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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 39 of the OT Schoolhouse Podcast. In this episode, Jayson reviews a 2015 article about what School-based OT looks like in the united states. It is the first in a series of journal articles Jayson will be reviewing. If you would like to review an article with Jayson, let him know with an email! ​ This podcast does not qualify as a Professional Development Podcast. You can learn more about how to earn professional development credits through the OTSH Podcast for your OT/COTA renewal certification here! ​ Links to Show References: Bissell, Julie & Cermak, Sharon. (2015). Frameworks, Models, and Trends in School-Based Occupational Therapy in the United States. The Israeli Journal of Occupational Therapy. 24. E49-E69. ​ Highlights from this article: Trending toward inclusion Expansion of Roles for occupational therapists in schools​ Response to Instruction and Intervention Collaborative and comprehensive evaluations Collaborative goals based on the Common Core State Standards Future Trends Assistive Technology​ Transition & Post-Secondary Outcomes Expansion of occupational therapist roles from being solely a function of special education to a general education role as well. 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 Episode Transcript Expand to view the full episode transcript Amazing Narrator     Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host. Jayson Davies class is officially in session.    Jayson Davies     Hey everyone, and welcome to the OT school house Podcast. Today, we're doing things a little bit differently. This is going to kick off the very first journal article review for well ever on this podcast. You know, we usually have nice, long episodes with a guest or myself talking about some experiences, but today we're going to switch it up a little bit. It's just going to be me, and we're only going to be here for about 10 here for about 10 minutes, and we're just going to break down an article real quick. And I hope to continue doing this offset with some of the other normally scheduled podcasts that we go a little bit longer. So again, these ones are going to be a little bit shorter. Sometimes it'll just be me, sometimes I might bring on a guest to help me kind of break down an article, but yeah, that's just kind of how that's going to go. So before I introduce the article, I do want to say real quick, you can find the reference to this article actually in iTunes. If you just kind of swipe up real quick, you'll be able or, sorry, Apple podcast, not iTunes anymore. That doesn't exist. Anyways, swipe up on the screen and you will be able to see a citation of the article as well as that will be a link to the article if you want to review it more. Whenever we have a journal article like this, I will go ahead and do that. You can also head over to OT schoolhouse.com , forward slash episode 39 for a few more links about the article. So check that out. But let's get into this article. So for our very first article. I thought it would be fitting actually to start it off with an article by Julie Bissell and Sharon Cermak titled frameworks, models and trends and school based occupational therapy in the United States from 2015 however, although they are from Southern California, this article was actually published in the Israeli Journal of Occupational Therapy back in June of 2015 so it is getting a little bit older in age, but still very relevant. As I read through it, it's a fairly long article. However, it is not a research article. It's more like a paper that describes school based OT and it's important like what I said about it being in the Israeli Journal of Occupational Therapy, because to me, it reads almost as a reflection of what school based occupational therapy looks like here in America. And so, I mean, it does have in the United States in the title, so it's kind of it seems like that's what they were going for. They're trying to share what our process here in America looks like to potentially other nations. However, obviously, I'm in a, I'm an American occupational therapist here in Southern California, school based OT, and for me, reading it, it actually almost read kind of like a, almost like looking in the mirror. And, you know, and like, sometimes you look in the mirror and you think to yourself, Man, I look great. And other times you look into the mirror and like, man, what the heck is going on with my hair? I need to brush my teeth. Man, you just, like, see things, right? And that's kind of how I read this article, in a way, you know, I saw a lot that just stood out to me as, yeah, you know, it makes me feel good. Yep, I do that. I do that. RTI, check. Got that all good. But then other areas, I kind of read it, and I was like, Huh, you know what? I may be able to get a little bit better in that area. So I'm going to kind of go through just a little bit and share with you some of the key points in this article. All right, so let's get started. So the article actually starts off a little bit with current trends in special education, not just occupational therapy, but special education as a whole. And in that sense, it talks a little bit about how inclusion is becoming more and more popular. It talks about the development of RTI a little bit, but then it goes into a little bit about occupational therapy and how occupational therapists in schools are expanding their expertise, you know, and promoting data driven services that we're working a little bit more with general education, not solely special education. It also talks a little bit here. It goes more in depth about it later, but just a little bit how assistive technology, as well as servicing older students, is becoming more of a trend here. So again, it goes into that a little bit later, but what they're trying to focus on here is just that over the last 20 years, we've seen an expansion of roles in the areas that occupational therapists can play within the school district. It also does say that, you know, the primary goal of occupational therapy in schools is to support the child's ability to access their education. And again, we have to always stress this. You know, we are not there necessarily for a student to get therapy. Per se, we are there to help the child access their education. If they need therapy to do that, then that's where we can step. Been but they may not necessarily need therapy, and we have to keep that in mind when we're doing when we're providing our services. The article then continues to talk a little bit about idea. I'm not going to go too far into that right now, because idea, most people that listen to this podcast are pretty familiar with it. Maybe another day we'll really dive into the specifics of IDEA, the things that some of us may not know, but this article just gives a little over brief of what it is for people who may not be familiar with the United States way of going through school based OT and other services. The next step that this article takes on is RTI, and it really talks about how we need to be data driven, and then based upon that data, we can provide treatment or consultation, and then we need to continue to take data to see whether or not that treatment actually had an effect on someone. So in the article, they do give several there's actually a chart that gives out several different types of tier one, tier two and tier three interventions, again, not going to go through these. I highly recommend that you do look up the article if you'd like to see more about that. Along with RTI naturally comes screening. And they do address screening in here a little bit. They do say that currently, teachers are the ones that are doing some sort of universal academic screening. However, moving forward, occupational therapists could potentially have a larger role in that universal screening, especially in regards to like kindergarteners or preschoolers, perhaps, you know, trying to figure out, trying to get that data, that initial data that can then drive into treatments and or consultations and collaborations with those teachers and so screenings are in here just slightly they're addressed as part of the RTI process. The article then goes on to talk about evaluations and how our evaluation should actually be collaborative in nature and should address all areas of concern, and that could be including academics, communication, gross motor fine motor skills, social, emotional and behavioral skills, as well as vocational and daily living skills to determine what needs the child actually has. One thing that I really appreciated about this article is that they looked to the world real health organization, the WHO at to actually formulate this type of model that they that they put together that is called the educational framework for child success. But they did that in a way that they share that, you know, we need to take so many different factors in to to our evaluation, or into this child, you know, there are environmental factors as well as personal factors. And then you also have to take into consideration the core body skills, the different activities that the child may need to do, and the ability to participate in the society, you know, as a social being, and all that kind of goes into the child's educational need. And of course, when we go down even further into the framework, you know, obviously most states, I think it's something like 45 states now, a few come and go as far as who uses the Common Core State Standard, and that's kind of our curriculum. And then, you know, if you think of the person, environment, occupation model that we often learn in school, it's like that three circle tiers. Well here they'd use three circles that kind of all come together, and that is the curriculum, the assessment and the intervention, and all of those have to come together to find that just right medium to where that child can succeed. So we need to look at the curriculum, the assessment and the intervention, and when I say we, I don't just mean occupational therapist, I mean all the collaborators that work with that child, so the entire IEP team, or if the students in general education, student, just all the different factors that make a school work together, they all need to be involved With that said. Dr Bissell and Dr surmack also agree, as far as what I think in that we should be writing collaborative goals that focus on the Common Core State Standards. So, yes, we can write a goal that has to do with the Common Core standards. You know, we can work with a teacher to develop a writing goal that somehow addresses the Common Core State Standards, and then we are there to provide the support, whether it be environmental, through activities or participation, whatever way, to help that student access those common core state standards. The final part of the article, like I mentioned earlier, kind of talks about trends moving forward, and a few of the trends I'm just going to talk about where they see occupational therapists really going from here on out, is like I was talking about earlier that assistive technology piece, you know, working with teams on the IEP to to establish at for a student that may need it. I mean, we have the skills to break down the task and. See what at may or may not work. And so that was one of the areas that that they really see us being involved in in the future. Another area of focus for the future to come happens to be transition and post secondary outcomes. So that is with our students that are older, that either are in high school, that are either in high school or even in that 18 to 22 year old transitional program and too many kids, and this has been identified, not just by occupational therapists, by educators as a whole, too many kids are leaving high school, especially with a disability, and unable to succeed in any form after that, after they leave, you know, the structured environment of the high school. And so there is a increased awareness right now for transitional care and transitional post secondary outcomes. And so Dr Bissell and Dr surmack, again, just feel like occupational therapy can fill in that role, you know, teaching those high school and transitional students, ADLs, teaching them work skills, teaching them how to live independently. So that was another area that that was discussed in the article. And the last topic of discussion in this article was just that continued role expansion for occupational therapists from special education into all of education. And that kind of goes back to what I was talking about earlier with the RTI, you know, having occupational therapists be there from day one, when those kids come into school being part of the screening process. You know, just because a kid doesn't have special education services on an IEP, that doesn't mean that there may be, there may not be concerns that have to do with fine motor skills, sensory processing, different areas of activities of daily living, and so all these areas could potentially be minimized and addressed more quickly if we're able to do that screening early on and then to provide that consult and collaboration with teachers. So yeah, this was just a really great article. Like I said, it's almost like looking in a mirror to see where what we've done and where we come from a little bit. And so I highly recommend it. I will be sure to put the entire citation down in the notes below. Just scroll up on your iPhone, or I don't know exactly how to do it on Google Play. I'm going to be honest with you right there, but you can find the citation. I'll put a link to the actual article in the Israeli Journal of Occupational Therapy, and we will figure this out together. So I hope you all actually really enjoyed this little short episode related to a specific journal and a specific topic. I really do hope to continue doing this in the future. And with that, I do want to invite anyone listening to potentially review an article with me. If you have an article that you know that you just been that you've had on the back of your mind for a while, and you just wanted to read it, and you kind of needed that extra little push to read it. Well, here's a reason, you know, send me an email, send me the name of the journal. You and I, we can read it together, and we can hop on here and have a short discussion about it. Discussion about it. So yeah, it's as simple as that. I hope if you did enjoy this episode, please let me know down in the comments, where you can rate us on Apple podcast, or you can send me an email, find us on Facebook, Instagram, let me know. But yeah, I'm really excited for this. I enjoy actually. I personally enjoy reading some articles. I don't get to do as much as I'd like, but I do enjoy that, so I hope to continue doing this. And yeah, that's about it for today. Again, the show notes, including the citation, you'll be able to find at ot  schoolhouse.com , forward slash episode 39 or you can go over to the website, click on the podcast tab, and you'll find episode 39 and probably the easiest way to do it@otschoolhouse.com is just click in that search bar and type in Episode 39 three ways. Really easy to find it. Yeah, that's all I got for you this week. We'll see you next time on the podcast. Take care and thank you everyone so much for listening. Thank you for taking me up on the free professional development opportunity a few weeks ago. Really appreciate all the support and love from you guys. Have a good 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. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 38 of the OT Schoolhouse Podcast. In this episode, Jayson interviews Danielle Delorenzo OTR/L, My Bui OTR/L, and soon-to-be OTR/Ls Michelle Vuong, Mary Nguyen, & Rivka (Students in the Stanbridge University Master's of Science in Occupational Therapy Program at the time of the recording). This fantastic group of OTs and OT students shares how they developed an evidence-based referral process and occupational therapy manual. This group has spent over a year together working on this manual for a school district in Southern California and recently presented their manual in a presentation at the Western Regional Occupational Therapy Symposium in San Diego. With any luck, they may also be presenting at #AOTA2019 in Boston, Ma. ​ This podcast qualifies as a Professional Development Podcast and you can earn 1 online contact hour when you listen and take the online quiz. Learn more here! ​ Interested in learning more about the special guests in this episode, simply scroll down (May not be visible on a mobile device). Objectives for this Professional Development Podcast Listeners will: 1. Identify and understand the need for an educational occupational therapy manual within a school setting and how to develop/ modify/ implement an educational occupational therapy manual within a school district ​ 2. Demonstrate the ability to identify how an occupational therapist can assist teachers in general education through the use of RtI (Response to Intervention) via collaboration and consultation 3. Educate and empower all teachers and district staff on how an occupational therapist can provide strategies to support all student's foundational fine motor and sensory processing skills necessary for optimal engagement in academic tasks. Links to Show References: Download the 40+ slides that go along with this Podcast presentation including the references. Follow along as you listen, or review at home afterward! Also, Download the 3 referral processes discussed in the show here​ Special Education Referral​ General Education Referral Parent Concerns/Referral Follow Danielle and My Bui on Instagram at @Mornings.With.An.OT.Mom & @ElevatedStateOfPlay ​ Email Danielle and My at MorningswithanOTmom@gmail.com Danielle Delorenzo, OTR/L is the creator of Mornings with an OT Mom, a multimedia experience about understanding the science behind play and everyday activities and their connection to overall development, emotional regularity, and academic achievement. Danielle is also the Co-Creator of Mindfulness in Motion. Together, with her work wife/business partner My Bui - Elevated State of Play, they are shifting the mindset of the masses by spreading the knowledge about how integrating movement and mindfulness can help to increase academic performance, life-productivity, and emotional regularity across a lifespan. Danielle is currently enrolled at the University of St. Augustine’s pursuing her post-professional doctorate degree in Occupational Therapy. She has a Master's of Science in Occupational Therapy, and postgraduate studies in Infant Mental Health. She is a full-time lead educational occupational therapist and previously was an adjunct professor/thesis advisor for the MSOT program at Stanbridge University. She has 20 years of experience in Special Education. It is her dream to empower all individuals with the tools necessary to facilitate independence, maximize educational potential, foster positive overall development, and support optimal emotional regularity necessary to navigate through life and be as successful as they can! My Bui, OTR/L received her Masters of Science in Occupational Therapy and has been a school-based practitioner for the past four years with an extensive background in neuro-rehabilitation. In addition to co-creating Mindfulness in Motion, she has also been the project manager of designing several therapy rooms and classrooms with a focus on prevention and remediation to increase independence and overall wellness through a multi-sensory approach. My just completed her biggest and most recent project, in a collaborative effort with her coworkers, to develop the OT policies and procedures for the district. Her professional goal is to promote a holistic approach in expanding OT in schools district-wide through advocacy, education, and empowerment. Michelle Vuong has a Bachelor of Science in Kinesiology from California State University, Fullerton, and is currently pursuing her Master’s of Science in Occupational Therapy at Stanbridge University. She is part of a school-based occupational therapy resource manual thesis project at Stanbridge University. She has internship experience at an outpatient pediatric clinic as well as fieldwork experiences at an adult’s outpatient hand therapy clinic, senior living center, and development center for typically and atypically developing children. After finishing the graduate program, she wants to work in inpatient care with ages across the lifespan and gain as much knowledge and skills as possible before specializing in one practice area. She also wants to receive specialty certifications in Physical Rehabilitation and Feeding, Eating and Swallowing. She is passionate about constantly learning the best practices to help clients with meaningful occupational engagement! Mary Nguyen has a Bachelor of Science in Human Services from California State University, Fullerton, and is currently pursuing her Master’s of Science in Occupational Therapy at Stanbridge University. She has experience working with people of all ages in a variety of roles such as youth ministry leader, after-school program instructor, student outreach university intern, private tutor, Karate For All volunteer, and ABA therapist. Her fieldwork experiences include a special education school, senior living facilities, and memory care centers. She is passionate about working with kids and hopes to work in pediatrics in a school or outpatient setting after finishing graduate school. She is excited to start a career in such a dynamic and diverse field that promotes independence and engagement in meaningful occupations. Rivka Negin Rahmani has completed a Bachelor’s of Science in Kinesiology from California State University, Northridge, and is currently pursuing her Master’s of Science in Occupational Therapy at Stanbridge University. Rivka has had extensive experience working with children of all abilities. She has completed fieldwork experiences in an outpatient pediatric clinic, an acute rehab unit, and recuperative care facility for homeless patients. Rivka’s favorite occupations are baking, dancing, and spending quality time with her family, friends, and pet cockatiel. She is eager to continue working in pediatrics after she finishes graduate school. She is passionate about Occupational Therapy, promoting occupational justice, and advancing the knowledge and awareness of our profession. Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript Amazing Narrator     Hello and welcome to the OT schoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host, Jayson Davies class is officially in session.     Jayson Davies     Hey everyone, and welcome to episode number 38 of the OT school house podcast. For those of you who this is your first episode ever listening to. My name is Jayson Davies and I am a school based occupational therapist here in Southern California, a little bit outside of Los Angeles. First of all, I just want to say thank you so much to everyone who came to Fresno. Actually, it's technically Clovis, but anyways, up in the Central Valley of California, you came to the OT Occupational Therapy Association of California, school based symposium for Friday and Saturday. I just got home fairly recently, but it was a blast. We had some wine. Some of you guys, I gave out some stickers too. I hope you're enjoying those. But we just had a great time learning more about school based OTs. So thank you for showing up. It was a pleasure meeting all of you. I'm just so glad that we were able to get 100 people and relatively short notice, and had a great time and learned a lot. So thank you so much. On today's episode, we actually have our first repeat guest, and that is Danielle de Lorenzo. She was on back in episode 28 I believe it was to talk a little bit about independent evaluations, also known as iees. But today she's back with some friends and some colleagues of hers to talk about how to develop a referral process and school based occupational therapy manual for a district. So she's here with her colleague from her district. She'll get into that in just a moment. But she's also here with three of her occupational therapy students that were actually doing this as a project. So I'm going to let them introduce themselves in just a moment for you. But I do want to let you all know that first, this is a professional development podcast, and I'm actually going to give this one out completely for free for the next two weeks, just so you all can get a taste of what it's like when you go to OT schoolhouse.com . Forward slash episode 38 you'll see a few places where you can say, get this podcast for free, or get this podcast professional development. Now, it only be up for free for the next two weeks. After that, there will be a price, but you can get it now. Check it out. See what it's like. You're going to get access to a few documents provided by Danielle and the crew, and that will be actually the slides for this show. Those you can get for free without purchasing, but just so you know, this is what you will get, the slides for the show, as well as some of the handouts that they reference to in the show. And you also get the professional development document that has a link to the quiz. And when you go ahead and click on that link, you'll take a short quiz. It's about 10 questions, and you will then earn a certificate of completion, which I will send to you in an email. So it's pretty simple. That's how it works. And you know, I just want to say, before we get started here, that Danielle and the crew, just like I am, were based in Southern California. So you're going to hear some California references, but that doesn't take away from the overall message. The last thing I want to point out before we get started is that this episode is going to be a little bit different. You're not going to hear my voice as much. It's almost going to be like they're presenting at a conference for the most part. I'll chime in a few times, but really, you're going to hear them as though they're presenting. In fact, they did present this not too long ago at the OTEC symposium a few months back. So without further ado, I'm gonna let them get into it. You'll hear me occasionally, but let me know what you think about this type of episode. I'd love to hear some feedback in an email or something, or even in the comments on Apple podcast or wherever you listen. That'd be great. So let's jump into it. Here is Danielle de Lorenzo and the thesis group that she's been working with for the past year or so. Hello, ladies, welcome to the show. How are you all doing today? I guess we'll start off with Mary. How are you doing today?     Mary Nguyen     Hi, I'm doing good. I'm Mary. I'm one of Danielle's graduate students from stanbridge University, and I'm really glad to be here.    Jayson Davies     Great. And then we also have joining us today is My. How are you today My?    My Bui     I'm doing great. It is E, S, Y, and much more chilled in the regular school year.     Jayson Davies     Yeah, extend to school year. Woo, woo. I got to go back to that on tomorrow. I think so. We also have Michelle joining us today. How are you Michelle?     Michelle Vuong     I'm doing well. Thank you for having us. Also another student from Stanford University and really excited for today's podcast.    Jayson Davies     Great. And the last student we have joining us today is Rivka.    Rivka Negin Rahmani     Hello. Thank you for having us. Jayson, we're really excited to be here.     Jayson Davies     Yes, thank you for joining us. And then I'm going to now pass it off to our final guest today, and that is Danielle Delorenzo, you might remember her from a few episodes ago. So how are you doing today Danielle?    Danielle Delorenzo     I am doing great now that tomorrow is my last day of work and I'm here with all you guys.    Jayson Davies     Yes. So what are we here to talk about today?    Danielle Delorenzo     So today we are going to talk about the educational occupational therapy manual, a district wide resource that we all created over the past year and presented that with OT. So what we're going to do is we're just going to kind of go into some brief introductions about ourselves and what the purpose of the project is, and we hope that all our fellow school based girls will really like our presentation, and it can help them within their setting.    Jayson Davies     Awesome. Sounds fun. Let's do it.    Danielle Delorenzo     Alright, so my name is Danielle Delorenzo. I've been in special education for about 20 years now, in a variety of roles. I've been in OT for about nine years, specifically in the school systems for the last five or so years. I'm currently a thesis advisor for stanbridge university within their MS ot program. I'm about halfway through my doctorate program at the University of St Augustine for my OTD with a focus on pediatrics, education movement and mindfulness. I'm the Lead ot at Rialto unified, and I'm the creator of mornings with an OT mom, which is an educational website focusing on the connection between fine, gross, motor, sensory play, mindfulness, and how it correlates to academic performance. I am going to introduce my fabulous work wife slash co worker, Mimi.    My Bui     Hi, guys. I am Mimi. I am working in Rialto unified, and I've been an OT for four years working primarily in special education. I've been focusing a lot of my current practice on flexible seating and building movement spaces, due to the current problem that as OTs see every day, which is the current lack of movement opportunities that our students are provided with when there is a lot of research correlating on how movement can promote academic success, I am in the process of building a platform that would integrate research and practical activities that can improve proficiency and effectiveness of learning for children.    Danielle Delorenzo     So we have our three fabulous graduate students that have worked so hard, and we are also proud of them, and I would like to give them a couple minutes to just introduce themselves again. So go ahead, ladies, introduce yourselves before we move on.     Jayson Davies     Go ahead. We'll start with Mary.     Mary Nguyen     Like I said before, my name is Mary. I am a student at stanbridge University. My interest is in pediatrics, and I had an opportunity to work with Danielle and Mimi at Rialto for my field work, and I just absolutely loved it. So I look forward to potentially working in the school base when I graduate.     Jayson Davies     And what about Michelle?    Michelle Vuong     Oh, hi. So as mentioned before, my name is Michelle, so I had originally started going into the OT program because my passion was in pediatrics, namely outpatient pediatrics, and so seeing the school based ot really changed my perspective. And I'm not too sure what I'm going to pursue in the future for specialty, but I know that whatever Danielle and Mimi have taught us throughout this term, it can translate very well into many settings, so it's been very valuable for me.    Jayson Davies     Great. And lastly, we have Rivka.     Rivka Negin Rahmani     Hi there. I'm Rivka. I'm also a Stanford student. I'm really excited to have worked on this project with these fabulous ladies. We put a lot of heart and soul into it. I love pediatrics, and Danielle and Mimi have shown me that school based is a lot of fun, and it has its ups and downs, but a lot more ups and downs, and I'm really excited to see where I go next.     Jayson Davies     Great.    Danielle Delorenzo     So you know, this presentation represents the journey we have been on the past year, trying to ensure best evidence based practice was being implemented via ot within an educational setting. Please be mindful that this presentation is about our journey with our school district on creating policies, procedures and resources that would be the just right fit for Rialto. This is meant to be a guide in how you can begin to develop your own policies and procedures or advocate for all things ot at your own setting.    Jayson Davies     Great and real quick. Actually, we are going to have the slides up for this presentation, and that will be at ot  schoolhouse.com , forward slash episode 38 so be sure to head on over there if you would like to see the slides. And you'll be able to get those completely free, so check that out, and let's go over some of the learning objectives.    My Bui     So at the end of this presentation, we want our listeners to be able to identify and understand the need for an educational occupational therapy manual within a school setting and how to develop, modify and implement it. We want to be. Able to demonstrate the ability to identify how an OT can assist teachers in the general education through the use of RTI, via collaboration and consultation. We also want to educate and empower all teachers and district staff through trainings, collaboration and consultation on how an OT can provide strategies to support students foundational skills necessary for engagement and academic tasks. We have found that the best way that OTs can make a bigger impact is through the power of collaboration and education. And through this approach, we can empower our teachers and district staff to incorporate ot components in their vocab and, more importantly, their classrooms. We want to give you an idea of how large Rialto is. Our district has over 2700 district employees and is considered the largest employer in the city of Rialto. And within our district there is 25,000 students. And our district consists of five high schools, five middle schools, 19 elementary schools and 20 preschools in the cities encompassing the Inland Empire. So within all of this number, only 20.1% of our students are proficient in math, and only 33.1% is proficient in reading, which ultimately affects handwriting. So looking at these numbers and considering that there are only three OTs in our district, which is Danielle me and our other co worker, Robbie, our goal was to make an impact that is bigger than just our assessment and our treatment caseload. So of those numbers, 3000 students are in special education, and only one to 2% are exited from special education. We have to remember that special education is not a place, but it's a service. So we ask ourselves, How can we OTs make a bigger impact to fit the needs of our student and our culture?    Mary Nguyen     So I'll be going over some of the things that we found in our literature review, we mainly wanted to focus our literature review on two themes, handwriting within the Common Core standards, and RTI, as we initially wanted to focus on handwriting, since OTs get such high referral rates specific to handwriting, we have since narrowed our focus of the manual to be about RTI, although parts of the manual address handwriting concerns, the next couple slides contain our compiled literature review on both of these themes and how to incorporate the Common Core writing standards into the manual. So an average caseload for a school based occupational therapist can be between 40 to 45 students at times, an occupational therapist caseload can reach over 100 students annually. Additionally, occupational therapists have to complete initial and triennial assessments, which can take anywhere from five to 15 hours per assessment to complete. We have a study from Holt singer and height in 2005 where they conducted a survey on over 500 school based OTs, the results showed that one out of 13 therapists were affected by excessively high caseloads. There are no specific guidelines as to how many students will be assigned to one therapist caseload, and it may increase assessment and referral rates when there's such a high referral rate and not a high recommendation of occupational therapy services, this significantly takes up time that could have been utilized to provide teachers with RTI supports and strategies. The majority of teacher referrals are being made for handwriting remediation, but teachers are referring for initial occupational therapy assessments without providing RTI strategies. First, some examples of RTI interventions for handwriting challenges could be changing up the type of pencil the student is starting with providing adaptive paper to guide the student when writing and supplemental handwriting programs like Handwriting Without Tears, part of the role of OTs in a school setting includes teacher education on RTI interventions. Most teachers are not trained on the scope of occupational therapy practice or how an occupational therapist can provide support in an educational setting. Teachers have little collaboration with the occupational therapist on tools and tricks to help students gain access in their handwriting skills or any other problem areas, this may be due, all in part, to pull out method of OT services, rather than the push and model where the OT works with the student in their own classroom in 2006 bionna et al stated that teachers were dissatisfied with respect to frequency of contact with The therapist, stating that there was insufficient time for collaboration and inadequate follow up by the therapist. This presents a need for increased time for the therapist and teacher to meet and consult on the students progress and exchange information. Lastly, we see that handwriting legibility is an expected skill for students to develop by the second grade. As stated in California's Common Core however, when we were looking over the common core standards, there's absolutely nothing to guide instructors to achieve these skills. Teachers have no guidelines placing a specific set of time in the curriculum for handwriting practice, and instead, students are expected to produce their own handwriting skills through other courses.    Michelle Vuong     So thank you, Mary for giving us an explanation of the overview of the problem. I'm going to now dive into the first theme, which is handwriting within the Common Core. So what we found is that decreased handwriting instruction time and lack of specifications under the common core curriculum were huge flaws that ultimately impacted writing, handwriting skills, the more technical side of handwriting problems were mostly related to students having illegible handwriting, inappropriate spacing, inappropriate sizing and placement and also having an awkward pencil grip. Teachers reported that due to emphasis placed on other academic areas, such as math and language arts, there was a lack of instruction time to develop these handwriting skills. Teachers also defined that the common core curriculum was seen as cookie cutter and it failed to acknowledge each child's different individual developmental needs. When doing our literature review on RTI strategies that address handwriting problem areas, several studies have reported that supplemental handwriting practice in addition to regular curriculum, have significantly improved the different areas of handwriting. So one specific study, Hoya et al, looked at the different interventions that targeted handwriting difficulties, and what they found was that handwriting practice, remediation and homework were key to improving handwriting skills. They also emphasized that handwriting practice should occur about twice a week, anywhere from 20 to 30 minutes in order to be effective. Furthermore, another study by Peterson and Nelson looked at first graders who received additional handwriting interventions twice a week for 30 minutes, and it showed a huge improvement in spacing, sizing and placement of letters. There also needs to be a strategy in place for a carryover effect in the students handwriting skills. Since students are not receiving handwriting practice through the common core curriculum, the need for additional handwriting practice can help to generalize this skill for students to apply to other subject areas in their curriculum. It is important to note that many teachers and other district staff may think that occupational therapists teach handwriting, and we know that we do not teach handwriting, therefore it is important to educate our teachers with the knowledge that occupational therapists support the foundational skills necessary to support efficient handwriting skills, and that is where RTI comes in. So moving along according to the OT and PPT guidelines, RTI is where OTs make suggestions to the teacher regarding the handwriting curriculum and strategies for fine motor and visual motor development, ideally, what we want is for all students have access to tier one, Universal Supports, and we do this by providing high quality research based intervention strategies. We want to prevent the need for any additional or restrictive services.    Jayson Davies     Real quick, Michelle, you actually referenced the OT PT guidelines. Is that? Where do you find the OT PT guidelines? Is that state specific, or is that a national ot PT guidelines? Or Where were those from?    Michelle Vuong     We can actually pull that off of, like, if you look it up on Google Online, you could totally pull up, like, a PDF version of it.    Jayson Davies     And it is the California ones that you guys reference to correct, yes, yes, that's what I thought. All right, go ahead. Continue.    Michelle Vuong     Okay. So ideally we want to have all of our students, like I said, have access to tier one universal supports. And I was just going to mention Colette et al in 2017 which is a study that identified a gap in RTI strategies being available, and teachers education on when and how to implement them. So another study, Cahill et al, found that teachers would benefit more specific from specific guidelines outlining RTI strategies as they are able to provide their students with the consultation of OT so our manual will give teachers intervention tools and strategies to implement on their own and in the hopes that these strategies are effective before referring their students to OT services. This follows the model of RTI, as I mentioned previously, for children who are possibly at risk for falling behind in their performance in the classroom. In giving teachers a manual that contains a process for making appropriate referrals, we hope that teachers will increase their use of RTI strategies, and I will now pass it off to Rivka, who will discuss our second theme.     Rivka Negin Rahmani     Thank you, Michelle. So as we know, fine motor and handwriting skills are the most common. On reasons for school based ot referrals and visual motor integration is a strong predictor of handwriting legibility and related academic performance. We found a study that discusses the effectiveness of RTI to improve those areas which may help reduce these referrals. A study by ot al showed that OTs led 30 minute lessons in collaboration with teachers for 10 consecutive weeks in the 30 minute lesson collaborations, the OTs provided the teachers with ways to model gross and fine motor skills to students, and gave the teachers visual aids to use. The teachers worked on skills such as how to hold a pencil, cut with scissors, draw a person and put on a coat with the students. The students were given time to practice what they learned, which then helped with the carry over of learning. There were two main things that we found to be extremely relevant to our project. First, the intervention group demonstrated significant improvements on the VMI and bought two average scores. Second, the therapist teacher at logs indicated that an OT provided an average of six to 33 minutes per week of consultation with the teachers. These implied that we realized that OTs play a huge role in tier one RTI strategies, and we can help consult with teachers these short term interventions can have a significant effect on fine motor and visual motor integrations or handwriting readiness. The study also validates the efficacy of collaboration between the OTs and teachers by providing the teachers with the right skills and tools they can use it with or without an OT present in the future. Another study by zultra and Pfeiffer in 2016 looked at the use of a handwriting intervention called Size Matters handwriting program, and found that 30 sessions completed twice a week over 16 week period demonstrated an increase in handwriting legibility. There's been this constant discussion between push in and pull out services. Ideally, OTs want to push in because we want to create the least restrictive environment and increase transfer of learning skills. Also decreased disruption to the child so they can remain their classroom and maximize their academic performance. This study ultimately showed that with push in services, the OT works with the child in their gen ed or special ed classroom, and is effective in improving their handwriting legibility. After conducting our literature review, we believe that taking the time to implement a handwriting practice program within the classroom through collaboration within ot can then increase handwriting skills and increase a transfer of learning to support students at all academic needs. And now I'm going to pass it on to Danielle.    Danielle Delorenzo     Okay, so now that we've talked a little bit about the literature and how originally, we wanted to start out with a handwriting program, and then we realized that, you know, in addition to handwriting, sensory processing, fine motor skills. So many other things can go into supporting a student's academic success through the use of RTI, and empowering our teachers to be able to have these strategies at hand to help really educate who we are, what we do, and what our role is within an educational setting. So hence the development of the educational occupational therapy manual, our district wide resource. We wanted to create a document that was esthetically pleasing and user friendly. We did not just want to hand a teacher another document and say, read this and never come back again. There are so many individuals that can sit in on IEPs when ot questions come up. Therefore, it was imperative to develop a district wide resource that was accessible to all to ensure accurate information be expressed district wide. Knowledge is power in an IEP, you must know the laws about all the related services, and you must have a foundational understanding of special education, the IEP process and how ot fits into it all. Moreover, through RTI, we can empower teachers and district staff with ot tools to add to their teaching tool bag to help not just students on ot caseload, but all students district wide. And through this process, we hypothesized that there would be an increase in appropriateness of OT referrals more teacher utilizing RTI within the classroom, and less students needing related special education services across a lifespan, specifically in the area of occupational therapy. You know, from July 1, 2018 which seems so long ago, that was the day that Rialto took back their ot services as a district so now district would be providing service up until around November, we were working so hard, collaborating with local districts, therapists, psychologists, SLPs, orthopedic impairment specialists, literally anyone that we can think of to try and incorporate strategies and suggestions that would be beneficial for. All students. We then presented to 30 speech pathologists, two psychologists and autism specialists, and all our graduate students were present. And it was amazing. Our presentation was very well received, and it was very empowering to the speech pathologists, which led to their own questioning as to what they can do as a profession in regards to also implementing RTI intervention within a school setting. Already, the empowering began, you know, and then after we presented to speech pathologists, we met with our director, and we had to make some revisions. Like everything is all about revisions. Don't ever think the first thing you created will ever be the thing that you end up with, trust me, ours project has evolved so greatly from the beginning, it's amazing. So through this journey, we then collaborated with ASHA Asher. And if you guys do not know who she is, she is brilliant. She is a school based guru with over 40 years of experience. You should look her up. You should read her articles. They are amazing, and so is she. We asked our director to have coffee with us one night after school, and She sure did. So it was myself and Mimi Asha and our director shout out to Olive market and Redlands for staying open late that night so we can all talk, all things. OT Asha was amazed that our director had came out to really listen and hear what we had to say. And you know, our director truly is a visionary that believes in inclusive practices and a push in model for services. And most importantly, she believes in us and tries to let us execute our vision as best as we can. So after we all collaborated, you know, we went back to revise and make our final edits before presenting at ot in March. And what we realized is that sometimes when a district is transitioning into a different type of support system and other policies and procedures, the transition can be a little rocky. It is imperative to maintain a collaborative relationship with teachers and other district staff to ensure smoothness during the transition period. In order to support staff and student needs, we are learning that when trying to implement change at a district level, you have to be like the tortoise and not the hare, because there are so many contributing factors that are outside of our control that can have impact on our own policies and procedures within our educational therapy program, such as funding, staffing, support, etc. So the components of the manual consist of the contributions, everybody who helped along the way, our purpose, mission statement, goals, what ot looks like in California, the big educational versus medical ot that I know all of you can relate to, the guidelines to determine the need for an OT referral, policies and procedures, The OT educational relevant concerns document, our referral form and our teacher resource. So much love to these amazing people. The collaboration for this project was amazing and such a great learning experience. It truly takes a village of innovative individuals to see the bigger picture, and most importantly, how each piece fits in the grand scheme of the whole child's education. Rivka, during our research, stumbled upon a copy of the 2015 Fresno ot handbook, and it reflected the policies and procedures that we were trying to implement here at Rialto. So I reached out to Michael Fletch, who was Fletcher, who was the program manager for Fresno, and he was more than thrilled to collaborate with us share his documents that he had. And then we got excited, because we just sent him our final edits to our manual. So we have been doing this back and forth, ongoing collaboration with so many people all across the country with one common goal and in mind, to collaborate, empower and educate. So it's really been quite a beautiful experience to see how many people really came into making this document and how it's evolved since then.     Jayson Davies     Yeah, real quick. So everyone can can know, obviously not, not everyone can see the slideshow right now, but she has people on here from Rialto. She also has all the names of the stanbridge students here, everyone that you're hearing from, as well as other occupational therapists from Fresno. And just Danielle reached out to so many people and the students did to make this project happen. And so if you'd like to see a full list of everyone that contributed to this project, be sure to get the show notes or the slides from the show notes, and we'll have those up for you.     Danielle Delorenzo     Yeah, like I said, we never would have been able to do this without collaborating with everybody to make this document happen. You know. So I think the purpose for us was to create a district wide resource on all things occupational therapy. You see a reoccurring theme with this. It's to educate, empower and communicate. Our mission statement is to provide and implement policies and procedures that will meet the occupational therapy needs of students in a uniform and consistent manner through the Rialto Unified School District in compliance with federal regulations, state laws and professional standards of practice. You know, we have very specific goals in mind that we wanted to execute through this document. We wanted to adopt the ecological model of student performance in the person environment, occupational model as a philosophy for therapy services. We wanted to provide a safe space for all students to engage in organized movement through fine and gross motor activities, sensory experiences and practice mindfulness to support emotional regularity and academic success. We wanted to provide RTI via tier one, two and three support in order to reduce referrals for special education services across a lifespan, while ensuring at risk children receive immediate support and intervention in the area of need. We wanted to improve transition of students between programs with appropriate delivery of therapy services as well as support with inter district transition, such as pre K to K, elementary to middle, middle to high and adult transition. We want to adhere to timelines for assessment and comply with laws for the delivery of therapy services, to educate and empower staff district wide on all things educational. Ot to collaborate and promote occupational therapists as part of the transdisciplinary teams servicing the special needs students, and to expand the range of occupational therapy service delivery options that were available. You know, the one beautiful thing about California is that they have their own specific ot PT guidelines. Unfortunately, they are just a guideline that you have to use in conjunction with federal laws in addition to what your district governs as their own policies and procedures. So you can't just take this document, walk right in and say, you have to do this. They don't. It's just a guideline. It's not the law. So remember, you have to take the law, the guidelines, and then your setting and how you fit into there.     Jayson Davies     Yeah. And Danielle, I don't know if I've shared the story with you, but one time I went into like a lead psychologist office when I was up at my previous school district, and I said, Hey, look, I found this really cool document, and it's all about, you know what ot should look like in California? And the response I got was, is it ed code, is it educational code? And I had to answer, Well, no, I mean, it's not law, it's not in the California Educational code, but it was that version of this, which was a, was it the first or second edition? I think it's all one and only isn't it?    Danielle Delorenzo     Yeah, they're working on the second edition. But I feel like Lisa test and I were talking about this at OTEC, where I feel like they're working on the revisions right now, or something that they're trying to get out there, but something that has to do outside of my area as to why they haven't been able to revise it, because some of the terminology in there has become a little outdated and needs to be replaced with What's going on right now?    Jayson Davies     Yeah, and so it is being updated, like you said. However, from my understanding right now, is that California Education Code, or the Department of Education, is actually not doing it with them, and they are basically doing this independent. So the next one that comes out, although it'll be fantastic, and it'll have so much good information, it will not be sponsored, if you want to say by the Department of Education, and not being sponsored by the the can't speak, not being sponsored by the Department of Education. Well, that doesn't, it's like, I mean, a bridge to nowhere. You know, there's nothing, really, no one can say it has any water, you know, or any substance to it, because it's not I wouldn't be able to say, Oh, hey, Director of Special Education, this is important, because California sees it as important. No, I'm only saying ot see it as important. So, yeah, yeah,    My Bui     Jayson, I think we encountered the same problem too. We had a meeting with our supervisor, and we're saying this is best practice, it follows our guidelines. And they're like, Well, is it a code approved? And we're like, well, we have to go back to the drawing board and kind of make it fit into ed code.     Jayson Davies     Yeah, yeah. And that's a that's hard work, because Ed code is so substantive, you know, there's so much there, and but at the same point, very little related to occupational therapy. So you really have to, it provides guidelines in itself, but there are very little set rules for occupational therapy in the educational code. And so you kind of have to, like you said, kind of make it fit.     Danielle Delorenzo     Yeah. Yeah, and I think that just stems from a lot of people's frustration, and at least from an educational occupational therapy perspective, because here we all are trying to do best practice, trying to do what we know the evidence is saying we should do, but there are so many disconnections between the law also having very outdated laws that should probably be updated in terms of, just like, you know, parts in the idea that really could help support us and working closely together. And if all of us just had, like, this generic policy and procedures for educational ot that can then fit into each district district, we'd have a little bit more room to stand on. But unfortunately, it's like we're all alone, and we just have these guidelines that it is literally up to the districts that we work for whether or not they want to enforce all, none or some of these guidelines. Yeah, and, you know, ot in California when we you know, so we have this guidelines. And I think what, well, a lot of people don't understand is we are a related service. Not many people know that. And what a related service means is that a student has to be receiving special education services in order for an occupational therapist to even come out and look at them in an educational setting. So a student may have an educational need as well as a medical need. However, some motor difficulties may not directly impact educational progress and may not constitute educational need. That's why I think it's important that parents and district staff understand what educational OT is, what it means as a related service, and how we can provide support for students that are not on ot caseload, but are still demonstration foundational concerns with the areas that fall when you know, under educational occupational therapy, another big issue is educational versus medical OT. Now you guys will see there's a chart up here. That's where we're at in our slide, and we attach this to our assessment reports, especially when we're not recommending services, so parents can understand why sometimes their kids are getting medical OT and not educational, and why from an educational perspective, you know, OTs are only going to Pick up students where they have difficulties accessing their areas you know related to OT concern within their education. I also think that you know one of the biggest misconceptions is where the information is coming from. Before they even get to the school district. You have parents are receiving their information about educational ot from practitioners IRC, the doctors in family based and medical models, and it begins before they even get to school. So the more that we could empower and educate within our community, to the local doctors, to IRC facilities, which we actually are in the process, we're going to be presenting at IRC. They are very excited for us to come and work on that, to share what we're have going on here. You know, parents, district staff, then if the community can be educated as a whole with accuracy and research based information relating to educational OTs, such as, please don't put ot on a prescription pad and hand it to me at an IEP. That's not how this works. So we have to kind of look at all of the factors that are contributing to the misconception, and work really hard on trying to really again, educate and empower all all people everywhere, on what we do and how it is very different from the medical model.    My Bui     Yeah, we even started signing in our emails and introducing ourselves as educational occupational therapist. To really emphasize that ot support has to be related back to access to education, I feel like being a school based OT, we're like, on our little island, and everybody else is, you know, the medical model. So we really wanted to change the lingo to really emphasize the difference between the medical and the educational occupational therapy.     Danielle Delorenzo     Yeah. So now we're talking about the guide to determine the need for ot referrals. So you know, as we talked about, a student might benefit from ot if he or she is having significant difficulties in the classroom, performance as impacted by curriculum, educational environments and abilities. Simply having deficits in the areas of praxis, fine motor skills, visual perception skills, sensory needs and self help skills, does not mean that a child needs occupational therapy. Special education teachers can assess and assist students who have special needs in sensory or motor skills. And most special education teachers with needs, most special education students with needs in these areas can and should be served by their teacher and other district staff. So again, you know, as stated earlier, we have a lot of teachers that are referring for occupational therapy services. Without taking a period of time to implement RTI interventions that what we've seen the research about 80% of the time. When these RTI interventions are implemented, it decreases these at risk kid OTs, and it also decreases the need for initial occupational therapy referral. And so by increasing the appropriate net of referrals where, when a kiddo is not responding to RTI interventions within that period of time, then we need to assess, to determine what else is going on, whether it is ot that is needed or another service to help. You know, in order, you know, we talked about, in order to receive OT, they have to be eligible for special education first, I think that within this framework, both the American Occupational Therapy Association and federal legislation focus on improvement of functioning and not servicing goals beyond the capacity of the individual. The objective of occupational therapy within you know, a school setting is to have a student participate and function as independently as possible. In the classroom setting, we have a lot of kids that stay on caseload for long periods of time, year after year. And I think it's important to remember we are not striving for perfection and pushing beyond the student's capability. We are looking for functionality and access to the education, and if they are able to do that with their supports and modifications set in place, then that's when we would start to be discharging those sit kiddos off of OT caseload, since all of their educational needs are met. So one thing that we decided to do was we decided to create a document that would help psychologists or case carriers or other individuals that are sitting in on initial IEPs. It's called the educational relevant concerns document. So the purpose of this form was to help facilitate a conversation when OT is identified as an area of concern, these questions are meant to help guide the conversation to determine if the identified area of need is related to educational occupational therapy, the goal is to shift the mindset to the identified area of concern to begin the process of providing immediate support. By focusing on the area of concern, discussions can then be facilitated to determine who is the best person to help provide support to meet the students needs in the area of concern that has been identified. This can help shift the mindset that it is not one identified member of the IEP team. Hence, my kid needs ot it's more my child is demonstrating a concern with handwriting legibility. But then when you talk more about it, maybe they don't like to write, and they're not motivated, and they actively say that they don't care what their writing looks like. Now, is it really a motoric or processing issue, or is it an issue of motivation? So there are many factors as to why individuals can be showing or demonstrating concerns in the area of OT but you need to really ask further questions so we can really decide who is the best person to provide that support. This is how we can begin to implement a multi disciplinary and multi tiered level of support that can help the students immediately and ultimately be able to help them access their education as best as they can. So some of the questions you know, do the students have difficulty accessing their environment? Do parents and teachers share similar concerns? Is this concern related to the home or school? What are the areas that these kiddos are having difficulty access? Are they making any progress? What led up to the request for additional support? What has the teacher tried if they have difficulty sitting still? Is it impacting their education? Because sometimes I have teachers tell me it's annoying that they bounce so much. I'm like, Well, are they paying attention? And they're like, Well, yeah. And I'm like, Well, let them bounce. It's more problem about the teacher rather than the student. So it really helps to put it on the student and what the student needs to be successful. You know, especially this one is the concern sensory related, and then ask for a specific task. What academic task is the sensory related concern impacting? Because sensory and behavior, they are very closely interrelated, but we're really trying to figure out what drives what and where the interventions need to take place, which is why we're so lucky to have amazing autism specialist and Behavior Support team that we can collaborate with to really help bring that multi disciplinary, you know, approach when We're looking at the whole child. I'm going to now pass it over to Mimi, who is going to review our policies and procedures that we have incorporated into our manual.    My Bui     So the referral process we. Wanted to make this as user friendly as possible, and so we decided to categorize it into three different categories. The first one is, if your student is in general education, what would the referral process look like? So we have, we made a beautiful flow chart. Mary made it really pretty. So the first top tier would say this kid is in general education. So specific classroom concerns. The teacher would fill out our educational occupational therapy teacher training form. And so what that would look like is they tell us specific, or, I'm sorry, General, classroom concerns, and then we would find a specific time and date that works best for the teacher to do a consultation with them to help the entire classroom. And then we also have a bracket on the other side that it's if it's student specific concerns, but they have no IEPs, and what that would look like. So the next one would be special education. So if the student is in special education, that's a whole different referral system. So if it's again, if it's a classroom concern, they do the same process. They fill out that form. We would provide general strategies. They would then take data for four to six weeks, and then we would visit those status and see if our strategies, our strategies were working, or if they weren't working, and then where we would go from there. So So again, we would provide general strategies and training in areas of concern. And then we would provide them with an RTI approach by providing them the OT teacher strategies handbook, which we will cover a little bit later. And then again, they would take data, because we are very data driven to support the need. And then we would also be available to them if they have any additional questions, and so say if the strategies are not working and they need additional ot support, that is when we would go ahead and proceed to an evaluation. We created the form called an educationally relevant occupational therapy assessment referral form and that would begin the process for an OT assessment. So this kind of puts sit back on the teacher to try RTI strategies before they seek out specific, skilled support from an OT because again, I think Mary discussed earlier, it takes us anywhere from the shortest, probably like 10 hours to the most, like 20 hours to do an assessment. So this would really help us cut back on on assessment referrals, or relevant assessment referrals. Okay? And then the last one is if there are parent concerns. So we the teacher would discuss the related area of concern, and then what would be the outcome of discussion? So if the team determined the area of concern is related to educational OT, and they would fill out that questionnaire we that Danielle previously discussed, and again, it would follow the steps of, you know, we would provide the teacher with the handbook, and then they would take data on it and do the RTI strategies, and again, we would be available for consult. Now, if the parent request and an OT assessment, then we would go ahead and fill out the Rota, which is an educationally relevant ot assessment form, and we would go ahead and assess them, because per parent request, we would have to honor their request for the the assessment.     Danielle Delorenzo     I just want to jump in and say that we've also had a lot of success with explaining our referral process to our parents, and we have actually had a couple of parents that who have requested an assessment. And after we said, hey, can we just come in there? Can we try some RTI first and just kind of see what we're doing, and then in a couple weeks, can we re me? And sometimes the problem, you know, took care of itself with RTI strategies, but then we were learning more information, and they were like, oh, you know what? This is a more appropriate referral. And then we were able to incorporate these RTI strategies with into our assessments, which just made it even more meaningful and more individualized to be able to really hone in on those students specific needs and really helping to increase the appropriateness of those referrals.    My Bui     So going back to the OT teacher handbook that we just discussed about in the in the referral process. So the purpose of this document is to provide teachers with a resource manual that outlines educationally appropriate ot strategies and interventions for students progress while complying with federal regulations, state laws and professionals. Agendas to practice going back to Ed code. So the OT guidelines mentioned are meant to assist and guide teachers and members of the educational team and administrative staff in implementation of school based ot strategies for all students in general and special education. Our objectives for this resource manual is to provide teacher education and protocol for specific common issues seen in students academic performance. So as you're listening to this, you probably already like came up with a bunch of common issues that your teachers might come to you for, whether it's pencil grip or student can't attend or student can't sit still. So our content. We pretty much broke it up like this. We gave our mission statement, our educational, I'm sorry, the purpose of the document, the mission statement, the frame of reference, contributions. And then we broke down educational, occupational therapy, Classroom Strategies, into sensory and then listing all of the areas that might be affected. And then we broke it down to handwriting and visual motor. And then we broke it down to a fine motor and self help. And within this resource, it's very user friendly, where they would basically have is your if you see this in your child, try this strategy. And these are very cost friendly, user friendly strategies. And we also want to use this form as a data collection tool where, let's see what you've tried out in the classroom. So they would just check it. Very simple, if you want to open it up, we will attach this also just a few sample pages. And so, you know, we go back and we're like, well, you tried this, you tried this, you tried this, it isn't working, okay. Maybe you do need our skilled expertise to address these concerns, okay? And then our future plans, everything we have done this year was just a few check offs on our large to do list, we want to continue doing what is best for our district and most importantly, our students. And here are our future plans to accomplish in the next few years, we want to provide trainings to all teacher district wide, all teachers district wide, on how to use the manual and implement RTI strategies with fidelity, that is the key word. And we want to share case loads and provide whole group interventions to support all student outcomes. We want to train and implement organized movement activities. Emphasis on the organized part. We want to create ot movement space at all 19 elementary schools, we want to incorporate ot in every classroom, district wide. And we also want to, most importantly, empower and educate teachers and district staff with all things educational. OT.    Danielle Delorenzo     You know, it is so important to remember that as occupational therapists within a school setting. We are just a small piece of many components that make up special education, that are within the entire educational system. This is the first time we have examined a very large organizational flow chart, and it is amazing how many individuals are responsible for so many different factors that can impact impact and occupational therapy program, we have learned that even when the research is showing what is best evidence based practice, there are constraints that limit what we can and cannot do. That does not mean it's a no, it just means it's a no for right now. The other lesson is that if you really want to do something make true change, you have to work very, very hard. You cannot give up. You will feel defeated. You will get knocked down, and you have to get up each time, because change doesn't happen overnight, and you have to always see the bigger picture. Focus on what you can change. Make small, attainable goals and do what is best for kids, and let that guide your practice. Working in a school based setting is super stressful, with pressing deadlines on a continuous timeline. Try as best as you can to separate the emotions from when frustrations arise, knowing that this too shall pass, be mindful of your role and strategize how you want to fit into the bigger picture, channel your energy and intentions on utilizing your caseload and assessment lists as opportunities to provide RTI through educating and empowering teachers on all things. OT, this project has evolved into something so much bigger, and we are so excited to see and watch it grow and continue to modify it as it goes, to continue to meet all of the needs of Rialto, you know, and what is best for our kiddos in all things occupational therapy.    