interventions. And, and not much of the literature really look at that population, you would think that most of our Handwriting Outcome Research would look at that, but it's really with the general population. So this was really unique in that way, especially with the RTI and I think it also provides some real important justification for why OT should be involved in RTI more, I don't always think we're there. And I think we need to be. Jayson Davies Absolutely, and you know, there's so much more research going on even now than there was a few years ago with RTI and OT, we have Dr. Bazyk who's doing her every moments counts program, where they're really embedding OT into, into the curriculum into the everyday places and, and other OTs are doing similar things. So I think it's awesome. All right, I actually want to come back to you, Beth, for this next question. Because in my experiences, you really have to do that deep dive into the literature review, to find out what you know, and what you don't know. And then you kind of come up with a hypothesis. That's my experience. But I won't ask you Is that right? Or Is that wrong? Beth Pfeiffer Oh, absolutely. I think that when we're generating research questions, we get the information we need from different sources, and one of them is clinical experience. So someone like Sheryl, who comes in with a wealth of clinical experience in the school system really can identify where we need to target our research. So that's essential. And that's where that clinician and researcher pairing is so important. So I think that's one area and the other one is the literature. We don't want to be answering a question that's already been answered. Right. So that's something that we need to know is that already, do we already do this work? Do we already know that information? Do we have the evidence? So we need to go in there and find that out? And then we need to really find out what question we should be asking. And that tells us what is missing? What do we need to know? And so that's where that literature comes into play. Jayson Davies And that leads us right down to you Sheryl, what was the question that was missing? And what did you decide to tackle? Sheryl Zylstra Yeah, so the question, in a nutshell, was that I wanted to answer was basically, is what I'm doing working, is what I'm doing every day when I go to work, which is a lot of handwriting groups, a lot of early literacy groups that make it different. And that's what I wanted to answer. So I have this specific question here. If you want to hear the long question. Jayson Davies Go for it. Sheryl Zylstra Will at-risk kindergarteners participating in the handwriting intervention group, utilizing the size matters, handwriting program, improve their handwriting legibility skills? And then in addition to that, we also wanted to look at, will this OT lead handwriting intervention, improve their pre-reading skills, as well? Jayson Davies So there are two parts to that. It sounds like yeah, the reading side, as well as the handwriting side. And I want to ask you because I think every time we read an article, we have to consider all factors involved. And you specifically, were looking at the size matters handwriting program. Was there a reason behind that? And if so, was it because you had experienced with it because you and Dr. Beth, were close, and you kind of knew about it? Or was the research behind it? What kind of drove that decision? Sheryl Zylstra Yeah, I will tell you briefly, and then I will let Beth take over this question. I actually had was working in a school that was using D'nealian handwriting. And I had some concerns about that because there wasn't any research that I had found to support D'nealian and D'nealian is when you add the little monkey tails to the letters, it was sort of supposed to promote that transition to cursive handwriting. And right as I was getting ready to work on designing the research project with Beth, the school dropped the D'nealian and said, we're not going to use it anymore, which I thought was great, but it left me a little bit stranded. And so I talked to Beth and she said, Well, I have this great new program that we're starting to do some research on, let me tell you about it. And so I'll let her tell you about that connection. Jayson Davies Oh, go for it. Beth Pfeiffer So, um, Dr. Moskowitz was actually I'm also a doctoral student, and she started the development and besides matters, handwriting program in Temple's Doctoral Program, so I had worked with her quite extensively on that. And then we continue to work together, she was very, very committed to having evidence for the program and evidence-based practice across the board. So that's something she did when she was developing this and conceptualizing it, that was something that she really integrated into the development process, as well as her long-term plan after she left the program, so we had done some work. And we had just finished a study, looking at the effectiveness of the size matters handwriting program in the general school population. And we had really incredible outcomes, very strong outcomes that suggest that this improves legibility, this improves your handwriting. And so that's always helpful when you're starting to go beyond the initial question of is this effective, you know, does this have efficacy. And Sheryl was in a place where she was looking at it with a very unique population and one that we needed to know more information about. So we knew that this had evidence that it is an intervention that can work and improve handwriting legibility. So that's a really good place to start. And now we need to take it to this next level. And this was a really nice transition into Okay, now let's look at it with a different population. Let's look at it in we did look at it within the natural context of the schools before, but within the natural service provision that was happening in terms of RTI and IEP services. So it really seemed to be a good fit and next step. Jayson Davies Okay. So just to kind of rehash what I heard was that the size matters program, there was already some research out there. And the population for that was mostly just general education, maybe middle elementary age. Beth Pfeiffer Yes, exactly. We had mostly elementary students in the initial study, and it was just with the general population. Jayson Davies Gotcha. And that leads us into our next question for Sheryl, then you were going to a more specific targeted audience. And I'll let you explain that. Sheryl Zylstra Right. Well, I know as an occupational therapist in the schools, I wasn't working with the general education population, I was working with kids that had IEPs, or that were at risk of potentially having IEPs as they got older, that were struggling with their handwriting skills. And those are the kids that I wanted to look at because those were the children that I see. Jayson Davies Gotcha. So again, you went with kindergarten kids, right? Sheryl Zylstra Yes. Jayson Davies And then it was with at-risk, what turns them as at risk? Or what made them at risk? How are they identified? Sheryl Zylstra Yeah, good question. So I typically work in what they called at the time and probably still call a resource room, where kids who are struggling to gain the kindergarten level skills are put to get extra time to learn those skills, basically. And so those children were a combination of children that already had IEPs, or that were being given extra intervention to potentially avoid having an IEP put into place. Jayson Davies Gotcha. So again, just to kind of reiterate, or not reiterate, but just kind of express what I'm hearing is that those kids either had an IEP, or they are already in tier two, maybe even tier three of the RTI process, meaning that they're getting small group or maybe even more of an individual type of service through the resource room, correct? Sheryl Zylstra Yes, exactly. It was a true tier two, because especially when I went in, I was seeing them in a group, and not individually. Jayson Davies Gotcha. All right, perfect. So let's go with that. Then explain what that looked like. What did it look like when you were working with these students? Sheryl Zylstra So it was really fun. Doing groups is one of my favorite things. So I would go into the classroom. And this is where, you know, again, as a clinician, I have these ideas, but Beth, as the clinician slash reach researcher, was really able to help me fine-tune what I was already doing, and make it sort of study able. So we would go in half an hour, twice a week. And I would lead a group using the size matters handwriting program, and we would just have a lot of fun. And we would use the principles, we had the workbooks, we would do a variety of activities that incorporated handwriting, one of the primary things that we did that is important to the size matters handwriting program is that we taught handwriting. So as an OT, I've been into many, many, many classrooms where teachers who are doing the best that they can and don't have a lot of knowledge about handwriting instruction, are printing out worksheets from the computer and giving the students worksheets to work on their own. But sometimes they're lacking structured handwriting instruction. This is how you make an H you start at the top you make a line down. That's really important. The actual there, there are some kids they say about 30% who are gonna pick it up. But there's this other group of children who aren't going to pick it up on their own. They need explicit instruction in order to learn handwriting. Jayson Davies Gotcha. And so you were doing this in the resource room. So were kids coming from their main classroom to the resource room, and then you were meeting with them in the resource room. Is that correct? Sheryl Zylstra Exactly. Jayson Davies Gotcha. Okay, perfect. Just so everyone has a chance to hear that. Awesome. So you're doing this in the group? You're doing it in the resource room? And did you have a chance to actually work with the teachers at all? Or was this strictly with the students? Sheryl Zylstra No, that's a really great point, it was really required that the teachers be an active part of the group. So the teachers were always in the room, I went in the COTA, the excellent COTA that I worked with also went in with me, the teacher was always in the classroom. And the teacher's assistant was always in the classroom. And the reason that was so important is that the teacher was learning the program as well. And she was incorporating the principles on a daily basis. So that was hugely important. That's one of the concepts that the Hoy et all article really pointed out to me is that practice, practice practice. You've got to repeat what you're doing in OT, outside of OT to make it work. Jayson Davies Yeah, absolutely. I like to tell therapists as well as other practitioners that work with students that, you know, sometimes we can spend a half-hour with one student and impact that one student's life. Other times, we can spend that same half-hour with a teacher, and we can impact 30 students lives with that half-hour with a teacher, and then the 30 students that the teacher has next year, and the year after that, and the year after that, just by training them a little bit. And so sometimes, you know, you can have more of an impact by stepping away from the student and working with the teacher a little bit. So absolutely. Alright. So when it comes to research, whenever you're going to look at the effectiveness of something, typically, you have to compare it to something. And so now, what were you comparing the size matters handwriting program to? Sheryl Zylstra Yeah, so Beth may be able to answer this question better than I, but I'll attempt it first. We were comparing it to the standard handwriting practice. So teachers often come up with their own handwriting curriculum. And so whatever that teacher in that classroom was using was what we implemented in the control group. So we said, we're going to come into this classroom, and we're going to do the OT lead size matters, handwriting program, you are going to do whatever you've been doing, and what's been working for you. Jayson Davies Gotcha. Beth, did you want to add to that, or Beth Pfeiffer It's exactly what I would just say, as well. It's really when we're trying to do research that's in the natural context. And I think for school-based practice, it's very important for us to be implementing our interventions and looking at their effectiveness in those environments. You know, oftentimes, you're comparing the situation to the standard practice. So and that's essentially what it is, was what they as his services or as his interventions. So in this case, it was what the teacher was doing to teach handwriting within that context for those groups of kindergarteners. And we know in kindergarten handwriting is something that they are starting to learn. And it's part of the curriculum just naturally. So that was really what it was compared to. Jayson Davies So we don't we don't technically know the specifics of that handwriting program, if you want to call it that, is we just know that in kindergarten teachers teach handwriting, and therefore this was compared to that. Alright, that makes sense to me. I hope everyone understands that. So then basically, you then compared students who came to work with you and compared them to students who didn't come to work with you. Is that right? Beth Pfeiffer Yes. Jayson Davies Okay, perfect. at all, it's all coming together to make sense now. Beth Pfeiffer In a lot of ways that we're actually comparing somewhat two curriculums, it's just that we don't have the one standard curriculum defined, because that can look differently, especially with handwriting. I don't think their standard curriculums in all the districts are in all the classrooms that are being used. Sometimes teachers make determinations on how they're going to teach that. So we're really comparing almost two different curriculums in some ways in the school setting, you know, a very, yes, this matters, handwriting curriculum, and program, you knew to what the standard curriculum was. Jayson Davies Yeah. And so just, again, just to kind of wrap this up, Sheryl, did you actually speak to the kindergarten teachers at all? And like, ask them, Hey, are you using the handwriting program or find out anything about that? Or do we know what they were using at all? Were they just using a made-up curriculum? Or did they have a specific curriculum that the district might want them to follow? Sheryl Zylstra Yeah, you know, again, it's often teacher specific. And I think what we're finding more and more is that I just read an article yesterday that talked about how using a specific handwriting program is important. We don't necessarily, it doesn't necessarily matter which handwriting program as long as it's presented in a very specific, repetitious, and consistent way. And so I do know that this particular teacher in the control group was a teacher with a wealth of experience many, many, many years of experience, and had taught handwriting in her kindergarten classroom for 20 plus years, and was using that same curriculum that she had developed over time. Jayson Davies Perfect. No, that's fine. Yeah, as long as we kind of know what they're doing, I feel like I know that they're actually doing it, I'd hate to, to measure our something versus something that isn't happening at all. And so that's great, we at least know that this teacher has some experience, they knew what they're doing, they had been doing it for a long time. And, you know, a school-based OTs, we've all walked into a kindergarten classroom, we've all seen what they're doing. We've all seen the letters up on the wall, we've seen them using the long stick to trace the letters and kind of show the kids how to how they do it. And so that's just wanted to see what that teacher might have been doing. So thank you. Sheryl Zylstra Yeah, I do. I do just want to add that I think this is where OTs can have a huge impact in the schools as well. Because after talking to a lot of teachers, you do learn that in their education programs, handwriting curriculum, or handwriting is not one thing they're very well trained in. And so they're asking us often what they should be doing, and they're doing their best, but often they are pulling things together. And it might be better to introduce them to a researched a well-researched program so that they can be more consistent in their approach. Jayson Davies Absolutely. And I actually had any experience doing this, I kind of did something similar to what you're talking about, except I went into a first-grade classroom. And I helped that first-grade teacher, the entire classroom, it wasn't a specific program, it was kind of a combination of all the knowledge I had a little bit from size matters, training a little bit from the handwriting, without tears training, I kind of put together my own 10-week curriculum. And I went into the first-grade classroom, I did it. And then low and behold, 12 weeks later, the administrator was much more open to listening to me about implementing some sort of program. And the next year, there was money available. And so the entire kindergarten, first grade, second-grade classroom all had the handwriting without tears program, which was awesome. And they sent several the teachers through the training. So you don't have to start big, you don't have to just go to your admin and demand something. Start small start with one classroom or one teacher and, and work up from there. Sheryl Zylstra Yeah, that's great. I love that story. Jayson Davies Thank you. So before we get into the results, let's talk about how you measured the success of the students. What tools did you use to determine if the size matters handwriting program was working or not working? Sheryl Zylstra So we started with the test of handwriting skills revised because it's really important if you're going to be assessing handwriting that you're using a handwriting assessment. So we use the test of handwriting skills. And then we used it because we were really interested in finding out whether this intervention would also potentially impact pre-reading skills. We used a screening tool that looked at letter sound-letter recognition and letter-sound recognition. So basically, there was a template with the alphabet on it. The letters were all mixed up. And I would point to a letter and I would say, What letter is this? What letter is this? And then the next time through, I would say, What sound does this letter make? What sound does this letter make? To assess if they knew the alphabet, and they knew the sounds of the alphabet? Jayson Davies Great. And Beth, do you want to add anything when it comes to figuring out what tools to use and kind of how you go about doing that? Beth Pfeiffer I think it's really important. It's an area that I'm particularly invested in this idea of outcome measures, we need to make sure that the tools we choose can actually measure change a lot of the tools, not a lot. But some of the tools that we use in practice, really are to help us guide our interventions. But they're not always sensitive enough to pick up the change. So it's very, very important to have a well-developed tool that you know, has been used either in the past or that you know, that can demonstrate that there'll be changes made. And we actually did a study specifically with handwriting, another study where we looked at the outcomes of handwriting, and it was with the size matters program again, but and we used a visual-motor integration tool, I think we use the berry and we used the test of handwriting skills revised. And what we found was that after the intervention, that there were substantial changes, significant statistical changes in the test of handwriting skills, revise, but not in the visual motor measure. So you can really, this is an area where you may be having an impact. But if you don't choose the right tool, or you don't measure the construct that you're targeting, that you might not see that change remaining. Don't be able to document it and research so it's really, really important. And when we were looking at the tools, the test of handwriting skills revised was a well-developed tool that had been used in handwriting studies in the past It also went down to a lower age range. That's one of the areas that was a real challenge and choosing a tool. This one only went down to six. And we were looking at kindergartens. Nurse. So we had some five-year-olds that we had to have had adjusted work, but it did go within the age ranges for the most part that we needed. So that was another factor as well. And then Sheryl actually had experience with the other assessment that really looked at kind of letter recognition and sounds. And so she had experienced that one before, and we were able to integrate that one as well. Jayson Davies Absolutely. I'm really familiar with the THSR, the tester handwriting skills, revise, it can be cumbersome to grade, you got to give every letter needs a one, two or three. And then you got the timing that you got to do. Yeah, but it is very sensitive, I would, I would say because it really details out a letter that has a gap is automatically scored at two, if I remember right, or no, I can't remember off the top of my head. But yeah, you got to look at that chart. And if it's crossing over, then it's a different number. So yeah, I'm glad you were able to find something that really helped fit the age of the kids and was also sensitive. So that leads us to our results. Obviously, the school-based OTs that are listening, we are not researchers, we are not good with T scores and P scores and all those other values that we often see in research. But what were some of the significant outcomes that you found? Sheryl Zylstra We had some really great results, and I'm gonna let Beth take this one. Beth Pfeiffer None of us would take this one. So as a researcher, I need to know a little bit about statistics. But I do think that we make statistics very scary for people. So I'm going to make this very non-statistic based and just summarize and say that there were significant changes in handwriting, legibility, and performance in the group that had the intervention, not the standard group in the group that had the intervention, there were some real substantial, significant changes there. And significance. Essentially, you always hear these terms like a P, that's, you know, .05. And essentially, what that means is that we are just 95% confident that that change was impacted by the intervention we provided. So that's, that's the interpretation of it, there's always this little chance that it wasn't this 5% chance, but 95% is pretty good. So and that's essentially what that means. And additionally, we also saw the same types of changes in letter recognition as well. So letters and the letter recognition as well. So there were significant changes in both those areas for the group that had the intervention, compared to the group that had the standard handwriting curriculum. Jayson Davies Was it just a letter recognition or both recognition and sounds? Was one of the other? Beth Pfeiffer It was on that test that assesses both letter sounds and letter recognition. Jayson Davies Gotcha. Beth Pfeiffer Watching the discourse. Jayson Davies Gotcha. And Sheryl, do you want to add? Sheryl Zylstra Yeah, sorry, I was gonna just point out that it's important to note that both groups made changes because we're talking about kindergarteners and a big chunk of their year. And there's maturation, and there's a lot of learning going on, and all the teachers were excellent teachers. So it's not that the control group didn't make progress. They just didn't make nearly as much progress as the intervention group made. Jayson Davies Gotcha. Perfect. And thanks for explaining that. For anyone who might have skipped past the first 20 minutes of this podcast, and maybe me who kind of we've already gone 20 minutes later, remind me again, really quickly, how long this was the program? How long did you do the program over? And were you very strictly adhering to the size matters? handwriting program? Sheryl Zylstra Yes, good questions. I'm going to I believe it was 16 weeks, twice a week for 16 weeks. And yes, we were This is one thing I really learned from Beth, is that I wanted to do a lot of fun little activities, in addition, and do some cutting and some coloring and this and that. And she really taught me about the concept of fidelity, and how I really did need to have a strong fidelity measure and be really true to the size matters handwriting program for this project. Jayson Davies Great. Thank you for sharing that. Because I know again, Dr. Moskowitz, I know she has so much fun in her training that the size matters handwriting program. It has a lot of fun components to it. You got the dice game, and you got star letters and whatnot. But you're right, you really have to adhere to it. Otherwise, what are you measuring? And so you got to make sure that what you're saying you're measuring is actually what you're measuring. So thank you for sharing a little bit more about that. And that is going to bring us to the all-important question of how can school-based OTs use this information. You did this research a few years back where a few years later, what can someone listening to this podcast take back to their school, their district, and use tomorrow. Sheryl Zylstra Yeah, several things. I think one of the biggest things is this idea of practice, practice, practice. And one thing I think we really need to ask ourselves is if we're still using sort of a pullout once a week model, is that the best model? Is that a model that's going to allow us to have this repetition and practice that the research is telling us we need to have? So that's really important. And then the other idea is this, really teaching the concepts using a cognitive approach to teach the concepts. There are those few students that will pick up learning how to write from a worksheet, but there's a large group of children that will not pick that up. And we really need to teach it in a consistent, constructive way. Jayson Davies I absolutely love what you just said, because I have never read an article that says school-based OT kids need once-a-week therapy services. But I have read articles like what you're talking about, I mean, your article, other articles, the size matters, other articles with other programs. They tell you how many times typically, they met with a student or with a kid over how many weeks? And that's awesome. That's something that more OTs, I think myself, we need to look on to that part of the article. A lot of times we just look at the article, did it? Did it work? Did it help did the program work? But we forget to take into account how much they actually saw the students. And you know, there are some articles out there that we have to almost dismiss school-based OTs because the program's four hours a day, we're never gonna have four hours a day with a student. But like what you're saying 16 weeks, 30 minutes twice a week is right, is that correct? Sheryl Zylstra Right. Jayson Davies That is something an IEP team can handle probably. Sheryl Zylstra Yes. And this leads me back to the Hoy article again, which I keep referring to. And even though it's becoming a little bit older, I highly encourage everyone to read it, because it really just talks about what works. But it also talks about what doesn't work. And one of the things that do not work is sensory-motor activities. And I will admit that as an OT with 30 years of experience, I've spent a lot of time doing fine motor dexterity activities with kids, thinking that it was going to help improve handwriting skills. And again, it doesn't mean that doing fine motor dexterity activities is bad if that child has fine motor dexterity concerns. But if my goal is handwriting, I need to work on handwriting. Jayson Davies Yeah, absolutely. So great. Now, obviously, school-based OTs can take this information tomorrow, they can implement it, they know that they need to potentially up their services for some kids who that might be beneficial for or potentially reduce services or work with the teacher because they can do that more frequently than we can in some instances. Now, I know like almost the last line in every single article is famous, there needs to be more research. And so if you were handing this off to a new doctoral student, someone who wants to go ahead and get back into research, what would you say the next piece of research to be when it comes to handwriting in schools? Sheryl Zylstra Well, I'll tell you what I'm thinking about right now. And COVID really played into this is because so many classes went online and schools were online. What is the effectiveness of our OT interventions when they're online? or via telehealth? So we're I'm looking at the friend right now about if we were to do a similar handwriting literacy intervention via telehealth, what would the outcomes be? How would that look, would we have similar successes? Jayson Davies That sounds amazing. So you would take the same program, basically the same research, it would just be over more than likely Zoom or Google? Sheryl Zylstra Exactly, exactly, to see if our results would be similar? Jayson Davies So does that mean you're working on that? Sheryl Zylstra We're, we're talking about working on it. Jayson Davies Awesome, awesome. Well, I can't wait. I'll give you about three years and looking at the AOTA journal and I'm sure I'll see something. So I could not be more appreciative to both of you, Sheryl, that because of the research that you do, I mean, I really appreciate you being here today sharing this a little bit. But even more so both of you and all the other therapists that do research that give us something to stand on. You know, this is something that an OT could, I always recommend that OTs have like a book of articles, and you know, taking that book, this is an article that you could put in that book. And when you need to refer to something in an IEP or if you need to go talk to your admin about something that's important to the kids that you work with. This is an article that you can take with you and share with your admin. You know This is why I'm justifying twice a week for this student because this is the program and it worked. And it was twice a week. That's why I'm recommending twice and not once a week, per se. And so again, I really appreciate you both for all the information that you have researched. And, of course, so much for coming on here today. So thank you. And the last question I have to ask is, are there anywhere? Or are there any websites or any other resources that you both would like to share? Where OTs would like to learn more? I know, you've already mentioned a lot about the Hoy article, and I will be sure to put that in the show notes so that people can find that. But are there any other websites or any other resources you'd like to make known? Sheryl Zylstra Yeah, so I would like to add the Jameson Engelhart article to that 2012, Lenin Grotto and Goodman have been doing a lot of work on promoting literacy. So again, taking that handwriting and making it bigger, are really talking about literacy. And then I also want to really quickly add that the minute to chime in here, that clinicians can do research. So if you're a clinician, and you're interested in doing research, by all means, collect the data. And then if you don't understand how to statistically analyze it, that's where you call someone like Beth, or you hook up with your local university and you say, I've got all this great data that I'm collecting in the clinic, can you help me make something of it. Beth Pfeiffer You actually said exactly what I wanted, Sheryl, that was perfect was that don't be afraid teller shy away from doing the research or thinking that you can't be the person that does it. Because there's a lot and lots of ways to collect that information. This study was a pre and post-test study. And we used what they call a convenient sample. So that means that we didn't separate people out randomly into groups, we looked at them in their natural context and their natural classroom environment. And that's really important information. And you can do that. And as long as you're using measures that target what you want to know changes, you can collect that very easily, just as part of your progress monitoring. So we need to do that in school-based practice, we need to monitor our progress. And we can incorporate collecting some of this information during those times. And we can really use that to one demonstrate that either need for services, and the value of occupational therapy, and advocate for what we think is the best approach in that situation, then also get that information out there to the profession to show that what we're doing and how we do it works. Jayson Davies Alright, I have a follow-up to that, Beth, what is the one? What's the one barrier that clinicians come to you most with? That is it just an absolute myth? What is something that therapists come to you and say, you know, what I can't do? I can't do the research because of a blank and why is it a myth? Or what is your response? Beth Pfeiffer I think, and I don't think it's a myth. I think it's a reality. But time is the factor, time and resources are always the factors that come up. And I think that it's not a myth because we all were also stretched for time, we have large caseloads in school-based practice. And we have limited resources in schools. We're under-resourced, to begin with, I think the thing we can do to overcome those barriers is to be innovative in our thinking. And also to realize it doesn't have to be this huge project outside of what we're already doing. So we can be collecting information as part of the natural process of providing services in the schools that we can look at some of the before and after. As I said before, we need to document our progress anyway. And that's part of the school-based practice. And so we can use targeted measures to be able to do that, and then collect that information. And it can be pretty easy to then have a small research study going over time. So I think there are ways and ways that we can overcome some of those barriers. The other thing I would encourage I know, Sheryl said this as well, working with your local institutions, there are a lot of graduate students in OT that would be delighted to help you in those settings and get that experience and they have research requirements. So using those resources, and accessing those, I think is a really important step as well. Jayson Davies Definitely. Well, thank you so much, Beth, thank you, Sheryl. Really appreciate you coming on sharing, not just about handwriting and literacy a little bit, but also a little bit about how you can get into some research if that's something you might want to do. So thank you both so much, really appreciate you taking the time to be here. And also really appreciate you being willing to go to the next step and do some research. Really appreciate that that supports all of us out here. So one last time. Thank you so much. I really appreciate you both being here. Sheryl Zylstra Thank you. Take care. Jayson Davies All right, one more time, please give it up for Dr. Zylstra and Dr. Beth Pfeiffer really appreciate having them on here. Like I just got done mentioning at the end of that interview, I really do appreciate them going a little bit further going beyond the clinician role and doing that research so that we have something to take back to our administrators to show them. Now with that said, I want to ensure that you actually go beyond that. So be sure to click over to the show notes and read this article, we covered a lot, but it is definitely worth a quick read over to make sure you didn't miss anything. Some things that you always need to read when you're looking at articles are those limitations and biases. And right after I hung up the phone with them, I realized I forgot to ask them. Now there isn't anything too big in there. But that's something that you should always look at with any article you read okay? So, head on over there, read the article, check out the other articles. And my favorite thing to do actually is when I'm done looking at an article is look at the citations. You don't have to go and click on every single one and read every single article that's in those citations. But you might be surprised by what you find. And you might find a really good article that again, will help you support yourself, support the students and support the teachers you serve as a school-based OT. So one more time. Thank you so much to Dr. Zylstra. Thank you so much to Dr. Pfeiffer. Really appreciate having you on and of course, thank you one last time to you, the OT practitioner listening to this podcast right now. I am so happy so excited. so thrilled to know that you want to make yourself a better occupational therapy practitioner, especially in the schools. Take care. Have a great rest of your day, and I'll see you next time on the podcast. 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 the 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! 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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 81 of the OT School House Podcast. In this episode of the OT School House Podcast, we are talking to recent graduate, Alexa Corley, about her OTD capstone where she surveyed and interviewed therapists, teachers, and administrators about the idea and use of a workload model. Listen in to hear her findings and a discussion about the positive effects of using a workload model. Links to Show References: Visit Alexa's website at Alexancorley.com 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 Hello there and welcome back for another episode of the OT School House podcast. My name is Jayson Davies, occupational therapist down here in Southern California. And I'm just super excited to be with you, wherever you're listening today, I am just happy to have you here listening and trying to improve yourself as an occupational therapist, learning what you can learn to better serve your students as well as the teachers that you work with. So again, super happy to have you joining us here today. So today, we are actually diving into the topic of workload and caseload just a little bit. And we're going to do that by looking at a capstone from Alexa Corley that she completed as part of her doctoral program at the University of Central Arkansas. So we're going to have an interview and discussion with Alexa. And she's going to tell us all about the research that she did leading up to, and the actual work that she did herself to determine what OTs, administrators, and teachers perceive about a workload and a caseload model when it comes to school-based occupational therapy. This is something that's very important to all of us a school based OTs, I believe, I really think that under a workload model, we could serve more students potentially in less time and have better outcomes. And well, let's just... I don't want to get too far in I just want to let Alexa share with you all the details that she came across, the research that she found, and then what her survey results showed. So without any further ado, here is Alexa Corley talking about her research on workload versus caseload. Hey, Alexa, welcome to the OT School House podcast. How are you doing today? Alexa Corley, OTD I'm doing great. Thanks for having me. How are you? Jayson Davies I am wonderful. Thank you so much for joining us. It's we haven't had an occupational therapist working on their doctorate on the podcast, at least in a while. I think we've had him before. But it's been a while. So I'm excited to hear a little bit about all the work that you've been doing in OT school, especially as it relates to school based OT. With that said, I actually want to give you a little bit of a moment here to kind of share a little bit about yourself and where you are in your OT journey. Alexa Corley, OTD Yeah, so I am currently in my final year, well, final weeks really of OT school. So I'm working on my doctoral capstone project. So this is the last thing we do in our OT curriculum that we follow. And so I've already finished my courses and my fieldwork. So I'm just working on my doctoral capstone project right now. And that is around a school based practice, which I know is what we're going to talk about today. So I'm excited to share about it. Jayson Davies Awesome. And you know what, we're gonna kind of get into more about your project. But let's just talk about OT and OT School first, what made you decide to sign up for Occupational Therapy school? Alexa Corley, OTD Yeah, so kind of an interesting journey. For me pretty much my entire life, I thought I wanted to be a teacher. So I went to college, and majored in elementary education. But during college, I also worked at a preschool just for extra money, you know, during college, so my boss, there was actually the first one who kind of told me, you know, you should really look into doing some sort of therapy, and you know, instead of teaching, and so she bugged me a lot about it. But I finally did look into it. And I found out that actually, a couple of my friends were interested in doing occupational therapy as well, and kind of got plugged in with somebody and was able to observe and OT at a pediatric clinic. And I immediately loved it, and decided that that is what I wanted to do. So as little as I knew about just observing at once, I still just thought that it was more suited for me then teaching kind of the one on one versus like one on 30 in the classroom. I kind of thought that that would be better suited for me, like I said, and so in my mind, it was still it's still teaching, it's still working with kids. And so just in a little bit of a different way and more personalized, which I think suits me better. So yeah, I continued on with my education major, finish that out, but I had to add some extra classes to get into OT school and ended up at the University of Central Arkansas and the OTD program. Jayson Davies Awesome. And so I have to ask you this while you were, what were you doing? Were you had a boss that you were doing, like teaching fieldwork or not a field work, but you were working in early elementary? Alexa Corley, OTD Yeah, I was working in a preschool and it was just like an after afternoon job. Just, you know, no field work or anything. It was just kind of at my church. I got plugged in got a job there. So... Jayson Davies Oh, cool. And so your boss, what was she by trade? Alexa Corley, OTD While she was the director of the preschool, I'm not quite sure of her entire background, but she had a daughter who was a speech therapist. So she kind of knew a little bit about the realm and didn't necessarily push the speech therapy, she just knew of the therapy world in general, and I guess saw something in me that would be good for that. So... Jayson Davies That's awesome. It's not always the case that we run into someone that knows about OT speech therapy and is able to give us that little bit of forethought to think about going into OT. So that's great that you had someone to kind of just even make you aware of the profession. That's pretty cool. Alexa Corley, OTD For sure. Jayson Davies So now, you made it to Central Arkansas University, and how has that been? What's your experience been like in OT school? Alexa Corley, OTD Yeah, it's been great and challenging. But in a good way. I, you know, I observed that OT once and then got into OT school and realized I really didn't even know what I was getting into. I didn't really even know quite what OT is. But it's been great. I've learned a lot and luckily still loved it. And you know, it was the right choice. It's been good, though, part and fun. Of course, COVID has, you know, it impacted our classes, we have a lot of online stuff, planning our fieldwork and getting that worked out was kind of crazy. But we got it and all my placements were wonderful. And so now I'm on the tail end with Capstone. And it's just been really great all around. Jayson Davies Awesome. And correct me if I'm wrong, but you are just about ready to graduate. Right? Alexa Corley, OTD Yes, August 7, just a few weeks away. Jayson Davies Well, I'm going to preemptively congratulate you by time this actually airs, you will probably be an OT graduate. So congratulations, and best of luck on the NBC OT. Alexa Corley, OTD Thank you so much. Jayson Davies Yeah. And so one more question before we move on to really diving into your Capstone. And that is we do actually have quite a few occupational therapy students that listen to this podcast. And what one piece of advice would you give to them, in their endeavor, working through OT school? Is there one thing that you learned that you could really provide some, some insight to? Alexa Corley, OTD Yeah, I love this question. I would definitely say maintaining that school life balance, especially in the beginning, you know, you kind of want to be perfect and studying all the time. And at least for our curriculum, the beginning semesters were the hardest, and just kind of figuring everything out. And so you kind of get caught up in all of that, but just maintaining that balance. And we're learning about occupations and helping others engage in their occupations. But then we kind of get stuck just only doing our schoolwork, so engaging your own occupations, whatever those are, and just kind of maintain that balance. Jayson Davies Yeah. And did you have one specific hobby, routine, occupation that helps you throughout OT school? Alexa Corley, OTD Anytime I could just get with my classmates outside of class, that was a big one, just anytime we could just go to lunch or anything, even if it was just in between classes. That was big for me. Jayson Davies That's nice. And you mentioned actually having a few friends that ended up being interested in OT when you were kind of finding out about it, did you all end up in the same program together? Alexa Corley, OTD One of them did. So we actually both were in the education program at my undergraduate college. And then we both are now about to graduate together from at a tea school. So that's been really fun. Jayson Davies That's nice to know someone throughout the entire experience and always have them to kind of have those those tough conversations with and then like you said, see each other outside of school, that's really sure. Alright, so let's talk a little bit about your Capstone. It is about school based. So the first question is, why did you pick a capstone based on school based OT? Obviously, you have some early intervention background? Is that it or Why? What else? Alexa Corley, OTD Yeah, so like you said, kind of that background in education, I've pretty much been interested in school based OT the whole time, I'd love to just kind of mesh those together, my education, mind and my OT brain, put those together in my practice. So I knew I wanted to gear my capstone towards school based practice, just learn a little bit more about it myself. And, you know, have that as kind of a resume builder as well, even. So, definitely wanted to do that. And when we started the process of just kind of submitting our capstone ideas, I had just briefly talked with a professor and honestly come up with a completely different idea from where I ended up. I think it was just I can't even remember exactly, it was maybe more preschool and parent involvement. So that was like my idea I pitched and then afterwards, my faculty mentor, when we were working on solidifying our ideas and all of that, he said, just go to the literature, see what's out there and then find the gap find the need. And so that's what I did. It was perfect advice. So I went to just a jot any articles I could find about school based practice and found my need for sure. So just kind of saw in that literature, all of the best practices per se or evidence based practice out there in the art goals and what LTA was recommending for school based practitioners, but then also just all these recent surveys that there's still some misunderstanding, still, you know, those practices aren't necessarily being implemented. And also found this idea of caseload workload, which is kind of where I ended up gearing my research towards, as we'll talk about. And that was what I found to be the biggest need just how do we transition to that, because we've already seen that the workload model is more beneficial for those best practices. And so where can we fill in that gap of actually making that transition happen? So that's where I kind of landed on my capstone. Jayson Davies That's awesome. Yeah, and I don't even know if I shared this with you when we were kind of talking a few weeks ago, but I actually advise some students in their master's thesis at a university around here. And what your mentor gave you was exactly right. I mean, a lot of people go in with an idea, like they want to solve world peace, but they haven't gone and looked at the literature behind real beast to see what is actually going to take. And so I really love that advice that your mentor gave you, because that's exactly what I tell my students as well as like, you know, yeah, we want to do something related to school based OT, I want you to get that experience of school based OT. But you obviously have never worked at a school based OT, you're still in college. So you need to start with that literature review, and find out what is the missing piece. I'm sure you ran into articles such as articles by Surya and Garfinkel, they're two really big names in this whole caseload workload world. Yeah, I mean, so let's, I guess let's dive into what did you kind of go from there what you did your lit review? Well, that wasn't even your full lit review that was just kind of giving them a piece of what might be out there. So where did you go from there? Alexa Corley, OTD Yeah, so I agree