Jayson Davies     Awesome. Well, thank you, ladies for for sharing all that. I want to ask you real quick. Danielle. What exactly would you like to make available for our listeners? So    Danielle Delorenzo     today, what we're going to make available for our listeners is going to be the PowerPoint presentation. I am going to pass along the policies and procedures those three documents we were reviewing, and I will be able we until, if people want to reach out to us for some further info, we would love to share what we have via a collaborative model. So it's kind of like we had this big vision at OT and forgive me, if there are any listeners from OTEC, I've already ran into a couple of them that have been like, where's the drive? Where's this collaboration drive? It's coming. It's just been a crazy school year. So our future plans is to have this nationwide collaborative resource drive where everybody can contribute to, you know, all things OT and to share, because that's we don't need to reinvent the wheel, you know. So at least from out of here, we want to be able to provide those so people could see how we formulated our policies and procedures, and kind of just like a guideline for everybody else. Because I know we've heard a lot of feedback, especially at ot that a lot of people are kind of stuck on, how do you approach change? How do you make this work? So this was how we did it, and we're hoping, by sharing all of this information, that anyone can take that and tweak it to bring it back to their setting, to help make the changes that they want to see.    Jayson Davies     Absolutely and just like the PEO, you know, person, environment occupation model, I think you also have to almost call it like a DEO district, environment occupation model, like every district is slightly different, and so no one, no one manual therapy manual, or whatever you want to call it, will work for every district, and I'm sure you guys have figured that out. And so even if you were to share your manual the way it is with another district, it wouldn't be applicable. I mean, yeah, maybe 90% of it will be but there's going to be those small things that need to be changed because the different policies that that district has, the different vision that district has, the mission, the type of students, everything and so yeah, but that's very awesome that you're gonna provide some resources, that collaborative document that you got going on. What's the best email to reach out to people.     Danielle Delorenzo     The best email would be mornings with an OT mom@gmail.com     Jayson Davies     All right, cool and mornings with an OT mom, she's also, that's Danielle. That's also her Instagram handle, and so you follow her over on Instagram, and then, yeah, that's pretty cool. I know you have one other project kind of going on right now, something about mindfulness and movement. What's that going what's that about?     My Bui     Yes, so we are working on a project with all of this being said, this was our foundation that guided our journey to start this mindfulness in Motion project. We realized that our there are so many hurdles to jump over when you're trying to make change, we felt like it was necessary to shift the mindset towards a new culture of how OTs can help on a larger scale by integrating movement and mindfulness to increase academic performance, life productivity and emotional regularity throughout a lifespan. So, yeah, Danielle's personal Instagram is mornings with an OT mom, and mine is elevated state of play. And you can find more about this project by following us@mindfulness.in dot motion on Instagram also.     Danielle Delorenzo     Yeah, we're really excited about this project. I think what we want to really show everybody, especially our graduate students, that when you start out with this little, little itty bitty idea, you never know what it's going to grow into or what's going to blossom from this idea. And this project came out of pure motivation to do what's best for kids and to provide a service. That's all we want to do. So we hope you'll check us out, and you can contact us at either Instagrams, and we hope you all enjoy what we're going to be doing.    Jayson Davies     Well, I just followed you on Instagram, so you have one additional follower. I hope everyone else out there will do the same. Go check them out. They got a lot going on. Danielle and mine, the rest of the team over there, sorry, me, not mine. And yeah, really appreciate all that you guys have have done over the last year and a half or two years or so, and putting this all together, it's really, it's really awesome to see OTs kind of stepping up the game and putting such an emphasis on RTI and access, or allowing kids to access education before needing that. That referral potentially. So very cool guys. And yeah, I think that's all we have for today. We will see you next. Some on the podcast.    Danielle Delorenzo     Thank you so much. Jayson,    Jayson Davies     definitely. Bye. Everyone. Take care. All right. Well, that concludes today's episode number 38 and I want to give a special thank you to Danielle, My, Mary, Michelle and Rivka for coming on the show. That was something that they did not need to do, but they were excited when I asked them about it, and they wanted to come on here and share everything that they've done. They put a lot of really hard work into this project, and it's gonna go so far to help Rialto school district. And you know several other people, you know people that are listening right now, as well as people that hear it at ot a potentially, and yeah, I'm just looking forward to seeing what these ladies do. They are all really ambitious and really amazing. So it's going to be awesome again. Be sure to head on over to OT schoolhouse.com . Forward slash episode 38 there you will be able to either get it for free, if you're quick enough, or purchase the professional development. It's one hour of PD, and you can purchase that or get it for free and take the short quiz to earn your professional development certificate for NBC ot renewal. So check that out, and we will see you next time on the OT school house podcast. Take care and have a great week.    Amazing Narrator     Thank you for listening to the OT school house podcast. Now that you've listened to this episode, head on over to OT schoolhouse.com , forward slash PB, as in professional development to earn your continuing education certificate until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 37 of the OT Schoolhouse Podcast. In this episode, Jayson interviews Erika Del Pozo, MOT, OTR/L on burnout in healthcare-related professions (yes, that includes school-based OTs too). We discuss everything from what is burnout to how to prevent and overcome burnout. Join in and listen to this episode if you have ever felt like work has gotten the better of you. You won't regret it! Plus, be sure to earn your 1 contact hour of professional development and check out the links for resources below! Erika Del Pozo, MOT, OTR/L ​ Erika has practiced in outpatient pediatrics for five years and also has experience working with older adults with progressive neurological conditions. Her special interests include promoting work well-being and burnout prevention in healthcare. She is the CEO and founder of Joy Energy Time, a business dedicated to empowering healthcare professionals to grow in their wellness practices and to become #ChangemakersInHealthcare and advocate to improve the industry. Erika is also the creator and co-host of the Burnt Out to Lit Up Podcast, a holistic wellness show for healthcare professionals. Listen in to this episode and earn 1-hour of professional development for doing so, as Jayson Interviews Erika Del Pozo, MOT, OTR/L, on what is burnout and how you can prevent yourself from becoming the next victim of burnout ​ Objectives for this Professional Development Podcast Listeners will: 1. Become familiar with what burnout is and is not; including the statistics behind healthcare burnout 2. Identify how burnout is different from depression but why some may confuse the two 3. Identify strategies to prevent and overcome burnout in any workplace environment Links to Show References: Have a question for Erika? Visit the Joy Energy Time website at JoyEnergyTime.com ​ Joy Energy Time Free Resources Visit the resource page at JoyEnergyTime.com for 3 free guides about Work Wellness, Mindfulness, and Emotional Wellness. ​ Sign up to join the Joy Energy Time Club waitlist and be a part of this exciting new venture with like-minded healthcare providers. ​ If you enjoyed hearing from Erika of the OT School House podcast, be sure to continue the journey with her on The Burnt Out To Lit Up Podcast. Erika, her husband, and each of her guests will have you ready to conquer the healthcare world in no time! ​ Maslach Burnout Inventory - Human Services Survey (MBI-HSS) is the assessment tool mentioned by Erika in this episode of the podcast. Click on the link to learn more about this tool. ​ Languages of Appreciation - Read Erika's Blog Post about the Languages of appreciation or read about it in this book from Amazon: The 5 Languages of Appreciation in the Workplace: Empowering Organizations by Encouraging People (Affiliate link that supports the OTSH) ​ Recommended Reading: ​ The Stress-Proof Brain: Master Your Emotional Response to Stress Using Mindfulness and Neuroplasticity by Melanie Greenberg, PhD ​ The Compound Effect by Daren Hardy Captivate: The Science of Succeeding with People by Vanessa Van Edwards ​ The Power of When: Discover Your Chronotype-- and the Best Time to Eat Lunch, Ask for a Raise, Have Sex, Write a Novel, Take Your Meds, and More by Michael Breus, PhD Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript Amazing Narrator     Hello and welcome to the 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 am the host of this episode number 37 ot schoolhouse podcast. Thank you so much for joining me today. As you can tell, I'm a little pumped right now. I just got done with the gym, and I am excited to be recording this intro for you all. Today we're going to talk a little bit about burnout, but first I want to say thank you so much to everyone who's been responding to my emails, my Instagram, stories about your case, loads about what challenges you guys are experiencing as we start this new school year. So big. Thank you so much to everyone who's been responding, everyone who's been sharing the podcast. Thank you so much. It's really been amazing just seeing everyone kind of come together around this podcast and really enjoy all the content that's going on. So I'm excited about that, obviously, and I'm just happy to be to be here and to provide you guys with a little bit of knowledge from all around the states. So far, I don't think we've had anyone actually from outside the states yet, but just want to say thank you so much for following along, being there with me and and taking this podcast wherever you go. Today's episode is actually a podcast professional development course, so you will be able to earn one unit of professional development upon listening to the podcast and then going to otschoolhouse.com , forward slash episode 37 that's where you'll see the show notes, as well as the link to purchase this as a professional development if you're listening in on Apple podcast or YouTube or anywhere there is a link, you can probably just click on that link that says Show Notes or episode 37 show notes, and it'll take you to the website right now where you can view all the links and stuff that we talk about in today's episode. When you do purchase that, you'll take a short quiz, and then I will send you a certificate of completion. So thank you to everyone who has already done that. I must admit, it's really cool when I get to send out a certificate of completion to someone who just completed the quiz. Some of those people that have completed the quiz will tell you, you know, I make a little personalized video for them, and just say thank you so much for listening to the podcast and doing all that really cool stuff and going through the quiz and listening. You know, it's just amazing that this is just a new form to get information out, and people are really digging it. So I appreciate that today on the show for that professional development course, we have Erika del Pozo. Erica is actually the host of another podcast that I really recommend that you all listen to, and that is the burnt out to lit up podcast, her and her husband, he's a PT, actually, they host the show, burnt out to lit up. And they also run the website called Joy, energytime.com , another resource I recommend you all to check out. As you know, we are obviously healthcare providers. Even though we work in education, we're healthcare providers, and healthcare providers apparently tend to burn out easily, and I think so do educators. So we're kind of like in a double whammy here. But I'm gonna let Erika give us a lot of information about this. We have some great discussions here in the next hour, so it's gonna be awesome. And you know what? I think that's all I have for you right now at this moment, please enjoy this episode with Erica del Pozo and check out the show notes at ot  schoolhouse.com , forward slash episode 37 see you over there. Hey, Erika, welcome to the podcast. How are you doing today?    Erika Del Pozo     I'm doing great. How are you doing?    Jayson Davies     Doing wonderful. Very happy to have you on here today. You've been doing a lot, whether it be podcasting, social media stuff, the lot of stuff going out there, and so I'm so happy to have you on here today. Before we get into today's topic about burnout, I actually want to give you a little bit of a chance to share your career in OT, kind of how you got into the OT world and what you're doing now.    Erika Del Pozo     Yeah, so thanks for having me on your show. My name is Erika. I'm an OT from Miami, and I experienced significant burnout during the first few years of being an OT, so that's something I didn't sign up for, you know, as we all sign up for healthcare, not thinking that can happen to us, but definitely happened to me and the first few years of work, I was working in outpatient pediatrics, actually, not until that long ago when my husband and I moved across the country, but I have mainly been working in outpatient pediatrics with some outpatient older adult in there. So working in with patients that have had strokes and Parkinson's and so have quite a bit of um experience working with with different populations and um I with the burnout I experienced, I can equate it to like how you sometimes fall asleep on your arm. So you know, when you go to sleep at night, you fall asleep on your arm. Time, a few hours go by, and then you'll wake up at three in the morning and you're like, Oh my God, my arm. I can't feel my arm. You know, my arm is tingly. You're trying to, like, get control of your arm, and you're looking at it and doesn't even feel like it's attached to you. And that's how, that's basically what I think about when I think about my experience with burnout. It happened over time, over months, and within a within a span of two and a half years, where I didn't quite understand what was happening, and I would get those moments where I would wake up and realize, oh my god, like, what's happening, and I would feel out of control. And so what happened was that I left a job that was had had sub optimal working conditions, to say the least. And after that, I started to reflect on my experiences. I began to heal and start just working on myself, because that's what I felt like was lacking. And after a lot of personal development and getting into all of the those things, I started to get into business things, and lo and behold, I became an entrepreneur, which is something that I never would have thought I would do. But it was those experiences and that pain that really pushed me to think, wow, you know, if, if I went through that, then I'm not the only one, like, I can't be the only one. And so in 2017 I founded my business, joy, energy, time. And in 2018 I created the burnt OTs little podcast. And as of now, we are media company online. We have some real life events going on with some of our ambassadors around the country hosting healthcare Hangouts. But we have the podcast, we have our newsletter, and we're very active on social media, and we're just trying to empower healthcare professionals to make change in the healthcare system and to provide resources on stress management, burnout and well being. And anyway, here I am today.    Jayson Davies     There you go. Yeah, I love just the social media stuff, because it's not all not everything you post about is directly related to occupational therapists or occupational therapy. It's very broad and it's very lifestyle centric. I feel like it's not just for OT, just for all healthcare, all people in general, which is super cool, but you guys, it's you and someone else, right?    Erika Del Pozo     My husband, he's a physical he's a physical therapist. He's like, behind the scenes, like, he'll edit things and he'll load things and but, yeah, he helps me with that. He helps him with the with the back end stuff.     Jayson Davies     Gotcha. Okay, cool, but, but you guys are just so, just lifestyle centric. Everything on there. It really reflects just a positive outlook on life, not just work, and so that's great. Well, I'm excited to jump into our topic today. It's something that I have heard a lot about. I may even kind of have experienced it, slash maybe am experience a little bit. Both my wife and I, we both work in public education. She's a teacher. I'm an OT obviously, and I think it's something that we both kind of struggle with, and I know a lot of educators in general tend to struggle with it. But before we get into the nitty gritty of burnout, why don't I let you kind of talk about what it is, just a little overview of what burnout is and what it looks like.     Erika Del Pozo     Yeah, so burnout is a psychological syndrome that involves a prolonged response to chronic stressors on the job. So that's what you want to underline and highlight chronic stressors a day at work, here and there. It's over time, acute stressors be turned into chronic fatigue. And you have three main components. You have emotional exhaustion, where you feel like you can't give any more of yourself at a psychological level, you have increased cynicism, you feel distant and detached from your patients or even the profession as a whole, and then decreased self efficacy. So you're questioning your competency, your abilities, you have low confidence in your work. And it's those three things that uniquely make up, make up burnout for what it is. So it's different from just being being depressed or being stressed out. It's these things that are related to work.    Jayson Davies     Gotcha, okay, but so would some of the symptoms then kind of be similar to depression?    Erika Del Pozo     Yes, though. So that's a great question, because where burnout is job specific, and depression is context free. There can be overlap, especially if you are experiencing depression and you also are experiencing conflicts at work. You may be experiencing difficulties at work, whether that be with co workers or your relationship to your work or maybe with your boss. Then burnout is a stepping stone in that process, and it's really hard to kind of tease them out, but they can both be present at the same time.     Jayson Davies     Gotcha. Okay, so are there any stats or anything out there related to burnout, maybe, how frequently people or healthcare providers are experiencing it?    Erika Del Pozo     Yeah. So unfortunately for OTs, there. Aren't that many stats out there, which I hope will change soon, but what I have found is that 35% of OTs in one study experienced high levels of emotional exhaustion, and 43% of them experience high levels of cynicism. But you know, we know looking at healthcare overall, there is a lot of attention and research on physicians and nurses. So for physicians, over half of us physicians are experiencing burnout, a rate nearly double that of workers in other professions, after controlling for hours worked, age, sex and other factors. And in a recent study, 63% of nurses experience burnout, and they're getting a lot of attention, attention, because I know there's a lot more of them that make up the workforce compared to OT and PT, but I know overall in healthcare, they're just healthcare in general, looking at healthcare burnout, there is a lot of research and a lot of stats on that.     Jayson Davies     Yeah, I'd be interested really, to know open up a whole nother field. I mean, specifically, what we're talking about, mostly on this podcast, is the education side, and to see what it is in teachers, because I always hear about teachers lasting few years and then dropping out of the teaching profession. It's actually becoming, I think, somewhat of an epidemic. But I wouldn't be shocked if there's similar rates among teachers and physicians, just because there is so much pressure on you have the sociology I can't even talk right now, you're the pressure of society. You know, with parents and kids. I mean, there's nothing more precious than a kid to a parent, and you were responsible for that kid for six hours a day. It's just a lot of pressure. All right, so what would you say? I mean, you kind of went over three things, but in the real world, what does it look like? What leads someone to be burnt out at work, especially in that healthcare field?    Erika Del Pozo     Yeah. So as humans, we are strongly connected to the concept of work, and we receive satisfaction from work, because if it fulfills our deeper psychological needs for greater purpose and value in this world. So it's no surprise that burnout has entered the picture in our modern world, because we spend a great deal of time at work and in the US, on average, we spend eight to 10 more hours at work compared to workers in Western Europe, and on average, full time salaried workers work 47 hours a week, and 25% of salaried workers work more than 50 hours a week. And we know from research that working more than 50 hours a week is correlated with increased risk for cardiovascular disease, and physicians typically, on average, work more than 51 hours a week, and that was from research. But I can tell you from my experience as an OT I worked over 50 hours a week, and that was just being at work that didn't count documentation at home or during the weekend. And so I worked on average, considering all the work I did at work and away from work, definitely closer to 60 hours. And so it was found that physicians working in specialties requiring more hours reported lower job satisfaction, and then physicians working in specialties requiring fewer hours reported higher job satisfaction. So being a workaholic is something almost that's not even in our control, because it's the settings that we work in that require so many hours. And to answer your question, there are two main paths that lead to burnout that has been found in research. So the first one is an unmanageable workload, and that leads to a greater sense of exhaustion, which leads to greater cynicism and reduced efficacy. So all the things that are burnt out and with an unmanageable workload, I want to point out, it's not just the quantity of the demands, but it's also the quality of the demands. So if someone is doing work outside of their scope of practice, or they're doing things outside of their expectations for what their role is supposed to be, then that is viewed as more burdensome than legitimate tasks. And then another, another really common path to burnout is a mismatch of values between yourself and that of the organization, which leads to all three aspects of burnout in full, which then leads to greater energy and involvement from you. So if there is a mismatch between what I value and what the organization values. A gap is created. And there's a discrepancy between work I want to do and work I have to do, or work that the organization values that I don't value, that doesn't align with me. And so that drains one's energy. And so that kind of leads into that reduced involvement, that reduced efficacy. And then there are other major things that lead to burnout as well, like decreased autonomy at work if you have insufficient rewards. And that isn't just financial, social, emotional rewards. Being appreciated is really important, and in studies that has been shown to correlate. A greater sense of efficacy in a study of OTs actually, and then being bullied at work. So if you're if there's a lack of fairness, if there's injustice, bullying, it can and that is a part of that spectrum. So having that can contribute to burnout. Also, time demands different, um, not having the proper materials you need to do your job well. Um, documentation demands bureaucratic delays. I mean, the list goes on and on, but those are some of the main core things that lead to burnout. And I know this is a long answer, but there's, it's twofold so, so from a per so now, talking from a personal perspective, there are some personal factors that can lead to burnout, or can contribute to burnout as well. So one of the biggest things that can interfere with the person's recovery from work is not being able to psychologically detach. So if you're going home and you're not able to detach or thinking about your patients you're checking into work, or whether it's you know, tele pressure, meaning that you feel pressured or obliged to check into work, or you are thinking about your patients or your stressors at work, then that interferes with your much needed rest and recovery from the stressors at work and other things.    Jayson Davies     So I was just gonna agree with you and say absolutely, yeah, keep on going.    Erika Del Pozo     Yeah, that's a big one, and that's something I experienced firsthand that I wasn't able to psychologically detach. And other personal factors too include quality of sleep and burnout is correlated with insomnia and sleep problems, and so there's a positive relationship between the two of them, and other things include difficulty setting boundaries, deep belly laughs, which is found, which has been found in research. So it has to be a deep belly laugh that turns the parasympathetic nervous system on and turns off the sympathetic nervous system and personality factors. So if you have high levels of neuroticism, you tend to worry a lot, you have Type A personality, then that can facilitate the acceleration of burnout. So it's kind of like a heavy answer, but there are many different extrinsic factors and intrinsic factors that can create a unique cocktail, so to speak, of what leads to burnout in an individual    Jayson Davies     Absolutely, and that's a lot, but I had a few questions that I wanted to bring up. Just, I mean, everything you were saying kind of hit home, like I kind of just you put words on my mouth, really. But what about phone use? What do you think I mean, is phone use having a big impact? Do you think people are taking their phone home, leaving their email on and checking their email, you know, every 10 minutes their work email?    Erika Del Pozo     Yeah, well, that's a form of tele pressure. So if you feel obligated to check into work when you're away from work, then that can interfere with your sleep, your quality of sleep, and that has been shown to be the case. And so Absolutely and we, because of our society, we're expected to be on we're expected to be available. I've been emailed while I've been on vacation to sign off on documentation, and it's unbelievable, you know, just because it's it's this lack of respect for your personal time. And I don't quote me on this, but I know I heard in France that, or somewhere in Europe, that when it hits five o'clock, then, literally, the tables will go up into the ceiling. I heard that. I heard that somewhere. I think I read it or saw it in a video, and so it kind of, it's a very literal signal that work is done. You go home now and you enjoy that time with your with your family.    Jayson Davies     That's really good. I mean, I'm sure it's only as few select businesses, but, yeah, that's really cool that they do that. I want to share some of my own personal experiences here, because it kind of correlates with some of the things you're talking about. Personally, I do have my work email on my phone. However, I use the Microsoft Outlook email for that, so I have it on a specific app. That way I can check my own personal email without getting distracted by the work emails, and I can choose whether or not. And actually, I usually, over summer, especially, I turn off the notifications and the badges on that app so that I don't see whether or not there's an email coming in this this summer, in particular, I made a specific objective not to respond. And, you know, every now and then I would peek and just see what the message was. But I was like, You know what? This is my summer. This is my time. I'm not getting paid right now. I'm not going to respond right now. So that's one of the ways that I kind of just said, You know what I'm done for right now. Come August, whatever day we go back, I will turn on my email and just sit down for a few hours and. On to all the emails, because that's work time. So great way of approaching it. Yeah, and I think, I mean, especially in education, like you said, it's expected, but I mean, a lot of people talk about educators needing to get paid more, but so many educators work when they're not on the clock. I got invited to a work meeting on a date that no one was expected to work. Like the teacher told me, it's like, we're sending out this meeting to schedule IEPs, but no one's getting paid for this. And so like five teachers and people met on campus on a day that they weren't getting paid. And I was like, You know what? No, I'm not going to to partake in this, because if you do it, then you're saying it's okay, and then the district's just going to, you know, want a little bit more of your time next time, potentially. And so yeah, two experiences where I just put my foot down this summer.     Erika Del Pozo     So yeah, I'm proud. I'm proud of you to do that, because you're right, because then that sucks. That sets the expectations for what's acceptable and that be unacceptable. And I that's a great point that you made, so I'm glad that you set those boundaries, because that was one of the personal factors that came into play, was you setting boundaries at work and in your life. And that is one of the biggest that's one of the biggest personal things that can contribute to that sense of experiencing burnout.    Jayson Davies     Absolutely. All right, so we went over some consequences, I think, and consequences, I think we talked a lot about personal consequences. But what about in the workplace? How is this affecting the actual business that you work for and the people that you work with?    Erika Del Pozo     So burnout, in terms of professional outcomes, has been associated with job dissatisfaction, low organizational commitment, absenteeism, presenteeism, poor job performance, intention to leave one's Job, higher rates of turnover, decreased patient satisfaction and dysfunctional relationships with colleagues. So it doesn't just affect you and how you feel, but it affects patients and your organization, yeah.    Jayson Davies     And, I mean, from a business standpoint, you and I are both kind of running businesses. I mean, the last thing I want is someone to be there eight hours, but getting four hours worth of work done or something, you know. And I can imagine that that could be not so great for the productivity of the actual business and the bottom line for the business. So yeah, personally, and taking it home, is there any research about relationships at home with their family, or anything like that? Have you? Have you come about any of that?     Erika Del Pozo     In Research there has been, there has been areas where people that are experiencing burnout that they will take that home with them, and that will spill over into their home life. And so that emotional exhaustion and that low Psychological detachment, think about how that will interfere with someone's home life? What energy are they going to have left when they come home? And I can imagine, and from my experience, it it's not experiencing burnout. It's not an isolated situation where it just happens at work and stays at work. It affects literally every part of your life, and so your relationships, your your your partner, your friends, your family. I don't know to what degree, because I think everyone experience it experiences it in such a unique way, but in one way or another that does spill over into other areas of your life.    Jayson Davies     Yeah, I agree. All right, so you've helped us to understand a lot about burnout so far, kind of the onset of it, and how it can cause some discord, both personally and professionally. So let's dive into what is currently being done about these healthcare professionals. Are there any type of assessments out there? Are there? I mean, Google. I just think of Google when I think of potentially some company that might be trying to combat burnout or something. You know those big companies. Have you heard of any assessment, screening tools, or anyone doing stuff like that?    Erika Del Pozo     Yeah, so that's funny. You brought up Google, because I know big companies in tech and other companies, they have such incredible employee well being strategies, and they have meditation rooms, and they have, they probably have nap rooms, and I know there's breweries inside these, you know, in these offices. But in healthcare, we're very behind in that regard. And one of the biggest assessments out there, it was developed by one of the leading researchers in this field of burnout, Christina mass lash. So the assessment is called the mass last burnout inventory, or MBI, and there's one specifically for healthcare professionals. So it's the MBI, HSS Human Services survey, and there are other ones out there, but honestly, this is for. Me the one I came across the most in the literature, in terms of what assessments were being used to measure burnout in research, there were other ones as well that kind of have some they go along with they go along with it, but they have some differences. But I would, I would recommend this one. I consider that this one to be the gold standard.    Jayson Davies     Great. I will definitely make sure to put a link to that. Show notes will be ot  schoolhouse.com , forward slash episode 37 so we'll get some information about that there. All right, so it's August. I think we're recording this on August, 8 or ninth, whatever today is. I just had my first day back at school. Everyone out there, most of the people that listen to this podcast their school or their school occupational therapist, school based OTs and so they're all heading into the workplace right now. We talked a little bit about, you know, disengaging from your phone. You mentioned a big belly laugh. I almost want to ask you for an example of that. But what are some things that you think school based occupational therapists or pediatric OTs can really do to try to prevent that burnout going forward in this, this new year that's starting up here in school.    Erika Del Pozo     So that's a great question, and in terms of preventing burnout, because we're, you know, in healthcare, especially in OTs, we understand the power of prevention. And one of the biggest tools that we can have is that self awareness. So the first thing you could do is to conduct a personal audit, and I'm in the process of coming up with a template for that, because I think that would be really helpful. But a personal audit and thinking about and dissecting the different areas of your life, so thinking about work, thinking about, Do I have the things I need to have at work to be successful, to do my job well, from actual tools, materials, equipment to enough social support to increased autonomy? Do I have these different things that support my well being, that support my performance at work? Do I have strong examples of leadership at work? Do I have opportunities to grow so looking at work as burnout most often, typically stems from the work environment, so I believe that would be a great place to start, and then thinking about yourself and how you cope with stressors, and thinking about, what do you what do you want in life, in terms of your career? Because I think so many of us, you know, we get a job because we get a job, and that can happen to anyone in any career. And I know for OTs, we're virtuous and we but I think sometimes we can get into a job and we don't necessarily have our professional and career goals fully developed, and we're just kind of taking it year by year. So I would encourage you to take a step back and work on those unprofessional goals and do your values align with your organization's values, because that's something that I think a lot of us don't really stop to think about and so, so looking at that, and then the personal factors, like I said, like how, how you're coping with stress, looking at your sleep, the quality of your sleep, are you moving your body, or do you have coping strategies? Do you have a strong social support outside of social support outside of work, and looking at the various aspects of your life, at your habits. And as OTs, we're really good at that, occupational analysis, activity analysis, so looking at our habits, our rituals, and are they de energizing, or are they energizing us? And you can start there and just looking at the different parts of your life and then creating some sort of plan, personally and professionally, to get you on the right path.    Jayson Davies     Yeah, so would you say that all those methods that you just gave us a lot of great information that we can start off with? Would you say that someone is already feeling burnt out? Are those the same recommendations you would give? Or is there any other things that you'd like to say for someone who's already kind of feeling that pressure and feeling like they don't want to go to work anymore?    Erika Del Pozo     Yeah, and that's such a hard place, and I've been there and thinking about how I how I coped with it. In the past, I was using a lot of avoidance to cope with that feeling. I was avoiding my feelings. I was avoiding dealing with how I hated work, and I just wanted just to go to work, and because it was a good pay, it was good place. Everything was fine from that end, but I was miserable, and some things were happening that I didn't align with. And so something I didn't ask myself, that I would ask myself, and something that you should think about, if you are in that place, is thinking about what's the most important thing for you in your life right now. Like, if you could change one thing right now, what would it be, and what is getting in the way of of you achieving what you want most in life and thinking more beyond I hate my job, or, you know, like my job sucks, thinking about i. Okay, let's, let's approach this from engagement coping, let's and engagement coping, there's two. We can break that down into two different sections, so emotion focused, like, for example, if you're stuck in traffic and you're going to be late to work and there's nothing you can do, because that's the one path, and you're going to be late no matter what emotion of focus coping is taking a few deep breaths and just accepting that situation and trying to self soothe yourself in that moment, and then problem, focus is okay. I'm going to I have a problem. I'm going to call in whatever social support I need, or I'm going to do whatever I can to proactively solve this problem. So don't be like me, where I was in disengagement, coping, and I was avoiding the problem, but instead practically address it with that question, like, what is most important to me right now? And I think that will give you that's a great place to start, and that will cue you into, Hmm, maybe I have little autonomy, and that autonomy is impacting my, my well being at work, or maybe I'm not getting paid enough, and I need to ask for a reason that's really impacting my, my well being too. So think about what is it that's really causing you to feel this way? And it could be, it could be 20 different things, or it could just be one thing, but get, get it all out on paper, and write them all down, and then get a highlighter and highlight the things that you I have identified as most important to your well being right now. And you can, little by little, work on those changes, but just start with the most important thing right now.    Jayson Davies     Yeah. And, I mean, I kind of use the similar mindset, you know, things that I can versus I can't control. And just an example, you know, over the summer, I could control whether and I looked on my emails. What I couldn't control is thinking about, you know, what my caseload is going to look like Come August. I had no idea. There's no way I can control it. It was up to the people way above me to figure out my numbers, and I would figure I would worry about that once I could have a say in it. Come today, basically. But another thing I wanted to touch upon you mentioned it a few minutes ago, was growth, and I think that's something that impacted me, because as occupational therapists in the schools, we're, I mean, we're OTs, that's what we are. There is no real position in most in most states, I believe that we could go up like we can't become an administrator or something like that. And so that's something that almost that has a direct correlation on me starting the OT school house and the podcast, because I was like, I'm an OT most pay scales are five to seven years. So I'm in my seventh year, so I'm pretty up there. As far as the pay scale, I'm kind of topping out. And then I was like, well, now where do I go from here? And so growth was a big thing that I couldn't get at work, which ultimately led me to really start the OT school house. Is that kind of what you mean by growth?     Erika Del Pozo     Or that's a great thank you for bringing that uprepancies, glass ceilings, as far as professional growth, that is a huge thing for OTs, and I can give you an example. So when I was a student in field work, I was in an inpatient rehab hospital, and there was a PT, she was a staff member, and I was, you know, I was a student, and I observed her. I would overhear talk about this. PT, that, you know, she would go and do her job. Had normal 40 hour week, but she was becoming an RN. She was taking classes at night, on the weekends, and she was getting her RN, register nurse, right? Yeah, yeah, registered nurse. And I was, I didn't understand why, like, and I asked my my fieldwork educator, why is she getting that? And then she told me, because she wants to be a rehab director, and we can't be that as OTs and PTs, you have to be a nurse or a doctor. And I was like, That's so silly. Like, are you serious like and that was the only way she could put herself in a position to advance. And I think for OTs and PTs, you're right, we're limited to opening a private practice, and many of us may not want to do that, but it may be the only option for growth. In terms of moving up. There aren't a lot of opportunities to move up, and so that is one thing. But when I talk about growth, I talk a lot about, like, personal growth and and there's a lot of different dimensions of wellness that you can that you can experience growth. And for me, that was what really helped me to become more assertive and confident in myself, and that's what helped me to kind of heal from from this experience. So growth, you know, professionally and personally is, is both important.     Jayson Davies     Yeah, and I think a lot of people also use continuing education as a way to build growth, build confidence and fulfillment. Even you know, you go and get a certificate. It, and you just feel so much more empowered by what you can take and help your patients with. So another way to to grow. Mm, hmm, all right. Um, well, let's see here. Moving on over. Do you think that when one is burnt out, that they might be able to fake it until they make it? Quote, unquote, you know that whole thing, you know, just smile, and eventually you'll become happy. Is that real or is that? I guess we could call it almost myth or real or whatever. What would you say?    Erika Del Pozo     Myth Busters like that show exactly so fake it till you make it. I think in this case, can only take you so far because the emotional exhaustion component of the syndrome, you are unable to give anything more, and that's what it feels like. So it your energy is already compromised and and if you're doing work that's misaligned, your values between the values of the organization, and you have an unmanaged workload. And there's other things into play, then your your precious energy is being diverted and drained. And so I think it's really hard to hide it. And, you know, we do a great job when we're working with patients, because I can speak from my, you know, from my own experience, I want when I'm with patients, I'm on, I'm on, especially with kids, you have to be 100% on, and and, but when you know, in between those patients, you know during breaks, when you're entering work, leaving work, there's other times where you just really feel it, and you can only do that so much, and people that kind of go on, and they have burnout, and they don't really, first of all, they might not even be really aware of it. It could have become their new normal. And when something's normal to you, you don't challenge it. So if you, over time, get accustomed to what burnout is, then, unfortunately, some people can just live through it. Put output the bare minimum at work. And you've seen, I've seen that. I've seen clinicians, practitioners that are more experienced than I have, and I know what it's like for someone to be engaged and someone to be burnt out, and it's you can only fake that for so long. And I like to think of it as like boxing. So let's say I'm a boxer, and I train. I get enough sleep, I eat well, I have an amazing coach, and I'm outside of the gym, I'm working hard and I'm working on myself. But when I walk in the gym, or when I walk into a match and I'm 100 and whatever pounds, and there's an 1000 pound man or whatever, it's intimidating, and chances are I'm not, I'm gonna lose that match. So I kind of equate that to going into work. You know, no matter if you work on the personal growth and then the per and personal development, good, good for you. You focus on having an energizing life. You focus on getting plenty of rest and sleep, and let's say you have great habits and routines. But if you get into work and the conditions are terrible, you know that's not going to support you, you're not going to thrive, and you're not going to grow. And there's, like we talked about many different things that can make that happen. And so at the end of the day, you have to decide, is this place, is this place of employment, going to support me long term is, or am I going to burn out and turn into one of those practitioners that is just giving little to nothing, and you have to decide for yourself, and it does take a lot of awareness. So don't feel bad if you've got into that place. If you know you're producing the minimum output. Don't judge yourself now, because it happens to the best of us. It did happen to me, so just take a step back, reassess, and then go from there.     Jayson Davies     Yeah. And so a little while ago, I asked you kind of about assessment tools, and I mentioned Google real quick. But what do you see as teams doing within the workplace to prevent burnout. We kind of mentioned, you know, kind of Google having some sort of Nap Room, or something like that meditation room. But what are you seeing that may be more realistic, or are you seeing anything?     Erika Del Pozo     Some factors that at work that were that brought the team together? I did experience some in some cases, and in one place where I worked, I could say there was a high sense of unity and community, and I did really appreciate that. And there was a lot of fun to be had. For Halloween, we dressed up the entire week, and we had themes, and we were really into it, and those things really made work enjoyable. And but there are, you know, things that team first of all, your team communication is really important. And so this is a quote from the Harvard Business Review. The single most important factor in team success or failure is the quality of relationships on the team. And so when I started to get. Into burnout, I started to realize how important the team is and team communication. And, you know, looking back, yeah, I felt good during that time, but it was because we had that strong sense of community. And so one of the things that can facilitate burnout is a lack of community and having de energizing ties. So you don't have to answer this out loud. Jayson, but have you ever gone to work and you ask someone for advice over someone else that has less knowledge, but because you like them more? Oh, yeah. Like, yeah. Like, that's happened, that that happens, and that's happened to me, where you because as humans, we want to seek an interaction that makes us feel good and and so having that those de energizing ties at work can facilitate increased turnover, can facilitate decreased motivation at work. And so effective team communication can be. There's different ways to different ways to do that. And one of the things that I really like is showing the work, like showing appreciation languages at work. So have you heard of that before?     Jayson Davies     Yeah, we, at my previous job, we did like the four different colors, whatever. And people, they appreciate different things. You know, some people appreciate nice language. Some people appreciate thank you notes. So is that kind of what you're talking about, or is there something?     Erika Del Pozo     Yeah, yeah. It's acts of service. So if and you can usually tell what someone's appreciation language is by how they show appreciation to others, and I think this is important and not to be overlooked, because it's these little acts of gesture and gratitude throughout the day that add up. And if that isn't happening, and if people are short with each other, or there's miscommunication, or there's, you know, just this mentality where I just do my work and I don't really, you know, interact with anyone, then that can, that can add to this greater sense of, you know, lack of community, so being intentional about showing each other, that you appreciate them, and it's these little things that have to be these big things, just the little daily things matter and understanding someone's unique personality matrix. And there's quizzes online that can help you to identify that. But let's say I like a lot of details, and I like I prefer a manual when you tell me something, whereas you prefer quick bullet points, quick takeaways, just give me the most important information. There could be a lot of conflict and communication, because I feel like you're not listening because you're not doing it my way. And so when you have these sorts of different personalities, and there's no good or bad, we all have different it's like the Big Five personality ocean so openness, conscientiousness, extroversion, agreeableness and neuroticism. We have to understand when we're working with people, we spend a lot of time at work, and so we have to make sure that we're doing our best to meet people in the middle, or they can meet us in the middle, or we can figure out how to work together, speaking to each other's a unique personality matrix so that we can have that effective communication.     Jayson Davies     Yeah. And then conversely, what do you think there are things? What do you think are some things that maybe groups of people do at work that facilitates burnout or facilitates feelings that lead to burnout?    Erika Del Pozo     So in one study, someone in a healthcare setting, people that complained about feeling burnt out to other people infected them with those feelings of burnout. So burnout is thought to be more of a contagious group phenomenon than it is an individual one. So one of the biggest things is complaining. And you know, it's important to have a safe space where you can share. Okay, maybe I had a bad patient. I had a bad day. But you know, if it's complaining for the sake of complaining, and it's always this negative energy around your interactions on a regular basis, you know, having that work BFF can be great. But if you guys are always, um, focusing on the negative things happening at work, talking behind other people's backs, and that can be a source of stress, and you may think you're bonding with each other because you have the gossip and all that stuff, but it's actually adding to this false sense of community. And so, you know, falling into those traps at work. There's actually names for it, like corrosive trap, complacency trap. So if you and we all play an important role in this, so if you and your team there's that negative energy, then that is, those are one of those things that can lead to this sense of burnout, because it's it's it's contagious, it's spreading. And so you have to do something different. You have to flip that script and add ways to mobilize energy in a positive way.     Jayson Davies     That's funny. I'm actually kind of scrolling through your your Instagram account right now, and I see one of your posts that you know, you do a lot of those little the words, just like short quotes. They're not really quotes, but. Little SANEs. And the one I'm looking at right now is the burnout is contagious, exactly what you just kind of said. And honestly, that's probably going to be the one thing that I'm going that's going to stick in my mind today, just because you just called me out because I was guilty of that today. So, yeah, I'm going to have to that's one thing that's going to stick out in my mind today is, you know, being being positive. You know, even though things might not always be going, going so great to be positive and and have an uplifting, uplifting spirit, I guess about about work and and take the take care of the things that I can control. All right, so in preparing for some of these questions, I also did look at your Instagram. I just, I always see your Instagram, I love it, but one of the themes that I've seen on your Instagram is post about not comparing yourself to others. And I love, I would love for you to share a little bit about the effects of comparing yourself to others, whether it be in person or maybe even on social media.    Erika Del Pozo     Yeah, and I talk about this a lot, um, because, you know, in the 90s, when we grew up, we we've always done it. It's just how, how it we do. It changes. And so in the 90s, you know, we compare ourselves to the models we see in magazines or to the athletes we see on TV. But now we compare ourselves to quote unquote, you know, influencers and people that aren't necessarily celebrities, but have quote unquote famous accounts, whatever you whatever you classify as, you know, as famous or popular and and so I think in the healthcare niche on specifically Instagram, there's a lot of these hyper, polished looks with the perfect scrubs, and you don't look at like you're tired. So you must be a new grad, right? Because, and it's and this, this false glamorization of medicine and healthcare that, for some people, is like, you know, you look like that, but I had, I feel like I'm in the worst place I could ever be right now, in my job. And like, you can compare yourself to those people that look glamorous, and they have the perfect scrubs and and they they're so in love with the the field, and you feel like, well, I'm not and so there must be something wrong with me. And so this, you know, with just like we know the the models on magazines, whatever you know on billboards, they're they're photoshopped. We have to know that you know what we see on Instagram or social media may look real, but we choose what we want to show and so don't compare compare yourself to others that maybe they're this, maybe they have a huge ot platform online, but maybe that's not what you want to do. But maybe I don't know. We have all these different ways of making ourselves feel inadequate. And so don't compare yourself. Just take it with a grain of salt. And if you find yourself that you're relying too much, if you're checking social media too much and it's making you feel bad, you need to do that. Could be a part of your audit. You know, am I checking this too much? How is it making me feel? Do I need to unfollow or mute people and then reassess? And maybe that has to do with how you're viewing it. You know how you're viewing people? Because, you know, I think for the most part, the healthcare community on Instagram, for the most part, from what I've seen, you know, they have good intentions, but it's it could be in how different people portray themselves that may make other people feel like less than or they don't have it all. And that's no one has it all. We just have to understand that.     Jayson Davies     Yeah, definitely agree with you 100% on that. What about in the workplace and comparing yourself? Maybe you're comparing yourself to that other occupational therapist that's somehow managing 99% productivity, or that other ot that just always seems to have it going for him?    Erika Del Pozo     Yeah, you You never know what someone is is going through. And as a student, one of my field work educators, I thought she had it all, actually one someone in the clinic, I thought she had it all like she was young. She had a few years under her belt, and she looked like she was like the best ot on planet Earth. And then I overheard her, you know, she's like, I eat ice cream for dinner every night, and I'm miserable, and I'm single, and I'm like, wow, you know, like, you just don't know what people are going through. And especially in healthcare, like, like, you know, with kids, we always have to be on, and so we could always feel like we're on. And people you might not really get to know someone, or they're they may not be showing to you their true selves. And so if you envy someone, think about why you envy them. Do you envy them for their experience? Do you envy them for how they deal with difficult patients? And you know you can take that as an opportunity to to learn from them. And I think you know, in that way, envy can be a little healthy, you know, and you know, you have to decipher what is healthy and unhealthy, and thinking about maybe those are attributes I want, but I'm not there yet, and maybe they could be a mentor to me, or I can learn from them. And so you can use it like that.    Jayson Davies     Yeah. Definitely. So I want to wrap up here shortly. But another topic that I know you're kind of interested in is emotional intelligence. And talking a little bit about we'll just start off with what is emotional intelligence. We'll just start off with that first, and then we'll dive into it a little bit.     Erika Del Pozo     Emotional intelligence is the way in which people process emotions and how they identify, express, understand and regulate and use their emotions. So it has been shown in research that people with high emotional intelligence or Ei, they also have high resiliency and high optimism. And there was one study that found that the higher the emotional intelligence in a group of of PTS, speech therapists, OTs, doctors and nurses. The higher the EI, the lower the burnout. Individuals with high traits of emotional intelligence, they're more likely to appraise stressful situations as a challenge rather than a threat, and they are more confident that they can cope with their with those situations, and so that overall ends up with lower reactivity, stress wise, in terms of psychological, like your mood and also physiological. So it's pretty interesting. And yeah, I know we as OTs, especially in pediatrics, we may help kids regulate their emotions. And we also have to think about how we how we are aware of our emotions, and do we regulate our own emotions?     Jayson Davies     I mean, I think of something like general writing or something or so, there's some different strategies that maybe you recommend for people that just want to kind of check in with themselves on their emotions, right?    Erika Del Pozo     So this was something I had a huge problem with, and I would just jump to the worst conclusion, and I and sometimes I still struggle with that, where I get or I face a problem, or I face a stressor, and I have high emotional reactivity, and I know that's something I'm still working on, but there is, you know, based on the research, I came up with an acronym. And it may not be the best or most memorable, but it's, it's savvy. It's S, A, B, I so I have a friend, Sabrina. Sometimes I call her savvy, so savvy. So the first thing is, stop, stop, and think what's really pushing my buttons here, because, you know, we have been hardwired maybe a certain way so a certain stressor can elicit a certain response, but this is an awareness tool to stop and think what actually is pushing my buttons here, A is, why am I reacting so strongly? And it could be a certain type of patient that sets you off, that you may think, you know, I can't work with these type of patients, but maybe it's they make you feel like you're not confident in your skills, whatever. I'm just using that as an example. So why get to the root of why you are reacting so strongly? B, what's the best or worst that could happen in this case, and then I How important will this be tomorrow? So this can be maybe a rift you have with your co workers. If they did something, they perhaps ate your lunch, which I don't think whatever happens, but I'm just trying to think maybe, maybe they you, you put a yogurt, and, you know, they, for some reason, thought it was theirs, but you were that was your afternoon snack, and it's not there anymore. So does this always happen? Was this so a one time mistake? Why? You know, think about how, why am I reacting so strongly? So that's the A Why am and then I tried to make this somewhat memorable with savvy. And then what's the best or worst that can happen? And then how important will this be? So a week from now, even the next day, won't be that important that she ate your yogurt? Um, and then so just thinking about what's worthwhile in terms of holding on to. And when you think about it, there's a lot of things that aren't worth holding on to, but we do. We hold on to them. We hold on to stressful events. We replay things in our minds. We think about, you know, we can really sit and dwell in that anger if we are allow ourselves to. And so that a lot of awareness techniques can really be helpful. And one of the best things is mindfulness. So if you're mindful of the situation, and then you can stop and think about, you know, the going through that, that checklist of questions I just said, that can be helpful. But then journaling is another fabulous tool that I use, that you know might not be able to help you in that moment, but over time, if you're journaling in the morning or at night, there was study that nurses that were journaling at the end of the study had lower levels of burnout and higher levels of satisfaction. And so it can really be a helpful tool and to diving. Deeper into some of your emotional triggers, and thinking about more useful coping strategies and journaling, in and of itself, is very calming for me, and so it has added so much to my life.    Jayson Davies     Gotcha, all right, I got one more for you. Off the off, the questions that I sent you originally, and it's about workload. And I think that is something I mean, whether or not you're a teacher, an OT whether or not you're in education or if you're in a skilled nursing facility, everyone struggles with workload, I feel like and so what are some ways that you've gone about, I guess, being proactive when you are given such a high workload?    Erika Del Pozo     So yeah, workload is one of the biggest things that can lead to burnout, an unmanageable workload, and like I said, it's the quality and the quantity, and you have to question what is in and out of your control, because a lot of times we may think that's out of our control, but there was one time where I hit that wall early on with burnout, where I was able to talk to the owner of the clinic, and we agreed that we're gonna cut some hours from my schedule to make my workload more manageable. And that was something that I didn't think I could ask like because I was new I was a new grad, so I didn't think I can make that change, but we adapted two of my mornings into just documentation time. Even though it was unpaid, it was still time where they weren't allowed to schedule patients for me. And I was so relieved by that, because I got to a point where I hit that, as I call it, like a burnout breaking point, and then I came to this realization, it was like the arm analogy, where I felt like I was drowning, I felt like I was out of control, like everything was out of control. I had so much paperwork that it was I couldn't sleep at night, because for one evaluation I completed, there was like seven more and and so I did speak with my manager. And there were times in that outpatient pediatric clinic where there were, we had re evaluations every six months, and there were some months where I had one or two, and then there were other months where there was, like 15, and it just happened to be the plan of care, you know, when it ended. And that was out of my control, because I can't control when planet carriers end, and it was very difficult for me. But if you I also learned that if I had too much on my plate, and another OT, maybe she didn't have any that month, and it only because of the patience we see that happened, I could go to her, she could go to me and be like, Hey, can you please do these two re evals just to help me out? And this, like that, that huge teamwork component, and that comes from a place of trust. I do have that basic fundamental trust, that psychological safety, that you feel comfortable going to someone, or are they going to snitch and say, well, so and so they can't handle it and but, you know, I just, I feel like settings like that are very hostile, and there's not that strong unity. So hopefully you're at a place where you can balance some of that workload a little bit so it becomes manageable, and it takes courage to set those boundaries, and that's something I didn't know I could do until I did them.     Jayson Davies     So, yeah, yeah, completely agree. All right. Well, that was a lot of information in a short amount of time. I hope everyone, I mean, I'm sure everyone got a lot from that. It goes to show too, because you're not a school based OT, but everything that you say is so applicable to a school based OT, and it's applicable to basically anyone in the workforce. So yeah, really appreciate that. Before I let you go, is there anything else that you'd like to share about burnout, or about how to how to cope.    Erika Del Pozo     So I think for someone listening, if they want more resources and things that you can look over your on your own time and different strategies and tools. We have a lot on our website that's joy, energytime.com , and also our podcast, the burnt out to lit up podcast, and this is my whole mission, is, because this topic is so complex, and there's so many different avenues you can take to approach this and to come to this place where you have the highest sense of well being at work and in your personal life. This is, this is really what my work is about. So going to our website, listening to our podcast, and then we have a newsletter, which is, I received such wonderful feedback from my subscribers recently, and they said it helps them feel like they're not alone. And that's really powerful for me, because coming from so many different people, it's like, I think we feel alone in this journey. We feel like we must be the only ones going through burnout, because our co workers look fantastic, but you don't know if they're going through it as well, and you know they're just kind of going through the motions to get by. But like I said. Can only figure to me make it so far, and so think about yourself. Take care of yourself right now. Don't wait for a bad, something bad to happen at work, kind of like, I'm from Florida, so we have hurricanes. And you know, we would prepare for, if it's hurricane season, like now August hurricane season, we would kind of have everything ready just in case, and then have lots of water and batteries. And then when a hurricane does come, they're not sudden, so we still have a little a few days to prepare. But nevertheless, like the whole point, don't just wait for an emergency to happen. Be prepared. So equip yourself with the personal growth tools. Work on your personal or, sorry, your professional goals, what you want in your career, focus on doing things that bring you joy, that don't necessarily have to have an end product. So I think as adults, we forget this, and we see kids, and we play with kids, and especially in therapy, but do we do anything like that in our own lives for the sake of it? And that's something that I'm guilty of. I want to start dancing again, not because I want to be a professional dancer like I used to want to be, but just because I enjoy dance. And I think so, just finding joy in your life, wherever that may be, is is a great place to start.     Jayson Davies     Absolutely, all right, Erika, well, thank you so much for joining us today. I really appreciate everything that you said. And yeah, I can't wait to share and share for everyone to hear this. It's going to be awesome, and everyone be sure to check out, burnt out, to lit up. Or did I say that? Right? Yes, anyways, having fun here on the OT schoolhouse podcast. And be sure to check out Joy energy time, Instagram, Twitter, the website, right is joy energytime.com and we will also put all the links on the show notes@otschoolhouse.com forward slash episode 37 so thank you Erika, and I hope you enjoy the rest of your evening. Thank you, Jayson, all righty, take care. All right. Thank you everyone for listening. A big shout out to Erika for coming on, taking the time to spend about an hour with me to record this for you all. Hope you really appreciate that. I hope you do take some time in your life for yourself, away from work, turn off the emails and all that good stuff. Be sure to check out the show notes at ot  schoolhouse.com , forward slash episode 37 where you will also have the opportunity to purchase this as a professional development course and earn one contact hour of professional development for your NBC ot renewal. So check that out, and we'll see you here next time on the OT school house podcast, take care. Bye, bye.    Amazing Narrator     Thank you for listening to the OT school house podcast. Now that you listen to this episode, head on over to OT schoolhouse.com forward slash PV, as in professional development to earn your continuing education certificate until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 36 of the OT Schoolhouse Podcast. In this episode, Jayson has a discussion with Dr. Sue Bazyk, OTR/L, FAOTA, about the changes in school-based OT over the past 40 years and how therapists can move forward to support ALL students. Listen in to hear about: ​ How OT came to be ingrained in school-based Practice How treatment models have changed over 40+ years in school-based OT What LRE stands for and why inclusive and embedded/integrated services are vital to school-based OT What the "Every Moment Counts" program is and where to learn more about it. (See below for links to several freebie Handouts) ​ Bio: Susan Bazyk, Ph.D., OTR/L, FAOTA is Professor Emerita of the Occupational Therapy Program at Cleveland State University where she taught for 34 years. Throughout her career, she has specialized in occupational therapy practice with children and youth in home, school, and community-based settings. Dr. Bazyk's research and publications have contributed to several areas of practice including parent-professional collaboration, understanding food refusal, occupation-based programming, and addressing the mental health needs of children. Since 2003, her scholarship has been guided by a commitment to exploring the needs of underserved populations – specifically, low-income urban youth. In addition to authoring the book, Mental health promotion, prevention, and intervention with children and youth: A guiding framework (2011), Dr. Bazyk has authored 30 journal articles and several book chapters. She is the project director of Every Moment Counts: Promoting Mental Health Throughout the Day. She is nationally recognized for her leadership in building the capacity of occupational therapy practitioners to address the mental health needs of children and youth by embedding occupation-based mental health promotion strategies and model programs throughout the day to promote participation in school, home, and the community. ​ If you enjoy this podcast, don't forget to subscribe to the show on Apple Podcasts and please share with your colleagues! ​ I hope you enjoy this episode! Be sure to check out the resources below. Links to Show References: Quick reminder: Links to Amazon.com and other websites on this page may be affiliate links. Affiliate links benefit the OT School House at no additional cost to you. I appreciate your support by using these links. The below references were mentioned throughout Episode 36 and generously shared by Dr. Bazyk. EveryMomentCounts.org This is the site to check out if you are interested in bringing the Every Moment Counts classroom, cafeteria, or Recess program to your school! Every Moment Counts Info Sheet​ (below) Refreshing Recess Info Sheet (below) Comfortable Cafeteria Info Sheet (below) Moments for Mental Health Info Sheet (below) Leisure Coaching Info Sheet Mental Health Tier 1, 2, & 3 Strategies (below) The 1st Annual OTAC School-Based OT Conference in Clovis, Ca. (Sept. 6th & 7th) Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript   Amazing Narrator     Hello and welcome to the 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 36 of the OT school health podcast. My name is Jayson Davies and well, I'm just gonna put it out there. I am recording this intro on the day before I head back to school. Tomorrow is Wednesday, and I am heading back to school. It is the end of summer for me, or at least the end of summer vacation. Tomorrow we get to get back in and get a little training in and start to figure out our case loads a little bit and do all that good stuff. I'm sure some of you have probably already gone back. I think San Bernardino here in Southern California went back this week. But I know several of you back on the East Coast, it sounds like don't go back till till September, after Labor Day, I believe still on that kind of traditional labor day as the first weekend of or before going back to school. So everyone, I hope you're having a good finish to your summer or a good start to your school year. Hope that's going great for you. Before we get into our conversation today, that's going to be all about integrated services, a little bit about the history of school based OT and then we're going to talk about a very specific program with Dr Sue basic here, very special guest. I want to let you all in on a little thing going on here in California. I mentioned it before, but I want to give you a little more information. It's actually the Occupational Therapy Association of California. We are having our first annual school based occupational therapy symposium here in California. And OT is the one putting it on the theme this year is going to be promoting excellence and school based practice. And this is going to be held Friday, September 6 and seventh in Clovis, California. For those of you who don't know where Clovis is, it's kind of in the middle of California, near Fresno, off the 99 freeway. So it's kind of in the middle of California. Is trying to cater to, you know, everyone, both down in LA and in San Francisco. And we love to have as many people there as possible. I know some people can't always make it to the A, OT, a event. It's been kind of back east the last few years, their school based ot symposium, or conferences, you want to call it. So this one's going to be here on the West Coast, in California. You're all welcome to attend. Sessions will be led by California experts and school based ot on MTSS PBIS, assistive technology evaluations and much more. And you can earn up to 11 and a half PD use. For more information on that, you can visit the show notes at ot  schoolhouse.com forward slash episode 36 or you can head over to OT online.org , OT is ot AC. I will be there helping to facilitate a few things going on. I'll also have some occupational sorry, ot school house stickers to give out. I'll be walking around. So if you see me, come say hi. We'd love to have you there. I believe it's under $200 right now for both days, but the price may be going up soon, so be sure to check it out ASAP. If you are interested. I know that's less than a month away, so be sure to check that out here shortly. All right, jumping into today's content. Like I said earlier today, we have on Dr Sue basic. Dr basic is a fellow of a OTA and a professor emerita at the OT program at Cleveland State University, where she was the director of the graduate certificate program in school based practice. Today she's here to talk about a little bit, a little bit about the history of school based, ot integrated services, as opposed to pull out services as well as her program, or the program She's the director of, which is called every moment counts. Some of you may have heard about that. We are going to really dive into that a little bit. She's going to tell us about the different programs that that are within that program. One of the things I love about it is that everything is free, so at every moment counts.org . There is three or four different programs. We're going to talk about it here in a moment, but they're all free for you to use. They talk about, I don't want to ruin it for everyone, but basically, we're going to talk a little bit about recess, cafeteria and in the classroom services, so be sure to stick around for that here just a moment, and all the links that we're going to talk about are going to be again at the show notes at ot  schoolhouse.com , forward slash episode 36 as well as her full bio. I gave a very short bio, but that does not do it justice. Doctor basic has done so much for our profession. And, you know, I don't think this is actually in the podcast, but when we were on the phone together, she told me she never, she never meant to be a leader, you know, in the world of OT but just the way that she has gone about her professional career and how much she cares for the students and. And the practitioners alike, and helping the practitioners help the students, she has become a leader in our field. So I urge you to check out ot  schoolhouse.com . Forward slash episode 36 to read her full bio and to check out what she's doing in her career still today. So with that, I'm going to welcome Dr Sue basic to the podcast. Hi, Dr basic, and welcome to the OT school house podcast. How are you doing this afternoon?     Susan Bazyk     Oh, great. Great to be here, and thank you for this opportunity.     Jayson Davies     Yeah, definitely. I'm really excited to have you here. I think, I think more people have heard about what we're going to talk about today, but may not know kind of the face behind it, the every moment Counts initiative, and so we're going to get into that a little bit. But first I want to let you kind of talk about yourself as an occupational therapist and how you became to be an OT and to where you are today.    Susan Bazyk     Okay, great. Well, I actually started out in a ot a program because I didn't know what I wanted to do, and fell in love with OT, and then went to Ohio State. So I really fell in love with OT. I was really going to go into art, but my father said you can't do that. You won't make a living. So anyway, I went to school. I've been at ot for 40 years, and I graduated from Ohio State University in 1978 so when I was in school, 1975 is one, the law was passed, yeah. And so I'm going to tell you a little bit historically of just my experience in seeing this evolve. So I got out of school, I really wanted to work with adults, and I decided to do my third field work in peds, just so I knew what this part of the my profession did. I did my last one at United Cerebral Palsy in Indianapolis, and fell in love with working with children, youth, families with disabilities. And I also went, I had to run the adult group with these adults with cerebral palsy, and it just amazed me that many of them never went to school because they didn't have the right to go to school, adults with appetite, CP, who were brilliant. So in my first job, I really saw the face of what not having the law did. And so then after that, I worked for UCP in Indiana, and then Florida. Fell in love with community based. Then I went into home based intervention. And I loved Birth to Three home based. And I started really involved through a OTA with family centered care. Because actually, when I started practice, I got criticized for talking too much to parents. It was before family centered care, and I really started, you know, thinking very much about advocacy for families. And in 1989 we know that the law added on the birth to three component and family centered care. So I was involved in a OT, a national initiative. We did trainings across the country a parent of a child with disability and an OT. We co taught conferences throughout the country. It was like 1989 about what family centered care is and what it should look like. And then I went into academia, and I taught all the peats courses, and every year I added more and more on school based practice, because that's where it was happening, yeah. So so I did develop, as a part of my role at Cleveland State University, a graduate certificate in school based practice for OTs and PTs that our students could take as an elective or they had to take elective courses. So I really see the need for more specialty education for entry level OTs, we do a lot at Cleveland State, but I hear of other programs that maybe have three classes.     Jayson Davies     Yeah, it's just tough. I agree with you on that. I mean, I don't feel like I came out of out of school ready to go into a school based position, and that said USC at the time, when I was there University of Southern California, they did have some sort of grant where people, they did, get more of that school based side. It was kind of that elective. I opted not to do that. I didn't think I was going to go into schools, honestly, and so I didn't do that. But looking back on it, one, I wish I did. And two, I realized how little information about schools I didn't get because I didn't do that very specific practice. So you're right. I think it's very cool that that you're that Cleveland is able to offer that option, and it is an option. So it sounds like people kind of have to know what direction they want to go, otherwise they're not going to get it necessarily right.    Susan Bazyk     And so just like you, I have Stu. Coming to me after they graduated, they started in skilled nursing facilities, but then they said, You know, I really love my practicum in schools, and I wish I did the school certificate. So that is an issue, but we do have a pretty heavy school based focus in our curriculum, but I think that's an issue nationally that I haven't been really involved in the Commission on education, but I do know through accreditation, there isn't a lot of specific criteria for school based practice.    Jayson Davies     All right, so you mentioned a little bit about the laws around 1975 I'm assuming you're referencing the Education for All Handicapped Children, Act also known as the EHA, as many people call it, given that you were going through school and just kind of starting out as an OT during that point. What did you see then? And what kind of shift Are you seeing over the years to the 2000s.    Susan Bazyk     Yeah, well, when I was in school, I might have had two classes on school based practice, and nothing was even in our books yet. I mean, there was very limited and what was there, I think OTs at the time. You know, the flood gates opened with this legislation that said, if children need ot to benefit from special ed, it has to be provided we were the small specialty, part of Pediatrics that was viewed as a small area. Now, 40 years later, school practice is the third largest practice area at 22% or higher. So I think we've evolved. But I think at the time we had hospital and clinic based OTs going into schools, really, not knowing about the educational context, they were freaking out about how to write an IEP. And I think they kind of translated their model of one on one service delivery like a clinic based type of service in a separate room down the hall, which still exists in some schools, unfortunately. So what's very interesting, I've been really involved with knowledge translation and how new knowledge enters practice, and it's estimated that it takes 17 years to translate knowledge to practice. And even with the law, I've heard people say we're still trying to make the law a reality. And so I do think OTs role is still evolving. I think it's I think it's really different. In different school systems, there isn't a lot of consistency, but I think that we're advancing in a number of ways, some of the shifts that I see, first, I think we're working to reflect LRE, the least restrictive environment with which the law states, by law, we should be providing services in natural context with the typical peers as much as possible, I think on a caseload model, we're still trying, trying to figure out how to do that. So it's a shift from clinic based model, where you're doing one on one in an isolated setting, to thinking about, how do I serve kids where they live, work and play and learn? So one of the things I wanted to mention too, so we are, are in the gen ed environment. Yeah, I presented at the World Federation of OT conference in 2018 in Africa. I had a poster on every moment counts, and there were OTs from all over the world coming up to me and almost drooling to say you're in the general schools. They call them regular schools or mainstream schools. And so we're talking about Canadian, New Zealand, Switzerland, Singapore in Europe. People want to be in mainstream or Gen Ed schools. They don't have a law that does that, so OTs have a very limited role in special schools. Yeah, and I came away from the World Federation with a much greater appreciation for what idea has done for us and how it has given us an opportunity to not only serve the kids with disabilities, but if we're integrating our services in natural context, we can impact all children and youth. And we all know that a lot of kids not on our caseloads can benefit from our services.    Jayson Davies     Absolutely. And so that whole shift kind of toward the general education that's relatively new with the reauthorization correct.    Susan Bazyk     Right in 1997 I think there was a real emphasis, too, that we should be providing services in the natural context. And so I know a lot of the OTs back then les. Lee Jayson was our pediatric coordinator at ot a and OT there was a lot of professional development around the need for OTs to understand the classroom context and curricula. So instead of just thinking of our little ot goals, we've got to think of really being educationally relevant. And so that's when even Barbara HAMP wrote a lot on consultation and collaboration. And so I would say that was like in the early two hundreds. So going back to some of the shifts, and some of this is a shift in how we practice as OTs. When I got out of school in the 80s, we were very focused on component, function, fine motor skills. NDT was big. I was NDT certified and si service certified. And it was doing the special stuff in these isolated settings doing pretend things that we call bottom up service provision, and the assumption that if you work on a pincer grasp, that that will automatically transfer to buttoning or pulling on your socks. So then, I think, in the 90s, things started changing because of theories of motor control and motor learning to function. And that really what we need to be doing is top down, working with people doing real things with real objects in the real environment. And then there was a revitalization of occupation based practice, and I think where we've gone from there, and even in OTs new vision, which I've been involved in, the focus now is participation for health and quality of life. Yes, and the function part is good, but I would always scratch my head and say, What about the kids who are so involved, who have very limited function. We can't just think about function. We have to think about health and quality of life. Is this person who's very involved in needs full support. How can we help them be healthy and happy? So in schools, I think the other thing that OTs and thinking of top down, really thinking about, how do we reflect our full scope of practice? So there's a lot of complaining about OTs do more than handwriting? Yes, absolutely, it is an important part of our role, but we shouldn't be teaching it. We should be teaching teachers and principals. We should be helping them identify the best handwriting curricula. But I think as a part of our role in education, we don't just focus on academic performance in the classroom. We still need to reflect our full scope of practice, which includes and includes social participation, play, leisure, meal times, bathroom and and so the law does state academic and non academic is what we should be addressing. But I think a lot of OTs somehow get the message that they should only be addressing classroom goals.    Jayson Davies     I think you're right sometimes, yeah, or, I mean, the classroom goals, slash IEP goals. And I also think when it comes to IEP goals, we've already had other podcasts about types of IEP goals, and a lot of people are still writing very specific ot goals, as opposed to more collaborative child based goal. Or, I guess you could say not child based, everything's child based, but kind of what you're talking about, kind of the health related goals, you know, not just about that, that pencil grass to use a pencil, but some way to functionally communicate.    Susan Bazyk     right? And well, the other thing is, you know, we address both. We address non academic goals. So if, when I started, and I've always worked very closely with OTs in the field, even as an academician, so part of my research philosophy is really doing research that matters. So having therapists tell me what they want to do in 1999 an OT Paula micheaux approached me, and she said, You know, I really want to do this integrated services. And she worked in two kindergarten classrooms, and she said, I want to integrate all of my work in these classrooms. And we did publish this. It was in a low income environment, and we looked at the emergent literacy and fine motor skills of both the kids on her IEP as well as the kids not on her IEP and the kids without disabilities also had a lot of delays, and so she integrated her services two days a week in these classrooms by modifying the class. This room, educating the teacher doing small group interventions during their little small group work. And lo and behold, after nine months, both groups made statistically significant changes in their performance. And so the principal who co authored the article with us said, I want to get the biggest bang out of my therapy buck. And so what we have to convince administrators and our supervisors is that when we integrate services, we can reach more children, and they're going to get more out of our therapy buck. So the struggle then is how to do that and within a caseload model, but the way that I'm seeing therapists do that is saying, if I'm in the natural context, I I need to be LRE, so if I'm doing a small group, I'm going to pull in some of the kids, not on an IEP, but that could benefit from my services. So small group interventions and beyond consultation, I think there's some new models that even Jay and K Smith wrote a lot about this before she passed away, she started really doing a lot related to co teaching. So the Right Start program that they developed is a co taught program in the classroom. The OT and the teacher, and I really got turned on to co teaching. I think I like the model, because instead of telling teachers do more and verbally telling them what to do, you're going to be in their context and doing with or taking some of the responsibility. So that's another shift.    Jayson Davies     I want to ask you a question, because you mentioned, I feel like some of the listeners might have this question, and you're saying that we can service kids who aren't necessarily on an IEP. And I feel like some people might ask, Well, what legal grounds do we have to do that? Because we are supposed to be within special education, per se. And so how does that work?    Susan Bazyk     The law again, going back to least restrictive environment, we shouldn't just, you know, we should be embedding our services in the classroom, in the lunch room. And I do think in their law, there is, there is a clause that talks about prevention. So when we think of models like RTI Response to Intervention and providing early intervening services, when we think of Positive Behavioral Interventions and Supports. I do think there are models in the school now that are thinking more about, how do we promote what we want in all the kids? How do we prevent what we don't want in the kids at risk or showing early signs? And then how do we intervene? But all of that should be occurring in natural context. And when we do that again, we have access to all kids.    Jayson Davies     So you're not suggesting at all that we're pulling these kids out, maybe some sort of RTI small group at the most, but for the most part, this is in the classroom. Maybe we're there to really focus on our kids that might be on our caseload, our workload, whatever you want to call it, but at the same time, we're able to access more than just those kids. Is that correct?    Susan Bazyk     Definitely, okay. And the reason we're doing that, it's because of LRE and it's because the law, yeah, and it's because of theories of motor learning and motor control. And the research indicates that children and people learn skills best in the natural environment, doing real things with real objects. So the other thing that the OT and I guess I'll get into this now with integrated services, because you did ask some questions. Have some questions about that. I do think this is a huge struggle for OTs how to do this. I think in some districts, they've been used to just pull it doing pull out therapy. And so one of my colleagues, Carol Conway, called me in 2011 and I happen to answer my phone in a in a big, suburban, wealthy district, and she said, I know what we're doing is not best practice. Could you help? And I said, Sure, because that, you know, I love working with therapists in the field. And she says, We're doing primarily pull out therapy, and I know that's not best practice, and these wealthy families want private therapy in the school, but that's kids go to school to receive their education and to participate, not to receive therapy. That's not school. So what we did is we started out and I we started thinking, how can we shift this big boat? I. And we started with an in service to OTs and PTs. With the they had to get permission from the head of Pupil personnel, special ed director to give them time off during the school day for this two hour in service. So I came and I kind of covered the law and best practice the research on integrated services and motor learning, and then we brainstormed what they could do. So they started with a time study looking at what they were doing already, and the head of Pupil personnel was very nervous about if parents heard that they were going to do more integrated and not pull out that they would fight that. So we decided as a group that we would take small baby steps, and we did develop a community of practice. We decided that everybody needed to be educated on why integrated services and not just springing this on teachers or other people. So we developed a community of practice, which is a group of people who agree to work together and learn together. We functioned for about only three to four months. We did the same in service to get buy in about why integrated services is best practice. And then they worked their time. Study in the beginning showed that they were only doing 20% of integrated services, and the rest was pull out within nine months, nine months to a year, they were providing 80% and so they were figuring out, how would I embed myself into art? How would I embed myself into language arts, the cafeteria and recess. And in terms of small groups in the cafeteria and recess, if an OT does a Lunch Bunch, for example, So Carol would do a Lunch Bunch, maybe with some of the children who are struggling socially on her caseload. And then she always ask the teacher, who else do you think would benefit from this? And the teacher would give names. You do not need parent permission to have them be a part of a Lunch Bunch during lunch and recess during times outside of academics. So that's really easy. Yeah, I did not know that. Yeah. So what I think is OTs can serve a lot more kids during small group interventions, and then also through universal services, which I will talk about with our cafeteria and recess programs.    Jayson Davies     Yeah. So I want to dive into that. I mean, we've talked a lot about really transitioning into that integrative model type of approach, and you did talk a little bit about how you made that shift. What would be your recommendation right now, real quick before we move on to every moment counts for any ot who's kind of in their job right now, they're kind of like, I understand. I'm doing the same thing. I'm 80% pull out, 20% push in. My colleagues are the same. Where should we start?    Susan Bazyk     Yeah, and usually when I present on this Carol, Conway presents with me, because she's lived it, and she's helped other districts to do that. But I think so people aren't overwhelmed. We had a mantra that said, look for the open doors. Which teacher thinks it would be a great idea. Introduced like she was friends with the counselor and they were starting to zones of regulation came out in 2011 and so they started in a special ed class resource room. They co taught a couple classes on zones of regulation. That was in 2011 it went over so well that now it's a part of their Gen Ed curriculum in this district. So co teaching again, going back to the open doors, starting small, picking one teacher, one classroom, finding out what the teacher's needs are, and you don't get buy in from a particular teacher. Don't let that stop you.    Jayson Davies     Yeah, I completely agree. Great. All right, so then I do want to transition kind of to every moment counts, and before we start diving into each individual program. Why don't you give us a little overview of how every moment counts came to be and what it is?     Susan Bazyk     Yeah. So, you know, I always worked with children and youth, always interested in I did a lot with feeding, and always interested in the psychosocial aspects of food refusal. That was an area of research for mine for a while, and then, so I was always connected at a OTA. And so in 1999 the Surgeon General came out with the very first report on mental health, and there was a separate report on children's mental health, and Barbara Hampton, Leslie Jackson, who were leaders in the field. They had. Held a think tank meeting at a OTA, which they must have had more money back then, 20 ot practitioners and researchers and academicians for two days to brainstorm and talk about our role in addressing mental health with children and youth. We had to read the whole Surgeon General report before we got there, and it was, it was really quite amazing, talking about the lack of what we were doing the Surgeon General really advocated for not just treating or intervening when someone has a diagnosis of a mental illness, but to really advocating for reduction of stigma and for prevention and promotion of positive mental health. So that was really a pivotal point in my career, and I kind of stepped up to the plate. One of the first things we decided as a group was to develop a practice guideline on addressing the psychosocial needs of children. And then, I think the second edition of that, I was asked to write a chapter on school mental health that was probably around 2006 and then I just got more and more involved in my mission was, how can we get OTs to translate our body of knowledge related to mental health into a school system practice or community practice. How can we articulate our role? Because some of the surveys that have been done by OTs have said OTs do address mental health, but it tends to be an underground practice under the auspices of holism, which doesn't mean anything to anybody. And so I started reading a lot about this public health approach to mental health, which was starting to be advocated for and written about in the late to like 2008 2009 and I had an opportunity to edit a book on applying this mental health promotion, prevention intervention framework to OT and so that was the book that came out in 2011 I spent a lot of time reading literature from outside the field and positive psychology and mental health promotion. And I said, This is who we are as OTs, this is who we are, and what I have found since writing the book. And I had several co authors of different chapters, we all got together, and we said we're applying this framework in each of the chapters. And so I was so excited to apply it to the OT process and come up with this whole idea of what can you do at the universal tier one level to promote positive mental health. What can you do at tier two to prevent mental illness? And what can we do at tier three for those identified with mental illness, and the problem there is because we're not licensed mental health providers at tier three for kids with just a mental illness. We're not always invited to the table, no to be a part of that, very rarely. But once we start talking about how what we do is different, that we can address mental health, but we do it, doing doing therapy, not doing talk therapy, that we can help diminish some symptoms associated with anxiety, we can help promote feelings of well being during activities. Then I don't think counselors are maybe as threatened, and they understand that what we're doing is different.    Jayson Davies     yeah. And so that led into EMC, every moment counts, correct.    Susan Bazyk     Right? So what happened after the book was published? I was so excited. It was pretty and I said, Well, who really cares if nobody that's it's not going to do anything. It was anticlimactic. So I went to a conference on Knowledge Translation in Canada, which was really another life altering kind of conference for me, because I realized that it's the researchers responsibility to work with practitioners to help translate knowledge in manageable pieces to practice and that, you know, a conference is not really the best way to do that, or randomized control trials, just reading research doesn't do that, that it takes coming together over time to read, reflect and dialog about this new knowledge and think about how to apply it. So I had this idea of this. I called it and I call it building capacity. I like building capacity because that's what we want to do. It's not evidence based practice. And so I couldn't even get funding. In 2011 I decided I'm going to do this small pilot study. I invited 14 OTs from diverse school districts, urban, suburban, alternative, rural. And I said, Will you join me for six months? I want you to read this whole book, two chapters at a time, and complete a discussion after every two chapters on how would you apply this? And then we met over three times, and I said, I got CEUs from our state association. And so it really didn't cost much, but one of the lessons there is, if you don't have get money, don't let that stop you, because nine months later, I met with a representative from the Department of Education. She oversaw related service providers. So in some states, there's a related service provider, person who should be advocating for us, and she told me about some funding. This was in January. We started our building capacity in like October, and I brought my group back, and I said, Now that you know this framework and what we should be doing as OTs, what? What do you envision? You know, I said, the sky's the limit. So it was really the 14 OTs and myself that envisioned every moment counts, I wrote the grant, and we were funded in May for 720,000 for three years. Wow. So this group has been a magical group of OTs, and we broke up in teams, and we had a cafeteria team. So when we were sitting there, we were saying, Well, part of OT scope of practice is meal times and social participation. Why aren't we? Why aren't we impacting the cafeteria, which tends to be a problematic time of day, and for kids with disabilities, they're in the cafeteria because it's LRH. What about we know about play and leisure? Why aren't we impacting recess? And then even with extracurricular participation, that's written into the law. We pulled up the law. We cover that whenever we present. Why aren't we impacting and it's number nine on the IEP in Ohio, it is, do you have an excurricular participation section?    Jayson Davies     I don't believe. So, not really. We kind of talk about a little bit like, it's one of the we talk about in the present level, the performance, a little bit about it, but I don't it's just kind of like social skills or something like that.    Susan Bazyk     Yeah, well, most of the time, people just check it off that if students need accommodations and supports to participate in extracurricular activities provided. So anyway, we got the funding, and that's when we broke up into teams and we pretty much developed model programs and embedded strategies. So the whole thing with every moment counts is not it can't be one class. It has to be a knowledgeable team of not only OTs, but all adults who kind of have an awareness of mental health, what positive mental health is, and how to embed interactions and strategies throughout the day to promote positive mental health. So for the classroom, we have on our website tier one, embedded strategies, all based on positive psychology research, and then a program called the calm moments cards. So three OTs, well, two ot ours and 1c OTA said there is so much stress in school, we want to develop something to help teachers and peer educators know how to recognize stress because they don't get coursework in that and then how to embed strategies. So we started with a literature review of evidence based practice, and came up with cognitive behavioral mindfulness and yoga, a lot of support and sensory based and we developed these cards surrounding 17 situational stressors. And so for each of the cards which is on our website, there's thinking strategies which are cognitive behavioral, what teachers can say to students. A lot of it is affirmations, positive affirmations, and then activities we have. We have mindfulness and yoga activities and resources and then sense reactivity. So and we did a study on the use of these cards, and showed some really positive results in teachers knowledge and confidence in embedding these strategies. So that's the classroom, the cafeteria and recess program. Them, so we had our teams, and we really thought about what would be realistic for OTs to do in the cafeteria and recess. We can't be there every day, but our role could be really to help prime the pump, so to say or shape those contexts by empowering the supervisors to know how to do their job and to empower the students to take responsibility for this time of the day. So we came up with, we did a literature review. We always start out with comprehensive literature review of what are best practices, but a lot of, for example, the cafeteria, a lot of literature was on just food, healthy eating, and not a whole lot on social context. So we developed a program six weeks, one day a week, the OT would embed some information, we have information sheets, and we had a theme for each week, so for both the cafeteria and recess that week two, the theme is how to be a good friend. And you know, I've done a lot with bully prevention, but one of the things I've realized is, if we don't teach children what we want them to be, then we're not going to get anywhere. We can't just teach them not to bully.     Jayson Davies     Yes, trying to be more preventative, rather than reactive. Or promotion, yeah, promotion.     Susan Bazyk     Learn some skills. Where are children learning how to be a good friend? And there actually isn't a whole lot of literature on that. Kelly Mahler, who wrote the Inner Inner reception, did write a little book on friendship. Week three. The theme is how to have a meal time conversation. And this is so much fun. I mean, some kids don't eat dinner with their families having a meal time conversation is a life skill. Week four is mix it up day, and it's practicing their conversation skills with someone new. And it's all about respecting differences and how to make new friends so they sit by someone new. And then another week is understanding the sensations of the cafeteria and kind of respecting differences. So the cafeteria, there's usually a lot of issues with noise, and we embed strategies on helping the supervisor know how to handle noise and teaching children how to regulate volume. So a big part of the program is empowering supervisors. The recess program focuses on active play and teamwork, and we offer some structured play activities, a quiet play activity or an active play because the research shows kids with disabilities or and who struggle socially do better when there's a structured play activity, because there's an instant invitation to participate. So they're wildly successful programs. Principals love these programs because we found it cuts down office referrals, and it cuts down injuries during recess. And so OTs, if we implant ourselves and create this role in one of the districts, the OT is now invited to interview, when they when they interview new cafeteria or recess supervisors and orient them every fall. How hard would that be?     Jayson Davies     Not hard at all. That's awesome. Because part of the reason that I knew I had to have you on here is because, in my experience, I worked in a toxic cafeteria, or one of my schools had a toxic cafeteria. And I mean, this is I've worked at enough schools now that I can kind of talk a little freely without everyone knowing exactly where this was, but literally, the cafeteria age were putting chairs five feet apart in the middle of the cafeteria. And when some kid, random, you know, the one kid that got caught for being too loud when everyone's being too loud, had to be isolated, sitting in this chair in the middle of the cafeteria without their lunge and it was just terrible, and hearing them yell all the time. And I was like, What can we do about this? And so what I learned about your program, which was just this summer, I haven't had a chance to obviously, implement it yet, but I knew I had to have you on. And then learned about the recess program, and it's even more so    Susan Bazyk     what's been exciting is there are OTs that look at it, or we've had OTs who've been really successful implementing these too. They're real hands on, folks, and you could everything. Instead of writing manuals for these programs, we decided that we would put everything on our website. Because it was really grant. It was federal funds. Going through the state and and we couldn't sell this. Yeah, so everything is free. So the manual, in a sense, is all on the website. We have one link that says 10 steps to success. So what would you do to gear up for this program and then just do it the six weeks? There's a lesson plan for each week. And so some therapists might be overwhelmed by it. We say, this is a flexible program. We had one therapist say, well, the cafeteria is too big, but she started with a classroom who happened to eat in their classroom, so that's a way to do it. But in one of our districts, nearby the OT who did it, the special ed director, was so impressed that now they're making it a district wide program.    Jayson Davies     Wow, that's awesome.    Susan Bazyk     There's so many creative ways to implement these programs. We're actually presenting at our state conference, ot a in the fall, and I'm gonna have a panel of OTs from different districts, talk about how they they did it, because it's, it's kind of different in every every district.    Jayson Davies     Yeah, that's great. So real quick, I want to jump back, because you did mention, in a way, the time commitment for the OT because a lot of the OTs right now, I can hear people, you know, it's all a great idea, but do I have time for it? And it sounds like the way that you guys designed it was for the OT to be more of that teacher, for the teachers, rather than a specific intervention, a list for the for the students.     Susan Bazyk     Is that correct for the cafeteria, recess or even the class? Yeah, any of them, I guess one of the other areas that we we looked at a lot is this whole concept of coaching, you know, so in the cafeteria and recess, we're demonstrating. There is more in the literature about the power of demonstration. So if the OTs implementing this program six weeks, one day a week, and some we always ask OTs, pull someone else in to CO, do the pro, you know, co implement like a speech pathologist, like a special ed teacher. And so the demonstration of simple themes, things like smiling, asking kids how they're doing, how is your weekend, all the pro social stuff, what we found is cafeteria supervisors, if they've if they've not been oriented to their job, they think their job is just to keep kids safe and to keep them quiet. That's reactive, instead of how to interact in ways that encourages friendship. And so our studies have shown that even in the six week program, we can change the culture of the cafeteria and recess, and it's really building capacity of those supervisors to think differently about their job and to challenge things like yelling at kids or having them eat in silence. So they're really fun programs, and what we see then, OTs tell me all the time is everybody in the school knows me now, kids run up to me and give me hugs in the hallway, and they're not even on my caseload. And that's the power of a universal service. And actually, at Cleveland State, we have a special topics course where our students are going into Cleveland schools and implementing both programs as a course, and they're learning to think in a bigger way what universal services mean, you're still serving the kids on your IEPs. So that gets back to the question of time. So you need to make a case that I have these three kids in this classroom during lunch who have a social participation goal, and this is how I'm addressing it. So it's really thinking smarter about utilization of time. And OTs, who are doing the study, they actually have more time because they're serving more kids at once. Yeah, the thing I know I remembered from before is we don't only just address our IEP goals, we can address more than what's on that goal. So if there's a handwriting goal, you can embed some strategies in practicing handwriting. If you're doing that that we know is promoting positive mental health, like acts of kindness is a strategy that helps us feel good emotionally. That's from research, and one ot told me he has kids write thank you notes when they practice handwriting that's embedding, teaching children how to be kind.     Jayson Davies     Yeah, I like that idea. That's awesome. Yeah, cool. So I think that's a really good overview of every moment counts. And again, everyone can access all that stuff at every moment counts.org . Correct, right. Awesome. I have one follow up question before I want, or not really follow up question. This is kind of an outside the box type of question that I wanted to ask you. And bigger. I mean, just thinking out 10 to 20 years, where do you see school based ot really kind of going. Where do you see this shift? Are we going to continue this integrated shift for the next 10 to 20 years? Or do you think there's going to be something, something else out there?     Susan Bazyk     Oh, I think we I think there's more of a demand for it. And we are being asked, we do do conferences all over the country, and I actually may be going to New Zealand in 2020 what's been exciting is OTs. I see more OTs who are speaking up, and I call them Mavericks, who are saying, mental health is a part of our business, and they're approaching departments of Ed and getting funding. We got funding in New Hampshire, an OT and a speech pathologist in Oklahoma, went to the related service person in the Department of Ed and said, We need to support and help build leadership in Oklahoma for related service providers, and they brought myself and Carolyn for a two day conference in May. It was all funded through the Department of Ed and the OTs and PTs and speech got to go for free. So what I'm excited about is that kind of leadership where people are saying, we need this. We need to do integrated services. More of these sessions were at a OTA this year. They were called contextualized practice. I like the term integrated. So what I hope happens is that as we do more of this integrated service, that we will be doing more universal types of programs that that help all children and youth be healthy, mentally, physically, and that we will be called in more like Nicole Furman, I will say in Mason City Schools in Ohio to be directors of programs that focus on mental wellness. That's where I think our strength lies. So we started out in the settlement houses back in 19 early 1900s those were centers in the middle of communities where we helped people adjust to the demands of living. I think schools are so exciting, and I think they're exciting because we get to work with children and youth and adults and families where they live, learn, play, and the other thing I didn't mention, we also have an initiative called Making leisure matter. And one of the OTs, Maria Lorena, who is just an amazing ot she and an ABA person and a speech pathologist developed connections their business, where they are offering groups in a rec center. They started out serving kids with autism, but now have, because of demand, have expanded to kids with other needs, and they involve typical peers. They started with cooking. Now they're making. They're doing a lot of how to make a lunch type, kind of group crafts, and I would love to see OTs in rec centers instead of clinics, because that's where families wanted to take their kids. And you don't have, you don't have overhead.    Jayson Davies     Yeah, no overhead, and even just the the mental health and you know, to some extent, stigma goes into that too. I mean, going to see an occupational therapist at a clinic is very different from going and getting naturally embedded services at a rec center, that it's not a clinic, it's more of just facilitation. So that's that's fantastic.    Susan Bazyk     Sir. Rec groups, just like anybody else offers a rec group, so they you can charge, but we have the knowledge to understand the sensory aspects they also offer, like adaptive part, like parties, who make maybe can't take their children to a restaurant or just need additional supports, yeah, so that's that's kind of where I'd like to see us go. But we schools, it will not that will not go away, and it's just exciting to see. How we're moving forward?     Jayson Davies     Yeah, absolutely. I just want to mention, real quick, I had a note that I took down while you're talking, and it was about a OTA, and I know nothing that we kind of talked about today was really like gun ho for a toa, a O T, A, and A O T, A has nothing to do with this podcast in general, but I do want to just kind of reach out and really encourage everyone listening to be an A OTA member. There's a lot of stuff going on, especially for school based stuff right now, whether it be the credentialing stuff, mental health, all that good stuff right now. So be sure, if you're not an A OTA member, give us some thought and potentially join a OTA as well as your state organization, because they really do help us out. So I just wanted to share that Ruth with everyone real quick.     Susan Bazyk     But yeah, I advocate for that. We have lobbyists on the Hill who are always advocating, if we were not written into idea as a related service provider, it could be very different. Would be very different. And also, there is a school mental health tool kit, if you just Google a OT, a school mental health tool kit that is free and downloadable. So there, for example, is an information sheet on depressed childhood depression, and how would that look in a classroom or in school, and what accommodations can you make and strategies. There's one on grief and loss kids who are grieving. There's one on obesity and the mental health risks associated with that. So check out those information sheets.     Jayson Davies     Great. Well, thank you sue for coming on to the podcast today. Are there any other resources, websites, any other way that you'd like to leave information out here.    Susan Bazyk     Well, the one last thing I've been involved in is a grant in North Dakota with Dr Susanne Nielson. And it was part of a SAMHSA grant, Substance Abuse Mental Health Administration grant. We were tagged on to it, and so what we've done is developed a five month kind of self paced capacity building program that interdisciplinary teams can go through. So we have five webinars. There's facilitation guides. So what my next step is, we'll be working with different OTs throughout the country to help them implement this. So it was just completely finished. It will be online and all for free, and you can get contact hours too through it.     Jayson Davies     Oh, awesome. And, yeah, is there a website for that one?    Susan Bazyk     I could share that with you. It's the Mountain Plains Technical Assistance Center. I haven't shared the link yet on the every moment counts website, but I will be doing that shortly.    Jayson Davies     All right. And as always, we'll try and put just about every link that we talked about today or something on the show notes at ot  schoolhouse.com , forward slash episode 36 I believe it is, and, yeah, that'll be a good place to start. You'll have links to every moment counts, as well as some of the other resources we shared today. So thank you sue so much for coming on this show. I really appreciate it. All your hard work, and everything that you've done is making a big difference in OTs kids, teachers and all their lives. So thank you so much for everything.    Susan Bazyk     Thank you for this opportunity. It's been fun. Definitely take care. Okay, bye, bye.     Jayson Davies     Bye. All right, everyone. Well, thank you so much for listening in on today's Podcast, episode number 36 remember, everything that we talked about today can be seen or clicked on, on links and stuff at ot  schoolhouse.com , forward slash episode 36 those are the show notes. Thank you so much to Dr basic for coming on today. Everything that she has done for our profession, like I said earlier, has just been amazing. Please check out every moment counts.org . Everything there, like just blew me away. When I looked at it, there's so many free resources. It can be a little bit overwhelming, I think because there is so much there. They really did put everything there for free. So definitely start off with one program like Dr basic was saying, start with one additional teacher that you know is on board, or maybe a speech therapist that can help you out a little bit. Start small. Work your way bigger as you see those successes. But whatever you do, just keep on getting better a little bit every day can go a long way. So take care everyone. We'll see you in episode 37 Have a great week and start your school year. 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 Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 34 of the OT Schoolhouse Podcast. In this episode, Jayson interviews Ralph Schrader, OTR/L, a part-owner of a therapy clinic in New York and creator of the toy brand, Hungry Cutters. Ralph set out to create toys designed to facilitate developing fine motor skills in the kids he treats. Now, he is sharing those toys with us, along with a few tips for anyone out there who may be interested in developing their own toys. Listen in to hear about: ​ How Ralph started to develop his own toys What drives the development of these toys How toys are tools for therapists and parents A few tips on how you could turn your self-made toys into a business Where you can find the toys Ralph has created (*hint*, scroll down for Amazon links) ​ If you enjoy this podcast, don't forget to subscribe to the show on Apple Podcasts, and please share with your colleagues! ​ I hope you enjoy this episode! Be sure to check out the resources below. Links to Show References: Quick reminder: Links to Amazon.com and other websites on this page may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you. I appreciate your support by using these links. The below references were mentioned throughout Episode 34 Hungry Cutters Scissor Magnets (Amazon) Get 10 magnetic "Hungry Cutters" that stick to scissors and make cutting fun! ​ Hungry Cutters Apple Picking Game (Amazon) Play-based learning at its best with this game that encourages proper scissor technique​ as kids pick apples with a pair of tong scissors. Hungry Cutters Pegcasso Build & Drill Set (Amazon) Use over 300 pieces to facilitate fine motor and visual perceptual development among your students. Hungry Cutters Website Find free, printable templates for the Pegcasso Build & Drill set at HungryCutters.com​ Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript   Amazing Narrator     Jayson, 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 Jason Davies, and I want to welcome you all to episode number 34 today we are going to leave it a little lighter. We're not going to dive into any other research. Today, we're actually going to be talking about toys, which is only appropriate, given that it is summer, by the way. I hope you're all enjoying your summer, if you get a break, if not, I hope you're enjoying still working with the kids, whether it be in the clinic or in their home. I know some of you are doing groups as a side gig during the summer, so I hope you're all having a great start to your summer. It is now July, actually, and so I hope you're all enjoying that and had a great Fourth of July. So going forward today, we actually have on the show Ralph Schrader, and he is the founder and creator of hungry cutters. Many of you have probably seen his some of his products that he has on Instagram, whether it be my Instagram, someone else's Instagram, or maybe you've shared it on your own Instagram. But he has actually been developing several toys for therapists specifically to use with kids, and so it's going to be a pleasure to have him on the show. I really enjoyed getting to know him a little bit, and I think you will enjoy hearing what he has going on in New York City. So I'm just gonna let him take it away, and we are going to have a good listen together. So everyone, this is Ralph Schrader from Hungry cutters. I hope you enjoy the episode. Hey, Ralph, welcome to the OT school house podcast. How are you doing today?    Ralph Schrader     I'm doing great. Thanks for having me on. Jayson, definitely. So.    Jayson Davies     I know I can see, not all the listeners can see, but you're actually at a clinic that you own, right?    Ralph Schrader     I am part owners. I've taken a step back from it to pursue this toy business. But, yeah, I've been a part owner since 2005 of my best friend David Green.    Jayson Davies     Gotcha cool. That's really cool to be in business with a good friend. That's great that it worked out for you.     Ralph Schrader     I know, yeah, it's it's more of a marriage.     Jayson Davies     Well, that's a good way to do it, man. So before we get into hungry cutters. How about you tell us a little bit about your background into occupational therapists or occupational therapy. How did you come across OT?     Ralph Schrader     yeah, of course. Well, so I've been an OT for 20 years. I've done peds throughout, I would say, my whole career. I feel as though I didn't choose peds. The peds life chose me. So when I first started, I went through a job placement service, and I really wanted to do more orthopedic stuff. I want to go into hand therapy. But at the time, the recruiter, this was, you know, late 90s, he really directed me towards going into peds, you know, he felt that's where federal funding was going towards and orthopedics and adults were getting a lot of federal cuts. Federal funding was really, they were really making cuts in that area. So the time being, in my late 20s, I had a six figure debt from both undergrad and grad school, I really had to, I mean, honestly, start making money. I wanted to get married. I wanted to start a family. I still tinkered with hand therapy at the same time. I was also a saxophone player, but that wasn't happening, you know, I thought maybe I would have a niche working with older musicians, you know, many of whom had strokes and had to get back to their occupation. You know that being a musician at the time, most people had no idea what ot was. You know, new grads today on Instagram make the joke and close these memes of patience saying the infamous. You know, what's ot Are you? Yeah, you're gonna get my son, my three year old a job, but, but back then, I mean, if you can imagine, we often, I mean, we often just told people, you know, we're like PT, but, and we were, and it was really a four part to do that to the profession. But, you know, I remembered my saxophone teacher at the time, asked me, you know, what, what were my plans? You know, as I was getting older, and I told him, You know, I was going to OT school. And I figured I was going to have to engage in this conversation of explaining to him what ot was. But he mentioned that one of his friends, and, you know, these are guys that were up in their 60s, 70s, he said, Oh, yeah, of course, I know what ot was. You know, this famous piano player who doesn't mind me talking about the same. His name is Barry Harris, one of the top, you know, jazz musicians in the world, had a stroke, and he told the story of how he owed his life to OT that ot brought him, you know, was allowed him to get back to playing the piano. So. It was at that point I had this like, you know, you read a moment where I had chosen in my profession, you know, so I did Pete's for a couple of years. I started doing home care. And I feel like that was probably my first step towards being an entrepreneur. Was to do home care full time, you know, many back then, you know, had a job at a school. They relied on the profession, the employer, to provide, you know, insurance, health insurance, a pension. So for me, that was the big risk was, you know, putting money aside to pay for my taxes to contribute to a pension. You know, the risk of having cases not having cases, you know, of course, like during the summertime, that caseload drops and you have to start all over again in September. But, yeah, you know, I, I went into peds. You figured 20 years ago, this whole sensory integration, sensory processing thing was fairly new. I mean, you have people, of course, like, you know, Lucy Miller, who they were, you know, deep into their research of sensory processing. I took some courses from with her, you know, Renee Okoye, out here in New York. She owns a dove Rehab Center. She was doing some fabulous things, but it really wasn't mainstream. And when you would try to explain it to people, they just were like, What the hell are you talking about? You know.    Jayson Davies     Yeah. And so, the gym that you or the clinic you have, would you call it a quote, unquote, sensory integration type of clinic.     Ralph Schrader     Yeah, absolutely. You know, we have a couple of hospitals nearby, so they it's almost like an unspoken agreement where they do more of the orthopedic stuff they're dealing with, you know, children with cerebral palsy, Down syndrome, and we're taking on those children that are on the spectrum, that have, you know, si issues.     Jayson Davies     Yeah, gotcha. And I don't think we mentioned it yet. Are you in New York? Where about?    Ralph Schrader     I live out on Long Long Island, or as we say, out on Long Island, Long Island. So excuse my New York accent, but our center is up here in Westchester, in White Plains. David, he lives up here in Westchester, so I commute, and it's a pretty far commute, which is taking its toll on me, both financially and physically, I get that, but a good hour drive for me.    Jayson Davies     Yeah, that's what I used to do, too, about an hour and 15 minutes. So I understand. I just moved closer this past year, actually, and I went from having an hour and 15 to a 10 minute commute. So.    Ralph Schrader     Loving it, yeah, that definitely has its worth, exactly.    Jayson Davies     So, all right, we got a little background on you. You know, you started, you've been doing peds for most of your career. You've got this clinic now that you you've been a part owner since early 2000s right? Yep, 2005 great. So now I want to jump into the the hungry cutter side of this. You know, many people listening to this, I'm sure have seen you, whether it's on Instagram, I know that's where I follow you most. Is on Instagram, and we see some of the stuff you got going on. So how do you go from owning or part owner of a clinic now to getting into that toy business?    Ralph Schrader     Yeah, you know first, let me start by saying thanks to you. I think, you know, I'm late to the I never really got involved in social media, so I just started with Instagram, probably in August, and I think you were the first one, one of the first people, not the first to like repost one of my toys.     Jayson Davies     Yeah. I think also.    Ralph Schrader     Right, yes, exactly. Wow. Look at this. I felt like a superstar then, because you had your podcast, and I listened to a few of them. So it was very humbling, and I very, very much appreciate that. But to answer your question, you know, over the last 10 years, I really took more of an administrative role up here at our center, and it's not me, you know, yeah, I mean, I really had to learn all about insurance, payroll, state regulations, labor laws, audits, etc. And to be quite honest, between that and just treating I was burnt out. And to keep myself mentally stimulated, I started, you know, just making toys, you know, out of anything, foam, aluminum foil, I mean, just anything. And I remember now trying to teach children how to open and close scissors. And I constantly sat there, you know, here I am now approaching 50, opening my mouth, you know, open, you know, chop, chop, chop, and it didn't work.    Jayson Davies     Yeah, yeah, you know.     Ralph Schrader     When I, when I drew a crocodile on a magnet and put it on the magnet, the kids were, I mean, their eyes just, I mean, open so wide, and they got it, you know, yeah. And what happened is, one of my, one of my first sessions, a new family came in, and one of our first sessions, I used these, you know, self made magnets. And the parent was sitting behind watching, and I saw her on her phone, and shortly after, she said, you know, Ralph, I can't find these, you know, because I call them hungry cutters at the time as well, just as a joke, pretty much. So they can't find these hungry cutters on Amazon, you know? And I probably said, Well, you know, you're young. Here they are. These are the first ones. They're not for sale yet. I would love to, you know, make something like this, but they're just something I use. And she was an attorney, and she pleaded that I do something about it, you know, she's like, Ralph, this is a great idea. You have to do it. You have, you know, I'll help you figure out how to protect your idea. But you really should try to, you know, move forward and get this created. And at the time, I had several other toys too, not just that, but, yeah, that's, you know, and I, again, I just got to a point where I kept on showing other therapists. And I think my turning point was my partner said, Look, if you don't do it, I'm going to do it. Yeah. So I yeah, I just went ahead and moved forward with it.    Jayson Davies     Yeah, to be honest. I mean, when I first came across hungry cutters, you know, like you were talking about back in August or so, I saw the peg cost award, and I heard the name hungry cutters, and I was trying to put two and two together. I was like, this, doesn't I understand the name hungry cutter? Like, I'm thinking of scissors and stuff like that. And it wasn't actually, until, I don't know, maybe a month or two later, that I finally saw on Instagram the actual hungry cutters themselves. I was like, Ah, now it makes sense.    Ralph Schrader     Yes, and that's good that you point that out. You know? It's like, I'm one of those people, as many of us are, especially, I think some OTs, you know, you run into analysis paralysis, you know. And I just was like, you know that we could do this with it, you know, they're too thick, you know, they come off too easily. I have to tell you, the first hungry cutters that actually went on Amazon were not the ones today. Oh no, and I just was losing sleep over it, and I recalled all of them back, had them shipped to my house, and I made some changes. The original hungry Carters did not have a magnet on every magnet, if that makes sense, the magnet that sticks to the actual blade of the scissor and then attaches to the little critters. It was one magnet, and you attached each critter to it, okay, but they were coming off easily. And I said to myself, You know what? I could just hear the, you know, these, the older therapists complain they come off too easily. So I called them back. I could recall them all back and had each, each critter with a magnet attached to it, okay, but going back, I don't know if I answered your question as far as what drove me, you know, to go towards into this industry, you know, Toys R Us closed, and E commerce. I mean, e commerce is just huge, growing so much. Things like Amazon just made it possible for someone like me to, you know, bring our ideas to life, absolutely, if it wasn't for Amazon, I would be at the mercy of, you know, the big wigs of these corporations, and just trying to get my foot in the door. And that doesn't happen unless it's, you know, like the old adage, you know, it's who you know. It's not so much what you know. Exactly, Amazon opened that door for a lot of us, and, you know, we are now in a market where it's not so much the brand name that sells the product, it's that social proof. You know, people going on Amazon, on Instagram and saying, Hey, I bought them. They're great, you know, and all that social verification from professionals, you know. You know, my goal with my toys, it's, is to spread it like a first set, give it to therapists, you know. And hopefully therapists tell their parents, their friends, teachers. So that's the strategy. So it doesn't matter if it's Ralph, you know, who's selling the toy, or, you know, not to like fish a price, or any of those. You know, what's going to make that what's going to decide, what's going to allow a person to make that decision? Is that social proof, five stars versus two stars?     Jayson Davies     Absolutely, absolutely, it's the two things. I mean, I think I told you in an email when we were getting in contact. You know, I honestly thought, when I saw the Picasso board set that first time, I almost thought that it was like, Fisher Price or something, having an OT brand type of company where they're trying to sell to therapists, in a way. And it wasn't until I saw the actual hungry cutters that I was like, Wait a second, this has got to be an OT coming up with this. And so like you talk like you're talking about that social, you know, connectedness on social media, people sharing your products. And again, as occupational therapists, we're one of the few professionals that use toys as tools, and it's got to be something good. I mean, because we're not using it, you know, we're not giving it to our kids. So to play with two days and then toss in the toy chest and it's gone. We need to, we need to use it year after year because, you know, public funding and all that good stuff in schools, it's minimal. And even clinics, I mean, we don't have that much money to spend on a bunch of tools.     Ralph Schrader     So I, I make that joke all the time. I say, a physician has his stethoscope, a carpenter has a hammer as an OT I have my tongs and scissors. Yes, these are our tools, absolutely    Jayson Davies     so, all right, so we talked a little bit about the hungry cutters, you know, and you talked about how those are basically these little animals that connect to scissors through magnets and use those to help kids learn how to how to cut. What other things do you have out there? I've been mentioning Picasso, but probably not everyone knows what that is.     Ralph Schrader     Yeah, so the Picasso, um, is a drill toy that comes with pegs, and then there are many out there, so it's nothing in that sense that's original. But when I saw it, you know, because there's some toys out there and it's nothing original that are just out there. So in other words, if you want to start your toy a toy company tomorrow, you can find a manufacturer of blocks and call it Jayson block set. Yeah, but the key to doing that is, you know, you have to differentiate yourself from the others. You know. Why should I buy yours over? You know, someone that's been out there for years, and the other drill toys that are out there, I just felt, you know, they were great, but they could be a lot better. And in the Picasso's case, what I did was I added templates to them, or if you some people call them activity boards, I've added some, you know, rubber bands. And more importantly, the one advantage I have, I would say, or the one thing that separates me from the larger corporations, is any product that I come out with. I consider myself married to that toy or that product hungry colors I consider a tool. I marry myself to that. So with that, I mean, like today, for instance, you know, I posted a template of the letter W that could work with the Picasso board. And I saw that we use, yeah, yeah. So we use rubber bands to, you know, give that proprioceptive feedback. I use the string just to kind of get that directional flow of letter formation. And I'm able to add, you know, characters and cartoons, which I love doing, you know. And I have, you know, my my dad involved, who's an artist. Oh, nice. Yeah, yeah. So, I mean, that's one of the reasons I got into toys, you know, just to go back. I mean, my dad is an outsider. Will call him a hoarder. But if I told you that he's been collecting the Hess trucks amongst others, for the past, you know, 30 years, I wouldn't be exaggerating. So to this day, I still get a Hess truck for Christmas. Nice, you know. So we collaborate on a lot of ideas. He helps me, you know, with the prototypes and designing them. But, yeah, that's cool.    Jayson Davies     Well, it takes time, and especially to come with prototypes. You're you're talking about using Styrofoam. I'm sure you use cardboard. I mean,    Ralph Schrader     yes. So I recently posted a picture of a bee toy that's coming out. And I, you know, I came up with the idea of designing a honey comb on top of the rim of the container. And the only way I could come, you know, design, this prototype was out of aluminum foil. So I really, like, I basically wrapped this aluminum foil around it. I had to be already done. I placed the bead on top of it. I contacted one of my manufacturers out in China, and I, you know, showed her this picture. I said, can you make this? And a half of three manufacturers I work with, one of them laughed, and, you know, sent this emoji, like, you know, smiley face with the tears coming down. Like, like, in other words, what the hell is this? That's funny. It was like, maybe four in the morning. Because you have to realize it's, you know, four in the morning. Here, it's four, four in the morning in New York. It's 4pm out in China. Okay, so, um, you know, I'm half asleep, somewhat delirious, but in my right state of mind, I'm sending you these pictures. And she was, I don't know what this is. I'm like, come on, you could figure it out. So that that's one of, one of the first clues as to, you know who you should work with as someone that wants to take the time and try to figure out what your idea is. So I sent it to another person, and within minutes, she sent me a three, you know, 3d rendition of what I was thinking of. I said, That's it. That's it, you know, she, she helped me with the dimensions. You know, we went back and forth and, yeah, I.    Jayson Davies     That's cool. All right, so you got a few manufacturers from China that you're working with. So everything, do you have? Everything shipped directly to your house then?     Ralph Schrader     Good question. And going back to what made me decide that I would be able to compete in this multi million the billion dollar industry, you know, storage is one thing you have to think about. You know, back in the day, you would have to rent, you know, have a warehouse and store these products. Today, with the brilliance of Amazon is you can have your product made in China or wherever it is. I mean, there are other competing countries out there, such as Vietnam, India, Thailand. You could have your product made out there. And if you can anticipate how many you're going to sell, you can have that product shipped right to Amazon and not have to worry about storage. Yeah, you know, the only trick to that is, you know, after a year, which recently changed. It used to be six months after a year, Amazon charges these enormous storage fees that literally render your product. I mean, it'll put you out of business if your products are still there. Gotcha. But if you can strategically plan how many or how much you'll sell in that year, it's a great deal. You know, you don't have to worry about storing your product. I mean, you can go right from China to the to the Amazon warehouse, you know. But it's prior to that. It's knowing and giving the okay that your products ready.     Jayson Davies     Yeah, that's the challenge, definitely. All right, so I want to go back. We didn't talk about one of the toys yet, and that is your you have, like an apple tree. I haven't played this one yet. Tell us about this.    