with the world peace example, you said before I answer your question, we especially I think my class, which it's great that we want to do all these world changing things. But with our capstone, we have 14 weeks. So my mentor also kind of had to bring us down a little bit and be like, you know, you only have 14 weeks to this, what's feasible. So yeah, I just wanted to throw that in there. But after that kind of initial just looking at some articles finding the need, I did do you know, some deeper literature review, especially with caseload workload, I wanted to mention, I found several things that AOTA does provide. And those authors that you mentioned, I read everything they have in their website, they're fantastic. So I looked more into that. And AOTA, there's a document from 2006, that I found, talking about the transition from caseload to workload. And then 15 years later, here we are, and they're still not really like I had never heard of it until I got into the literature. And that has that document has been updated in in 2014. But anyway, so I just saw that gap. And that kind of like blew my mind. Because the wet my personality, I'm like, why are we not? Don't we always want to be better, you know. And so the fact that it's taking so long is that just kind of blew my mind. But I saw that as a need that I could, you know, kind of try to address with my, my capstone project. And so I knew I would need a research component. So I kind of came up with what was needed based on some of the articles I read, kind of what questions have already been asked, What do we need more of to support. And I wrote the proposal for my project to include an online survey to kind of be that research component. And then also kind of included just some goals within my project to create some resources or something like that to aid school based OTs, just in the misunderstandings and the lack of education that are continually being reported just by other school staff and OTs, and just anyone in the education world kind of filling that research to practice implementation gap that's out there. Jayson Davies Absolutely. Yeah. And, you know, one of the therapists to I have had the pleasure of talking to on the podcast, and she's going to be presenting at the back to school conference that we're hosting in August, Dr. Susan Bazyk, and, you know, she has some research about how it takes, I want to say it's like, she found research, I don't think she conducted the research, maybe it was her but 14 years for research to make its way to practice. And that just kind of talks about or goes to show what you're talking about, you know, even though AOTA was talking about the transition of workload 14,15 years ago, we're just getting to the point where people are taking it seriously and really thinking about it. So it's unfortunate that it takes that long, hopefully through that. That's one of my goals, actually, through this podcast is to get research out there quicker. And so I hope we're doing that. And I'm so glad to have you on to talk a little bit about your research. So, going forward, did you have a hypothesis before you started to send out we're going to get into your questions a little bit deeper, but Before we do that, did you have a hypothesis that you were expecting to hear back from therapist? Alexa Corley, OTD Yeah, so just based on what was already out there, I hypothesized that the workload model group, so any any practitioners taking the survey that said they're under a workload model, that they would be either more likely or just more often to engage in those practices that are out there stated as best practice? So multi tiered systems of support or collaboration, anything like that, so that they would be more likely than those under that caseload model. Jayson Davies Gotcha. Okay. And then so how did you develop your questions that you were going to send out to OTs, based upon that hypothesis and your literature review? Alexa Corley, OTD Yeah, so I looked at, there's been a few surveys done, and either on caseload workload or just kind of perceptions of various educational staff and their perceptions of OT so I just kind of looked at all of those, and took some similar components, and also some different components more geared toward the caseload workload, I also have several mentors that helped me kind of fit that know a little bit more about the school based practice, since I'm obviously not working in it yet. And they kind of know what's going on in our State of Arkansas. And so they kind of helped me fine tune those questions and kind of what, what we were trying to get at with that hypothesis. Jayson Davies So would you mind sharing a few of those questions that you actually were able to include in in the questionnaire? Alexa Corley, OTD Yeah, so I the ones related to the caseload workload? Well, first, I did have a few demographical type questions, you know, where do you practice? And then the model of employment? Because I think that can kind of play into it. So are you contracted? Or are you directly employed? And then obviously, do you feel like you're under a caseload approach or workload approach? So then kind of looking at that caseload or workload approach? I asked about their, the effect of that on their practice. Do they feel like they're able to meet all of their demands in their workplace? And then have they ever advocated to their administration for that model? So kind of thinking, like if they're in that workload model, was it because they advocated or not. And then they're just also they're competent in what they felt like their competence was in advocating, as well as the level of support they feel they have from their administration. And then also looking at those best practices I just asked either some form of have you, do you? Or how often do you do these certain practices? So that was like collaborative goal writing, collaborating with teachers providing professional development. Are you involved in school wide support, so not just like the direct intervention with your IEP kids, but multi tiered systems of support, things like that, and then also contextually based practices. And one of the really good questions that kind of will show up in my results, when we talk about that I asked the practitioners to quantify with the percent their time spent weekly in several different practices that I listed out. So they put percentages of how much time they felt like during their week was split up among direct intervention, evaluations, screenings, collaboration, and a few others. So that was one that was ended up being very helpful question. And there were some other other questions, but those were kind of the main ones regarding the caseload workload differences. Jayson Davies Gotcha. Okay. And so let's talk a little bit about the population. Of course, that's always a part of the capstone or any sort of research, you got to talk about the population. So who ended up taking your surveys? How many responses? did you get back? What did that look like? Alexa Corley, OTD Yeah, so there were 92 responses started, and I ended up with 61, completed and submitted. So that's kind of how it goes with your online surveys, but it was still good. And being from Arkansas, and just the way I was able to kind of send out my survey, most of the responses were from Arkansas, it was about 55%. And then the other less than half was from around like 15 other states, but just kind of like anywhere from one to three respondents from those states. So the majority of our were from Arkansas, and then the majority were also caseload and less so of saying that they were under that workload model Jayson Davies And that was just a like a self identified I work caseload or I work workload, right. Alexa Corley, OTD Yeah. So I kind of I defined it in the question. So I asked the question if they felt like they were under caseload or workload and then I said caseload refers to workload refers to and actually also had an unsure option in case they still... that wasn't enough for them to really identify themselves. And I only had six that said, unsure, so those were not included in all of data analysis. Jayson Davies Gotcha. Okay. Can I ask you actually how you defined caseload versus workload on there? You don't need to give me the exact terminology. But in general, how did you kind of word that? Alexa Corley, OTD Yeah, I believe it was something like caseload refers to only looking at the number of direct treatment sessions, or I may not have said direct treatment sessions, but kids on your caseload, the number of kids on your caseload, whereas workload encompasses all of the demands that you do on a weekly basis, something along those lines, Jayson Davies Absolutely. No, that's exactly what most of the resources that's kind of how they define it as well. So yeah, that's right. Alexa Corley, OTD Yes. Jayson Davies Cool. Alexa Corley, OTD Yeah. Jayson Davies And you said most of them were from Arkansas, fewer, or less than half are from outside? Did you have a majority OT, majority OTA, a mixture? Or was that not even a question asked? Alexa Corley, OTD I actually didn't ask that. Specifically. I, I included it and if they wanted to take the survey, it was open to either, but I didn't define it. Jayson Davies Okay. And then you said, Yeah, like you said, most of them were Arkansas, did you have? Did you ask for other demographics, such as age or anything like that? Alexa Corley, OTD I did ask for not age, but years of practice. And I kind of divvied that up with like 1 to 5, 6 to 10 and 15 and up or something like that. And I believe I don't want to lie, but I can I can. This will be on my research, as we talk about later, but I believe most of them were that 15 and up. Jayson Davies Oh, wow. You actually had quite a few experience therapists? Alexa Corley, OTD I believe so yes. Jayson Davies Awesome. You know what, one thing that you actually mentioned earlier, too, is that you ask people whether or not they were a district employee contractor, did that skew in one way? or the other or any shockers there. Alexa Corley, OTD There were actually more people directly employed than I would have thought especially considering more people also said they were caseload approach. I guess in my brain, I was thinking, if you're directly employed, hopefully you've kind of are trying to move to that workload model approach. But that didn't necessarily correlate yet. So that was a little bit surprising, but still good that there were more directly employed than I would have thought. Jayson Davies Gotcha. Well, that's nice. I mean, I know being directly employed or being a contractor is very regional based, it really depends on where you are. I know talking from some therapists in New York, that like almost everyone is a contracted therapist, versus I'm in California. And a lot of districts are starting to hire now, their own OTs, I think, a few years ago is a lot of contractors. But now districts are really trying to hire their own therapist. And I think there's so many factors related to that. I mean, what the district considers a caseload or workload, obviously factors into that, what the pay scale is for an occupational therapist, and that general area also contributes to whether or not a district decides to hire their own or, or outside. Unfortunately, I think districts also take into account whether or not that person will be a part of a union or not, or things like that. It's HR and hiring practices are way beyond my scope of understanding. But there's so many variables that that are considered considered with that. And so it's kind of nice to hear that it sounds like you're saying in Arkansas, that more OTs are employed directly by a district or a county of education or something like that. Is that what it seemed like? Alexa Corley, OTD It seems like maybe with my survey, now, I'm not sure you know, depending on who took it, maybe they were just the ones that happen to be more likely, because also in Arkansas, we just have a lot of small rural districts too. And so that's kind of a conversation I've had with my mentor, and just some other, you know, educational staff that we probably will never not have the need. And like you said, by region, it really just depends on never not have the need for that contract model just with the smaller schools and the needs. So it's just interesting, I guess, maybe just with my survey, they just happen to be more of them than if it were directly employed. So I'm not really sure about the state of Arkansas, cuz like I said, we do have a lot of smaller districts. So it's interesting. Jayson Davies Yeah, in the smaller districts, they don't have a need for 40 hours a week. And so right, you might have a therapist split between five different districts and then oh, bless, then you have to drive like an hour in between school districts every day is it's crazy. Alexa Corley, OTD Yeah. Jayson Davies All right. So let's get into some of your results then. What was your overarching finding those kind of the biggest thing for you? Alexa Corley, OTD Yeah, so I got to To run all of the fun statistical analysis, and there were some, you know, statistically significant differences between the caseload workload groups, and some of those variables, you know, from the questions I asked. So one of the things which I didn't mention this as a question I asked earlier, but this was something my mentor and I talked about, I asked them if they were members of professional learning communities, or PLCs. And the results of that showed that in a workload model, they were more likely to be members of that PLC than in the caseload model. And that just said to me, you know, they're more they're more a part of the school community, that they're being engaged in more of those collaborative processes with other educators. And like I said, Yeah, just seen as part of the school community. So that was just kind of an additional question I asked that gave a little bit of insight about the collaborative process. And then as far as those best practices I mentioned earlier, and how much time is spent in those activities? Like in that one question. practitioners in the workload model, spent more time engaging in collaboration with teachers. So that was one of those variables, providing behavioral supports, and consulting with family. So those three variables from the percentage question that I mentioned earlier, workload model lends itself better to those. And then they also spent more of their treatment hours with those contextually based services. They reported more time with that, which is one of those evidence based practices, there's continuing education articles about that. And also just the way that IDEA spells out the least restrictive environment, you know, being supportive of that. So that was a good finding there. And then workload model practitioners also reported spending less time in just the direct intervention category, compared to the workload or the excuse me the caseload model. So on that percentage question, I asked how much time they thought they spent in direct intervention. And the caseload model practitioners, that mean reported there was higher for for those caseload practitioners than the workload practitioners. Does that make sense there? Jayson Davies Yeah. So they were spending more time with direct therapy, potentially one to one or small group, as opposed to the workload therapists who reported using a workload model. Were getting into the classrooms more and helping the teachers collaborate a little bit more, it sounds like, Alexa Corley, OTD exactly, yeah. So that's kind of what that was telling me too, that was an important because they're not just spending time, you know, there's always going to be the kids that you do need that direct intervention services, but IDEA and ESA, and all of those things also tell us we can be a part of prevention services and school wide supports, and educating staff and all of that. And so the way that the workload model practitioners, their time was split up was more distributed to all of those things, rather than caseload being mostly distributed to that direct intervention. Jayson Davies Awesome. Love that you found that. Alexa Corley, OTD Yeah, yeah. So the open responses, I also had just some open response questions that I didn't, you know, specifically analyze in, I just kind of looked at myself and kind of coded myself. So they, the workload model practitioners also just describe, they use a lot of words talking about flexibility and being... having an easier time with scheduling and adjusting their staff. And then the caseload model practitioners reported a lot of things like, not enough time scheduling is too hard. We can't they don't understand pushin services, we can't do this, and this and this. And so it was a lot more negative terms, kind of with those open responses. Whereas the workload, people kind of talked more about flexibility and being able to maybe easier, more meet those demands that we've been talking about all those different practices. Jayson Davies That's awesome. I think I see. I mean, I've never done research on it. But just in my clinical practice, I've seen similar type of attitudes. I feel like, you know, a lot of people feel like they're restricted by case loads. I mean, I've had conversations with a lot of administrators and it's more like, well, this is why everything needs to be an individual pullout, or even small group is because it comes from a model where the schools get reimbursed for that. And, you know, we are told that we are not supposed to base our treatment recommendations based upon insurance or any type of reimbursement. And there's a huge disconnect there because we're being told one thing by our district, potentially And then doing another thing, and or we're doing what our district is, is telling us to do simply because of that, that one payment reason. And a lot of times administrators don't know that another way can happen. And that's a barrier to because there are OTs, they want to make the switch. But obviously, it's difficult for them. I actually want to dive into this next part, because you haven't mentioned this yet. But I know you have like a whole other aspect. I know, it's a small aspect. But you actually went beyond just talking to OTs, right? Alexa Corley, OTD Yeah, I did. So kind of while my survey was, you know, just out getting responses, I had some meetings with different school staff. So I was able to meet with some special education directors and some school based OTs, and just kind of go a little bit deeper, just for my personal learning about what school OT looks like. And various districts in Arkansas, I kind of tried to meet with different districts, you know, in various areas of the state, because like, we've talked about regions, it can be different. I just know, in Arkansas, we've got several places where things are kind of changing. And other, you know, smaller districts, like we talked about, where they still kind of need some education there. And so I was able to meet with those people over just over some zoom meetings. And I met with the sped directors and OTs, from two different districts that are already kind of using that workload model approach to services, and they're doing some great things. And so at each of those schools, I was able to talk to the sped director and the OT from from each of them. So I got both perspectives. And so those two districts kind of talked about their transition process to the workload model. And for both of them, it came from a bit higher up in the chain. So for one of them, she talked about the sped director talked about their superintendents being the ones who gained some sort of information, I'm not sure specifically what that information was or where it came from, but some information from the state level, and brought that change brought that information into their school district of hiring their OT directly, and implementing them into more school wide supports, and like social emotional learning programs, kind of allowing them to head that up. So that's really awesome for them, and they're still, you know, their culture is just kind of always what can they do to be better to be better for the kids. And so they're, they're still doing some great things. And then the other district, I also talked to the sped director, and it wasn't this particular director that had spearheaded the change, but he knew about it and kind of came in in the middle of it. And he told me that for their district, it was the sped director who kind of did the same thing, he came across some information from his higher ups, I guess, and realized that they needed to do some things differently. So they hired their OTs directly, and began transitioning to that more school based workload approach. Now in that conversation, what I found interesting was that he knew that it would take a few years, and he told his staff and his OTs, like, this is gonna take three years, give it three years to get this, you know, more fully implemented, where the teachers know what's going on. And everyone's kind of educated more about what OT can do. And now they have this past year, they implemented some RTI groups. And we're even, you know, taking data on that, which is awesome. That's kind of, you know, another piece, I think that we need to be doing, keeping that data and following up to show the improvements. And you know, really what OT the benefits of OT and being a part of those processes. So those were kind of the workload districts now the other, I think it was two or three districts I talked with, we're not even really familiar with those terms, caseload and workload, which is a bit more of what I expected. So especially with OT and RTI, like I mentioned that a few times, and they were like, no, that's not really a thing here, and, and then I kind of gave some examples of what that would actually look like. And I remember one of them being like, Oh, yeah, I guess that would work. So you mean, like more schoolwide and like education? And I was like, yeah, we can do that. And so the, you know, it's kind of some discussion and education, you know, I wasn't stepping on any toes, but I was just trying to kind of get some thoughts rolling and was able to do that with those districts that weren't as familiar with it. So just from those overall, just kind of the education and advocacy piece that kind of needs to be get going to kind of get everyone on the same page, if that makes sense. Jayson Davies Yeah. And at those districts, were you still talking to a director of special education or was a principal or what? Who were you talking to those ones? Alexa Corley, OTD Yeah, those were still the special education directors, I tried to get in touch with principals and superintendents at some of the schools and just it wasn't able to kind of plan those out with them. They're a little busier, I guess. So that didn't get to work out. But the other conversations are great. Jayson Davies Whenyou were talking to the special ed directors, how familiar with even occupational therapy did they seem? Alexa Corley, OTD So they actually did seem pretty familiar with OT, and what they were doing, and even complimented their OTs and some of the things they did. And so I think they were trying to do, you know, do some of the, you know, quote, best practices, and they were doing good things, for sure. But I think just not quite understanding the full school based model. And I think if you don't really even understand that fully, then it's kind of hard to go to the caseload to workload transition, if you're not even sure about what OTs role is in the school, you know. Jayson Davies Absolutely. But that's awesome that you at least got a general idea that they understood OT, I think by time you get to a special ed, Director type of position, you've been a special education teacher, likely, you've might have been an RSP teacher, or maybe a teacher in a more severe needs. And you might have even been a coordinator something in special education, and you probably have had to work with some occupational therapists over the years. So that's nice that they at least seemed like they understood OT because I've talked to people and their boss, who might be a coordinator, the director of OT of the occupational therapist, they really don't understand their job. And it's unfortunate when you hear that, so I'm glad that these people kind of seemed like they knew what what occupational therapy was. Alexa Corley, OTD Yeah, for sure. Jayson Davies What would you say are kind of, we'll get to the point where we're starting to wrap up a little bit. But what do you think are your overall key takeaways? You know, you're about to head into your career as an occupational therapist, potentially, in the schools. What were some of your key takeaways from this? Alexa Corley, OTD Yeah, I would say the main thing is that just the need for the wider education on a piece roll in school, like school wide, like those teachers, perceptions, and even across the state. So I also asked an open response question in my survey about the barriers and challenges to school based OT, which I had seen in previous surveys, but just kind of wanted to know, just kind of wanted to ask it again, and about half of the responses mentioned that the people in their school don't know what OT does. So that's just still like the main kind of thing that matches the previous study. So I think if there was just some guidance, or education kind of from that top down level, that will be helpful, especially like those two districts. As an example, you know, they started that change with the superintendents, or the sped directors, and so kind of that top down, change. But then also, I think, you know, OTs themselves needing some resources on how to explain the transition, and practically applying their advocacy skills and, and describing, you know, what they can do in the schools. And so, you know, at that district that said, it takes three years to fully implement with both encouraging and discouraging, you know, that it would have to take so long, but also, maybe there are more people trying to transition to that, and it just takes a while. So you know, change, good change, all that takes time. So I think just those education and advocacy pieces, and also just, you know, we talked a lot about my literature review, just the importance of doing and reading research, I think is important too. And that's something I've definitely taken away from this Capstone. Jayson Davies That's amazing. And that is a lifelong skill, right? There's understanding that you need to read the research, you need to stay up to date with AOTA or sorry, well, AOTA gets you a job. So if you stay up to date to AOTA you get access to Asia, and you also get access to other research as well, the Canadian Journal of OT and yeah, there's so many good journals out there. I know you created some resources. But first, I want to ask you go back to those interviews that you had with occupational therapists. How did they describe the transition? I know, it was long, three years, potentially. But what did they think about the transition? Alexa Corley, OTD Yeah, they were pretty much they were mostly positive about it. I mean, they've, they were on board with it, too. You know, I think I also talked to some contract based OTs that, you know, they liked that model, and they which like we said, you know, it's needed that they kind of liked their being able to just go in for the day and leave when they you know, got to leave and not not that that's a bad thing. But the ones that were kind of transitioning with that workload model, you know, they kind of they wanted that change and they put the work in for it and helps to educate the teachers and you know, we're all positive about how that has helped their school. You know, kind of talking about the results of their RTI groups they implemented or the social emotional learning programs when I talked to did like some yoga things in the classrooms and just all the positive results from that. So they definitely said that it was worth the three year wait or, you know, however long it took for that to fully implement. Jayson Davies Yeah, and you know, I'm sure you know, you're one, maybe they did a little bit of push in for one or two classes. And then the next year, those two classes turned into four classes. And then by year three, you're surprised by how quickly you can go from pulling students out every 30 minutes to instead of pulling them out, you know, you can see, maybe three of your kids are all in one classroom. And instead of pulling them out 30 minutes each, which adds up to 90 minutes. You just went into that classroom for an hour instead. And you were able to help them all, despite not pulling them out individually. So there's so much you can do. Alexa Corley, OTD Yeah. Jayson Davies All right. So based upon all of this, I know what the capstone, yes, you do some research, but typically, there's another side to it something that you're actually acting on doing based upon your research. So what is it that you're doing, obviously, an awesome podcast, but that's not even part of your your Capstone, by the way, everyone listening out there, but what are you actually what what is the back end of this project? What are you doing to further that caseload workload, gap or momentum that we have? Alexa Corley, OTD Yeah. So like you said, there is that other aspect of the capstone. So one of my goals was to create some sort of resource tool, based on my findings, and just all the information I've been looking through for the past four months, I don't even know how long. So just all the things I found during this experience that were helpful for me, and I will say a lot of that was from AOTA like, they really do have a lot for school based OT and just a job. So I definitely encourage people to be AOTA members, we've had to be through school. And I definitely think it's helpful. So I... back to my resource. So I created that this kind of resource tool just to be kind of just a culmination of, like I said, all the things I've found. So it's pretty simple. It's really just kind of my study findings. There's links to some fliers that I've created, there's links to my research manuscript. And just any kind of links, or any kind of programs I've found helpful, or looked through that are school based OT related. So I've just kind of included all that in one place, and then kind of put, you know, links in there to those different resources. And then I've also had the chance to create a presentation for OTs role in RTI processes, Response to Intervention processes. And so that's been fun to just dive in and learn more about that. And just kind of provide that as a tool for school based OTs. And hopefully, that will be kind of published soon, I'm working with my mentor to put that she works at Easter Seals and kind of put that out there for people to have. And that will be linked in my resource tool, too. So yeah, that's kind of what I have done to culminate all of this. Jayson Davies Awesome. And so I have to ask you, obviously, is that available that people can access your your resources? Alexa Corley, OTD Yes. So I went ahead and made a website. So every thing and everything I've done related to this can kind of be found in that one spot. And so some of it's still being finalized and the final touches, but as soon as it's ready, it'll be on there. And it's just my name. It's alexancorley.com. I'll spell that out. A-L-E-X-A, the letter N Corley C-O-R-L-E-Y.com. Jayson Davies Awesome. And we of course, will be sure to add that link in the show notes so that anyone can find it for the future. Awesome, perfect. Well, I am excited to also check that out, I gotta be sure to get on there and find what you got on there. For anyone listening, Alexa obviously already knows this, because I'm gonna tell the story about how Alexa and myself came to actually doing this podcast. Alexa, I gotta thank you, because you found out I am in the process of creating a course for school based OTs that just kind of that how to transition from a caseload to a workload model. And you just decided to send me a blind email basically, and say, Hey, I'm doing my capstone on this. And I would love to kind of just share what I have and help in any way. And so I really want to just say thank you so much. I really appreciate you reaching out and just being open to talk about this because this is something that's so important for school based OTs, and I don't know that everyone realizes yet how important it is. I think it is. It's going to be so beneficial, not only for us as a profession, but also helpful for the students that we serve the teachers that we serve and the districts that we serve. I really think that we have more to provide than a pullout model caseload every 30 minute sessions, and I really do think that it's important that we make that transition to a workload where we can get out of those pullout model sessions and really get embedded into the classrooms. And, and helping teachers because if you pull out a kid, you can only see that kid for 30 minutes, maybe once a week. But if you are able to use that same 30 minutes to teach a teacher, something new, that teacher is going to teach 30 kids this year, 30 Kids next year, 30 kids the year after that, and touch so many more lives, that you would ever be able to help if you don't teach that teacher that one lesson. So I think that is so valuable. And yeah, I just really appreciate you coming on here. And I really appreciate the the research that you that you did. Alexa Corley, OTD Yeah, absolutely. Thank you for being so responsive. And just excuse me, all that you do with your podcast and the school based OT resources, I think I've listened to like half of them just in doing my just kind of learning and doing my capstone. And so yeah, I agree with all of that you said and I know how it worked in school based OT yet, but I had so much fun learning and doing this research, and so I can't wait to hopefully be in the schools in the future. Jayson Davies Yeah, definitely. And you know, whatever school district whatever contractor you end up working with straight out of school, they will be very lucky to have you just having someone that understands what school based OT is, even before jumping into it. I mean, just knowing that you know what IEP stands for Ida those things, you know, that's so that's so valuable as a school based OT one final question, I guess for you is, is that the route? Do you think you're going to end up trying to find a job in school based OT after school? Or what are you thinking? Alexa Corley, OTD So honestly, at this point, I'm not super Sure, just with the timing of you know, graduation is in August, and then have to study for NBC OT, and just kind of what I've seen that's available right now in our console. I don't know if that'll be the immediate route. But definitely in the future. That's, that's where I'm headed. Even if I have to get some experience somewhere else at first. Yeah, I'm definitely headed for the schools in the future. Jayson Davies Yeah, definitely. And you know, I add a school out of occupational therapy school, I got lucky, I found a contract gig. And I got very lucky, it was a contract gig. But like you were talking about, I was really, I clocked in and clocked out. I didn't have to build every single session for that we were really basically a part of that school. And so we felt as though we were employed by the school, even though we weren't it felt that way, and very lucky to have that. But a lot of times, it may be easier to get a job with a contractor, get that experience and then move into a district. And so of course, I want to I want to wish you the best of luck with that. And the last thing that I have to ask is research never happens in a bubble and never happens all on your own. So is there anyone that you'd like to shout out for their support or for helping you out? Alexa Corley, OTD Absolutely. I had three mentors for this project. My faculty mentor at UCA was Dr. Chris Ryan, and then my expert mentors just kind of in the field were Jessica Cruz, and then Dr. Amanda Britt. So Dr. Ryan is like I said faculty at UCA, he just kind of made sure I was on track doing what I needed to do. Jessica is she was a school based OT now she's a school based OT consultant. So she had tons of expertise to offer me. And then Amanda has previous experience as a superintendent. So I got her perspective on that area and her, you know, perspective on OTs in schools and making that transition, she had experience with that as well. So I got all of their perspectives and feedback throughout this process. And just definitely want to say thank you to all of them for their help. Jayson Davies Definitely. Well, Alexa, it has been so nice to have you on. Thank you for sharing everything that you did for the school based OT community with us. Alexa Corley, OTD Yeah, thank you for having me. It's so fun. Jayson Davies All right, well, we will have to stay in touch because I'm sure you have more great things coming up in your future with school based OT. So please feel free to reach out anytime, if you ever need anything. All right. Alexa Corley, OTD Awesome. Thank you so much. Jayson Davies Alright, I hope you all really enjoyed that discussion with Alexa Corley. Everything that she's doing is just for the betterment of school based OT In my opinion, I really think that we do need to move from that caseload to a more workload approach. And I'm so glad that she took in the perspective from people outside the role of OT from the administrators or whatnot. That is just awesome. Be sure to check out the show notes so you can find her website and get those resources she was talking about. And yeah, one more time. Thank you so much to Alexa for coming on sharing everything that she did. And thank you, to you for listening to this episode. Really appreciate it. I could not do this if no one listened to the podcast. So I love that you're here. I love that you are continuing to learn. And I love that you want to learn so that you can better serve your students and the teachers you work with. Take care and I'll see you next time. on the podcast. 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 OT School House.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

This past week my wife and I were browsing through our local Target. I am a school-based occupational therapist and my wife is a now a 4th-grade teacher. Neither of us work in the school district we, or this target, reside in. So given the fact that we both work in education, you can imagine our excitement when we found this setup at Target (pictured) and realized that each teacher at the nearby schools had a handout for needed school materials. Literally, each teacher, from each school had a handout in those little slots noting what students in their class would need. And while yes, I know, schools should be providing all the materials (hence, a FREE and appropriate public education) the reality is that teachers (and OTs) need help sometimes. So yeah, I thought that was super cool. But it also got me thinking... What if OTs got to make a back to school list for parents to have? What would I put on my list of supplies Target puts out as Mr. Davies' list of occupational therapy supplies for your child. So, I posted this picture to Instagram and asked @Target if I could put a list of OT supplies together for them including many items children could use to succeed in schools. I can assure you, @Target did not respond... But some of you did! A few of you raised your hands, using emojis of course. So then I started making a list and here it is. Keep in mind, this is not for any 1 age group... Mr. Davies' List of OT materials to help kids succeed in school Three different types of pencils Small or broken crayons A fidget (not a toy) Accordion file folder Something appropriate to chew Stickers Stylus Earplugs Words of encouragement Box Wiggle cushion See our curated Amazon shopping list with these items Click Here (Amazon Affiliate link that supports the OT School House) Get the list in a PDF handout form below! Some of these, of course, seem obvious to you who are OTs and special education teachers, but others may not. So I'm going to do two things below. First, I'm going to explain why each made the list. And then at the bottom of the post, you can download a cheat sheet of this list to do with as you will. So let's get started. #1 Three Different Types of Pencils Why 3 different types of pencils? Because you never know which one is going to work for a kid. Some kids do great with a small pencil, others prefer fat pencils. Who am I to judge. As adults we all have our preference, so why shouldn't our students. I am a believer in the idea that we all gravitate to what works for us. Hence, let your student have options and see what works for them. Here are 3 pencils you may want to try out. (Click on the picture to view on Amazon) #2 Small or Broken Crayons Now, I love the look and smell of a brand new box of crayons as much as the next person. But sometimes we just have to break 'em. Crayons that are broken into small pieces, or just small in general, help children on the verge of developing in-hand manipulation skills and functional a pencil grasp. So the next time you see broken crayons about to be thrown out, grab those suckers and let the kids go crazy with them. Break some regular crayons or check out these tiny crayons. #3 A Fidget (not a toy) A toy is something a child actively engages with. It not only entices their hands but also their mind. A fidget, on the other hand, keeps the hand or hands busy with minimal exertion from the mind. Sometimes a fidget can even soothe the mind without even consciously trying to do so. Think of that coin in your pocket that you sometimes mindlessly flip in your pocket or the pen you click aimlessly at your morning meeting. If your student may need a fidget, check out these "fidgets" on Amazon. #4 Accordion File Folder This is one for the kids who have some difficulty organizing their papers and homework. If you know a student who's binder really does look like the dog chewed it up, this may be something worth trying out. Find one that fits into the student's backpack and can be opened without having to take it out. Then, work with your student to label each section in a way that makes sense to the child. Here's one from Amazon: #5 Something Appropriate To Chew On Many kids are soothed by chewing. Chewing can work like a fidget, except it occurs in the mouth as opposed to the child's hand. Some kids wear chewable necklaces while others prefer to chew on straws. I have frequently advocated for students to be able to chew gum at school. Sometimes, just providing the student with a crunchy snack can help. Either the teacher or the parent can provide these snacks. Here are a few things on Amazon you might try with your students: #6 Stickers! Stickers have so many uses! They with with everything from assisting preschoolers in refining their pincer grasps and bilateral hand skills to helping first graders with spacing between words. You can check out the entire post I wrote for more ideas on why stickers are so amazing and how you can use them to help your student(s). Check out these Emoji stickers! #7 Tablet Stylus Every time a child uses a tablet, we have the opportunity to reinforce their use of a pencil by using a stylus. So many schools are putting iPads into the classroom, but they are are not looking at the fine motor side effects of using a tablet. I'm seeing too many kids using their middle finger when using a tablet as opposed to their index finger. Then when they go to pick up a coin, they use their middle finger for that as well. That makes it more difficult for them to manipulate that coin or other small items. By using a stylus, you prevent children from developing poor habits through tablet use. Check out these styluses: Here are some apps you may want to try out as well! #8 Earplugs Let's be honest, there are a lot of loud noises at school. Be it the teacher, the proctor, or the bell installed back in the 80's, these things can hurt little ears. Even if it doesn't damage the physical structure of the inner ear, the noises can be very disruptive to a child's focus. They are simple and discrete; for the right student, they can make a world of a difference. Some teachers and schools will even allow students to listen to music during independent work time. #9 Words of Encouragement The best thing about this one, it's free. Or at least it can be. I saw this idea years ago and I think it's too simple for any parent not to do it. Just write down a few words of encouragement on a colorful paper and stick it in your child's lunch pail. You can even "batch process" several of these weeks in advance. Make it more interesting by making a game out of it. While it may not help a student focus more in class the moment they read it, feeling loved has never hurt a child's ability to succeed. Here's some from Amazon if you'd like to save some time of need some for the days you are in a rush. #10 Box or Stool Have you ever gone into your student's classroom and noticed that they cannot reach the floor with their feet when seated properly in their chair. You likely take quick note of this without diving any deeper into the effects of this. From my years of experience, students who cannot touch the floor are more often wiggling in or rocking their chair, half sitting-half standing in their chairs, out of their seat completely. While a correctly sized chair an desk is the best fix for this problem, it is often hard to come by in public schools. A quick fix can be a small step stool or solid box of some kind that the student can rest their feet on to feel stable in their chair. When in a jam, you can even use this box: Or you can purchase a small foot stool like this one: #11 Wiggle Cushion If your child still likes to move around a lot even with his/her feet stable on the ground or a box, you may want to try a Disc'O'Sit air cushion or wiggle cushion as I often call them. This air-filled disc is easy to fill with a pump and can withstand most kids playful attempt to pop it. More importantly, it allows students to get their movement in while staying in their seat. It is ideal for the student that appears to be lost in space, but can then answer any question when called on. Plus, it's easy to move to the floor during circle time. Just be sure that once you put it on the chair the child can still reach the floor. And of course, you can find it on Amazon! Just click on the picture. Sum It Up! Alright, that's my 11 item list that I would suggest every parent look into for their student, even if they don't receive special education services. Nothing is crazy expensive and most teachers would be okay with them in the class so long as the student does not misuse them. You can see every item Here on our Amazon list. Interested in having this list on a one-page handout? Download it just below this text! If you'd like more freebies that we have to offer, sign up here! When you sign up, you'll receive 3 more free resources and receive periodic emails from us about more free stuff when it becomes available. Thank you all for checking out this post. If you feel I missed something on my list, comment below. I'd love to hear your thoughts. Take care and I hope you have a great start to the school year! -Jayson Learn more about Jayson on our About Page