Ralph Schrader     So the apple picking tree, I think, is that bridge to using, let's say, play doh scissors, plastic scissors, to real scissors, or just kids who are not interested in using actual scissors for cutting, their tongues that are that work like scissors. You know, they have that hinge that pivot in the middle and they act as scissors, but the idea is to pick the apples off the tree without knocking them down. So the added benefit, which I use with a lot of my kids that are impulsive and just very disorganized, is to slow down, you know, try not to knock all those apples off the tree at once. The apples are designed that they're close together. So if you're using that pronated grasp, you know, with your palm first facing down, you're more inclined to knock all the apples down. So it really requires a delicate, you know, careful approach to taking them off. And the other side is a little bit easier, where the apples are spaced out further apart. But, yeah, I recently, I think it was last week, an OT on Instagram forwarded a text message from a parent who has a child that's on the spectrum and really had no interest or idea on how to use scissors, just the opening closing aspect of it, and she ordered the apple picking toy, you know, as a recommendation from this therapist. And the mother texted her back in tears that for the first time he was opening and closing, had such an interest in picking these apples, you know, nice. So I like it. Yeah, I've had some criticism from the OTs I work with here, but I love them. Definitely. That's another Yep, go inside.     Jayson Davies     I was gonna say what I like about it is like you were talking about it requires that precision for the kid to slow down, because we have too many kids that don't know how to stop and don't know, I mean, I know this is the next step, going beyond, you know, just trying to get an app off the tree with the scissors. But I mean, when you actually get to the part where they're cutting paper, kids don't know how to cut corners, they don't know how to stop cutting, they don't know how to turn the paper. I know that's the next step, but that's where you're you're starting with this apple picking is it's very precise movements that they have to make and be conscious about what they're doing.    Ralph Schrader     Well, said Jayson, I should use that for the promo.    Jayson Davies     There you go. Man, help in any way I can. Thank you. All right, so. Man, we talked about most of the toys, talked a little bit about entrepreneurship, but what sense of fulfillment do you get from all of this?    Ralph Schrader     Another great question, like I said, I was really at a point where I was getting burnt out, you know, treating and I'm someone that, you know, I'm constantly coming up with ideas, you know, to the point that it's annoying. You know, my wife's getting really tired of it. You know, I'm coming out of the shower. I got an idea, you know, what do you think it is? And she's like, Oh, just leave me alone. I have to go to work. But when I come up with these ideas, and some of them I can put together with some, you know, some of the toys you have and, you know, right at your disposal, I love putting together. There's something, or getting a prototype and just racing to work to try it out on some of my kids. And nothing's better than seeing a kid smile, or better yet, ask for that toy the next day. You know, I remember once, I think was about a year ago, I had the apple tree, a different version of it, which I hope to one day put in production. This is, you'll love this one, but I had a model of it, which I worked really hard at at home. And when I brought it to a school, like, three kids were jumping on it, and the teacher said, you know, he only brings this, you know, all he's doing is really, you know, testing out his toy. And I'm also doing therapy. But you're right. I get the added benefit where, you know, I have this is research and development. My biggest critics are the other kids, you know. And some of the things I've come up with kids over time, I've said, Nah, I could do without it. But the Picasso is my O, my go to what I love about that one is, you know, the kids can grow with this toy, you know. And that's, that's really what I try to do when I post all these different templates and ideas, is that, you know, you don't have to shower your kid with toys. You know, I see a lot of kid parents with children that have, you know, some issues that they're working on. They feel the answers to constantly shower them by the toys. I mean, they have it. They have a toy store, yeah, yeah, or an app store, you know.    Jayson Davies     Yeah, yeah. It's funny. You actually mentioned that because they're, I can't remember. I didn't read the research, but someone was sharing with me, you know that recesses need to be longer because it takes kids a long time to get bored, and if you keep feeding them a new a new toy, they never get bored, which never facilitates creative thinking. And so, you know, if you give them that Picasso, and you know what, maybe they start to get bored with a drill. Well, now they're gonna have to figure out how to use the screwdriver, or how to use the rubber band or the other piece of plastic to build.    Ralph Schrader     Well, they say, you know, the average, the average child puts that toy in the corner within two weeks. So after two weeks, the child is done with the toy. So my goal is to try to bring that toy back and say, take a look at it differently. Turn it over, right. Turn it around. What happens if I give you some rubber bands? What can you do with it? Now, you know, absolutely, and I love toys that have a three dimensional aspect to it. So that's where the Picasso comes in, again, where you can build and, you know, a lot of our kids, like you mentioned with the apps, you know, it's just a two dimensional world, you know, I want them to, you know, feel things, you know, get acquainted with depth perception. You know, how tall is that thing behind it? Yeah. I mean, how many blocks have to put on top of the one that's behind it that I can't see? So, yeah.    Jayson Davies     Yeah. And I was, you kind of mentioned it a little bit, but I want to go into a little further. Is that on your website, you have two different types of templates. Not only do you have things that you can print out and put right on top of the Picasso for people to kind of just use as a picture board, per se, but you also have pictures up there that you could potentially print out and have the kid copy like you have different diagonal lines and things that kids need to somehow copy. So you would put the picture next to the Picasso and they would have to copy it. So for anyone out there, if you have it, be sure to check out hungrycutters.com because he does have those templates that you can just print out, or even just show the kid on the iPad and have them copy it. So, yeah, definitely. Alrighty, man, well, I'll ask you one last question, and then we'll, we'll get back to our day, and that is, what would you suggest for the OT out there that maybe has an idea for for a toy, or even if it's something like starting a clinic or something, what's that first step that you would recommend to that therapist?    Ralph Schrader     Well, I would say, be prepared to, as I've used the word many times, get married to that idea, you know, as another adage, I like to use, you know, I work 80 hours. I don't have to work 40 for someone else. You know, I literally have been working seven days a week for the past 20 years, and my wife and kids. Could tell could, you know, could tell you that as well. But to answer your question, what would I tell them? I would say, get familiar with business. 101, you know, unfortunately, I feel like ot going to OT school. They really don't prepare you for management, entrepreneurship, um, you know, just how to run a business, just simple business terminology, like, what's a bill of lading? You know, what's you know? What are shipping terms as as you know, such as FOB freight on board, you know, COVID. Container terminology, uh, full container loads. And let me tell you, if you don't know these terms, and you start, and you inquire to a manufacturer on getting your product developed, they they'll just ignore you if you don't, if they're, if they're giving you these acronyms and initials, and you are responding, I don't know what that is. And to be quite honest, when I first started, I didn't know what they were. Yeah, you know, someone asked me, you know, give me your AI file. And I was like, what is that? Artificial Intelligence? I mean, ai file, you know, luckily, we have Google, so, you know, it's Adobe Illustrator they wanted an Adobe Illustrator file. And, you know, what's MOQ? They know, they will, they will ask you, what's your MOQ? So I didn't know what that was, you know, minimum order quantity. So what are the you know? So first, I would recommend that you become familiar with simple business terminology. Second, you know, look into, how do you want to protect your idea? You know, there are three ways, I guess, you can protect that idea, you know, getting a trademark, getting it copyrighted. Or, you know what I'm trying to do, getting it patented. So if you're, if you have drawings, music, literature, you know, chances are you're going to want to get a copyright. If you have a unique name, like I like my hungry cutters name, you know, I want to get that trademarked. If you have a unique logo, like a Nike swish symbol, you know, you want to get that trademark so people aren't using that. And at the same time, with your trademark, you know, people can't copy the name in similar ways, you know. And finally, a patent. You know, if your idea is good enough, you at least want to get a patent pending status. So pretty much you're telling people, Hey, you know, stay away. Yeah, you have a year to follow through with that patent, which is very expensive, but for a year you can have a patent pending status. And in that year's time you really want to, you know, present your product to the public, and you want to present it strong. You really want to get it out there and bombard the public with it, at least, get that name out there so everyone's    Jayson Davies     talking and let them know, is yours? Yeah, exactly, exactly.     Ralph Schrader     So at the very least, if, at the very least, if someone's copying it, they'll say, You know what? That's a copy of hungry cutters. I've seen them do it before, you know.    Jayson Davies     Yeah, and especially in the toy business, I can imagine, because, I mean, you know, Fisher Price and all them, they just have people out there scrolling and looking for ideas that people maybe got that patent yet. And so they had, they had the money, you know. And if they got, if they got wind of your idea, and it's not patented, you know, they can have it out tomorrow, versus it takes you some time to get it out there.    Ralph Schrader     That's and you bring up a good point as far as giving advice, you know, if I had to do it differently, and I'm exploring those options now, and I and I'm in talks with several companies, you know, it's an expensive undertaking to say the least. You know, I've spoken to and I'm on a few blogs of inventors, or, you know, toy designers and so forth. And someone's eight years into this, 800 grand into it. Now I'm not, I'm not anything like that, but it just goes to show you that this can, you know, you can really go down a rabbit that's hole with this? Yeah, so I would recommend that to reconsider this undertaking. And another good alternative is to get your product licensed. And by that, I mean, there are a lot of toy companies that are open. They want people like us, you know, that have ideas, and today, you can easily get a 3d rendition of your idea. It's not expensive. You can reach out to someone on, I think, Upwork, you know, they have a lot of freelance graphic designers, those that are familiar with Adobe Illustrator, you know, some are overseas, so they're really inexpensive. And you can put your idea, you know, into design. You know, it looks like the real thing, yeah, you know, years ago, you would have to get that drawn by an artist, and doesn't look it, but you can get a 3d drawing that looks like the real thing and present it to a company, and if they're interested, they'll contact you back. And with that, the other piece of advice I would give is, when you do contact these companies. They may not respond to you, yeah, and you have to be persistent. And they may tell you it's not a good idea, or they're not interested, and that, but that shouldn't, that shouldn't now make you feel as though you need to, you know, junk that idea, because what's a bad idea for them today may be great tomorrow. So the perfect example of that would be like if I had a toy that had a unicorn that, you know, somehow incorporated a unicorn. Maybe five years ago, they weren't interested. But today, everyone's making something with a unicorn. Of course. Of course, unicorns are hot right now. Yeah. Remember, 10 years ago was the narwhal. Everyone was the narwhal song came out. If he had, if he had a toy with a novel, they probably would have jumped on today, I don't think, I don't think that narwhal sort of thing. It's unicorns again, yeah, it's like Baby shark. Keep in mind, yeah, exactly, yeah. Great example. 15 years ago, I'm scared to show up there. I don't want a shark, you know. So just because the idea is not good today doesn't mean it won't be a good, a great idea tomorrow. So just don't give up.    Jayson Davies     Absolutely. Man, all right. Ralph, well, it's been a pleasure having you on the show. I'm so happy to see you using your ot skills to have a different type of effect that we don't see a lot of OTs in. And so that's really cool to see what you're doing and to have that, that ot lens on toy development, just super cool. So we'll be sure. We'll be sure to share links to hungry cutters, as well as the Amazon links for all the different toys on the show notes. I mean, it's been a pleasure talking to you. Hope we can stay in touch. Oh, absolutely.    Ralph Schrader     Jayson, thanks so much for having me. This has been such a great experience. I loved your podcast. I listened to them while I'm in my car going from patient to patient. So thanks for the work you do. Great.     Jayson Davies     Thank you, man. We'll have a great rest of your Saturday, and we'll talk to you later. All right. Jayson, all right, everyone. Well, that is a wrap on episode 34 the OT school house podcast. If you'd like to see some of those resources that we were talking about, head on over to OT schoolhouse.com forward slash, Episode 34 I want to give a special shout out and a thank you to Ralph for coming on the show and sharing a little bit about some of the toys that he has created, why he doesn't and a little bit honestly about how he does it, in case any of you out there are interested and have some ideas for toys that you might be able to build one day. So with that, I say thank you so much. I appreciate your time, your energy and the fact that you listen to the OT school house podcast and continue to learn. We'll see you next time on the podcast. Take care.    Amazing Narrator     Thank you for listening to the OT school house podcast for more ways to help you and your students succeed. Right now, head on over to otschoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 33 of the OT Schoolhouse Podcast. In this episode, Jayson shares what it was like transitioning from one district to another and the lessons that were learned as a result of doing so. Join in to hear about: Some pros and cons of both contract and district jobs Distinct differences between working in districts big and small The importance of advocating for yourself The role of occupational therapy in assistive technology Why Jayson feels there is a constant change in school employees What to consider before taking on a new job Don't forget to share what you learned as you completed this past school year with me at Jayson@OTSchoolHouse.com or on social media @otschoolhouse I hope you enjoy this episode! Be sure to check out the resources below. Links to Show References: Quick reminder: Links to Amazon.com and other websites on this page may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you. I appreciate your support by using these links. The below references were mentioned throughout Episode 33 Edjoin.org A place to find School-based OT Jobs in California and some other regions​ iPhone & iPad Apps (Some of these apps can also be found using the Goole App Store)​​ SnapType​ (free) SnapType Pro (necessary for full access)​ Speechify Homework App Breathe Breathe for Kids Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript   Jayson Davies     Hey everyone, and welcome to episode number 33 of the OT school house podcast. My name is Jayson Davies, and I am so happy that you are joining me here today for this episode. So this episode is going to be a little bit different than most of the other episodes. It's summertime, so I thought, What the heck? You know, let's just change it up a minute. Let's relax a little bit. There's not going to be a guest today, and things are just going to be a little bit more relaxed. It's just going to be me and you. So I guess you could say this, this podcast is going to be a little more qualitative versus quantitative, as I'm going to be talking a little bit about the things I've learned over my ot career, as well as this past year as I transitioned into a new district. So we're going to get into all that in just a second. But first, let's Cue the intro. I'll 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, and I'm back, and like I was saying, I just wanted to share some some things about myself and my career as an occupational therapist in the schools, as well as some of the things I've learned in the past. So those are the two things that I do want to go over. I'm going to start off by just sharing you a little bit about the three different school based ot jobs that I've had, and then I'm going to dive into some of the things that I specifically learned this past year, or maybe some things that kind of built up and eventually, you know, just came to fruition this past year as I transitioned into a new district, actually. So for those of you who don't know, I've talked about it a few times, I think. But this was my first school year at a new district. I worked for the district, as opposed to being a contractor like I have at one district previously, and so I'm going to talk a little bit about that, the differences between being contracted as well as in house or a district employed therapist. So yeah, I've done some reflecting, and I'm excited to get on with this episode. So this is typically the the time in the podcast where I get to introduce our guest, but since you know there isn't a guest, I'm just going to talk a little bit honestly, kind of about where I've come from and the jobs I've had. So let's get into that right now. So I am now at my third job as a full time school based OT, and I have had a few side gigs over the years, you know, working at a skilled nursing facility or through a home health agency on the weekends or on my way home from work. But it just didn't last too long. I'm definitely a school based OT. That's where I belong. So I have worked as both a contractor and as a district in house employee for schools. And I am currently employed at a district as opposed to being a contractor. And that is my that is my preference. I did move from my contracted gig to a district gig because I wanted to get into the actual district. No, there's some benefits, pros and cons for each, and I just kind of I prefer the benefits that come with being in a district, so hopefully we can have a whole nother discussion about all that in another episode. But yeah, it's just something that I prefer right now. Currently, I also have a role as a thesis advisor at a local ms ot program here in Southern California, I actually have two groups of four students, which I advise and provide guidance on a thesis manual and project that they work on. I work closely with them about once a week. I hop on Skype or something, and I really enjoy that. Actually, I could see myself potentially working as a educator at a ot school, or maybe a a C Ota COVID school or something like that. I think it'd be really fun to do so something that I'd be interested but the last role that I kind of work in as an OT is that I do actually try to keep up with the California Occupational Therapy Association, or OT, as it's called, Occupational Therapy Association of California, actually. But that's actually one role that I tend to struggle in a little bit to keep up with between all the other things I got going on with the podcast, the thesis advising, and, you know, the actual full time gig. But I do try to keep up with that, and that is something that here in California, we're working on educational credentialing for OTs in schools. And as you've heard on previous podcasts, I am passionate about that, and so that's kind of the area with ot that I try to focus my time to, all right. So like I said, I want to talk a little bit about the jobs I have had as a school based ot so let's start with the first job. I actually had, this right out of OT school, and I'm gonna explain a little bit as to how I got the job. So if there's any new grads out there, this is for you. I'll leave out the names of people and the companies, or I'll just create fake names or something, just to keep things fair. Nothing is bad. I just don't want any. Going to feel like I'm using their names for my own purposes. So my first job, I actually had no idea that I was going to be a school based OT. I really thought I'd be in a private practice or something, because that's kind of where my roots were, where I kind of learned about occupational therapy. But my friend had gotten this job as a contract occupational therapist for schools, and it was a company that was pretty well established, at least here in Southern California. I think they've even gotten bigger now, but she set me up with an interview over the phone with someone at the company, and my friend kind of shared with me she had a little more experience in school based ot through her field work experiences, as well as like a track at USC that was for school based OTs. So she shared with me a little bit about the ins and outs of school based OT and then I had my first interview with the company over the phone, and it was very chill, actually. You know, it was more of a conversation than an interview, and things that I didn't exactly know the answer to, they helped me with the answer. They knew that I was fresh out of college, and so they understood that, that I wasn't going to know everything. And actually, because they were a contractor, a contract occupational therapy company, of course, they need people in order to fill roles or fill positions that other districts needs. So they actually did help me with the answers. And then I had a second interview with not only them, but also the district that I would actually be employed through, I guess you could say. And I knew all the answers then, because previously, I had already talked to my previous my colleague and I also had talked to the contract company, and they had kind of helped me out with some of the answers. So by time I did the interview with the district, you know, I knew what idea was. I knew what an IEP was. I knew a little bit about collaboration and the need for collaboration, all that good stuff. So yeah, I basically got that job, and I had secured that job even before I passed the NBC OT, and so I was basically just waiting for my boards exam scores to come through, and then I was good to start working. So there was a contracted ot at a school district where most of the OTs were contracted by the same company. There were no in house OTs at that position or at that district, I guess I should say. And this isn't always the case, you know, sometimes there are some district OTs and others, times it's all contracted, but sometimes it's also a mixture of in house and contracted occupational therapists. So overall, at this job, you know, it was a really positive experience, and I learned a ton, you know, this is where I learned how to start treating kids in a school based model. This is where I learned all about IEP is how to write reports, how to complete evaluations. And, you know, when I look back on that year, it's almost like a blur, but it was an area of high socioeconomic status, you know, and so we had some high maintenance cases, but part of that, like, that's why I learned so much. You know, I had to deal with parents. I had to be very I had to learn how to communicate very well. I had to learn how to work with the parents, work with the kids, the teachers, all that good stuff. And, you know, this was a district that is known for having good special education services, and so we had actually people that would move to this area specifically for the special education services. And overall, you know, it just felt really good to be in a place where I got to learn a lot. We had a fairly big ot team that provided some mentorship and taught me the ropes. And I'm just so grateful for all those people that I had a chance to work with. And so about a year later, an occupational therapy assistant friend of mine actually who worked in that role with me at the job that I was contracted, she actually informed me of a posting on what's called Ed join.org It's E, D, J, O, I n.org , and this is a site in California where most districts post their openings, whether it be a teacher opening an occupational therapy position or any other administrator position, whatever it's on edjoin.org and so I checked out the job and I actually applied. It wasn't in House District job which I was keen on because of the medical benefits, the retirement plan, stuff that I mentioned kind of earlier, a little bit, but it also paid very well, according to the ED join posts. And you know, that's always a plus. The downside to this job, as I found out during the process of applying and interviewing, is that it was over an hour commute from home, and it was actually a relatively small district. So previously, the district I was in was pretty darn big and in a well established area, this one was small and in a rural area by California standards, they were interested in switching over from using contracted OTs through the county, over to having their own OT and OT assistant. So I interviewed, and that went well. I basically left the office feeling sure I had the gig. You know, it just was a very comfortable, relaxed interview. And the people there, we just kind of clicked really quickly.  And so that all went well. But because of the small district, the HR department took forever and a half to get back to me, like I had almost accepted, I kind of basically accepted another ot job. And then they finally got back to me, or like, hey, we want you here, come up here. And I had just felt that connection with them, so I did go up there. And I just want to thank the sped director, special education director up there, Jennifer for, for making that call to me and just saying, hey, you know what, we really want you up here. Come on up here. I just so glad that I did, because it was such a great experience. So working as an OT in that small district, you know, directly under that special education director, myself and an assistant, you know, we worked to transition all 90 or so kids, about 90 from the county services over to the district services, and we developed the OT program there from the ground up. We developed the OT handbook, we developed referral forms, we created the RTI programs there, and we established some handwriting groups to try and cut down on some of the referrals. And what I really appreciated there was that we were actually contracted to work through the district for over 200 days, and the typical school year is about 180 so that gave us time, not only to service extended school year, but it also gave us the time that we needed in order to get ready for the school year, you know, get organized and develop programs and forms and stay organized because it was a small district. You know, our director relied on us the OTs as well as the SLPs and the psychologists to be almost like program specialists of sorts. They didn't have program specialists because they were a small district, so we, as the specialist in the IEPs, kind of had to fill that role a little bit, also because of the small district, I had time where I could actually develop trainings, and I conducted trainings, you know, before the school year started, or sometime in the middle of the school year or after the school year ended, I got to put together training on fine motor skills, on handwriting, on some sensory stuff and and it was just really cool because we had that time to do that versus, you know, if we only have 185 contracted days, you're basically there for an additional, you know, five days before and after and during the school year. You just don't have that time to do that. So also at this district, you know, that's where I got to help hire Abby perrona, and which many of you know, she helped me to start this podcast in the OT School House blog. Abby's no longer with ot school house as there were some things just to attend to as time went on, but we're still friends. We keep tabs on each other, and hopefully she'll come back and visit us on the podcast again and and share with us what she's up to. So she's actually in the process of moving from California to the other side of the country, kind of closer to where she grew up and has family. So I wish her the best of the luck, and you know, we'll always stay in contact with her. So over the course of those five years in that district, again, Abby and the certified occupational therapy assistant, you know, we grew that ot program, you know, from the ground up, and it was just really fulfilling. You know, we got to start from nothing, from zero kids, and we transitioned all the kids over from the county, or the self, as they call it out here in California. And we built that program. We got to interact with the teachers, the parents, the students, everyone at the school, you know. And so it's just a great experience. The other thing that I learned from this small district is that I worked directly under the special education director, like I was saying. And so I just learned so much about how a special education department worked. You know, from the roles that the that the administrative assistants play, and, you know, all the paperwork up to the referral process, and then even just how the IEP works, you know, I got to sit in on meetings to hear, you know, what the state wants to see from the district and what the district and what the district wants to see from the special education department. And just like kind of the the vertical orientation, I guess you could call it of just all the different programs that go up the line and down the line from the individual schools all the way up to the district, and even beyond that, a little bit. So it was just really fantastic job. I got to work in that small location there where everything was just so tight knit, and I got to learn a lot about not only occupational therapy, but also special education in general. So definitely love that job. And that brings me to the beginning of this past school year, 2018 Those in 19 school year, I was at that job, that previous one for about five years, but last summer, I decided it was time to work closer to home. So I exchanged an hour plus long commute for a 10 minute commute at a local school district, you know, I must say it was a bit overwhelming. You know, I moved from a district that had 13 schools, two OTs and a coda to a district with over 30 schools, more than 10 occupational therapists and a preschool through adult transition program. I forgot to mention that the district I was at previously only had K through eight, so this was a big change, you know, going from servicing kids of eight or nine grades, all the way up until the full spectrum of services. So, but, you know, I made it through the school year. It took a little bit of time to get used, to figure it all out, but I did make it through. And you know, I made some new friends. You've heard some on the podcast, and I've just had new experiences that I thought you might like to hear about. So that's what I'm here to share. I know some of my current colleagues listen to the show. So real quick. Hi team. Don't worry. I don't think anything that I'm about to say in this lessons learned. I think I have about six lessons learned. Nothing's too crazy, and I'm pretty sure we talked about most of this. So let's get into it. Here are the six lessons that I have learned through transitioning this past school year into a larger district that's closer to home and just a little bit more well established. So here is lesson number one. I'm going to start with what I've already talked a little bit about, and that is that the district was a lot larger, and I just came to realize this past year that larger districts are not always the most organized, especially when it comes to the onboarding of OTs. This was realized very quickly, like within the first day or week of working there in August. And so I want to share that with you a little bit. So back in June, July, maybe I got the job. And so I signed all the paperwork with HR, and they gave me a calendar with 190 work days on it. All was dandy. And, you know, I was ready to show up on August 5 for my first day of work at Special Education Department, you know. And so it was a new employees training, or so, I thought. And I had heard that there was another new ot starting this year with me, so I was excited to meet him or her. Didn't know. But other than that, I had no idea what to expect. So I show up and find out that I'm the only ot there among about five new school psychologists. I don't think there are any SLPs, but there might have been one. So I thought to myself, what happened? You know, maybe the other ot isn't coming today. Maybe she didn't get processed yet. I don't know. So I'm sitting there in the small conference room with some school psychs and the director of special education, a coordinator to a special education all are mostly going over like psychologist info, you know, talking about the psychs telling them where they're going to be and telling them that they have like a central hub at this one school side. But I seemed a little shocked when, or they seemed shocked actually, that, you know, there was an OT there a little bit, you know, they played it off pretty well. They they made some copies for me. Told me where my schools would be, and stuff like that. But at the end of this roughly hour long, maybe hour and a half intro to the district, the schedule the special education department, the coordinator, shares with the psychologist that they can go to that that hub that I was talking about a minute ago, and to me, they simply say, Well, you can head over to your school sites and start to get ready. You know, mind you, I had not met anyone at my school sites. I my site administrators had no idea that I was going to be their occupational therapist, at least, I don't think they did. And I had no equipment. I had no access to caseloads or other online programs that I might need access to, you know, but I did as they suggested. I went to one of my school sites, and I remember not being able to get into one of the school sites, so I was like, I don't know what's going on here. So I went to my other school site. And this was about a week before school started, you know. So not even the teachers were on campus yet, the doors, all the gates, were locked in, any and everything. So like I said, I went to my other school site. I got into the OT room. It was in one of the portables, and I must have found an email list of the OT department, or maybe they gave me one back at the special education department, because I emailed the OT saying, hey, you know, is anyone else working today? And to my surprise, most of them said no. Actually, I think one said yes, but she was just kind of working for a few hours and then going home. But most of them said, No, we're not supposed to be working for another two days. Yeah, so I'm sitting here on Monday, and all the other OTs are like, No, we're not supposed to be working till Wednesday, and that's how the school year started off. So. Apparently the other ot that was supposed to start at the same time with me. She had heard that she was supposed to start the same day that I did, but she had gotten a hold of the OT department and found out that, no, they weren't supposed to be starting until the seventh as I finished out the rest of that day, you know, reviewing some files that I found, I couldn't help but wonder what the sped department staff were thinking when an OT showed up to the psychologist training that day. Honestly, I gotta admit, like I said, they they played it off pretty well, and they were very accommodating on me and and they did give me all the papers, or at least most of the papers that I needed. But, yeah, it just was a tough first day even, you know, just because the HR department, the special education department, just kind of wasn't synced up. And so to follow that up real quick, I also want to say that it was tough at the beginning of the school year, you know, going forward, because I didn't have access to the district online programs. To start the year off. I think I had access to my email, but it took a good week in the school year to get access to like my caseload, we use sase out here. I know some of you also use sase, and then it took me almost two months to get access to our billing program called paradigm. And I have no idea why it took that long. I think maybe someone had left the district, but just to get a simple login and be able to go on there and start accessing my or to input treatment notes. Took me, like, two months. So the first two months of school, I was keeping notes in Excel spreadsheet, and during the last week of school, you know, like a month ago, I was inputting those back entries into paradigm. And so that just took up so much extra time that could have been avoided by a little bit of organization among the special education department and the use of their programs that they have. So it wasn't the worst problem to have, but, you know, it could have been a little more easily facilitated. So getting access to all these programs in a big district, it can be tough, you know, because there are just so many people and very few people actually know who to refer you to in order to get the correct access. I remember sending a bunch of emails being like, Hey, can you help? And they're like, No, someone else takes care of this. They email that person be like, Oh, no, someone else takes care of that. So yeah, it was just tough. Likewise, at my previous district, I had access to a program that allowed me to see what classes students were in. So, you know, I could pull up Johnny Garcia or whatever, and say, oh, okay, he's in this teacher's class at this school. But at this district, I didn't have access to something like that. And so they actually had the same program. You know, they both use Aries, but at this district, they didn't allow me to have access to it. As you can imagine, at a high school, this made finding students very difficult. I had to email either the case carrier or the attendance office to try to get a copy of each student's schedule. But of course, as many of you who may work at a high school know, schedules are always changing, especially in the first three weeks of school, and so just trying to keep up with that, you know, I'd get one kid's schedule. I try to see him the next day, and his his entire schedules change, you know. And so that can be a little difficult, I guess. What I'm trying to say is that just be mindful that with with more people, comes more to be organized, and the likelihood that things will not be as organized, that's a tough pill to swallow sometimes, you know, especially for people like me, who you know, I use spreadsheets for just about everything. You can actually see one of them up on ot schoolhouse.com When you subscribe, I share one of my treatment, not treatment, sorry. Caseload templates that just helped me to keep track. I still use something similar to that. But yes, when you find someone, as Sure, many of you know are very organized, it can be a little frustrating when a new job just isn't quite as organized. So moving forward from that point, all this disorganization led to the need to advocate, which is actually lesson number two. And this starts before you even work a day at your new at your new job. I could argue it even starts during your interview, as you share your experience and how you have likely advocated for students or yourself at another job, maybe you just share that you listen to a podcast to better support your needs and the needs of the students. But you know, I think it's important to show that you are willing to advocate from day one, the first time I actually advocated for myself at the school district was the day I was actually offered the position. They said, hey, you know, you've got the position. And maybe it wasn't the same day, but eventually, you know, I wanted to know where on the five step pay scale that I would start, and I was excited to be moving closer to home, but I knew that it was likely going to be a pay cut, and so that was something I was a little concerned about. And I can tell you right now, it's not common for districts to just offer to move you up on the pay scale, you know, unless you advocate for it. In this sense, I was told that all OTs start on level one, and the clerk informed me, you know. If I wanted to potentially petition that I could submit an email with my current pay stub and ask to be raised higher, but that it doesn't always happen. But you know, I did. I drafted an email to the director of HR, I believe it was and, you know, I just said, Hey, this is what I'm making at my current job. And I really want this job, but, you know, I can't, I can't afford to take, you know, a substantial pay cut. And so I advocated for myself. And sure enough, I ended up getting, or starting at a higher pay level because I had advocated for myself a little bit, I sent in that, that extra email that it took in order to move up a little bit. And so that's something that was a little tricky. You know, I kind of sat there for a few minutes developing this email, thinking, like, why am I doing this? I'm getting a brand new job. And maybe it's I don't want this to affect, you know, my job here. I don't want them to say, oh, you know what, never mind. We can go find an OT that's going to start, you know, for 10, $15,000 less a year. You know, that's something that could potentially happen. I don't think it would, but you never know. Another common reason OTs need to advocate is for their caseload or workload. You know, the OTs in the district made it clear when I got there that shifting to a workload approach had been kind of addressed a little bit in the district, but was completely shut down by the school administration or district administration. And, you know, part of me understands why it is more costly and requires more work on the district part to figure out each person's workload rather than just managing, you know, here's 60 kids to you, 60 kids to you, 62 to you. You know, it takes a little bit more work. It also, in a roundabout way, can promote therapists to increase services in order to have fewer students to manage. So for instance, if someone's seeing 30 kids twice a week, and another therapist has 60 kids and they've seen them once a week. You know, that kind of, I know both of those are really large caseloads. I'm just making up numbers, but yeah, you know, it kind of could potentially promote therapists saying, Oh, well, if I give this student more therapy, then I won't have to take on another kid potentially. So just just my kind of being devil to advocate. A little bit, I fully think that a workload approach is more appropriate, but I'm just trying to see it from all different angles. Anyhow, by February of this year, you know, 2019 my student number had dipped down a little bit. I think it was around 48 and you know, the district's trying to keep us right around 60. But I was doing a lot of assessments, so I was staying pretty busy. I did try to send out emails to some of my colleagues, saying, Hey, if you need some help, let me know I do have a little bit of free time. But at the department, the coordinator that oversees the OT department, around January, she sent out an email saying, hey, I want to see all your schedules. And so, you know, I sent him my schedule. And like I said, you know, it was a little light. I already knew that. And because of that, she asked me to take on an entire additional school with a caseload of over 30 kids, like 33 I want to say so that means I would have, you know, do the math real quick, 4833 81 I think. And so in that one to one meeting with my coordinator, after she sent that email, I nervously, but politely, you know, said, I can't ethically continue to provide treatments to that many students. And I suggested, you know, I was like, maybe I can take on 15 instead of the 33 that meeting actually ended with me asking or sorry that meeting ended with her asking me to consider it and to look at my calendar and send that to her again, and just to consider if I could do it. So I did. I emailed her, I restated my concerns and again, offered to take on about 15 students, showing what my calendar may look like if I did, and then nothing. I didn't hear anything from her for a little bit. It must have been at least two weeks later, I received an email stating that she was asking me to only take on 12 students. And so I like, whoa. I mean, I offered to take on 15, and she's only asking me to take on 12, which then put me right at that 60 student mark, and so that helped, you know, I did go to that other school, I took on part of the caseload, and there was actually a contracted occupational therapist that took on the rest of the caseload, but it proved to me, You know, that that advocating worked, you know, using not only keywords, you know, using the words ethics and how that I can't ethically provide services to 81 students, especially without an assistant. I mean, I really, honestly did plan, because I kind of figured that that was coming, and I had to plan for what my words would be. And. I was asked to take on a caseload of of, you know, 80 kids or so, and so, I do suggest that you sit down and just think about, you know, what would you do in that situation? If someone was trying to ask you to take on more kids and more schools, then you could potentially take on what would you do? How might you plan for that. Or how might you react when your boss sits you down and says, Hey, I'm looking at your calendar, and I think you can take on an extra 20 kids. I mean, you know that a 30 minute session doesn't just take 30 minutes, and so you need to be able to express yourself and advocate for yourself as well as your student. All righty, on to lesson three, and then we'll see if we can take a short break this. One's a little bit more positive, I think, but I know there are going to be some of you which may disagree or feel you are inadequately trained for this, and so that's okay. You know, Lesson three is that OTs can be at specialists. Assistive Technology is what I mean by at and you know, very few districts have at specialists or someone that looks into at and thus they often are required to outsource evaluations for assistive technology. And this can be costly, like $10,000 per evaluation, costly. So districts are, you know, especially right now with with the technology age upon us, districts are looking for people who can fill this role. And for one evaluation this year, I actually had the chance to, in part, fill this role. I want to preface this by, you know, saying I have not received any special training or formal training for assistive technology. I do hope to do so in the future. But this evaluation that myself and another occupational therapist in the district completed together was pretty straightforward and did not include the use of augmented communication, ot com. In that case, if it would have, if it would have included some ot com, I would have said no. Or I would have at least, at the very least, been like, I need an SLP, a speech pathologist to join in on this with me. You know, I can look at some of the physical aspects, but I need that speech to look at the communication aspect so but in this case, the IEP just wanted to know if the student required access to more than just the classroom computers in order to access his education. So together with my occupational therapist colleague, we observed the student in a middle school classroom, his classroom, of course, we spoke to his case carrier, we emailed some of the other teachers to get feedback from them, and then we also conducted, of course, some formal and informal assessments. We looked at his typing abilities and compared his typing speed and legibility to his writing speed and legibility. We also reviewed some of the previous OT and psych reports, just to see if there were any underlining skills such as manual dexterity or maybe some cognitive skills that may inhibit either writing or his typing ability. Overall, the student was accessing classroom computers pretty well, but he didn't want to stand out. And I mean, what middle schooler does want to stand out? You know? So likewise, the computers that he had access to in the classroom were not really in a good location for him to learn while using the computer. You know, they were at the back of the classroom and faced away from the teacher. So basically, you know, the teacher would have been teaching to his back while he's at the computer trying to write his assignment. It just didn't make sense. So the district did, or the school did actually have Chromebooks, you know, carts of 30 Chromebooks, or whatever it may be that they could use. And so it was suggested that the school try using those before looking into further technology needs. This is definitely an area that I think OTs could and probably should be more familiar with as we move into and we are actually already in the digital age, this is definitely an area that if you feel comfortable with, then you might want to kind of take a few more trainings and get specialized in that, because there are other areas that you can actually do a lot more with it. And so I do suggest that, for instance, at the high school that I worked at, I became known as kind of the tech or app guru, actually in the IEP, so I would often recommend applications for students to try out. Some of those apps include snap type, which I know several of you are familiar with, speechify, which will actually read, it's a speech or, sorry, text to speech program. And so you can take, like a picture of a document, and it'll read it to you different homework apps and other organizational apps, especially at the high school level, for those kids that are just cannot remember to do homework or cannot plan out a a project, type of assignment, you know, that takes several parts to it, or several pieces to the puzzle. I also found some mindfulness apps for students to try out, such as breathe and breathe. For kids, two different ones that I did try out, and for students with physical disabilities, I worked with them to figure out a way to access their iPad or their computer in a way that made sense for them. You know, as OTs, we have a way. Say about our task analysis, that we look at the whole picture and not just the school. And so we often come up with ideas that other IEP team members may not this is definitely an area we can advocate for and take a larger role in, you know, because we do think about potentially, what the kid's going to need at home to do homework, what the kid may need even in the car or on the bus ride or something, you know. And so I suggest that if you are interested, you know, just just seek out that training. There's several different certifications or different types of classes that you can take. There's probably even stuff online. So one last comment on assistive technology, OTs can especially help students learn how to access their at devices in the community. I had the opportunity to do this again at the high school and in the adult transition classrooms a little bit, because every week they would go off campus, they take a field trip, or they'd walk to Albertsons, or they would go somewhere. And so often at the beginning of the year, these devices were being left in the classroom. They weren't going with the students, and so myself and the SLP, you know, we work together, and we're like these kids need cases on their iPads that are strapped to them some way, you know, whether it's an over the shoulder strap or something, so that they can take this with them. This is their communication device. You know, how do we expect them to actually participate out on the field trip if they don't have this device with them? So again, just a that's kind of mixing assistive technology and advocacy. All right, so we've been going on for a while now. I want to take a short break before I get to the last three and I want to ask you, what is one thing you learned this school year and share with me on twitter or instagram using the, you know, the tag at ot schoolhouse. Or if you aren't quite ready to maybe publicly announce what you learned, you know, send me a direct message, or even just say it out loud to yourself in the car to make it more tangible, if you want to take a moment to reflect on this past school year, you know, feel free to press pause if you need to, and just take a moment, take a few deep breaths and think about real quick. What is one thing, if everything else you had to leave behind, what was one thing that you really learned this school year that maybe you need to jot down just so you remember it come August or September, when you go back to work? All right, I hope you all took that quick moment to just jot something down. We all need to take a moment to just reflect and learn from our own experiences. So this next one, I don't think, is specific to large districts, but this year, we seem to have a revolving door of special educators, including occupational therapists. The district I now work for, actually lost two, at least two therapists before I started. And then over the course of the year, including myself, we hired four OTs this year, and so we are losing one of those OTs this summer, you know, again, just continuing the revolving door. And likewise, at one of the elementary schools that I was at this year, we started with two brand new teachers, special education teachers in both the primary and the upper grade special education classroom, both of them resigned during the school year, and we now have two new teachers, or we had two new teachers to finish out the school year. Hopefully, I think they will both be back with us next year, but in that time that we transitioned, you know, we either had long term subs or several, one, two, maybe three day subs. And that just hurts the kids who need that routine and then who need that continuum, continuum of services. You know, when they're gone, when you're having new people every day, you just can't keep that consistency at the high school. We also lost one special education teacher halfway through the year, and we're actually losing three more special education teachers this summer, as well as the two SLPs that were there are being reassigned or are moving in one way or the other. And on top of that, I have been reassigned to a different school within the district. So several district psychs and SLPs, they've also left the school for one reason or another. The district for one reason, you know. So next year, both the teachers and the students are going to have to get to get used to a whole new IEP team. And ultimately, that just hurts the kids, unfortunately. So it's sad, but at the same time, you know, we have to ask ourselves, why is this revolving door? You know, why are people coming and going, coming and going so often? And my theory is partially because of high, high case loads, lack of training and support. You know, a tendency to respond to adversity as opposed to planning for adversity. You know, it's just school districts as a whole. I find we tend to wait until caseloads are impacted, rather than to anticipate that we are going to be bringing on new students this year, or anticipate the kids will be transferring to us. You know. Know, it's just something that happened. And typically caseloads, if you look at at least my past seven years, the caseload tends to be higher at the end of the school year than it does at the beginning of the school year. I don't know about you. Let me know if, if you see something different. Unfortunately, you know, at that point where the caseloads are too high, it's too late. You know, that's when people get frustrated and potentially want to leave, and the paperwork is endless, and there's just not enough time in a day to catch up and get the help one needs. You know, it's a little ironic that we are trying to implement RTI in the schools, as opposed to a wait to fail approach for our kids. Yet we wait to fail when someone is overburdened with a high case load or too many assessments, you know, when it comes to those teachers and the service providers, not just OTs, SLPs, psychologists and so with that, I also want to just say, you know, it's not your fault if you're feeling overwhelmed and like you can't get work done. Well, then we need to go back to number two, which was lesson number two, which was to advocate, schools are under pressure financially from the top down. Everyone is being pressured to cut costs. And unfortunately, special education is an expensive department and takes up a large part of the budget in most districts, and that's why we're kind of being asked to cut, honestly, not just OTs, but special education as a whole. And so when you have this revolving door going on, you know, it can have a negative impact on the students and your ability to make progress with with every new staff member, new rapport has to be developed. You know, whether it's with a kid or the staff. For me, this affected my ability to run a classroom RTI group last year at that school, where I told you, we had two teachers both leave in the middle of the school year. I had set up an emotional regulation group with a teacher, and then she was gone two weeks later. Then we had substitute teachers for several weeks, which make it hard to make plans, you know, like, how do I come in and say, Oh, hey, you're here today. I'm coming in, and you and I are doing a group together. And then finally, you know, a new teacher comes in who I kind of felt bad for because she's trying to take over a classroom in the middle of the school year, like, how am I supposed to go in and say, Hey, welcome, by the way, next Tuesday, we have a group together where we're going to be talking about the zones of regulation or something like that. You know, it's a difficult task for her. It's something that I don't really feel comfortable because she's already overwhelmed, and I don't want to, you know, just add on to it. But again, this ultimately affects the students. So yeah, the revolving door of staff, it's, it's definitely something that altered my ability to provide services this year, and so I recommend that you do what you can do to support your teachers and other OTs so that they feel valued and they feel confident in their ability to make progress with their students, because maybe that's just the one thing that they need in order to not go looking for another job, or to Not even decide to get out of education completely. Because I don't know the exact numbers, but I've heard that in education, it's one of the highest rates of people wanting to completely leave the profession that they're in. You know, it's not just that they're looking for a teaching job at a new district. It's just that they don't want to be a teacher anymore, and that's sad. So or maybe OTs, you know, school based OTs, maybe they just don't want to be school based OTs anymore. They just want to go do a whole nother realm, because it's overwhelming here. All right, number five, it's going to be a quick one, but it's a good one. This year, I learned that a 10 minute commute is not to be underestimated. Like I said earlier, my previous job, I commuted over an hour to work each day, and then closer to 90 minutes in the afternoons to get home. There are actually days that I would stay late at work simply because I didn't want to start the drive. You know, now I work about 10 minutes from home, and I don't even have to hop on the freeway. It's awesome. That old commute that was spent listening to podcasts most days. So I do miss a little bit of my podcasting time, but instead, I'm here producing a podcast for you rather than listening to podcasts. So I do have time to take care of my own self care and, you know, duties as a husband and and likewise, I've learned a bit about what it's like to live in the community that I serve. And you know, it's not too bad. Every now and then I see a a student at a movie theater or a parent at the grocery store, but so far so good. No no awkward conversations or anything like that. So not too bad. All right. Last one, and again, this one's a pretty short one, but for those of you who don't like cliches? Well, I'm going to end this with a short cliche real quick, and that is that the grass isn't always greener on the other side. It's just a different type of grass. And what I mean by that is that every district is different. They all have a system that keeps them well watered for the most part, but they all have some yellow patches, and there's just really no. Way of avoiding that. So just like in an IEP, how we use a strength based approach to solving problems, if you do the same thing as an employee and stick to a positive growth mindset over time, hopefully you can start to minimize the amount of yellow spots and start small. Don't be too ambitious. Collaborate with those who are willing to collaborate. You know, forcing change on anyone who's not ready for it is only going to end poorly. So don't do that. Find a small group that you can collaborate with. OT is still not a household name for many people, especially in the schools. People have no idea what we do. Sometimes I use IEPs as a way to educate staff. I might explain ot in a great detail at an IEP meeting to the parents, per se, but I'm hoping that the staff member may just kind of happen to catch on to what I'm saying a little bit, and over time, you can see that happen. By the end of the school year, even my assistant principal, like knew what I was going to say before I did, and so she could advocate for myself, even when I wasn't there, and that's just awesome, because I now know that that she knows what OT is, and understands OT and knows when a referral may be appropriate and when a referral may not be appropriate, you know, so just keep in mind that people are always listening, and that can help with You being able to collaborate. The same goes for the word sensory, which is commonly misused or not misused, but used in a different way by different professionals. A little teaser for you here. We're actually going to talk about the word sensory and how it is used differently in the next episode. So stay tuned for that. But going forward, I just want you all to know that every district is just a little bit different. They all have their yellow spots. And if you're thinking about potentially going to a new district just because you think it's going to be better, you know, talk to some people there, find out what are the good points and what are the bad points, because you might find that it's just the opposite of where you're at now, or you might find that there's just different things going on there. So just try and see what you can find out. All right, one last bonus for the new grads and the younger OTs out there, every year goes by faster than the last. I'm sure many of you out there have already figured this out, but take advantage of your time now. You know, if there's a training you want to attend, view it as an investment in your time and your money. The same thing goes for small mistakes. You know, learn from them and definitely find an organization system that works for you. You know, time is so valuable, and if you don't advocate for your own time to yourself, you know, stop lying to yourself. You know you only had 24 hours in a day, and you got to spend time sleeping. So you need to find a way to organize yourself, your time and everything that you do. And you know, if you don't do this, you're going to end up working past 5pm every day, at least during the school year. And so figure out a way to manage that time. Alrighty, well, that is a little bit about me, my experiences and some of the lessons I've learned this past year or so. And I hope you enjoyed getting to know me a little bit better. Perhaps you learned something similar, or maybe you learned something completely different. I don't know every school is a little bit different. Every person's a little bit different, and every ot has their own works and things that they learn. So again, if there's something that you would like to share with me. You can reach out to me at ot schoolhouse on Instagram, Twitter, Facebook, or shoot me an email at jason@otschoolhouse.com and share with me what you learned. I'm excited to hear about your school year, and I'm excited for the next school year. And if you're enjoying this podcast, please be sure just to hit that subscribe button up at the top, just to make sure that you don't miss any of the future episodes. We've got a lot of good stuff coming up. We're gonna talk a little bit about trauma. We're gonna talk about the integration of services into the classroom, into recess and other areas. So just stay tuned and we'll see you next time on the OT school house podcast. Take care everyone.    Amazing Narrator     Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 32 of the OT Schoolhouse Podcast. Have you been hearing the term "Primitive Reflexes" pop up in IEPs or in the OT room? What about Reflex Integration? To be honest, I remember learning a little about some of the common infant reflexes were in college, but it was only a quick overview. We definitely did not cover what we could do when a child presented with retained primitive reflexes. ​ In this episode of the OT School House Podcast, Jayson interviews Sonia Story. Sonia is the creator of the OT/PT CEU Brain And Sensory Foundations courses at MovePlayThrive.com See the limited-time discount offer below. ​ Sonia is absolutely passionate about the use of innate rhythmic and reflex movements to help students who are struggling with behavior, learning, anxiety, and ADLs. She originally got started in this field while trying to help her own children several years ago and has not stopped learning how to better serve the families she now works with. ​ Listen in to this episode if you are interested in getting a taste of what reflex integration is and what it could potentially look like in a school setting! Links to Show References: Quick reminder: Links to Amazon.com and other websites on this page may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you. I appreciate your support by using these links. The below references were mentioned throughout Episode 32 Visit this special page and share your email with Sonia at MovePlayThrive.com to get the: Slides related to this episode A free handout related to integrating reflexes And a limited time discount for $30 off on the Brain and Sensory Foundations course (valid until 6/30/19) Smart Moves: Why Learning Is Not All in Your Head, by Carla Hannaford (Short book) Autism: The Movement Sensing Perspective (Frontiers in Neuroscience), by Elizabeth B. Torres & Caroline Whyatt (Textbook) ​ Brain Gym: Teacher's Edition Book on Amazon Visit the Move Play Thrive Facebook Community Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript   Amazing Narrator     Jayson, hello and welcome to the OT schoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host, Jayson Davies class is officially in session.    Jayson Davies     Hello, everyone. And welcome to episode 32 of the OT school house podcast. If you haven't listened to the podcast before, my name is Jayson Davies and I am the host, and we got some cool stuff to get to before we get into our interview today. The first thing is our contest winner. So last episode, I kind of challenged you all to go ahead and post something on social media that shows how you're listening to this podcast. And well, we had a book to give away from the dysgraphia consultant Sherry daughter, as well as a sticker and a bookmark, so we're going to give two of those packages away right here in a second. But first I want to say thank you to everyone that participated, thank you for listening all the way to the end of the podcast to learn how to do it. We had several entries, and unfortunately, I can't give away that many books, but I hope to have many more giveaways in the future. It was really cool actually seeing where you all listened to I mean, some people were saying they were listening to Hong Kong, other people in Australia, we had one person who was talking about how she was listening while she was on a ferry going to work. She actually takes a ferry to work, like the car type of ferry, and then on other days, she actually has to hop on a plane to go to work, to be a school based. OT, so that's just crazy. And that wasn't that was in Missouri, I believe, or Michigan. So yeah, it's just really cool to see everyone listening to the podcast where you're listening in from all that good stuff, really cool. So with that, let's announce the winners. I'm gonna take a drum roll right here. And the winner is from Twitter, Kenzie Lindquist and from Instagram, Bethany wiltscher. Bethany and Kenzie, if I haven't reached out to you already, I will shortly, and you will get your handwriting brain, body disconnect book from Sherry daughter, as well as a dysgraphia bookmark that comes with that. And also send you an OT school house sticker to go along with that. So congratulations on winning, and I will send those out to you shortly. Again. Thank you to everyone else who participated in this giveaway. I really appreciated seeing all those Instagram and Twitter and all the other social media posts come in. It was really cool to see. So thank you. All right. Well, it is officially June, and we're going to jump into today's content, which is about primitive reflexes and reflex integration. So today I'm bringing on Sonia story of moo play thrive.com where she actually teaches a course called the brain and sensory foundations. And in that course, she has different levels, but she's going to kind of give us a little introduction of what primitive reflexes are and how to potentially integrate reflexes. A little bit so quick. Background on Sonia, she does have a little bit of medical background, but she's not actually an occupational therapist. She did get into reflex integration because she thought that it would actually help her kids. And from there, she just started taking every course she could potentially take on different types of movement integration, reflex integration. Ball of physics was one of the courses as well as brain gym. So that's kind of how she got into this. And while doing all that, she actually trained with several psychologists, several professionals, kinesiologists, and has since developed her own training at move, play, thrive.com , under the name brain and sensory foundation. So she's here to introduce us a little bit to that, and she's actually going to offer some free resources, including some slides to go along with this presentation, as well as a discount code. So I will be sure to put those up at ot  schoolhouse.com . Forward slash, Episode 32 for you all to reference to. And with that, here is Sonia story from move playthrive.com , I hope you enjoyed the interview. Hey there, Sonia. Welcome to the podcast. How are you doing this morning?    Sonia Story     Hi Jayson, I'm doing great. Thanks for having me great. And    Jayson Davies     so you are up in Seattle. Why don't you tell us a little bit just about where you are?    Sonia Story     Well, I'm a couple hours north west of Seattle. So I'm in the country on the Olympic Peninsula, and hope to see you up here sometime visiting me. That'd    Jayson Davies     be fun. I haven't been up to Seattle or that area in a long time, so that would be interesting. So tell us a little bit about your background. We're here to talk about some the integration of reflexes and stuff like that. But how did you get into this, into this realm?    Sonia Story     Okay, so I this is an interesting story. So when I went to college, I got a degree in it was a combined major of biology and psychology. Then I. I got married, had children, and was really wanting to figure out more of like, what I could do to be of service in the world, and what would be suitable for me to do as my kids were growing and I but I was actually having some troubles with my two children, because our first daughter was very sensitive and our second daughter was really hyperactive. So between the two of them, they triggered each other all the time, oh no, and I was in tears many days, just trying to be a parent and and I picked up a book called Smart Moves, why learning is not all in your head. And it was a book that featured some of the movements from brain gym. And I started doing that, and they worked really well, whereas other things I've been trying to teach my children, like nonviolent communication, those are great tools, but in the thick of things, when you're triggered, they didn't remember to use them, nor did I, and it was basically a painful experience trying to be a good model for my children when their nervous systems were dysregulated, as was mine and when my family we were living in Hawaii at the time, and when we moved to the Pacific Northwest, I had the opportunity to take courses. We were in a big transition, so my husband didn't have work yet, and so he stayed home with our two girls, and I went and started to take courses. And it was such a fortunate time in my life, because I was able to take course after course after course after course. At the end of my brain gym training, I got my certification and license to teach that, but I also learned about these reflexes, these primitive reflexes. And I was utterly astounded, because I recognized, just in the one course, one, that they were fundamental, fundamentally important to our functioning. And two, I had a lot of them that were on integrated, and I just couldn't believe it was like, Why haven't I heard of this? And all I could think of was that I remember a physiology professor saying, when the baby's born, they have a suck reflex, and they know how to get their nourishment. That's all I could remember about primitive reflexes. And I was hooked, because I started doing the movements for myself, for my children, and it made a huge difference for all of us. And so I went and got more training, and then more training and more training. And I really, after several years of going to course after course, after course, I and I realized, wow, I'm learning from some of the best mentors in the world. In this subject, I studied with Dr Harold Lombard, who's a psychiatrist, Moira Dempsey, Kinesiologist, Dr moskatova, who's a psychologist. And any anyone I could go with. I even studied with Mary kuar A little bit. And it was so fascinating to me how well these movements worked and how much of a need there was. And I kept thinking, gosh, we got to get this out to parents. We got to parents. And so I started formulating like the best of the best tools I could figure out that I could teach in a condensed but in depth, comprehensive way. And so I started putting together a course, which evolved into my brain and sensory foundations course. And I've just been so thrilled with how well this works, and that's how I got into it. I just put together the best of the best tools, and then what happened is, parents didn't come, but OTs came.    Jayson Davies     Oh, okay, so I want to stop you there real quick then, because we haven't mentioned it yet, or maybe I have in the intro, but you're not an actual occupational therapist. You're not a physical therapist. And usually when we think of these types of treatment strategies, that's what we tend to think of, an OT, a PT, maybe a vision specialist or something like that. But that's not what you are and so but you have taken all these classes. It sounds like you got into this through your kids. But have you noticed that going through these classes, not being an OT or not having that medical background? Was it more difficult? Or how did you feel while taking these courses?    Sonia Story     Okay, so I was absolutely so excited to take these courses. I was just. Go into it, it was like, this is the best thing I've ever learned in my life. I mean, it was so applicable, applicable. I could see results right away. I started doing this with other children I had. I started working with private clients of all ages, but mostly children. And the parents would come back and just say, this works so well. And then I started to feel like I really had a responsibility to share it. And I was scared, because I'm not a medical professional, and when OTs and PTs started showing up at my class, you better believe I was very nervous about it, but at least I had the basic language of biology, because that that's what I studied, and I learned a ton from them. And I realized, okay, these souls are my friends. Yeah, right. And they also wanted to know about the research, so I got really into reading the research and presenting it, and I learned a lot from them. And I kept asking. I literally asked hundreds of OTs. I said, do you learn this in OT school? And what they said was almost unanimously, they said, no. What we learn? We learn about primitive reflexes. We learn how to test for them. We learn that they're soft neurological signs, but we don't learn what to do about them and how to integrate them and how to work with them. And so then I realized, okay, so what I am teaching, there is a huge need for this absolutely, yeah. And so since then, I've just had so many OTs that one of the things that just kept coming back. Was so many OTs who were highly trained, came back and said, these are the best tools I've ever learned for sensory processing issues. And I was like, wow. Well, I knew they were great, but why is that working so well? And then what I realized is, this is just what we're doing, is we're replicating development, and we are just taking normal development and doing it over. Because there are so many gaps in normal development. I just want to say one more thing, because and then we can go but the thing is, is, because this is normal development that we're working with, I don't see myself as a medical professional. I leave that to OTs, PTs and doctors and healthcare professionals. But what I do do is i It's not that I offer treatment, it's more like I offer movement education. So I see myself more as an educator, a movement educator, and I always refer out it, you know, to other medical professionals when there's a need. And there often is, I often refer out to, you know, functional medicine doctors or OTs or PTS or chiropractors, things like that, Vision doctors. But what I do know is that these movements are hugely important, and they are absolutely the foundation for function. So I just see myself, as you know, having had a lot of training and replicating development, so it's more of an educational process.    Jayson Davies     Gotcha, okay, and that's perfect, because the reason that I really wanted to bring you on today is because I have seen an influx of parents or reports from an outside psychologist or something like that, and in their findings, they are actually recommending, I'll put this in quotes, is reflex integration therapy. And like I said, that happened to me personally. So when that happens, when, when someone asks you, what is reflex integration therapy? What do you what is your definition for parents?    Sonia Story     Okay, this is so funny because I realized this is something that requires some explanation. Like you can say yoga, and people have an idea of what that is, or you can say, you know, swimming or dance, or you know, but if you say reflex integration, people have no idea what that is, and it really does require an explanation. So I guess the simplest way to put it is, we're filling gaps in development, things that should have happened in development but did not. And usually when I say that, one say, or I might say something like, well, I teach movements that help the brain, the body and the sensory system mature. And people will often say, oh, yeah, yeah, I know that, crossing the midline and everything. And I just kind of laugh, because it's so much more than that. And then they'll say, no, no, I know what that is. It's like crawling around and stuff like crawling. Important, and I'd still laugh, because there's so much that goes on in the womb and early infancy, prior to any kind of crawling that is so foundational to our core strength, our balance, our emotional stability, our I mean, the foundation of any human skill you can think of lies within these reflexes. And the foundation of our sensory system and how it functions also lies within these reflex movements. So I guess that's my short explanation.    Jayson Davies     I'm sure it can go on much longer, but, yeah, no, I think that is a good a good starting point. So thank you with that. What are some of the most common reflexes that are frequently not integrated, that you see?    Sonia Story     Well, okay, so Moro reflex is a huge problem. The asymmetrical tonic neck reflex, the tonic lover and thin reflex, the symmetrical tonic neck reflex, head writing reflex. In fact, one of your listeners has taken my brain and sensory foundations courses, and she wrote me back because she knew I was going to be on your program. Make sure you tell all those school based OTs to learn about head writing, because often I just do a little bit with head writing, and it makes a huge difference for the children. And the teachers notice it. They notice it very quickly. So head writing is interesting because it's a postural reflex. It's not a primitive reflex, and it should be there, working for us, for our posture and our movement, after the primitive reflexes are established, but oftentimes that's not established, and it really interferes with functioning. So to give you an example of like, the depth of how important these movements are, if we go back to the moral reflex. And also, you know, I didn't list them all, but there are hand reflexes, feet reflexes, reflexes of the back, tactile reflexes that really have a lot to do with core strength. Yeah, need to ask me a question. Or,    Jayson Davies     well, I was just gonna say, I mean, like you were talking about earlier, you know, they don't teach us everything in school about reflexes, you know. And so all these reflexes that you're listing off, I've heard of, I've heard of, and at one point I knew exactly what they were, but there's some that you're saying that I don't even remember exactly what what they are. And so if you can just give an example of what a few of those ones that you listed, what does that look like?    Sonia Story     Okay, so let me tell you a story that Mary Kawar actually shared with me. So she because she even said, in her course, she said, I have a very comprehensive vestibular program. She said, I have a very comprehensive sensory program. And the kids I'm seeing are showing that they really need this reflex work. And so what she told the story of this little boy who every morning he would get ready for school, he'd hop in the car, and as soon as the seat belt got buckled in on him, he would unbuckle himself and run back into the house because he had to go to the bathroom. So that had to do with his final galot reflex, which is a tactile reflex. It's stimulated by tactile input to the back, and it's hugely important, because if it's not integrated, we don't have our proper hip movement, we will have weak back muscles that often get tense because of the weakness underlying and we have a tendency to be bed wetters or to have an immediate reaction through the bladder, and so he was getting stimulated as soon as he got buckled in. The other thing about when spinal gallon is not integrated, it is hugely important to the sensory system, because the back is super hyper sensitive, and these are the kids that wriggle around. They're not comfortable with anything around their waist. They're super fidgety, and trying to get them to sit still is almost impossible. So she talked about how she worked with the spinal gallon and he could finally go to school, you know, sit more still and be Bucha into a seatbelt. So it was kind of a funny story, but they just got on the, you know, they sat on the floor and played, and she showed like this, wriggling around, movement on the back and and it worked    Jayson Davies     well. Yeah, cool. So, and that kind of leads into what other aspects Do you see kids having difficulties in when reflexes aren't integrated? You obviously just talked about one right there. But what are some of the daily living activities that kids really struggle with?    Sonia Story     Well, let's go okay, so I love your question, and because these are really the foundation for function, let's talk about the foundations, because they affect all the functional activities. So for example, if you want a child to be able to do handwriting, the thing that occurs to all of us is, okay, let's practice handwriting, or, let's, you know, strengthen the hands. But if you have unintegrated reflexes, this was one thing that Dr Blomberg taught us, they always will interfere with muscle strength and muscle function and and stamina. So you cannot get full muscle function until that reflex is integrated. And because otherwise, if the if the reflex should have been integrated in infancy, which, when we're talking about a primitive reflex, of course, that means it should be dormant. But time, you know, infancy and toddlerhood is passed, yes, so that if it, if it has gotten all of its proper use, that reflex, it will grow all these pathways in the brain, the muscle function will be there, and then someone will be able to naturally learn the skills of handwriting With with a little practice, those kids who it's just so painful, and sometimes it's literally painful, but sometimes it's emotionally painful, so but they are struggling because their hand wants to do something completely different than it's being asked to do, and that's because The reflex is interfering not only with the movement, but the underlying muscles aren't properly developed for the ability to hold a pencil or pen with with ease and that that even goes for like our core strength so like Moral reflex, tonic, labyrinthine reflex. Those are so important to our core strength. So you'll see a lot of W sitting, you'll see poor balance, you'll see poor head control, and all of that relates to how our sensory system is functioning and how the sensory processing channels are functioning together or not. Yeah.    Jayson Davies     So when I think of reflex integration, obviously has that, that one of those keywords that we use in sensor or in sensory is that integration word. And so from your standpoint, do sensory integration and reflex integration, those models and treatments have similarities or they, or are they uniquely different? Or how do you view that?    Sonia Story     Okay, so you know so much of what I've learned Jayson is parents coming back and telling me, oh, here's what I've been doing, here's what I changed, here's what's working now. OTs coming back and saying, Wow, this is amazing. Here, you know, here's what I'm doing. So in addition to the reflexes, one, often the reflexes are more familiar to OTs, but there's another whole piece of this, which are the rhythmic movements. And these are innate movements that babies will do spontaneously along with the reflexes, as long as they are given the opportunity to move, as long as they're not stressed, and as long as they are healthy, they will go through all these rhythmic movements and reflexes in normal development. So we combine not only the reflexes, but the rhythmic movements and the developmental movements, the milestone movements, together, and that really fills in these gaps, because so the way I view the sensory system is that the reflexes if they're not and this is also something I learned, not only from OTs, that this was working so well for sensory But Dr Blomberg also taught us that when you have reflexes like the moral reflex, if that is not integrated, you will have sensory issues and and it you will not be able to resolve sensory issues fully until that's integrated. There's some reasons behind that. What the big one of the biggest ones is our brain stem processes sensory information. When our brain stem is not mature, it cannot do its job fully and well, one of its jobs is to you. Filter sensory input. Another one of its jobs is to relay sensory information up to the cortex, which it does through the reticular activating system. So if the brain, if the brain stem is not mature, and it won't be mature, if the reflexes aren't mature, it can't, like you cannot get full brainstem maturity if the reflexes aren't integrated, because the primitive reflexes are housed in the brainstem. So so the other thing is that when you have that moral reflex active that is a startle response, that is a response that generates cortisol and adrenaline or epinephrine, and when those neurotransmitters are excreted, because you you're basically it's a startle response. It's fight or flight. It's fight or flight. Exactly. So when that's going on, you are going to be more sensitive, because those neurotransmitters make us more sensitive, which is an adaptive response if we're in an emergency, like, we want to be more hyper vigilant, like, where's the threat coming from? What do I have to do? Do I have to fight or flee? So our nervous system and sensory systems are heightened with those neuro chemicals, and if they're going on all the time, this is what happened actually, with our daughter, because she had a traumatic birth, she never integrated her moral and but I didn't know. I mean, I actually took her. We took her to a pediatric physical therapist when she was 18 months, and he tested her on all kinds of things and said, well, she's either above or right at age level for where she should be. So we thought, okay, great, that's fine. And there was, like, you know, a little bit of hyper tone in her calf muscles. But other than that, we're like, Okay, it looks like we're good here, you know, yeah, we've been doing a lot of like, you know, she did. We did teach her how to nurse, which was a challenge at first, but in about 10 days, she was able to pick that up because she'd been in ICU for 12 days. But what we didn't realize, and what the pediatric physical therapist didn't realize, is there were all these underlying reflexes that weren't integrated, and Maura was one of them. So as she grew, you know, everybody just was like, Oh, she's so sensitive, so sensitive, you know, and, and she was Yeah, so her moral reflex never got integrated, and she just kept getting more and more and more sensitive, especially to, like, sudden loud noises that she wasn't expecting. Like she would just be like, you know, the gas and our arms would fly out, oh, no, the whole movement, yeah. And so it leaves, it leaves a dysfunction, because the brain can't mature properly. The sensory system can't mature properly. And the other thing when you don't have brain maturity is you cannot sit still, you literally, to whatever degree that is. And this was a big thing that Dr Blomberg taught us, but I saw it in my sessions. And I always tell this story, because it's so important. I asked a little boy once who was just talking non stop and bouncing off the walls in my session room, I asked him to lay down on my table so I could check his feet reflexes, and he laid down. Then immediately he got back up. So then I was able to do a little bit of rhythmic movement with his mom so he could watch. And then I did a little bit with him. No more than a minute, I could see he was slightly more grounded. And so I thought, Okay, I'm gonna ask him again. Can you please lay down on my table? It's just gonna be for a second. I just want to check it. He laid down. His eyes got really big, like he was afraid. And I said, I said, what's going on when you lay down? I said, What does it feel like? And he said, like, I'm gonna explode. Yeah. And this was a five year old, and he clearly knew I feel like I'm going to explode when you asked me to lay down still here on this table. Yeah,    Jayson Davies     that's a very intense response, yeah.    Sonia Story     And we'd been in the session long enough so that he knew he was safe. He knew I was not a threat. But you know, it was a new thing. It was the first session, but he came right out with it. He did not even hesitate. He said, feels like I'm going to explode. And I was like, Oh, this is what Dr Blomberg told us, that when the basal ganglia, which is a cap over the brain stem, when that's not mature, you can't sit still. It's like you're running, like a. OT or all the time, and to be asked to sit still is painful. It's not it's not going to work. And so what the reflexes do is they provide us with and the rhythmic movements as they provide us with the brain maturity and the sensory maturity, so that we can keep developing and do those functional tasks that we haven't been able to do, like, you know, button our buttons, or do handwriting, or even have our balance to walk with a normal gait. That serves us, because walking is also a developmental and rhythmic movement. It's just that it one. It's one that constantly should stay with us and constantly tune up our brain, as long as our gait and our balance are good.    Jayson Davies     Okay, so what you're talking about just prompted two questions. So I'm going to ask two separate ones. The Walking that you just talked about one of the things that we often ask parents is, did your did your son or daughter crawl? What do you make of that? When a parent says, oh, no, my son or daughter never called. They went straight to walking or, you know, scooting and all that good stuff, what do you make of that?    Sonia Story     Yeah, okay, so there, are two things. So when? So let's go to the scooting first. So any kind of scooting, asymmetrical Crawl, crawl that's like one leg out and one legs bending, or one leg doesn't bend, or one arm moves and the other one doesn't, or there's homolateral Instead of cross crawling. So any strange crawling or scooting or rolling to get around is problematic. It means that a step of normal development has been skipped and kids will or babies will unconsciously move into these alternate patterns of locomotion, and there's a reason why. And what I think the reason is, is because they've never been in prone enough. They should be in prone from the minute they're born, and they've never been in prone enough, and they haven't developed their reflexes. So they never got the core strength, which means they never got the head control, which means, as they grow, being in prone is going to be hard, and because they've never had the practice to begin with, and they don't have like their head feels too heavy for their body as they grow, and they never really developed. See so many of the reflexes have to do with developing our core and our neck muscles. So if those aren't developed, then your head just feels too heavy. So you're going to develop alternate patterns of crawling depending on you know, what was skipped and missed. So if, if someone says, My child skipped crawling and never went to walking. That's also problematic. So because crawling does so much for our brain development and our sensory development and our future gates, as you know and like, for our second child, she only crawled for a couple weeks, and then she was up in and walking at like, 10 months. And I think that was compensatory, knowing what I know now. I didn't, I didn't know it at the time, but neither of my children spent nearly enough time in prone if I had known I would have done that. But you know that that was a problem, and she was hyperactive. Oh my gosh, she was so hyperactive, and we really had to do a lot with these movements and give her a much better foundation.    Jayson Davies     Gotcha. Yeah. So my second question that came up is you gave us a quick glimpse into what that initial treatment that you're talking about, or that evaluation, if you want to kind of call that with that little five year old. But going forward, what does your treatment tend to look like? Are you giving parents different activities to do at home? Are you seeing a kid every week? What does that look like?    Sonia Story     Well, for me, because I'm not an OT I don't have the ability to see children every week, so And parents often come to me from long distances. So I often will see a child maybe once a month, maybe once every two months. So I'm giving a pretty detailed home movement program, and I'm also recommending that parents take my course, because when they do that and the private sessions, we get the best results, because the parents go, Oh, I get now. Why this is so important. I. Used to just give private sessions without parents having to take the course. And now I'm requiring it, because I found that the we'd get by far the best results when we did the combination and and parents, honestly, the best results come when the parents are also doing the movements, because they're so good for de stress. And you know, children will unconsciously model their nervous system off of what they're seeing in their parents. And parents often, especially when they're stressed and exhausted, they often have unintegrated reflexes too, and so that's when we get the best results. So I for OTs, who are seeing children once a week, I still think it's really important that the parents are doing things at home, at least the rhythmic movements. The joy of the rhythmic movements is that they're so simple, they're incredibly effective. I mean, when you see how simple they are, you just go, that can't be doing anything, but they are so good, parents can do them easily, and it's a way of having an enjoyable bonding activity with their children. And they only need to do like, five or 10 minutes, and you'll see, you'll see great results. So I know for school based OTs that it is more challenging to get parents on board, but I do recommend it if you have the opportunity, and also if you don't, if you really don't, then even seeing a child once a week for 30 minutes can give good results.    Jayson Davies     Okay, so in that sense, some of the OTs obviously, you're not a school based ot What have you heard, as far as feedback from school based OTs that are using your brain and sensory foundations, type of program within the school? What are they saying? What do they do when they see that kid for 30 minutes a week?    Sonia Story     Yeah. Well, so I am doing my best to emphasize to OTs, who only have a limited amount of time to really focus on these movements, because they they are the most. They're going to give you the most for the amount of time you're spending. As far as I know, I don't know any other movements that can do what these do as fast as they do it. Because if you again, like, if you start off on functional tasks, and there's an underlying weakness, or underlying foundational challenge there, then you can, you may be developing what, what I learned this term from OTs Splinter skills, and so they can do something while you're right there telling them what to do, But then it doesn't carry over. Or they can do something for a little bit, but it doesn't, you know, it doesn't carry over. I'll give you an example. This is a story that a speech pathologist told me so she was working with this little boy who had a lisp, and he could not speak without the lisp unless she was right there, like sort of reminding him, but then it would always come back. And within two weeks of doing these rhythmic movements, his mom said he woke up and did not have the lisp. Wow. So that's I mean being able to speak is a very functional activity, right? Absolutely it. It absolutely depends on a sensory motor foundation. But one of the beautiful things about the rhythmic movements is that they mature the brain stem. And one of the other functions of the brain stem is it controls muscle tone. So that's fascinating, when you think about it, and we need our muscles for every functional activity, absolutely? Yeah, of course. So these simple, rhythmic movements that really don't look like they're doing anything have the power to mature the brain stem, and that's just what they do in development. And when the brain stem is mature, we have all kinds of other functioning. We even have the ability to pay attention much better, because the brain stem sends it's got that pathway from the reticular activating system to the cortex, and so does the cerebellum, by the way, so smooth, rhythmic movement stimulates the cerebellum, so that also is maturing, and then that takes the the pathways start developing, from the brain stem and cerebellum to the cortex. Once those pathways are developed, we have our ability to. To pay attention and focus. So one of the things that Dr Blomberg often teaches about is how these movements can be used to overcome the symptoms of ADHD. And that's kind of I gave you a little snapshot of why they work. Yeah.    Jayson Davies     OT So, and I don't want to go too far into this, because I know this is partially, you know, really what your course is about. But are these, you're you keep referring to these rhythmic movements. Are we doing? Is this kind of a progression, like, you know what, no matter what your area of concern is, you want to start with this specific movement, or is it really based upon what the concern is. So, like you mentioned, a speech concern is a speech concern a kid with a speech concern doing different movements than a kid with that bladder concern you were talking about earlier,    Sonia Story     right? So, because there are so many challenges with children today, you can really go through and just integrate all the reflexes, and you would be doing them a world of good, gotcha, even if you did, even if you knew nothing about assessment. I do teach assessment in my course, but most of the focus is on actual tools, like practical, experiential tools to use. But even parents, or anyone who's doing assessment, you could kids are so different in how they come out in these assessments, especially school age kids, because they're already they've already been compensating for a number of years, and because they've already been compensating, you might not see the reflex like a textbook briefly. You know what I mean? Might learn Okay, here's how I check for it. Here's what are the possible responses. But some kids have literally locked down their muscles because it's so uncomfortable living without integrated reflexes so their body learns to compensate, and there are all different ways of compensation. So even if you just went through and did a foundational program and made sure you did all the innate rhythmic movements that you know and all the reflexes that you know, you would be hugely helping that individual. So now that being said, you can absolutely target things, like, if you know how to assess and or even if you don't, if you can just, like, look at the list of symptoms that typically happen with each reflex, so you can determine, like, Okay, it looks to me, like for this child, these three reflexes are really impacting him the most, and then you would focus on those along with rhythmic movements, because the rhythmic movements are absolutely key and foundational. I feel I've just seen that over and over again, and that actually surprised me, because I learned about reflexes before I learned rhythmic movements. And so when I went to the rhythmic movement training course with Dr Blomberg and Moira Dempsey, that course was a combination of rhythmic movements and reflexes. And I went because I knew the reflexes were really important, and I was like, Oh yeah, these rhythmic movements are nice. They're, they're, oh, I got somebody outside blowing weeds. I hear blowing down yet. So anyway, where were we? So I was saying that in my first rhythmic movement training course, Dr wamber told us that, you know, these rhythmic movements are really powerful to mature the brain in the sensory system, and especially the brain stem and the cerebellum. And I was like, yeah, they're nice, they're really sweet, and they're they're really relaxing and everything. But tell me about these reflexes. I want to learn more about these reflexes, because I knew they were so important, but I had no idea how powerful and important the rhythmic movements are until parents and OTs started coming back to me saying, This is amazing. I can't believe it, like you're just doing this simple rhythmic movement, and all of a sudden, this kid, who's nine years old, who could never ride his bike because he didn't have good balance, he just hopped on his bike and started going. And I'm like, what I can't, you know, it was amazing, and it's because the rhythmic movements are very maturing, but they also help reflexes to integrate, and it just makes sense. That's why we have them in our development. They're like a perfect system together, and so I do always recommend those rhythmic movements, because they are they're like golden to do, and they don't take a long time to do, and you don't need any special equipment, and parents can learn them, and they help children sleep. They're amazing,    Jayson Davies     all right. Right? Well, I know that's, that's part of your course. And so we're going to continue to go on, and eventually we'll kind of get to that. So I have something I want to ask you, actually, and that is that I have a high schooler who, you know, he's in a severe, profound class. He does have autism and but he really kind of has that that rooting or that sucking reflects a lot, and he just randomly in class will look over at him, and, you know, he's pretty functional. He He has difficulty with academics, but as far as socially, you know, he can, he can socialize pretty well with with same age peers, but it's really those academics, and, you know, writing a lot of difficulty. So what might you start off with? Then, for this, he's a 10th grader, I believe, and he's really presenting with the the sucking reflex. Okay, I know that's not a lot to go off of, but,    Sonia Story     yeah, so um, I what I would actually do is I would start with the hands, because in infancy, the hands and the mouth are connected. And I've had PTS coming back and saying, Wow, I did these hand reflex movements, and this kid stopped drooling, or I did these hand reflex movements, and this kid can hold his tongue in his mouth for the first time. And it also has a relationship to speech and obviously, handwriting. So I would start with hand reflexes. You can actually press your thumb right in the middle of the palm, and then have them squeeze around your thumb like make a fist, and just grasp and Squeeze and hold for a few seconds. That's kind of a really easy thing to do. Just press the middle of the palm and stimulate it. Then keep your thumb in there. And you don't have to press hard, just a little light press and then have him squeeze and have him do that. You know, several times a day. You can even do it for himself, so that will help with sort of compulsive mouth movements. But then with sucking, it would probably be really good to work with the hands and the suck reflex. So we've got, you know, a whole big protocol, but what I could, and that's in the second level. The sucking and rooting are in the second level, course, but very simply, you could, you know, if he'll allow it, you could take a little like paint brush and just sort of stimulate around the lips a little bit. And then, does he have rooting, also rooting and sucking? Probably, probably, yeah. So you could stimulate around the lips for sucking, and then you could kind of stimulate and make, sort of like, like, if you were painting cat whiskers on for rooting, no, like, back and forth, and have him turn his head. And you could have him like, suck water through a crazy straw. Those crazy straws are really thin, so you have to suck hard. You know, it's challenging, because sucking, you know, you really want the tongue pressing on the roof of the mouth and and a lot of kids don't even have proper tongue posture, and, you know, they have problems with mouth breathing. And it gets really that those things are more challenging to to work with, you know, and there are all kinds of dental devices and things like that, but at least initially, you could do some simple things for him to help with his rooting and sucking. And the main thing is, is, you know, you can stimulate the reflex and then go into movement pattern as best you can.    Jayson Davies     Mm, hmm, all right, wow, that's actually helpful. I know I'm I'm interested now, so yeah,    Sonia Story     and if he likes applesauce, you can have a regular sized straw and have them suck apple sauce up the straw. Oh,    Jayson Davies     wow, to even thicken it up a little bit more. And yeah,    Sonia Story     but don't do that with a crazy straw. Crazy. Only water,    Jayson Davies     the too thin. Yum. Yeah. All right. So like you mentioned earlier, the OTs, want to know about the research. We are obviously very big research space, and so is there any research that you can either briefly kind of share off the top of your head, or somewhere where we can go and get more research on this.    Sonia Story     Yes, if you go to my website, move, play, thrive.com , forward slash research, you'll see I've got research and compiled there, and I've also written about the relevance and evidence base and on the rationale for ot practice. So that's and it applies to PT practice as well. And that is, that's up there. I want to expand it more, because I keep finding more research. Another great book that's a compilation by Elizabeth Torres, and I think it's Carolyn Wyatt, they're the editors, but it's a compilation of research, and it's called Autism, the movement sensing perspective, and it's great because they're talking about how movement and sensory processing challenges are a core characteristic of what we call autism. And actually, this is kind of heartbreaking to me. It's so frustrating, because if we only knew that we could help children so much earlier, because you can tell very early on, if you know what to look for with movement and reflexes, you can tell if a child needs help very early, like when they're babies. And so to characterize autism as just you know, a social language and behavioral to characterize it that way is so it's really wrong and it it doesn't help us as far as how to work with it in ways that are more productive. So, you know, it's quite a complicated illness, and it's so much more than just what it's characterized as. Yeah,    Jayson Davies     gotcha. I want to ask you a question. Then, have you ever worked with a school directly to facilitate some sort of rhythmic program within the school? Have you ever done that, or thought about doing that? Or know someone who maybe has?    Sonia Story     I know some, some souls who have done that, and it's been very successful. I have not done that myself. Boy, I would love to do that. Yeah, because    Jayson Davies     I know brain gym, they do a lot of trainings for teachers and stuff like that, and I know they do different types of rhythmic movements. I don't know if they're the same as yours, but they often will have trainings for kindergarten teachers, special education teachers and stuff like that. But    Sonia Story     rhythmic movements are not the same we're doing rhythmic movements that are the innate rhythmic movements that babies do, gotcha. But, yeah, I mean, to get this into schools would be ideal, because it's not only the kids that you're seeing in your practice. All the kids have on integrated reflexes I have yet to see. I mean, I would say it's in the high 90% now, that doesn't mean that all of them are as severe, because they're not there's a huge range of being unintegrated on a mild in mild to way more severe. There's a big, huge range. But all can benefit. So like, if the OTs could get together with the PE teachers and start giving these movements to kids, it would absolutely change everything for those kids and for the school, everybody would be functioning so much better.    Jayson Davies     Yeah, I love that you that you bring that up, actually, because I haven't had the chance to do it in my new job. But at my old job, I was really close to one of the ape teachers, and I did work closely with him on not necessarily. I wasn't trained. I'm still not trained. And, you know, all the the items that you're talking about here today, but a little bit in the sensory integration aspect, I would talk to him about, you know, different types of crossing midline activities and and we work on those different balancing, you know, different types of stuff. And it was fantastic because now the kids are, you know, they're getting ot once a week, and they're getting a pee once a week or more, and they're just getting so much more of that information that so much more of those movements and all that good stuff. So highly recommend collaboration among all service providers. You know, if you're in an IEP team, we really need to be working together with all team members and educating everyone.     Sonia Story     Yeah, that's fantastic, yeah, and that i It's so exciting to think like, what could be done. But I'll just tell you a story about my friend Nina, who is in Ashland, and she has a program where they find the children who are coming to their school, it's a private school, and the ones that are having trouble reading and who also have sensory issues, she has them doing movement four days a week, and they are within two years, all of those kids who are markedly special needs. As far as reading goes, they're reading at grade level in two years, and some of them within a year. And some of them, the teachers in the classroom are coming back and saying, these kids are reading better than my kids. Oh, wow. So yeah. And also, Steven Kane is a school well, he's retired now. Yeah, but he took this course and he applied it, and he actually wanted to teach it, so he and I ended up spending a lot of time on the phone together, talking about everything we'd been learning and seeing. And he's the one. He was one of the ones that said, Look, I took this work to the OT or to the PE teacher at my school, and we're seeing all these kids who are neurotypical, who, you know, can't do some of this basic stuff because their reflexes are also on integrated. And that started to really open my eyes up. And I started asking around people who had access to whole classrooms of kids, and if you you can test neuro typical kids who are working at grade level, and you can clearly see that they're struggling with on integrated reflexes, maybe not to the same degree, but yeah, so I hope I'm answering your questions.     Jayson Davies     Absolutely, no, definitely and no, what you're saying is spot on, because I had an interview not too long ago. It's already on the podcast with Sherry daughter, and she's a dysgraphia consultant, and she was saying, you know, 33% of kids have some sort of dysgraphia, and of those, 33% of kids only nine or nine out of 10 are not even being treated because they don't have, to the extent that they're in special education, and so you're absolutely right. You know, there are many kids out there that do have difficulties that just kind of, I don't want to say undiagnosed, because it's probably not necessarily a diagnosis that they need, but they're not getting treated in the way, because, for the most part, they're pretty functional. But there's a few things that, like you said, they probably, they're probably compensating for, and they've learned to compensate for, so.     Sonia Story     Absolutely, way more stress than they should. Yes, things end up being a lot more difficult for them. And then, as you know, as the coursework gets harder and harder as they move through the grades. It's, it's, it gets more and more stressful,    Jayson Davies     absolutely. So obviously, you are very informed in this topic. I've really appreciated having you on today. I've learned a lot, and I want to learn more. And I'm sure other people out there listening also want to learn more. So I want to give you the opportunity to share a little bit about your website, move playthrive.com , and what you've mentioned a few things already, but what do you have over there?    Sonia Story     Oh my gosh. Well, my favorite part is the case studies. So you'll see in the case studies, just there's one after another after another, of just huge transformations, and it's they're very inspiring. Some of them are longer, but most of them are really brief and easy to read, and they're fantastic. So I would say read the case studies. So just go to move playthrive.com and you'll see the case studies tab right there. And there are two pages of case studies, and they each have, like, a picture and a caption. They're so much fun to read. There's also a lot of research and many articles on the in the Learn More section. And then, of course, we have courses available, so I highly recommend the brain and sensory foundations courses, those are really so worth your while, and they're so packed with information and practical tools that you can use?    Jayson Davies     if I remember right, you are a OTA approved for continuing education on those.    Sonia Story     Yes, yeah, I finally, after years of OTs saying, Can I get CEUs? I finally did all that, all the paperwork. Yeah, I did all the work. So the courses are approved for a ot a CEUs, and the first level course is also approved for PTS through the Federation of State Board of PT, they don't call it CEUs. They call it continuing competency unit. So they call it CCUS. Those are in place for the first level course, and I'm hoping this year, if all goes well, that I can get my application in for the second level course, because that one's great also and but that's in place for OTs and then for pts. I still because for OTs, you just like you have, your whole company gets approved or not. They do it course by course. Gotcha to do it for the second level course that's on my list. All    Jayson Davies     right, great. Well, thank you for sharing all that information. That's brilliant, and I can't wait for people to learn more about it. You mentioned your website. Is there any other social media accounts or email that you'd like to share if people want to get a hold    Sonia Story     of you? Yeah, I am on I have great article. And research and tips and fun stories and things like that on Facebook. So Facebook is just facebook.com , forward slash, move, play, thrive. And my it's easy to contact me through my website and what else. So also, I think for your listeners, we're going to come up with some kind of discount code for them. Oh, perfect. Yeah. So we'll do that, and I'll give you links and things like that to different articles and things that are some of the ones that I love to share at the beginning. And I can give you links to articles that you know, your ot listeners can also share with parents, oh, because they have great visuals, so that parents can also understand, you know, why this is important?     Jayson Davies     Yeah, that would be perfect. We're always looking for a little handout so we can keep on hand to give out at IEPs and stuff like that. So that'd be perfect. Great. Well, thank you, and we will definitely put all those resources up on the show notes at ot  schoolhouse.com , forward slash, Episode 32 but yeah, thank you so much. We really appreciate having you on. And I can't, I really want to stay in touch. And like you said, we'll have to come visit when we're up there sometime and and, yeah, see how things are going. Yeah, thank you. And have a wonderful rest of your Saturday and take care. Thank you. Jayson, thank you. All right. Well, that does it for episode 32 of the OT school house podcast. I hope you enjoyed hearing from Sonia story all about primitive reflexes and reflex integration. And definitely be sure to check out the resources at ot  schoolhouse.com forward slash, Episode 32 Sonia did provide me with some some slides that kind of go along with this show, as well as a free handout and a discount on the show for people who get on over there this June of 2019 so have a good one. Take care. We'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 otschoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 35 of the OT Schoolhouse Podcast. In this episode, Jayson interviews fellow school-based occupational therapist, Colleen Cameron Whiting. Colleen has recently had two articles published (cited below in the resources) on providing trauma-informed care (TIC) in the school and today she brings to the podcast a model about how school-based OTs can work with other educators to creating an environment in which students feel safe and welcomed. We also dive into what exactly trauma is, how some trauma can have adverse effects on the developing brain, and what occupational therapy using a TIC model looks like. Colleen Cameron Whiting MS, OTR/L ​ Colleen is a school-based occupational therapist in Massachusetts. She is also the owner of The SPARK Sensory Clinic and the Faculty of the STAR Institute. Recently, Colleen has devoted her time and energy toward ensuring that other therapists recognize the importance of Trauma-Informed Care in public schools. Listen in to this episode and earn 1-hour of professional development for doing so, as Jayson Interviews Colleen Cameron Whiting, MS, OTR/L, on Trauma, its effects, and what OTs can do about it. ​ Objectives for this Professional Development Podcast Listeners will: 1. Be able to identify 3 levels of stress and how they may impact development. 2. Identify what Adverse Childhood Experiences (ACEs) are and how many ACEs are considered above the normal threshold. 3. Identify tiered strategies to help build a trauma-informed school. Links to Show References: Have a question for Colleen? Visit The SPARK Clinic website at SPARKsensoryclinic.weebly.com ​ STAR Institute's School-Based Learning for OTs Course Use this link to check out the STAR Institute and the various learning opportunities for occupational therapists working in the schools. ​ Every Moment Counts Every Moment Counts is a mental health promotion initiative that encourages OTs to go outside the normal pull-out sessions to create an inclusive school. They even provide free step-by-step guides to incorporating a few of their proven programs. ​ Kelly Mahler In the Podcast, Colleen mentions Interoception and Kelly's website, kelly-mahler.com. Be sure to check out her free webinars and paid course on "Improving Interoception" ​ Best Practices For Occupational Therapy In Schools 2nd. Ed. Both Colleen and I agree that you need this book on your shelf if you are a school-based OT. The second edition is now available on Amazon and at AOTA.org. (Amazon links help to support the OT School House) ​ AOTA Podcast Learn more about the importance of supporting children with mental health concerns from Colleen, a parent, and an educator in this AOTA Podcast . Articles Written By Colleen ​ Whiting, C. C. (2002). School performance of children who have experienced maltreatment. Physical & Occupational Therapy In Pediatrics, 21(2–3), 81–89. doi:10.1080/J006v21n02_07 ​ 12. Whiting, C. C. (2018) Trauma and the role of the school-based occupational therapist. Journal of Occupational Therapy, Schools, & Early Intervention, 11:3, 291-301, DOI: 10.1080/ 19411243.2018.1438327 Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript.   Amazing Narrator     hello and welcome to the otschoolhouse com, your source for school based occupational therapy, tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.     Jayson Davies     Hey everyone. And welcome to episode 35 of the otschoolhouse podcast, as usual, I am your host today. My name is Jayson Davies. I'm an occupational therapist Registered and Licensed here in Southern California, and I am glad to be joining you today. I really want to say thank you for listening in, making this a part of your day, whether you're at the gym, whether you're in the car, wherever you are just thank you for listening. And I know it's summer. A lot of you are on vacation right now. Actually, as I record this, I'm getting ready to head out on vacation, and the day that this episode actually goes live, I will be returning from Europe, so I just got back now that you're listening, and I guarantee I had a great time. I've been waiting a while to get this episode out to you. I really wanted to put it out for all of you to hear. It's fantastic. Today we have a very special guest for you, and her name is Colleen Cameron Whiting, and we're going to introduce her here in a hot minute. But first I have two things. I want to actually let you all in on a little thing that's going on here in California. We are having a school based symposium, actually, and it's going to be put on by the Occupational Therapy Association of California, also known as OTEC. And it's going to be kind of in central California. In this small city of Clovis, it's supposed to be central so that, you know, everyone from from San Diego and in LA can head up north, and people that are maybe in the bay area or further up in California can come down south a little bit. But it's going to be all about school based. And it's going to be September 6 and seventh. That is a Friday and a Saturday. Everyone is invited to join us. Of course, there is a registration and a fee and all that good stuff. You can find more about that on the OTEC website, at OTEC online.org , I will obviously have a link to that in the show notes for anyone who needs that. But just want to let you all know about that. I will be there. Hope to see you there. If you're there, come find me. I shouldn't be that hard to find, since I will be helping out a little bit with that. All right, diving into today's episode. It is a continuing education course today on the podcast, so you can earn one hour of professional development by taking the quiz, after listening, purchasing that taking the quiz, and then I will send you a certificate of completion. Today, our very special guest, like I said earlier, is Colleen Cameron Whiting. Colleen is a pediatric occupational therapist based out of Massachusetts, Hopedale, to be specific, and that's where she actually has a small clinic, along with providing school based occupational therapy services. Colleen has been an occupational therapist for over 18 years, and she is, in fact, sift and dir Floortime certified. She also teaches on the faculty for Dr Lucy Jane Miller star institute that's based out of Denver. We'll talk about that a little bit. But recently, she's published two articles related to programming treatment for children with trauma, and that's exactly what we are here to talk about today. Like, what is trauma? What does it look like when our students have experienced trauma, and then how to help those kids who may have experienced trauma to better integrate into the classroom and access their education? So I think it's time to jump right into that interview. Here is Colleen Cameron whiting here to talk a little bit about trauma informed care. Hope you enjoy. Hi, Colleen. Welcome to the podcast. How are you doing today?     Colleen Cameron     Very well. I'm excited to be here. Jason, thanks for having me.     Jayson Davies     Yeah, the pleasure is all mine. I'm really happy to have you on the show, and I am excited to see where we go today with this. But first, you know what? I want to let you kind of share about how you decided to get into occupational therapy. I love hearing these stories.     Colleen Cameron     Yeah, everyone kind of has their own path, right? So I was actually a psych grad in undergrad, major in undergrad, and I was working on a psych ward, child psych ward, and came across this woman that was an occupational therapist, and I'd never heard of the profession, and just fell in love with how she worked with the kids. She had such a focus on the children's strengths. She was really looking at the whole person, the whole child. And then I always knew I wanted to work with peds, and so getting into school based, it was like I had found my people, so.    Jayson Davies     Yeah, that's awesome. So actually, I wanted to ask you, because I kind of saw that you were a counselor in a psych ward, or I don't know, Psych unit, I guess you could call it, what did, what did that job look like? What were you doing in that role?     Colleen Cameron     Yeah, so it was something that you it was kind of an assistant role to helping kind of the psych ward works. You would help run groups. You could help, kind of keep tabs on where kids were going, doing check ins with them, helping navigate if they had to go to appointments. And it was just a really nice way to get a sense of the kids themselves, and kind of just hanging out with them, as opposed to, like this targeted piece, because I would be with them for, you know, an eight hour shift so that Is really cool.    Jayson Davies     Awesome. All right. Well, let's move kind of into the here and now then, and in what capacities are you working as an occupational therapist now?     Colleen Cameron     Well, I wear many hats and very busy. First and foremost, I've been a school based ot for almost 19 years now, in the public schools. I also have a very small private practice on the side that I see kiddos, Spark sensory clinic. And my other other role is I'm really honored to be on the faculty for the star Institute for SPD, which is where Dr Lucy, Jane Miller and Dr Schoen are. I'm able to do some teaching there some course development. I've actually helped them develop their most recent course, which is a school based intensive and what that looks like is a kind of a hybrid intensive training model. It looks at theory, the star frame of reference, adapted for the schools, and then intervention at all across the tiers. And then, of course, my experience with the trauma realm is I've actually published two journal articles around school based role of the occupational therapist and trauma, and had the pleasure of presenting at lots of conferences around the country. So.     Jayson Davies     Well, that's awesome. We are definitely very honored to have you here on the podcast. So I wanted to ask you real quick, the star Institute, you're not, they're in Denver, correct? Or near Denver, and you're not in Denver, so you're doing all that online. And when you say hybrid, does that mean partially online, partially in person classes?     Colleen Cameron     Yeah. So for the school based course that I'm currently teaching for them, it's hybrid. So it's one day that's actually of taped lectures, which we tried to make it manageable for school based therapists to be able to not, you know, they can't take off a week of school, and so one one day of the lecture, online modules are taped, and then there's two days live. And I so I travel around, not just to Denver, but all over the country, kind of doing those two day live experiences. But I always also get to go out to Denver sometime and play, so.    Jayson Davies     Awesome, yeah, I love going out there with all the snow they have out there, fun to get up on the slopes. Yeah? All right. Well, the other thing you kind of mentioned was your journal articles about trauma, and that's kind of where we're going in this podcast today. So we won't tap into that yet, but, you know, we'll get into that in a minute. With that. We're here to talk about trauma. All right, yeah, today, we're here to talk about trauma. You know, how these experiences may affect students or kids and how we can support them. So my first question for you today is, why is this such a topic, a hot topic, especially in education right now?    Colleen Cameron     Yeah, it's a good question. It really is a hot topic. Everyone's talking about it, bringing up a lot of initiatives. I guess the bigger piece is trauma informed care has really become a federal initiative for service providers across settings. So that's the first piece, but the research around trauma right now, the neuroscience, really the knowledge about the long term changes that can happen as a result of trauma is exploding in the research, and so that's led those in the education setting to realize the importance of becoming more informed. And what I really try to when I'm out presenting, is talking to people about really the beauty of the sensitive school or sense trauma informed model, is that it's really helpful for all students, not just the ones that have experienced trauma. So.    Jayson Davies     Yeah, that's perfect, especially when we get into kind of talking about RTI and the the three tiers. Because, of course, you know that tier one we're trying to hit, you know, 95% of the kids, or 80% of the kids, whatever you want to say. But we are trying to help every kid, not just those kids who may have experienced trauma or may have fine motor difficulties or whatever. We're trying to help all kids. So exactly, that's fantastic. So when we talk about trauma, I just want to make sure we're all on the same page here. So I want to come up with a working definition of of that. And so from your standpoint, how is trauma defined in a child's life?    Colleen Cameron     So yeah, people do different definitions of trauma, and depends kind of their how wide a lens, but in most general terms, they look at it including loss, loss of a consistent caregiver, household challenges, domestic violence, substance abuse, that can be different kinds of abuse, neglect, traumatic loss, are all included under that category. And was really, I think was around 1997 that the adverse childhood experiences study came out. And that was really what kind of moved this movement forward. It was the largest investigation at the time of childhood abuse and neglect and household challenges, and they made an incredible connection to later life health and well being. And what they found is those that have experienced four or more ACEs, which is what they consider the adverse childhood experiences, they were more likely in later life to engage in high risk behaviors and experience really quite significant health issues.     Jayson Davies     Okay, so. You use the word average, four being like the average is that or     Colleen Cameron     So they if they experience four or more ACEs, that's where they really sought found those significant results.     Jayson Davies     Gotcha. Okay, so if a child you know had one experience, would be like a divorce or something like that, correct? So if they just went through that. Maybe we wouldn't call them high risk, but if they had a divorce, then they also went into an orphan, or they became an orphan, or something like that, and a few other things happen. Now we're being concerned.     Colleen Cameron     Yeah, and I think it has to do a lot with as far as what kind of resources they have available, because for each kid, it's really an individualized experience. So it might be that one piece might be really traumatic for that child, so I like to think about different levels of stress, kind of thinking about what this trauma and this might be helpful to think about in this framework. So we think about positive stress being when there's just that mild increase in stress. Psychologists call this zone of proximal development. We, as OTs, like to use the just right challenge. The positive stress is what really is motivating you is more short term, increasing improving performance, then we move into tolerable stress that's more significant. It can cause anxiety or concern. It's activating the body's alert system as a result of more severe, longer lasting difficulties. It could be a single piece, like a loss of a loved one. It's more time limited, but often buffered by supportive relationships. When it becomes more impactful for the child, is really toxic stress or trauma. We're talking about strong, frequent or prolonged adversity. So that's really kind of the difference, that activation of the stress response and the child doesn't have sufficient resources to combat it, and it takes that cumulative toll on them, their physical and mental health, which was found in the ACE study and actually shown to be toxic to the developing brain architecture of these little guys. So.    Jayson Davies     Wow. And so it seems like the positive types of trauma, you know, we have a little bit of control over, um, tolerable. It sounds like, you know, that's the death in the family. We, we obviously have no control over that. But in a way, it can be understood as a natural life event. However, the toxic it sounds like the kid might have absolutely zero control over it, and it is completely something that is unexpected, and you should not expect that a child would have to go through these things.     Colleen Cameron     Yeah, I think you know, it's different. Kids have different capacity to cope, different resources available to them. Their surrounding circumstances and social context might be different. So I like to think about, when you change it to thinking about toxic stress and trauma is really they don't have the internal resources to the coping skills or that positive, you know, view of their personal future and their external resources, such as a safe and supportive family or access to consistent nutrition or safe housing, they don't have the internal and external resources sufficient enough to buffer the effects of that trauma.     Jayson Davies     Gotcha. Okay. And so then moving forward, you know, we kind of see these kids at school. When should we start to worry about a student when it comes to experiencing trauma, like, are there things that we can look for as far as trying to see if there's a student that we should, not target, but, you know, try to be more mindful with?    Colleen Cameron     Well, you know, the fact of the matter is, we don't, we can't identify, you know, all the kids that have had trauma. So that's what's really nice, thinking about the trauma informed care, is that we're really providing this for all students, if we as OTs, can be consistent external resources for them trying to build their internal resources. That's really where we come into play, as being available. We've done some outreach as far as identifying through, you know, whether kids have had specific trauma, I've worked really closely with, you know, my BCBA, if a lot we have a lot of behaviors come up, we'll be really trying to look into the why of what's going on, as opposed to just making assumptions. So it's something definitely in the back of your mind that considering that this child might have experienced on some trauma in their life?     Jayson Davies     Gotcha. And I mean, I don't know the answer to this, but are there people that are screening children for trauma like I've never seen that in my school based capacity, but have you ever seen a certain, I don't know, in psychological, psycho educational testing, do they screen for trauma, or is this something that's happening?    Colleen Cameron     They don't screen for trauma. I mean, Nadine Burke Harris, who's a pediatrician, has really put together some really nice, quick screening tools that she's trying to advocate for pediatricians to use in their office, and some of the schools have adapted those models to do, you know, say, on kindergarten intake. Screenings, asking some of those questions, but it's very sensitive information on those. It's kind of just more marking, whether some things have happened, not giving a lot of specifics. And then it's really important then for the school psychologist to be the one to kind of reach out and have a supportive conversation around it. So this is something because it's, you know, can be difficult to to talk about and to disclose to the school.    Jayson Davies     Of course. And, you know, we all go through training as mandated reporters and stuff like that, and, and all of that is so, I mean, it's borderline stuff, you know, when to make the call or when not to make the call, and, and the ramifications of that too. You know, a lot of I've seen teachers make that call to whatever the state's program is for some sort of abuse or neglect, or whatever it is, and that can have, very much, can have adverse effects on the parent, teacher relationship, student, parent, student, teacher relationship, all that good stuff. So yeah, definitely, that can be a tough topic to talk about,     Colleen Cameron     Very hard to navigate, yeah.    Jayson Davies     Yeah. So now we have a little bit of an understanding of trauma and what is defined as, what it might look like, a little bit. Let's move into how these experiences are affecting our students. So what does the research say in regards to how trauma is affecting the brain and the body?    Colleen Cameron     Yeah, So it's really exciting. All the research that has come out about this on a very fundamental level, these kids often their physiological stability is impacted their ability to have appropriate adaptive responses to what's happening in their environment. Scientists have found that the their neurobiology is influenced even their epigenetics, that these pieces can be passed down across generations, the children oftentimes can have difficulty with an appropriate arousal regulation. So you know, their stress responses I mentioned before has been triggered, and this can lead kids to operate on in this like hyper aroused state, and that's their baseline. So when that's happening, you can't really access all those great functions of your prefrontal cortex. You know your executive functions becomes offline. You're having trouble monitoring and modulating your own behavior, and you've left with this really overreactive limbic system that often can take over, and that's what controls your arousal, your emotion on that fight, flight or freeze response. I really like the way that Dan Siegel talks about this because he talks about kids flipping their lids. So just being really matter of fact with kids like, you know, your lid has been flipped, your prefrontal cortex has gone offline, your emotional system. And then how can we, you know, that feeling, that downstairs part of your brain? How can we get them to be able to flip back up to that thinking part of their brain? Because that really provides them with the capacity to be thinking and reasoning, maintaining all of that flexibility. And then, I don't want to forget to mention also, we're seeing a lot of these kids with sensory modulation difficulties. In particular, we're seeing over responsivity for a lot of these kids, for some of the children that have experienced neglect, we're seeing some under responsivity, in particular to auditory and tactile and vestibular. And we're also recognized in the classroom. These kids have a large amount of hyper vigilance to visual input. They're constantly scanning their surroundings. So you know, we're talking about really some significant body based pieces these kind of kids are coming to school with. So.    Jayson Davies     Yeah, and of course, in the schools, you know, we're not giving a diagnosis, we're saying that a student has characteristics of autism or characteristics of ADHD or something like that when we bring them into special education. But you kind of started down this route a little bit. What? What else might we see in school when it comes to behavior for kids who have experienced trauma?    Colleen Cameron     well, yeah, along that diagnosis line, you see a lot of these kids coming with other diagnosis. They're diagnosed with ADHD. They're diagnosed with conduct disorder, Oppositional Defiant Disorder, reactive attachment anxiety, pieces and you see in the school from an OT lens, a really strong impact on their occupational areas of play, of their social participation and their education. So we're seeing them more likely to have been suspended or failing a grade. They're often, at times, achieving a lower academic achievement, more impaired intellectual capacity. I mentioned about the difficulties with the executive function, memory, concentration, seeing language delays and then challenges in their relationships with peers and teachers. They're demonstrating delayed play skills. So it's really quite comprehensive the impact.     Jayson Davies     Yeah, and so you mentioned a little bit from the OT perspective. But what about from the teacher to or the administrators? What do they say when you tend to if they're talking about a student that might have some trauma, what do you tend to hear the teachers and administrators saying about the student?    Colleen Cameron     Yeah, these kids get discussed a lot, because there's often, you know, the kids that are kind of in. That more of that fight response, we're getting some aggression, loss of emotional control. We can see a lot of these kids having really self deprivating, deprivating comments. Oh, that's, yeah, it's early, self injurious behaviors. You can also see these kids like really socially withdraw. We can see these kids fleeing classrooms when they're upset, or you can have them really digging their heels in and wanting that sense of control. These are kids historically have had that lack of sense of agency or ability to kind of control their environments they might be trying to exert more control, and which often impacts their ability to function in the classroom.     Jayson Davies     Absolutely. I mean, I know I'm not the only one who says this, but one of our first roles as educators, whether we're a teacher, an OT, or any role as an educator, we have to ensure that the child actually wants to be at the school. And so many times I see a kid, you know, the walk out of OT and like, you can just see, I mean, it doesn't happen often, but you just see that they don't want to go into the classroom, like they're almost scared to go back into the classroom, or something like that. So I can just imagine how this toll could potentially affect a kid's ability to learn.    Colleen Cameron     Yeah, and I think that, you know, we provide, we're really, you know, co regulating them and meeting kids where they are, and they're feeling really safe in these ot environments, and so that's what's really important about spreading it out across the tiers, that we're developing that sense of community and safety across the school. So.     Jayson Davies     Yeah, all right, well, let's jump into us As occupational therapists. Why are we the right fit to help these students, and what unique contribution can we make for these students?    Colleen Cameron     Well, I It's like my personal mission out there. I really feel school based OTS need to be recognizing their distinct value and providing supports for students that have experienced trauma. It's a important seat for us to have at the table. I know I recently presented at a conference down in DC, the trauma sensitive schools conference. And there were 1000 people there, and there were four otschoolhouse com, we have to rally our troops to understand our distinct worth in this starting off really looking at there's a great new chapter in the new best practices for occupational therapists in the school book that just came out a couple months ago, actually by some very talented and passionate OTS that I would encourage people to read. That's a great place to start. But OTS are such an untapped resource in this model, if you think about we're really trained to analyze tasks, modify environments, and identify participation barriers, and we've already recognized that. So a lot of what these kids are presenting with, we have this great, extensive knowledge about sensory and motor arousal regulation. We're trained in mental health. A lot of us don't recognize that capacity that we have, that that's a really important role for us in the schools, and we are trained to work bottom up with body based relational supports for these children, and so we have such a knowledge base and a skill set to come forward to really help these kids feel safe, help them build resilience, and they talk a lot about post traumatic growth, that's a real area that we can impact.    