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 79 of the OT School House Podcast. Money makes the world go round. It's that simple... Okay, well, maybe it's not that simple. But even if you don't believe that money makes the world go around, as an occupational therapist or occupational therapy assistant who has graduated in the past 10 years, you know that money does pay your student loans. That is one thing for sure. So on this episode of the OT School House podcast, we have Amirra Condelee, OTR/L, who you may know as @marvelousmiracles.OT on Instagram, to share her experiences as a new grad occupational therapist trying to pay off student loans. We're going to talk about some different ways to go about paying off your student loans and a little bit about the idea of refinancing your loans. Amirra is also going to share with us where she and her significant other are at in relationship to their student loan process, If you have ever felt overwhelmed by your student loans or even just finances in general, you're not going to want to miss this episode Links to Show References: Follow Amirra Condelee, OTR/L on Instagram Check out Amirra's website at marvelousmirracles.com where she provides money strategies along with other mentorship opportunities for therapists. YNAB.com (You need a budget) Get a free month of budgeting - Affiliate link Mint.com (Free site and app to keep track of your finances) Info on the Public Service Loan Forgiveness (PSLF) Info on Perkins Loan and forgiveness options Clever Girl Finance Podcast https://www.mastermyfire.com/ https://savemycents.com/ 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 Money makes the world go round. It's that simple. Okay, well, maybe it's not that simple. But even if you don't believe that money makes the world go round, as an occupational therapist, occupational therapy assistant, even, especially someone who's graduated in the past 10 years, as an OT or an OTA, you know that money does pay your student loans. That is one thing for sure. Today, on the podcast, we have Amirra Condelee, you may know her as a marvelousmiraclesOT on Instagram, and she is coming on to share her experiences as a new grad, an occupational therapist trying to pay off student loans. So we're going to talk about some different ways to go about paying off your student loans and talk a little bit about refinancing different options. And she's also going to share where she's at in her student loan process, not just herself, but also her significant other, and how they are managing their student loans both together and kind of in their own way. So you're not going to want to miss this if you have student loans. Or if you're thinking about potentially negotiating for another job in the near future. This is definitely going to be an episode that you want to listen to. As I said, Amira is a new-ish grad, as she says on her Instagram page, and she is going through all of this. In fact, the day that this podcast launches, she's actually doing a webinar tonight on money matters as an occupational therapist, where she's talking about all this stuff and more. So you are getting a sneak preview of that right here in an interview format. Be sure to check her out on Instagram at marvelous miracles.ot. And I'm sure if you type in her name or look down in the show notes, we will have a link to her website. All right, so enjoy this episode with Amirra Condelee. Hey, Amira, welcome to the OT School House podcast. How are you doing today? Amirra Condelee, OTR/L Hi, Jayson. I'm doing great. How are you? Jayson Davies I am doing wonderful. Thank you so much for asking. You know, I have to start off by first just saying I love your Instagram page. Everything that you are doing over there. It's not only so much information, but it's also just super amazingly cute. Just like it makes me happy. I get on there just like oh, I like this. Amirra Condelee, OTR/L Thank you so much. I feel the same way about yours. I'm so happy that we have this OT Instagram community to make these amazing connections. Jayson Davies Absolutely. I'd love it. You know what, tell us a little bit actually about your Instagram. What is your kind of purpose for your Instagram account? Amirra Condelee, OTR/L Yes, so I started my Instagram a little over a year ago. Now during quarantine, I just wanted to explore the social media Avenue and I'm so glad I did. And so my whole purpose over there. So just share life as a new-ish graduate and OT graduate and I talk about my job in an early intervention I talk about so many things just you know my life, how I navigate being a new OT, you know, providing that mentorship to other students and kind of helping them get their foot in the door in certain settings that they might be interested in. So you know, just really sharing life as a new grad and a new grad and early intervention. And I absolutely love it. Awesome. Jayson Davies Yeah, as I said, it's so much fun to watch over there, your stories, your actual pose, they all just kind of cohesively come together. Well done. Amirra Condelee, OTR/L Thank you. Jayson Davies Marvelous... Amirra Condelee, OTR/L marvelousmiracles.ot Jayson Davies Yeah, marvelousmiracles, I didn't want to mess it up marvelousmiracles.ot. So go ahead, if you got your phone out right now, open the Instagram app and find them here. Trust me, you won't regret it. It's great stuff. Alright, so moving on a little bit. That's the Instagram account. But you do have a "day job" or at least one "day job". So tell us a little bit about the actual occupational therapy job that you do during the week. Amirra Condelee, OTR/L So I work in the amazing setting of early intervention. I work with kiddos from the ages of birth to three years old, who have a delay and one or more areas of child development. We used to provide therapy directly in the homes but since COVID, we went virtual and we are still virtual, and we're trying to get some benchmarks met before we're able to go back into the homes. I very much seeing miss seeing my kids and my babies and my families in person. But I'm so glad that teletherapy has been an option and has been working very well. So I do that as my full-time job but I also do independent contracting on the side as my part-time job. And that is through my business called marvelous miracles pediatric therapy, kind of independent contracting, plus my Instagram brand and some things that I do there. It's kind of lumped into that one business and I am a supervisor for I think I have three or four Now OT assistants that I supervise. And then I also see only about four kids a week through that independent contracting job. And that is also virtual, but it used to be me going into the homes, and that is pediatric home health. So they're all over the age of three. Jayson Davies Gotcha. That's a lot going on. Let's break it down a little bit. So let's talk about the first job that you mentioned early intervention, you're doing that. We're talking about finances today. So I'll kind of want to break down some things that we typically want to talk about, you're a W-2 employee for that job, correct? Amirra Condelee, OTR/L Correct. Yes. Jayson Davies And so just for anyone who may be listening, W-2 job and Amirra feel free to jump in anytime. That means that they're taking your taxes out, you may have an option to jump in with insurance, if it's a large enough company, they should have some sort of an insurance plan that you can join into, they probably have some sort of a 401k type of program that you can jump into that sound familiar or no? Amirra Condelee, OTR/L That is typically how the meaty jobs are. So my job, they do take out the taxes. And they do provide insurance, they do health insurance, and I also get dental and vision insurance. But I do not actually have a 401k. And I'm sure we'll get into that later. And that wasn't that was something that I knew that I wasn't going to have with this position. And so typically, just with a W-2 position, you get a handful of benefits. And so most of my benefits are around insurance, I get like a work laptop, and also, I cover a really faraway region, that's about two and a half hours. And so they would pay for my housing out there, when I would go and stay for a couple of days, they would pay for that hotel room. But if I was an independent contractor, I would have to cover that expense myself. So typically, with a W-2 job, your salary is going to be a little bit on the lower side, but it's made up for in a package of benefits. Jayson Davies Absolutely, I was just having a conversation about that the other day, you're right, you tend to make a little bit more as a contractor, but you also have more expenses typically. Amirra Condelee, OTR/L Correct. So with my independent contracting job, they do not take out any taxes, and it's a significantly higher rate than my W-2 job. But I have to set aside money for filing taxes, both federal and state, I also have to have my own professional liability insurance, and you know, all of those insurances that come with having a business. And you know, the company doesn't provide anything other than basically referring me to clients who need OT services. So that's kind of the trade-off is that it is a much higher salary. But I have to be very careful with how much expenses I'm racking up. And knowing that I am not going to have benefits. But again, I have a W-2 job. So I get my benefits through there. Jayson Davies Absolutely. Wow. So much to consider when you have two completely different types of jobs, right? Amirra Condelee, OTR/L Oh, absolutely. And I will say I was at my W-2 job for about eight months before I took on that second job. Jayson Davies Yeah, that's probably a good idea, especially as a newer grad OT Oh, definitely just stick to one job for a little bit before taking on something else. Amirra Condelee, OTR/L Yes, exactly. Jayson Davies Well, you know what, I'm going to take this opportunity, actually, you haven't worked in a school district, many of the OTs that listen to this, their options are often that 1099 position, or like I think your other job kind of is where you are contracted for a company, you work for that company, but you're contracted to another agency. So maybe you work for my therapycompany.com or my therapy company, but my therapy company is then using you to work at whatever school district and that's how some contracts, jobs work, you are an employee for them, but you're contracted through them for another agency. On the flip side, the other percentage of people that work or that listen to this podcast, they're actual employees of the school district. And being an employee of the school district is very similar to what we were just talking about as a W two employee, you do get a W-2 at the end of the year, that lists all your how much you made, how many benefits you got, personally, again, this is more specific to the environments that I've worked in Southern California, is if you work for a school district, you actually now some are making more than what that 1099 contractor may be making. And you have a lot of great benefits. And so people are really interested in and getting into a district position because you do have typically districts here at least in Southern California, they're paying for your insurance completely. And you don't have to pay anything out of pocket for the insurance. Of course, you have to pay out of pocket for co-pays or whatnot. But then you do have all the access to a 403-B which is the public sector of a 401-K. So yeah, it's very interesting, all the different types of settings that an occupational therapist can work in. There's just so much going on. Alright, that was a lot This is an unusual podcast, usually we're talking about OT, but we're talking about money today. And it gets real when you start talking about money. So... Amirra Condelee, OTR/L But I think it's important that we do have these conversations surrounding finance and money and student loan debt and income and negotiation. Even as an occupational therapist, I think that there's so much taboo surrounding the money conversation. And that's something that I've started to incorporate more even within my own Instagram page that like I said, is primarily me talking about, you know, all of the rainbows and butterflies that comes with being an OT, but also I want to spend time talking about my student loan debt that I have, that's pretty significant, and how that's impacted just my lifestyle as a new teen, you know, those types of conversations that I've been having on my Instagram page have really, really resonated with so many, you know, or has really resonated with so many people in that community. And I really appreciate just having this conversation with you today. Because I think that a lot of times people feel bad people in like the healthcare room, or just that type of sector, we shouldn't talk about money, because we're just doing it, because we love it. And we have a heart for it. But it's also really important to talk about the financial aspects of things, too. Jayson Davies Yeah, and I don't think it's a secret at all right now that if you're going to go get a degree in occupational therapy, whether it's a Master's or a Doctorate, you're looking at $100,000 Plus, and unless you're able to get scholarships, and unless you're able to, I don't know, work and make $100,000 to pay it off in four years, that's not gonna happen. I mean, it's tough, even an Occupational Therapy Assistant job, or not a job, but a degree to be an OTA. I've seen those private schools like in 60 years in the 60,000 range. And that's ridiculous even more if you go to a private school. And it seems like a lot of people are either if they want to get into this field, they have to choose between being on a waitlist at a public school for two, three years to get in in order to pay a little bit less to get that degree, or they can pay up overpay. Some people might say, and go to a private school and get in right away. It's still competitive, but you can at least get in a little bit quicker, but it might be twice as much expensive. That's crazy. So do you mind sharing your kind of transition, maybe a little bit about if you're comfortable sharing how much you did actually come out with, and maybe a little bit about your plan for going about paying it off? Amirra Condelee, OTR/L Yes. So I went to school in Boston, which, let's just start there. It's an extremely high cost of living that I did not take into account, you know, as far as housing, just everything that comes with living in a higher cost of living city. So I went to school in Boston. And I won't say that's my first mistake. But I will say that's the first thing that I should have considered is where I was going to school. And I am originally from North Carolina, and I have the option to go to school in Virginia, which would have given me a much lower cost of living. So I went to school in Boston, I did go to a private school and I got an OTD. So as you can imagine, those are three enormous factors. For now, being in well over six figures of student loan debt. My program, tuition was over $100,000, I actually just checked right before we had this chat. And the incoming class right now is roughly 150,000 for the three-year OTD program, which is very, very significant. Mine was not that much because they've steadily increased that tuition and fees, overall, you know, the price tag for that degree over the years. And so it's now you know, four years difference or so and so it is roughly 150,000 miles a little bit less than that. But that is a very hefty price tag, considering what you're really going to make as an OT, I did go to the entry-level OTD program, which is also significantly more expensive than just about any other route to becoming an OT when I was looking at the profession, I was not super familiar with OT in general. And then I kept hearing these rumors without the mandate for the OTD. And I was like, well, I just want to make sure I make the right decision. And so I decided to go to the OTD program. And so I won't say that I necessarily regret that decision. But I think that I made that decision out of a place of fear. And I didn't really take into consideration that price tag. And then the fact that again, I was living in a higher cost of living city. So I borrowed even more than that, tuition and fees that I had, I still need it more to cover my housing. I did work as a nanny and a certified newborn care specialist. And so I was making a couple extra $100 a month, but it wasn't enough to cover all of the living expenses, living expenses that go into being a full-time graduate student. So I definitely had to take out you know even more and then I also went out of state for both of my level two, so I was in Houston, Texas for my level two field works. And then I went to Seattle Children's Hospital for my, for my OTD capstone project. So then I lived out of state and so I had to borrow even more money to cover the housing out there. And so you know, you really just don't think about all of these numbers that start to add up. And then when you see Oh, my gosh, I'm in well over $100,000 of debt, once you get out, it just feels very, very overwhelming. And then you look at the income that you're going to make, and you're like, how am I ever going to pay this off? So I definitely, you know, I was kind of that person who was like, Well, I'm just going to be paying these until I die. And that's just going to be the reality of it. And I wasn't really thinking, I want to aggressively pay them off. When I first graduated, I was very overwhelmed, I was very stressed out, I had a lot of anxiety about it. And I was like, I'm just going to make the monthly minimum payments. And you know, hopefully, somebody forgives that later on down the line. And, you know, that'll be that. And my mindset definitely started to shift, I will say that I ended up getting married. And my husband is huge into finances. And so you know, we took a look at our finances, how much debt I was in how much debt he was going to be, and after his graduate program, and he was like, we need to come up with a plan. So it definitely shifted because you have to consider paying off over $100,000 as a single person with one income as an OT and then also being married having a two-person income. And you know, both of you earning pretty decent wages. And so I but I don't want that to discredit the story. I know that now I do have a two-person income. And so things are, I think I should be out of debt within the next, you know, five or so years. And when I was just single Amirra, it was looking more like eight or nine to 10 years. And so I will say that now that I am married, and I have that second income, and we're doing things together, it is going to knock down how much time it'll be for me to pay off my loans now. Jayson Davies And what about your husband? Did he come out of school with some debt? Or is he still in school with some debt or going to have debt or how's that looking? Amirra Condelee, OTR/L Yes, he's graduating from his program in August, and he will also have over $100,000 of debt. So we have racked up, you know, hundreds between the two of us. And he is in a CRNA program. So he's becoming a nurse anesthetist. And so, you know, typically they do have a much higher earning. And so taking that into consideration taking the job that I live in Arizona, I work in Arizona, and it is, you know, one of the top five highest-paying states, so we both do have significantly high incomes, but we also have significantly high debt. So, you know, as I said, I don't want that to discredit anything that I'm going to say because I still think everything is still going to apply as far as needing to know your numbers, know your budgeting, stick to a strict budget, all of that even if you do make a high income, you still have that high debt too. Jayson Davies Absolutely. And that's a great goal that you have for you know, four or five, maybe six years trying to get that cut out. Because it's amazing. For me, I was paying like $1500 a month, I think when I came directly out of school, I mean, three months went by your grace period, as they like to call it, and then all of a sudden, boom. Amirra Condelee, OTR/L So yeah, mine was about 1300 a month, and that was only going to cover the interest. Jayson Davies Yep. Amirra Condelee, OTR/L That was to leave the meter exactly where it was. To not actually go towards the principal, I just needed to make the payment of 1300 a month, only to cover the interest. So I think that's something that it's so hard to wrap your head around that much money is not even decreasing my overall principal balance. And so I initially started off on just the standard repayment plan. And it was feasible for me, but I never wanted to get into a situation where I couldn't afford that really high payment. So I switched it to the income-driven repayment plan. So that lowered my monthly payments. And I just tried to do, you know, double, even sometimes triple that amount. So I mean, we're talking 1000s of dollars per month to cover the interest and the principal up until COVID happened in it went into 0% interest rate, because my loans were all federal. Jayson Davies So let's talk about that because I don't have my loans already paid off. So I haven't experienced this whole loan forgiveness. It's not forgiveness, but the COVID plan what happened and how is that impacted your repayment. Amirra Condelee, OTR/L So the Federal Interest rate is now 0%. Meaning I don't have to pay that 1300 to just leave the meter where it is I can use that 1300 to just attack that principal balance, which is really nice because like I said, depending on how high your overall balances, that just number to pay, your interest can be really high so it's really nice that right now it's not accumulating any interest and all of your payments are going towards your principal. balance. So that has been really nice. I will say that. So I actually misspoke, I did have two private loans through Sallie Mae, which was for undergrad school. So I won't really talk too much about that. But those are paid off, I paid those off last year, those totaled about 15,000. And so now I'm just kind of focusing on my OT school loans right now. And those are all federal. And that's nice because that's 0%. Now, if I would have refinanced it to a private, then I would not have had that 0% interest rate. So I'm really glad that I held off because that is something I considered doing to lower my overall interest rate, which was around 7%. And I could have got it at three, 2 to 3%. But I wouldn't have still been having to do that two, to 3%, if I would have refinanced with a private lender. Jayson Davies Wow, just so much to consider, like all the numbers being thrown around. And you know what, I actually want to ask you this, then, what did you know about loans? Before you jumped into graduate school, you might have known a little bit because at well, just a little bit, because they should, they should have told you a little bit when you're an undergrad. Right? And then they probably should have had you take another course before you took out more loans potentially in graduate school. Is that the thing still? Amirra Condelee, OTR/L Yes, what is it called, like the exit counseling, or some type of counseling that you go through, and you go to sign up for a loan, but honestly, you just like keep scrolling, and you just click accept, and then they give you money, and you know, you're young, they give 18-19-year-olds this massive wad of money, and then you get these refund checks that you don't realize, I should probably put some of this aside to pay back, you know, once I graduate, so I would be getting these enormous relief, I mean, between 10 and like, $15,000, I was getting these refund checks while in OT school. But again, I was using those to live off of so I was using that for rent. And for utilities, my you know, car payments, basically everything because I was barely I mean, I had a job, but I was barely working. And so I was using those, you know, if I wanted to fly home for Christmas with my family, I would just use part of my refund check. So in hindsight, I probably should have not done that. I probably should have budgeted that refund check a little bit better so that I wasn't using the whole expense of it. Um, but back to your original question, Jason, which is... Jayson Davies Do you recall having any information about these loans prior to actually taking the loans? Amirra Condelee, OTR/L Right, so, they just give you the number and you get the interest rate. But you know, what I didn't know about compound interest, I didn't realize that you would get interest on top of interest. So I think that is the biggest shock that I had is I remember getting an extra $20,000 on top of my principal balance. And I called them frantically and I was like "what just happened?" And he was like, "Oh, that's, you know, that's your interest capitalizing, that's compound interest." And I was like, "What in the world?" So, you know, you have these numbers in front of you, but you don't really understand at least you know, me, I have these numbers in front of me. And I didn't really understand what is this actually going to look like once I graduate, you know, sometimes you have loans that are accruing interest, even while you're in school, depending on which loans that you have, you are not required to pay those back or anything. But if you have loans that are steadily incurring this interest over a period of a few years, that can just significantly raise that total tab, you know, that total number, so although like I said my school right now it's at like 150,000. If you take out that full amount, you're gonna have to pay more than that back. And I think that's the part I didn't truly understand. Jayson Davies Yeah, because I mean, at 7%, I'm not going to do the math in my head, but 150... 7% of $150,000 is a lot. And with the compounding effect, it becomes even more, I just want to clarify because you said about the loans that are making interest while you're still in school. You don't have to pay that interest while you're in school. But you still have to pay that interest once you get out of school. Correct? Amirra Condelee, OTR/L Correct? Yes. And again, that totally depends on what type of loan, you know who your lender is it it's a lot of different factors that go into it. But I did have some loans from like undergraduate that were steadily I was steadily getting charged interest. And again, that's you just you know, you're focused on becoming an OT, that's all I was thinking about him. And I was like, I'm gonna make great money when I get out. And that's a whole other conversation, but you know, how much you can realistically expect to make as a new graduate. But I was like, yeah, I'll just cross that bridge when I get to it. But I think that you really have to go into wanting to be in this profession with this in the back of your mind so that you don't end up having a fairly I mean, I make a fairly decent salary right now, but I also have massive student loan debt. So it just you know, it doesn't balance out. So I think there's just like I said that the finance conversation needs to be had, I think even before you start OT school to pick the best path for you, that's gonna set you up for financial success. Jayson Davies Just hearing you say that it's like a conundrum I like basically we're telling 17-year-olds that have never had to budget more than a couple, maybe a couple $100 at the most, to budget $150,000 Plus, and to figure that not budget, but to know like, "Hey, you're gonna owe $150,000 in four years, or five years, whatever that might be." That's crazy. Amirra Condelee, OTR/L Yes Jayson Davies I want to cap this conversation off just a little bit with a challenge. And that is to everyone that has student loans listening right now. Next time, you get that email, it's probably on AutoPay. But the next time you get that email, look at it, and just look to see how much of your for round number $1,000 is going to interest versus how much of that $1,000 is going to principal, you might be surprised that 800 of your $1,000 is going to interest, which means that your principal is only going down by $200. And so that's what Amira was talking about, I think when she's you know, paying more so that she can knock down that principal right now, I did the same exact thing. And whenever I had some extra leftover money, boom, I put it in toward that principal, because that is the key to knocking things down. My dad always instilled in me early pay, make at least one extra payment a year, at least one extra payment a year. And you'll actually see that start to come down. And so I did that. And then whenever I could I tried to do a little bit more. You talked earlier about different types of payments that you could make, I think you said you were on the standard payment, and then you changed it to an Income-Based Payment. Do you know a little bit more about the different types of payments that are available? Amirra Condelee, OTR/L So yes, and no, I know those two, because those are the two that I thoroughly researched. But I would definitely start by I finance through Fed loan. So they have a really great page on their website that talks you through exactly what's going to be the best options for you. But I will just say so the standard repayment plan is the one that they calculate for you. And they say, "okay, you pay X amount, and then in 1020, whatever years, you're going to not have to pay anything else." So you have that standard repayment, but the standard repayment is typically, again, depending on your overall balance. If you're like me, and you have over 100,000, it's going to be significantly pretty high for that standard repayment. So not saying it's not doable, but you're just setting yourself up where you're going to really have to be very intentional about your spending, and have that strict budget so that you can afford that really high payment. The income-driven repayment plan is the one where they look at how much do you make, and you know, they calculate a percentage of that. And then that's what you have to pay. But if you do that, that typically extends your amount of time. So whereas the standard repayment plan, it was about 10 years until I paid everything off, I switched to income-driven repayment, and it doubled and it was about 20 years to pay it off. So just making sure that because at the end of the day, you still have that balance, and they want that full balance back. So it's basically just, you know, you can pay more, and then you are not gonna have to pay it for the longer period of time. Or you can pay less, but you're going to have to pay for a longer period of time. Jayson Davies Exactly, yep. Because there's going to be more interest. And so yeah, the standard is basically this is how much time you have to pay it off. This is how much you owe. And they just break it down month by month. And that's how much you owe every month. But yeah, with the income-driven, it gets a little more tricky to compute and make sense of how much you're actually going to be paying. I know those are the two main ones that I hear about as well, that people use. Next question, are you planning to use any type of loan forgiveness over the course of your time to pay off your loans? Amirra Condelee, OTR/L No. So that is definitely the other option that I hear about a lot. And it's the public service, loan forgiveness. And first of all, you have to just be eligible. And because of the company that I work for the agency, I work for early intervention, I am not eligible not to say that if you work in early intervention, you're not going to be eligible because I have had conversations with people who work in AI and they are able to apply for public service loan forgiveness. So you just want to understand all the parameters of you know, what types of companies what types of agencies you can work for to even be eligible, you do still have to pay something so even if you do the public service loan forgiveness, you're going to have a monthly payment. And I will say like I said I automatically just didn't qualify for this. But there are just a lot of stipulations and fine print when it comes to public service loan forgiveness that I don't think everyone has a ton of knowledge about and I definitely can say I started looking more into it because I had more questions about it. And I was like "Wow, you know, this isn't all that great that it's cracked up to be" there are so many fine print things. And you know, they say the devils in the details. And that's so true. And you know, the rate of people who apply for public service, loan forgiveness and actually are accepted, it's extremely low, like, I don't want to say an exact number, but it's very low. I mean, the last time I checked, it was like 1% 2%. So it's really low, the number of people that they're actually approving to even have the remainder of their student loan, forget, forgive, and are forgiven, and that's forgiven. Jayson Davies All right. Amirra Condelee, OTR/L The amount is supposed to be forgiven. So I would just say if that is what you're pursuing, really just like and study those details and make sure that you're going to be eligible that you're going to have that remainder actually forgiven. Jayson Davies Yeah, and I'll speak to my experience, to me, I looked at it as well. And I think what I came to the conclusion was that with my income-driven, because I did, because of my student loans, I took a higher paying job out, again, kind of like what you're talking about in a rural area, because I was going to get paid more. And I went out there. And because I was making quite a bit of money out there, my income-driven model wouldn't have lowered my payment very much. And so part of the stipulations that you're talking about that you have to meet is you have to pay your loan, using one of the payment options that are available for the PSLF Public Service Loan Forgiveness plan, you have to pay consistently for 10 years. And I believe if you maybe then have a missed payment in there, you can like lose that ability to get the PSLF. But when I did that, I found out that by the end of the 10 years, my loan would already be paid off anyway, so there'd be nothing left for them to pay off for me. And so that's part of the reason that I didn't pursue that one. But what I did pursue, and what I did actually get a little bit was taken off was the Federal Perkins loan, that I was able to, use, because I worked at a low-income School District. This always says it's for teachers, but if you're an occupational therapist, you can qualify for it. I know, because I found a website that says it, and then I did it. And over the course of five years, I think I had, it wasn't a whole lot. But I mean, in comparison, it's a lot of money like $10,000, in comparison to 120 $150,000. It's not a whole lot, but it still is a lot that was taken off. Because I worked in a school district and a low-income area for I think, was five years, you get a portion of that Perkins Loan taken off for every five years. And I'll be sure to put links into the notes to the PSLF and the Perkins loan forgiveness for anyone interested in finding those. All right. Well, you talked about budgeting a little bit. Tell me what do you use specific software for budgeting? Do you and your husband sit down once a week, once a month, what's your budgeting look like? Amirra Condelee, OTR/L I love the app, mint. MINT, is phenomenal. They have the app, but actually like the desktop version a lot. And that allows me to really have I mean, especially if you're a visual learner, it has some great visuals that can really help you track your spending, I do have it connected to my bank account. So they're automatically able to categorize my spending. And I think, you know, you never really realize how much you're spending, you know, those quick target trips or Walmart trips or no dollar store. And that stuff really starts to add up even your subscription services that you don't even think about. So I really like to use that it also shows you any other like they show you your checking account, your savings account, I have it connected to my fidelity account, or my Roth IRAS which is a retirement account. So I really like that it just lays out basically your entire financial portfolio right in front of you. It'll even show you your debt, it shows you individually all of your student loan debts. And then it also shows you like your assets if you have a house and it'll show you like your overall net worth. So I think it's a great tool to use to really visually track your spending and see where you can cut some costs. They also have a really cool feature where you can set up goals. So like I did one goal was to pay off one of my student loans, one of my student loans... Jayson Davies Payments. Amirra Condelee, OTR/L Well, yeah, so one of my student loan payments. And so it broke it down to say how much I needed to pay per month to meet my goal of having that one paid off in six months. So I really, really liked the mint app. Jayson Davies Awesome. Yeah, I've been using mint since my college days. I don't know how I found it. But I remember being at USC finding this app, and I don't think I've ever said this on the podcast. When I was in college. I worked basically as an Uber driver before Uber existed. USC has its own student safety taxi program. And so I would drive around from six at night to two in the morning driving people to libraries, but more frequently from party to party. Yeah, but I don't somehow I came across a man and I have been using it since. I mean 2010. So Wow. Like I've been using it for about 11 years now. And I love it. I have everything inputted in as well, my cars, my house, all the loans that we have. My wife's income is also in there as well. All of her liabilities and assets are in there as well. And so we get a huge picture overall picture of our finances. It's fantastic. I recently came across a program called YNAB Have you ever heard of that? YNAB it's one that sounds familiar, Park Figueroa. Entrepreneur summit. Yeah, she is the one that led me to that one. And it's not too much. It's like 80 bucks a year or something like that. And it's really nice because your money goes into the to-be-budgeted pile. And then you just say, All right, I'm gonna budget $100 to this category this month, I'm gonna budget $100 to this category this month. And yeah, just some really great resources between men and white app, I would definitely recommend mint for sure. And if you want to go a little bit further, YNAB is also a good one. So how do you and your husband? Do you guys try and sit down and do it together? Are you guys both taking your own loans separately? Or what's that look like? Amirra Condelee, OTR/L So that's such it's such an interesting conversation to have about, like finances and marriage, and we're newlyweds, like, we just got married. And we'll celebrate our six-month anniversary this month. So we're still pretty new to everything. And so you know, opening like joint accounts and things like that. But what we're doing is everything. We're just combining everything. So we're we've combined both of our incomes, both of our student loan debts. And that's kind of the way that we're going to tackle it. And we are likely I think we talked about we're going to do that snowball, Jayson Davies or Robbins method, I think we're basically you pay off the smallest loan first. And then you take whatever you were paying on the smallest loan once that one's paid off, you apply all of that to your next smallest loan. That sounds about right? Amirra Condelee, OTR/L Yes, yeah. That, yeah, yeah, that's the Dave Ramsey method. And the reason so the reason I, the reason I like that one is because I need small wins. So I need to have paid off, you know, a $4,000 one before I pay off a 40,000 one. Now my husband's a little bit opposite, and he likes to avalanche better, which is that one is the one where you pay off the one with the highest percentage, or with the highest interest rate first, which is typically your biggest loans. So you might be paying on just one for eight or nine months before you pay that one off versus paying a small one. And you haven't paid off after two or three months. So we're definitely still talking through all of the different options and things like that. But either way, what we've really sat down and done is how much are we going to make per month? And how much of that is going to need to go towards our loans, how much of that is going to go towards our living expenses and kind of dividing it up that way? So I like that way, too. It's just looking at it per month. So what do you need to make per month? What do I need to make per month? And where is everything? Jayson Davies You know, I struggled back and forth. I paid off my loans in about eight years. And I'll go into more detail on that, I think on a separate podcast now, because we're just talking about so much right now. But I went back and forth so much on which loan Should I apply that extra money to? And ideally, I always wanted to go for the highest interest loan because that one's the one that's going to cost more over time. But just like you're saying to the snowball math is like yeah, you want to get that one that like you only have $3,000 left on it. But it's only like, it's your lowest percent loan and you're like, well, should I give it to the 7% that's still $9,000 or just wipe out that 3% or, and I'll do I'll give one thing right now about what I did to help pay off my loans is actually I got in a car accident. So I had bought a Honda Accord. I don't know it was kind of my "Hey, I got out of OT school. I need something I need a new car. I earned it right. I graduated." So I went out I bought a new car. About three years later, I got in an accident, some guy decided he wanted to be in my lane on the freeway and took me out totaled the car. Well, the insurance payout was going to be about 14,000 I think after the car was paid off, I was gonna get about 14,000. So what I did was I took that 14,000 and instead of buying a new car with $14,000, I actually took that money and I put it directly into my highest interest student loan. And so that was $14,000 gone of a seven and a half percent loan. And then what I did, I still needed a car. And so I went and put a very very low downpayment on the new car, but, or used car actually used not a new car for me, but it was used. And but that loan was only 2% for the car. And so I took $14,000 basically put it into a 7% loan and replaced that with a 2% loan, kind of a little refinances in a non-typical way. But yeah, so I turned I basically wiped out, I think one or two loans with that 14, and then we got one loan at a 2% rate. So a little tidbit that I have that could help with wiping out some student loans. Hopefully, none of you get in an accident. And if you do get into an accident, you are perfectly fine. And okay, and have the ability to do that. But don't go getting in an accident just so you can pay off a student loan. Amirra Condelee, OTR/L Good advice. Jayson Davies All right. All right. I think I got a little off track there. But I had a question earlier. And we were on a roll. So I didn't ask if has had these student loans affected any business decisions that you have made? Obviously, you have two jobs now one is more of a job. And the other is kind of a side hustle gig, it's your own thing? How have your student loans impacted your decisions when it comes to business? Amirra Condelee, OTR/L That is such a good question. So I will say you have to consider your startup costs when you are starting a business. And fortunately, mine was very low. Basically and I actually didn't even have to pay to get my LLC set up. Because the company that I used to contract through they have like a whole legal department. And they actually just sent me over the paperwork had me look everything we had had me look over everything. And we had a couple of calls. And that was it. So it actually wasn't a fee for me to set up my LLC. But depending on where you are, your LLC might be, you know, more or less expensive. So I think that would be the first thing to consider when you're kind of pursuing entrepreneurship and everything like that. So I would say that's really the only type of startup cost I had. And it wasn't even really a cost. But it's just the one to consider. You know, when it comes to student loans, you just want to keep all of your expenses as low as possible in every facet of your life, so that you have more to allocate towards your student loans. So from there, I would say the way it's impacted me is I've just been forced to learn about certain things related to business. So I recently filed my taxes. And I'm very excited about it. Because I figured out how to write off business expenses and how to do deductions and things like those things that I might not have ever really considered, I would have been like, Oh, well, I just have to pay a couple $1,000. And that'll be that. But I was like, you know, let me sit down because that couple $1,000 that I might have to owe, I could actually get that back instead, and use that to put towards my loans. So I think it just gave me that extra push to sit down and really figure out what I'm doing when it comes to having a business and having a business and using that to my advantage. You know, it doesn't matter if you make $100,000 a year, if 30,000 of it is going to go towards taxes, the key really is figuring out how to save as much of that and how to, you know, keep as much of what you make in your pocket without going to taxes. So you know, just in, that's probably another conversation we could get into but just knowing about like deductions and expenses that you can write off. And so I figured out, I could write off a percentage of my car leaves and my apartment for my home office, I can write off, you know, my canvas subscriptions because all of these things have to do with the independent contracting job that I do. And so just knowing that that is an option. And knowing that the whole point of that is so you don't owe a lot of money in taxes. In fact, you can get some money back, and then you can put that money towards your student loans. Jayson Davies Absolutely. Well, I can't speak right now. Absolutely, you are correct. And I personally have been using someone for help with taxes for the last few years, partially because of OT School House, and it being a business. And sometimes you pay a few $100 for taxes, and they are able to find you more than when you pay them for. And you do get that money back as opposed to having to pay so yeah if you own a business definitely worth doing it. I know it's a little bit more tricky. If you don't own a business, doing taxes tends to be a little bit more simple, a little bit more fixed. It's hard to write things off if you don't own a business. But interest on your student loans is absolutely a write-off. Unless you make a certain amount I found. If you make too much, then they don't let you write off your student loans. Don't quote me on that. But that's what basically someone told me when I was trying to do taxes. Amirra Condelee, OTR/L Yeah, because you get that forum at the end of the year that tells you how much you've paid in interest and then you can use that. But like I think I also wrote off things like my tie. So I go to church and I tithe 10% of my income so you're able to write that off. And then I think my biggest thing I would say to you like content creators on Instagram. If you are starting to make money from that you can absolutely have that as your business and In anything that you do related to your content creation, or you know, being an influencer or things like that, you can also write off those expenses. And so I think that you know, when you have debt, you're forced to get very creative and things that I normally would have been like, I'm just gonna go to H&R block. And then I'm like, No, I'm gonna sit down and learn and figure this out because I have a lot of debt. And I need to find money to put towards the debt. So I think if anything, having debt just makes you really creative and really eager to learn about finances. Jayson Davies Yeah, yeah, absolutely. All right. What about in your, obviously, personal life? You've talked a little bit about how you got married, and you guys decided to tackle things together? But did when you check when it came to getting a job out of college? Did you make your decision based upon how much you'd be willing to accept as a new grad, based upon the debt that you had? Amirra Condelee, OTR/L Oh, absolutely. So 80,000, right, that's the number that most of us here, at least, that's what we heard in our OT program is what you can expect, you know, starting out, and that's what if you like Google, the median for OT salaries, roughly around 80,000 comes out. So that's the number that I've always had in my head. So I was like, you know, whatever my first job is, it needs to be at least $80,000. So I will say I was very fortunate that we ended up moving to Arizona, I didn't know this at the time, but Arizona is one of the highest paying states for OT, and the median there is some somewhere in there like mid 90,000 a year. So I already have that advantage going to a state that's going to be higher, we also have higher reimbursement rates for the early intervention program. So this is not the same everywhere. So I know, you know, in Massachusetts, for example, there be may, reimbursement rates are not as high for providers, meaning that providers don't make as much. So early intervention salary drastically differs depending on where you are. So if you're in like, Massachusetts, I've heard of as low as 40 to 50,000 a year. Whereas in Arizona, you know, some of our bases are like 85000...95000. So it's, it's really amazing, you know, that I ended up being in a place that I was able to accept something that I was very, very comfortable with, we also have a lot of just earning potential and the company that I'm with, so like I mentioned, I would drive about two and a half hours out to a very rural community that didn't have a lot of services. And I would provide OT out there for about four to five days Max, and I would earn an additional $30 an hour on top of my hourly rate for providing services. So that alone, I don't even I can't even think about like the overall per year amount that was but by doing that, it raised my overall salary. Pretty, pretty high. So I think you know, just knowing what the different options are out there when you're looking to accept a job. But yeah, I definitely have that 80,000 number in my head. And like I said, I had to do that because I have so much debt. So I needed to make at least that so that I would feel comfortable, be able to pay that back. And now, you know, I'm very thankful to between the W-2 job and my independent contracting job to be making like well over that. And so I'm like I said, I'm at a very comfortable place with my income. The problem is, the debt is still there. And so you know, but But yeah, so that's the number that I had in my head. And that's it. I didn't want to accept anything lower than that. Jayson Davies Yeah. And you know, I want to bring this up, because this whole conversation that we're having today came as a result of me sending out an email to my following and saying, Hey, I heard that there are some OTs out there that have to work two jobs just to get by. And I think for, for you what I'm hearing you're comfortable, you could probably be okay with that one job that you have. You're doing your other job, I think more it's, it's something that you personally really enjoy. And you see the long-term benefits of it. But you could probably survive off that that one W-2 job that you have. Does that sound about right? If you really had to? Amirra Condelee, OTR/L Correct Yeah, Jayson Davies Okay. Amirra Condelee, OTR/L I wouldn't be able to get my monthly facials from a doctor. Jayson Davies But I am hearing now that in other parts of the country, there is some oversaturation potentially of the OT market. And then OTs are getting paid really low. And you've kind of just talked about how it does come it does depend on what state you're in what the reimbursement rates are, especially for EI I think it also depends on the size for this audience, the size of the district, if the districts in a more rural area if they're in a high paying area or not high paying area, more of an urban area, but also again, someone brought up to me is how many schools OT schools there are in that area, and