Jayson Davies     Definitely and real quick. I want to say two comments from what you said is that the book will definitely have the new school based ot book, or best practices in school based ot I'll put a link to that in the show notes at otschoolhouse com, forward slash episode 35 and then the other thing is that about mental health, I know. I mean, here in California, I recently went to the otschoolhouse com health, not necessarily in schools, but just in general. OTs being a mental health you know, that's kind of almost where we have our roots. And now only, I think, 3% of OTS work in mental health. And I also know that's been a big focus of concern for aota as well. I know Amy Lam, the outgoing president of aota, has talked several times in her just or in her keynote speeches about mental health. So that is an area that I think OT is really moving forward into. And I think we also need to continue that trend, not only into mental health for adults, but also mental health for students as well, since we are prominent in the schools.    Colleen Cameron     Definitely. I mean, Sue basic, I don't know if you're familiar with her work, but she's a huge advocate for this area. So anyone that's interested in really feeling empowered to work in this area, in the school, she's a great resource. Her she has a website every moment counts, where she has all these really great tier one, tier two strategies for supporting kids, and she's a huge advocate for that. It's very, very important.    Jayson Davies     Absolutely, actually, you know, it's funny you say that I was just watching a video of her on YouTube. She has like, an hour long lecture. I think she had won an award, and so she was kind of giving a lecture that went along with that award, and she was talking about this program that she helped facilitate in a cafeteria. Yeah, and it was about teaching social skills in the cafeteria. And what I loved about it was that it wasn't just the students she was working with, it was the cafeteria employees she was also working with. I mean, I don't know about you, but I've been in toxic cafeterias where, for sure, where the aides or the whatever you want to call them paraprofessionals, are downright mean, and I've had discussions with principals about it. I mean, I know principals don't always make it in the cafeteria, but I've gone and been like, Excuse me, Mrs. Principal, but have you been in the cafeteria recently? Because, I mean, they were isolating students at one point in a way, and I was like, What's going on here? So that's really cool that Susan Sue Susan right. Sue basic, yeah, Sue basic. She's doing so much for our kids, so that's awesome.     Colleen Cameron     Yeah, definitely.     Jayson Davies     All right, so back on track. When you think about intervention and support, what frame of reference do you utilize?    Colleen Cameron     So I'm very eclectic. I feel like every you know, everything needs to be really individualized for kids. So I pull from a lot of different places. I've think the the biggest advocate in this area has been Tina champagne. She's really been a champion of the cause. So that was originally, what really got me started on defining ot role in the school, was her work, sensory modulation and trauma informed care is She's a real leader in the field the sense, of course, sensory processing and integration. I have strong background in the work of Dr Ayers, but also Dr Kumar did really was a champion in getting OTS involved from a sensory realm as well. Of course, my working at the star Institute for SPD, their frame of reference actually kind of highlights three pieces, sensory regulation and relationships. So that's really what informs my thought process and intervention. I'm also dir floor time certified, and so that whole connection and Intune and CO regulation for these kids, and recognizing that has been a strong influence for me. I've done some coursework, if anyone's interested, the neuro sequential model by Dr Bruce Perry. He's actually come out with an education track, and it's specific for clinicians and school based providers, and that's something you can to do online. That's a really great reference. I've done some of his work, and then Dr Steven Porges, his work with polyvagal theory has really influenced me, and that's thinking about the influence of their physiological state and how that's expressed through some of their behaviors.     Jayson Davies     Great, yeah. And we'll definitely make sure that we get as many references to those on the show notes as well. So be sure to check that up, there's going to be great show notes this episode. So     Colleen Cameron     I love giving people more resources.     Jayson Davies     right? You can never learn enough, and that's why I love doing the podcast, because every time I do a podcast, I get to interview someone, and I learn new stuff. So it's awesome, as do the listeners. So now I know you are keen on tiered tiered interventions, such as like RTI response intervention, and we talked about it a little bit a few minutes ago. So what are some of the tier one strategies that every school based ot can partake in to make a difference for these students?    Colleen Cameron     Yeah, it's really imperative that OTS are supporting students across the tiers with a continuum of service delivery. So with tier one, we're referring to the whole school support, and that's when you can really team with administrators in the school to making sure that they're defining a trauma informed vision for the whole school, having some attention centered on things like self regulation and relationships, social support, helping to promote some of those positive Mental health initiatives, having a focus on all the classrooms, on social, emotional learning, thinking of ways that they can minimize unnecessary triggers in the environment, some of those prevention pieces, but I guess the biggest piece is really collaborating with administrators to help build that feeling like I mentioned, the feeling of cohesion and community for the whole School is essential and really great again for all kids.    Jayson Davies     Absolutely. I mean, sometimes I feel like I can do it all on my own, but I know I can't. And you're right. You absolutely have to collaborate with every single person at the school. I mean, like we even talked about in the cafeteria, even those noon aids or those people need to be involved in this. So yeah, you're spot on collaboration.     Colleen Cameron     Yeah.     Jayson Davies     So are there any specific activities you would recommend to therapists or classroom teachers?    Colleen Cameron     Well, if we're talking about wanting to increase that feeling of safety in the classroom for these kids, consistency and predictability is very important setting aside time for developing relationships or increasing some of their external resources. So I like to give teachers ideas for whole class pieces, some of Dr Bruce Perry pulls out a lot of things that are rhythmic pattern activities that reinforce really repetitive opportunities for self regulation. So. Examples could be like drumming or chanting songs, humming, clapping, hand patterns. So I have some teachers use that for transitions from, you know, snack time to rug time, or how they're getting kids attention and thoughtfully working that into their classroom day. I also like the idea of adding in mindful minutes throughout the day. And if that's something you can do across the board, where administrators are on board like everyone has a mindful minute when they make that really difficult transition right from recess to like a quiet activity, we know it's hard for all kids. Is that something that we can make consistent and predictable for them to be able to develop opportunities, to develop social, emotional competency and some of that positive self concept and increasing some of those internal resources as well.    Jayson Davies     Absolutely. And we actually had an episode about mindfulness. I believe it was episode seven, if anyone hasn't listened to that, but that was a great one on mindfulness, and we did talk about those little things in the classroom that you can do just to keep the kids in the moment. So another area that we often have to look into is when we talk to parents. And obviously, as otschoolhouse combat OTS in particular, we spend a lot of time in IEPs with the parents. And so what are some suggestions or topics or key points that you sometimes have or you find yourself having conversations with with the parents.    Colleen Cameron     Yeah, for so for these kiddos, it's really important to team with the parents about developing healthy life habits and routines at home. Sometimes that can include just education about for these kids, it's really important for them to be having access to consistent nutrition and hydration. So like a protein and water every two hours, or they might not be aware of if these kids are having, you know, meltdowns and they're using up all of their energy and glucose pieces, you can see they might need to be thoughtful about having a snack afterwards. So some of it can be elements like that. Some of the sleep routines for these kids can be really, really challenging. So working with them to develop a healthy sleep routine. Can they think about setting aside time to just, you know, play and develop that feeling of safety and connection at home, getting them some ideas for that. And then, if you're really adventuresome and a go getter, thinking about, can you bring in some family parent nights where the kids are kind of doing an opportunity for shared family activities. So.    Jayson Davies     Yeah, so it sounds like you're a little involved. I know some therapists are. They waver on you know, how much do I talk to the parents? How much do I send home and stuff like that. Are you the type of therapist that would print out a sheet and give it to the parents. Do you have different handouts or something like that that you provide to parents sometimes?    Colleen Cameron     I don't do a lot of handouts. I'm not a handout because I really feel like it needs to be individualized, and so important to be relationally connecting with the parents, because they might have different concerns. I wouldn't say that I'm spending hours upon hours doing this piece, but I am very thoughtful about having parents be part of this, being feeling educated and empowered for these kids, it helps me be more successful. The teachers be more successful with the school. If the kids come with, you know, appropriate nutrition and hydration in the morning and a good night's sleep, it's, it's helpful for all. And so it doesn't have to be something that's super time labor intensive, but a thoughtful, quick phone call or email touch base is really helpful for these families.     Jayson Davies     Yeah, and again, I think that's also very important that we're there for the IEPs too, so we can have that connection with the parents. So all right, so that was tier one. Now let's move on to tier two. What are some different ideas you have for tier two?     Colleen Cameron     So for again, the relationship piece being really critical at that classroom level. We're going back to our mental health training here. How can we give the teachers ideas to build some of those strong relational foundations, welcoming invitations to the kids. As far as, how can they present consistent, proactive pieces. Can they build in a morning meeting in the morning, or a cool, welcoming thing that they do when the kids come in that they're giving them some individualized check in time? I think it's really important to consider teachers own their own stress response and their own sensory profile and making these pieces, because the teachers are coming with their own elements, but really helping to educate the teachers. As far as the relationship being so critical for these kids, and that's how we're kind of rewiring these brain patterns, that feeling of safety, and having them understand that when they feel safe and connected and regulated, that's when they can be open to challenges in the classroom of academics. But really they have to feel that first before they can be open to those academic challenges. So understanding kind of that first then piece is essential.     Jayson Davies     Gotcha. And you know, as tier two, sometimes I will actually kind of go into the classroom, whether it be to do like a handwriting group or something like that. Do you collaborate at the teachers inside the classroom at all?    Colleen Cameron     I do. So I'll go in and we'll kind of model things together about how to implement and add things into the classroom. A lot of times I'll go in and they'll say, this is a difficult time of the day. So I can go in with my ot lens and think like, Okay, well maybe could we modify the task or the environment or the structure of how the classroom is set up in that moment, so giving our specific lens of how to problem solve things with the teachers,    Jayson Davies     great. All right, this is going to be a little bit of a throwback, because I know this is something we talk about in otschool, but it's something that I think might fly over a lot of heads, and that's the therapeutic use of self. And so I wanted to ask if you could explain that one just a little bit more, because I think that therapeutic use of self is important when it comes to mental health. Because yes, there's some things that can be tangible, but there's also some things that are intangible, that are more relationship based versus activity based, and that's where I think the therapeutic use of self comes into place. So would you mind unpacking that a little bit?    Colleen Cameron     sure. So if we're looking for the kids to be able to feel at ease and motivated therapeutic use of self, is really the therapist having a conscious effort to optimize their interactions with the child. So that's being aware of yourself, what you're saying verbally, what were some of your nonverbal experiences, your body language, how you're using your own judgment. So communicating as you respect even by body position. So I've even gone into classrooms and working with assistance saying that they're really not there. The kids are really responding to their interactions with them in a very you know, they're feeling very hostile or defensive pieces. So we've kind of talked about, instead of looming over behind them, could you pull up a chair next to them and kind of be on their level like so sometimes just that simple shift in body position, and then it really then brings it into a collaborative piece, so that we're not having kids, we're not doing things for the kids, we're connecting together, so that we're empowering kids to be able to do for the things for themselves, and they're on the kids are co producer, producers of the support, and not just passive consumers of that support.     Jayson Davies     Yeah, definitely. And I think that kind of leads into the next question I wanted to ask, and that is about the environment. What can we do about the environment that has such a huge effect on our kids?     Colleen Cameron     Yeah, it's funny, because one of my pieces I always talk about it is lighting in the classroom having such a big impact and being the end of the school year, a lot of worked, a lot of my teachers that's going around my school, there's a lot of teachers with lights off around this time of stressful year, and it's and you go in and say, the kids off the wall, they're like, yes, but I also need it. So these are all things that can be helpful for everyone's arousal and regulation. So thinking about other dimmable lights, or, you know, pole lighting. A lot of these classes have been put you know, that big fluorescent lighting in the classroom can be really, really abrasive. So thinking about, can you offer dimmable lights, Altena alternative seating options. Can there be a spot that you can to dedicate in your classroom? A lot of teachers like to do this with, like a reading nook corner, a spot that's kind of dedicated for kids to be able to have a safe place that they can go to to regulate so it's not like a time out spot. It's a really a time in where they're kind of recognizing of themselves. They need a moment to re regulate, and having that being a connected experience that someone's potentially going over with them. So offering things like a bean bag, some scented pieces, some fidgets, some oral motor pieces, I like to use pinwheels in the corners. A lot of times you have kids trying to take deep breaths, and when they're really having a hard time. They're taking really shallow breaths, but it's really the exhale is what activates your parasympathetic nervous system, not the inhale. So you have kids taking deep breaths, and they're doing a lot on the inhale. So building things like a pinwheel or bubbles are things that are focusing on that exhale allows kids to kind of bring their arousal level back down. It's regulating for them.     Jayson Davies     Wow. Okay, so I want to follow up on that. Then I see the same thing with, you know, people developing these different types of nooks or little corners or whatever. How much do you want to have a role in your teachers developing this nook? Are you giving them specific suggestions, or are you just saying, Hey, you should look into having a nook. How involved in that process are you? Or do you like to be?    Colleen Cameron     Yeah, so I've collaborated a lot with my principal on this, as far as having it be an expectation of classroom teachers developing these nooks. But for me, for kind of the generic having a beanbag or a place to be regulate. It's not as much about me having a specific opinion about, you know, this fidget versus that fidget, but the kids being involved and having it be really individualized. Because even, you know, if they have, like, a scented, you know, lotion, per se, some kids could smell that and be really alerted by it. Only come after a thorough assessment in which it was found that sensory processing challenges were specifically evaluated and found to be affecting their participation in the schools.    Jayson Davies     Gotcha. Okay, so you kind of started down this route, but I want to even ask you to go a little bit further with the sensory processing I like what you're saying today, because a lot of it has to do with large group, tier one interventions, but when it really comes down to that, sensory processing, a lot of times, we need to make sure we're doing a very thorough evaluation and that people are trained completely on sensory integration and sensory processing before they really try to do some treatments, because it's not necessarily effective unless you're really doing it the right way and are looking at the right things. And so can you dive a little bit deeper into what you're talking about when you say an evaluation and treatment and sensory processing for these kiddos?    Colleen Cameron     So for an evaluation, you know, here, okay, here comes my big pet. A sensory evaluation is not giving a parent and teacher survey and calling it a day. You know that that's a really important lens that you can have into what their perspectives are, but it really needs to come from your own clinical judgment, seeing them in the classroom setting, as well as having them going and doing a clinical evaluation where you're doing formal and infernal, informal clinical observations, doing some standardized testing pieces, and really making an informed decision. Because some of times, you know, if I'm really talking about a direct model, I take that very seriously and a pull out piece, because we are in that educational setting. So, you know, I get the question like, Oh, these kids have trauma, you know. Now you're going to be doing some pull out models. You know, I'm really very clear as far as not only if I'm finding sensory processing pieces, but it needs to be affecting their participation in the school setting as well,     Jayson Davies     Definitely. So now we are working with these students. What are some potential outcomes of an OT using a trauma informed approach, when working with these students, what are we hoping to have as far as our student participation outcomes?    Colleen Cameron     For really highlighting that person centered, strengths based approach, I'm looking for change across their occupational performance areas in the school environment, but that can look like different things. It can be an increase in their ability to self regulate, in their strategies, an improved ability to problem solve and communicate, that they're better able to advocate for their needs, like they're able to independently recognize that they're having a hard time and choose a calming sensory strategy when they're needing that change for an arousal change overall that we're really looking to bring help bring success for these kids, like you were saying like that, you know that looming feeling of going back to the classroom or looking for them to feel successful in their occupational performance areas and empowered to really build some of that resilience and be engaged in in their school job?     Jayson Davies     Yeah, definitely. And so in preparation for you know, this interview, I definitely went back and looked at your 2018 article on trauma and the role of school based OT. And one of the things that really struck out to me, and of course, you've already talked about it today a little bit, is your emphasis on collaboration. And so I really want to dig into that. And as far as collaboration with other IEP team members, what are different ways that we can we can collaborate? I mean, obviously there's that person to person collaboration, but within the IEP, there's so many different areas that we can collaborate, whether it be goals, treatments. How do you collaborate? I guess I should ask.     Colleen Cameron     So I do it lots of different ways, because individualization is the game for me. So I've done well. First of all, for your question about IEP goals, I will oftentimes do a collaborative goal for these kids. So sometimes that might be with my BCBA around adaptive behavior, or sometimes with my school psychologist around emotional regulation, or the classroom teacher as far as accessing some of their academics. So for me, it needs to be back in in the classroom as far as participation, and it's it's not just one person working in isolation. We need a full team on this. And So collaboration is so key for these kids, because we're all bringing different skill sets to support them in direct service pieces that can sometimes be a co treat with the school psychologist, as we know as OTS. If we have kids coming out that some of these emotional pieces, you get a breadth of them, kind of sharing what they're nervous about or how they're feeling, and it's a really exciting piece of connection, of CO regulation and opportunity to really help kids recognize and name their own emotions and be able to feel empowered to make a plan.    Jayson Davies     Gotcha. Okay, one question that I sometimes get, whether it be on Instagram or an email, is that OTS are coming, are having struggles, I guess you could say, with those collaborative goals, creating collaborative goals with teachers, you know, they're getting a little pushback for. A teacher, a counselor or something. How have you found the way to break down those walls into help teachers understand that collaborative goals can be not only appropriate, but sustained and high quality?    Colleen Cameron     So I actually do use goal attainment scaling for all of my goals across the board, and so that I am going, you know, was before with the IEP meeting, I sit down with the teacher and we talk about what their concerns are in the classroom again, bringing it back to participation challenges. And that's what we highlight, really in on our objectives of whatever we're working on, is, how does it? Bring it back to the classroom so they feel a part of what the goal says. First of all, we're not implementing that. And then the other piece is really data collection. It comes down to them, you know, because a lot of my data collection is about how they're participating in the classroom, so you need to be thoughtfully making it obtainable for the teacher to be collecting data on that goal. And that's something that's weighing them down with a lot of time pieces.    Jayson Davies     Okay, I want to, I don't want to go too far into this, because I do plan on having a whole other podcast on goal attainment scales. But would you mind explaining it just a little bit for people who may not be familiar with it?     Colleen Cameron     Sure, So goal attainment scaling was originally in the mental health world when they were trying to find a way to make things that were a little bit harder to make measurable measurable. And so it's built along a zero a negative two, rather to positive two scale. Different people kind of define it different ways. But so negative two is really what the kid is presenting, whether their performance, their baseline, at baseline, yep. And then your zero mark is going to be what your objective says in your IEP, and what you're filling in for those other pieces is negative. One is slightly less than expected. Plus one and plus two, obviously are more than expected, but we're really only changing one factor across the board, so that could be their number of times that they're doing an amount of support that they're needing for it, but we're only changing one thing, and it's really very helpful for as far as progress reports, to make things measurable that are a little tricky to measure.    Jayson Davies     Gotcha, absolutely, I can't. I really want to learn more about the goal attainment scaling, because I think it's something that helps us, not only help the kids, but also to really understand if what we're doing is actually effective or not, because you do have those different levels of attain, of attainment. So, yeah, all right. Another question that's very popular is the sensory versus behavior question, you know, is it sensory? Is it behavior? But no one's ever asked, as far as I know, you know, is it trauma? And that's something a little bit from a different lens. And so what do you make of different behaviors exhibited by children dealing with trauma.    Colleen Cameron     So the big question that the trauma sensitive community looks toward is moving from what's wrong with you to what's happened to you. So it's like you were saying, kind of digging a little bit deeper into the reasons behind what's going on, trying to find a way to better understand the motive behind the behavior. So the behaviors, oftentimes that we're seeing with this population is really their attempt at Adaptive coping responses. They're physiologically based. Their nervous system has been triggered to protect them. They could be shifting into fight or flight. And what we want to think about, and I work a lot with my BCBA on this, is understanding the individual differences, so we're not looking at just the what has happened is what has happened the antecedent piece and the behavior, but we're considering the individual difference of what that child is bringing to the table, how that when it flows through the child before the behavior, what are some things that are different? So that could include sensory but include so much more that we need to consider. So then, when we're talking about like a behavior plan, we're offering redos, we're communicating the child's worthiness and not shame, and we're not focusing on decreasing behaviors, but increasing their capacity and competence. And polyvagal theory has a real focus on this, as far as we're using that social engagement system and the relationships really, to get there.  Gotcha. Okay, you've mentioned BCBA or ABA a few times now, and I know that that is a topic. It's not a bad topic or anything, but it's something that OTS sometimes struggle to really work together with an ABA in schools. I've heard of it. I have had good experiences, but I know other OTS have have struggled to incorporate that collaboration. So could you dive into a little bit what that might look like when you're collaborating with the BCBA? Absolutely. I just actually submitted an article with my BCB and interprofessional collaboration perfect, and it's a really important topic for me, because I think that there's a lot of misunderstanding. I happen to work with a phenomenal BCBA, so that really helps, that she's really open, but we've learned each other's language, and we've learned to kind of recognize that a lot of the things that she might be working on, I might be seeing when just kind of calling it a different piece, but part of that can be for these kids. In particular, recognizing, you know, a big thing in the community of of trauma is that they don't like those clip up charts, right? That are really powerful, you know, popular as far as kids getting clipped up or clipped down. So the concept with this would be a kid, you know, you could have them being clipped up for proactive, pro, social, rather, behaviors in the classroom, but there's no, you know, kind of clipping down pieces. So for me, that collaboration is really centered around proactive strategies that we can put in place for these kids, as opposed to being reactive. And that's very much what from a behavioral lens, what they're looking for. And if you're working with a really skilled BCBA, they're not just looking to decrease the behaviors. They're also looking at, you know, those the skill piece, as far as increasing their competency as well.    Jayson Davies     And in your previous response, you mentioned ABC data, antecedent, behavior, consequence, but then you also kind of tied in something that I never heard before. Was individual personalities or individual Sorry, what was the difference? Differences?     Colleen Cameron     Differences, yeah.    Jayson Davies     So it's almost like aibc or something, if you want to call it that. But I want you to dive into a little bit deeper. How you in that BCBA, then, how does that collaboration work? Or how do you help to identify those individual differences for the student?    Colleen Cameron     Yeah. So I think that when they're doing their functional behavior analysis, oftentimes they're the first ones on on the ground that's been called in, right? Because these kids are having behavior challenges, and so we have a really close collaboration. So she's seeing pieces where she's, you know, this isn't just that they're trying to, you know, avoid this task because it's too hard. But I am seeing them have big responses to things that I wouldn't necessarily consider, or I'm feeling like they're when they do their FBA, there is that sensory category, which is that internally motivated category, and she's seeing a lot of facets like that. We've talked about that if she's seeing kind of some of those highlighted pieces, that that's an important piece for her to come to me, and we're looking to dig a little bit deeper on so a lot of times, even for these kids, if we're doing an initial evaluation, it's the BCBA looking from a behavior lens me looking for my ot lens. And the school psychologist is really delving into what some mental health contributions to this. So you're really getting, you know, looking at differential diagnosis very systematically.    Jayson Davies     Wow. And that really sounds like you guys have a good team that works together and stuff, because that's hard to find a really good team that everyone's kind of using this lens and can Yeah, knows each other's roles well enough to know, hey, I see this area, I need to go to the psychologist. I see this area, I need to go to the OT or the BCBA. So that's fantastic,    Colleen Cameron     yeah, and being comfortable with that overlap and not getting defensive to really have to, you know, put up your walls, because we, you know, if you really have a great understanding of that distinct value and role and being able to articulate that piece, but you're also being open and respectful to other people's lenses that helps to kind of bridge that gap.  Yeah, you did mention on the FBA that the BCA, the BCBA, you kind of mentioned how they said they'll see something sensory, but it's called something else.  So it's actually called sensory in their categories. But really what it means is not that they're seeing a sensory processing deficit or integration deficit. What they're seeing is that it's internally motivated versus an avoidance or escapement, so that there it's something internal that's motivating the behavior. And so that's when you really need to be thinking about digging deeper. Because they're not making a determination of what that is. They're just kind of like, oh, well, it's not avoidance of the task. It's not, you know, that they're trying to get someone's attention. And so that's where we can really collaborate to give them some more in depth knowledge as far as what's going on internally for that child, those individual differences?     Jayson Davies     Wow, that's the first time I've heard that explained. So thank you. I appreciate that. All right, well, we're coming up on our on our hour, so let's wrap this up. But first I want to give you the opportunity to kind of share with people, if they're interested in learning more about your work, about trauma, informed care, what are some you've said so many resources, but are there any other ones? Or if you wanted to kind of wrap it up and summarize everything, where are some different resources?    Colleen Cameron     So I think that I've tried to make it available for people to be able to read my article that don't necessarily have a subscription piece, but I am allowed to put it on a personal website. It's kind of the pre published version. So that would be my first thing is on my personal web page, which is spark sensoryclinic.weebly.com , if you go into the Resources tab, I actually have the PDF for my article, so that's a really great way to delve a little bit deeper into some of this tier three intervention. I'm also traveling around the country and actually doing some international teaching for that school based intensive for Star Institute. And I've really incorporated my trauma informed approach into that training. So that's another great place to delve more into. That's www dot SPD, star.org and if you go under education, you can see those courseworks. And I also have some new publications in the works. So keep up. Keep an eye out for those.  Definitely and is the best place to reach you through your personal Weebly spark Clinic website? Yes.    Jayson Davies     Perfect.     Colleen Cameron     There's a connection to my my email, and I'd be happy to hear from people    Jayson Davies     Great. Sounds good, Well, Colleen, thank you so much for joining us on the on the podcast today. I feel like this was very informative, and I can't wait to share this with everyone. So I appreciate having you on and best of luck in all your new publications going forward.     Colleen Cameron     Great. Thanks so much.     Jayson Davies     Thank you. Take care.     Colleen Cameron     You too.     Jayson Davies     All right, everyone. Well, I hope you enjoyed that very thorough interview with Colleen Cameron Whiting. I know we got a little bit off topic there at the end, but I think it was just so fascinating. So I left it in. And I hope you did enjoy hearing a little bit about how she collaborates with a B CBA or ABA therapist. It's very cool that they're working together to get some stuff done. If you did enjoy this episode and would like to earn your professional development for doing so, be sure to head on over to the show notes at otschoolhouse com, forward slash episode 35 or to otschoolhouse com, forward slash PD, as in professional development there, you'll be able to purchase the professional development course that goes along with this, and basically you already listened to the podcast, so all you'll have to do is complete the 10 question quiz, and I will then send you a certificate of completion for one hour of continuing education for your NBC OT and or state license. Be sure to make sure that your state recognizes online, independent based learning before submitting it to them. Most states do, but there are a few that don't so check into that. Otherwise. I hope you enjoyed this podcast. Can't wait to see you guys next time in Episode 36 until then, take care.    Amazing Narrator     Thank you for listening to the otschoolhouse com podcast. Now that you've listened to this episode, head on over to otschoolhouse com, forward slash PV, as in professional development to earn your continuing education certificate, until next time, class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 31 of the OT Schoolhouse Podcast. Just when Dyslexia seemed to be the new buzzword in IEP meetings, Dysgraphia and Dyscalculia joined in on the fun. Dysgraphia, especially, has cemented itself into the confines of the Occupational Therapy world. If there is an IEP team using the word Dysgraphia, there is sure to be an OT evaluation to follow. ​ In this episode of the OT Schoolhouse Podcast, Jayson interviews the author of the Handwriting Brain-Body DisConnect, Cheri Dotterer, MS, OTR/L. ​ Cheri has been an Occupational Therapist for over 20 years. Much of that time has been serving students who have been referred to her for handwriting concerns. With that said, it was her own children's struggles that really got her into studying Dyslexia, Dysgraphia, and Dyscalculia. ​ Listen in on this episode to learn how Cheri defines Dysgraphia and explains what the six types of Dysgraphia are. She also shares how we as OTs can help students to overcome some of the problems they face by using the Motor Learning Model and The Sensory Integration Model. Links to Show References: Quick reminder: Links to Amazon.com and other websites on this page may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you. I appreciate your support by using these links. The below references were mentioned throughout Episode 31 Handwriting Brain-Body DisConnect: Adaptive teaching techniques to unlock a child’s dysgraphia for the classroom and at home By Cheri Dotterer, MS, OTR/L Buy it on Amazon Email Cheri at info@Dysgraphiaconsultant.com Body Sentence Alphabet at DysgraphiaConsultant.com National Special Education Advocacy Institute Beth Pfeiffer, Beverly Moskowitz, Andrew Paoletti, Eugene Brusilovskiy, Sheryl Eckberg Zylstra, Tammy Murray; Developmental Test of Visual–Motor Integration (VMI): An Effective Outcome Measure for Handwriting Interventions for Kindergarten, First-Grade, and Second-Grade Students? . Am J Occup Ther 2015;69(4):6904350010p1-6904350010p7. DOI: 10.5014/ajot.2015.015826. This​ is the article in the AJOT referenced by Cheri regarding the Test of Visual-Motor Integration Size Matters Handwriting Program Paper Cheri's recommended paper for teaching Handwriting Our featured listener question was from Laura @TheOTButterfly on Instagram ​ DysgraphiaConsultant Facebook Page Cheri on Linkedin Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript   Amazing Narrator     Hello and welcome to the 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 this is episode 31 where we're going to talk about dysgraphia, and we're going to unpack a little bit about what dysgraphia is with Cheri, daughter of the dysgraphia consultant.com she also has a new book that we're going to talk a little bit about. You guessed it, it's about dysgraphia, and can't wait to get to that. But first, just a few things. I'm super excited for two reasons. One is that you are here listening to this podcast. And two, because it's the end of May, I just want to congratulate everyone, myself included, honestly, that we got through another school year and now we get to celebrate a little bit. Yeah, maybe, maybe you got to work a little extended school year, es, y, but yeah, it's a little bit more chill, and we get to get have some fun, get out and have a vacation. So I'm excited for that. I'm excited for you to all have a great vacation. I'm also excited for summer because I'm gonna get to do what I haven't done in a long time, and that is to produce some solo episodes for you. We're gonna take out the guests. We're going to just strip it down a little bit and talk about the nitty gritty ot in the schools. I have a few episodes that I want to get together that's just going to be me talking to you, and I can't wait for that. So, yeah, it's going to be fun. Can't wait. The only other thing I have to say before we jump into this episode is that we actually do something a little bit different, and that we are doing a giveaway at the end of this episode. So last 10 minutes or so, we're actually going to give away two copies of Cheri's book, handwriting, brain, body, disconnect, adaptive teaching techniques to unlock a child's dysgraphia for the classroom and at home. So stay tuned. Like I said, last 10 minutes or so, we're going to give those two books away, and that's going to be in a week from now, actually. So you have to do something between now and a week from now in order to earn those books. So stay tuned. Sit back. Enjoy some wonderful communication dialog about dysgraphia. You're going to learn a lot. I did. I already took my notes. Oh, you may want to grab a pencil and paper right now. There's some good stuff coming up. So here is Cheri Dotterer. Hi Cheri. Welcome to the OT school health podcast. How are you doing this evening?    Cheri Dotterer     Oh, I am doing wonderful. I am so excited to be here. It's amazing. This technology talking to you here in Pennsylvania, all the way over in California, that blows my mind, yeah,    Jayson Davies     even though we did just have some technical difficulties, we've got it all going now. It is awesome. You can't get enough of zoom, Skype, whatever platform you're using. It's all authentic, amazing.    Cheri Dotterer     It's amazing. And there are so many teachers and OTs that I've been talking with via phone. They're like, I don't know about that zoom thing. And so we need to get them out, get used to the fact that this new technology is out there, and it's not that scary, no.     Jayson Davies     And I mean, we already had one episode on telehealth, and that's exactly what they're doing. They're using zoom or Skype or some other platform, and it's just the way that the world is going now, whether you're in business, whether you're an OT a teacher, you're going to have to be using this type of platform.     Cheri Dotterer     Yep, and, and I might be answering a question ahead of time, but I work in cyber schools, so that's how the kids are going to school. They're sitting at home, they're going on to zoom, and they're seeing their teacher and their other students, and they're getting educated from the chair in their office or their bedroom or their living room on the sofa. Who knows where they're sitting, oftentimes, but their kids are learning from the from this platform. It's amazing, yeah,    Jayson Davies     and, well, I mean, let's just keep going then, I mean, we're here to talk about dysgraphia, but I do want to talk a little bit about you and how you got to where you are now. And so you said you work with cyber schools, but you yourself actually go house to house, correct.     Cheri Dotterer     That is correct. So the students are going to cyber. So there's different platforms. They are that is of actually a public school in Pennsylvania, there is different than homeschooling. Homeschooling, they for fit their special education rights under IDEA. When they're cyber, they it's a public school, so it's fully funded under IDEA, and it has all the rules that special education carries, except they're going to school at home. So you get an IEP, you have a 504 plan. You have all those pieces that we talk about when we're working in school based therapy. Then there are charter school. Schools in Pennsylvania, those are in person schools, but they are special. So they could be a dyslexia school, it could be a autism school, it could be a school for ADHD. Then there are some other platforms, and then you have private schools in Pennsylvania, which didn't also forfeit their FAPE and their special education pieces, some of the charters do that all depends on the platform that they've chosen to be on.    Jayson Davies     Gotcha. So in California, we have what's called MPAs, or non public agencies, and then or NPS is sorry, we have MPAs, but we also have NPS, which is non public school, and that's typically where we have some of our more higher needs populations, that it could be like a very specific autism program or something like that, and it is actually a, typically, it's an IEP team decision to send that kid the district is saying we don't have the resources for that student. This is a placement that weekends we can offer your students.    Cheri Dotterer     We call them APs. Is in Pennsylvania, approved private schools. Okay? Same thing, different terms. The difference between an approved private school and a charter school as well. So it's very it gets very complex when you get down to the nitty gritty and really start to understand what all the laws are about. Incidentally, sidebar, cyber schools originated in Pennsylvania, which is very unusual, because usually Pennsylvania is one of the last thing people to implement, but they implemented them in 1988 because there was a school in western Pennsylvania, a middle school, that basically burnt down, and they had a find a way to educate these students. They were sending them over the border into Ohio. But the Ohio laws and the Pennsylvania laws were not meshing too great, and they needed to get them back. So cyber schools started out of necessity, wow. And then they expanded across the nation.    Jayson Davies     Yeah, that's crazy. And yeah, like we already talked about everything's just going digital nowadays. So yeah, so    Cheri Dotterer     I know that wasn't even anything that we were going to talk about. But, you know, we need to educate the OTs as to how the cyber world got started, because not everybody has been working in that platform. It is a new emerging field.    Jayson Davies     Yeah, well, that's just like extra Indians in baseball. You know, once it goes past nine innings, you get free, free baseball. Well, here we're giving free content, free extra stuff, not just describe, yeah. All right, well, so we got into a little bit, but little bit about what you're doing now, but tell us a little bit about the history. How did you get into how did I get here?    Cheri Dotterer     Well, I started college thinking I wanted to work at Fox Chase in the cancer unit, doing medical technology. Didn't happen. I what I grew to not particularly care for test tubes and wanted to work with people, but still wanted to work in the science field. I found out about ot in January, and by June, I was in OT school. Wow. I had already had a bachelor's degree in biochemistry, okay? And ended up, three years later, going back to school, and then I went back a second time and got my master's degree, because when I got it many, many moons ago, anyway, I went and got my master's degree. And about two years into my master's program where I was taking one class at a time. Mind you, I couldn't do it any other way. They started the OTD programs, and I didn't feel that I should switch, but I still feel that my education was just as intense as getting an OTD program. Okay, because I got an advanced masters. So that what led me into where I am now, when I was in my master's program, I took some business courses because I really wanted to be in private practice. Really wanted to start working with kids. I had been working in adults for years, and I really wanted to work with kids. I actually started in schools without any knowledge of school at all. I started my own private practice. Had no support except for who I was calling on the phone. It was bizarre. It was a crazy first year, but I worked with two CODAs that were absolutely amazing, and had an OT that I called on the phone almost every night, crying. Why did I do this to myself?     Jayson Davies     So were you working in, you said schools, but you said you started your own private practice. Were you in a clinic that was contracting or how did you do it?    Cheri Dotterer     I worked with a school based brick and mortar ot practice. Yes, and had this the cyber schools privately on the side. So I was working with another company as well to get some get some assistance, to get some help, get some idea what I was doing. But I'll tell you what the first when you walk into a classroom and you're going, what am I doing? I'm supposed to be helping handwriting. What does that mean? I was helping somebody's hand that wasn't working before. What do you mean I their hand is working? So it really was an eye opening experience walking in and really understanding what it meant for an OT to be doing handwriting? Yeah, definitely.    Jayson Davies     And I mean, that kind of leads right into dysgraphia.     Cheri Dotterer     Obviously, it does lead into dysgraphia, which is kind of what why I began to really specialize in that. Because one of the questions I was getting was, but my kid can read. Why can't he write? Then people were not making that connection. Teachers didn't understand it. I didn't understand it. I couldn't find anything online. And thank God for the world of the internet, because it has made life so much better that we can find information. I don't know where I'd be if the internet didn't exist, because that is definitely the resource that I use to answer that question. In answering that question, I found a lot of things that just didn't make sense, and one of the questions that you had sent over to me was, why are why is my why are my definitions a little bit different than everybody else's? Well, it's because I didn't understand anybody else's one of the definitions by the dyslexia community was you can be have dyslexic dysgraphia, but not have dyslexia. And I went, huh, it didn't make any sense. I had to figure out what that really meant. So I reworked what they were saying. Found other material to really support where I was going with it, and I came up with six developmental levels, which are in the book, which I fully explain in the book. The basic level is visual, spatial. So really use the sensory, motor foundation and that understanding and that knowledge to create the types so using motor learning theory and the sensory processing foundation, I created the types. The bottom is the visual spatial. Alongside of that is motor. You need the visual spatial and the motor, along with memory, to really have the basic pieces of writing and reading, but then you have to start using them so visual, spatial, motor and memory are mechanical. They are like that. Fizzle, by go, mechanical pieces of of handwriting, word formation and sentence formation really get into the language structure and language of of reading and writing, where, when you get to paragraph formation, you're really starting to use a lot more of your cognitive features, so I consider that the cognitive level. So you do incorporate all of the everything all together along the way, but you still are, are developmentally creating the almost like an inverse triangle. Yeah, you're just kind of building on on each other to to work through the levels of dysgraphia. Now what happens is, if you got something that's not working, you got a brain break, yeah, there's a glitch, and that glitch is what causes the dysgraphia.    Jayson Davies     Okay, so I want to ask you real quick, when you say memory, are you talking like working memory? You know, having seven things in your mind at once. Are you talking about muscle memory? What kind of memory are you talking?    Cheri Dotterer     Okay, that's a very good question, because I'm talking about all of the above plus some. Okay, your limbic system is really where the foundation of how your memory and how your sensory motor is going to be affected by what is going on in your emotions. So part of what I did in my research when I was. Looking at positive psychology research was the impact of emotional memory as well as muscle memory, as well as working memory, as well as processing speed, all working together, that impact, that whole memory level.    Jayson Davies     That's important, because I feel like I often have to sit in an IEP and someone parents teach or whatever, they don't understand how important memory is, because if a kid can't remember the word that they're trying to start writing, you know, they're trying to write the word the and by time they get write down T they don't remember what they're writing, right? And so that does have a big effect, right?    Cheri Dotterer     And one of the things I also learned from a speech therapist friend of mine when we're looking at IQ testing, one of the things that I didn't realize and I didn't understand the delineation of them when I was looking at psychology reports is processing speed is what you're actually see visually. Working memory is actually auditory. I didn't realize that until more recently, which I found out after the book was written. So it's not in the book, sorry, little tidbit of extra information. But yeah, I didn't realize that when you're real, when the actual test, when they're testing IQ processing speed. They're just testing their visual. When they're looking at working memory, it's auditory.    Jayson Davies     Okay.    Cheri Dotterer     So it's good to know, yeah, I I would really had to work through that thought process, because I thought working memory was visual.    Jayson Davies     Yeah, and you know what that that leads directly into what I want to talk about. Because all of us, OTs who work in school based, we sit in those initials, we sit in those triennials, and we listen to the psychologist report. I mean, that's one of the key things, man, I just dial in whenever the psychologist is talking, because there's just so much information in there. But with that, the psychologist very rarely, if ever, uses the term dysgraphia, dyslexia, any of those diagnostic type of words. And I know many out there know why, but I want you to explain why is that?     Cheri Dotterer     Yes, there is a big reason. When you are looking for the words dyslexia and dysgraphia, you will find them in the DSM five. They are medical mental health diagnoses. When you are in the school, you can't be practicing medicine, and that's the big, simple fact of the matter is, if you were to use the word diet, dyslexia or dysgraphia or dyscalculia, it's a medical diagnosis. It doesn't work in the school because you cannot provide a medical diagnosis. There are 13 educational classifications. The educational classification that dysgraphia, dyslexia and dyscalculia fall under is specific learning disability, which really is a specific oral expression, written expression, math expression, disability.    Jayson Davies     Okay, so in that case, say I get a report from my psychologist at the school, and then I get a report from potentially an outside neurologist or something that says, dysgraphia. Should I carry the same weight whether it comes from either or or are there things that I may get from one report that I won't get from the other.    Cheri Dotterer     You may get different information from the two reports I would I would consider both of them equal in weight. The neurologist has the permission to make the official mental health diagnoses. The school psychologist does not. A neuropsychologist will also make that because they are also a doctor, unlike us as OTs, even though we have a big trend of people getting an OTD, it's not the same as a medical background the medical doctor. It's not the same level of doctorate, so we have to really watch where we're treading. And one of the things that I was concerned about when I was thinking about how to classify myself was, are people going to want me to be testing and I had to really make sure that I was clear. I am a consultant. I am explaining the symptoms. I am explaining how those symptoms can be used in a school setting. I'm a consultant for the school setting. I am not a clinical um. Person that's going to be diagnosing the dysgraphia for you. However, I will say that if they can find a neuropsychologist that specializes as dyslexia and dysgraphia, they should run and take whatever money they can put together to get that diagnosis, because they are the ones that have the most understanding of the medical piece and the educational piece interesting.    Jayson Davies     That's good to know. And I'm sure a lot of parents, I'm sure it's not cheap, like you said. They probably do have to in    Cheri Dotterer     the East Coast, that evaluation runs around $5,000 Wow. And so I don't know what it is on the west coast.    Jayson Davies     Yeah, who knows. But as far as Have you had the chance to, like, observe what they do when they diagnose or do you know what types of testing they do, or what they're looking at compared to what the school psychologist would?    Cheri Dotterer     They are doing some of the taint same tests, but they're taking a deeper dive and adding specialized testing that in addition to the IQ, so they have better and more advanced education, shouldn't say better, more advanced education into understanding the whisk and the Wyatt and the Woodcock Johnson, and they can go, that's bot. Doesn't make any sense. Compared to all the other scores, let's just zero in on want that one little piece, and that's where they are different than the typical school psychologist is they have a different understanding of some of the levels. That's not to say that the school psychologist may not the school psychologist may have that same education if they've gone to get some advanced training. There is a book out that has over 300 assessments that can be used by a psychologist and neuropsychologist. So to say, what's the the assessments would be? I'm not there. However, I also went for a course in within the last 10 years from the National Special Education Advocacy Institute. So I am an educational advocate as well as the occupational therapist. Part of that education was sitting and being able to decipher and understand what it meant to have that neuro that school psychologist evaluation in front of you. It was definitely an education understanding what the real meaning behind a lot of those tests were was very, very enlightening, and I think that was part of the drive to really understand how can my child read and not be able to write? Because the I was seeing a lot of those, not those scores that were not making sense with the school psychologist and going, well, there's a problem here. There's a problem here. We need to figure out what it is. So I'm there to support the school psychologist and give a little bit of extra to the report, but we can't make that final diagnosis.     Jayson Davies     Yeah, okay, before we get too far. I mean, we've already we got a lot going on. I'm really digging this conversation, but I know some people out there are really going to kind of want to hear, what do you consider to be like, the core symptomology, or core symptoms of dyslexia, or what does it look like?    Cheri Dotterer     Well, I made it easy for everybody in my book, okay, which is handwriting, brain, body, disconnect. You can find it on Amazon if you hit to page four of that book. It has 18 SIP symptoms. Excuse me, I'm going to read them to you. You can have an idea, because they are very subtle in their differences. Because you're going to look at listen to some of them and going, that's the same thing as what she said before, but if you really dig into it, if they really are not the same. So All right, go for it, writing slower than the typical students of the same age, odd positions of the wrist or the paper, mixing upper and lower case letter forms, inconsistency in forming letters, cramping fingers or hands, irregular letter formation, size, sequencing and line placement, poor letter organization, organization thought process when writing paragraphs also repeat that one, that one didn't make sense. Unorganized. Thought Process when writing paragraphs difficult, managing margins inefficient, pencil pressure, poor. Spelling, intentionally watching their hand while they write, awkward pencil grasp, poor fine motor skills, avoiding writing tasks, letter and number reversals, difficulty with written expression. Need extended time to complete tasks. It's a big, big list, isn't it?    Jayson Davies     Yeah. And, I mean, I feel like it's very encompassing, like, so just about every kid that I work with kind of falls into that.     Cheri Dotterer     And so falls into some piece of it, yes, and, and I don't believe that the research isn't done enough to really say this area, these three symptoms go with this form of dysgraphia. These three symptoms go with this form of dysgraphia. That is one of my long term projects that I'm working on is to really delve into the symptoms and the questions that parents have and that teachers have, and that OTs have to really be able to say that this is happening, try This. So this was a the beginning project of the project. I must say this is the beginning of the project. The research really needs a lot more in depth, specific details, and that is my long term dream is to have a research institute, okay, that's specifically dealing with dysgraphia.    Jayson Davies     That's cool. So we're on that we just kind of identified what dysgraphia is. But you can't really, we've already talked a little bit about dyslexia. How is dyslexia distinctively different from dysgraphia?    Cheri Dotterer     Well, that is one of those questions that has really confused a lot of people, and it did for me for a long time as well. So what I really went and delved into was what is happening when you're reading. When you're reading, you start out by having oral conversation. You apply a symbol to it, then we apply words, then we apply spell sentences, then we apply paragraphs. However, there's a piece of it that is all oral, there's a piece of it that is red, and then there's that piece that is written. So my delineation between dyslexia and dysgraphia is a little different than the dyslexia world, where I'm really saying that anything that's going into the system, anything that's sensory, anything that's red, is the reading part. That's the dyslexia. If it's got to turn around and come back out and it's actually on paper, that's the dysgraphia. Okay, so I had tried to make it easy to really delineate the two pieces because it was very confusing the way the rest of the community and the world was trying to explain it. So I tried to break it down a little bit further.     Jayson Davies     And I'm sure that there's also that difficulty of, if a student has dyslexia, the in, the in, I guess the inward portion of that, you know, the bringing information. In, then you can only, I guess it's not natural, but you would assume that maybe the output would likely be difficult as well. So then, if they have dyslexia, they're probably more likely to have dysgraphia. Is that?    Cheri Dotterer     That is correct? That is correct. The statistics are now saying that 33% of the population has some form of dysgraphia. The research is also saying that nine out of 10 of those students fall on that bell curve that they do not qualify for, like, visual perceptual assessments. And that was one of the other things that bugged me on that bell curve, is so you get an 85 that means you can't get ot Hello. What else is going on that is making it that of a much of a borderline. So I really wanted to look at that person, that kiddo that got the 8485 8687 on all of our standard visual perceptual tests. And one of the things I also learned in the educational advocacy program is there is a clause. In the idea that says that we really shouldn't do one test. We should do a second test to support and make sure that the first test was not a false or.    Jayson Davies     Some sort of outlier or whatever, and be an outlier.    Cheri Dotterer     Yeah. So really, if we want to do best practices. We really should be supporting ourselves and having that second test. The other thing that I found out, and this is one that's going to blow everybody's mind, but there is a research report in a OT, and I do not remember where it is, if I can find it in my journals that I have in my computer, I will send you the article name. But there is an article that says that any child that understands a symbol as a letter and number should never be given a VMI. And that like blows everybody away. Yeah, yes, everybody wants to do it. And this article really blatantly says that the VMI really is null and void for every child that has any kind of knowledge of a symbol or a number interesting.    Jayson Davies     I'm gonna have to look that up, and we'll put in the show notes at ot  schoolhouse.com , forward slash episode 31    Cheri Dotterer     If I will find it for you. Because I know I have it in my journal articles, in my computer. I know I have it because it was one that really blew me away.    Jayson Davies     All right. Well, I look, I'm looking forward to that. I'm sure many people out there listening, probably.    Cheri Dotterer     They will, and they're gonna, like, think I'm crazy until they read it. But, and I hate to tell the person who, the person who invented the VMI of that piece, because I know they account on a lot of OTs to use it, but I have to, I stopped using it, and I use other assessments to work on the the visual perceptual and the visual motor. I actually try to do one that gives me a global and one that gives me a more specific area so I can really look, say, okay, globally, they're right here on the border. Specifically, we only are really looking at maybe figure ground as an issue, or we're looking at visual closure as an issue. So it can really say to the parent, look, overall, he's doing pretty well, but this one area really skews the results.    Jayson Davies     So what I'm hearing you say is maybe you'll do like the test of handwriting skills, as you're kind of over Archer, maybe overarching one, maybe. But then do the DV, or the developmental test of visual perceptual skills, that's kind of your breakdown.    Cheri Dotterer     I actually use the wide range assessment of visual motor abilities, and then I do a DVD.    Jayson Davies     Okay, that makes sense, because the rabma gives you a very broad.    Cheri Dotterer     Gives you a broad. It looks also a lot closer at the three dimensional. And getting that whole, the whole matching piece of that is is three dimensional, where the other tests don't all really hit that three dimensional piece as well. And then I, I do prefer the ths, the test of handwriting skills, over anything else, because it's the only one that has normed values. The print tool is a percentage. It's really doesn't have normed values. The etch I happen to have a little in with somebody who has knowledge of the etch. And there was something, and I don't know all the specifics, but something happened with the scoring of that that it didn't come out as well as they had hoped. So that gave me that uneasy feeling. So I tend to to not use that because it's also very difficult. I don't know how we found the etch, but I found it difficult. However, there's one page in the etch that I use ever, almost every time I'm doing an eval, and that's that back page where it has all the scores on words per minute. Yep, that back page was absolutely gold. Yeah. And to be fair, it's probably a little dated at this point, but it is the only thing. It's the only table that I've found that can give you at least like a starting point for where starting point.  And there are other there are other things that you can find that have been done under the educational platform, but there's nothing that has been done under the OT platform other than on that page.     Jayson Davies     Gotcha, Good to know. Alrighty. So one of the. Questions. Sorry, go ahead. So    Cheri Dotterer     another, another thing that I will really look at when I'm doing a an assessment, as I really do look at the sensory processing pieces to it. And Lucy Miller has a new test out that only came out maybe in 15, called The Goal. I don't know if you've heard of that one. I've heard of it. Yes. The goal is really amazing. It takes from where the sensory processing, the sipped ends, as far as norms go, and it starts there to continue through the high school. Okay, so one, that's one of the reasons I never got sick trained, is because they were like done till I actually got to see them. So this because they only go to, like, age six or something silly, like that.    Jayson Davies     Eight, 811 Yeah, but it's like, weird, cut off point.     Cheri Dotterer     Yeah, yeah. It's just not what I didn't see it as cost to benefit to take that, but I did get goal certified.     Jayson Davies     Okay, cool. So I had this question on here that I wanted to ask, but I'm not sure if it's really the right question, because I was going to ask, How does dysgraphia present differently from a fine motor delay? But it kind of sounds like a fine motor delay could be a potential reason or cause of dysgraphia.     Cheri Dotterer     I believe that you answered that correctly.    Jayson Davies     I don't want to elaborate at all.     Cheri Dotterer     So I believe, I believe, one of the things that we have done as occupational therapists is we've looked at all those symptoms and just never pulled them all together and put them in a nice, neat package and says, Look, parent, this is where we're at. One of the things that I really delved in when I was doing my research for the book was spelling. Because if you look, there's even less information and support on how to remediate spelling than there was about what dysgraphia is, and that's saying a lot, because there wasn't a whole lot on dysgraphia either. And I developed a an alphabet that helps students, so I did some testing with them, so if you were a student who was having trouble with spelling and you spelled like a phonetic speller, how would you spell the word enough, e, n, u, F, exactly. So we got a lot of kids that are out there spelling things like that a lot of times. So you got kids that are spelling, please, pl, Z. I kept looking at it going, how do we get these kids to really understand it? What can we do? And I went back to motor learning theory, back to the basics, back to that whole sensory processing piece. And I came up with a body, sentence, alphabet, and I don't know if you caught the email I sent you, but I am offering it for free to everybody, if they sign up for that link that I sent to you. Okay, so basically, it's taking movement and it's incorporating a movement associated with your body to go along with each letter in the word. So e is your I, N, nose. O, open your mouth. U, under your chin, like the shape of the U, G, give me your hand. H, high five. And what I do with the kids is I start on Monday, when they were looking at their spelling list, and we do these big motions. By the time we get to Friday, I'm looking at and I'm saying, Look, you need to have that in your mind, in your mind's eye, and that's where that whole emotional memory piece really becomes important, because they need to be positive when they're taking those big motions and making them little and putting them into their mind and being able to follow them. Another thing that the Orton Gillingham, the dyslexia community Wilson program, if you've heard those terms mentioned, they use some things called tapping. So to tap out the zip code with each you make that really loud. You hear the sound I'm making. I'm not really at the microphone, but every time you say one of the numbers for the zip code, you tap it out. It really works well for five and 10, but sometimes kids aren't quite sure of the number of taps when there's not five letters or numbers or or 10 letters or numbers. Sometimes they get confused, but the tapping is also something that really helps the students get through there. I noticed one of the other questions you were going to ask me, and I'm going to go right on to this one, is some treatment ideas. That's one of them. The other one that I really is one of my go tos, and I'm working on a project with with this right now, and it's much more cumbersome than I envisioned it to be when I was had the idea. But I'm using mazes, and I'm actually grading mazes and upgrading them and downgrading them, and changing the border width and changing the path width, and really using mazes as a visual spatial pencil control piece. And it's really does help the students really refine the those little fine motor movements that they need to write out words.    Jayson Davies     That's actually one of my the the maze, or it's not a maze. It's a labyrinth, if you want to call it on the bot, as well as the mazes on the M fun or two of my most informative, like just observations that I get from seeing those two parts done, I just get so much because you get to see their planning take out, or you get to see how they're holding the pencil. You get to see if they're making the fine motor movements with the with their fingers, or are they using their wrist? There's just so much that you that you do get to see with one maze.     Cheri Dotterer     So yeah, is it amazing how that that works? The other thing I use a lot is word searches. But I don't use them as word searches. I use them as letter searches. So I have a lot of kids that have so much trouble with the visual scanning, and that is part of the part of the pieces that are going together is their ocular motor and being able to visually scan really impacts the reading piece. So really working with the kiddos that are struggling with reading as well, I really try to use the word searches, and I'll pick out letters that we've been working on that week. I said, find them. Find all the B's. And did you know that A S, T, O, N, E, A stone, are the most used letters in our English alphabet?    Jayson Davies     I did not, but you're just making me think of wheel of fortune at the bottom of the screen.    Cheri Dotterer     There you go. So, so, and r is a stoner, but you know, weird when you say that the R on the end but a stone are the most used letters in the alphabet. But sometimes I don't want to say use the same letters all the time, but when you're looking at a word search, think of a stone as the letters that you're going to be able to find the most because they're the most used letters.    Jayson Davies     Gotcha. Yeah, that makes sense.    Cheri Dotterer     And really, if you watch how the child is circling those letters, it tells you a lot about what they're doing with their visual scanning. Wait, say that again. Watch how they're circling them. Are they going left to right? Are they going, oh, there's an a, oh, there's an eight, oh, there's an eight, oh, there's an A, and they're called scattered all over the board, um, are they missing the middle? Are they missing the outside? Do we have a tunnel vision or a peripheral vision issue going on. It was, and that stems from my years in working with adults were working with strokes and hemiparesis and pieces that I would do that same activity. I would take the word search, cut it into four, and really count the number of yeses and the number of misses and give a ratio and, and you really can tell with the kiddos that just are all scattered. What happened? You just look at the paper, and you go, wow. And, and then you talk to mom or dad a little bit, and they'll go, Yeah, well, they've always had trouble with reading. There you go, visual scanning, where it brings us to one of those controversies, and that's vision therapy. Where, if it really is truly an ocular motor issue, that is the problem, vision therapy will help. If it's not the ocular motor vision therapy is probably not going to help.    Jayson Davies     All right, that's good to know.    Cheri Dotterer     Yeah, that was, I could see by your face that that one took you off guard a little bit.    Jayson Davies     I was like, wait, because and I do work on ocular motor skills, as I'm sure many people do, and that scanning and stuff like. That, you know, putting stuff up on the wall and using the laser pointer and stuff like that, you know. But I don't know enough about vision therapy and vision services, and in the school, it's not very common that we see that no.    Cheri Dotterer     And they don't like to pay for it a lot of times, even though it is covered under IDEA, they don't like to pay for it a lot of times, because you can't get a vision therapist to come into the school. They got to send them out, which takes away time for for their education. And today's education is very difficult to get everything done in the day's time. These teachers have a lot of pressure on them. They do. I don't envy them today.     Jayson Davies     No, not at all. Today, it gets to the point where you almost feel bad about taking out of a student, out of the classroom, because it's like, you pull them out, they're missing something. I have so many kids that get so anxious about missing something in the classroom, and I'm like, I need to talk about this.     Cheri Dotterer     Here's my question to you is, how often do you do inclusion and pushing therapy?    Jayson Davies     I do. I mean, it's not quite 5050, but it's I do both.    Cheri Dotterer     Another thing that I learned when I was doing the educational advocacy class is and this kind of goes against everything that I was learning as an OT is that OTs really shouldn't have their own goal on an idea, on an IBP. We should really be a an SDI and a supportive service related to the written expression goal, yes, so whatever that written expression goal is that the teacher is writing we should be providing objectives underneath it, rather than our own separate goal.     Jayson Davies     Oh, that's a good way. I never heard about the adding objectives underneath it, but that makes sense.    Cheri Dotterer     So it's it, but it kind of goes against the everything that we've learned, doesn't it? Yeah, it's kind of counterintuitive.    Jayson Davies     It is because we, especially if coming from the medical side, you know, we have to have our goal. But I have been, there are some teachers that I have talked my way into those types of goals and explaining, you know, this is why it should be this way, because they're here to get an education, and you are the educator, and I'm here to support them so that they can get that education. And, yeah, in my opinion, that's how the goal should be written in that case.     Cheri Dotterer     So I'm glad we agree on that one. But it really kind of it throws us a lot of therapists for a loop when they hear me say that, they're like, no, no, that can't be. That can't be. But really, if you look into the IEP, and you look at what it really says, I mean, the idea, not the IEP, about the IEP, that's what it's trying to tell you, is that we really should be short term objectives underneath there, and then be really working with the teacher towards that written expression goal, yeah. All right, or the math goal, depending if it has something to do with the writing.     Jayson Davies     Yeah, yeah. All right. I have a few more questions I want to ask, and I want to let you talk a little bit more about your book, because I'm excited for that, and I know everyone needs to at least know about it. Remediation versus accommodations. Okay, what are your thoughts on that? Is there a certain time you know, everyone wants to know, oh, What grade do I stop working on handwriting? Or what are your thoughts on that?    Cheri Dotterer     The research says that you can work on handwriting up and through high school, your brain will solidify the neural pathway when the frontal lobe starts to really get to the end of its developmental stage, which is now they're saying is around 30. Oh, wow, every time I turn around, it's later and later and later. But really the if you're really looking at the neurodevelopmental and the neuro science behind it, you're looking at puberty, their brain, yes, it's growing, but they also have all those hormones going on in there. Their brain doesn't have enough time to shift between education and hormones and everything else that's going on, right? It's really a bad time to stop. It's really a bad time to stop. And motor learning theory says practice, practice, practice, continue to practice, even if you are converting over to keyboard, still having that practice and really, truly the whole Common Core and taking cursive out of the system, yeah, was not a good idea, nope. And there are states that are putting it back in. Mm, hmm. Yeah, and I sigh, because it's, it's really bothers me. But one of my goals will always be that the child will be able to write, make their signature. I mean, we're granted if it's feasible. Now I'm looking more at learning support students who have some writing skill, yeah, they will be able to write their name. The other thing that I really see with a lot of these kids with memory issues is they can't remember their basic demographics. I've been working with one student this year who is in fifth grade. It has taken us till now from September that he can remember his name, address, phone number, date of birth, and know how to spell the words he still doesn't have the month, right? Yeah, but he doesn't even know how to spell his middle name correctly. It wasn't one of those things that was forced. We haven't even started working on writing his name in cursive, but that's one of the things that mom agrees with me before I discharge, that he needs to be able to write his name. Yeah, and it's sad. It's so sad and frustrating. These kids are not going to be able to read the Declaration of Independence. They need to have some kind of ability to recognize those letters, whether they can still write them or not. They need to be able to recognize it so they can try to decipher them. Yeah, because a lot of them are a lot different looking, they've also made some major changes because of the US mail system. The Q that used to look like the letter two is no longer valid. You need to make your Q like an O with a like a printed o with kind of like a blend between a printed O and a cursive O, because the new computer systems were mistaking the two for the queue for a two, and really having problems. So you have to be aware of those things. And then you look at some of the writing systems that are out there, they haven't caught up.     Jayson Davies     Yeah? Well, I mean, even when you're trying to make a worksheet for your kids, and you're trying to use your computer, you have to figure out what font to use, because, man, you get you get the century Gothic.     Cheri Dotterer     Use century Gothic. So I'm going to say on that one, there we go. I did a webinar about two years ago and how to make your own paper, and I went through all the major handwriting programs, because they're all slightly different. I went through Excel and I went if you're using this handwriting paper, you use this size spacing pixels to create that size of a letter for your child. It was, it was absolutely crazy. I still have that the video, which I need to put up on my your website, on my website again, because I don't know that I could live through doing it, repeating it again, because it was just very intense, and it takes so much work to create worksheets, and also it takes a lot of work to change worksheets that are already produced so that students who have issues can manage them. One of the issues I keep running into with figure ground is too much color, too much on the page, so separating the worksheets down to having one problem on a page, mom looks at me and goes, You're kidding me, and goes, No, right, too much paper. It's child's Look at me, going, that's the only way I can answer it.     Jayson Davies     Yeah. Okay, so that leads me to, I'm going to combine these two adapted paper and adapted pencils.    Cheri Dotterer     Okay, can I tell you my go to paper? Can I be honest? Can I can I tell you the world?     Jayson Davies     Most people know that we have our own paper, but go for it. Whatever paper you use.     Cheri Dotterer     My go to paper is the size matters. Handwriting program, okay, there's a research based program. It has all the varieties of different papers that you can come up with. I've even used the paper and came up with my own. Whatever works for the student is what you got to use. Well, yeah, whatever works for that student is what you got to use. Adaptive. Um pencils, adaptive grips and all that stuff. Same thing, the same thing. It's whatever's going to work for the student. Some students really, absolutely do not have the strength in their fingers to hold that pencil. That's a standard pencil. They just don't have the strength um doing I call it the the jellyfish that that one where you're going in and out with your hands. Kids can't do it. Yeah, and they, they their hands cramp. They don't know how to deal with it. They don't know that inverting the prayer pose really changes the strength or the stretch on the flexor muscles, and really will stop a cramp.    Jayson Davies     No idea.     Cheri Dotterer     Pressure, pressure points in your phenar eminence, squeeze it as hard as it can, and it's going to hurt. You got to tell the kids, make your make your hand hurt, because when you leave go, it's going to feel fine. So teaching them the trigger point and the the inner eminence, and teaching them the little tricks like that that they can do that aren't going to take up time in the classroom, and they kind of don't even have to realize if they doing those things a lot of times they're doing them naturally. They don't even realize it.    Jayson Davies     Gotcha. All right. Well, I have one more, and this was from someone on Instagram. Her name's Laura, her hashtag or not, her hashtag. Her name on Instagram is the OT butterfly, and she wanted to ask if you have any tips for setting expectations when talking to parents who have been told their kid has dysgraphia or what your thoughts are are on that.    Cheri Dotterer     Incidentally, sidebar, I love the OT butterflies. Ot challenge for the month of April, and I know I never got to put a post every day it was blow blew me away. But I just want to say the OT butterfly that she had a great ot challenge, and I would like, I'm I have it all listed out, and I'm going to continue it. It's just not going to be every day. But as to answer her question, which was, gosh.    Jayson Davies     That's all right. That's all right. It's a Monday night. We're getting through this. Do you have tips for basically, parents and setting expect, okay, parents found out, like my kid has dysgraphia. What? What? Okay, what are we telling them?    Cheri Dotterer     I would explain to them that what I told you earlier are on in the conversation where dysgraphia, dyslexia, dyscalculia, are medical diagnoses. In the school setting, we need to use educational classifications. They are there's only 13 of them, whereas if you look at the DSM five, there's how many plus there's how many ICD 10 codes. So trying to explain where we're getting the numbers from and why we can't use the medical numbers in the classroom might help a parent look at the symptoms. One of the phrases that we used in the educational advocacy program was, what does it look like? Explain what it looks like, because then you're going to be looking at the symptoms and you're not going to be making that diagnosis piece. So the diagnosis piece can't enter into the world of the education, it can only stay in the medical model. Worry about the symptoms and look at the symptoms and for yourself, figure out, are they visual, spatial? Are they motor? Are they memory? Are they those foundational pieces that are impacting word, sentence and paragraph formation, and find ways to be able to work across the spectrum and help out. Incidentally, one of the things I haven't really said was we can work on paragraph formation with students we, as OTs, can work with all levels of dysgraphia. We need to create accommodations and modifications and educate the parents and the teachers on those educational pieces. That's where we that's where our expertise is. Task analysis.    Jayson Davies     Yes, yes, I completely agree with you. In fact, I just got an email from one of my case carriers and showing me a, you know, five paragraph essay that this kid had written out, and he just can't put a paragraph together. Yeah. I mean, he has a page and a half, two pages of written something, but there is no organized. Organization to his paragraphs. And this is a high schooler.     Cheri Dotterer     And one thing that, yeah, one thing that you can work with them on, is just identification. So think about it. When they were younger, when we were first teaching them the letters, they need to identify the letter before they could write it. They don't know how to identify parts of speech. They're not there's no time to teach grammar. They don't understand the parts of speech. I'm working with a kiddo right now where all we're doing is, okay, here's a sentence, and we're color coding the different parts of speech. I'm not teaching language. I'm helping him identify and using color coding and working with those pieces to help him go, oh, he he will. And he was also having trouble with text to speech and speech to text, getting kids to slow down is another piece of the puzzle that they're not being taught how to do, because education is so we've got to get all this done, and it's boom, boom, boom, boom, Boom, boom. We, as OTs, need to teach those kids how to relax. Yeah, absolutely. We need to teach mindfulness those pieces, those augmented pieces that we don't necessarily think of right away, that are going to really affect dysgraphia. Well, they are, because they're affecting that whole emotional memory. Yeah, yeah. Alrighty.    Jayson Davies     Well, that's fantastic. Thank you so much for all that I want to give you now the opportunity you've got this book, it just came out. It will have been out for like, a few months, maybe two or three months by time this podcast gets out there. But it's the handwriting, brain, body disconnect, adaptive teaching techniques to unlock a child's dysgraphia for the classroom and at home.    Cheri Dotterer     Yes, thank you. Yeah, it's in there. What is in there? The book starts off telling you what dysgraphia is, then it talks a little bit about reading, then it talks about writing, then I go into the whole neuroscience behind reading and behind writing, and I talk a little bit about where the glitches are that create problems. We didn't really get to talk about this a whole lot. But why do you think a child could might have trouble reading versus writing? The short answer is they're coming from different parts of the brain, but teachers don't know that. We learn it, but maybe don't retain it. Yes, then I talk about the strategies at the end of the book, and we really go into where, since the visual, spatial, what's motor, what's memory, and I go and I break them down, and I talk about each one of the levels, and give provide strategies that you can use in the classroom. It's been amazing. The feedback I've gotten, knock on wood. I haven't gotten any negatives yet, but I'm waiting for that to come. But everybody has said that it has been an easy read. I have one person OT, mind you, so she has some background. It wasn't a parent, but an OT told me that she read 70 pages in one night. Wow. I was like, wow. That blows my mind. So that proves to me that it is an easy enough read for the person who doesn't understand the details. That was my goal was to break it down so that a parent could understand it. It is not a textbook. It is not a neuroscience book. It's a book to educate parents and teachers who haven't been able or haven't been educated in this area, so that that's where we would and then the very, very end of the book, I do go into some the IEP, some accommodations and some goals that we as ot standalone goals that we could use that incorporate all ADLs, instrumental ADLs that reflect that are also reflective of dysgraphia as well.    Jayson Davies     Gotcha. Well, that's great. You know what? I had no intentions of doing this, but I'm gonna go on Amazon right now. I'm going to purchase your book. Whoa.    Cheri Dotterer     Thank you.    Jayson Davies     Yeah. Course, I'm also going to purchase a second copy of the book, and I'm gonna give that out to someone who actually who screenshots a picture of them listening to this, this episode of the podcast, Episode 31 and tags us in a social media post. So ot school house in a social media post. Again, all you got to do is screenshot your phone or take a picture of yourself listening to this episode and then put together a little clever caption, whatever you want to do and tag us on Twitter, Instagram, Facebook, you know, using the at ot school house. And I will choose one winner a week from now, and I will send the book to them. So I'm going to be reading it, and I hope someone else will be reading it right alongside me and listening to the podcast. So I'm excited to do this. Wow, that's amazing.    Cheri Dotterer     And I will, and I will send them. Will send a second person a copy, and both people will also get a copy of my bookmark. Hold on, Jayson, I have a bookmark that on one side has the symptoms and on the other side just has the types of dysgraphia. So I'll get a couple of those sent out to you.  Sounds good. All right, thank you. I appreciate you doing that like I said, Man, we just make things happen here.  So yeah, some and some things I have coming up with a couple, a webinar that I have on my website that you can take for a low cost. That's one hour, just a quick overview of the entire beginning of the book, overview of the types of dysgraphia. And then there's an in depth eight hour eight hours worth of video, plus some really intense educational pieces that it all ultimately is a 90 hour course, wow, you do everything that's in the course, it takes about 90 hours to get through it. So there's a continuing ed course on the on the website that you can take as well.     Jayson Davies     Awesome. Well, we spent one hour with you this evening, and I'm sure we could have gone three. So at least that's awesome. I love it. But yeah, again, one last time. Where Can everyone get a hold of you?    Cheri Dotterer     Sure, dysgraphiaconsultant.com .     Jayson Davies     Awesome. And I know you're also on Facebook, Instagram, Twitter, everywhere.     Cheri Dotterer     I'm on, yeah, I'm on Facebook and Instagram as dysgraphia consultant, I have a Facebook group, handwriting, brain, body, disconnect, the name of the book, and I am on LinkedIn under my name because they don't. They make you do a company. My company is on there, and I am putting up articles and under the company name up in LinkedIn.    Jayson Davies     Great. And like always, we will be sure to have all the information on the show notes. You'll get that that link in just a second here, as well as everything right below. If you're listening on iTunes, you can just scroll down and you'll see a bunch of links. Go ahead.     Cheri Dotterer     I do have another favorite to ask of your audience, though. Yes, go for it. I have been nominated for the author Academy Awards, so I will if everybody, anybody who is listening to this, can after they're done with their looking at whatever it is they need to do to find me, go on to author Academy awards.com click the red button that says vote, and then page down a little bit, you're gonna see a thingy. We can scroll left and right. Scroll to page six, look for my book and click on my book.    Jayson Davies     All right, that's simple, yeah, that's simple.    Cheri Dotterer     And go find out. I'll try to I'll put the directions. I'll send you the directions, and so you have the actual link and such.    Jayson Davies     Sounds good, Alrighty, well, Sherry, thank you so much for coming on. Really appreciate that I learned so much tonight, so.    Cheri Dotterer     I hope you can absorb it. It it might take you a few times listening to this episode, won't it?    Jayson Davies     Maybe we'll see. But I'm going to try and use some stuff this week that you talked about, so it's going to be wonderful.    Cheri Dotterer     Wonderful. If you need to get a hold of me and ask questions, you can give me a buzz my my email is info at dysgraphia consultant at.com but you can always look at look it up on the website. Sounds good? Consultant.    Jayson Davies     Easy enough. Alrighty. Well, thank you, Sherry. So much for for coming on and it's a great episode. Take care and have a great rest of your evening.    Cheri Dotterer     Thank you. You as well. Bye, bye. Now, all right. Well,    Jayson Davies     that was Cheri Dotterer, aka the dysgraphia consultant of dysgraphia consultant.com and as she mentioned, she does have her new book. It is called the handwriting brain, body disconnect, adaptive take gene techniques to unlock a child's dysgraphia for the classroom and at home. Also, real quick, we kind of touched on it in the end of the podcast there, but I. Uh, as for the giveaway, there will be a total of two books as well as two bookmarks, along with those books that are going to be going out to two lucky winners that do take a picture of how they listen to this podcast, basically screenshot you listening to it or whatever, post that on social media, tag at ot school house, and we'll be sure to pick a winner in a week from now, which will be June 4, is when we will select our winner. So thank you everybody, and we'll see you next time on the OT school house podcast. Take care.    Amazing Narrator     Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 30 of the OT Schoolhouse Podcast. In this episode, Jayson interviews Dr. Stephanie Foster, PhD, OTR/L, and her daughter, Nicole Foster on the effects of technology use and the promotion of healthy balance. Dr. Foster is a veteran pediatric occupational therapist with specialized training in Sensory Integration and the Therapeutic Listening Program among other programs. She also runs her own pediatric clinic right out of her garage. This created a unique experience for her daughter Nicole, who basically grew up in a sensory clinic with a parent who understood the need for a balanced life. Dr. Stephanie Foster, PhD, OTR/L, and her daughter, Nicole Foster embrace in a loving hug. Notice the lack of technology in the picture as they share a fun and memorable moment together! Listen in, and earn professional development for doing so, as Jayson Interviews Dr. Stephanie Foster, OTR/L, and her OT-bound daughter, Nicole Foster, on the current state and future trends related to technology use among teens. ​ Objectives for this Professional Development Podcast Listeners will: 1. Learn current trends related to technology use among teenagers and why this may be problematic. 2. Become familiar with some of the current research related to development in a world with technology. 3. Understand how the Transtheoretical Model of Behavior Change can be used to assist those who may be addicted to technology. Links to Show References: Have a question for Stephanie & Nicole? Visit Dr. Foster's website at www.kidswork.biz ​ Click here to email Dr. Foster ​ Talking Back To Facebook: The Common Sense Guide to Raising Kids in the Digital Age (Book & Affiliate link) The title of this book really says it all. And as Dr. Foster said, "There is no going back." Social Media is here to stay and all we can do is learn to adapt. ​ Stanford Marshmallow Test: Carlson, SM, Ozle, A., Schaefer, Catherine et al (2018). Cohort Effects in Children’s Delay of Gratification . American Psychological Association Vol. 54, No.8, 1395-1407. Zickuhr, K. and Smith, A. (2012). Digital Differences. Pew Research Center. Retrieved from http://www.pewinternet.org/2012/04/13/digital-differences/ Cash, H., Rae, C. D., Steel, A. H., & Winkler, A. (2012). Internet Addiction: A Brief Summary of Research and Practice . Current Psychiatry Reviews, 8(4), 292-298. Doi:10.2174/157340012803520513 Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Abby, hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.     Jayson Davies     Hey everyone, and welcome to the OT school house Podcast. Today we have on two very special guests. Actually, we have a mother daughter combo to talk about the effects of technology on human development, but primarily in teenagers. So this is going to be a great one for any of you. OTs working in middle schools, and especially high schools, so stay tuned for that. But first, I have just a few things I want to say. And first this episode, there is an option to earn one and a half contact hours of professional development or continuing education. And you can take advantage of that and see the show notes at ot  schoolhouse.com , forward slash episode 30. For this episode, Dr Foster has graciously provided me with the slides as well. For anyone who does purchase the professional development opportunity, you will receive a copy of those slides to reference to in the future. Also for this episode, I felt like doing a little something different, something special, and so I want to offer to anyone who listened to this podcast within the first week of it, releasing a 25% discount on that professional development opportunity. So all you have to do is go to OT schoolhouse.com , forward slash episode 30, within the first week of this episode, releasing and purchase that professional development it will be 25% off, and that is without any promo code. You just have to do it by May 21 as this episode is releasing on May 14, 2019 and last, but not least, before we head into our introductions, I just want to let you all in on a little secret. Maybe you haven't been listening to podcast for very long. Well, podcast, you can actually speed up. And so you can listen to them at one and a half times the speed. Some people even listen to them at twice the speed. And so in this case, that means you can earn an hour and a half of professional development in about an hour by just hitting the little button on your podcast players. Usually down at the bottom, you might see a 1x and if you click that, it might turn into a 1.25x or something like that. And so I just wanted to let you all in on that little secret, in case you want to listen to the episode a little quick or get through it and still get the content. So without further ado, let's get into introducing Stephanie and Nicole Foster. Dr Stephanie Foster is a licensed and registered occupational therapist here in California, and she currently owns her own clinic here in the central coast of California, where she primarily works with children of all ages. Dr Foster has received specialized training in the sensory integration and Praxis test, also known as the sipt. Many of you learned about that back in episode 25 but she also has specialized training in the wheelbarger Brushing protocol, as well as the therapeutic listening program and vision therapy. And not only has Dr Foster received specialized training, but she's also contributed in some form to the development or data collection for several of the tests that you've probably well, you're probably very familiar with them. Some include the sensory profile, the bot test of motor proficiency and the Miller functional scales, assessment tools, also known as the M fun in 2011 as part of her PhD at the Santa Barbara Graduate Institute, Doctor Foster completed a large qualitative study entitled The relationship of prenatal perinatal and developmental risk factors on children's sensory processing patterns that looked at several factors that made children more prone to developing a sensory processing disorder. Also joining us today is Dr Foster's daughter, Nicole Foster and Nicole is currently a third year kinesiology student at Cal Poly San Luis Obispo, and we're very lucky to have her, because she has a lot to add to the topic of teenagers and technology. So let's jump into it. Here is Dr Stephanie Foster and her daughter, Nicole. Foster, hi. Dr, Foster, Hi, Nicole. How are you doing this evening Dr, Foster?    Stephanie Foster     I'm very happy and excited to be talking with you tonight. So I'd give this a thumbs up evening.    Jayson Davies     I love it. And how about you, Nicole,    Nicole Foster     I'm doing well too. This is great, and thank you for this opportunity.     Jayson Davies     So I was just sharing in the introduction how you two are a mother daughter combo. But I actually want to give you the the chance to talk a little bit about this dynamic that you guys have going on with occupational therapy and the family and and the mother and daughter kind of working together a little bit.    Stephanie Foster     So it's a real privilege and an honor to to get to work with my daughter. I've always I've been an OT now for over 26 years, and I've always tried to integrate my work. As much as possible with my children and with our home life. And you know, from the actual physical location of my clinic, I run a sensory integration clinic that's very small and private, right out of our home. And I've always integrated my children. They got to be my Toy Testers for us. Yeah, they are well tested. Whenever a new assessment came out, my children provided me with what we hopefully, what we call hopefully normal development, and they let me practice on them for at all stages.    Jayson Davies     Let Did they let you? Or did you just do it anyways? You got it    Stephanie Foster     when we're talking about throwing balls and drawing pictures, I didn't have to do much more. So of course, I'll come out to your room, sure, and    Jayson Davies     it's not like they had to go very far to get to the clinic. You know, everyone listening can't see this, but you guys are in your garage slash Occupational Therapy Clinic, doing this interview right now. And you gave me a little tour of it a second ago, and it's pretty darn nice. I mean, for all purposes, it works out well, right?     Stephanie Foster     It does. It's really a great business model, and really helped me to balance my roles, even as a professional versus as a parent. I found a nice balance in working at home.    Jayson Davies     nice and obviously the commute is unbeatable, and you were also able to be home. I mean, one of the reasons that I have aspirations to own some sort of business where I can work for myself is because of the kids. And it sounds like you were always able to be home, and they came home from elementary school or whatever, and you were there. So I'm sure that was a blessing.    Stephanie Foster     Is a huge blessing. It gave me a lot of control. It gave me a lot of flexibility.     Jayson Davies     Awesome. So right and close, right and close Exactly. So Nicole, tell us a little bit about yourself. Where are you at in life right now?     Nicole Foster     Yeah. So currently, I am a third year kinesiology kinesiology student at Cal Poly San Luis Obispo. I do want to be an occupational therapist, so this has been just a wild ride to be part of this project. Definitely growing up as the daughter of an occupational therapist has really given me the exposure to kind of explore what I wanted to do. And like you said, I grew up with this clinic in in my garage, my own little play place. I don't it was, I don't remember how old I was, but I definitely was. It took me a while to realize that, like, this wasn't my space clinic.    Jayson Davies     That's funny. Were there any like set rules about the kids in the clinic?    Stephanie Foster     Put away whatever toys you pulled out? That's pretty much it. We also had a lot of strict rules about if you ever saw a child here, that you saw in public, that they could never identify, that the key that my children learned early on that privacy is very important. Go    Jayson Davies     HIPAA, yeah, absolutely, that's important. I mean, I never thought about that part when you told me that you worked out of your garage and that the kids are always around. Never even thought, because they were probably going to school with some of the kids that you might have been treating so definitely very important.     Stephanie Foster     So then it was always, yeah, very privacy is important. They couldn't identify him in the playground, same rules that we would follow. Yeah, of course, practitioners, I do have to say, though, that the other benefit of working out of your home is we have probably the number one place for kids to sleep over.    Nicole Foster     All my friends, even in the high school, love coming over because we have crash pads, we have swings. We have basically everything you'd need for a sensory integration treatment room, but we could actually play with it treated, you know.    Jayson Davies     Yeah,    Stephanie Foster     and they would fight over the ball pit, like, who got to sleep.     Jayson Davies     Of course, every kid fights over the ball pit at some point.    Stephanie Foster     Play great movies while kids are watching both it sitting in the ball pit.     Jayson Davies     Yeah, cool. So today we're here to talk about some technology use among teenagers. And my first question really is, why did you decide to start looking into technology among teens?    Stephanie Foster     You know, I, like we just discussed. I've always tried to integrate my professional journey and my role as a parent. And as we were growing up as parents, we were part of that age when we remember when there wasn't a phone. Slowly the phone became more and more prevalent, and I was thought, I felt I was a responsible parents. So as we gave our kids phones, we also gave them boundaries and rules on when to use them, how to use them, what kind of content that they could look at, and we found that we thought we were doing everything right, but despite our best efforts. Yes, we have children that follow those rules, and then we had children also that thought that they didn't have to follow those rules. And surprisingly, you know, through my children's adolescence, they balked against the rules, and it left us in a quandary, what do we do? It's it's a great opportunity to be able to have a phone, but it caused a lot of problems, rift rifts and stress in our families. And so it wasn't until I kind of turned it around and said, Okay, I might I must not be alone in this, struggling with this, that I kind of turned to my ot roots, did some research, started asking around for help, and then I was able to dig up some really good resources and created the talk, created the early development of this talk.    Nicole Foster     And then somewhere along the way, I jumped in, because I felt like teens needed to be defended, to be completely honest, that was that was my initial reaction, but It also gave me an opportunity to look at the research myself and to engage with why the rules were the way the rules were, and that helped me to kind of be the advocate for teens, but also be like, here are some better ways, or Here are some ways that I think, me specifically, I think would work to help this transition between no technology to technology flow better between kids and parents.     Jayson Davies     Gotcha, Perfect. Well, I mean, let's just keep going with that then. So what is the definition of technology that we're going to talk about today, and I guess leading off of what you just said, you know, parents and kids look at technology differently. Is it the same for both, or is it a little different if you're a teen versus an adult?    Nicole Foster     I would argue that it needs to be the same, or at least the definitions need to be understood. We are specifically talking about any instrument utilizing a virtual interface as a means of finding, learning, communicating and relaying information. Um, that includes the internet. Um, a more specific term for this could be specifically communication technology. So we just drop the communication and talk about technology. This is your phones, your computers, your TVs, those kind of devices that would help you communicate with other people to access that information, but specifically, like they have a screen, you know, it's not a book.     Jayson Davies     Absolutely, so right now, then, what are some popular trends among teenagers and technology? What are they using?    Nicole Foster     So teens are probably using smartphones the most. That's got to be the computer that's in your pocket. We're seeing a lot of wearable technology like Fitbits and Apple Watches, which have increased connectivity between individuals. We've also got a lot of lot of computers. As computers are moving into our classrooms, especially as college students are you know, it's really easy to take notes on a computer. So there's our more technology available to consumers, and we see it everywhere. We've also got TVs that have been around, you know, since TVs we've been around and we've got, yeah, that's mostly it.     Jayson Davies     Computers, iPads, tablets. Tablets, I count that as a computer, but yeah, I mean. They're just as powerful now, so definitely exactly all right? And so now we have all these devices. You're right, not, not everyone has every device, and most prefer one device over over the other, right? For the most part, you can do the same thing on just about every device. And so what are we seeing teenagers using technology, mostly for?     Nicole Foster     Communication and entertainment. Would be the biggest things that teens are using technology for?    Stephanie Foster     Yeah, I think Nicole hit it right on the mark. Impact. We just asked the youngest teenager in the foster family, and she said, and don't forget, entertainment.    Jayson Davies     And so entertainment being games and Okay, so any type of media that you just take in, and kind of, I think of it as almost passive intake when I think of entertainment a little bit. But there are also, like games which are very not passive and very active. So I guess I can't just say passive, yeah. And so what does the research say about social media and teens? Is there some research out there    Nicole Foster     according to the Pew Research Center. In 2015 most teens were using technology several times a day or less. Um, but in 2015 or in 2018 when they redid the survey and they found that 95% of teens are almost constantly on some sort of device, they're online, they're on their phones, they're on their computers. So that's an incredibly significant jump. As far as their views on social media, those can be pretty ranged again, by the Pew Research Center, about 45% think that. 45% of US teens say that social media has neither a positive nor negative effect on people their age. So that's our biggest group. But 31% say it's mostly a positive effect, and they cite that being connected with family and friends is really important to them, and that's what most social media is supposed to do. About a quarter of teens believe technology is mostly negative, and the biggest reason for that is cyber bullying and rumor spreading. I interpreted these results as teens, in general have a pretty realistic view of technology, and as a group, they're aware of a lot of positive and negative effects of it, yeah.    Jayson Davies     And my only take on that is that this was, it sounds like a self report correct, as far as we know. And so this is how people feel about their own personal use and or just the use of cell phones or technology in general. And I know, and I don't, I don't necessarily expect you to have any information on this, but maybe you do is that I'm sure there are other people now that are looking from the outside in and looking at what the actual effects of someone using technology greater than eight hours a day, or something like that could be and I'm starting to see more of that coming around, where there's people it's not just a survey, it's more of an actual research that they're taking qualitative data on. And I'm sure that's going to continue to pick up, as those numbers that you're just talking about a dramatic spike in three or four years of how often teenagers and adults, I'm sure, are using technology every day. So yeah, how do you feel? Do you agree with the findings of the positive and negative sides of technology    Nicole Foster     for the most part? Yes, I do think that technology, specifically the internet, has allowed us to stay connected to friends more. I mean, I have friends overseas, and it's been really nice to just text them instead of writing letters. Also, information is a lot easier to access, right? You can Google anything, but that comes with its downsides. You are more exposed to false information, wrong information. You are exposed to negatives. Could it like the teams are identifying as bullying and rumor spreading. You also have the pressure to have a personality like a specific way you present yourself online, and that could be really life destroying if it's not what you need it to be.    Jayson Davies     So what I'm what I'm hearing you say, is that some people are trying to pretend to be someone online, that they may not be in real life, and that's kind of the new peer pressure is online peer pressure in a way that people are expected to, you know, take the perfect selfies and and post or reshare this person's post versus this person. You're not allowed to share their post or something like that.    Nicole Foster     So that that that phenomenon we're describing is called the E personality. It's the idea of you have a specific way of presenting yourself online. And yeah, there is high pressure for teenagers to present the best version of themselves when you're online, gotcha.    Jayson Davies     And so, I mean, obviously this is, this is a growing phenomenon, like we were just talking about the the numbers are extreme and changing. What guidelines are out there among well, for anyone, for technology use, is there guidelines for teenagers versus kids or for adults? I don't know who wants to take that one.    Stephanie Foster     Yes, absolutely, because of the prevalence of technology use, the American Academy of Pediatrics has actually come down very firm and very clear on the appropriate media use for children's all the way birth, all the way up.    Jayson Davies     Oh, okay, and so what does that look like?     Stephanie Foster     So here's and here's one of the. Good things that even over the last 10 years, that recommendation hasn't changed. So we checked recently just to see if our doctors are changing their minds, and it actually they're standing firm. So the recommendation is there is never a reason to put an infant in front of media, period.    Jayson Davies     All right, that's pretty clear cut.    Stephanie Foster     And that, I love that they are very firm on this, that really, there's no reason to put any child or toddler, anybody under 24 months old, in front of a TV. The only time that they say that it might be okay is that if that media allows for connection, and they're talking about having a video conference with your grandmother, who lives on the other side of the country, so so that it's okay to Skype with your grandparents as a way of connection and building relationship, but they do. Doctors do not recommend putting a child in front of a TV as a manner of babysitting so that the mother can get dinner cooked or the father can cook dinner. They further pull that out sometime between 18 months and 24 months that it is okay to watch high quality, educationally based movies, but that needs to be done together. So it is okay to put your two year old in front of it, Sesame Street movie, as long as you're together again, never separate, okay? And then as the children grow, the recommendation is for kids two to five years old, only less than an hour per day. And I like that again. I like that a lot, because that's another time when parents can be sitting with your children. They call it co viewing, or just cuddling and on the couch and watching together. And not only is that a time for really good, physical connection, but it's also a time where parents can then say, how does this relate to our world? What is it that we're watching, and how does it relate to the real world?    Nicole Foster     I mean, not in those words, because the five year old, wouldn't you, but that's the idea is, it's, yeah, it's building family, it's building connection.    Jayson Davies     So I remember when hearing you both speak at OTEC, the recommendation for anyone after five years of age was less than two hours of technology a day. But aside from that, what other guidelines are in place that we should try to adhere to, especially when it comes to our kids are, you know, older than five, but still.     Stephanie Foster     Kids after that, we just want it to be so that it doesn't get in the way of function and playing outside. Okay, kind of recommendations are to always have a parent monitor what they're doing for media content, to avoid fast paced programs, to avoid violence in the programs, to turn off the media when it's not in use, so that your movie in the background does not provide the background noise in your house. Okay, actually, watch a movie together and then you turn it off. Okay? They also recommend keeping your bedrooms meal times and parent child times screen free, so we don't bring our phones to dinner table, right? We don't see each other enough anyway. But meal time is not a time that we can look stuff up very, very strong recommendations and good research coming out on the use of screens one hour before bedtime, that we do know that affecting having looking at your phone an hour before you go to bed can actually interrupt your deeper levels of sleep.    Jayson Davies     Yeah, and I will absolutely admit that I'm guilty on that one, and I noticed the effects last night was not a good one. I stayed up. I stayed up late, on top of that, and I was basically on my computer until I basically shut my computer and walked to bed. And so it was hard to fall asleep, and it was late. So now I'm like working on a little sleep right now. But yeah, so I, I'll raise my hand. I'm guilty on that one.     Stephanie Foster     So, yeah, so you did notice, like, racy thoughts and difficulty settling down, yeah.    Jayson Davies     And then I jump into my mindfulness practice and start to slow down my breathing and to offset but hopefully, you know, I need to, and I am mindful of it, and I I make the conscious decision to disregard it, even though I know that it is best practice and evidence based, and I should be doing it. But, you know, knowing it versus doing it, two very different concepts. So, oh, yeah. So. So what was that?     Nicole Foster     Oh, I was just gonna say that, in and of itself, is one of the problems why parents have issues getting their teens to follow these rules is knowing it versus just following a rule.     Jayson Davies     Yeah, so I'm gonna, I'm gonna come back to that in just a second, Nicole, but your mother was talking about, actually, she used the very key word that, like I picked up on and babysitting, letting an iPad or a phone do the babysitting. And I just want to get your thoughts on that, because I see it. I see it too, and and your thoughts can totally be like that. Maybe we shouldn't call it babysitting, or maybe we need to call out parents more or what, because it's it's a hard term to use, and so I want your thoughts on that.    Nicole Foster     Oh, I was very empathetically shaking my head, no, don't ever, ever do it. One of the things I'm learning is from all this research, is technology should never be a substitute. It is a tool, and using YouTube or using Netflix shouldn't be a substitute for other forms of entertainment, especially because screens have such an impact on neural development in kids. So, yeah, don't, don't. Don't put your kid in front of a screen just so they will be quiet. You're I don't think that that's in the long term, helping children develop skills that they need later in life.    Jayson Davies     Yeah, and I absolutely agree with that. I think that's right on. So my thing, and maybe you're, we're not quite there yet, but I think this is going to be, eventually, an area of practice that there will be. I don't know if it's going to be OTs, hopefully it will be, but people that are helping, helping parents to help their kids with technology. And where do you see that going in the future?    Stephanie Foster     Well, even just in our own case, just getting the word out there, that there, that that schools and that society is so pro use of technology across the board, whether whether you are in an academic setting or you're in a grocery in a store, there's just pushing, pushing. You can use your phone anywhere you're at and the response that we're getting from this message that we need to promote some balance has been really wonderful. Where I offered to give this talk two years ago to a school system, and the superintendent told me she really wanted the teachers to buy into it, and she didn't want to present the other side. And we presented this idea in the last couple weeks to present it to the same school district, and the superintendent is ready to bring us in for parent education night.    Jayson Davies     That's important. What you just said, actually, because I did a similar thing, I actually gave a presentation about the importance of play to a group of parents at a school about a month ago. One of the things I said was, you know, we need to limit technology. We shouldn't rely on technology. All that to parents, and I was actually doing this at my wife's school. She's a fourth grade teacher, and then afterwards, she comes up to me and she's like, it was great, but our school is so heavily focused on technology use, right? I mean, there's high schools now that have a that they provide students with a computer, and every student on campus has a computer, and it's just like the evidence is saying we need to limit technology, and here we are putting it and forcing it down their throat basically seven hours a day, right? And so I again, this is going to be a topic of discussion for many years to come. I believe so going forward, if I remember right, you have some information as far as brain development and how, potentially, what we need to look at as far as technology and neuroplasticity. This is a awesome topic, and takes a little bit go ahead and and let us know what you're thinking as far as the neuroplasticity and technology. Sure.     Stephanie Foster     Let's start with just a very brief review of brain development, I have so much respect for the way our body is wired and that we naturally and beautifully develop and and you probably know that prenatally, your brain is the first structure to form, and then by the time that What do we call neonate, reaches six months gestation, they've already developed a lifetime supply of neurons. So even before the baby's born, they have what they need structurally at birth, a baby is born with 100 billion brain cells. Now these are immature pain. Brain cells, but the baby has everything that they need to live and to grow throughout their life. At eight months old, this number increases to 500 trillion connections. I can't even visualize 500 trillion connections, and then by two years, it's up to 1000 trillion connections. By three years old, the baby, or the child's nervous system has the greatest density of synapses it will ever have, and the brain structure and design is nearly complete. So then the child continues to vent, to develop, and by 10 years old, most of the synapses that they will ever have are completely formed, and at that point we see something called pruning, or the pruning process. Pruning is a process of removing neurons which may have been damaged or degraded in order to improve function or their networking capacity. And this leads this pruning we use only the strong ones which can become permanent and again in normal development. By 18 years old, these this pruning process has decreased the number of connections by half. So that's just a very quick overview of brain development. And then we want to talk a little bit about neuroplasticity. And we we define neuroplasticity as the brain's ability to reorganize itself through the forming of new neural connections. And neuroplasticity is so important. It's what allows us to recover from injury, from environmental exposure from anything that's going to cause a problem in your nervous system, and it occurs over a lifetime. It's neuroplasticity is what allows you to recover from a stroke from a head injury, depending on the level of difficulty or severity. So how does neuroplasticity work? I mean, it's a wonderful, wonderful concept. There's a large amount of research right now that focuses on this question. Scientists are certain that the brain continually adjusts and reorganizes itself. In fact, while they were studying monkeys, they found that the neuron, sorry, neuronal connections in many brain regions appear to be organized differently each time they were examined, so it's kind of neat that we can do the research. We have the brain conduction studies out there that actually can track. Oh, you know, these pathways are working right now, but following this particular type of injury, we can now actually visualize how neuroplasticity is working and how the brain itself is reorganizing so that life can continue.     Jayson Davies     Gotcha. And then. So what are some of your hypothesis that exist around technology and brain development? I mean, whether they're your hypothesis or if there's any What are you reading about or hearing about?    Stephanie Foster     Well, we're hearing in a very scary way, that technology has changed how our brains develop. So there is a whole debate in the science world about nature versus nurture. And when we talk about nature, that's what you get when through your genes, so it's your basic wiring, and then there's that nurturing, and I believe that's what you're getting at. What is the nurture? And for us, you know that nurture comes from your environment, and what is the environment doing to fine tune our brains? And we are finding a huge impact and huge change in MRI studies or brain scans between people that have an over abundance use of technology.    Jayson Davies     Yeah, so I know I've seen some studies as far as people using either virtual reality or some sort of technology with patients that may have a stroke to kind of work on that neuroplasticity. What other types of interventions have you seen that maybe focus more on that technological side, as far as aiming toward neuroplasticity?    Stephanie Foster     So there's some really wonderful research out there, ot that that point to the positive implications of using technology. One of them was printed out in came out in 2014 that looked at traumatic brain injury treatment. This one was an online program that taught problem solving for executive dysfunction in children following brain traumatic brain injury, and what they found that this particular online problem solving game improved long term memory, improved executive function, and it helped children with focusing on problem solving communication and self regulation. So. And this particular study looked at adolescents over 14 years old. Another study that came out in 2013 that looked at neuroplasticity in children with ADHD. And this was an online cognitive training program as an alternative to medication, which as an OT I really like that we are still talking about alternatives to medicating, and it found to be very, very helpful for kids with ADHD.     Jayson Davies     Are you from reading that that study, were you able to kind of get in tune with what it kind of looked like, what that model or what they were really doing, or not quite? I know sometimes it can be tricky when you're reading an article to really get the gist of what they're actually doing. It says that they're using this cognitive development type of strategy, but it's hard to see.     Stephanie Foster     So, yeah, no, no, they the article is very, very specific on which one that they're that they were using, um, I'm not finding exactly it here in my notes, which one for this study, okay, but I know even in my own practice, that I am using a internet based technology to help with attention span. So an example of that would be using the interactive metronome, which is a really, which is something I never, first off, never thought I would be advocating for. But the interactive technology, interactive metronome sets up a metronome beat, and children have to meet that beat with their hands and clapping or with hitting one side of their leg. And then when they get good at that, then they use both upper body and lower body, and they're given and they're playing a video game. So the kids are really, really motivated to get the video game to give them scores, and they try. And what I have found here in my clinic is that they try really hard, and they're given really, really specific feedback on how quick, how quick, or what their automatic responses are.     Jayson Davies     So I want to touch on that then. So you're saying it measures their clapping, or it measures their how they hit their knee. How does it measure that? Do you have to put some sort of sensor, like, are they wearing a glove or special pants that have sensor in it? Or what does that look like?    Stephanie Foster     As it's computer based they get they wear earphones, and they hear a sound and interactive technology. It's a cowbell sound, and they have to clap or make a response as close to that cowbell sound as they can. So they are improving bilateral skills. They're improving the reflex response, and the computer then times the difference between the cowbell and their response down to milliseconds. Okay, so    Jayson Davies     does it use like a microphone to pick up when they clap, or is it okay? There is, there is a microphone that attaches to it as well.    Stephanie Foster     They they wear a little trigger on their hands, so when they clap, it triggers, okay? And, yeah, yeah. And if you, you know, like, in one of them, there's a monkey, and he gets to eat a banana. After you get so close milliseconds, the monkey gets the banana, and then that's the inter that's the reward for getting more and more coordinated.     Jayson Davies     So it really is a video game. Then, like, it's straight up, it's got an objective to it, and you just got to do make the right moves to get the banana cool.    Stephanie Foster     Correct, correct, highly motivating, really colorful. And then, as an OT, again, I like that. I can track something right hand and left foot, and I can. I can move it that forward, you know? I can. I can be that specific. Oh, because, you know, I would never be able to tell. What's the difference between five milliseconds and 30 milliseconds, you know, but the computer allows me to be that specific.    Jayson Davies     Yeah, all right. Well, I'm kind of ready to move on to the next area, because I think this is going to be like the super fun, super like, interactive area, and that is looking into the good, the bad and the ugly of technology. And so I don't know. I think we should start off with the good aspects of technology. I know we just talked a little bit about how some of that technology you're using, like the interactive metronome through therapy, but what else is, is the good side of technology.    Stephanie Foster     So I do find in even in my small private practice, that I use technology a lot. So I do have a website. I do reach out to parents on social media. I don't have to put an ad in the newspaper anymore. When people are searching for help for those children, they go right to technology. So that gives us more information quicker. It helps us deal with the problems that we have throughout our day faster. I also use it to help children who are non verbal. So we have something called the pro low quo to go it's a fun word, and that's a software that helps us build communication boards.     Jayson Davies     Yeah, and that's an iPad app, right, or phone app, or some sort of app.    Stephanie Foster     And some kind of app right, use on your computer so you print or you could use it on something smaller that you bring with you, that that the child can press into in order to produce a sound. Okay?    Jayson Davies     And then I want to bring this up, because you guys actually touched upon this when I got to see you for the first time, and that was the marshmallow test. This is one of those things that I think every ot you know, you may not remember it, but you probably heard a little bit about it in in school, and it's about delayed gratification, correct, correct. Yeah, I'm going to let you kind of explaining the original and now the new study.    Stephanie Foster     Sure, and you know the reason why I included this? Because initially, the results horrified me as a parent and as a reader of the research, it horrified me. So I'm going to present it to you, and I'm going to challenge you and and our listeners to make their own conclusions. Yeah. So in 1960 Stanford University came up with the marshmallow test, and they they said that this was the gold standard for testing delayed gratification. The test looked at preschoolers of children ages three to five years old in the 1960s in which a child was brought into a room, sat at a table, and on the table, there was nothing in the room except a marshmallow, and the child was told that the examiner had to leave the room, but if the marshmallow was there, when the examiner came back, that the child would then get two marshmallows. At that time, only 1/3 of the kids were actually able to put it off to delay gratification. So in other words, two thirds of the kids couldn't enough, and they just grabbed the marshmallow and ate it. That would have been me. So recently, they so they they have continued this test. And recently, 2018 the American Psychological Association, put together the latest findings, where they checked again on children's abilities to delay gratification in the they did. They use the 1960s they use the 1980s and then they use the 2000 the 2000s and they compared them across for the time. And it took the time that children were allowed, or, I'm sorry, not allowed, but the time that children tolerated looking at that marshmallow without grabbing it. And what they found was that the actual time that children were able to wait increased, which pretty interesting, right? The amount of delayed gratification has actually improved for this particular.    Jayson Davies     And of course, I mean, we're talking 50 years difference between when it originally happened and technology has only been super prevalent for the last 1520 years, you could argue. And so there's more than just technology to that. But I mean, what do you take away from it?    Stephanie Foster     See, the authors were saying that this increase in delayed gratification is due to increase in symbolic thought, the increase in use of technology, the presence of preschool, and where more kids at that age range are actually attending preschool, and also a greater emphasis in parenting on executive functioning skills, so planning and preparing for whatever is coming Next, being able to take your backpack and put in what you need for school and bring it with you. What do I take from it? Do that's that's the challenge for me. Do I agree that kids these days have a greater ability to delay gratification? I'm not sure. Yeah, I'm not sure if I agree with these research, but researchers, but I think that it's food for thought. I think it's something that parents really need to talk about. Do we see that kids are able to wait these these? The authors said that it explains why kids these days have more access to games, and they the games that they play require more ability to wait. So you don't just get to get to the end. You actually have to use, use your coordination to go through each level of the game in order to get that golden prize.     Jayson Davies     That's interesting. So they actually did talk about a little bit of technology within that article, then, and gaming and stuff like that, correct? Wow, okay. Because, I mean, when you say that, when you said that, I was a little taken aback, because I kind of thought it would be the opposite. Because, I mean, now in video games, you die and you come back to life in two seconds. I mean, there's very little time that you get to actually. That you're not, quote, unquote, not playing, you know, your downtime, and so that's actually a surprise. But on the flip side of that, from my video game experience, yes, you're right, that there is that I was never good at finishing games because I didn't like playing like, 810, 12 levels to get to the end. I was more of that I wanted to play the games where you're dead for five seconds and came back to life and so, but there's different types of games and yeah, so All right, well, it's interesting how that that works.    Stephanie Foster     The good news is that, if this is true, if, if our children today have greater perseverance and greater ability for delayed gratification than the children back in the 60s, that it really behooves the parents to take an active role in their technology use, that parents really need to challenge their kids and have these discussions to say, you know, and what am I doing to teach my children perseverance. How do I help my children delay that gratification? How do I help my children plan so that whatever that goal is, or the task is, you know, can be more effective and and maybe that's one way to do it is to use video and video games together as a tool to build that idea of planning and executive function.     Jayson Davies     Yeah, and I just keep going back to that conversation we had earlier about the like, you know, using technology as a babysitter, and I see that, you know, you're at you're out at the store, and a kid starts crying, and the first thing that we do is hand the kid the iPhone, the iPad. And you know, what's that doing for delayed gratification? I mean, maybe not a whole lot.     Stephanie Foster     So yeah, right, you're absolutely right. It's teaching the child that, if I cry when you get the phone, yeah, in a in a public place. But it doesn't have to be that, yeah, it really doesn't. Parents can make that decision on how they want to train that moment.     Jayson Davies     Yeah, all right. So done with the bad. And on to oh no, sorry. Done with the good. My bad. I could see how things you know from one perspective, they're good. From another perspective, maybe not so good. It all kind of depends on your own personality and beliefs on technology too. I mean, everyone has their own beliefs, but jumping into some of the bad aspects of technology that some of the maybe the research or whatever, is showing what, what do we need to look out for?    Stephanie Foster     So one of, one of the books that I found really, really easy. Talked about the rap on digital media. And the rap on digital media is coming out of MIT. This is talking about the rap is how digital media affects your relationships, affects your attention span, or any potential addiction to to using it, and also privacy. And what they are talking about here is that this constant connectivity really does disrupt our attachments to other people so much that you could be in a room with many other people and you can still feel alone.    Jayson Davies     Yeah, I mean, I get that, because technology kind of draws you in, and you get very caught up on that one thing. And you know where, I know you guys aren't school based practitioners, but I'm sure you're probably familiar with IEPs, and it's funny, every now and then you'll be sitting in an IEP and every single person's on their phone. And I'm sure there's many other places where that happens. And you know, it's kind of, make of it as you will, but it's, it's an easy way to get out of a conversation. It's an easy way to embrace yourself in something that is not in the moment. And so now, I mean, we're adults, and that happens. So what about teenagers? I mean, what does this look like for our teenagers?     Stephanie Foster     Then, right, right? I'm sure we've seen lots of groups of teenagers. They go out there together, and, you know, three quarters of room are on a phone. And so how is that an interaction? I think text messaging and the way that we communicate now is also increase it. In some respects, it's increasing our connection, but it's also decreasing the quality of that connection. Because what do you text to your friends? Meet you in five minutes, right? This class is hard, whatever that short snippet of a conversation is it really? It really is making it minimal.    Jayson Davies     Yeah, lots of emojis, yeah.    Stephanie Foster     Now we can even express how we're feeling by sending a smiley face.    Jayson Davies     Yeah. And so I think the next progression that to talk about is for parenting, like, what? What guidelines? I mean you we talked about guidelines early. Year, and there weren't really any guidelines past five years old. And so as parents, what? What's your take on parents and disciplining using cell phones? I mean, it can that be done nowadays?    Stephanie Foster     I'm going to say yes. I'm going to say yes. It depends on the rules of the family and it depends on the conversations that happen. So for example, in our house, we had really good rules about our technology use, and then we had an incident. So we had several incidences where those rules didn't apply. And as parents, we were going to be strong, and we took away their phones and the reaction to from our kids surprised us immensely, that the children then withdrew. They started doing sneaky behavior, and at one point I was told, You can't do that, Mom, you're taking away my ability to breathe. It was rough. And of course, as a parent, I said, you're just going to have to learn how to breathe without your phone. Yeah, right.    Nicole Foster     It didn't go down so well.    Stephanie Foster     Go down so well. I mean, it makes sense to me, the parent, but in the teens mind it didn't. And then I came across some more information coming out of the child MIND Institute, where they were replicating my own personal experience, where they were talking about the teens emotional life, they started to not where teens don't trust their parents anymore. They call it an invasion of privacy, and they children just became more and more withdrawn or depressed because the parents were using the phone as a behavioral either motivator or a reward, deterrent, deterrent, sorry, reward or behavioral deterrent.  Thank you. Thank you. So that really surprised me, and what come what comes out of that? What's the lesson learned on that is, as a parent, it's my job then to improve that communication. Do everything I can to open and continue to talk with my child, to build trust and to really understand the whys. Why am why is it important for me to have your phone after nine o'clock at night. Why is it important that you know at any time I can take your phone and I can search wherever you've been going? Kids need to know that the parents still hold those boundaries and still hold them because they want to keep their kids safe.    Jayson Davies     Absolutely. And I see it in IEP still or now, because often I work at a high school, and I mean, there are very few IEPs where we're not talking about a, the student using their phone way more than they need to be using their phone on campus during class. Or B, how can we use their phone to help them succeed in class? And it seems to be one of the other it's either it's too much of a problem or we need to use their phone to help them, such as, you know, using the Calendar app, using voice to text, using, you know, just telling Siri to remind them to turn in their homework, you know, something like that. But it's becoming, you know, super prevalent. Kids all have phones now, I think, right. I mean, can you agree that that every kid, at least in high school, has a phone, I think, and so, yeah, it's just something that we're talking a lot, a lot about. Nicole, yeah, go ahead.     Nicole Foster     I was just going to say that's why balance is so important, because technology, your phones, your computers, those are tools. They're not anything but a tool. And getting that message across to teenagers takes many different forms, because you've got different types of people, you've got just different experiences, and that's our challenge as professionals, as parents, as teachers, to develop that that balance between overuse and just the right amount.     