people are starting to actually bring up the idea that maybe there's some oversaturation in the OT market. Have you seen or heard or experienced any of that? Amirra Condelee, OTR/L I definitely think it goes back to where you are. So, in early intervention in Phoenix where I am, there wasn't an oversaturation. In fact, there was a shortage. And so actually use that to my advantage, because I was like, Hey, you guys need me. So I can use that as leverage, you know, to negotiate. So I think just, you know, being aware of that fact too, but in some areas, like acute care is, was pretty saturated. So there weren't a lot of jobs. And I think that, from what I know, from who I've talked to, I think that's kind of across the board, acute care, and like outpatient pediatrics, a lot of times they have a lot of applicants. So it's a little bit harder to negotiate, it's a little bit harder for them to offer a higher salary because they have someone, you know, if you don't want to accept 6000 a year, someone else behind you will. And so I think just being aware of some of those different settings, home health, in general, is not as saturated, and there's usually a pretty high demand for it. So you can usually negotiate more. and home health is also known to have pretty high salaries across the board, whether it's PT OT, you know, whatever, you're in therapy, they have pretty higher salaries. So I think just being aware of what setting you're looking into and knowing, you know, for whatever region, you're going to be in how, how open are those jobs? because that'll kind of give you a good idea of if they're going to be paying you more or less. Jayson Davies Yeah, and I completely agree. In Southern California, it doesn't seem like there's an oversaturation, there's still plenty of jobs out there. Every time I check, there's always an OT job available. And, yeah, there's a lot of applicants, but I think most of those applicants have jobs but are looking to upgrade their job. With that said, I am hearing a lot about even more OT programs opening up in Southern California. And we already have quite a few OT programs here. And I'm sure that's going on everywhere. Because OT keeps getting nodded as the top 10 jobs or whatever it might be by US News. And people are learning more about OT they're seeing how great it is. But I think that some new grads are kind of coming out of school is like wait, like what you said, I'm hearing $80,000. And what do you mean, I'm only making 60? that's a big difference. If you're expecting 80 and you're getting 60. That's a pretty significant, well-upset feeling that you get. So I don't know I'm seeing it right now. I don't see the oversaturation here, but I'm hearing about it in other parts of the country. And I am seeing more and more OT programs continue to open up. And they continue to fill up once they open up. And I know actually from my sister, who's a fieldwork coordinator that is getting very hard to find placements for field works for OTs, OT, and OTs. So if you are an OT, if you can take a student on please do. But yeah, it's I think it's going to be an issue in the near future because there are just so many programs opening up. Amirra Condelee, OTR/L Well, and not only that, but the programs, they're pricey. And their tuition continues to go up every year, whereas our median salary is not really going up. So I think that's something else to just consider is and like, you know, some programs are now starting to switch over to that entry-level OTD, or new OTD programs are popping up. And it's like, of course, that's another conversation. But is that really necessary to have this many OTD programs? So I love the post-professional OTD option, I think that's great. But you know, these entry-level ones that have these huge sticker tags, and then new graduates come out and be like, Oh, I haven't OTD I'll be able to make more and you know, I'll be the first place for a job. And it's like, no, I wish I could say yes, but No, that wasn't the case. I haven't OTD. And I can say that absolutely was not the case for me. Jayson Davies Yeah, someone reached out to me the other day and was asking kind of, if I have my OTD, will I be overqualified at all? No, you won't be overqualified, you won't get paid more because of your OTD. But you won't be overqualified most of the people and I am kind of talking specifically to school-based positions right now. The people that are hiring you, won't take a second look at your OTD they won't think it means that you're a better OT. I don't know, maybe someone might have a personal bias, but any OT that's looking at it isn't going to potentially think you're a better OT. In public schools, they set a price before you're hired. They have a price that you can make. And whether you have a Master's or bachelor's because you graduated back in the 90s. Or you have your OTD you're going to make the same. Very few districts have a stipend that you might get for a doctorate, but it might be 1500 to $2,000 a year. So nothing major. So yeah, just want to throw that out there, I guess. All right. I have one more question. I want to go back. We're gonna wrap up, go back to talking about loans, what would be the recommendation you have right now, for a new occupational therapist out of school, maybe they're a year, maybe they're two years out, three years even. And they have a huge statement bill in front of them with their student loans, what would be your recommendation. Amirra Condelee, OTR/L So, there's not a ton of different options here, right, you need to decrease your spending and your expenses, and you need to increase your income or find multiple streams of income. So I think, you know, those are definitely the two areas that I'm focusing on right now is making sure that I keep my expenses as low as possible. And for example, I joked about wanting to get facials every month, that is something I really enjoy. But because I do that, I try and say, Okay, I can pick up an evaluation on a Saturday or Sunday, because that's something that I want to do. So just making sure that you have ways to increase your income. Part of that also goes into, like the importance of negotiating your first job and, you know, setting the bar for yourself at a place that you're comfortable with. And that way, you know, as you continue to progress in your career, you make sure that you're making, you know, more and more and more. And so negotiating even as a new graduate is a huge topic, something that I am very passionate about, because I was able to negotiate, I actually asked for $10 more an hour, but I ended up getting $5 more an hour, but that was perfect. That's exactly what I wanted, actually. So you know, you want to overshoot it. And like I said, I knew that they needed me, you know, just recognizing your worth, as a new graduate, they need you, you're more than qualified, you're ready to jump in there, you have this fresh perspective, and you're excited. And so just using all of that to your advantage. And then you know, not being afraid to negotiate things like benefits and you know, getting higher benefit packages and things like that. So you can negotiate even more than just your salary. But just, you know, focusing in on that, and even just asking for $10 more an hour so that you can get $5 more an hour, that's going to really help you in the long run. So I would say those two areas, really just decreasing your expenses and making sure that you have a way to have higher income or making multiple streams of income. Jayson Davies All right. I know I said that was the last question. But you got me thinking, when did you ask for that increase of the $10. Amirra Condelee, OTR/L So, my negotiation story is so wild. I actually did it after I accepted their initial offer. And the reason is, I ended up getting another offer. But it went to my spam folder and my email, and that one was a higher salary. And I was like, no. So I reached back out and ask, you know, I know this is really unorthodox. And people probably don't do this. And I was like, but I realized that I had another offer. And so I just wanted to come back and discuss it. And they did. They said, you know, this is highly unusual that we reopen the conversation to negotiation, they were like you were you know, an awesome candidate, we would love to have you. And so yes, let's go ahead. And so, in general, I wouldn't recommend that. But I still did it. And I was like, you know, should I do it? Should I not? And I was like, it doesn't hurt to ask the least they can. The worst they can have said is no, you already accepted it, we're not going to go back. But I would say in general, you know, doing it after you get that initial offer, then opening the door to negotiations, if they try to like just call you on the spot or offer you it on the spot, which did happen during one of the interviews I was on. I was like, you know, thank you so much for the opportunity. I'm really excited. I would love it if you would just send me the written contract so that I'm able to look over it. So you don't have to answer right at the moment, even if they call you or ask you in person because you want a chance to do this, gather your thoughts. Negotiating can be really scary. So just allowing yourself time to look through that contract, look to see what you want to negotiate. But just doing it after you get that initial offer written down. Jayson Davies Definitely agree. In fact, another thing that my dad always taught me was to sleep on it. And I actually use that as an excuse. I'll say it I use it as an excuse. If someone even when I go to buy a car, and they offer me a deal. Sometimes I'll say I'm sorry, you know, I this looks great on paper, but I need to sleep on it. So I will call you in the morning. Or when it comes to a job, the same thing, just see it. But take it in, don't respond right away. It can be nice when you see a number on paper, especially as a new grad for the first time. Maybe it's right at that $80,000 mark, and it looks great. But think about it. Have you applied to other places? Are you waiting to hear back from another interview and what they might offer? So definitely take the time to kind of digest it, compare it, maybe talk to a few OT friends that you know, have recently got jobs and they've been through that process. Talk to them a little bit and just think it over a little bit. So yeah. Yes, thank you. Would you like to share any last words of wisdom and also add in where people can learn more about you? Amirra Condelee, OTR/L Yes. So I know that having massive student loan debt and I'm talking to those of us who have you know over $100,000 of student loan debt It can feel so overwhelming, it can feel, you know, just like you're never going to climb out of it. But I really just want to encourage you, I just want to encourage you, I just want to tell you that you can do it, take it piece by piece, you know, you don't have to be making two $3,000 payments every month. And that's what I thought I needed to do. And I was like, you know, what, if all I can do is $200 a month, extra this month, that's okay. Take it piece by piece, chunk by chunk, you will get through it. And don't let it stress you out. And also, you know, if you have this, you know, I mentioned having a strict budget, yes, have a strict budget, but also build in some time for you build on that time to go get a manicure or go treat yourself to dinner once in a while, you know, it's really important to do these things for ourselves. Even if you are in debt, you can still enjoy your life, you know, just be very smart about it. Jayson Davies Absolutely. Sorry, one more, any books or websites that you recommend to learn more about personal finance? Amirra Condelee, OTR/L Oh, yes, I have so many. So I love the Clever Girls Know Finance Podcast, they are amazing. They also have a ton of free courses. It's just clevergirlsknow.com. And they have you know, free courses about budgeting personal finance, investing is another huge one, I just want to put a plug in here you can still invest even if you're in debt. That's something I'm more I know, he didn't even get into it. But I have recently started investing. And so you know, it might make your student loan repayment time a little bit longer. But it's so important to invest right now. Because time is truly money. So they talk a lot about investing, investing while you're in debt. So I love that one. And there are so many days and maybe I'll just send you over a list of my favorite resources to put in the show notes. Jayson Davies Sounds good. I will I got plenty of notes here that I've got to add in from meant to why now, which is you need a budget to fed loans, repayment plans, Ramsey snowball versus avalanche payments, they're all going to be there. So be sure to check out the show notes. And we'll have plenty of information regarding student loans, and budgeting, and all the good stuff that we've been talking about today, "good stuff". All right, Amirra, and one last time, make sure that you shout out yourself. Where can people find more about you? Amirra Condelee, OTR/L Oh, yes, my Instagram is at marvelousmiracles.ot. And I also have a website, www.marvellousmiracles.com. And over there. I actually have a blog where I talk a little bit about finances sometimes too. I definitely talk about finances on my Instagram. And I am planning to talk even more about finances in a couple of different ways. So definitely stay tuned for that. Jayson Davies Sounds good. And one. You didn't mention it. But I know you're part of it. The podcast? Amirra Condelee, OTR/L Oh yes, I kinda forget. So I have a podcast and another business with two of my OT besties. Sarah Pyatt and Danielle de Lorenzo. And we are called "The Real OTs of Early Intervention". And we have a website, we are planning to start offering more mentorship and coaching. We have a podcast where we have really small tidbits of information related to early intervention. And they're meant for you to be able to listen to you like in the car. So there are only about you know, 15 to 20 minutes of bite-sized chunks of information. So if you have any interest at all in early intervention, definitely follow along with us. Our website is therealots.com and then our Instagram is therealotsofei. Jayson Davies Absolutely, you cannot go wrong with Amirra, Danielle, and Sarah, they are the best minds in early intervention, be sure to check them all out. They all have their own individual Instagrams and programs going on that are all amazing. But together, it just makes for a fun podcast that you learn a lot from so be sure to check that out. All right, Amirra. It has been so nice having you on thank you so much for taking the time out of your day to spend with us and sharing all of your knowledge. Really appreciate it. Amirra Condelee, OTR/L Thank you so much for having me. Jayson Davies Definitely Take care and have a great rest of your day. Amirra Condelee, OTR/L You too. Jayson Davies Bye. Alright, everyone, thank you so much for joining me and Amirra on this episode of the OT schoolhouse podcast really appreciate you being here. I'm sure that you learned one too if not many more things that are sure to help you out as an occupational therapist trying to either pay back some student loans or be maybe negotiate a little bit more for that higher paying job. Be sure to check Amirra out at marvelousmiraclesOT and see all this she's got going on over there. All right. Take care and until next time, peace out. 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

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 78 of the OT School House Podcast. Today we are talking with school-based OT and creator of the popular LegiLiner tool, Polly Benson, OTR/L. After years of drawing lines on paper for kids and trying to convince teachers to do the same for kids in classrooms, Polly took action in her own hands to create the LegiLiner tool back in 2019. With more than a dozen varied rolling stamps that instantly create lines for kids to write on, Polly is changing how teachers and therapists adapt writing assignments one classroom at a time. Be sure to check out this episode to hear the story of how the Legiliner came to be and how it may help you and the kids you serve! Links to Show References: legiliner.com Get the Legiliner on Amazon 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 everyone, and welcome to the OT School House podcast. My name is Jayson Davies, and I'm so happy to have you here today. Today we have a very special occupational therapy guest. She is a school-based OT and she's also an entrepreneur. And she has used much of what she learned as a school-based OT to create her own product. Many of you have probably already heard of the Legiliner. Well, today we're going to talk with Polly Benson, who is the creator of the Legiliner. She's only been doing this for about two years. But as you have probably seen, it is just an amazing product. And she is selling out of them. They are so great. They help you to create lines on paper in a fraction of the time that you could with a ruler and a pencil as she talks about in just a little bit. So without any further ado, we're just going to jump right into it. Here is Polly Benson of the Legiliner. Hey, Polly, welcome to the OT School House podcast. How are you doing today? Polly Benson I'm good. Thank you for having me. Jayson Davies Yeah, thank you so much for coming on. We actually met not too long ago at a St. Augustine entrepreneur, well it wasn't an entrepreneur class but in an AT class, if I remember right, is that correct? Polly Benson I've done both. So it could be either one but a grouping of OTs and businesses to talk to students about how they got started on the entrepreneur side. Jayson Davies Yes. And actually Joe friendly, of friendly shoes was in there with us. And he's gonna be on a podcast episode with me as well. So great, great opportunity to meet new people, new occupational therapy entrepreneurs. It's fun to do that. Polly Benson Yes, for sure. Yeah. Jayson Davies So let's go ahead and get started with a little bit about you. Would you mind sharing with us a little bit about your career as an occupational therapist? Polly Benson Okay, sure. So I have been practicing for over 30 years now. I went to Ohio State University. And I started off and work hardening work conditioning, kind of moved into some home health when my kids were born. And then eventually I did some inpatient rehab. And then most recently, the past 15 years I've been in school-based OT. Jayson Davies Awesome. You know, I want to ask you a question, because I don't think work hardening and work conditioning is really a term that's used that much right now. And... Polly Benson Yeah Jayson Davies Like, I don't hear OTs being in that role. So what was that like? Polly Benson So that was where I worked in a clinic. And we had clients that had been hurt on the job. And we helped to rehab them back to their job. So a lot of what I did in that job was job simulation, and trying to figure out how to bridge the gap between "Okay, this person's in rehab, and they're rehabbing their arm injury or leg injury or back injury, and then they have to go back to the job." And you can't just jump right back into eight hours of work. A lot of what we had was like a truck driver, and you can't just go sit in a truck for eight hours and not expect to be hurting. So we would work on two hours a day with these clients that would come in five days a week, and then we bump it up to four hours a day. And then we did lunch breaks, and we get them out to about six hours. And then they were discharged from our program. Jayson Davies Oh, wow. Talk about an occupation base. Like that's exactly what we do. Awesome. Love it. Polly Benson It was so fun and being creative because I had to problem solve, how can I, you know, replicate driving and holding your arms up on a steering wheel or the bounce of the impact of a chair or, you know, sometimes we would have a forklift driver. Well, that's extremely hard to replicate. But I could get to a local company and work out a deal where we actually borrowed a forklift, and he would drive it in our back parking lot, you know, and we got some empty crates the skids. And he would move them from one end to the other. So just like where you're moving weights, and you're working on carrying milk crates and helping these clients to become stronger. We did it with big equipment, too. We just had an opportunity to be creative and problem solve and something I've always enjoyed. Jayson Davies Wow, that sounds really, really fun. Polly Benson Yeah, Jayson Davies it just reminds me of the last physical attitude before getting my last job. I had to go win and they had to, I had to lift up like a 50 pound. Polly Benson Uh-huh. Jayson Davies I don't know the cart. I was like, Why do I have to do this, but whatever. I guess we work with kids, and they want to make sure that we're not going to hurt ourselves if we pick up. I don't know how old How old is the kid before they go over 50 pounds in second grade, maybe? I don't know. Very true. Very true. So that was kind of where you started, but obviously, you did end up in the schools. Tell us a little bit about your school-based OT career. Maybe some of your preferred parts of it. And maybe some of the difficult times? Polly Benson Well, initially, I wanted to get into the school system because I had young children. So I wanted to, you know, pursue having a similar schedule, similar days off, similar vacation schedules, things like that. And so I had a company I had been working outpatient OT and what I was doing for them was actually functional capacity evaluations. And sometimes I would go to the job site and help to modify a job site like if someone had a computer workstation, I might recommend equipment for them. So within that same company, I would like to start doing some schools. And she had a couple of school contracts that were coming open with a severe to profound school. So a lot of people in school-based OT are in regular, typical type settings. So this was a specific school for severe to profound kids. So my first experience, in fact, my first day on the job was quite eventful, because we had a student with self-injurious behaviors, a helmet, and was like punching himself to the point of blood. And it was scary, but yet so interesting to me at the same time, and I just learned how to do the IEP process. And I learned, you know, how we can incorporate functional activities into a school day and the function of being a student. And how do you work with a special needs student that, you know, needs to learn how to write, but then also needs to know how to drink and eat. There are other students that it was behavior and skills and social skills. And so it just really was a fun transition to move from adults to pediatrics, and really see a whole different side of therapy. Jayson Davies Wow, yeah, that's very different from work hardening and working with adults to move into Polly Benson Yes Jayson Davies Severe population with students who have a lot of needs. Polly Benson Right? Jayson Davies That's a big change. Polly Benson Yeah. Jayson Davies So were you at that school? Are you still at school... Polly Benson Yeah, no, that school is in Ohio, and I was there about five years, and then I transferred to Atlanta, Georgia. And so when I came to Atlanta, Georgia, I applied at the school that my son goes to, and they had a contract agency. And so when I interviewed and got the job when I started working with I was placed at a school where I was going to work with a therapist, and I said, Well, I'll take all your severe kids and your, you know, EBD classrooms, and she was like, Oh, my gosh, how that is, you know, she didn't have a lot of experience with it, it kind of scared her. But I was coming into a school system with a lot of experience and how to deal with those severe behaviors. So that's kind of how I got my initiation in my current job where I was working with students that were severe. And then as the little guys kind of scared me, I learned my way into the little pre-K. And how do I do with these typical children who, you know, it's one thing when an adult child or an older child doesn't listen. But with the little children, they're still learning how to listen, right, and they're still learning how to follow directions. And so that was quite an interesting transition. And the way that I moved into that job, too, but of course, eventually fell in love with so many of these sweet, sweet children, and whether they had autism or Down syndrome, or whatever their issue was, I just really found, found my place there with the kids. . Jayson Davies Gotcha. All right. So in that school-based realm, was there anything that you've just truly felt? Was it the difficult part of the job? Was it maybe the IEP is all the paperwork? Was there a specific population? Was there something that was just always a struggle for you? at all? Polly Benson I guess Initially, it was more of dealing with the rules and regulations on what you could do in a school-based setting versus what was typical of a medical-based setting. So even though I had a lot of medical background, I had a lot of rehab experience. And then even though I was in school, at in Columbus, that was a severe profound school, there were still a lot of medical issues. So it was still somewhat of a medical model was okay, because they were very much like, do whatever you can with these kids, we're just here to help them. So when I moved to Georgia, and it was very much it has to be in the IEP, and it has to be school-based and we can't overlap with the medical outpatient therapist. So that was probably the most challenging thing initially, as time went on, then it was more about you know, communicating with parents. So that's trying to get them to carry through and follow through on what we were doing in the classroom. So but I always enjoyed the kids. I had great teachers. I was fortunate every now and then, you know Try to get something implemented. And it may take a while for people to buy on, you know, with your theory, but eventually, they could see where OT was definitely helping students. Jayson Davies All right, perfect. No, I couldn't agree more with that. And, and I think all occupational therapists and occupational therapy assistants right now, I think if there's one takeaway from the past year in the pandemic, and whether you were doing treatments online for two weeks, two months, or the entire past 16 months, we have had so much more communication with the parents. And I think that's something that a lot of OTs have taken away is that they've been able to communicate with those parents and see that, that overlap and see them carry over things that they teach them, and then come back a week later. And they say, they tell us like, yeah, we actually use that tool, like every day for the past week, and you're kind of excited. So... Polly Benson Yeah, definitely. For sure. Yeah. Jayson Davies All right. So I'm gonna ask you one more question before we jump into the Legiliner. And that is, what were some of the tools that you used before you had a Legiliner to help kids with handwriting. Polly Benson Okay, so yeah, we... I tended to take a typical approach where, you know, we did handwriting on paper, we did color pencil, you know, we're trying to motivate these kids to enjoy writing. So I would have all sorts of different sizes of paper and thicknesses of paper and paper with yellow lines, paper with raised lines, we try to incorporate coloring and cutting, gluing, you know, fine motor skills, some type of warm-up with putty, or building Legos, and then fine motor manipulation. So, you know, as far as handwriting, and worked a lot on grasp, and fine motor skills and my tools were limited to worksheets or papers that I had in the classroom. And I found that when I would send that student back to the classroom, that they ended up, not always carrying fruit. So that was where I first had some challenges. And in the handwriting is carrying over into the classroom. And the student might have had a workbook like science or social studies workbook, and they had a box that was like, Yay big, where you had to write sentences. And they would write one or two words, and they ran out of room. So hand drawing lines for them asking the teacher to draw lines, or I would give them extra paper like this paper is working really well in our classroom? Would you please have them answer these questions on this paper? And then we could see that the student would have that practice in the carryover. But what we didn't see was good organization skills. So a lot of the kids would lose their papers. And, you know, we tried, we even did things like dictating or copying, you know, you dictate into a phone, and then you copy that on paper and email that to the teacher, you know, things like that. So just a lot of challenges with getting that carry over into the classroom. Jayson Davies Absolutely. I think every occupational therapist is nodding their head with you right now, because we've all experienced that, you know, you talked about that box, and you know, teaching both the kid and the teacher hey, can the kid just put like a number one in that box? And then on a separate piece of paper, right, number one, and what goes in that box or something like that? Yeah. But then you do have that, that organizational difficulties. And the two papers get split up, and they’ve never seen each again together? or whatever it might be. So yeah, definitely. And I'm the same way. I've always tried to work with the teachers. And I would always tell them, you know, at least add lines into those boxes, you know, especially with what do they call them, like the big bubbles, there's like a story bubble, right? You have one idea in the middle, and then you have paragraph number one in this bubble, paragraph number two in this bubble, right? Polly Benson Graphic organizers Jayson Davies Yes, there we go. Graphic organizers and they never have lines. Never right. Man. So with that, go ahead. That's the perfect segway. Go ahead and tell us a little bit about the Legiliner. Polly Benson 14:07 Yeah, so one day, I was just thinking, you know, we just, we were hand drawing lines. So I was trying to draw with a ruler, a solid line, a dashed line. And a solid line. A solid line with a ruler is not that hard to draw, but a dashed line to draw it quickly, where it's not too big, or it doesn't make you know, the student can actually use it as a handwriting line. And then the next line I would draw and the space between the middle line and the baseline or the middle line, the top line was different, you know, and or be crooked or whatever. And so it just was such a hassle and I did a lot of crafting when my kids were little and there was a stamp called a roll a graph where you rolled a stamp line like pizza. So I have one here to show you. I know you can't see this on the podcast, but the roller would print patterns across the paper and it was really fast and I thought, Why couldn't I get a roller made with handwriting lines. So instead of a Paisley, or Instead, it was always a repeating pattern instead of Florida’s leg, let's do handwriting. So I contacted a company that did custom roller graphs. And I had a roller graph made with a running line. And it was not cheap. It was like $30 plus shipping. And so, but I had one and I knew that it was just what I wanted. And so I started taking that into the classroom. And it's a self-inking stamp. And so I would just roll out some papers really quick on that graphic organizer, and I had people's like teacher's jaws dropping, like, Where can I get one of those? And my intent initially was just for myself, it wasn't really to sell them. And I'm like, Well, I can't really sell something that's $30. And market, what market up to 60? I mean, that just wasn't in the works, right? So I just kept using it and saying, well, it was a custom one I had made. And so a lot of great feedback. And a lot of people said you should patent that. And like well, I can't patent role graph, sorry, patented. But, you know, maybe I should design something that is similar, that would be a self-inking rolling stamp to drawing and writing lines. And so I went down the process of applying for a patent, and I got a provisional patent. And then I had a year to come up with the design and figure out how I was going to manufacture something when I had no business experience at all. So that was quite a year that I learned so much in that year on how to move from a patent-pending prototype to an actual product. Jayson Davies Absolutely. That's amazing. And yeah, I know none of you listening can see the item right now. But be sure to check out the social media pages for OT School House, probably even Legiliner, and you'll probably see the original version. And we'll actually put up a picture with the comparison between the original and the current version. So it's a good comparison to see. Alright, so you actually went through a lot of that pretty quickly, I'm going to have you break it down a little bit more. And I want to ask you, do you remember a particular moment or maybe even a particular conversation that you had with maybe someone you're working with your husband, whatever it might be that you just knew you had to create this item? Polly Benson Yeah, I guess, you know, there was enough feedback from teachers and OTs that I just knew that it was something that I want, I finally decided I want to do this before someone else does. And so as I went down the process of figuring out how to get something made, I had a prototype in my head and trying to get it on paper, I could not believe that this did not exist anywhere. And so I ended up researching and found on the internet, a security stamp. And it was a rolling ink stamp that drew out patterns to blackout people's names and addresses and account numbers and things like that. And I was like, that was more of the size I was looking for. And it was more of the style is pretty much exactly what I wanted. But I needed to figure out now how do I get a custom one made. And so that spun off a lot of samples that I ordered and looked at and decided I wanted something high quality, I didn't want it to fall apart. I didn't want the cheapest thing out there. But I knew I was going to touch my name to do it. So I came across these security stamps and ordered some. And in order to get my own pattern. All of a sudden the cost was you had to get 1000 minimum. And so that was a big like moment where I was like, Okay, this is a commitment now and do I want to order 1000 in a custom pattern and told my husband I said I'm I want to do this, and I got this patent pending. And you know, all of that could kind of happen behind the scenes. I didn't tell until after I paid for the patent that I was working on a patent are you talking about? So I kind of jumped the bullet on that one a little bit. But anyway, so he said to me, okay, hold on, hold on. I don't know if this is going to be successful. But he said if you can sell 100 presales, like if you can talk to your friends and teachers and whoever you know and sell 100 then that'll give us some seed money and get some feedback. And then I'll let you order them. So that's kind of where we started and I created a website and I put it out there and there's actually a group I think you and I are both a member of on Facebook, OT-PT school-based OT group, and put it on there. And just had a couple of friends buy it up until that point, and then all of a sudden that day, like it was like Ding, ding, ding, and I was having these sales and I'm like, Okay, this and my husband's like, okay, that might work. I think we're good. So, you know, we'll let you move forward. So I ordered my first 1000. And the pre-sales were still kicking in. So it's kind of like a Kickstarter, but I did it on my own. And then after I'd sold, I forget how many exactly, but I was like, Okay, I really want resizes. I don't think as an OT, I work with so many children that one size does not fit all. And so that's why immediately before I even had my first shipment, I ordered sizes two and three with that seed money. And so we had all, all of them come at one time, so and that also saved on shipping. There's a big difference between shipping locally and internationally versus having freight. That was a whole new world to explore as different freights and freight prices and bigger shipments. So yeah, yeah, like the learning process. Jayson Davies That all scares me a little bit. And that's why all of my products are completely digital, still. Polly Benson You have to use your sensory calming, and you take one breath at a time and one step at a time. And that's what I did. I was like, okay, what's the next thing? And okay, I find a new term that I had to find the definition for. So, okay, what's this mean? And I contacted somebody else that I knew did shipping, and I'm like, okay, explain the difference between freight on board. And, you know, what's the less than truckload and you know, I had no idea what these terms were. And now I'm helping other people to understand all that. Jayson Davies Wow, well, congratulations. And wait. I remember all of that happening on the Facebook group. Obviously, I didn't know you back then I didn't know all the behind-the-scenes going. I kind of figured you were doing something like this. Because obviously, you weren't just going to order 5000 pieces without having anyone ready to order one. But I remember that happening. I remember the Facebook group. And I remember it quickly. I mean, everyone was very quick, like, Oh, my gosh, this is amazing. I want one. I remember going to the website and seeing it sold out. I mean, I got lucky, my district was able to get me a few. I don't know how they got them. But they got me relatively quickly. But yeah, that's, that's awesome. Polly Benson We started in May of 2019. And then I ordered in June, and they came in July. And it was about October that then I went down the path of how do I list something on Amazon. And there was a lot more to it. Because I'm my own brand. It wasn't like I was listing a product that already existed. So I had to learn how to get barcodes. And I had to learn how to put barcodes on the packaging. And I had to learn how to package it to ship it to Amazon and do amazon prime. So we didn't end up doing Amazon Prime until 2020. But in January of 2020 is when I sold out. So some people got a hold of the Amazon listing and shared it and it started to just share like crazy. And within I think it was a day and a half, I had about 4000 orders. And I did not have 4000 stamps. So that was that that was a really fun day. It was right the day before my birthday and kind of ended on my birthday. And it was like wow, happy birthday to me, this is definitely going to be something that's going somewhere so Jayson Davies Awesome. Polly Benson That added some validity to it as well. Jayson Davies Yeah, I bet. So you've given us a little insight into the experience of just being the owner of this item and selling it to people. Do you recall maybe a specific reaction from a teacher or from a kid even that first time that you showed it to them? Like what was the first time that maybe a student? You rolled it out as soon as like, I don't know, what experiences have you seen that just kind of made you feel really good as an OT the develop this, this product for a kid? Polly Benson Yeah, I mean, I would say the feedback. 99% positive. I mean, I've had, like, teachers say, thank you so much. This is awesome. I've had students enjoy drawing their own lines. But I think in relation to your question, you know when I've had students working with the Legiliners and progressing through so I have 13 different patterns now and to be able to see them move on to a new size, they get very excited about that. And they're like, are we gonna draw those legilines? Can we draw legilines today? And so asking questions like that has been very rewarding. Having friends that I don't even know have that I bought one for my niece or my guy like I just put it on my personal page and to hear people say that running into other people in Facebook groups. And I might recommend the legiliner and a coupon. And they're like, Oh my gosh, you're the owner. I'm like, yeah, and so they're flora that I'm just like you and I am in this group, and I am sharing ideas. And I am hopefully helping you, and you're helping me. And I started as an ambassador program and working with people that just want to share the legiliner because it has helped them and their students and for no other reason. But just to help and to get the word out there. And so we're continuing to grow. We're hoping someday to be on Shark Tank we have applied. So fingers crossed, that's one place, we need to scale, we need to get the word out, and we're still growing. So you can say to me, you knew me when? Right? Jayson Davies Absolutely. You need to send in a podcast to them to get some credit, you know where to? Right. Alright, so I was browsing your website a little bit earlier. And I saw that you guys have a mission on there. And I wanted to ask you a little bit if you could share your mission for the legiliner with everyone listening. Polly Benson Yeah, so you know, it started off. As you know, I really wanted to help kids to have a tool that they wouldn't be embarrassed about. So pulling out a big piece of adaptive line paper, could be embarrassing for a student like they're in third, fourth, they're in later grades, and they're still working on handwriting. And so that can be an embarrassment and trying to give the teacher a tool that she could quickly draw some lines, where he wouldn't really be different, he could still work in the workbook, or he could still work on the same worksheets, we didn't have to adapt too much and give them extra paper. So the idea initially was also to empower the student to have a love for handwriting, but to empower the teachers, so that they could just be able to have a tool that could quickly draw lines for any student that needed. So you know, with UDL, Universal Design for living, it's all about grading accommodations for kids that everyone can benefit from. So something like where we would draw lines on a worksheet, she can then make 15 copies, and everybody can use lines, you know, on the younger grades, kindergarten, first grade, where they're all working on handwriting, it allows you to adapt the other subjects, we can use them for math and working on numbers. And so I really want to empower the teachers and the students to have a love of handwriting, I had quite a few ABD kids and some boys that just could not stand handwriting. And so you know, it was forcing them to copy or to do a writing assignment. So allowing them to at least draw the lines was fun, first of all, but then to have them we've come up with a lot of creative ways on our Facebook group to have them practice handwriting without seeming like, it's just paper and pencil activities. And they might draw the line on a project construction paper on a box on cardboard, you know, where can they draw the line and can we've had people come up with some great ideas like draw legiline, and then cut down the dashed line. So it's a cutting guide, and teaching kids how to cut and, you know, being able to write in color rainbow writing, trying to do, I give out a free worksheet every week that are adaptable to use with many different legiliners. So that's kind of where the empowerment piece came from. And then, because it was successful, I wanted to give back to my community. So I like to give both financially to special needs community, to dyslexia, to autism foundations, things like that, giving back the money to these organizations, but also giving away a lot of legiliners, I love to give away, I love to just find someone that's posted something on Facebook, and they were struggling with their student. I'm like, I want to send you a legiliner right now. Like, just send me your information. And so my heart goes out to struggling writers, kids that are struggling parents that are struggling with getting them to follow through. And also just financially. I've been blessed. And I want to turn that blessing around to other people. Jayson Davies Yeah, you know, and I did see on your website, actually, right at the top. I think it says that you donate a certain percentage back to students with special needs, right? Polly Benson Yeah, so it does say 10% I actually have been giving more than that. And I'm proud of that. But I do try to give at least 10% back to the community. I'm actually trying to work on a handwriting club program right now where I just want to sponsor so if there are some therapists listening that want to do a handwriting club this summer, I'm willing to give you funds if you're willing to run it. So I have a few resources. I've done handwriting clubs and handwriting camps in the past, but I want to financially support other therapists, so if someone's if money is the issue, and it's holding somebody back, please tell them to contact me. I'd love to get more involved in sponsoring handwriting clubs. Jayson Davies Definitely. Wow, that's amazing. I have been seen on the Facebook groups that people are getting, I mean, entrepreneurship right now. It's just like the thing. And people are looking for ways to do side hustles. And I've been seen a lot of a lot on the Facebook groups just like, hey, thinking about doing something this summer. And I know people are looking at handwriting clubs, starting a website, or whatever it might be. So yeah, hit up, Polly, you can see your will make sure and you're going to give out your information in just a little bit. But we'll make sure that it's all in the show notes. So just visit the show notes for this website. And there'll be a link to the email her website and all that. So awesome. Polly Benson Sounds good. Jayson Davies All right. Another question about the legiliner. And you know, stamps are not a new thing. And you've talked about this a little bit, how you had to go and kind of go out of the way to get this large thing and it cost 30 bucks. But why do you think it took so long until 2019? For a teacher or an occupational therapist or something to kind of have the mindset to do something like this? Polly Benson Yeah, you know, I don't know. I mean, for me, I started thinking about this back in, probably was 2013 or 14. And I just thought, like, I wish I could just create a stamp, but I never went down the path and made that first step. So I think is OTs and problem solvers. You know, we know what needs to be done or what needs to be created, but we don't ever think, Oh, I could do it. And I think it's the confidence and trying to take the next step. So, you know, if it was an overwhelming emotion for me to feel like how can I get from point A to selling like to point z? You know, how do we get through all that, and it's a big task. And so it just took a deep breath, one step at a time. What's the next thing I need to do? So I just started contacting stamp companies. And can you make something for me? And have you ever heard, have you ever do you sell self-inking stamps? And, you know, we had made hand stamps for a lot of students that needed to stamp their names. So they couldn't write their name, but they would do some type of a signature, and we would transfer that and make that into a hand stamp. So they could sign their name. And it's like, Okay, well, I could do that white, and it just started rolling. From there. Let's get the custom stamp. Let's do handwriting. And I remembered the roller graphs. And when I first was trying to design my own, I was trying to design it like a pizza cutter. And that's what the roller graph looks like a pizza cutter. But you know, it didn't have a lid and it didn't have anything. And I wanted something that was self-contained. And that would cover the ink so it wouldn't dry out and wouldn't get all over the place. Jayson Davies Yeah, that's awesome. Polly Benson I don't know why it took so long. And yeah, so many people say, I wish I would have thought of that. Or why did we think of that? Or we should have done this? And it's like, yeah, so I mean, that's definitely a feel-good feeling when you hear that? Jayson Davies Yeah. Now anyone listening? You just got to take that own your own idea that you have right now and just know you got to go for it. Two things real quick, Polly. First of all, it took you five years. It sounds like from that original idea to actually build up the momentum and go for it. So for anyone listening. Yeah. I mean, if you feel like you've been sitting on something forever, and it's only been two years, it really hasn't been that long. There's still a lot of time ahead of you. Polly Benson Yeah, yeah. Jayson Davies And the other thing, Polly, I'm sure you've already figured this out, but you're not to letter Z and a list of things you have to do. I'm sure you figure it out. Polly Benson Right, right. There's still more to go. Yeah. Jayson Davies Yeah. Might be around with a J or something. You've got a lot to do, I'm sure. All right. Awesome. So you know what, we're getting close to the end now. But I want to ask you this skill. What? What have you learned in this process? The whole, you know, from 2013 to today. And designing, building, patenting the legiliner that you think may be a skill you've learned has made you a better occupational therapist today? Can you think of something that's just really helped to be even better today than maybe you were back in 2013 or before? Polly Benson Well, I think one thing that I've morphed into over the years is a giving person and always trying to think about the other person versus myself. And I think working with special needs has really taught me that. It's not about me or my schedule or my agenda. It's about you. And I think that one of the things I really try to promote within my business is good customer service. I tried to, you know, replace something that might have got damaged in the mail or lost in the mail. I mean, when I went viral, lots and lots of packages were lost during COVID. And I tell everyone, well, it must have got quarantined and it never came out of quarantine. So, I mean, I'm a therapist too. And I would want someone to treat me that way, I would want someone to replace those items that got lost by the mail system, you know. So that's kind of my goal is to treat other people how I would like to be treated. And I'm not a big box company that sees you, as you know, dollars, I see you, as a therapist, a teacher, you're struggling, one of the things that I designed with the half of my stamps are refillable ink. So I kept it in mind that I didn't want something that would only last a couple of months, and then run out of ink. And so it is an oil-based ink, I'm still using some of my original legiliners, they have not dry as long as you tap them, they don't run out of ink. And I have a video that I'll be posting, I was in the hallway of school one day and went up and down and back and forth. This big long piece of butcher paper, making my little roads, you know, some people call them the little roads is the, you know, adaptive handler writing lines. And we did over 15 passes. And it was probably 100 200 feet long of paper. And so it was a long piece of paper and it didn't run out of ink like and you could stop and I had to stop hesitating. I was on my knees up and down the hallway. So I had to stop. But then as I started again, it was dark again. So it's like a sponge that has the ink in it and has to kind of reabsorb. But they do last a long time. And six of them are refillable. And it's important to me that it's cost-effective for the teachers and the students. But I want you to see the value is not just in selling the stamp, but sharing my OT knowledge with you and creativity. And so in our Facebook group, we've got lots of creative people that post new ideas and ways to use the legiliners. And like I said, for the cutting, we use them to draw roads and little maps, we have one that's a number line. And my initial thought behind the number line was just a number line. But someone said, Well, why couldn't you use the spaces between the tick marks for writing, if you're working with an older student that's working on spacing their letters, draw a number line, and I was like, wow, that's brilliant, you know, and I do try to listen to the feedback that I get. I have an ambassador program where they do give me some feedback on ideas that I have. We're working on an exciting new stamp that I can't tell you about. But if you people listening want to follow me on Facebook, you might get some glimpses of some new stamps coming out, hopefully by the end of summer. But we're working on a new patent for something that therapists frequently use in handwriting and but I do listen to feedback and suggestions. And I had someone suggest the boxes and we made the big boxes, which is a three quarter inch box like the handwriting without tears. But we're using two-color patterns and make games and not just for copying, but for numbers and had someone suggest making the squares. And so we have small squares coming out this month. That's our newest one. And I had a speech therapist say that she wants to use it for data collection. So how awesome is it that it's not just for writing? And they're not just for, you know, number line or music line. But they're for other options. And there's just a lot of versatility to them. And I love hearing the creativity that people come up with. Jayson Davies Yeah, and you know, I had a question earlier, and I skipped over. But I want to get this out there. How have you seen teachers, kids therapists using this in the classroom? Are you seeing some teachers or schools order one per kid? Or maybe are they potentially getting one per classroom so that all the kids can share them? I know, half of the time you've been selling them we've been in a pandemic? So that's obviously a little tricky. But what do you think would be a great way for a school district or a school to potentially implement this? Polly Benson Yeah, so typically, what I see is more of a classroom setting. So the classroom might buy two or three and within a range of the ages that they're working with. I've got therapists that buy them kind of as needed. Being in the ambassador program, the ambassadors can earn some free ones, and so they can earn the exercises. And then whenever we come out with a new one, we do send those to the ambassadors ahead of time. You know, I think one of the things that I also learned as an entrepreneur is how to accept a purchase order so many people were like, Can we get on your Can you be an approved vendor so we can buy these for you. So I'm an approved vendor on lots of schools’ lists and figuring out how to accept purchase orders has helped them too. So I've seen OT departments buy 30 for their 30 OTs and then the OTs go out and use them and then the teachers see them and then they want them So we provide discounts, codes all the time for book discounts or, or we have on our webpage, if you're just a single person and want to buy a few of them, we have an option to bundle our legiliner. So instead of just paying $15, for one, you can bundle and save 5% on two or 10% on three. So as a frequently as a gift to different influencers and different people, we offer a discount. And I think we when I talked about that a little bit before, so we do have a 10% discount for your listeners. And so they can just buy one at 10% off and try it out. So that's the benefit of having a connection like that. Jayson Davies Awesome. And I think you said that that promo code will be OT School House one word, all capital letters, right? Polly Benson Right, OTSCHOOLHOUSE all one word, all capital letters. Jayson Davies And you can do that at legiliner.com. Polly Benson Right. So you enter the code at checkout. Jayson Davies Perfect. Yeah. And I just want a second of what you were just saying though, that's exactly what I was doing as far as, as an occupational therapist walking into a classroom saying, hey, teacher, check this out. This is awesome. I got my hands on it. Sorry, no, I can't give it to you. Because I only have one of each. But I will show it to them. And you know, I can't, I can't force them to buy it. It's on them. If they want to get it, which they all like it. It's on them to go a little to the next step and say, Hey, Principal, hey, special ed department, whatever it might be. I'd like to order some. But yeah, I recommend at least having your own personal set as an occupational therapist. Right. And that way you can, you can share the benefits. Yeah, real quick, you've already mentioned, I think most of them, but how many totals are there now? Polly Benson The 13th, one comes out this month. And I have on my Facebook page a special little discount that might have to do with the number 13 on a pre-order for that one. So that one is the small squares that it's just a single line of squares, the boxes that we use as a double line are intended to be like, we're going to write out what you have to direct copy. And then the student can copy below. And then as they progress, they can do two lines of text on their own. But we came up with that idea for 10 frames. So in kindergarten, they use 10 frames for math. So that's why we came out with the bosses. But yeah, we started off with just the three adaptive line patterns, we moved into two solid lines as they use in handwriting without tears, the three-eighths inch and the 1/8 inch. And we came up with music lines. And now we've added a warm line that has that fourth baseline to show students where to stop, we just added dotted third and double-stack most recently. So those were both added in March and April. And the dotted thirds are a lot of times used in cursive. So the dotted line is where they call it the go-through line. And the top line and bottom line are solid. And so that's the stuff lines. And so that's been really efficient for cursive. And then I also have space so the spaces stamp can help students to space one letter at a time it's one inch It is my tallest stamp at a one-inch height. And when kids are beyond the spacing needs, then the therapists are flipping them upside down and having a broken top line because you really don't need the solid top line as much as you need the solid baseline. Jayson Davies Gotcha. Okay. Polly Benson Yeah, lots lots of options. And like I said, follow me on social media. You might we're all excited about one that's coming up, hopefully by then the summers. Jayson Davies That is exciting. Awesome. Well, Polly, we thank you so much for coming on. I want to give you just really quickly a chance to share where you think people can go right now if they want to learn more, visit the website. I know you mentioned social media just kind of want to maybe share were you, legiliner. Polly Benson Yeah. So if you go to my website, legiliner.com, you'll see a pop up on there where you can join my email list and I won't spam you but I will send you a set of five emails to kind of tell you a little bit more about legiliner and where you can connect with us on social media. I am at Legi-liner on Facebook and Legiliner Community is our group where we share all the fun ideas on not as much of an Instagrammer but I do put out a worksheet every Wednesday and so you'll see a post on Instagram. I'd love some Instagram followers. I'm hoping to maybe by the end of 2021 get up to the 10,000 followers so I can do the swipe up I guess level that you hope for. We have about 15,000 or more on Facebook that follows us And so yeah, those are the two main places is the Facebook business page, the Facebook community group, and Instagram but that all comes in the series of five emails So if someone just wants to go to my website legiliner.com, then they will get that series of five welcome emails and they will hear from me. So Jayson Davies They also get like 150 that they can use or something. Yeah. Polly Benson So as a thank you for signing up for my email list, they get a list of 150 themes that you can use for teletherapy. And a lot of times, you'll see my worksheets are following those themes. So we're putting out more and more worksheets every Wednesday that follow those themes. And we're adding more to the themes as we go. So it's, it gets you a lot of value for that too. Jayson Davies Awesome. Love it. All right, Polly. Well, thank you so much for coming on sharing a little bit about you your background, and of course, the legiliner. I look forward to using my legiliners and I'm sure many people listening are thinking the same thing too. So thank you so much. Polly Benson Sounds good. Thank you for having me. Jayson Davies Definitely Take care. Bye. Polly Benson Bye. Jayson Davies Alright, everyone that is going to wrap up our episode today. Thank you so much to Polly for coming on and sharing with us a little bit about her background as an occupational therapist, as well as all of the time and energy it took to create a tool that all of us are using nowadays. Really appreciate it. Polly, thank you so much. Thank you also for listening to this episode. Really appreciate you being here. And don't forget to use promo code OTSCHOOLHOUSE at legiliner.com for 10% off your first order. All right. Take care and have a great one. Bye-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

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 77 of the OT School House Podcast. Today we are talking with a former school-based OT who is well aware of the struggles OTs come across while working in the schools. In fact, it is that school-based experience in conjunction with other OT experiences that led Joseph DiFrancisco, MS, OT/L, (AKA - Joe Friendly) to create a new line of adapted shoes for people of all ages! If you have ever had a parent ask about a shoe tying goal, be sure to listen to this episode. You may have a new favorite recommendation for those parents. After you listen, be sure to check out Friendlyshoes.com to see all the styles Joe and his team have come up with to support those who may benefit from an easy to put on shoe. Links to Show References: Friendlyshoes.com Friendly on instagram Joe DiFrancisco on Linkedin 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. The class is officially in session. Jayson Davies Hey there, welcome back for another episode of the OT School House podcast. Thank you so much for joining me today. Whether you're listening in the morning on your way to work, in the evening on your way home, or maybe on a walk during the weekend, I really appreciate you taking the time to spend a moment with me and talk about school-based occupational therapy. So today we are talking with a former school-basedOT who knows all the struggles of what it is like being a school-based OT, but we're actually not going to talk about OT too much. We're actually going to talk more about his new company. Well, it's not too new anymore. But he is an occupational therapist, he still has his credentials, but he has gone on to use those credentials to create a product. That is for all abilities, people of all abilities will be able to use his. Well, I'll just share the news. Now. It's an adaptive shoe. But it is a shoe that can be used by anyone. He's here to share it with us. His name is Jo DiFrancisco, and he is the Chief Friendly Officer as he likes to say, of friendlyshoes.com. So let's go ahead, we're going to jump into this interview. I'm going to let Joe give a little background into himself and his career as an occupational therapist, and how he came up with the idea of making that adaptive shoe for everyone, kids, adults, whether you have a disability or not. Feel free to check out friendlyshoes.com and the rest of this interview with Jo DiFrancisco. Hey, Jo, welcome to the podcast. How are you doing today? Joseph DiFrancisco I'm doing all right, Jayson. Thank you so much for having me. Jayson Davies Yeah, definitely. It's a pleasure. Well, we met about a month ago in an OT program, entrepreneur type of deal, right? Joseph DiFrancisco That is correct. I believe it was the University of St. Augustine and Tech, USA. Jayson Davies The USA. St. Augustine. Nice. Love it. All right, man. Well, so I'm excited for this one. And I'm sure many of those who are listening will also be excited. Because as school-based OTs, we often get the question, what about shoe ties? What about the student's ability to put on their shoes, tie their shoes and be functional in the school? I'm sure you've heard that several times already from pediatric therapists. There's always a big question about shoe tying. So before we get into that, though, I want to give you an opportunity to talk a little bit about your career as an occupational therapist, how did you decide to become an OT? And where are you today? Joseph DiFrancisco Oh, great question. So I'm not really sure how I really ended up in occupational therapy I know that I grew up with a single mother kind of influenced me to help others. I finished my undergraduate and about physical therapy, ended up finding out about this thing called sensory integration while I was doing my kind of PT assistant work under an orthopedic in New Jersey. And no, it just seemed like there was so much more to it. So much of the unexplained I had gotten the opportunity while viewing the physical therapy stuff to watch the OTs, watch these children coming in maybe dysregulated. And then in the coming out, you're like, this is a whole new kid and, and the amount of information you were able to get into their brains during this sensory stuff. And I just one thing clicked and I'm like, Oh, my gosh, I would love to pursue this. It turned out. I think that my family and I were kinds of sensory kids. We chose sports to get this self-regulation. And I pursued it and then up at Seton Hall University. Jayson Davies Nice. And so where did life take you after college? Joseph DiFrancisco Ah, that's a great question. I have two cars, here, there and everywhere. I had plans to move to Hoboken, New Jersey, I was going to practice in Manhattan. One thing led to another my roommate fell through. So I moved to San Diego. Jayson Davies Oh, wow, big change. Joseph DiFrancisco Yeah, big change. I had the opportunity to get into San Diego Unified School District here and so out, practicing, you know, anywhere from high school mental health, middle school, elementary got to do special education, early childhood. Before I had actually come out here I practice for a couple of months by taking six months in early intervention. So it's interesting to watch through the lifespan, how much you've learned and how you can implement these things you've learned into other areas of practice. Give all of your listeners a lot of credit, school-based OT is not easy. Talking about the IPs. Talking about the data, talking about the interpretation of the data. We got out here initially, I'll never forget the first kind of tape recorder I had in front of my mouth and you're trying to do the right thing. I'm trying to help you guys. Like why are you trying to record me with this Your advocate there like it was, it was a humbling experience. But yeah, you guys do great things. Jayson Davies Thank you, Ben. So you're not in the schools anymore, though, are you? Joseph DiFrancisco I'm not. I made two years. And then my mom got sick, she got lung cancer. And then I kind of bounced around had some questioning of my whole life future had this OT education, my back pocket and just trying to think bigger, how I ended up in shoes, you assume that I wouldn't be a physical therapist. So now I ended up in shoes, I hate feet. This was also influential in my decision for OT. So I'm no longer practicing. But we still do have a rapport with some San Diego unified schools and giving shoeboxes for certain class projects and stuff. So it's good, I have a lot more insight regarding bureaucracy with my six and seven-year-old, you know, My son was having some learning challenges and speaking to the teacher, and definitely, some eye-rolling there when I said that he's having potential challenges with his Virtual Education. Like, I don't see that and you're like, Yeah, Jayson Davies Sure. Alright. Well, you kind of started to bring it up the shoes. That's what we're here to talk about today. And so I'm excited to have you on exactly to talk about this friendly. When I met you, you first introduce yourself as Joe friendly, because you are, as I like your title, the CFO of friendly. So you know, when I'm going to give you a second to just kind of tell us a little bit about what friendly is maybe like that elevator pitch. Joseph DiFrancisco The elevator pitch is always changing, I hate to say that, I've definitely turned a corner to a bit of a businessman, but I always appreciate opportunities to speak to OT. My initial kind of vision was being friendly, was helping others. And in practice, you know, starting out with, with the seniors, because I at some point was doing when I stopped doing the school-based, I ended up in skilled nursing and then home health. And then they would give us these, these hip kits. You know, these, these long handle repairs, and tight, nothing was working for me, there's a doctor told me this would work and outside of the socket, this thing ain't working. So I do this. And it just would frustrate me. In Home Health, I was able to kind of almost be friends, a couple of my patients where he had taken me when he finished his service. And we did private sessions, affluent guy here in Southern California, real hard worker, honest guy. And I had to adapt, I was looking at the shoes in the market. Everything was kind of you to know, disability shoes. If you look at some of those orthopedic shoes of the diabetic shoes, or even some of these, like easy access zipper shoes, just the upper is affected. And it's cool. But you know, people want options. So I did the right thing. And when I initially started, I started doing the fabrication of the shoe just like an OT would do a hacksaw zipper. I think I stuck a door hinge and the opposite side of the opening portal, we have Well, no, I got really unique and ended up getting something that I guess you'd call prototype, I'm not really sure. I met a cool patent attorney out here that was nice. And, you know, was friendly, in regards to prices. So I buy "be friendly", "friendly" and "friendly shoes" for trademarks. And they all went through. While that simultaneously was going on I just, you know, I was still practicing. And then I was working after hours to try to push this into real shoe manufacturers and took a lot of I guess adversities and a whole bunch of companies that just couldn't do it right and ended up in South Brazil. And then we got a prototype and I'll never forget looking at it just like now I'm gonna have to do this. Jayson Davies The real, the real moment set in, huh. Joseph DiFrancisco Yeah, the real moment set in I had my trademarks. And that takes quite a bit of time. And when we got the prototype, right, we were patent pending. And then we moved forward. And now in this process, we managed to get two patents thus far and more kind of pending. So things have changed, you know, the humility of being an OT is fantastic of my business partners are way smarter than me. We got JD is it just an attorney and a Ph.D. with some Pfizer experience and research and just a real detail-oriented guys, but they’re not like OTs, they're not willing to make as many mistakes are not willing to adjust and the ability to adapt is really what influenced us getting here are the guys that are always about being perfect and making mistakes. That doesn't really bother me. Jayson Davies Awesome. I love that being able to make mistakes and continue on. Yes. All right. So you went through a whole lot and we're gonna break that down a little bit more for everyone out there who you know, most of us are school-based OTs, we don't know patents. We don't know trademarks. We don't know all that. So we're gonna get them to break it down. But you actually mentioned that you were in a skilled nursing facility a little bit and I'm not gonna lie, I did a little bit of LinkedIn stalking you. And it says, aging in place specialist. I think it's kind of what you have out there. So share a little bit about that. Joseph DiFrancisco Yeah. So in my kind of endeavors to think outside the box, I ended up finding the ability to age in place. When you work in home health, it's just you really, sometimes in a school district or within a facility, or you're operating in big brother's watching, so you have these limitations on what you could do with home health, it's the complete opposite, right? You're just like, oh, gosh, what am I going to do? I couldn't even explain it, the simple adjustments I was making within the home, that would change everything without actually going through the thorax, right? That would actually go through some of the stuff that we were kind of forced to do within the therapy clinic. You know, for instance, color contrast thing with painters tape in the bathroom, individual with Parkinson's. I once had a gentleman that was co-morbidities, he had Lewy body dementia, and Parkinson's, and the wife was just, oh, gosh, what do we do and like, I was kind of a middle-aged five years under my belt, I was a competent therapist, but I was like, I don't really know. But I'm gonna work really hard to help, you know, figure out what we can do. And she was totally cool with my honesty. And I'm just taking that painter’s tape hitting the books, hitting online, and helping this individual age in his space that he wanted to agent. I mean, it's, it's an amazing thing, to have them actually be in their, their home and their desire environment where you know, they have this last chapter in their life. So that's how aging in place specialist started the email. And when I actually met with contractors, and I did a certain certificate through the National Home Builders Association, I realized, I knew nothing about No, I stopped doing that. Jayson Davies Awesome. All right. And so you started to go down the route. Also, in the previous segment, we're kind of talking about how you grabbed a hacksaw, you grab some zippers and, and created this first, "prototype", per se. Do you remember this specific client or that specific moment when you were? I mean, is there a story really behind it, where you decided to, hey, you know, this person would benefit from it, and you went forward with it? Or is this more of a, I don't know, an accumulation of items, then decided, Hey, I'm going to try it out. Joseph DiFrancisco I would say accumulation. I had multiple people in mind, one guy, I would say was my focus. He was, we're a big military town over here. So, you know, shout out to anyone that you know, serves the country, I think it's an amazing thing. This guy grew up with nothing and earned, you know, everything. And he would just fall and like, be like, you know, I felt like, I gotta report this to your doctor doesn't do it. I felt like four times like he wasn't, he didn't really care that much. He had a stroke. You know, when I had him do hand stuff he like, hated me. I'm like, dude, you gotta you know, this is important for everything. So he was a stroke. So neuro, you always kind of taking that same clinical approach, when you're trying to invent anything. And it just stuck in it, whether with thought processes or keys is this individuals going to do this, from what position, right, but you've been sitting most of the time, how's he going to get the foot in, he didn't have hip flexor to get the foot up. And you know, if collapsible heel technologies and various other adaptive shoes, which is great for us, that are coming to market. So he had to be able to keep his hip flexor to what it was. So entering through the back was important. And that was a guy that helped kind of influence how I manufactured the first easy shoe access. When you get to that stuff, you don't want to know about the patents and trademarks. And it's a bit of a legal wrestling match with words they make up. But when you post it, you just have to be careful what you post when you post because you know, big companies are watching, so I'll leave it at that. But looking at this individual had you know, comedy is affected extremity, upper, and how to affect his, you know, affected lower extremity. And he did have some visual perceptual issues too. So, I mean, how can I make it best for I mean, we'll call him Bill. I did it. Didn't really realize that once you actually get the foot and you got to accommodate that aging two-story perhaps. Jayson Davies Yeah, I can just imagine just like, "Yeah, we got the foot in now how do we close it up over his foot and make it so that it doesn't come off while he's walking and so many other problems that go into that?" Joseph DiFrancisco Yeah. Jayson Davies Alright. So I have a question for you. And that is, I'm sure you didn't just jump out and say, "Hey, there's no other shoe out there. That is adaptable". I'm sure you did some research, did your homework a little bit. What other types of things were out there and how did you set to be different? Joseph DiFrancisco So I mean, I did this so slowly, and admittedly, probably not to my benefit, where You have Zappos adaptive that's out there that are now our partners. They really helped out when I filed for the initial patent and trademarks, they didn't even exist. So I just kind of I did what I thought was right. And during the process, I mean, I'm sure this wasn't the best decision because I'm not a very good businessman. Currently, I wasn't aware of any competition, I think there was an easy shoe, and something called hatchbacks. That was kind of cool. But they kind of look for me, like, the fashion element is super important. So kind of, I don't want to break on a brand. But I mean, not what I was trying to work toward having this normalized upper, and how can you meet, you know, we want individuals to be friendly, and kind of like, you know, show your disabilities cool, like, you know, don't be ashamed. But we want people to have options. And this was the biggest challenge. To your question, I probably could have done more research, but I was practicing full time. And I had my son that was under a year old during the time. So I did not actively identify all of the potential competitors. And, you know, to speak to the patent process, before these large companies come to market, they have the ability to audit your stuff. So a large company came to market with something that was eerily similar to my shoe. And I'm just like, Oh, no, we posted, and they use something called a continuation pattern to defeat the claims that I had. And then, you know, the competitor and me, kind of leapfrog them. And that's where we sit today. I don't know what's gonna sit tomorrow. Jayson Davies Gotcha. And so your shoes, they don't have they have laces on them. But there's no lacing involved, right? Joseph DiFrancisco 16:47 No, so we have elastics coming out. But that takes away the ability for tension opportunities. There's not that much research, but I feel like clinically, it's common sense, at least, maybe just for me. But if you don't have proper footwear, and you're wearing slippers, you're going to be you know, the potential increase in Fall probability. I mean, you need to have these on your feet, slippers move around, you don't get something that we've found in the research called fixation of the footwear on your feet. So all the laces are free, we do have one style called "our forces" that is more of a slipper, but it is intended in a wider foot to accommodate, you know, footwear issues like funyuns, hammertoes, all these, you know, variables that are associated with aging. So, ya know, we, I think we did well, in that keeping the free laces, we have pediatric lines coming out and based on feedback, limitations, when you don't have the laces, just not worth it. So it's kind of a set, you know, set it once and forget it. And then if you're going on long tracks, and you can't tie your laces at the one potential pitfalls, you will have to require assistance. But you know, the pros versus the cons. If you can't do it, then you can't do it. So you better be that way. Yeah, absolutely. Jayson Davies So then how is it going to be for kids who can't tie their shoelaces? Just like everyday wear? If they're at school and whatnot, what does it look like for that kid? That's going to have your shoe? Are they going to have to adjust the shoelaces at all? Or is it only? Not very frequently? Joseph DiFrancisco Great question. So our first line doesn't have laces at all. And that's our friendly force. It's a wider last. So you know, we have tried to make sure that it does have some depth, and something called the instep coming across the top of your ankle area to accommodate AFOs and SMO's and KAFOs. But if the child does have the laces, if you double knot it, you should be straight. We haven't gotten many issues. We're two years in now. So we've had we've gotten a lot of feedback. So should be set once and forget it, you double knot and there shouldn't be a problem. And the zipper in the back should, you know, it's a kind of separate, separate on the zipper and off you could do with one hand that was super important with me, you could actually do it without once it's broken and kind of like a baseball glove or that door opens up through that medial portal. You could do it hands-free, which was also important. If you have the balance, if not, right, you rest your hand on some type of surface to assist that ability. So you're always looking for different strategies, but that tension is super important. I just know the OCD in me is if the shoe is moving too much in the foot, it's not gonna be good. I agree. Jayson Davies I mean, growing up, I was always a kid. I had to have my shoes super tight. I played baseball, basketball, sports, everything. And yeah, it had to be super tight. If it wasn't super tight. Then I was like down on my knee making it tighter. So yeah, you got to have that tension. You're right. Joseph DiFrancisco The opportunity because everyone seems to be different. Jayson Davies I believe it. Yeah. Joseph DiFrancisco Now we have. My daughter's here talking to me more bringing out one of our new kids for back to school and she's helping us named Charlotte. What's the name Mr. sparkles. Oh, Princess Sparkles. As he said, Princess Sparkles and gold, pink Cheetah, and we're looking for real, you know, just to have that, you know, Flash, right to be able to have some swagger and your footwear? And I don't think it necessarily existed before. Yeah, we have two different types of easy shoe accesses and rear easy shoe access, which we do have the patents on. I mean, the uppers essentially look like a regular shoe. I mean, that was the trick. Yeah. And that was a difficult part. Jayson Davies Yeah. And you know, this is an all for the most part audio experience, we might cut this up a little bit and get some visuals, but friendlyshoes.com, right? It's where people can go and check it all out. Joseph DiFrancisco Yes, Sir. Jayson Davies Alright, and we will be sure to link to that as well in the show notes. So you can check it out. And yeah, you have the two styles that I saw was the heel cup, the one that kind of opens almost like a door in the back. It's like a little door. And then you have the other one correct me if I'm wrong, that opens up more like a what are the what are they called the Ferrari doors? Joseph DiFrancisco They kind of open up what is the full form of, yeah. Jayson Davies Yeah. So those are the two main ones are there more, you said something about a slip-on. Joseph DiFrancisco The slip-ons have that we call it front easy shoe access. And then we have rear easy shoe access. And the challenge with the rear easy shoe access as an OT, you know, your, if you bring the zipper line too long, you can't reach it, then you got to elongation pull tab, and that's where that publicly-traded company tried to really compete with us. And I think they lost to an OT and just one OT in that. Making that over open and stopping a certain area on the shoe, you had to make the opposite side of the zipper bendable. So you have a straight shot into the shoe. So making you know, if you have two firms it's called heel counter, it doesn't bend. So you essentially would have to hockey stop in, we make your zipper open. And then it just bends nice and easy. And then it's easy for the individual to reach for it. I think something that OTs would love is we added an eyelid in it. And some people think it's aesthetic. I'm not sure it gets used for this much. But it's for dressing. My goal is these I got to use this dressing stick or something. Because I'm not sure in 10 years of practice I ever saw it used for anything outside helping shoulder range of motion issues through an armhole and a shirt. So yeah, so the eyelid was initially made for a dressing stick. And as we're starting to go commercial and we're starting to scale. I mean, we're talking Canada, UK. We have an interest in New Zealand. We're sending them out in the next couple of days in Australia. They don't I'm not sure they people really realize but now we're just going with it, a dressing stick-holders. Now just part of the friendly story. You know... Jayson Davies I love it. OTs making a change in style. Joseph DiFrancisco And functional change. Jayson Davies Yes, absolutely. So from the zipper, the eyelid. What else have you guys done to make Friendly a truly friendly shoe for people of all abilities? Joseph DiFrancisco Oh my gosh. Alright, so I'm going to kind of give some information here at this podcast that I appreciate everyone being Hush Hush. So the simple thing, you have to make sure there's arch support, you have to make sure that their support shank or something in the heels. So you want to have the outsole firm, but not too firm has to have the cushion for individuals that might have co-morbidities we work on different pull tabs, so individuals with gross grasp, right, and individuals that have their fine motor are both able to do it. We are working on our kids and this is the Hush Hush. Don't tell these big publicly traded companies that y'all have them contact but we're working on sensory-friendly materials we're working on left-right discrimination. We're working on color contrast in certain parts of the shoes where it is visual impairment friendly. It's just the more and more information and the more shoes we sell, the better we get. Oh, I'm having a problem, and then you know, they kind of stick me in my dark area where I just think of how to solve problems and they push on the business stuff so we're always looking for different things of how to make it for all abilities. Our push toward having that front easy shoe access was because the rear easy shoe access no wasn't forced certain abilities. So this is surely not about the money for me at least. It just doesn't. My mind doesn't stop I guess. Perhaps my curse will someday be everyone's gift that their mind that just keeps ongoing. It's just I'm always trying to develop something new. I'm always trying to accommodate different people. That sensory-friendly stuff. I think a couple of shoe brands came out with color palettes to ease autistic children's effect or regulation and you like, okay. I'm back, see the research on that. So we're always trying to Google up always trying to talk to colleagues, we're working, you know, with a couple awesome publicly traded companies, I don't want to rip on them all on research that they might have gotten through their affiliations with pediatric hospitals, and all of that, you know, the context they've had, I said before, is Apple's adaptive has been absolutely fantastic. They've helped us in every way, including cash flow, you guys get the business, they have like, net, the 90s, net, 60s, net 45. So essentially, you have to, you know, bring the goods here, and then you have to wait a certain period of time before they pay. And they just mean, they really, they help us because they know the cash flows important for us to continue to develop, continue to get information based on their feedback, our feedback, and just create, you know, hopefully, something for all abilities. We all know as OTs that it'd be impossible to have one shoe for all abilities, but I'm hoping we get different iterations to accommodate all abilities. It's a big thing for me, like, I ain't making a disability shoe, I'm just not doing it. I want, you know, my vision is to have you know, a little brother, and the older brother, the little brother with a disability, like, you know, doesn't get to hand me downs from an older brother. And like that, you know, now he's going to take the hand-me-downs, his older brother that's typically developing maybe aspiring in athletics, he's able to, you know, little brother gets it. It's like, that's your shoe. And it's, you know, it just keeps it when you guys are wearing the same shoes. That's a real width challenge. We'll discuss that later. But that's my vision, all abilities. It's not a disability show. Jayson Davies I love it, man. That's great. Yeah, that's, that's full inclusion when we're able to have, like you said, one kid who needs it needs the ability to use a zipper and another kid who maybe doesn't need the ability to use a zipper. But hey, you know what, it works for both. They can both wear it. And that's awesome. So, I want to ask you this one, what has been the most rewarding moment you have experienced as a result of creating these friendly shoes? Joseph DiFrancisco Alright, you know, I've had a couple of them. Yeah, where you will, you know, and the first one I thought I was, you know, I knew what I was doing and shoe business or anything else you're getting into. Had a Ruth Segal, a Ph.D. professor at Seton Hall, they kind of said, "Hey, guys, your first two years, play conservative, you're not going to know what you're doing." And I'll never forget around the time I hit 2 years, like, everything slowed down in OT like I've seen a lot, you know, staying hungry, you're learning. I had a woman on our first day when we had our opening party at our pop-up store, and she couldn't put her shoes on. And well, then she could like, and, and she walked in and her husband, it was an Italian gentleman like myself are very family-oriented, and he got to take care of your lady. And you know, he's helping her in and she... you know, kind of slumped back and she puts on her shoes, and her posture comes up. And she just like walks out of his door. Man, it really was, it's, it's just an amazing experience. I had another couple of grown men shed tears when it's just, I mean, it's your ability, and I laugh with my colleagues all the time, I'm essentially with our video chat on friendlyshoes.com we have the ability to essentially give OT from afar. And if we can't, you know, accommodate their needs, then I'm going to put them some other shoe company that can that's just that's the way we are at friendly. And I've had a couple of grown men shed tears. I mean, it's just it's, it's that easy. You made the technology, the ability to reach out to scale now the ability to reach out internationally just we got a five star this morning from a gentleman with Parkinson's and I know Parkinson's well neuro was like my favorite thing and having these visual cues. The other thing in addition to the dressing stick was having the eyelid to create a visual cue for the individual with Parkinson's. And I know this is school-based but the visual cue helps in addition to carbidopa-levodopa and I send them in and the medication they're having with the dressing window where they have the most volitional control of their muscular-skeletal system so I seem to be getting them as their shoes get better and better I've become a bit of an addict of having these moments and unfortunate you know, to the other side of it when I cannot accommodate it, I take it personally and I know I can't touch that the scale but we are trying our best with our you know startup wrestling match we got going on here. Jayson Davies Good deal, man. That's so much going on. And I know you and me kind of had a little chat over email and like, you know what, what about the kids in school and you already mentioned it earlier that right-left discrimination being able to put the correct shoe on the correct foot. And one thing that I do like about what you have is that the way that the shoes open up, they almost kind of prompt you as to which foot should potentially go in, and it kind of looks like and you have the zippers They're on the inside, right? Joseph DiFrancisco Me outside. Correct. Jayson Davies So they're on the inside to also potentially not make them as seen as much. I don't know if that was part of the design to it, but they're on the inside so that maybe the zipper doesn't stand out on the outside. But yeah, I think that's great. Because I use stickers, I use Sharpies I use whatever I can to try and get a kid to know what shoe goes on what foot. And so I think that's great that even just a little design, but into you can do and it's not. Again, going back to will it work for every kid? Or does it only work for a kid who has right-left discrimination issues? No, it works for everyone. But it'll help that kid with a right-left discrimination difficulty. I love it. Alright. I know you're not doing this alone. So I want to give you a chance to talk a little bit about your partners, your... everyone working with you at “friendly” to make the world a great place who's all involved in this? Joseph DiFrancisco Now a great question. As I was kind of doing this, I had a CPA that was helping me with books at my aging in place specialist company once upon a time and we were talking we got the prototype to a certain point, as I said, and ended up in El Cajon, California and met a man named Edwin Lee was treating his father and his father had, he was preparing for hip replacement and preparing for a poster or entry or lateral approach, but he was going to have hip precautions. And I'm like, I gotta test this out. And now we just ended up talking and Edwin is he's a Ph.D. microbiologist that went to Berkeley for his Ph.D. University Chicago for his undergrad. And he's the brilliant quiet guy you got to watch out for in the room. You know what he processes and what you process are two different things. He's as trusting and honest as can be. So I met him and while we were working in a coffee shop and Little Italy, San Diego, we have this kid behind us. He's like, like, why is this kiddo? He's here. He's like, he's definitely listening. And he's on his computer. And that's the introduction of Ryan Garcia. Ryan Garcia is a gentleman from Hawaii. Waimea I think it's a big island. And he's a recovering attorney. He ended up being too honest of a guy to practice law, he had the opportunity to make a ton of money in personal injury law, which you call trial attorneys. And, you know, Ryan came on at the time he was a child author. he's a proud father. We both really I mean, how we develop our kids. Now they're developing side by side, we have both our girls and competitive jujitsu, and no gender lines. no stopping our killers are gals. So yeah, Ryan came on. And we definitely had no clue what we were in for in that first year, when you're penetrating the market. It's quite difficult. No one really knows about you. Your value propositions all need to be sharpened, your pricing needs to be sharpened. So you know, Edwin Lee, Ryan Garcia, no chance I'd be here without them. Our brains are so much different. And I think that's so important. He's a business undergrad, Edwin, as I said, was a research rat. And for me, it's all about function. So he started to grow from there. And now we have a designer in the UK, we have a shoe dog, and handles all that quality control and challenging stuff. So the team just kind of growing. And now we, you know, we try our best I know down the road, we might have to develop more of a corporate structure, but we keep it as family. For the time being, it's all about family. We have another structural engineer from Turkey. His name is Barack and he's come on since and he's our real computer Guru is stuff really well in person. It's not going to scale unless you put it on the computer and put it in the right column funnels, the ability to get the message out. And as we're developing these partnerships with Zappos adaptive, this company called Juniper that's out there and it's an adaptive market space this stuff, if any, y'all with your, you know, school-based thoughts. I know we talked at the gal at the USA event the University St. Augustine event, the Legiliner, just fantastic. And she's really thinking... Jayson Davies Polly Joseph DiFrancisco Polly Yeah, no, it's great. Y'all really don't know how good an OT mind really transfers to business. Jayson Davies The dog decided to come be part of the podcast, no problem. I always tell people it's a dog-friendly podcast. Joseph DiFrancisco Oh, yes. No, I'm sorry. Jayson Davies It's dog-friendly. I always tell people it's a dog-friendly podcast. Although your dogs good so far. Your dogs are barking it'll... Joseph DiFrancisco We'll see how she gets in the future. But she's not a barker. She actually was a rescue. And when you when you're a parent, you just learn to kind of let go of control in your house. That you could do. Yeah. Jayson Davies Awesome, man. Well, let's wrap this up with one laughs good question, I think here and that is what do you think the skill that you brought to the table as an OT really made Friendly be able to happen? What skill do you have that really helped to make Friendly come to life? Joseph DiFrancisco Great question. I would glad to hear that process, I would say perseverance, you know, being an OT, not afraid to get things wrong. I'm not sure I was diagnosed with a learning disability. Not sure I believed it. But I don't see letters as everyone else does is definitely visual perception. They call it SLD, a specific learning disability. So when you go into like paragraph form, I would have to rewrite entire books, break it up from my eyes, so it's an easier process. Yet the tactile, kinesthetic kind of learning, actually, like putting it down into the structure helped kind of get that in through an additional sense of perseverance, I got so much stuff wrong, developing as a child, it's not really that big of a deal to me, my mother was probably Middle School, you know, education. She was a high school dropped out, she dropped out by age of 16. And I did my Master’s. And I keep going, I just don't mind getting stuff wrong, like other people, just these are opportunities. I tell my son, a daughter this all the time that you know, if you're getting it wrong, like that's, that's actually the best thing you could do. But the issue is, if you don't study what you got wrong, and figure out why you got it wrong, it's not really that good. I just perseverance, I get it wrong. And then I study why, and then I fix it, get wrong again. Then I fix it. That's how we started this stuff, you know, alone, without anyone and this is years and years before we even entered the market, which was two years ago. So yeah, perseverance keeps at it. You know, kind of encourage anyone listening to it, you know, you have that advocacy for your students and you get stuff wrong and don't follow the book, per se, keep trying different things. Even in my parenting strategy, I'd be lying if I didn't use both classical and operant conditioning, a wooden spoon in the house, giving an auditory cue, really, you know, the way my mom used to do it, where they hear that spoon, and they're gonna respond accordingly. And then clearly, you got to have your know your positives, the positives in everything. But even as a parent, you get stuff wrong and you make adjustments and I think that will surely bring someone to the best place, whatever endeavor they choose to pursue. Jayson Davies Absolutely, can't be afraid to make a mistake here and there. Gotta be ready to go. So, Alrighty, man, well, obviously friendlyshoes.com. Is there anywhere else where people should check you out? Joseph DiFrancisco Yes. So we are, you know, helping Zappos with their singles program. So, individuals with these KFOS EFOs, SMOs, go to Zappos adapt, that they're fantastic. And for the first time ever, individuals with these orthoses can buy different size shoes, and there's no having to buy double. So I definitely encourage you to go to Zappos adaptive, you could get the kicks. And then if you go to Australia to a company called every human couple, the nice young gentleman over there ambitious, not afraid to get stuff wrong. everyhuman.com.au and yeah, no, that's we have now a juniperunlimited.com as I mentioned before, is, is another one and silvers.com in Canada. Jayson Davies All right, good to know. Sorry, when you said different sizes, you mean like a size eight for one foot a size nine for the other foot? Is that what you're talking about? Joseph DiFrancisco Yes, sir. You could buy. And we, not only did we reinvent the shoe, but Ryan, I guess the competitive nature and him had to outdo me for trying to reinvent shoes. So he redid the shoe box. So we have our friendly shoeboxes on the Zappos platform for this singles program. So you got an A a full you need a size eight and the right and your foot without that and about half size, sometimes full-size difference you by 7.5 in the left hand, no big deal, and they handle the returns and make it really easy for us. Nice deal. Jayson Davies That's cool. It's a good thing to know. All righty, man, well, thank you so much for coming on the OTs go house podcast really appreciate having you here. And I just love hearing about OTs that are doing different things in the world and making the world a better place. So kudos to you. And thank you so much, man. Joseph DiFrancisco Jayson, thanks so much for having me, man. Jayson Davies Definitely Take care. Joseph DiFrancisco Take care. Jayson Davies Alright, everyone, I hope you all enjoyed that real and candid talk with Joe. He is an amazing person super friendly. And he just has so much going on with friendlyshoes.com. I'm super excited to see where that leads to with Zappos and all the other big players in the shoe market. It's gonna be awesome. I gotta admit, I'm just so glad there's an occupational therapist behind the adapted shoe company that is friendly shoes. You know, just like me, and maybe some of you Joe started off in the schools and he has now gone on to create his own company. And I know he said a lot of terms that maybe you don't quite understand because you don't run a business. And that's okay. You know, neither myself nor Joe knew any of those terms, maybe 2, 4, 6 years ago, and we've gone to learn about it. As you said, perseverance is key. And as an occupational therapist, I like to think that we all have a ton of that. So whatever you might have in your mind, stick to it. Go on YouTube, learn, listen to podcasts, like you're already doing, and you will make it to be successful and whatever you want to be alright. So take care, enjoy the rest of your evening, your day, whatever it might be. And we'll see you next time on the podcast. Take care. Bye-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! 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Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 76 of the OT School House Podcast. Have you ever heard of the Schoodles School Fine Motor Assessment tool? I recently became aware of it and have now added it to my repertoire of evaluation tools that I can use. In Episode 76 of the OT School House, I am welcoming to the podcast the Authors of the Schoodles Assessment to further understand for myself why this tool is so valuable and how we as OTs can use it to support our practice as School-Based OTs. Please help me to welcome co-authors of the 4th edition of the Schoodles Assessment, Marie Frank, OTR/L & Monica Fortunato, OTR/L About Marie & Monica Marie Frank OTR/L Marie received her Bachelor of Science in Horticulture from the University of Minnesota in 1983. She went on to work in a variety of jobs and kept gravitating toward working with people with disabilities. She went back to school in 1994 and received a certification of the second major in occupational therapy from the College of St. Catherine. She has enjoyed working in public school systems ages birth to 21, clinical pediatric settings, and a regional pediatric treatment center. Marie has taught as an adjunct staff member at the College of St. Scholastica and provided clinical supervision to students. She has mentored occupational therapists in school settings. She is a presenter for Sensational Brain. She currently works with very young children and their amazing parents in Maplewood Minnesota. She lives in Stillwater Minnesota with her husband Ged Monica Fortunato OTR/L Monica received her degree in occupational therapy from the College of St Catherine in 1983. She has worked in a variety of settings including psychiatric inpatient and community outreach. She currently provides occupational therapy for children in the charter schools of Los Angeles. Monica is Level 1 certified by Handwriting Without Tears and has created handwriting programs that have been featured in the Los Angeles Times and on BBC radio and is a presenter for Sensational Brain. She has mentored occupational therapists in school settings and is a USC certified Sensory Integration therapist. Monica lives in Hermosa Beach California with her son Carter and husband Robert. Links to Show References: Schoodles.com 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 and welcome to the OT School House podcast. My name is Jayson Davies, and I am here with you today for the next hour or so because I know you're not gonna want to miss a moment of this one. This is an amazing episode that we have here I am interviewing Monica and Marie from the Schoodles Assessment. Some of you may have heard of the Schoodles Assessment. For others, this may be the first time you are hearing the silly word that is school and doodles put together to create an occupational therapy assessment called the Schoodles. You're not going to want to miss a second of this one because we are discussing the classroom skills as well as the support skills that the Schoodles Assessment tool addresses for occupational therapists. I am pretty new to the Schoodles myself. I've only used it a handful of times, but I'm looking forward to using it more in the future. And I know you will, too after hearing this interview. Not only are we going to get a quick introduction, actually a pretty extensive introduction into the Schoodles today. We're also going to quickly review the difference between a standardized and non-standardized assessment tool for anyone who's been out of school, I don't know maybe more than five years and just needs a little refresher on this. It actually really helped me so I'm happy that Marie shared that with me. So, let's go ahead and jump into our interview with Marie Frank and Monica Fortunato. They are both occupational therapists and sisters. Enjoy the interview. Hello, Marie. Welcome to the OT School House podcast. How are you doing today? Marie Frank, OTR/L I'm great, Jayson. How are you? Jayson Davies I'm doing pretty darn well. This is a Sunday afternoon. I'm enjoying myself and we just had a dog walk. So, the dogs happy. I'm happy. The wife is happy. Everyone's happy. We're so we're all good. How about you, Monica? Monica Fortunato, OTR/L I'm doing great, Jayson. It's great to be here with you. And just want to say thank you for everything that you do for school-based OTs. You are just pumping out the info and it's great to be a part of that. Jayson Davies Thank you so much. I appreciate it. Yeah, you know, we're on about Episode 75 ish now. And it's just amazing. We've been able to have some great conversations with OTs and I love it. So, let's go ahead and jump into it a little bit. Today we are talking about the tool that you all have developed, written, authored, which is on the fourth edition now. The Schoodle's fine motor assessment tool. And we're gonna get into all that today. But first, I'd love to hear about how you kind of got to where you are as an occupational therapist today. So, Marie, would you like to kind of share a little bit about your OT background? Marie Frank, OTR/L Sure. I have been an occupational therapist for over 20 years. And I started this with another occupational therapist. I felt disorganized, I can be very disorganized myself. And going into assessments, I would be in the assessment trying to come up with scissors or, or a shape to cut or, or something like that, and it didn't feel good to me. And the other thing that didn't feel kind of good to me as I would use the BOT and which is a great tool. But I wasn't feeling like I was getting enough information to speak intelligently about the student or get enough information to identify the need that the student had. So, we got together Amy Wang was the other therapist, she's awesome. And we started that about 17 years ago, I thought initially it was going to take about three months to put together and it took a lot longer than that because the more I dug in, the more I found I needed to dig in. And so, it took a while longer than that. And then about six years ago, Amy dropped off and Monica joined and Monica is my sister. So, this works out perfectly for us to have a business together. And Monica brought a whole new skill set to the operation, let's say and it's growing wonderfully because of Monica's expertise and ideas. So... Monica Fortunato, OTR/L Thank you, Sis. Jayson Davies I love it all I have to jump in real quick and then I'll let you go, Monica. I just love it because my family is also an OT family, my older sister is an OT. And that's how I came to find out about occupational therapy. My sister is about six years older than me. And so, by the time I was kind of heading into college, I was volunteering with her at a pediatric clinic and really learning about OT and then got to college. And that was the end of it, OTs. Yeah, so Monica, what about you? What has your OT career kind of look like? Monica Fortunato, OTR/L Well, I, like Maria have been an OT for a long time. I was an OT before she was and convinced her were great professional occupational therapy was OT you would love it. You'd be so good. And then, when I started a family and then took a few years off, and when I wanted to go back to work, Marie, at that point was a school-based OT and said, "You should be a school-based OT, you'll love it, you'd be so good." So, I went into school-based OT and that's when I started using Schoodles, you know, just taking it with me. And my first few months as a school-based OT, Marie gave me a lot of confidence. And you know, every day on my drive home, I would call her and ask questions. And as I started to use Schoodles, I was thinking of ways to make it better. Like, "oh, we could add this or what if we explored this area," and Marie loves research so much that she was doing the research. And then I was like, the boots on the ground, trying things. And that's how we came up with the fourth edition, which is the actual manual, we doubled in size added a lot more Student Workbook pages. And I know we'll talk a little bit more about everything that's in Schoodles in just a minute. But that we just interchange. I mean, my even though we're not twins, our mother says we're like twins that we read each other's mind. I don't know if that's true or not. But we work well together and feel like we have come up with something great. Jayson Davies That's funny, I like what you said about how you just kind of were using it. And then you're like, "Hey, Marie, let's... what if we did this" because I think every OT has been doing an assessment and be like, "man, if I can make one change, this is what I'd want to do." If only I could contact the author and be like, "Hey, can we do it this way, instead?" How nice it was that you just so happened to know the author of this? Monica Fortunato, OTR/L Yes, yes, that's true. Jayson Davies Awesome. And now you are a part of it, which is amazing. So, before we jump too far into this, how and why? Well, we're going to jump into all the how and why. But before we get too far, deep into it, why don't you just briefly give an overview of what the Schoodles is? Marie Frank, OTR/L Okay, it's a, Schoodles is a performance slash, observation-based, systematic assessment that uses age levels are over 20 skills to determine whether a student is delayed for his age. But it also looks qualitatively at how a student moves through a set of activities. So, you're with each activity, you're looking at a whole set and range of components to that activity, which I'm sure every OT does, anyway. But we kind of organized it for ourselves and others, and it's broken down into two separate components. It's broken down into classroom skills, which are the skills that teachers talk about. And parents talk about handwriting coloring, cutting those skills, and then supporting skills. So, the underlying skills that are needed to produce skilled fine motor work, so things like core strength and strong arm and hand muscles, and balance and those kinds of things that that's what I was digging into. When I was building it, I thought, "Oh, my gosh, there's so much that goes into the handwriting. It's crazy." Jayson Davies Right? Marie Frank, OTR/L And then the ops observations kind of build on each other, which is with each task that you look at you kind of confirm or reject each theory that you might have in your head about why something might be happening with that student. And then, yeah, okay, go ahead. Jayson Davies Go ahead. I'm sure we will get into everything. We have a lot of questions. I'm so happy for everyone that's listening. This is going to be great. Before we get too far in though, as I want to ask why schools obviously, this is a school assessment. So, I understand the school part of it, but who came up with Schoodles? Marie Frank, OTR/L Oh, hey, Amy and I love wimzie and fun. And we didn't want some stodgy name. So, we were messing around with words. And we took Schoodles, school, and doodles and put those two words together. And when Monica joined me, I asked her if she wanted to change it. And she said, No, she liked it. So that's kind of stuck in and it's mispronounced constantly, but I guess that's okay. Jayson Davies That's funny. I don't even know if you notice, but I accidentally when we put our notes together, I had accidentally typed it as a school with the owl and then d-e-l-e-s. And I had to change it. But even me, it's so it's got school in it. And so, I put the whole school word in there. I've since changed it is and correct me if I'm wrong, Marie. SCHOODLES. Correct? Marie Frank, OTR/L That's exactly it. Jayson Davies Yeah. All right. Great. That'll help you find their website when you're going to look for this later. Marie Frank, OTR/L We're not Schnoodles is when... Sometimes, which are adorable little dogs, but it's not us. Jayson Davies That's funny. That's funny. All right. So, Marie, I'm gonna I think this is going to be for you as well because you were kind of you and Amy originally developed this. You said you developed this, I think it was around 17 years ago, I think you said it was Yeah, yeah. Wow. And just for people who are in my age realm, we grew up with so much internet. And like now we all have Canva, we could easily make a quick little task to print out and cut. But 17 years ago, you said that you thought it was gonna take you three months, and ended up taking you a lot longer. So, if you could even just kind of talk a little bit about that development of what you guys went through? Marie Frank, OTR/L Yeah, you bring up a really good point that I hadn't thought about for a long time. But you're right, we didn't have all these fancy tools. But Amy was a graphic artist and a communication specialist before she was an occupational therapist, and her husband was a marketing person. And so, they had those skills. And we use very expensive computer programs put together a lot of this, the graphics and the things like the puzzles, which are something you can easily find on the internet now. So, what we did, I did a lot of research at one of the colleges that I lived near, and then some the on the internet as well. So that's how we kind of pulled it together that way. And I guess that's where we came up with the new additions to we thought we kept finding more information that we needed to add, make it current. So... Jayson Davies Yeah, and that's great because I don't think anything is ever finished. And as we all know, as occupational therapists, kids’ skills are changing. probably at least every decade, the averages have to be the norms have to be changing a little bit. I mean, kids are going to school earlier and earlier, things are changing technology versus no technology, how much all that's going on. And so, it's great that you've been able to keep updating it and the Monica has helped you with this now, the fourth edition. So, let's go ahead and jump into a little bit of the specifics. And what were the key areas you wanted to focus on when it came to creating this assessment? Marie Frank, OTR/L You know, we were looking at handwriting, because that's where you get all your referrals, right? Jayson Davies Basically. Marie Frank, OTR/L Always handwriting. So of course, that's what we wanted to pick apart handwriting, and those classroom skills, because that's not what was in the standardized test that we were using. So, I was constantly trying to marry what the bot was telling me what the BMI was telling me or what the P body was telling me with what I was trying to sort out in the classroom. So, that's kind of where we, what led us is what are we seeing in the classroom? And what do we need to be looking at with kids in school, because some of those assessments were, or clinic-based work? They were developed for clinic-based work so that's kind of where we went with it. And then and then it seems like a natural thing to do to break it into those two parts of classroom skills that are very, very identifiable things to teachers and parents and then everything that's OT related, or what we look at it what gives us efficacy, I guess when we're speaking about it with one another, and then in an IEP, and, and then we can explain those things to parents and teachers and administrators. Right. Jayson Davies Always advocating for ourselves a little bit. Whenever we can. Marie Frank, OTR/L Half our job as salespeople, right? Monica Fortunato, OTR/L Oh, wait, wait, where are you? You told me half my job was telling people what I wasn't going to do. Jayson Davies That's true, too. Monica Fortunato, OTR/L You know, what I would add to what Marie is saying is that, you know, we go to these IEP meetings, and we want to tell a story and explain something to a parent or the teacher, but mainly to the parent in a way that makes sense to the parent. And what Schoodles provides is it helps us tell the story, we have these work samples that the student-produced that we can share, and that has a real-life... apply to the real-life situation of a student and what they're expected to do in the classroom. And you know, just the age ranges, which we'll talk about in a minute. But being able to compare how the student is functioning to the typical age range, I think that makes sense to parents in a way that and teachers in a way that maybe just a standardized score doesn't. So, I think just Schoodles helps tell the story of the child and why they're struggling, where they're struggling, and why they're struggling in a way that so I liked the bot a little bit more than Marie does. So, I mean, I use it so. But those two things together worked well. For me. Jayson Davies That's great to hear because I can see you know, people who've tried to get, I mean, we almost get stuck in our ways. We find an assessment tool that we use, and we tend to go back to that assessment tool. And it's hard to keep up with new assessments or maybe not even new but just assessments that maybe your friend is Using across the country and they recommend the Schoodles, they recommend the M fund, they recommend a different assessment that you've never heard of. And it takes some energy to learn a new assessment. But that's great that you can find assessments that kind of work together a little bit. So, Monica, you actually kind of started down. So, we'll just continue with that. What is the age range for the Schoodles? Monica Fortunato, OTR/L It typically starts at age three. So, then we start with basic skills like tracing and design, imitation, you know, that is more of a preschool. And, you know, most of the tasks, if you're looking at kids who are in general education, it would like to be up through fourth or fifth grade, I use parts of it for middle school or high school students, for students that are in special day classes, who maybe are functioning at a lower level, you can use Schoodles to assess where are they as far as their developmental levels. So, the age range typically is age three through fourth or fifth grade, but I've used it all the way up to 18-year-olds. Jayson Davies Yeah. And I think we all have kind of go above the cap, if you want to call it that for assessment tools, for that same exact reason for kids who are a little bit more severe in needs and yet still appropriate to the kind of understand where their skills are. So that makes sense. But like you said, I think so around the fourth or fifth-grade level, for a Gen Ed kid student a typical developing no IEP, they might, they should be able to basically get good scores across the board. Marie Frank, OTR/L Exactly. Right. And one more qualifier for the Schoodles, you know, on the downside of it on a three-year-old side, that three-year-old would have to be able to follow some directions to be able to get useful information off of the Schoodles assessment. And if they can't, then you know, you default to the Peabody and keep going down. Right? Yes, Jayson Davies Right. Marie Frank, OTR/L But yeah, so I often get that question when I'm talking to therapists, and they're wondering about schools. So yeah, they have to be able to kind of follow directions. Jayson Davies Yeah, yeah, definitely. And I'll speak to that, actually, because, well, first of all, I love that it starts at three because that is your typical preschool-age entrance for most kids, right, three years old, that's when they're first going to move over from an IFSP if they have one, into a potential IEP preschool level. So that's great that it starts right than kind of goes along with the name Schoodles. Your second point, as you said, the kids need to have some ability to attend to these tasks that are functional. And I experienced this firsthand, Marie and Monica, were so kind to send me a copy of the Schoodles. And I did it recently, probably not to the full extent that I probably could have. Because just like what Marie was saying, these kids were in that three to four age range. But diagnosis that they had, the ability to attend, especially over a computer made that very difficult, I spent a lot of time trying to teach the task to the parent, and then have the parent teach the task to the child. But that stuff, I mean, and in this case, particular case, it was a foster parent who had only had the kids for a short period of time, which you can imagine any assessment that would be a little tricky, but yeah, no, I love it, though. I've had my hands on it and been looking at the manual. And I appreciate some of the things that that they've put into it. I'm going to ask them in just a second actually to share some examples of what you might find when you open up the Schoodles. But first, I want to ask, we're in the fourth edition now, how have the Schoodles changed from the first, second, third? Did it skip an edition? I don't know. Where are we at? How did that go? Marie Frank, OTR/L It's basically the same tool that we started with originally with what that Amy and I put together and over, you know, we kept wanting to make it a little better and add a few more things and add more evidence. So, what we've ended up with now, you know, since the first second, and the third was pretty good, but when Monica joined, we wanted to kind of redesign some of it and add some more like classroom observations, teacher questionnaires, goal, we added a goal writing template. Let's see what else did we add? We add Oh, and then most recently, we added an online version. When this was before the pandemic, we had a large school district asked us you know how they could purchase our tool but they wanted some more control over it. So, we ended up adding a membership, which we have just loved because we can add, add all kinds of new stuff. We can change things based on what therapists think and tell us and we can add new tools to that membership without having to add another addition. So... Jayson Davies Nice. Marie Frank, OTR/L Yeah, yeah, that's evolved. It's evolving. It's still evolving. Jayson Davies Right? Yeah. And you know, back to that whole, you know, technology has changed the world and things that you can do now are nice. You're right. I mean, you can add something because well, you don't have to send out a whole new book or whatever. If you change one thing, it can just be a new printout that people can access. So, that's awesome. Marie Frank, OTR/L Exactly. And therapists are kind of us don't want to be continually buying new addition. So, this is the last one. This is it. Monica Fortunato, OTR/L Is it? Really, no, we have to keep going. You know, I wanted to add an area that we expanded where we expanded our handwriting worksheets. So you know, I know we keep looping back to handwriting, but we used to have one handwriting worksheet, and now we've expanded it to handwriting A, B, and C, so that you can have with a kindergartener who's starting to write you would use a, and then, you know, they progressively get more complicated the sentence they have the cop murder, and then we're also looking for, you know, can they, if something's been dictated can they write and then also self-generation, you know, which is a school-based OT, it's really important to differentiate where the breakdown is in handwriting. Can they copy neatly? Right? Does the breakdown happen when they have to self-generate come up with the idea to access their short-term memory to spell come up with the grammar? And so, we want to analyze all of those things. And I think, between the Schoodles manual and the banded worksheets that we've made, it's very easy to say, Aha, the break that they're really falling apart when they have to self-generate, you know, and then what part of the self-generation is hard. And then, you know, as OTs, we're always asking ourselves, why, okay, if they can copy neatly, why can't they self-generate, and then we start talking to other team members, if I can just share a quick story of a boy I assess last week, he was a 10th grader, who he was, okay, we know his handwriting is bad, we need to call the OT. And so, when I was talking to him, he could copy everything was fine. He said, “I can't take notes.” And when I take notes, you know, because when the 10th grader, of course, I just asked him a lot of questions like hardware that aren't. So, it's hard when I take notes. Well, lo and behold, he has qualified, he's had an IEP for many years. And it's a learning disability related to auditory processing. So, aha, he can't listen. And the process and then also take notes at the same time. So, my recommendation was not that he needed OT because his visual motor skills were an area of strength. What did he need copies of class notes? So, I think that's where Schoodles you really can start digging into that information with real, real examples, rather than you know, BOT is never going to tell you that. So, anyway. Jayson Davies Absolutely. That's a great example. I love it. Actually, I want to continue with that. So, there are some handwriting examples that you just gave, what other classes I think you kind of refer to these Marie as the classroom skills, what other classroom skills are, are looked at within the Schoodles assessment? Marie Frank, OTR/L So, we have puzzle skills coloring, cutting, draw a person? And am I forgetting any Monica? Monica Fortunato, OTR/L Yeah, we have a copy design. And the cutting, we have a graded cutting. So, it starts with um, snipping on a straight line, curved line, zigzag line, Circle Square, and then we have our complex shape. That is an adorable little fish. So, I will say that I like the bot. So, I don't want your listeners to think that I am trashing the bot. But I will say if you give a child especially a younger child, the picture of a cute fish and say, you want to cut this out or that page from the bottom, where they always say, what am I making? Well, sorry, you're not really making anything, you're just cutting out a circle. So, then they always ask you like, cut out the square? No, no, no, it's right. But when you give them the fish, you know, as OTs we always think about motivation. Well, little kids are more motivated to cut out a cute fish. So, I have gotten a better cutting sample with the fish from Schoodles that is a common label when a circle should have been easier for them. But there was nothing in the circle that engaged them. So anyway, and there are the fishes very interesting because they like to cut off the top fin, you know, they'll kind of go and then that will tell me like, okay, they couldn't turn that corner, make it up and over. So that gets snipped off. And then I'll look at did they notice that they cut it off? Did they even see that that part was cut off? Or do they just keep going and say hey, you know, great? So, I get more information from the fish, swimming, the cutting is broken down into many different steps. And was that your question? Jayson? Sorry. Jayson Davies Yeah, basically, I mean, what are the different types of activities that we would see in the classroom that the Schoodles assesses? And you kind of went through that. So different cutting activities, handwriting, and you mentioned a few others. So great. And then going beyond that, earlier, you kind of mentioned that you kind of look at the classroom skills, but then you also look at the skills needed, I think you called them to the support skills. So how do the Schoodles then look at some of those support skills? Is it built into those classroom tasks? Is it a separate part of it? Or what does that look like? Marie Frank, OTR/L So, great question, those supporting skills are separated. And you can do them in order, or you can do them, mix them in with the classroom skills to keep your students energized and engaged. But those so they're separate. And so, you're looking for, for different things, perhaps then, in the classroom skill, so you're looking for motor planning, strength, balance, those types of things with those supporting skills. So, we would do jumping, jacks, skipping, hopping, some balance tasks, muscle testing which I had never seen done, with kids. In the school system. I was never trained that way. But it was something that we added in that we find very helpful, because you're getting your hands on the kids, and feeling their muscles, some vision, visual tracking, some of those types of things. So, lots of different little bits and pieces that you can glean information from and kind of make create your story like Monica was talking about. Jayson Davies Great, I love that I always tell therapists that our evaluations need to be top-up, top-down. And I think what your kind of explaining you start with the classroom skills, which is your very top, you're very observational, can they do this activity, and then it’s kind of sounds like you get to more of those supporting skills. Alright, now let's break it down. Let's find out what processing skills what other skills are preventing or even providing the student with the capacity to access those upper-level observations, not observations, but the classroom skills? That's a good term. I like that term classroom skills. Marie Frank, OTR/L Yep. Excellent, excellent explanation, Jayson. Monica Fortunato, OTR/L I'm gonna use that. Jayson Davies Thank you. Right. Well, let's go ahead and continue, we've used the bot. So, I'm going to kind of use this as an example. Oh, and I wanted to actually touch on that. I feel very similar to Monica, about the bot, I use the bot. However, I don't think it gives you those classroom skills that we were just talking about. And so absolutely, I think that the bot gives you a lot of information. But I don't know that it gives you the same type of information, using the story we were just talking about. It gives you the processing skills, potentially as opposed to those higher classroom skills. So, all right, go ahead. Do you want to add to that, Monica? Monica Fortunato, OTR/L Yeah, I just think the way that I look at the bot, so this could be another podcast for you that the bot score, okay, it is more than a score. I mean, I'm watching, you know, how are they problem-solving with the manual dexterity? How are they picking things up? how, you know, I'm not just looking at the score at the end, which often, you know, even like with the design copy, do they have for closure, because they have attention, and they just whip through it so fast. That, you know, they're just you know, that isn't necessarily visual, it's a visual motor delay, it's attention. So, you know, the bot gives me a lot of information that maybe I might not see all of that in Schoodles, and the districts that I work within need a standardized score. So, I know not all school districts need that Marie referenced a school district that is exclusively using Schoodles, but we need a standardized score. If I can't get it, I mean, I can say that the SPM or the sensory profile is a standardized score as part of my report. But I think marrying the bot or even the VMI, but I prefer the BOT over the VMI with Schoodles to me is like I feel like I'm done. I have I do my observations, talk to the teacher talk to the parent. And rarely Am I stumped with what's going on here. I feel like that all those data sources, you know, we have to collect data from multiple sources. And once you've done all of that you're covered basically with information gathering. Jayson Davies Absolutely. And you know what? Monica Fortunato, OTR/L The other piece of information galleries, I always look deep into the history, the IP histories. My last little piece there. Jayson Davies Absolutely. No, that's exactly what I teach in my courses to start first with that reason for the referral. And then get the information that you can gather from previous IEP IFSP is other documents that you have access to. And then that next step is to start doing those observations and figure out those classroom skills. So absolutely. All right, you actually just answered the next question, which I think was awesome about additional tools. Do you use additional tools? And I know you've already mentioned you'd like to use the bot potentially with it, maybe you'll jump in there with the SPM, or the sensory profile use, it sounded like, Maria, did you want to add anything to that? Are there other tools that you like to use along with the Schoodles? Marie Frank, OTR/L I mostly did not use the bot and use the VMI. Pretty much all the time. I liked those two, mostly because I was getting so much information from Schoodles that I wanted something very short and easy that I could corroborate with schools, and then use those scores, those standardized scores and talk to other service providers to see what they were getting in on their testing to see if it matched, to see if it was going along with what they were getting in if I was in the ballpark. So that's like, actually, what I did was, I loved the VMI. So, Monica and I diverged on our standardized testing choices, I guess. Jayson Davies Okay, that's perfect. As OTs, we all get our own little creative license to find the tools that we think will suit us best. So that is perfectly fine. Yeah. All right, I want to kind of, like, obviously not wrap up, we still have plenty to talk about. But before we kind of move on to our next session or section, I guess I could say, what does the data collection look like for the Schoodles? I think most therapists are very familiar with the bot with the VMI. How does the collection of the data? Are you marking down items as students’ complete stuff? Do you have to go back and look at the work samples the score? What does that look like? Monica Fortunato, OTR/L So, we have, um, it's a clinical observation chart that I print off. And I'll just talk about how I use it, I print them off, I have it sitting there with me, while I'm with the student, I do tell the student you know, I'm gonna write this down because I have kind of an old brain. So, help me remember later, which, sadly, kind of true at this point. But I, I write everything down. So, I'm making notes as I go along. I will look at the work samples later. But mostly, I'm able to make all my notes while I'm assessing Unless, you know, occasionally I'll have the student where you just have to move quickly from thing to thing because you lose them if there's even a slight delay. So, there is there isn't a score. That's all qualitative. And it's the most of the things we're looking at, as we talked about before, Marie is really into research. And so, she has done extensive research to find the typical age ranges or skill attainment or each area. So that's included in Schoodles. And so, when you go to write your report, you may reference that chart memory can talk a little bit more about the criterion reference chart, but a reference that chart to find out are they where they should be, you know, matching their chronological age. So that's the data collection is in real-time. And then later, you can take the information that you have and compare it to the chart and see where what level your student is functioning out. Jayson Davies Great. And, Marie, do you kind of want to hop in there and talk a little bit about the criterion reference right now? Marie Frank, OTR/L Yeah, yeah, I believe we've got about 20 skills outlined on the criterion-referenced chart that we created. And I dug into every skill and I found, it's all evidence-based information. I didn't include anything that wasn't on that chart. I wasn't, you know, me guessing on the ages, so there are some things therefore that aren't on the chart, because there wasn't any research that I could find on that, like muscle tone, we don't have that on there, because there isn't any qualitative or quantitative measurement for that or age levels of when you should have a certain kind of muscle tone. So maybe those types of things aren't on there. But there are, there are, I was surprised at how much I did find, and then put that all together on one in one place. Jayson Davies Great. I love that because that means that you can go and you can do this assessment tool. And then like Monica was kind of referencing you can have that, that "cheat sheet", I'm just gonna criterion reference right there next to you and say, all right, well, on the fish, this student was able to do this and this but maybe they weren't able to. I'm just gonna say maybe they didn't use two hands effectively or something like that. And then they can kind of cross-reference that to your criterion reference sheet and say, Okay, well at age four, that's okay. But maybe at age five, they should have been able to better use both hands to cut around the fish. All right. Marie Frank, OTR/L exactly. Perfect. Jayson Davies Cool. All right. I want to ask one more question about testing. Because I know this is something we all learned back in OT school, but it's something that I think we quickly forget. And that is a standardized test and what is and what isn't a standardized test. Earlier, you did mention that this is not a standardized test. I think I heard that correctly. Right. Marie Frank, OTR/L Yep. Right. Jayson Davies All right. So, what makes a standardized test? How is this not a standardized test? And what are the benefits or, or doubt duffles? Did I say that right? If there are any… Marie Frank, OTR/L Yeah. to not have, okay, so a standardized tool is used to compare a student's performance to a normative sample population. So, you get your standard score, you get a standard deviation, and you get percentile ranks. And this is often where you find the qualifying scores for special ed, you need standardized scores for that. But being a related service, we only need to show needs. So, we don't necessarily need to use a standard score according to IDA to be able to serve a child with a need, we just have to show that they need occupational therapy. So, I found this description that I liked. It's a standardized assessment seeks to measure the measurable, while non-standardized test measure students’ skills that are noticeable and may be significant, but cannot be quantified. Yeah. Yeah. I love Wow. Isn't that great? Well, non-standardized tools are performance-based then which is what Schoodles is, and the criterion-referenced tools are a form of non-standardized assessment. And these are not designed to compare one child's performance to another. So, this would be something like the help of the Carolina I don't know if you've used either of those Jayson. Jayson Davies No, I haven't Marie Frank, OTR/L Teeny tinies. So those have a breakdown of different age levels where kids should be attaining and achieving their, their developmental skills. So, this is very similar to that. And these types of criterion reference tools are more helpful in assessing functionality, which is what we're looking at with Schoodles, they are very helpful to measure progress. If you're in early intervention, you're constantly measuring progress and looking to see where the child is to see where you need to go. Which is another way to use criterion reference tools to see what's what, what they need to be doing next on that list. And then you can link when you see where they need to go. That's where you can get your goal. That's the next thing on the checklist for what they need to be doing. So, I think sometimes these criterion reference tools because you can, you can vary the way you're wording, the question, or you can change the amount of help you're giving. Or you can change the type of toy that you might be offering or the type of pen that you might be using can you can change things around a little bit to get the best performance out of the student, and also find out what they could do if they had this kind of help, or what they could do if they had this kind of scissors. So, what you cannot do with a standardized test, I guess that's Does that answer your question? Jayson Davies Yeah, absolutely. And you said, you know, you can use a different pen and my, my immediate, you know, reaction just, I got a picture of a red pencil in my head. And everyone knows exactly what that red pencil is. You don't have to use a red pencil with this assessment. You know what, you don't want to follow that up. Monica, you may even go with your question or where you were going with it when it comes to writing goals and measuring goals. How can you use the Schoodles in order to potentially measure the goals that you're writing? Monica Fortunato, OTR/L I think that that it actually because you've assessed function like our goals are supposed to be written, what is the educational need, what is it that you're trying to help the child to achieve in the classroom or their school environment doesn't it might not even be you might be out on the playground or you know, in a different area of the school. But, you know, the goals are not supposed to be the clinical sounding goals about increasing strength or range of motion, the goal should be related to the function within the school. So, if you have work samples, and you've collected data that directly relates to the function of the child at the school, then your goal can be taken directly from that. And you can measure with percentages. So, if you have a little, little person who maybe can copy all of their capital letters, but from memory, they can only come with five, you know, then your goal maybe we'll be able to you know in order to complete classwork x student will be able to write 20% of capital letters from memory on three out of four trials. So, the goal is derived directly from what the student can do. Now here's what's interesting as well about goal writing in and I see this on the Facebook forum. So, the OTs, Facebook, is that some school districts, there is not a separate goal for Occupational Therapy, I will say what where I work, they want to separate goal. However, you can cure. I know, I'm not saying it's right or wrong, Marie, I'm just saying that my job, I cannot show up without a goal. So. So Emery was shaking her head no, as we're talking so. But at least you can take the information from schools and contribute to the goal if it's a team that's writing the goal. So, there's a lot of good, good direct information to goal writing that you can get from Schoodles. Jayson Davies Yeah. Marie Frank, OTR/L I ended up sitting with teachers and writing goals with them because I was told not to write my own goals. And I thought, Well, how do they know? How did they know what I want? So, I would go and sit with a teacher and we would write the goal together so that it was their goal that I was supporting. Jayson Davies Yeah, and if I can jump in, and, I'm just going to do an example really quick, Monica just had a goal that she created out of thin air, which kudos to you for being a little pull a goal out of thin air, while on the broadcast. on the spot, she had a goal of you know, trying to increase maybe a student from being able to write from their own, just from memory, basically, from the move from five capital letters out of thin air to maybe 20%, which what 20%, I'm gonna guess is somewhere around like eight to 10 letters, capital letters, I don't know, I'm not a mathematician. But anyway, maybe we're trying to double the number of capital letters that they wanted. They want to be able to formulate, right? Well, now I think, Marie, and correct me if I'm wrong, you might say, Well, I'm gonna go talk to that teacher. And we're gonna say, hey, the student is going to start every sentence with a capital letter, and 20 to 40% of their sentences. And that is now a teacher and an OT goal. Am I right? Marie Frank, OTR/L Exactly. Perfect. Jayson. Yep, exactly. It was, it often did look completely different than what I had in my mind because it is it better. And it did fit better with what they were trying to do in the classroom, which is what we want. Jayson Davies Exactly, you know, I've struggled with the same, that same idea of whether we have to have our own goal, whether we can be on a teacher's goal, and I have most commonly found that it depends on the teacher and depends on the IEP team and depends how they want to do it and you have to be flexible and be able to kind of go both ways and work with the team to kind of make a make an IEP come together. So definitely. Alright, well, we're gonna kind of get to the final few questions. We can wrap it up. We've been having so much fun time flying by telehealth, obviously, right now, we are kind of getting to the tail end of the pandemic, people are starting to go back to school. I will the time that I did try the assessment. I kind of mentioned that earlier. It was over a telehealth model. Maybe I should have asked you this before I did it over the telehealth Model Can the Schoodles be used over a telehealth model? Does it look different? Does it look similar? What have you found? Monica Fortunato, OTR/L So, I have been using it over the past year remotely. So, we have we do send a package of the Student Workbook to the student ahead of time. And what we do is we send a little pair of scissors and pencils and crayons because a lot of students I work with are a low resource. And so, we want to make sure they have everything we do have to most often have to have an E helper. So ahead of time we talked about there has to be a parent sitting there helping will interview the E helper ahead of time. And usually, it's a parent, so it's a good time to both get your interview questions in and then just let them know what to expect on the assessment. Typically, they've gone well, the students that have a harder time are for me, it's very hard to manage behavior through a screen. So, you know, it's hard to control your materials through a screen. And so, but it has worked well we've figured it out when the pandemic happened, we interviewed some telehealth, OTs and asked them what they needed. And they gave us some good ideas. What they needed was videos of us doing visual motor, the fine motor coordination so they weren't having to demonstrate it and watch the child at the same time. A part of the online membership of Schoodles essentially videos of me going through all the fine motor, you know, look at me, copy what I'm doing. And so, the therapist can just play the video, and then the student will be watching the video. And then the evaluator can then watch the student and get your data that way. So, um, it has been pretty effective. And the thing about Schoodles was telehealth is I will have that student hold up their work sample to the screen. And as long as they... you've probably done this, Jayson, as long as they hold it steady, I can print a screen picture of it. Hold it steady. If I do the bot, which I've done remotely if it's only verbal directions, the VMI the bot, but I have to get those protocols back. So, we have a mechanism to get them back. But with schools, you don't necessarily because you're not scoring it. You don't necessarily have to get the actual test materials down. Jayson Davies Yeah, I often have my parents try and scan it with their phone and email it to me or something like that. But yeah, you can do the print. If the kid knows how to use it, how to get the camera in front of the camera. It's funny the things you see when the kid tries to put the paper up to up to the camera. Monica Fortunato, OTR/L to record our directions. Okay, back in it. Okay, now. Hold it real still. Jayson Davies Right? And then also, I mean, how many times have you asked to see the kids work? And then like, you can't see anything because they use the pencil and like, just to light unless they're using a dark cran or something. It's just you can't see it anyway. Monica Fortunato, OTR/L Yeah, definitely challenges with that. Jayson Davies Yeah, definitely. I will say I prefer in-person occupational therapy. I, I just do Marie Frank, OTR/L any arguments from us? Jayson Davies Yeah, shout out to anyone who's doing very well and enjoying the process and making it work because it is tricky. I know, I get comments on social media every day from people who are saying it's hard. I'm right. They're very hard. It's hard. Yeah, very hard. Alright, so I have two more questions for you. We're gonna wrap this up. The first one is, for anyone who is listening right now, maybe they've never had access to the Schoodlesand they go to their school district? Or maybe they're even just going to go buy themselves. And it comes in the mail on day one, what is your recommendation that they start with first? If they just got this Schoodles in the mail? What should they do first? Monica Fortunato, OTR/L I would highly recommend going through the manual, it's not very long, it's a pretty quick read. And it outlines each skill that you're going to be looking at and what to look for while you're with the students. So that would be it's not long, it's not like you're reading a textbook, it goes pretty quick. And we've tried to make it as you know, just the facts, you know, just we're not going on and on and on about information. It's like this is what you're looking for. This is why and next. So that would be the first and then step to dig in. You know that we have a penguin the color we have a fish to cut out I mean; the kids love it. You're not going to go wrong. You know, I think we get all nervous with these standardized tests, especially the ones that you have to say things in a certain way that does not school you just you can bring your crayons your pencil your scissors and have some fun with it with the kids. Jayson Davies Love it. Maria, did you want to add anything to that? Marie Frank, OTR/L No, I loved what she just said you know don't be nervous about it and just try even if you just try a small part of it and get you to get information from that and then you try it you know add a little bit more the next time and add a little bit more than next time to your comfort level that that and then you know always you can email us we answer Jayson Davies That's perfect. Monica Fortunato, OTR/L Or anything like that. We love to talk to other therapists. It's really fun for us. So yeah, it's you can email Monica@schoodles or Maria@schoodles. If you want a research-driven response, go to Marie. Even with babies, I've been with K through 12. So, if you have a question more to do with K through 12 what Marie knows K through 12 two but you have a question with more older students you can market Schoodles. Jayson Davies Alright, sorry, the way that this podcast works is that I come up with questions on the fly based upon what I hear. And so, I haven't asked you any questions Marie about research and Monica has been throwing it out all day long, but you love research. So, I'm gonna ask you like what is your relationship with research? Have you done research? Do you just love reading it? Are you researching the Schoodles? Marie Frank, OTR/L Oh, that's such a good question. I think I just want it to be correct. I just want to be, I am, I am such a science nerd, I want everything to have evidence. And I don't want to be putting things out there that aren't correct and true. And, and, and have science behind it, that that's just the way I am. Jayson Davies Agreed. And that goes with that criterion tool that you've talked about earlier, you went through and found all the research and, and put it on paper. So that's great. Awesome. All right. Well, you mentioned your emails, Monica@schoodles and Maria@schoodles, where can anyone get more information about the Schoodles quickly, if they want to find out more? Monica Fortunato, OTR/L You can go to our website schoodles.com. There's information there about purchasing either the hard copy of Schoodles or the memberships. There's also information if your school district has a PO or you want to group memberships on group pricing, it's all there on the website. It's schoodles.com. Jayson Davies And just because I know it's easy to do, and I did it earlier, that's schoodles.com. Marie Frank, OTR/L Yeah, Jayson Davies Alrighty. Well, that's gonna wrap us up for today. Thank you, Marie. Thank you, Monica, so much for coming on the show. It has truly been a fun experience and a knowledgeable one. Monica Fortunato, OTR/L Right. Thank you, Jayson. Jayson Davies Thank you. Marie Frank, OTR/L A delight. Jayson Davies Thank you. You guys make my job easy. So, I appreciate it. Thank you so much. Take care and have a great rest of your Sunday. Bye. Monica Fortunato, OTR/L Thanks. Jayson Davies And that is how we are wrapping up the OT School House podcast today. Thank you, again so much to Maria and Monica, for coming on and sharing all that information with us about the Schoodles and just about assessments in general. So much of what they said was appropriate, no matter what assessment tool you use, whether you're using the Schoodles, the bot, the VMI, or any other tool assessments are still assessments. And they take a lot of information, a lot of knowledge, and a lot of skills from the occupational therapist to have a good assessment. And with that, thank you one more time so much for listening to the OT School House podcast this time, and every time that you listen, I appreciate it. I'd also really appreciate it if you took a moment to leave me a review down in the comments on Apple podcasts. Those reviews help me to grow this podcast to make it better for you and every other occupational therapy practitioner that listens in at any time. Thank you so much for taking the time to learn with me today. And I'll see you next time. Bye-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 OT School House.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

Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 75 of the OT School House Podcast. In this episode of the OT School House Podcast, Jayson gets real while breaking down a 2018 article outlining a specific typing program and its effectiveness versus a free typing program. In this discussion, we will look at various typing methods, the lack of available norms for typing speed, Motor Learning Theory and Keyboarding, and how a premium paid program compares to a free program. Listen in to hear why the research is still not great when it comes to typing. Article Citation: Denise K. Donica, Peter Giroux & Amber Faust (2018) Keyboarding instruction: Comparison of techniques for improved keyboarding skills in elementary students, Journal of Occupational Therapy, Schools, & Early Intervention, 11:4, 396-410, DOI: 10.1080/19411243.2018.1512067 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 for Episode Number 75 of the OT School House podcast. You know, actually, as I say that I have to apologize, I think last week was Episode 74. And for some reason, I said Episode 73 in the intro, so I'm sorry about that. But we are officially on episode 75. My name is Jayson Davies. Thank you so much for being here today, and I'm looking forward to this episode. Now, this is a journal club discussion podcast. And well, what we do in these Journal Club podcast is we look at a journal article based upon some concerns that I've been receiving comments about. So recently, I've been getting a lot of comments and questions about typing. And when I say that, I mean, questions about what are some of the norms for typing, you know, what, at what speed? or How should a third-grader be using a keyboard? What should they be doing? Also, when is it time to switch from handwriting to keyboarding? Those are the two main questions norms related to speed, and when is the time to switch. Also, do OTs even address keyboarding? That's another one that I get. So today, we're going to go through a journal article and address some of those questions about keyboarding. Let's go ahead and get started. Today, the article that we're looking at is titled "Keyboarding instruction: Comparison of techniques for improved keyboarding skills in elementary students". This article comes from the Journal of Occupational Therapy, School and Early Intervention, and it was published in 2018. The actual study took place in the fall of 2016, to the spring of 2017. The authors of this article are Denise Donica, Peter Giroux, and Amber Faust. And like I mentioned, it does come from the Journal of Occupational Therapy, Schools, and Early Intervention. Now real quick, before we get into the background of this article, I just want to point out that not every article is perfect. But, that doesn't mean that we can't learn from it. So a little bit later, I'm going to share with you some of the pitfalls I think about this article. But again, that doesn't mean that there's not something that we can't take away from this article. I actually think that the background that we're about to talk about is really strong, and provides a lot of great information for us. So, let's go ahead and do that. And then I'll tell you a little bit about what I didn't like so much about this article as we get later on. So as I mentioned earlier, this article does come to us from 2018. And the actual research itself was conducted in 2016 and 2017. So this isn't going to be research that we can really say, is a result of the pandemic, things have changed, especially with typing as a result of the pandemic. But I think the authors would agree that typing has only become even more important, as a result of the last 14 or so months, with everything going all online. Thankfully, things are starting to open back up now. But we know that technology has changed, and school has changed forever when it comes to the use of technology. So, I think the researchers would agree that this is such an important topic, both in 2018, and even more so now. To start off with something that I really appreciated within this article is just some of the terminology. The authors pointed out that students who have difficulty with typing may face challenges meeting their student occupational demands. And I don't know about you, but I really like that little phrase right there, student occupational demands. I think it's something that all of us as school-based occupational therapists should actually use more frequently. I think it will help to share with others, teachers, as well as parents and administrators, exactly what our job is. We are not fine motor, or handwriting, or visual-motor specialists. While we do look at those areas, we are really looking at the student's occupational demands every day. That's what we're focusing on. That's what we're trying to improve on and make the student more independent. So student occupational demands, I think that's a great terminology are a great term to add to your dictionary. And when it comes to student occupational demands and technology, there are three areas that the researchers identified that students really have to use technology nowadays. Those three demands that are now regularly presenting themselves for students, include reading and accessing digital textbooks, partaking in computer-based testing, and also simply just completing online or word-based activities. That can be anything from playing an academic game on the computer to maybe writing a three-page essay on a Word document that can also be putting together a PowerPoint show for you to present in class. Each of those is an example of assignments that happen more and more on the computer these days, as opposed to maybe even a few years ago. And that then leads to the next point that they make in the background review of this article, and that is that just about like everything, the earlier you start, the better. And so the earlier that you introduced touch keyboarding instruction, the better because they find that it does allow for higher-level keyboarding, as the student gets older. No surprise there, right, the earlier you start something, hopefully, the better you will be in the long term. Now, one thing that I was really hoping to get from this article were some established norms as to when kids should start typing, maybe what speeds that they should be typing out, what age and you know what, it just isn't out there yet. The authors note that there is no real standardized assessment to measure words per minute and that over the years studies have found varied results, partially because there isn't a standardized way to measure this. For example, one study found that students' grades first to third, average nine words per minute, while another study found that second graders average five words per minute. I mean, yeah, that's only four words per minute, but that's a 50%, actually, almost 100% increase from five to nine, right? Furthermore, a third study found that third-graders type up to 30 words per minute. That's a huge difference. That's like a 300% increase from the nine words per minute. So it's just very up in the air right now, as far as what is a norm for a student to be typing. It's also not known when a student should be using touch typing, versus a one-finger hunt and peck method. However, one thing has been pretty consistent as far as what the research has shown. And that is that, in order for a kid to actually use typing effectively, they need to be introduced to typing prior to the grade level where the computers are expected to be used for that academic work. And I think that is pretty common sense. But you never know that we need to actually teach someone how to use something before we expect them to actually use it to complete a project. So yeah, you know, for a lot of OTs out there, you're listening to this, and you're like, "Oh my gosh, this is the same thing with handwriting, right?" We expect them to come into kindergarten expecting them to know how to write their name, and to write all their letters, but no one's ever shown them how to, you know, use a pencil to draw some simple shapes, let alone show them how to form letter A. I think that that has simply frustrated many OTs and teachers alike. Speaking of frustration, let's go ahead and dive into what the Common Core State Standards say. Yeah, I went there. Just kidding. But Alright, so Common Core State Standards. It isn't until about the third grade, that students are actually expected to do typing and produce published writing with technology. That's when you first see typing or keyboarding, within the Common Core State Standards. However, once you get to the fourth grade, it does state that a fourth grader should publish one page in a single sitting as a fourth-grader, and two pages in a single sitting as a fifth-grader. That's quite a bit of writing. I mean, especially if you haven't been taught how to touch type, and you're trying to search for letters as you write. I don't know exactly how many characters are on a single page, maybe if I highlight my document that I'm looking at right now, I can figure that out. But it's hundreds. So that's a lot of looking around a keyboard trying to find the right character that you need and the punctuation and whatnot. So if you're not touched typing, or even at least familiar with a keyboard, that can be tricky, and can probably also be a little overwhelming, I would imagine. And that then brings us back to the different ways of how students actually type. The researchers pointed out five main methods. The first method is the traditional one finger, on one hand, hunt and peck method. This is the most immature model of actually typing. The second method is one finger on each hand to hunt and peck. And of course, here you are still heavily relying on your vision. The third model is moving up to two to four fingers on each hand while looking at the keyboard. The fourth method is using all of your fingers but still looking for the letters, kind of relying at least on visual feedback. Maybe you're not looking consistently at the keyboard, but you're still relying on the visual feedback. The fifth model, which is the most advanced, most mature method of typing, is what we widely know as true touch typing, where the typer uses all the fingers on both hands without visual feedback and instead is relying on kinesthetic feedback. The author then takes a moment to actually share a little bit about motor learning theory and how that feeds into the ability to type and they talk about the different processes of cognitive, associative, and autonomous stages to get to touch typing. Cognitive stage number one is that it takes a lot of that executive functioning to plan out what key you're going to hit, using your vision to figure that out. And starting simple by just hunting and pecking, then you start to move to that associative stage where you're relying on your vision a little bit less, maybe you now you're using two to four fingers. And you're not quite always looking at the keyboard, but your stuff to look at the keyboard. And eventually, you get to that autonomous stage where you are able to just, you know, get that kinesthetic feedback, and really start to quicken up your typing and also become more accurate. Alright, so that's going to go ahead and wrap up the background review that they discussed in this article. And now we're going to move forward a little bit to the actual goals or the hypothesis that they had with that article. And here the researchers thought to discover if the learning without tears typing program would be more efficient than a free alternative online program that is commonly used, specifically the free online program that the school that they were at, we’re actually using. We'll talk a little bit about the population in just a moment. But for the goals, you just got to know they wanted to compare the learning without tears typing program to the free alternatives online. They also wanted to be able to determine if there was a relationship between the number of activities completed on the keyboarding without tears application, and the overall keyboarding speed and accuracy. So basically, they wanted to determine that if a student completed five activities of the keyboarding without tears program, would that then correlate to a one-word or two-word improvement in their word-per-minute score. So then who were the participants in this study, the study looked at Southern suburban elementary schools with grades kindergarten through fifth grade. Combined, there were a total of about 1900 kids, I believe it was 1908. About 45%, and a 55%, split between who was in the control group versus who was in the intervention group of the learning without tears. Now, I know many occupational therapists, those who work in special education, they want to know what our special education students included in that group. And they were for the most part unless they were in a self-contained class. So if they were a kid who received RSP services or something like that, then yes, they were included. And they did participate in both the learning as well as the pre and post-test. If they were in a self-contained class, then no, they did not participate in the study. Like isn't mentioned earlier, this took place in the 2016-2017 school year, it was most of the school year, they started in August to September with that pretest. And then they had the same post-test later that school year in the month of May. And speaking of that pretest and post-test, they used a website called typingtestpro.com in order to collect that baseline and then compare the baseline scores later. In that same academic year, what they use were two, one-minute timed tests, and one two-minute time test. The two one-minute time tests, we’re actually at a first-grade reading level. And then the two-minute time test was at a fourth-grade reading level. Now, this is the first thing that I wasn't too thrilled about because they tested kids from kindergarten all the way up to fifth grade using the same exact test. And so for those poor kindergarteners, and they admitted this later, and the limitations that, you know, maybe they should have done something else for the kindergarteners at least because they didn't even know what letters were some of them at the beginning of the school year. And yet they were asked to basically copy a paragraph that was written for first and fourth graders. So that was a big struggle for them. Likewise, on this testing, they actually disabled the backspace button. And I don't know about you, but if I was a kid learning to type, I'd be a pretty frustrated kid, if I couldn't use that backspace button. For those kids who get really anxious about not being a perfectionist. In fact, for most kids in general, they want they just want to be able to use that backspace button. That's what they've been taught, and they couldn't use it. And so they did do this test again, once at the beginning of the school year, and then once at the end of the school year for all the kids involved. Alright, so let's go ahead and jump into the interventions that were used. This is where it gets a little interesting. This was a quasi-experimental pretest-posttest design, meaning that there were two separate cohorts, the intervention cohort, and the control cohort. These cohorts only did one of the two interventions. One was given the keyboarding without tears intervention, the other use the free typing programs that had been used by the teachers the year before. The teachers that were providing the keyboarding without tears program received five hours of training in that program. The other teachers received no training and keyboarding, in addition to what they had already had previously. All of these interventions occurred within the computer lab at the school site, it wasn't exactly clear if there was a specific computer lab teacher that was in charge of providing the intervention, or if it was just the typical teacher that was providing that intervention. The authors did note that these students sped to anywhere between 45 and 60 minutes in the computer lab, but that not all of that time was spent on actually keyboarding practice. So it's unclear as to how much time each group actually did spend on practicing keyboarding. The handwriting without tears program notes that it is supposed to be implemented up to 10 minutes a day, or up to about an hour per week. So we can assume that was what the intervention group the handwriting without tears group use, but we're not sure about the other group. What we do know about the other group, the non-keyboarding without tears group is that they use three specific websites, they used freetypinggame.net, learntyping.org, and PBSkids.org. Now, when I first tried to type in freetypinggame.net, I actually typed in freetypinggames with an s at the end .net. And well, let's just say Google Chrome, and my router blocked me because it was going to take me to a dangerous website. So I don't know what would happen if a kid accidentally typed in an S at the end, which I think actually makes sense because there's more than one game on this website. Anyways, just wanted to point that out. I also want to point out that if you have a moment, and you've never been to freetypinggame.net, go for it look at it, you're probably going to have the same feeling I have that teachers probably shouldn't be using this website. It is a very cluttered website, there's a lot going on on it, and even when you do actually click on like the "Learn to type", it is very outdated, their, their processing is just very poor. And I can see a kid getting lost on it. The same thing happened when I went to learntyping.org it was just not a good website, period, not alone typing, it just was not a good website, period. And so I'm surprised that these are the websites that handwriting without tears learning without tears decided to go within the comparison group. PBS Kids is a more established website. It's a very popular website among educators, I believe, although it is not specifically a keyboarding website. Personally, I would have liked to see keyboarding without tears, compare their product to something more familiar to myself, and more familiar to the teachers that I know that work on typing. And that program would look more like typingclub.com or typing.com where the student can actually create an account, log in all for free and track their progress and go along with the flow. In fact, with those free websites, I know at least on one of the two, the teacher can create their own teacher account and actually have their students under them so that the teacher can track the progress that the student is making, as opposed to learning without tears using these three websites that are just really not that great. Now, I know this was done in 2016. But still, these programs have been around for a while. So I would have liked to see that. Likewise, it was noted that one of the schools was selected as the keyboarding without tears school based upon familiarity with the school by one of the researchers. I just think that the school should have been randomly selected and randomly applied to either the control or the intervention group, as opposed to the convenient leap selected. Because one of the researchers was familiar with that school. It just doesn't seem right for an article that you're publishing for the world to see. Despite all of that, let's go ahead and talk about some of the results that came about. Personally, I'm not completely thrilled by the way that they expressed all the results. And so I won't go into all the details because I'm not a researcher. I'm not someone who went to school specifically to read articles. And I just don't think that the charts and the narrative that they put out there were the easiest to understand. But what the key takeaway from the researchers say they found was that in grades K through two, those students increase their ability to improve their keyboarding method, you know, from using maybe two fingers to hunt and peck using four fingers to hunt and peck significantly more than the students who were using the free program. That was in the K through two population and the third through the fifth population, they found that those students increase the rate of typing, more so than the students in the free programs. That was the key takeaway the younger kids got better at the actual methodology of typing using their hands and improving the touch typing, or maybe not getting all the way to touch typing, but using more fingers understanding the keyboard a little bit better. While the older students improved their fluency per se, they were able to type longer and faster. Surprisingly, the older kids in grades three through five that were not doing the learning without tears program actually improved their typing methodology more than the other kids that were in the learning without tears program. Again, the typing methodology meaning how they actually typed from touch typing to the hunt, and peck method. All in all the authors came to the conclusion that this study indicates the importance of using a developmentally based comprehensive curriculum for keyboarding, such as the keyboarding without tears curriculum to improve student's typing and both general education and special education. The research also was noted to support that student's keyboarding skills improve with the exposure to keyboarding and instructional tools against such as their program and that this provides promising evidence of the keyboarding without tears effectiveness to improve net words per minute over a free web-based activity. Now, this brings me to the limitations, and based upon what I've already said, you might expect me to have a few limitations of my own, but I'm gonna start with their limitations. The researchers did note that limitations included the size of the study, as it was a small study and limited to a certain geographical location. They also noted that the free program that they use for the typing test for the pre and post-test wasn't great for the younger kids, because kindergarteners maybe didn't even know what letters look like, and they were asking them to copy a paragraph, and they didn't even know what letters were. So that would be two things that they established as limitations. Personally, like already mentioned, I think that they chose some of the worst online programs that are free for typing and that they could have compared their program to potentially a better free alternative. And you know what, they might have still found similar results, I'm not sure. As I also mentioned earlier, one of the schools that were selected as keyboarding without tears school was based on research or familiarity with a school as opposed to random selection. I would have liked to see that random selection. And they didn't exactly explain other than familiarity for why that school was selected to be keyboarding without tears or KWT school. The last and potentially most blaring limitation and conflict of interest was that this complete research project was, "supported by learning without tears". I'm not sure what the full extent of the term supported means. I don't know if a financial was supported. But it was supported by the program, which was being tested. Likewise, the two key authors which I didn't realize when I started reading this article, but at the end, they made very clear that two of the research authors actually work part-time for learning without tears. So it's really hard to take some bias out of this article. It just kind of is right there and front, but they don't put it in they don't tell you that information until the very end of the article. So that was a little disappointing for me. Furthermore, after reading this article, figuring out that there might be some bias. I actually went to the learning without tears website, lwtears.com. And I looked at their keyboarding without tears program, I looked at what their marketing materials look like I looked at the program itself because like I said, I've never used it before. And what I found was that this article is being used as a marketing ploy to say that students who use their program are typing 43% faster than students who have not taken the program. And I'm not sure that that is entirely a fair estimate or a fair statement to be making. So with all of that, I didn't come on this podcast to jump on here and talk bad about handwriting without tears. I mean, I really like handwriting without tears. It was one of the first training I ever went to. And I've been using concepts that I learned in that training for nine years as a school-based OT and I do really value all the content that they have created and everything that they put out. But I really cannot look at this article read through it and with a straight face think that Yeah, absolutely handwriting without tears. Sorry. keyboarding without tears is a better program than some of the other programs out there. I really wish I could have jumped on this podcast today with full enthusiasm for learning without tears and the keyboarding without tears program, but I simply can't. I just don't think that this was a great article, you know, yes, this may be a great product, I've never used it. But I can't say that this article really proves that their program is better than other programs out there, even the free ones. So to the authors of this research article, I really do appreciate the background that you put into creating this article. I appreciate the term that you use for student occupational demands, I think that is something that we should all be using more frequently. I appreciate the information on Common Core State Standards. I really do. I understand that there aren't any norms. Thank you for sharing that with me. But at the end of the day, the actual research itself, I just can't look at and take straightforward. I just think that there's a little too much bias involved here. And I just can't I can't say that I can't go to an IEP and say, Hey, parent, you know what handwriting without tears there, keyboarding without tears program, that is the best option. When I know that there are other programs online that are free, that might do just as much or better of a job for free. I'm sorry, that's just my final takeaway from this episode from this article that I read was that it doesn't really tell me that I really need to use this program over some of the free programs that I'm aware of. Alright, so with that, I'm going to go ahead and wrap up today's session of the OT School House podcast. This has been Episode 75 and it has definitely been real. I hope to see you next time for Episode 76. Take care and see you next time. Bye-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

Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 74 of the OT School House Podcast. "What is the difference between ADHD and Sensory Processing disorder?" Has a parent or a teacher ever asked you that question? This has always been a touch question for me to answer. I could always explain sensory processing well, but I hadn't learned much about the neurological processes behind ADHD. To help you and I better understand the differences between ADHD and SPD, I am welcoming to the podcast, Debbie Lund, MS, OTR/L. Debbie is here to share with us her experiences of working with children who have SPD and/or ADHD and how our treatments may need to vary based on the child's needs. Meet Debbie Lund Debbie is the Owner of Two Fish Therapy, LLC. She has worked with a variety of children with various learning needs for over 20 years. Her occupational therapy experiences include working with children with diagnoses of Sensory Processing Disorder, ADHD/ADD, learning disabilities, dyslexia, visual perceptual disorders, dysgraphia, motor coordination disorders, autism, to name a few . Before completing her Master of Science in OT she worked in a variety of community settings including homes, schools, daycares, and after school programs. She has particular interest in designing new and more effective therapy and educational programs for children in schools. She works everyday to ensure that her company provides the best available; consultation to teachers, individualized learning plans for kids and schools, integration therapy with education in classroom and treatment. She aims to support and advocate for child-centered learning styles, especially for children with attention, sensory and coordination issues, with every family and child she meets. She also strives to build relationships with key professionals in the community in order to enhance potential, success and connections for families and their children. Links to Show References: TwoFishTherapy.com Two Fish Therapy on Instagram Empowerment Plans on Instagram The STAR Institute Books Sensational Kids Out of Sync Child 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 everyone, and welcome to Episode 74 of the OT school House podcast. My name is Jayson, thank you so much for joining us here today on the OT School House podcast. Really appreciate you being here. This is gonna be a fun one. We're talking with Deb Lund, who is the owner of two fish therapies down in Florida, if I remember right, and we're going to talk about the difference and similarities between ADHD and sensory processing disorder. So if you have been caught in the middle of a conversation, trying to explain the differences between ADHD and sensory processing, you are in the right place. This is the podcast for you. We're going to talk about the differences in the DSM, the DSM five, the manual that kind of outlines what a disorder is, and kind of what the definitions of it are. And yeah, we're going to talk a little bit about evaluating how to determine whether we need to go in the direction of treating ADHD or treating a sensory processing, and then even what that might look like the treatment as well as the recommendations that we might provide to parents and teachers. All right. So you do not want to miss this again, this is Deb Lund, and she is the owner of two fish therapy. You can learn more about that at twofishtherapy.com, and she has a bunch of resources that you'll hear throughout this episode that she has compiled for us that you can get at the show notes for this episode. All right, so enjoy the episode. This is Deb Lund. Deb, welcome to the OT schoolhouse podcast. How are you doing today? Debbie Lund Great. Thank you so much for having me. Jayson Davies Yeah, no problem excited to have this conversation. This is a question that comes up a lot. I'm sure you've heard it many times, obviously. Because we're, we're talking about today. And that's kind of the difference between ADHD, sensory processing, and how you kind of see those differences. So I'm excited to have this conversation with you. Debbie Lund Oh, thank you, me. Me, too. I'm really excited. I do hear that question a lot. Jayson Davies I bet. Debbie Lund I think a lot of you as well, teachers, and probably pediatricians. Jayson Davies Absolutely. And I love that, you know, we already have a question a little bit down a little bit, you know, in a few minutes, maybe 20 minutes or so I'm gonna actually ask you kind of that specific question is how do we explain? How do we explain this to parents who might be wondering this and don't have a medical background. So we'll get into that in a little bit. But first, I want to give you an opportunity actually to share a little bit about yourself in your OT career and how you got to where you are today. So tell us about that? Debbie Lund Well, I like from the time I was a kid, I always wanted to be an education. So I think originally I wanted to be a teacher or something. And then as I got older, I was just I think my parents really pressed upon me how important it is to get an education and have a good education. And going through my educational career, I saw so many intelligent people like really smart folks who struggled so much to access education inside the box that we have as education, right. So, you know, in a lot of cases, quite frankly, and I think a lot of people would agree with me who experienced this, and this is even neurotypical folks like education can actually be more of a catalyst, I mean, more of an obstacle than a catalyst to people's life success, right? In terms of if you have learning differences, or if you don't fit within the style of that education. And although So, so I always wanted to support access to learning. That's what I wanted to do. So I wanted to help people get through school, I wanted to help people do well in school, I wanted to help them be successful. I was going to be a teacher. And then I thought, well, maybe I'll be a psychology like a school based psychologist. They don't got it on my undergrad, double majored in sight, I found out that it was a lot of testing and a lot of mental health. And that was not what I was looking for. And then just through working, you know, with people with disabilities, like I worked in group homes, and I worked in schools, and I worked in the community, I did some independent living stuff with folks. I happened upon OT and I apply for I was like, This is perfect. Like, this is exactly what to do. I want to enable participation. I want to enable access in school systems like this is, you know, so that's how I got there. I applied and here I am, like running a school based therapy company is out there. This was speech paths and educational assistance and, you know, Yeah, Debbie Lund wow. Yeah, it really sounds like you found the right job. Debbie Lund This also you know what, I'm Canadian.Yeah. So I went to McMaster University in Ontario. I'm from the east coast of Canada. And I actually just after grad school, packed up and drove here. Jayson Davies Drove here being Where? Debbie Lund To Florida to Florida, where I live now. Yeah, and I own this practice. And I do all of this. So it's, it's been a real adventure. Wow. So from Jayson Davies Florida what a change? Debbie Lund Definitely, yeah. Jayson Davies Yeah. And a lot more ways than just one. I mean, more than just weather. Debbie Lund Yeah. Jayson Davies All right. Well, actually, were your parents in education, you said that you were kind of instilled with education, were they in education. Debbie Lund We weren't in education, but I just I was just a big part of what they believed in, like, they just really wanted me to get an education so that I could do well for myself. Great. So it wasn't, it wasn't bad. It was just the I think it's very common for people, you know, to, to hope that their children will get the best education that they can get, you know, Jayson Davies absolutely. Alright, so I really liked what you touched upon too, with house for some education can be a something to build up upon. But for other people who might have a learning disability and maybe a little bit more tough and like you, I think you said it might be an inhibitor for some people. Yeah, like, yeah, and obstacle. There we go. Great terminology. Yeah, we're gonna get all into that. But I want to ask you one more question. And because you kind of started to talk about it is is your company? What does your company actually do? You mentioned that you have a school based OT company, you also mentioned, educational assistance. So tell us a little more. Debbie Lund Yeah. So I currently own a company in St. Pete, Florida. And we go specifically into private schools right now, to support them with their therapy services. So speech in OT. And then I also have educational assistance or reading specialists, learning specialists, educational specialists. So I have, I have a couple of tutors who work with me one Spartan trained, the other one is Linda mood Bell trained. And then I've also trained them in how to do some of the the home programs that I would generally give parents. So they'll start their tutoring sessions with a little OTs protocol, you know, important move protocol, and then they'll go into the rest of it. So we're kind of sharing and make like enabling more of that access to the treatment plans, more more frequency, intensity duration, because they're seeing me and then they're seeing them a few times a week, so they get it more frequently through us, especially if the parents aren't able to on account of schedules or whatever the situation, maybe Jayson Davies that's really cool. I would love to see some sort of research done, where there is that much incorporation between the OT and it sounds like to me, your educational specialists might be something like we call them out here. RSP resource specialist teachers or something like that. Debbie Lund Yeah, exactly. Jayson Davies Okay, great. All right. Well, that's awesome. So yeah, and we'll direct people to your website, so they can learn more about your website a little bit later. But let's jump into sensory processing and ADHD a little bit. Sounds great. Yeah. So to get started, let's start off with the ADHD side a little bit. And would you mind sharing with us a little background on ADHD and for anyone who's not quite so sure about it, this listening what it is? Debbie Lund Okay. So ADHD stands for attention deficit hyperactivity disorder. And I think like to explain it, I'm just going to go right into like differences in terms of our brain functioning. Okay. So we know that children who have attention deficit hyperactivity disorder, there's some issues with the neurotransmitters and that there's not enough dopamine and norepinephrine. So that's one that's one area of difficulty. So there's some struggle with some focus there. And then there's some difficulty with the reward system and motivation associated with those things. And then there's a lot of great imaging now, you know, like scientists come so far. So neural imaging actually show some abnormalities in the frontal regions of the brain, which is to be expected because, you know, those are the areas of the brain that are involved in executive functions, focus, tension, planning, self monitoring, working memory, these type of things. So we know that children who have attention deficit hyperactivity disorder have brain differences and their behaviors present as struggling to focus struggling to plan struggling in those areas in which those brain those brain differences are present. Jayson Davies Gotcha. Okay. The next question is going to lead right into that, and ADHD I, there's always been I mean, this is ever since I was back in high school, I remember there was always like, is ADHD are there different types of ADHD is add a thing. So I just want to quickly ask you a little bit about As far as are there different types of ADHD? And if so what are they? Debbie Lund I think that's changed, like, as of recently, and I don't know, I hate to say as a risk I feel the older I get, the more years pass. Jayson Davies It's relative, relative time is relative Debbie Lund it's relative to my age, which I really don't want to get into Jayson Davies Not on this podcast. Debbie Lund So now there are three types that you can actually have in terms of the DSM five, there's three different types. So there's the combined presentation and and it's some combination of either being the inattentive type, or being the hyperactive impulsivity type. And I'll give you some characteristics of that in a second. But just for you to understand how the diagnoses go, you can have a combined presentation, which would be the childhood or the or the adult person would have to meet the criteria of both in attention and, and attention and hyperactivity, impulsivity. So there's a list of characteristics that come with that. Or you can have predominantly inattentive presentation, or the child struggles with just hyperactivity impulsivity, or you can have no sorry, within attention, struggles just predominantly within intention, or you can have predominantly hyperactive impulsive, which is they meet the criterion for hyperactivity Jayson Davies and impulsivity, Debbie Lund impulsive over the over the plastic, and this is all happening over the past six months from which they're tested or beings. Okay? Jayson Davies So it's really based upon what? Debbie Lund they have to meet these criteria and within six months of being in the doctor's office, or whoever's doing the assessment, Jayson Davies gotcha. Okay. And then so you started to say that you would also share with us a few of the behaviors that that might look like, depending on whether they're in the inattentive type or the was it hyper activity, impulsivity, so go ahead with that. Debbie Lund So if they are in an inattentive, this is like directly from the DSM. So the Diagnostic Statistical Manual that's used to create some criteria and provides diagnosis and diagnosis codes. So for the inattentive type, here are some characteristics so they make careless mistakes or lack of attention to detail. Difficulty sustaining attention doesn't seem to listen when spoken to fails to follow through on tasks or instructions. exhibits poor organization avoids or dislikes tasks requiring sustained mental effort is easily distracted. So those are some criterion for inattentive type. For the hyperactivity, impulsivity type, it's fidgets with our taps, hands or feet and squirms and seats leave seats in situations where they shouldn't be remained seating are seated, has difficulty engaging and quiet, leisurely activities is on the go or acts as if driven by a motor talks excessively. blurts out answers, has difficulty waiting their turn, interrupts or intrudes on others. Okay, so those are some of the symptoms were acquired for a diagnosis. Jayson Davies Yeah, and like you were saying earlier, it sounds like there's three different models, not models, but three different ways that a child can be diagnosed with ADHD. And so you might get mostly that inattentive, my most of the hyperactivity, impulsivity, or a mixture of the two, correct? Debbie Lund presentation. Exactly. Jayson Davies Great. Alright, so I couldn't help but think, well, you were mentioning all of those behaviors, that it can sound like some of our kids also, who might have a sensory processing disorder, maybe some of our kids with autism, and all right, so Exactly. Right. So let's go ahead now and talk a little bit about the sensory processing side of it. I think as OTs we inherently get a little more training in sensory processing than we do in ADHD. I think maybe that's different depending on what school you went to, and what trainings you've taken. But what are some of the key behaviors that might be seen in a child with sensory processing disorder. Debbie Lund So I think in terms of like behaviors associated with being able to attend for school, like access education, and learning behaviors, very much the same as those characteristics for inattention and hyperactivity and impulsivity, and I and you know, considering where the processing breakdowns are, which we can get into or we'll get into a little bit later when we start talking about SPD presentation and neuro imaging, but it makes so much sense that higher levels of the brain would be impacted such as the areas in the frontal region, because there's the processing or as Jane Ayres would describe it, like traffic jams in the in the lower back regions, right. So if there's disruptions that affect efficiency and access to brain centers, then obviously these kids are going to struggle with attention. And they're going to struggle with impulse control in these frontal lobe regions. So those behaviors are very common in the kiddos that we see. Jayson Davies Gotcha, yeah. And one thing that I always recall from like anatomy classes, and then it was reminded of it when I took some si classes was that you have the old brain and you have the newer brain, right? And that old brain is like central located. And that's where all that sensory processing is really, that's where that traffic jam often is, is in the brain. And so those signals can't get to the new brain, which is more of the cortex and the frontal lobe, I like what you're talking about, right until they go through the old brain. And so I think it's absolutely I think you're right on and with the brain, it has to go through that old brain before it gets to the new brain. And so that's why you might see some of those similar behaviors. Debbie Lund Yeah, I recently took a course actually, with a woman who is, was a psychologist, and I was taking it trying to get a psychology perspective, just a well rounded perspective on self regulation, was a self regulation. For those looking more like, I was thinking was going to get more mindfulness yoga, sort of like, anyway, she was so well versed in sensory processing, I was very impressed by that fish, she went back to this old brain piece. And she actually talked about how, you know, Jean, who is the pioneer of sensory integration, she believed that 80% of our brain is involved in sorting, organizing, and storing sensory information. So when you think about there, it's involved in that much so that much of the brain is actually receiving, sorting, organizing and storing sensory information. It's just, it makes so much sense, really, because everything we receive in terms of learning at some point comes in through a sense, right? And then we organize those responses, we organize that information and process it and then create responses to it. So it's a really powerful perspective in terms of taking a bottom up approach for sure. Jayson Davies Absolutely. And so and, you know, our brain has to do that whether or not we have a sensory processing disorder, whether we're a typical learner or whether we have ADHD. And it sounds like the difficulties might be similar in some cases that a student with ADHD or a student with sensory processing disorder might have, they might show similar disabilities. However, the processing within the brain is different. I think you mentioned like dopamine and epinephrine, being more indicated with ADHD, as opposed to sensory processing is very much in that old part of the brain, the brainstem, correct? Debbie Lund Yeah, definitely. And the lower regions of the brain associated with visual auditory and some metal sensory processing. This is what the imaging found. But more importantly, let me I got ahead of myself. So let me just step back. So I think in terms of you're saying one of the key behaviors in kids with sensory processing disorder, and I said, Well, all of the inattentive and learning behaviors that I just described for attention deficit disorder, but also there's a need for sensory but I need to seek sensory input or avoid it. So there is a some sort of association with sensory input in a kid who has a sensory processing disorder. If that isn't there, that can actually be a key feature for us to determine whether it's an ADHD issue, whether it's a higher brain region issue whatever's going on, or whether it's rooted in sensory processing stuff. Jayson Davies Stuff Well, let's let's go into that a little bit more because I know you know it, I'm gonna, I'm gonna pull it out of you. Okay, let's kind of break down sensory a little bit what might a student or a child be seeking or avoiding when it comes to tactile? Debbie Lund Okay, so you want some specific behaviors of what they might be thinking? Like, Jayson Davies yeah, we'll go with that. Debbie Lund Okay, so So kids who seek tactile input, this is the kid Okay, who you have a difficult time setting them any like we're thinking if we're thinking kindergarten to grade three, this child Do you struggle with having him standing in a line having him sit in circles having him be anywhere close to somebody else, because he's always touching, seeking bumping crashing, or she bumping too hard tagging too hard seeking out this extra input all the time. Whereas the kid who is an avoider is going to get very upset from a tactile perspective. If they're in line and somebody just taps them gently it's going to be Oh, my goodness, you know that he hit me he hit me, you know, this over responsiveness, so the tactile input, so and then over responsiveness to clothing to to materials, like play materials and school, especially in terms of like glue, slime, sand, all of these different textures and even pencils, sometimes. Even pens. Oh, yeah, definitely for sure. Yeah. Jayson Davies All right. then what about are you you've had on yours, and I wanted to talk about it was the the ocular motor concerns when it comes to sensory processing? Debbie Lund Right. Jayson Davies And so I wanted to ask you about that one. Debbie Lund So that's huge. So when I think that, you know, oftentimes ocular motor concerns are overlooked. I think that as OTs within the school system and correct me if I'm wrong, like within like a public school system, or within a school system. Who else is considering the child's document motor skills, I don't know of anybody else who's pointing that out, right? And similar system is wired to the like, you know, our muscles or muscles within our eyes are controlled by our vestibular system. And our vestibular system also controls our postural activation, our body awareness. So when you're thinking about these kids who have sensory processing issues, and they're rooted in vestibular difficulties, you see there, they then have a difficult time controlling their eye movements. And the impact of not being able to control your eyes is tremendous when it comes to academics, particularly for what's important for, you know, administrators or for like the test givers in terms of like reading, writing, and math. Because for reading, you need to be able to sustain visual attention in order to be able to read or to attend to anything really in school, you need to be able to sustain visual attention, you need to be able to track across the page for all of that work or across the room without losing visual attention. You need to be able to your eyes need to be able to skip in a systematic like stockades just type of eye movement, from letter and letter to word to word with accuracy in order to be able to receive reading information, letter information, etc. You know, I've just narrowed it down to those two, Jayson Davies what I also think about, Yeah, I also think about copying from the board specifically going from the Debbie Lund far point to near point, divergence and convergence to like, where your eyes when you look up, your eyes naturally team out together. So your belly, your eyes, abilities to work together as a team. And then when you come in to look at your page, your eyes actually team in closer together, and whether or not those are working in an organized way affects your ability to do things like that. So yeah, Jayson Davies Great. And another term. And another terminology or term that I wanted to also ask you about was discrimination and what discrimination means in relationship to sensory processing. Debbie Lund So your ability to script discriminate is and this is actually a pattern of sensory processing disorder as well. But your your ability to discriminate is your ability to sense the subtle qualities differences, and sensory input. So let's say visual description, we're going to speak specifically to the sense of vision and example of visual discrimination would be being able to differentiate between P and Q, or B and D. Whereas if we were talking about auditory discrimination, we would be talking more about being able to discriminate between maybe cat and cap. So we're thinking of like phonics and phonemic awareness and these and listening and receiving instructions, and being able to hear your name another type of discrimination is being able to sort if it's like a foreground situation, so being able to hear your name being called when there's background noise going on behind so if you're if a child on the playground, and and there's a lot of noise going on and the teacher is calling them or the teachers giving a signal like time to come in and you know, for that child to be able to pick up that auditory cue, and, and and respond in a timely fashion like the rest of the kids. It's it's a negative, if it negatively impacts their ability to be able to do that. If they have issues with auditory discrimination. Jayson Davies Alright, and so you kind of started going down this route. So I'm just gonna go with it is describing some of the sensory patterns that a child may exhibit, I think you mentioned that discrimination is actually one of them. So why don't you elaborate on maybe give that one the full name, I'm not sure if you said it or not, but and then go on and explain the other few. Debbie Lund So there's, there's three patterns, and one of them is sensory discrimination disorder. And you know, this can happen in an all of your eight senses, or any of your eight senses. Maybe some of your senses maybe more affected, and other senses, it's the children present differently. Each child is unique, and their brains are unique. And their their experiences and the way they process information is unique. So, so there's sensory discrimination disorder. And like I said, that's the weather unable to distinguish subtle differences in sensory input, and then give meaning to them. Okay, all right, such as cap cat, P and Q, then there's also sensory modulation disorder. And that's when a child struggles or a person struggles to modulate the responses to sensory input in a functional, meaningful and purposeful way. So that for these kiddos, they have differences in the rate, they receive the information or notice the input when it comes in. And then the intensity of their experiences are different. So we're, you know, and this affects their behaviors and their responses and how they respond to it. So these kids are categorized in over responsive, under responsive or sensory seekers or cravers. So a child who is over responsive is this kid who has a huge intense experience associated with input, and their responses reflective of that, okay, and then a child and not like, you know, with treatment, where processing and probes and responses improve. And that's the whole point. But I'm saying, when there's an area of difficulty, and there's a disorder, and it's struggling, children are struggling, their responses are impacted. Jayson Davies Gotcha. Debbie Lund And then if they're under responsive, they're actually the rate in which they're receiving the information is delayed compared to other children, and they're not in the reaction times are delayed, and they're not getting the intensity that they need in order to activate those responses or activate that brain activity that's required for class. So these kids, you know, these are the kids that I think often go nest, like they often go on identify, I think over responsiveness people are more aware of, and it's more spoken about, but under responsiveness and passive. So these kids have, you know, poor strength, pouring durance, poor body control, they have they generally overall weak and they're a little bit slower or sluggish. They're very passive, they're easy going to get along with, so they often slip under the radar. And a lot of people you know, a lot of teachers, I'll hear from them, I don't know what's going on with this kid. He only does he only does his work when he wants to do his work, you know, I think he's just lazy. He's way smarter than this, his output doesn't match how intelligent he could be doing something, you know, this type of kids. So that's the I see that as the unresponsive kid, these kids that are just not identifies, Jayson Davies I can think of that kid in my head. Yeah, and, and I've also, he's also the kid that in the classroom, like you're saying, isn't getting the attention, even though he's probably the brightest kid in the classroom. He's not getting the attention that he may get otherwise, because other students are more outward with their behaviors, I guess you could say and you know, they're very much attend. They demand the attention based upon the behaviors that they exhibit. Debbie Lund Definitely for sure. And then there's the sensory seeker the sensory Craver, and those kids are still under responses. They're not getting the intensity that they need. But unlike the passive under responder, they're seeking out what they need their brain is continuously telling them light me up on more important I need to grow. We got to get you got to get me this in for if you want me to attend, I need to move if you want me to listen, I need to move you know, it's always trying to get organized by seeking massive amounts of input. So that's, that's the seeker and then there's the over responder that is presence and then there's the overall responder who avoids situation so they have such negative experiences with the cafeteria or you know such negative experiences with lighting situation or maybe noise or a public situation that they avoid interacting or those situations, just the thought of it gives them anxiety so they avoid those events or situation. Yeah, stimuli. Yeah, thanks. So those are basically the three Oh, and then their sensory based motor disorder. So there's that sensory modulation disorder. And then there's sensory discrimination disorder. And then sensory based motor disorder is actually two types and one is postural disorder and one is dyspraxia. So postural disorder is, so these are obviously difficulties with motor function and motor output. So the way we receive process and respond to sensory information for executing motor responses is affected, okay? So your postural disorder is that you have poor strength, and it's rooted in like a core strength, your core strength, your endurance is poor, poor motor skills, poor bilateral skills, here, we get into more ocular motor skills are affected I hands affected, and they struggle to stabilize their body to do functional skills at school, whether it be sitting themselves up in a chair, sitting themselves up in line, or stabilizing their bodies in order to like hit a ball with a bat or play, catch, etc. And then the other one is dyspraxia, which is, um, this is disorder in, there's a breakdown in the areas of motor planning. So coming up with an idea, so ideation part of motor planning, coming up with an idea for a motor plan, and then sequencing and planning that, and then executing that plan and evaluating it and changing it if it needs to be changed in order for you to do better the next time. Those are the three patterns of sensory processing disorder. Jayson Davies And I wrote him down just so he can, it's sensory modulation disorder, sensory discrimination disorder, and then the sensory based motor disorder. And there are kind of some subcategories within each of those, Debbie Lund yes, Jayson Davies we're not going to review all of them, you said them. If you want to go back, use that 3o second rewind button on your podcast, and you can go back and break it down, each one Debbie Lund The Star Institute has is a great place to go if you're interested in getting information like Lucy Miller, um, there's some great books I can talk about later on, as well to some resources for sensory processing. But if you're interested in learning more about it, the star Institute is a good is a good place to start. Jayson Davies I actually want to ask you a question based upon those you mentioned three main types, and then a few subtypes. How often would you say or I don't know, just frequency, whatever. Do you think that they often occur independently? Or do you think that they are often co morbid, potentially where kids who might have a sensory based motor disorder also has a modulation or discrimination disorder? Debbie Lund Definitely, So you know, I took there's, there's some great courses actually offered by a woman named Julia Harper. They're online, Julia Harper. And she, she owns a company called therapies. But, and that's where I got a lot of my training in terms of how to do assessment specific to brain areas, like we were talking about in terms of sensory processing, and what it looks like. And then protocols associated with those to help improve processing. But you know, based on that information, and a lot of other information that that I've received over the years, the idea is, is that if there's a modulation disorder, then that's that's happening at a lower level in the brain. So modulation disorder happens closer to the point of entry, we'll say, okay, where the inputs coming up through our central nervous system and our spinal cord, and then a sensory based motor disorders. And then sensory discrimination disorders are happening in areas higher than that. So if you have a modulation disorder, you're going to have some patterns, or some symptoms of affection, like affected areas above. So what's really interesting is that in these protocols, and in the teaching that that I got through those courses, was that you would learn where to start treatment and how to treat that area of the brain, and then prove and then move to the next area of the brain. So you have a systematic protocol approach in order to isn't Yeah, for treatment. So yes, they can be comorbid. Jayson Davies And you actually, I mean, it makes it sound more like it's not that they can be comorbid. Yeah, it's more like they often will be comorbid. Debbie Lund Yes. Jayson Davies Especially if it's that lower brain the sensory modulation, I think you said it was Debbie Lund like he was a child and you find that they have a modulation disorder, then they're going to have difficulty and a lot. Yeah. I think a lot of kids Who were identified and referred to us for sensory. It's because they have some sort of a modulation decided maybe that's wrong. I don't I think in my experience, I get motor referrals, but I get motor referrals more associated with fine motor skills than sensory based motor, the teachers don't know sensory based motor. Jayson Davies Yeah. And I also think I also think when it comes to sensory referrals, a lot of times for teachers, it is the modulation aspect and the behaviors that are due to the modulation aspect that the teacher feels is inhibiting the student's learning as opposed to the motor side. So yeah, definitely. All right, well, we got a good recap now a good introduction to SPD and the different types as well as some ADHD and so we're gonna continue on here. And I want to ask you, in schools we don't do especially not OTs, I mean, we're not allowed to diagnose but even psychologists in the schools don't diagnose they they do a report, they do an evaluation, but they're not diagnosing who is the person that would typically diagnose a child with either ADHD, SPD autism or whatever it might be. Debbie Lund I have like, I don't know if that changes that varies state to state, I'm not 100% sure to be honest with you. But I know here in Florida, it can be it can be your pediatrician, honestly, or it can actually be. And that's what's so interesting to me is that it can go from being your pediatrician with, with from what my family's report being a sort of questionnaire based subjective, or objective sort of experiences based on the parents reports to being on neuropsychologist, who does a full gamut of evaluation, or like a psycho educational psychologist who does a full gamut of learning, you know, so there's a variety of people who provide diagnosis for ADHD. Yeah, gotcha. Jayson Davies Yeah, I think that's absolutely, I think that's pretty consistent here. I think now it's starting to go a little bit more above the pediatrician because I think they're just kind of that refer out here a little bit. I would always recommend, I think, to a parent that if they feel that they need more information, I would definitely recommend reaching out to trying to get your pediatrician to refer you to a neuro psych especially in neuroscience, not a psychologist but definitely a neuro psych. Debbie Lund Definitely neuro psych i think is the best neuro behavioral if you can get somebody that's it. That's I think those I've had the best success in terms of comprehensive assessments and like, explaining to parents what's going on, and them having an understanding of what's going on. I think, neuropsychologist know behavioral sort of an end to end. I've had a lot of great, say, Good psychologists, as well. But I think you want to have a comprehensive evaluation. Jayson Davies I don't think I think you kind of mentioned the pediatrician, they might just do a little subjective type of questionnaire. And yeah, I mean, great. You have a diagnosis, but what have you really learned from that subjective question? Debbie Lund Right. Exactly, totally. And there's a lot to learn. Jayson Davies Oh, yeah, absolutely. And I know a lot of parents do a great job at trying to figure out what to learn through going to trainings that maybe we might go to, and parents are doing it because their child has a diagnosis. Which brings us actually to the next question, we just did a great review of ADHD and sensory processing. But we use a lot of jargon, we were talking about epinephrine and door and dopamine in parts of the brain, when you're sitting in an IEP or you're maybe it's not an IEP, maybe it's a private student. How do you go about explaining the difference between ADHD and sensory processing? Or I know, sometimes we're not comparing sometimes we're explaining it separately. But how do you explain that to a parent in a way that they understand? Debbie Lund So I def, if I'm trying to explain the differences between the two, I definitely do talk about parts of that the differences that there's processing happening in different parts of the brain, and therefore we need different treatments and different type of therapies or interventions to support performance, right, and optimize brain growth and function. So I will talk a little bit about parts of the brain if I think they're interested. You know, it really depends on the parent and you have to feel your parents out in terms of what kind of information they need. So I will talk about brain differences with some parents, I often, but I think the biggest piece is that children who have Sensory Processing Disorder need sensory experiences and sensory interventions in order to support their attention. Whereas children who just have attention deficit hyperactivity disorder won't necessarily benefit from sensory experiences to support their attention because of these different areas of the brain that it's happening in. So it's important for us to know, you know, do a good assessment and understand what's going on so that we can give the right interventions and children with ADHD, you know, that there's, they're prescribed medication, and a lot of kids have had a lot of success with medication where that's not indicated for kids with sensory processing disorder unless it's calm, calm, or more morbid. So Gotcha, yeah, it's hard. It is, and I think as long as we stay Debbie Lund it's not too late like it. And it's hard to explain, like how you would explain it to them, because it is very different for each parent, I think you have to be client centered in terms of who you're talking to, like, if a if a, if a child's parent is a doctor, you know, you're gonna come in and deliver a different message than maybe if this is their first experience and ever having the conversation about development or, you know, neuroanatomy or, you know, whatever. Jayson Davies Yeah. And then the same way also, depending on how their child is presenting to, I mean, making a specific to the way that their child was presenting. Yeah. All right, so you actually started to talk a little bit about the assessment process in there. And so I want to jump into that that evaluation process what how do you kind of go through assuming, let's almost use an example, if you get a child who someone says, Hey, they're having difficulty with attention, they may be seeking out some sensory stimuli? Where do you go from there? What's your brain start to? Where does your brain start to take you as far as what you're going to evaluate? Debbie Lund Well, I, I am generally what I generally do in my product, like what the company is, I've created a lot of questionnaires and screening tools that go over various areas of development, so I can hone in and I can better focus my lens for assessment, you know, so I get that feedback back. And I identify by by that, whether I see that there are sensory that this is definitely within the area of sensory processing in that area of development and, and whether or not I feel that they need to see me for a story if they if I should refer out to say good for us, depending on the symptoms, and how the teachers fill up those questionnaires. Okay, so that's where I start is trying to figure out what the first point of access should be. Because I have that Liberty because I'm in private school. So I'm, I'm working with the schools closely and they've been various, some of my schools have been in very, very awesome about calling me to do the screening, first as an OT, and I'm the first point of access for these kiddos. And then we discussed, you know, what we're going to talk to the parents about next. So that's really quite lovely. So that's, that's, that's where we start. And then if there are sensory symptoms associated or if there's behaviors that the teacher is observing, that look like they're rooted in, in sensory or reflective of seeking or avoiding or sensory based motor, etc, then I'll go in, and there's a few assessments, you know, that that we can choose from. So there's the sensory processing measure, which is, there's one for home and it's one from school, that's really great to give you information in terms of you're looking for a significant result for scoring. It will it breaks down the various senses and social participation in motor planning, etc. It's a great tool. There's also the sensory profile, which is when he does, she does, she has a great, great tool that helps a lot with identifying modulation and regulation. And that then I assess reflexes primitive reflexes, because that's all within that same area of the brain. And it gives me an idea of the processing is actually happening in those sensory upper brainstem areas. Jayson Davies Yeah, and if I can interrupt I am. So I don't know how to say this. I have not taken any trainings on primitive reflexes. I know very, very tiny. I know very little about it. I actually had a guest on way back in episode like 32, maybe way back when about it. And I've never actually got more into it. But I'm hearing so much about primitive reflexes and sensory being very combined the kind of like what you were just saying, so do you have any resources or any classes that you actually might recommend for primitive reflexes? Debbie Lund There's quite a few courses. It depends on how comprehensive you want to. But you know, what I can do is I can put some together for you and you can put them in the comments of this section. Based on because the thing I think the thing that's heartbreaking for me for us as OTs is that it's so it's it can be so expensive. Yeah, especially for new grads and whatnot. For us to Get the education that's needed in or like talk about in accessibility, right? So it's trying to find these courses that give you what you need considering your role in the school or what you're doing in the community or what your ambitions are for a career that are affordable for you. So there's there's a variety of different courses. There's one that's very comprehensive. There's another one through therapies who is the woman I just spoke about, which is excellent thing that I like about her courses as well is that she breaks them up into modules. So the first module you'll take, I think it's like $200, or two to $300 or something. And it's just on sensory modulation, then the next one's on regulation, then the next one's on and you can take them in pieces like that digesting information larva, but she also has a primitive reflexes that specific to clot to to school. Oh, interesting. All right. As well, Jayson Davies alright, I cut you off here. But what other assessment tools do you use as well? Debbie Lund So those are like I do my sensory profiles, my sensory processing, measure primitive reflexes, and then we're moving up into movement, right? So we're talking, I get beyond getting a sensory based motor and trying to get some more data to support that there's a motor issue happening. So then I start looking at using tools like movement, ABC, or the bot. Do you use those ones? Jayson Davies Yeah, I mean, I'm very familiar with the BOT, I don't use the Berry as much, but that's because the psychologists tend to use it. And so instead, I might use the WRAVMA, or like the DTVP, or something, you never use the WRAVMA, it's very, it's very similar to the berry, you have your visual spatial component, then you have your visual motor component. And then the motor coordination is different. It has a peg test, but it doesn't have the the VMI has like where you stay in the lines, right, you have to basically trace the same line. Yeah, it doesn't have that one. Instead, it has a pegboard speed test, which I very rarely use. But I use the first two parts, kind of like the VMI I feel like no one uses the entirety VMI they just use like to subtests Debbie Lund depends on what your your, your motivation Debbie Lund is right necessity, and everybody has their way. So that is so those those and then like some ocular motor assessments. So those are n generally for ocular motor, what I do, although I've taken a lot of great courses for like, astronaut training, and you know, like, I love integrated listening. So like I've done a lot of different things that includes a hand or visual motor integration, and ocular motor skills and tracking that incorporate that multi sensory piece, I generally do a screen and then talk to the family about seeing a developmental Optometrit or opthamologist just Yeah, because I just adopts and I want to make sure that there isn't something else going on eye health wise, etc. So I'm very, very aware of my area of competency. And I generally screen out, I generally refer out or give the families and power the families with the choice to do that, with the information that I collected. If I if I find that there's an ocular motor concern there. Jayson Davies Yeah, I do something similar. I often use just like a tennis ball and play some different games with the tennis ball to look at ocular motor skills a little bit, whether it be well and I know the bot has some tennis ball stuff built into it. If you go that far enough into the I can't remember which sub tests It is one of those sub tests but yeah, I think, yeah, playing catch dribbling, and throwing a ball at a target. So that'll give you a little bit but I go a little bit further than just having like toss the ball to themselves a little bit and just trying to focus on those eyes while they're playing with a ball game. Alright, so that's some sensory process or testing that you might do with sensory processing do anything differently if you might think more the ADHD side. Debbie Lund So I ADHD I generally So generally, if I'm screening in the relationship that I have, like, if there's nothing going on from a sensory motor and ocular motor, I start thinking multidisciplinary team family wants to find out what's going on. It's more rooted in psycho emotional or maybe anxiety or those executive functions. But I say, you know, your first stop should be a neuro psychologist and she sends you back to me or we decide we have functional behaviors to happen, then come back to me and we'll work on it, but, you know, start there and come back. So I agree, but yeah, okay, good. Jayson Davies I just think I think it's important. Debbie Lund I don't know. Everybody has a different practice, right? Yeah. No, I Jayson Davies think it's important You know, I almost I am a big believer and that I think we need to have a psycho educational evaluation to really have a good OT evaluation at least upon in the schools. I think we really should have that learning testing that's going on and some of those other tests that are going on. Debbie Lund Yeah. Yeah. I don't think one discipline should be responsible for like I do a lot of that within my company. But that's different than a school based like a I'm, you know, it's different than like a public school system where there Yes, cycad is a very, very important, but so is OT I think, especially in terms of the the younger ones, like when they're really little, a lot of developmental pieces that are so important, go missed, because we aren't there first, or we our perspective isn't considered right off the get go. Do you know what I'm saying? Where? So I played with a lot of models where I like I was mentioning earlier, we do the screening, we go in and decide who we're going to refer out to, once we've done those fundamental developmental neurodevelopmental type of screens, you know? Jayson Davies Absolutely. Debbie Lund Yeah, totally. I think cycad is so important. So is speech, so is PT, you know what I mean? Like, it all has such a massive role in the kid, and the kids development and their their progress and intervention. So once the child has been referred to psychology, or if I'm doing a screen, sometimes I'll do an assessment called the test of information processing skills. I don't know if you've heard about it, it's not very common, but it actually tests the child's short term, like their sensory memory, their working memory, and then their delayed recall for both visual and auditory. So you can see if there's a difficult time receiving processing and responding from those and whether there's differences in terms of their profit information processing skills with those two areas. Jayson Davies And what was the name of that one, again, Debbie Lund It's called the it's called the TIPS is the test of information processing skills. So it's really, I really like it in terms of coming up with in terms of like accessing new learning. And, you know, our kiddos who are struggling to fartlek working memory is huge for our kids in terms of access, and in terms of being successful and following instructions. And, you know, being able to execute any sort of multiple step. So I like to have that information, because it will show you if there's a statistical difference as well, which is really valuable. So which so if a child has stronger visual processing skills than auditory processing skills, that will be reflected in the assessment. And then you can then make recommendations in the classroom, for how the child's accommodations to be or support should be more visual or more auditory to meet their learning style. So I love that I like that test for that, that that type of information, and then maybe in terms of like, maybe the child has an auditory processing difficulty, or maybe the child needs to see a vision therapy, like, you know, somebody, an eye doctor, Jayson Davies yeah. Okay. So, I'm not going to, we're actually getting a little close to be toward the end of our time, which is perfectly fine. So we're going to skip ahead now just a little bit to some recommendations that you might provide to both a teacher and a parent, based upon your outcomes. We just don't have time to get into like solid treatment. But what are some recommendations that you would give to a parent and or a teacher, based upon maybe a will start with sensory processing disorder? What what recommendations might you give? Debbie Lund Okay, so I think that always for both of them, I always start with how important how much research search there is everywhere and evidence to support this everywhere. Sleep, nutrition, exercise, for doesn't matter if you have ADHD, if you have sensory processing disorder, the effect of a lack of sleep poor nutrition or not enough exercise on brain growth and neuroplasticity is everywhere, nobody can deny that. So, you know, even if it's your sensory processing system that's affecting your sleep, nutrition, you know, or if it's your, you know, executive functions, difficulties biorhythms whatever it is. Start there, get those, the quarter nailed down. That is such an important foundation for any future change. So I definitely recommend that those are the first first steps. All right, Jayson Davies I just sorry. In my in my mind I just came up with you know how people come up with those like words to remember things. Yeah pneumonic devices is that what theray are called? pneumonic? I just thought of Super Nintendo, it's often or NES is what they call and so I'm going to use any as as nutrition, exercise, sleep any Yes. Yes. nutrition, exercise and sleep. That's the core. Debbie Lund Yeah, it's so important, those are so important. And then you know, if it's sensory based, you know, trying to get educated yourself as a parent or as a teacher, and what that looks like what the child's specific profile looks like, whether they're over responsive, under responsive whether they have, so that you can then teach them and empower them with the education about themselves that they need in order to self regulate, and access and advocate for themselves and access activities or environments that support brain growth and success, you know, so get getting educated and learning as much as you can by working with a professional that specializes. So whether that be like psych or whether that be OT I think for OT you know, we do a lot of interventions, with alerting activities, calming activities, organizing activities, we use different tools and different strategies to support moving through those areas. So Jayson Davies sorry, I just thought of a question I wanted to ask before we went too much further. And that was, do you know of any great resources for parents that when you say, Hey, I think your student might have a sensory processing disorder, I think that your student might be over under react under reacting to sensory stimuli? Do you have any particular resources that you might share with that parent? Whether it be a book, a website? Debbie Lund Yes. So the first I Love Lucy Jane Miller's book, sensational kids, okay, Jayson Davies transitional kids. For anyone who's obviously this isn't a visual, but Deb is right now reaching back to find her. Debbie Lund Sensational kids hope and help for children with sensory processing disorder. That's awesome. That's a great book. It's very, it's very informative. And then the out of sync child is another I can give you a list as well, if you want to attach them to. Jayson Davies Yeah, absolutely. Debbie Lund And then there's a few great websites that I also recommend for information that I can send. Jayson Davies Yes, just send it to me. Yeah. And when for anyone that I mean, Debbie Lund share it with no problem. Jayson Davies Yeah, I'll put it up on the on the show notes, which should be well, it'd be OTschoolhouse.com/podcast forward slash podcast and find the episode number for this episode. And you will be able to get all of the links and great stuff that we're talking about today. Great. So we'll go ahead and do that. Debbie Lund I'm putting that together. Jayson Davies Alright. And then where were we Oh, yeah, recommend recommendations for parents and or teachers, I think you have a few more things I don't know. Debbie Lund So I always I think that in terms of teachers to like appreciating the magnitude of a sensory diet, or incorporating movement breaks or sensory breaks to give those kids that input they need. And like teaching, teaching parents and children undertake teaching parents about children, or therapists, teachers about children. In terms, I think what I think sometimes teachers and parents don't realize that it's an accumulation of experiences or a lack thereof throughout the day. So the idea of a sensory diet is that, you know, if a child is over responsive, we'll say if we're incorporating calming and organizing activities throughout the day, the chances of them experiencing overload becomes a lot less because we're helping them to organize and regulate the experiences that they're having. And when we provide, you know, supports, like sound dampening earphones, or we put the shields over the lights in the classrooms. So those one of those terrible lines, fluorescent Jayson Davies fluorescent lights, yeah, Debbie Lund yeah. Debbie Lund When we put the blue shields over top of that, we're actually supporting dampening the intensity of that input or them so that they, they sustain a regulated state and if you were intense experiences throughout the day, and that's the same with a child who's under responsive who needs more so if you can incorporate movement and exercise and alerting activities for that child, you're better able to keep them in it and adjust rate level like an optimal performance level and not in a low state, or have them overseeing and hopping up into like an an overstimulated state. Gotcha. That's my takeaway for sensory processing. for ADHD. I think those those tools are more executive functions. So we're looking more at like, exercise is still key. But using a lot of techniques for regulation that are cognitive based and top down based. So we've got some great programs. So coming at OT like zones of regulation, a lot of kids have emotional regulation, difficulties that are rooted and an intertwined with sensory issues as well. So that's a great curriculum that has some awesome visuals for the classroom that helps kids to learn how to regulate their emotions and sensory systems. And a really big one, too, I think is and it's so simple is just like, taking abstract terms that they use, like be a good listener, and making them concrete. Do you know what I'm saying? Like I think it's a social thinking curriculum has Larry the Larry's listening tool, and it's a boy. And it's basically he teaches you through a poster and a whole book, there's, it's a part of the curriculum that like, what does it mean to be a good listener, a good listener listens with their eyes, they listen with their brain, because they're thinking about what the person is saying they listen. So taking those abstract things, making them very con create and putting visual reminders on the wall, are helpful for those kiddos who just need those, those ongoing reminders. And the visuals are supportive there for them throughout the day to remind them of those things. Yeah. Right. And then mindfulness and yoga and breathing. And there's a lot of strategies associated with regulations for that for kids. And then and then obviously, I don't recommend medication, not that I'm against medication, but that's far outside of my area of conflict. Like that's not what I do. Jayson Davies I have been in too many IEP meetings, and I'm the same way I don't, I might ask a parent, like what medication they're on. But that's specifically for my evaluation purposes, basically, right? Just so I have it documented. But I cringe when I hear a teacher or an ABA therapist or PT or anyone be like I, you know, maybe you should try. Debbie Lund That makes my stomach because that is so not within your realm of right. Yeah, I know that. Be very careful. Because another thing as well is like as a parent, you like what your teacher you're not in the classroom, right? You don't know what your child's doing from the time a little. So a teacher's recommendations to you and a teacher's perspective on how your kid is doing at school, and what is going to support them. Here is a lot of weight in a lot of cases. So you really have to be careful about what you're saying for sure. Definitely. Jayson Davies It's one thing to provide knowledge that there are options out there. It's another thing Debbie Lund to try to persuade someone, or in some cases, I've even like people like teachers, parents come to me saying that they they're at this point, they feel guilty because they haven't medicated their child because they're teachers. So Oh, Jayson Davies yeah. On top of them. Yeah. Debbie Lund Yes, on top of them that it would improve their life. And, you know, Jayson Davies yeah, Wrong. Wrong. Wrong. Wrong. Go get your get your doctorate degree if you want to do that. Yeah. Exactly. All right. Well, let's go ahead. And actually, I think we're, I think we've given out several strategies of what we can do. Let's go ahead and wrap this up. And as we do, I want to give you an opportunity to kind of share a little bit about where people can find more about you. And you've already shared so many resources. And we're gonna, again, like we mentioned earlier, put some of those in the show notes, but any other resource or recommended resources that you might have, where people can learn more about you, ADHD and sensory processing. Debbie Lund Okay, so so I'll give you a list to definitely of the resources that I talked about for sensory processing, and for ADHD. And we'll put those in the notes. I would like to share that I'm getting ready to launch a variety of courses for teachers to begin with. So for classrooms for teachers, and then later on for parents that are solution focused and action plan focus. So So in my career in working so much with teachers, their number one complaint is that we're not taught this in school. So we spend so much time at the door as an OT, struggling between what we can do with that five minutes with the T shirt. If you're like, do I take this moment to educate them? Or do I just give them the tool and hope they're going to implement it? Or? No, you don't know what they don't know. And you're like trying to get this information to them. And if you give them a handout, are they going to read it like, what this situation is? So I'm in terms of improving accessibility for kiddos, neurotypical neurodiverse, whatever, I am creating some some courses that are available, and they're going to go through those areas of development, sensory motor, and then executive functions. It's going to be based on what is it like we just talked about sensory, and then it's going to talk about red flags if there's something going wrong, and then it goes into some strategies and support. So I'm not expecting them to be therapists. But I'm offering education on why particular strategies and not strategies, but accommodations or how to strategies, yeah, strategies. So particular strategies or tools can actually be solutions, because we're using them with these particular kids. So if you're an OT, and you're really solution based, and you're looking for a variety of tools, and tricks, and strategies and tips associated, I will give you a discount code if you want to as an offer, because they're not designed for OTs, particularly, they're designed for teachers and parents. So there'll be a discount code available for you. But if it's something that you think your teachers or your schools might be interested in, please follow me share with your families share with anybody who you think it might support, I would appreciate it so much. I just think there's such a massive disconnect between our professions. And you know, as OTs, we're trying to do all of this with the children, and then the teachers are trying to do something, and we need to come together more to support each other and be on the same page with what we're doing. So and once that change is made, so much so much more can be done in terms of the system, you know, Jayson Davies yeah. And are you doing that through empowerment plans are to fish therapy. Debbie Lund So I'm doing that through, I'm doing it through to fish therapy. But empowerment plans is actually the tool. So for every course of the teacher takes they're actually going to fill out their action plan as they're taking it. So as they're learning empowerment plans is actually the name that I've given the plan that there so when they leave a course, they're going to know exactly what they're implementing in the classroom. So if we're talking about we're talking about sand dampening earphones, if we're talking about whatever the strategies are using auditory tracks, any technology they're going to, they're going to have it all listed out and ready to go what they're going to implement when they leave that classroom. So an empowerment plan is taking you from education to action. And that's that's what it is. But it's not going to be the company. It's more of a tool. Gotcha. That the courses. Jayson Davies Gotcha. And so they can learn more about that at to fish therapy calm. Yeah, that's Debbie Lund the fish therapy. Yeah. Jayson Davies Great. Well, thank you so much, Debbie Lund especially my social media outlets. So if you're interested follow to fish on Instagram or follow to fish at Facebook. Jayson Davies Sounds good. Awesome. Yeah, we'll have that listed on the note page is as well. So we'll get to that. All right. Great. Well, Deb, thank you so much for coming on. It's been a pleasure talking to you for the about an hour now. It's been really great. I appreciate it. And thank you so much for coming on. Debbie Lund No, thank you so much for having me. I really appreciate it. Jayson Davies Of course. You too. Yeah. Thank you for all the information on both ADHD and sensory processing. Thank you so much. Debbie Lund My pleasure. Thank you. Jayson Davies Alright, and that is going to wrap up our episode on ADHD and sensory processing disorder. Again, another huge thank you to Deb for coming on the show and sharing with us the difference between the two the similarities between the two, and then what she does based upon whether or not she's thinking sensory processing or ADHD. Again, thank you, whatever you are doing right now if you're driving at the gym, whatever it might be. Thank you so much for joining me today on the OT schoolhouse podcast. Until next time, take care. Bye. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to OTschoolhouse.com until next time, class is dismissed. 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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