Jayson Davies     Gotcha. And we're gonna get into we got one more section, and then we're really gonna get into that whole teenagers using phones, and what we can do about it. But I want to give you the second to go over the ugly of technology first, and I know we've got some stuff about that to go over. So, yeah, ooh, what is like the worst now? I mean, we've talked about some pretty bad things. We've talked about some good things too, but what is where are we going?    Stephanie Foster     Ah, well, I'd love to just jump into one of the framework, one of my research. I'm sorry it's not mine, one of the research reports that I found that looked at prenatal exposure effects and how it affects postnatal development and behavior. And this particular study was. Done on rats, and mostly it's done on rats because not ethical for us to do this kind of research on living beings. But this study investigated how, how, how maternal restraint stress, which was called being caged up with minimal exercise and Wi Fi signal exposure impacted post natal development of behavior. I found it very interesting. They looked at four groups of pregnant rats. Their control groups were pregnant rats who just were left alone undisturbed in their home cage. There was no Wi Fi, there was no stimulation. They were just left alone in their home cage, there was a Wi Fi Expo exposed group. And the Wi Fi exposed groups actually were two for two hours a day. These freely moving animals in their home cage were exposed to whole body radiation coming from a Wi Fi Wi Fi device via a wireless router, router or antenna, and that antenna was placed 25 centimeters from the cage. Then there was a restraint group, and they took these pregnant rats and restrained them in a between front and back. So they put in Plexiglas boundaries, and they made these rats just basically lay still for two hours a day. Now, the researchers did check so that the rate the rats were not under huge distress, but they were limited. They couldn't do anything for two hours a day. They just leave there, which I thought was pretty interesting, because two hours a day might be you sitting Netflix, not moving, right? So that was really interesting. Recording a podcast. Recording podcast, yes. we're not moving much, right? We're sitting here. So they measured everything. They measured the length of gestation of these, of these, of their babies. They mentioned they measure the number of live, live and dead pups. They measured the sex, they measured eye movement, they looked at neuromuscular tests, and they looked at anxiety like behaviors at 28 days old, and they also looked at it later on, in the in the pups lives, across the board. The end result is, and we're going to make this really simple, because this report had lots of data on it, but across the board, the prenatal Wi Fi radiation and the restraints group had more behavioral and biochemical impairments in both the juvenile and the adult age offspring.    Jayson Davies     Wow. So all that signals that are flying above our head at every given moment of the day. I mean, obviously this was with rats, but we have no idea what the long term effects are for everything that we're experiencing throughout our days, right.    Stephanie Foster     Right? And that's why this was like, wow, we can actually measure it. Now. We can actually measure it. Couple other interesting ones. There's a lot of work being done on addiction, Internet Addiction Disorder. The World Health Organization is actually including internet gaming disorder now in the ICD nine. That's the good news. The bad news is that they won't actually use it. That particular classification system is not out until 2022 but at least it's there. At least it's on the way and they're finding prevalence. They're really doing some nice work on prevalence. So what is the presence of internet addiction that they're seeing now? Because I actually believe you found this one that we were looking at in 12 to 25 year olds, that they were somewhere between 5.7 in males, it was higher 8.4 versus females in was about 2.9% of a population.    Nicole Foster     A lot of that variability is due to the lack of a specific diagnosis between countries, and so I would recommend that we figure out a diagnosis for this disorder so we can have a better handle on how common it is and how to treat it.    Stephanie Foster     But we're finding pretty much it's between that 10 to 20% of the population is coming up with an Internet Addiction Disorder.    Jayson Davies     wow, yeah, and that could potentially mean that they have decreased cortical thickness, is what that research is saying.    Stephanie Foster     Correct, correct. There was some additional research that talked about cortical thickness, where they looked at 15 male adolescents with internet addiction and compared them with a control group of for matched subjects, they did MRIs on them using a 3t MRI, and the results confirmed that actually, male adolescents with interactive internet addiction had significantly decreased critical fitness in the right lateral. Orbital frontal OSC was significant. I was a significant in in all the statistics. And so they are concluding that, yes, Internet people that have internet addiction have actually changed their for on a permanent basis. They've changed the cortical thickness, and they've changed those structures in our brain that are so important, wow.    Jayson Davies     Well, you definitely lived up to the ugly side of technology. That does not sound good. And so, I mean, I guess the next thing to really do is talk about, what do we do about it, and what is based upon. Again, you guys are have done some research. You guys have done some literature reviews. What, what are people doing, or what can we do?    Stephanie Foster     So the message is, and in one of my favorite books, is, there's this really great book called talking back to Facebook, and it was a professor out of Stanford. His name is James Sayer. Is the very readable, readable research. I'm sorry, it's a very readable book for anybody, not just people that like research. And he said his bottom line is that, as parents, what we really want to do is protect our kids. We want to protect them, and we want to help control their environment. But the reality of our modern age is that digital technology is everywhere, that it's impossible to get away from it, and we can't change it, and we can't go back, that we're just it's something that we have to do so as parents and as educators, it's up to us to help kids use their their screen time for productive manner in a way that's balanced.    Jayson Davies     And so then, how do you propose that parents or therapists? I mean, because I have told I've never actually done this, but I have told people in an IEP that I could probably come up with a goal for a student in a school related IEP about social media and or telephone use, because it is absolutely true that you can't separate the two, like you were saying there's no going back. And I know from personal experience now that kids use social media to complete schoolwork. They share notes on on Twitter, they share notes on Snapchat, they send each other videos of like YouTube, videos to study from like. It's completely intertwined, and so obviously we can't, like you said, we can't take this away. The students need this to succeed. But what can we do to, you know, kind of keep it from being too much of an overload.    Nicole Foster     So a media diet is a way to promote that balance use of screens and social media, you've got to help teens develop the skills they need to use media, social media, internet appropriately so that they can use it as that tool and minimize the health effects that can come from that one model of behavior change that I was introduced to as through my classes was the trans theoretical model of behavior change, and this model was designed for behavior change relating to addiction, but you can take the general concepts and apply it to anybody who wants to change their behavior.    Jayson Davies     All right. Well, then how do you apply that to teenagers who may be using their phone too much?     Nicole Foster     There are five basic stages that behavior will cycle through at any time. You've got pre contemplation, which is you, the individual does not recognize that they have a need to change their behavior. Contemplation is the stage where that individual would start to think about their behavior and consider whether or not they need to change or not. Preparation is the planning for that behavior change action. Stage is, where you're developing and adopting those new behaviors and working them into habits, and then once they become habits, you move into that maintenance stage where you're where you're trying to maintain that ongoing new healthy behavior. To move from each of these stages. Are a few concepts called the stages of change, or the processes of change. And there are roles for teens, parents, counselors, health professionals, you name it, in most of these stages, for example. So to move an individual from pre contemplation to contemplation, you have to make the teenager aware that they're spending too much time on their phone. Environmental reevaluation is assessing how your environment is affecting you and other aspects of your situation. So for a teenager, it would be assessing how a screen time affects their physical and social environment. Dramatic relief is the ability to express emotions about your behavior. So this would be helping a teenager express both their positive and their negative emotions about their phone usage, you know, getting them to be real. Like, is this affecting you negatively and well, how does that make you feel? This is a stage where parents and counselors and occupational therapists can be helpful to get those teams to kind of evaluate their situation and evaluate where they're at, to move from that contemplation stage to actually preparing to make a change. Teens have to evaluate themselves and understand what it would be like without this excessive team, the excessive screen time, and then the teen has to make the decision to change their behavior in order to move into that action phase. So this the contemplation to preparation stage is where parents and professionals can help the teen weigh those pros and cons for the excessive screen usage and and help, you know, help prepare, make a plan, come up with realistic ways to change your behavior, and then the team has to make that step to change their behavior. And I would emphasize that this concept, it's called self liberation, would be completely the team's choice, because if it's not, then it's really hard to get the behavior change to stick. The team has to make the decision to spend less time so that they're really behind this behavior change, and then to move from the action to maintenance phase, basically to move from decreasing screen time into a permanent behavior, you have a couple of concepts that can help maintain a healthy media diet. One is counter conditioning, and that is substituting unnecessary screen time for something else. So instead of watching YouTube or Netflix, you read a book or you exercise or you do something that doesn't require you sitting in front of a screen. Yeah. Helping relationships are incredibly important for developing the support you need, the social support in particular, so that the team will continue that good behavior. They're supported by their friends, their families or their professionals that are around them. Stimulus control is controlling situations that would trigger excessive phone use. So if you know you've got, if the team knows that they've got 20 minutes between, I don't know, being picked up from school and when school actually ends, and if that's a case where they're on their phone too much, then got to come up with situations to to stop that trigger. So maybe taking the effort to talk to your teacher for an extra five minutes, or focusing on getting a little bit of reading done for your homework, basically controlling the situations that would trigger excessive feedback. Reinforcement management is also effective to making sure that rewards for not being on your phone are appropriate. So if you are trying to decrease excess screen time, a reward could be face to face social interaction. So instead of being on your phone while you're waiting in line, you actually talk to the person next to you, and you gain that relationship, that friendship as a reward, that one's kind of tricky, and that's where parents and professionals can really help the team hone in on what extrinsic and intrinsic rewards are effective in continuing decreasing their screen time.    Jayson Davies     Yeah, and how, how do you go about monitoring screen time? I mean, how is there a way to monitor your screen time versus today, versus yesterday or or tomorrow? I. Mean, how do you actively measure this?     Nicole Foster     So there are a few apps specifically for smartphones that could help with that. I know, um, my my Apple phone has a built in. I don't know if it's an app or whatnot, but it actually my phone measures the amount of screen time that I use my phone, and it categorizes it based on what I'm doing. So at this very moment today, I've been on my phone for two hours and 35 minutes, and 40 minutes of that has been social networking. So there are other apps you can download and that will help you monitor your phone screen. So I would guess the one way to monitor screen time is to have something that measures it. Other ways are to have you like write it down to be more of an active participant in what you're doing and to write it down like i Whoa. I'm on my phone. I've been on my phone for five minutes. I need to write this down, or I am planning to work on my computer. So I'm going to write down the time I'm starting, and then I'll write down the time I stop.    Jayson Davies     Yeah, and I mean, you started to talk about media diets a little while ago. I mean, what does this kind of sounds to me like? We're headed toward creating a media diet with what you're saying right now. And so what does that ultimately look like?    Stephanie Foster     So a media diet would look at that balance between work, res, play, and time on a screen, and really, really quantifying for people, how much time you're you are talking or being around your family, how much time you've pulled out your phone and you're withdrawing and promoting balance, so that if you know that, you know if, if in your house, it's okay to be on your phone for two hours, then you make sure that you have an equal amount of time outside in the sun playing games and an equal amount of time being nurtured or interacting with your family or your parents. So it's about balance. It's about kind of regulating what that intake of media is balanced with that time that you can just grow live and play.    Nicole Foster     A realistic example for teenagers is, let's say they know they've got two hours of homework that they've got to do because they got an essay that they need to type. So they plan for those two hours, and then they turn around and make sure they get two hours of physical activity. It's really balancing. You know, you have to be on a screen. And then there's the time that you just want to be on the screen with other activities that are engaging with other people or taking care of your health, yeah.    Jayson Davies     And so I want to ask you two more questions before we kind of potentially wrap this up. One is, we've talked about it a little bit already. But why is this important for occupational therapists? Why do OTs need to be aware of technology among teenagers and what? What can they do in the future about it? What do you really see? Where do you see their role in this? This for both of you.    Stephanie Foster     OT don't just look at me. No, I think for OTs, we are, we have a prime role to pay play in self regulation, in that ability to be up, to be down, to be okay with your energy levels. And really teaching children how to regulate their their behavior throughout their days, and seeing the impact of technology on on that self regulation teaching, teaching these kids they have trouble sleeping anyway. You know, using technology and not using technology as a tool for teaching kids regulation. I think that's very critical for us to really step up to that. I know a lot of kids in my caseload don't sleep through the night, and that's very hard for parents. And I think teaching, you know, being being a professional enough to look at a parent and say, you know, maybe it's time to put that phone away, and how can you take it away an hour before bed? Or maybe they this child actually eats two hours before bed so that they can sleep through the night, then they can be happier, healthier throughout the day.    Jayson Davies     I lied. I have an additional question, can parents really get their kids to use less technology when we as adults are using it so frequently.    Nicole Foster     Thank you. Actually, a concept I'm fairly passionate about modeling behavior is incredibly important because you can't expect kids to do as you say. A not as you do. You parents and teachers and anybody who wants to encourage a teenager to use less screens has to also show that they are decreasing their screen usage. Kids know, kids watch. Kids understand that if the adults can do it, then it must be okay, and you've got to be aware of how much power parents have in influencing their kids behavior. So you've really got a role model, and you've really got to explain why you're doing what you're doing, so that they will have more buy in and more intrinsic, more intrinsic rewards to not use their screens as much.     Jayson Davies     Yeah, I think that's something that we all need to work on, whether or not you're a parent or I mean, just that modeling, especially working on a school. If you work at a school and you know you're walking around with your head down on your phone, I mean, that's something that all those other kids, they're seeing, they're seeing that.     Stephanie Foster     So all right, yeah, there's three. I mean, if you want it, this three major, major kind of your take home points, yeah, go for it. Okay, so our three, our three major take home points, is set your rules early and follow them. And this is whether you're the parent or the teacher. Set your rules early, and that means early in your child's development, and keep them you always want to keep your computer in common areas. You want your phone use to be defined, and set that when they're young, so that it's not a sudden rule when they're 15. And don't want to follow your rules. My number two is set your children up for success.    Nicole Foster     And this rule is looking at helping kids to understand why they have to follow the rule. This includes avoiding villainizing technology, but also not putting it up on that pedestal you have to be realistic about what using technology means and how to best use it. This also means including teens in your discussions about technology usage, because that'll get them to engage in their own behavior in a more analytical way, so they're not just following whatever mom and dad say they're actually being like, No, this is a good idea because blah, blah, blah, blah, blah, and that's why setting up your children for success really includes bringing them in of the conversation Absolutely. And last, our third point is, be a good role model.    Jayson Davies     Which we just talked about, so we write that one down. All right, I have one more question. This is not in technical relationship to your presentation or to our to our interview, but I recently came across on social media, of course, on Facebook, that there may be a proposed bill to California about completely eliminating the use of technology. Well, I think it's mostly cell phones on campuses in California, on public school campuses. What's your guys' thoughts on that?    Nicole Foster     So I was curious about this, and I looked it up, and according to the press release for assembly bill 272, this requires school districts to develop a policy that either prohibits or restricts the use of smartphones on school grounds during school hours. Basically, this bill is making schools evaluate their media policy and and to come up with a plan, you know, to be to outright prohibit it, or to to put limits on what could be used. You know, maybe immersion feeds are okay or or for educational purposes. You can use your computer. But this bill puts the power in the local school districts to develop programs and develop policies for their students.    Jayson Davies     Yeah, and that's, that's a big one, I think, because, I mean, like, again, I work at the high school, I see kids with their ear pods, and all day long, I see kids on their phone. They go to the bathroom and they're making phone calls during, you know, class, it's something that's being used a lot. But on the other side of it, our teachers are required, if they're allowing their students to use their phone for research purposes, they have to put a piece of paper up on their door outside the door saying kids are using their phones for research purposes at this time. And yeah, they have to do that at the high school that way, in case the principal walks in. She knows before she walks in that okay, it's okay for them to have their phones out they're researching a project. Or, you know, maybe a parent on campus that day walking in. The last thing you want is a parent going to the principal saying, Man, I walked into a class. Everyone was on their phone without without knowing it was for research purposes. So it kind of sounds like maybe this high school is already kind of on that track that's going on. But yeah, it sounds like maybe something that I'm sure other schools may not be as caught up to date with and and maybe they do need that.     Stephanie Foster     So just what I like is that it's it's making it a law that the school districts have to create this policy, but the state is not dictating what that policy is. So okay that they're allowing the local school board who should know best what their students need, and it allows for exceptions, for emergencies and educational purposes. But I really like that. Okay, now in California, we are going to say you need to have a policy so you have a thoughtful discussion on on the use of technology, and how much are you allowed to use your phone?     Jayson Davies     Yeah, gotcha. And if there's anyone out there that doesn't live in California, and they already have something like this, and have something like this in place, I'm sure I would love to know. I'm sure you would love to know. And with that, I guess, where can they let you know? What can you share your contact information with us? Maybe your website, at least, if not more?     Stephanie Foster     Yeah, absolutely. We are very sincere that we would love to hear from people. We'd love to hear your comments, suggestions to make, and how this this particular topic, has affected you in your life. So I would be happy to hear from you. My website is kids work. It's www, dot, k, i, d, s, w, O, R, k, dot, biz, B, I, Z, I am Dr Stephanie Foster, and I am also welcoming people to reach out and email me. There is a link through my website, or you can reach me at Stephanie, S, T, E, P, H, A n, i e, at kidswork, dot biz.    Nicole Foster     Great. That's probably the best way to get a hold of me, as well as through the website. Great.    Jayson Davies     There you go. You're not working actually on the business right now, are you Nicole?    Nicole Foster     So growing up, I was helping with summer play groups, and I've even started like developing programs for some of those play groups, and at this point, I am doing more of an office management role because of I'm in school myself.    Jayson Davies     Yeah, gotcha. Well, I really cannot wait to see where you guys go with this in the future. I know you kind of have plans to do more talks like you were talking about at schools. Nicole is just about to start her master's program. So, you know, she's going to be doing stuff related to this, potentially a master's thesis or something, depending on the school she goes to. Yeah, I just can't wait to hear what you guys do at Future A OTA or OTEC or different conferences and stuff. I'm sure this will be something to keep a watch of. So thank you so much for coming on the show, and we'll be sure to keep in touch and maybe have you on again later to see what's going on. All right, thank you an honor. Thank you so much for coming on. I appreciate it. Well, take care. Have a good night, and we'll see you next time. You too. Thank you. All right. Well, that was Dr Foster and her daughter, Nicole Foster, and we really appreciate them coming on to share all that they have from all the insight into neuronal development by Dr foster as well as all the information about the trans theoretical model of behavioral change presented by Nicole, everything was fantastic. I can't wait to get back into the high schools and really look into technology a bit more. So I'm excited. You just listened to this podcast. It is about an hour and 25 minutes long, and because of that, you can earn professional development now that you've listened to it. So head on over to OT schoolhouse.com , forward slash episode 30. There you will have the opportunity to purchase the professional development. It's not too expensive, and all you have to do is take a short quiz that shows that you listen to this episode, and I will then send you a certificate of completion. So so I'm looking forward to seeing you over on the website, and until next time, 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. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 29 of the OT Schoolhouse Podcast. Do you work with students who use iPads or other technology tools to access their educational curriculum and environment? RJ from RJCooper.com is a computer science guru that specializes in developing tools for people with special needs and the people who serve them. For nearly 40 years, RJ has worked primarily with people who have developmental disabilities to help them benefit from highly specialized switches, computers and applications, and mechanisms that position these tools. ​ Listen in to learn more about how RJ develops tools and hear what tools he recommends for every classroom with a population that may require specialized equipment. Links to Show References: Quick reminder: Links below may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you The below references were mentioned throughout Episode 29 RJCooper.com If you'd like to have RJ visit your area, visit RJCooper.com/roadtrip Email RJ at RJ@rjcooper.com ​ Closing The Gap Conference (October) ​​ ​ Assistive Technology Industry Association (ATiA) Conference - January/February ​ JaneFarral.com Jane is an SLP and special educator with a passion for literacy, Augmentative and Alternative Communication (AAC), and Assistive Technology. Her website has many references and recommendations related to these fields. Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript.   Amazing Narrator     Abby, hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.     Jayson Davies     Hey everyone, and welcome to episode number 29 of the OT school health podcast. My name is Jayson Davies, and I'm your host of the OT school house podcast. Really appreciate you being here. In fact, I was just admiring some Instagram posts where you guys are sharing that you're actually watching the or, sorry not watching. This is a podcast sharing that you guys are listening to the podcast, but I'm seeing that you're listening to it by looking at Instagram posts and seeing everyone sharing it. In fact, actually, I wanted to kind of press pause here real quick and ask you guys to to share that, actually to take a picture of maybe your phone or the computer, a screenshot, and just share on social media that you're listening. I want to know maybe like where you're listening, or how you're listening, and when you do that, go ahead and tag at ot school house so I can be sure to see it, and we'll see. Maybe I have a few things to give away for people who are actually doing that. I really appreciate that, and I can't wait to see all your photos. Excited with that. Before we get into it, I want to make sure that you all just remember that all the show notes from this episode can be found at ot  schoolhouse.com forward slash episode 29 Wow. That just made me realize that we're almost episode 30. Alrighty, but staying with today. Our guest today is RJ Cooper from RJ cooper.com and although he is not an occupational therapist, he has been helping individuals with developmental disabilities for nearly 40 years as an AT specialist, what started off as a passion to work with computers quickly turned in to a passion for helping people with disabilities when he realized that he could combine the two. Since the 80s, RJ has been writing code for applications as well as developing physical products that don't exist otherwise or maybe are just too expensive to access, and he puts those together to help people who need just the right equipment and in order to access both technology and the physical world. And now, as we jump into today's episode, I want to say a quick thank you to doubletimedocs.com for sponsoring today's episode of the podcast. Doubletimedocs.com is a software designed to help you write comprehensive evaluations in half the time. Use promo code ot sh 20 to get 20% off your first order of evaluations now. And without further ado, here is RJ Cooper from RJ cooper.com Hey, RJ, welcome to the OT school house podcast. How are you doing today?     Rj Cooper     I'm doing well. Thank you. How about yourself?     Jayson Davies     Doing pretty well for Tuesday. It was nice to have a three day weekend, and now just back to it. So did you have the chance to take yesterday off? Or were you busy? I was busy. Of course, this kind of goes with owning a business, I think. But I wanted to say something. I mean, it's not really related to the podcast, but you mentioned that you actually coach tennis. I thought that was super cool. I used to play back in high school. Where are you coaching?    Rj Cooper     In Irvine, Tustin and Santa Ana in California.    Jayson Davies     Oh, is that like, Are you, like, teaching at a JC, or is it just kind of a private thing you do, or?    Rj Cooper     It's, they're all privates. They're freelance. So I have six juniors right now that I coach.    Jayson Davies     Oh, that's cool. It's always fun talking to people and just finding out what other things they do outside of, you know, their nine to five jobs. So that's pretty cool to do. Thank you. Yeah. Well, I want to give you a second to kind of go ahead and dive into a little bit of your background and tell us about what you do.    Rj Cooper     Well, I started in Computer Science at the University of Utah, when they got close to graduation, I wanted to do something with it. The Peace Corps wasn't interested, but I wanted to do something like that. So on my own, I came up with the idea of using computers for people with disabilities. That was back in 1983 no real audience existed for computers back then. People thought that computers were some big mainframe somewhere else in the world, and I introduced micro computers to Utah. And I worked on a project with speech recognition, with a young man that had a cliff diving accident the summer before, but wanted to continue his education by speaking to a computer and having it understand and we worked on that project. It was mildly successful, but it was enough to make me sort of famous within Utah, and then I've just carried on with it over the years.    Jayson Davies     Wow. So that was so speech recognition. Was this like a speech to text, type of program, or what did this do?    Rj Cooper     It was speech to text early, very early on in 1983 there was a manufacturer down here in Irvine that was making a speech recognition board for the Apple two computer was very limited, but I saw the potential for Brian and I drove down one weekend and got one of the boards and drove back to Brian, I wrote a program to allow him to design a schematic, a circuit. Diagram by voice, and then we showed it off at the nest Governor's Council on the employment of the handicapped, and it was a big hit.    Jayson Davies     Wow. So just because this was you said 1983 about so what did this look like like? What did the setup look like?    Rj Cooper     It was an apple 2e which was a beige monster, about the size of a about the size of a briefcase, about the size of a briefcase, okay? And then on top of that was a 17 inch green screen, so it only had two colors, green and black. And then we had a floppy, five and a quarter inch disk drive, and then we had a microphone, a little headset that would go on Brian's head, and that was it.    Jayson Davies     And we've come so far now to iPads, eye touches, iPhones, all this good stuff that's crazy, but still, I've.    Rj Cooper     been in touch with Brian over the years, and he's progressed along with the industry, is doing some great stuff now too.    Jayson Davies     That's awesome. That's always nice to be able to follow people that you've worked with in the past. I'm sure you get to do that quite often.    Rj Cooper     not as much as I'd like, but every once in a while, it's very rewarding.    Jayson Davies     Yeah, that's cool. So, so that was 1983 and obviously, I mean, we kind of, we know you're kind of going into technology and stuff. So what kind of came after that?    Rj Cooper     I started writing software for the severe, profound population, because I got involved with a special school in Salt Lake City that had 201 severely disabled children students, and I found my passion, which was to help those most severely disabled do something in the world. And I started had to write software, because no one else was writing software at all for special needs, let alone for the severe, profound population. So I sort of found my niche that way. Moved to California, started growing an international audience that was interested in my work with that type of a population, and it just grew in leaps and bounds there in the late 80s and early 90s.    Jayson Davies     Wow. So I know when I last heard you speak, I think it was down in Orange County at a at an OT school based conference, and I honestly was kind of under the impression more that you were doing a little bit of the adaptive technology, in the sense of, like the arms that hold the iPads and stuff like that. But it sounds like you really got your start with the actual programming. So that's really    Rj Cooper     cool. That's correct. That's correct. I really wanted to help that population, but in April of 2010 Steve Jobs came out with the iPad, and the whole industry changed.     Jayson Davies     Oh, I'm sure. And I want to get completely into that, but, but first tell us about some of the programs that you've developed.    Rj Cooper     The one that I started with, and I still continue it today, is called point to pictures, and that's a program where we can choose pictures that are personally motivating to a specific individual, put them on a grid, such as back in those days, there was a unit called the Power Pad, which was a touch towel, touch touch device. These days, of course, there's the iPad, which is the computer, and the touch device all in one, but we can put 234, or even nine pictures on one screen and make the program really pop at them so they really understand that what they've selected they're going to actually get in real life. And that really spoke volumes to that type of an individual,    Jayson Davies     absolutely and and do you typically find that you start with, you know that that least amount of pictures on that board?     Rj Cooper     Oh, yes, I always start with two, and if they can't get any type of discrimination between the two because they're both good, then we have to put one that's non preferred on there so they can learn the difference between the pictures.    Jayson Davies     There you go. Kind of like a picture exchange communication, except two pictures.    Rj Cooper     Well, it is an evolution, shall we say, of picture exchange communication, pecs, as it's called, but definitely an electronics version that allows more than one thing to be displayed.    Jayson Davies     At a time, absolutely. So, I mean, I know there's a lot of different things. I know one of our go to at at our school site is the Proloquo to go on the iPad. I've seen some other ones. How is yours kind of different from that?    Rj Cooper     Well, pro local to go is a rather complex, complicated beast. It's wonderful for those that are high cognitively and physically, but when it comes down to needing some type of fun factor, which pro local has none of and hand holding factor, which pro local has none of. Then you've got to get down to something that's instructional and point to pictures. Is instructional in that it actually teaches them how to select from pictures to real life, whereas pro local makes the assumption that they already know that.    Jayson Davies     That I can speak from knowing pro local. A little bit that that is completely true. In fact, so many times we have kids that probably need kind of what you're talking about, but yet they have pages and pages and folders and folders of these different pictures and and text on those pictures, and they just get lost.    Rj Cooper     It's a it's it's a constant battle with school districts not to immediately purchase pro local to go with an iPad, because someone assumes that everyone will be able to use Pro local to go rather than figure out what program, what app would actually be appropriate.    Jayson Davies     That's kind of like the augmented communication side of it. Yes, what you're talking about in that app.    Rj Cooper     Yes. Okay, so.    Jayson Davies     Do you also do more, I guess, assistive technology. I know we talked a little bit about how I thought you were doing, kind of the arms and stuff. But what else do you have, other than the augmented communication that you do with the students.     Rj Cooper     As I work more with the students at Hart vixen school, that special school in Salt Lake. I also got a chance to work with some physically disabled people, students from three through 21 years old that allegedly had quote, unquote normal cognitive skills, but very physically challenged. I found that very quickly that not only were they physically challenged, but simply by lack of hands on experience with the world, they were developmentally challenged also, so a person that was 15 years old, well that we can't put them in the severe, profound cognitive range, but they're going to be operating somewhere at about a five to six year old level thinking skills, Even though they're 15 years old and allegedly, quote, unquote, normal. I like that we use the word typical rather than normal.    Jayson Davies     So what were you able to help them out with?     Rj Cooper     Then, this was get into the access area. Back in 1986 this would have been the term assistive technology didn't exist yet. We were calling our field adaptive technology, but then someone decided assistive technology fit better. But at that point, at that point, I started to get into switches and access points on somebody's body, and then being able to mount that switch in such a way that you can put it on the wheelchair very easily, get it in a perfect position, but then be able to move it to somebody else's wheelchair very quickly, and that became a very strong revenue source for me, also being a specialist with adaptive arms buttons and other things that would help somebody physically access a computer and hence, eventually, an iPad.    Jayson Davies     Yeah, and, and when you talk about switches, you bring those up as OTs, you know, we get to, we get to work with some switches between us and the speech pathologist, we tend to have kind of the switches down. What different types of switches have you worked with?    Rj Cooper     I've worked with every switch that's been available over over the course of my 35 years. However, when I travel and I do on site assessments, I literally carry four switches with me to cover 99% of the situation.    Jayson Davies     All right, there we go. What are those? One?    Rj Cooper     One is a large, round, five inch switch, and I have a version that's just a regular switch, and also a Bluetooth version these days, so the electronics for it to communicate to an iPad are actually inside the switch and it has no cables. That's nice. And I also carry with me a three inch switch, once again, is a fairly standard three inch switch, similar to like a jelly bean switch from AbleNet, but I also make that again as a Bluetooth switch so that people don't have to worry about a cable. And I also carry a one inch switch for people that need it to be in the palm of their hand, that we can velcro a small button in the palm of their hand. And then I also carry a very special switch that's once again held in the palm of your hand, but it can be activated by the slightest touch of your index finger or your thumb. And those are my four switches that cover pretty much everything, just about all of it, huh?    Jayson Davies     Wow, yep. So you mentioned the Bluetooth, and that kind of goes back into this whole crazy technology. What has the development of an iPad? And all those, those new, you know, the last 10, maybe 15 years, what has that done to your profession?    Rj Cooper     Well, it's changed the revenue base completely, as well as what people are actually doing out there in the field. The iPad is basically a full computer in a tablet sized so we can make movies on it. We can take pictures on it. We can record our voice on it. All of those required three separate things before you'd have to have a video camera, you'd have to have a digital camera, you'd have to have a microphone and a sound card, even back in the day, and the iPad just put everything all into one so beautifully in the September. September of 2010 the parents first jumped on the bandwagon, and the parents said, Wow, this is really groundbreaking tech for our kids, and they actually led the way technologically in that September of 2010 whereas before that time, the speech he usually would have to drag the parents into technology kicking and screaming once the iPad came out, the tables were turned, and the parents were now. They were the pioneers. They were leading the charge. They were telling the speech path, or OT, what they wanted their child to do in school. And it was very nice to see the parents get so so involved, some of them to the point of learning how to program their ot apps on iPad.     Jayson Davies     Wow, that's crazy. I mean, I was just reading an article about how someone actually, I think, whose parent created this, it was snap type. I'm sure you've probably heard of SNAP type, but it was a parent, I think, that actually developed it for their kid who had difficulty with writing, and so they developed an app that they could take a picture and then just type right under the picture, so you're absolutely right.     Rj Cooper     There are still, when you go to the two industry events that we have each year, closing the gap in the fall in Minneapolis area, and then Atia, the Assistive Technology Industry Association, their annual event in Orlando, right around middle of the winter. There are still booths like mine, exhibits like mine, where there's actually parents and or individuals that have taken up this challenge and are still doing it just as individuals, rather than as a corporation entity.    Jayson Davies     Yeah, and I know it's it's getting very popular for for corporations to do stuff like what you're doing. I know Microsoft, they just had their huge release of their controller for the Xbox, which they, I think, had a Super Bowl ad, and so that was amazing. But how does being small help you? In a way.    Rj Cooper     I've always picked a niche within the assistive technology field. At one point, I was a very big fish within a small pond. But as the 90s evolved, I became a smaller fish in a bigger pond, as companies like my Toby acquired speaking dynamically, and then they acquired DynaVox, but it allowed me to stay in my own individual little customization area. My path was never to grow my business. My path was to help individuals, and that's what I've stayed true to all these years. When I go out to a cornfield in Iowa and work at a very small school there because someone has a situation they just can't figure out, and they call me in as sort of the big gun, so to speak. So I've stayed true to that.    Jayson Davies     Yeah, and I'm sure even as adaptable as Microsoft Xbox controller is, there's probably like, like, you're kind of mentioning those few people who it still doesn't work for. And I think that's where you can kind of come in. Is it not that you are entirely correct?    Rj Cooper     I still get the real personalizations so that I'll get a call I have a student that my child needs, things of that nature. I love to respond to those calls, I bet.    Jayson Davies     Tell me about like, what does it look like when a school calls you up and says, Hey, you know, we got this kid. We've tried a few things, and we just can't find that thing, that thing that works for him or her. What does that look like? When you get that call.    Rj Cooper     I immediately refer them to my website page for that type of a visit. It's called a road trip, and it's at RJ cooper.com , forward slash road trip, all lower case, no spaces, no periods, and it details what's necessary for me to come out of my own expense to their area and work with kids on site there and local other districts around them. So all they have to pay for is my lodging. I take care of my airfare with Miles, usually, and then I take care of my time, and I fly in on a Tuesday night, Wednesday, Thursday and Friday. I visit different schools. Usually they set up eight people for me to work with, from three through 73 because they bring in all sorts of agencies. And in front of a group of about 100 people, I try to make a change in that person's life right there, using the technology that I've developed. And over the course of all my years, I've gotten quite good at it. So I can usually bring what I call an Oprah moment to happen. That's when, you know, people start to cry and they're going, oh my gosh, it's a miracle. I call those Oprah moments.    Jayson Davies     Sorry, when you said Oprah moment, I also, I also thought about just giving everyone away a car. I don't think you're able to do that.    Rj Cooper     One, but I do give away in order for it to be very entertaining throughout the day, I do give away little things throughout the day, like a pen that's also a screwdriver, things of that nature,    Jayson Davies     nice little things that everyone can can use around cool. Yeah, yeah. All right. So what do you recommend? And that even just kind of a classroom should have on hand as a sort to try different things with different kids. Is there, kind of, like you said, you have your four buttons that you carry with you everywhere? Do you think there's, like, a few different odds and ends, different tools that kind of every month, severe, severe, profound classroom should kind of have on hand?    Rj Cooper     Well, I do think so now that if you had asked me this question 20 to 30 years ago between then, every special needs classroom that had a computer had it in tele keys that was standard. Every one had a Big Mac communicator, which is a five inch round one message button, every place had a jelly bean switch. Most places had a switch interface for their computer. And then, of course, they had their computer. And those were sort of standard fare for the whole country. In from, I'd say, about 1988 through the year 2000 Okay, in 2010 though my recommendation, and of course, it's going to be a vested interest in the things that I've developed. I always develop. I always develop things from need. In other words, somebody calls me or emails or speaks with me, and they have a need, and that's what I fulfill. I generally don't create something that's already created unless I could bring it in at like 1/4 the price, because somebody else just completely over pricing something. So these days, my recommendation, of course, is an iPad. I like the big iPad, the 12.9 even though it's not as popular as the smaller ones. But when it comes to situations with disabilities, bigger is always better.     Jayson Davies     Can I stop you there? You mentioned iPad, the bigger the better. What is your take on an iPad versus an iPad Pro? Is there any difference? There?     Rj Cooper     No, no. You can go back to 12 nine is an iPad Pro? There are actually four different iPad Pros, the 9.7 the 10.5 the 11 and the 12.9 Wow.    Jayson Davies     I know people think, yeah.     Rj Cooper     Some people think just by saying Pro, that sort of delineates the iPad, but there are four different pros, and now there's both a first, second generation 12.9 those are basically the same, but then they've changed it completely on the third generation 12.9 Okay, so bigger is better. The next thing they need, they need some type of a stand to get the iPad on about a 70 degree angle. Having the iPad flat on their lap, flat on a surface, just leads to what I call hunching. They're hunching their shoulders over, and they're looking down, and they're really just in that little bubble, putting it on a stand that puts it at about 70 degrees, holds their shoulders erect. Their trunk is erect. Their head is up. Their eyes are forward, and they're touching forward and back, rather than down and up. So that's the first thing is a very good, solid stand that can't be tipped over. Coincidentally, I happen to make one of those. Next thing would be, next thing would be some Bluetooth buttons. Why use wires at all these days? Just get a switch that has Bluetooth inside, and you're done. And then you'd either get one three inch, one five inch, or one of each, depending upon your need. Then the last thing that I think that is really necessary is, well, another thing to go along with the switches, you definitely need at least one type of positioning arm so that you can get that button into these weird situations that you find yourself in. So a positioning arm would be another must have, and finally, would be a keyboard, a keyboard that is large with large buttons. And my particular take on a keyboard is colored rows, so each row is a different color. Coincidentally, once again, I made mine from need because I got tired of having to point out the keys to the learners. Now I just say looking for the cue it's on the blue row, and sure enough, that they just scan that row left to right, like they've been trained their whole life, and they find the key by themselves nine times out of 10. Those are the essentials, the keyboard, the positioning alarm, a Bluetooth button, and a stand for their iPad. And as they say in the UK, Bob's your uncle.    Jayson Davies     All right. Well, I'll be visiting that later this summer, so I'll have to keep that one in mind, but to keep that in mind, yeah, is that the keyboard you're talking about? The colored keyboard? Is that also Bluetooth?    Rj Cooper     Yes, you bet. Why use cables if you don't have to, especially when 90% of therapy, I would say probably 90% of therapy in schools these days, technologically speaking, is done with iPads. Computers are sort of passe.    Jayson Davies     Yeah, I think you're looking at my district that's pretty similar those numbers     Rj Cooper     And I travel all over, and I see it all the time and and I don't see this trend diminishing either. The Android. Market has not impinged on the iPad market at all, and Windows has definitely not made a resurgence.    Jayson Davies     You don't think so. What I have seen with with Windows or Microsoft in general, is that they are trying to cater to kind of the the quote, unquote, disability market. In a sense, they're trying to make things that are more open access and able to be used by people with more abilities.    Rj Cooper     Well, unfortunately, it's that's just not a true statement. Oh, not quite yet. The only, well, it's not ever, in my opinion, any word there is try. They try because it looks good. PR, wise, they just put 20 filled $5 million into AI for disabilities. However, if you go to Atia or closing the gap, where all of we people that actually are the movers and shakers go, you can see that not much becomes of those dollars. It's a lot of hot air. The real work is done by the small people in the field, but also the bigger corporates now that are using their own funds and they're just working the bigger players are the ones that still sell these bloated communication devices for $13,000 and they're still shopping, yeah, they're still getting it so Frankie romich Toby, they're all still getting these big bucks because Medicare pays and they have people that can get it funded so that the user or the teacher doesn't have to pay anything. You and I, Mr. Taxpayer, are paying for a $13,000 device, like an eye gaze device for a person of a cognitive age of one year old. And that has not changed.     Jayson Davies     Gotcha, okay.    Rj Cooper     However, like Microsoft, Apple, Sun computers, all the big players in the computer world, all of them put some funds in to the disability market. It's good. PR, I would say Apple is the only one that's really done their share by adding accessibility features to the iPad time and time again, with some of them being very, very good, and other ones being just not needed at all. You can tell that they were done by an engineer who thought they were needed, but they just put them in because the engineer said, Well, this might help, but Apple has definitely put, I would say, as a programmer myself, I probably put $2 million worth of man hours into their free accessibility features on iPads.     Jayson Davies     Okay, so you mentioned those? What? What accessibility features are on the iPad? Would they just come with the box that's correct?     Rj Cooper     You got zoom, so you can make everything large on the iPad. You've got voiceover, so you can hear everything that's happening on the iPad, and then the latest one that really affects my field. My particular area is the Switch Control, which came out about three, three and a half years ago, which enables switch access to some apps that normally would not have switch access, gotcha, and most of the time, most of those are the Apple apps themselves. So mail, messages, music, camera, photos, Safari, things of that nature work pretty well with Switch Control. When you have somebody that's very physically limited, but cognitively they're pretty intact.    Jayson Davies     Gotcha okay. And so earlier, you're mentioning mentioning Bluetooth. And I remember, I don't know, a few months ago I read an article about how old school Bluetooth really is, and it kind of, you know, it was designed back in the 80s, and yet we're still using it today. When it comes to Bluetooth, are you able to connect multiple items to an iPad, or is that even not necessary?    Rj Cooper     Oh, very good question. Which people don't know that Bluetooth is not like Wi Fi. They're both radio frequencies, so they're not infrared, like your TV remote, but Wi Fi is one on one. You connect one iPad to a Wi Fi connection, and you can connect another iPad to the same Wi Fi connection. Bluetooth is just a reverse. The iPad is the host, and you can connect up to 65 Bluetooth devices to one iPad. I had no idea, and that's why, when you pair something on an iPad, that little spinny circle is still going because it's looking for 64 other things.    Jayson Davies     It all makes sense now. So now that just begs me to ask the question is, what has been the most that you have paired to work efficiently? I mean, obviously, maybe you tested 65 just for the kicks and giggles, you know. But what have you seen to actually work?     Rj Cooper     The easiest way to see this in action is to go to a trade show where there are, you know that there are a lot of Bluetooth enabled phones, and you power up your Bluetooth, and you look at your iPad, and you can see, like, 100 different things Bluetooth that are in the hall, wow. And that means that all these different devices are Bluetooth. They're not paired with your phone or your iPad, but you can see that they all are capable of being paired. So you could, if you had all 100 people there, you could ask 65 to pair with your one iPad. The most I've ever paired is about five devices. And even with five, the iPad started to get confused, as far as what the switch was.    Jayson Davies     I'm sure, and what the switch was for, potentially, right?     Rj Cooper     Yeah, it got confused, so I would have to reduce the paring down if I was doing switches, I would basically reduce the pairing down to my bluetooth keyboard and one switch just to keep the iPad in sync with what I was doing. Gotcha.    Jayson Davies     Okay. So when it comes to setting up a switch with an iPad, Is it as simple as just connecting it? Or I mean, like I feel like if I had my my iPad right here, and I connected a switch, I wouldn't know how to use the switch with the iPad. How do How does one go about learning that?    Rj Cooper     Well, that is the crux of the matter. Is we can pair something with an iPad, but it doesn't mean we know what to do with it once it's fared so you've got Switch Control. When you pair a switch, you can have that switch, or even two switches control, basically the Apple apps, and that's pretty cool. Then you can use switch enabled apps. So these are apps that are switch friendly. They've been programmed by somebody like me for someone like you to use with somebody with a disability. And some people call those switch compatible apps. Some people call them switch friendly apps. Some people just call them switch apps. So pro local to go is a switch friendly app because it has that switch compatibility built in. My Apps are switch friendly app because they have that switch compatibility built in. There are about 100 apps altogether that have switch compatibility built in to do things such as cause and effect, which would mean you press your switch, some music plays for a while, it stops. And then the user, the learner, actually would need to know that he has to press the switch again to get more music. So we would call that a cause and effect tasks. And then you go up to selecting. So if we use my quote to pictures as an example, and we have a grid of four reinforceable activities on the grid on the iPad, and then we scan amongst them auditorily, verbally, in other words, and we move a box around amongst them, the person can use their switch to select from the four. The app goes about its Bing, bang, bang, to make the person aware that they've made a selection. And then we, in the real world, actually give them the balloon or the water or kick them outside or whatever they've requested. Yeah. And then, at the highest level, you generally have a high cognitive ability, but physically very challenged. So you're talking about pro local to go for communication or one of about there's about five apps that are competitive with pro local to go that are in the same price range and that have the same basic feature set. But then you also get into other types of things, such as early academics. Not many people in the world make switch friendly early academic apps. I'm not sure why I make two of them scan a word for early spelling and then, well, actually, only one, and that's for people that are starting the spelling process and need real help to get through. But if you look around for any type of academic or early academic switch friendly apps, you just won't find any 90% of switch friendly apps. Actually, all apps for the iPad are AAC apps.    Jayson Davies     AAC meaning augmented communication. Yes. Okay, so is there a way to easily know what apps are switch enabled?    Rj Cooper     There actually is. There's a person in Australia that keeps great track of apps, in general, for special needs. Jay Farrell. Is her name and her website, I believe, is Jane, j, A, N, E, but then you've got the Farrell spelling, so it's either F as in Frank A R R E L, L, or F as in Frank a r e l or some variation. My guess is as soon as you type Jane F and Google, it's going to pop right up. And she does a great job, and she's been staying current with the apps, and she really she's made it her mission to do that.    Jayson Davies     Gotcha, that's really cool of her. Recently, I also heard that Apple may be introducing the function to use a mouse with the iPad. Have you heard about that? And if so, how do you think it will potentially help this population?     Rj Cooper     Well, actually, it's a thing of these present right now, at the ATI conference down in Orlando, two weeks ago, there were two companies showing off a magic box in which you can plug in a USB mouse of any type, which could be a track ball or a head mouse. In other words, you can track somebody's head to move the cursor around on the screen, or even if you had it eye gaze. And it allowed all these USB devices to plug into this magic box, the magic box communicated by a Bluetooth with the iPad, and presto, change. Oh, it put a cursor on the iPad within all apps. It was pretty impressive.    Jayson Davies     Yeah. I mean, that kind of seems like a really big step, and I'm surprised that Apple didn't somehow come up with that. You know, we've been How long has an iPad been around? Since about 2010 or so.     Rj Cooper     You said that's correct in April of 2010 Wow.     Jayson Davies     So eight years, and we finally have a mouse that you can use with an iPad.     Rj Cooper     There is that. But again, but when we're working with people with severe cognitive situations, the more direct link between what they do and what happens, the more they'll understand what's going on. Very true as soon as you as soon as you give them a device that's connected by cable to something else that they did have to watch something moving around on the screen and understanding that they're pointing to something cognitively that's almost an order of magnitude more challenging for them. Yeah, so the iPad itself speaking and asking them to touch the iPad directly. Cognitively, it's much easier for somebody to understand that whole situation rather than moving a mouse, knowing that they have to be careful how they move the mouse, how they click the mouse, that the mouse is connected to, the iPad, that the iPad is showing an arrow, that the arrow is pointing to something, you can see how confusing that could be to someone that's not totally typical.     Jayson Davies     Yeah, and I think that kind of goes back to the conversation we had a few minutes ago where you were saying that iPads are more prevalent than like a computer, and that's kind of the same reasoning, in a sense, with the computer, obviously you have to use the mouse and so well.    Rj Cooper     There are, there are people that will learn a computer, and they'll learn mousing, and then they'll go to an iPad and they'll say, Where's the mouse? That's the situation where this new magic box would come in handy, because it would give them a mouse. Unfortunately, the magic box the price tag more than the iPad.     Jayson Davies     It's $400 there you go. That sounds about right, but I can't imagine. Well, I don't know. I kind of feel like Apple would be able to come out with a mouse that just goes directly to the iPad that they could sell for. I mean, you know, they're going to overprice. It be $150 or so, but still cheaper than this potential.    Rj Cooper     Now, what they would do if they were going to do it, and I'm sure they've discussed it probably a gazillion times, is they would just make the iPad through Bluetooth mouse compatible, that would probably be an hour's job for one of our programmers. So it wouldn't be hard at all. So obviously they would have had this discussion many times over, and they decided that mousing wasn't really part of the plan for iPads, because they could have done it 1000 times by now, and they've chosen not to.    Jayson Davies     Absolutely. Yeah, you're right. So, all right, I want to ask you one more question, kind of looking forward into the future before I let you go, and that is exactly that. Like, where do you see assistive technology, maybe even throw in AAC communication within like the next five to 10 years. What do you see as being the next big thing?    Rj Cooper     Well, my hope is mind reading five to 10 years. That's my hope. The biggest challenge we've had over the years has not, has not been cognitive. We've come up with learning tools that Once applied, they really do their job. We've come up with physical access tools that, once implemented, they really do their job. Where we're missing on is speed and you being an OT I'm sure you've rubbed their balls with speech paths and people where it takes a gazillion years for them to create a message using any app whatsoever, any program. Yeah, it just takes too long. I'm talking to you at a rate of at 120 words a minute right now. I'm sorry, 180 words a minute right now. I'm talking to you at the rate of three words per second. If I was to slow down my speech to two words per second, I would lose your ability to concentrate on what I'm saying.    Jayson Davies     You are absolutely right.    Rj Cooper     People using AAC are outputting at about 20 words a minute max. And so for somebody to stay engaged with an AAC user that's creating text right there at 20 words a minute, even that Max is not going to do it, and that's why, when you're out in the real world, you don't see people using communication devices. No, you can think of that as the failure. When was the last time you went to a grocery store and somebody and saw somebody using a communication device.     Jayson Davies     Ever other than the kid that we you? That it's his goal to use it and we go to the market with them. No, you're right.     Rj Cooper     Never, never. Well, that's we're 30 years into this, and the word is never. And that's a failure, in my opinion. So the failure here is to retrieve and create messages on the fly, which is technology for now, and that's going to require some type of predictive ability based on context, based on artificial intelligence. I'm not sure what it's going to take, but anything that I've seen in any trade show, any of the conferences that I go to, that claim that they're mind reading, they only do it for the click of the mouse. That's it. So it's sort of an on off. So they count that it's mind reading. They count that they're using these electrodes on the brain. But when you actually ask them what's being accomplished, they go, Oh, we can click the mouse with that. Well, that's nothing. That's just ridiculous. So I'm hoping that somebody comes up with a clever and actually effective method of increasing the speed of people using AAC or creating text and Microsoft Word, something creative. We've had some attempts over the years, but they've been so off the walls that people have looked at it and said, I have no idea what I'm looking at, because it just didn't make intuitive sense to them. So whoever comes up with something clever like this, it also has to be intuitive, because most people that are implementing technology at the school levels are going to be between the ages of 30 and seven years old, non technical people, and that's the those are the people that are implementing technology for the most part. So whatever is being made has to be completely intuitive and reasonable for somebody to be able to that's my say on it.     Jayson Davies     Yeah, in my house right now, I actually have a few Google Home hubs, and I know a lot of what you do has to do with augmentative communication, but what do you think about the power of voice for some of those people with disabilities, physical disabilities, and being able to use their voice and able to access communication, to be able To access all sorts of things?     Rj Cooper     Well, first off, by far, people that have a physical disability, congenitally from birth usually have a voice disability. Also, it's rare when somebody by birth has a severe physical limitation and they speak typically, that's very rare. You rarely run across that. Okay, the only times you really run across severe physical limitations and typical voice patterns are in acquired type of injuries. So accidents, war, war, victims, situations of that nature, which are not as many as you would think come across my desk. I think because people know my area of expertise, so I don't see a lot of acquired injuries about maybe four or five times a year, I get involved with them and voice especially with Alexa being so darn dependable, as compared with Siri, who's not nearly as dependable? No, not at all. So Alex Alexa is really a nice forward advanced by Amazon. I've not tried any of the Google devices, but I can only assume by their presence in Best Buy and other stores of that nature that they're as good on their speech recognition as Alexa, because if they weren't and wouldn't be able to compete. Yeah, Siri is only still around because the iPhone is still around, and probably always will be, but Siri is not that good at voice recognition.    Jayson Davies     Yeah, I've basically, I like I said, I have the Googles, the Google Home and the Google minis, and I have basically replaced Siri on my phone with the Google Assistant app, and for me, it's easier to talk to Google on my iPhone than it is to talk to Siri. As far as using Alexa, a few of my friends have Alexa. My parents have Alexa, and it seems like the speech record ability to recognize speech is pretty comparable, but it sounds like the Alexa still has more different items that it works with, in the sense that there's different more light bulbs, more locks, more cameras. I agree, yeah.     Rj Cooper     So I agree, yeah. I agree. Alexa definitely has is the big player at the moment, with Google, second and then Apple, with its home kit, definitely a distant third, but Alexa definitely has the third party support, meaning people like myself that make things for Amazon, for Echo and Google doesn't have as many. But if you go into Bill. Spy, which I use as a litmus test, and you look at their their smart bulbs or their smart jacks, smart plug, about half of them say both Google and Alexa, but almost all of them always say Alexa. Yeah, yeah. Now, now going back to your original question, which was, how does that affect what I do? Since I contend that most of the people with physical limitations are not going to have typical voice patterns, that also means that Google Alexa and Siri will not recognize these people, and that is just a fact, yeah, and that means now you have to make a choice of how to control these devices, either through a Google device, or through an Amazon Echo or by some other method entirely. Yeah, so I make several things that are in the some other method entirely category.    Jayson Davies     And what's that?    Rj Cooper     There's several things that I make that allow a computer that can be operated by Naturally Speaking, which is a very, very dependable speech recognition program for both the Mac and the PC. I make software and hardware that allows the PC to control infrared devices such as entertainment devices. Specifically, it can also control x 10 appliances and other things that plug into the wall directly. But the trick, the last final trick here that I've got to run off to, is, most people don't think of this, but a few have, and that is, you can have your communication device. Let's just say you have an iPad and you're pretty you're pretty good with it. Let's say you're a pro local and a go user. You can have that speak something to Alexa, and Alexa will get it 100% of the time. Oh, well, it's pretty cool. It's Oh, it's really cool. You just program something on your communication device, whatever it is, it comes out, Alexa hears it, and then it's just like somebody spoke the command. It's really slick.     Jayson Davies     That is pretty awesome. I was actually thinking about that while you're talking. So I'm glad you answered that And sorry to anyone out there if we set off your Alexa, but Sorry, not sorry. But anyways, all right. RJ, well, thank you so much for coming on the show. So happy to have you. I'm glad I could get in touch with you and and this was fun. I appreciate it.    Rj Cooper     Well, speaking of getting in touch with me, if I could just say I'm at RJ cooper.com is my website. RJ, at RJ cooper.com is my personal email. One 800 RJ Cooper is my phone. I think that pretty much takes care of it, perfect.    Jayson Davies     And we'll be sure to link to all those on the show notes and put your number on there in case anyone needs to get a hold of you. So yeah, again, I appreciate it. Thank you so much for coming on and can't wait to hear how things are going in the future with you.    Rj Cooper     Very good. Okay, thank you for your time. Take care. Bye.    Jayson Davies     bye. Hey, it's Jason again. Just real quick. Want to say thank you so much for listening to Episode 29 of the OT school house podcast. And also, just wanted to give another shout out to double timed com. Jayson Gonzalez, the creator of double time docs has over 16 years experience as an occupational therapist in school based and pediatric settings. He's seen evaluations written up in states such as Hawaii, New Jersey, California and many in between. He developed double timed docs.com after finding out that it takes any occupational therapist about two and a half hours to actually write a report. So he created this software to help you write evaluations in 30 minutes and be more comprehensive while doing so, be sure to get your free 14 day trial with no credit card required at double timedocs.com . Thanks again. Everyone. Have a great week.     Amazing Narrator     Thank you for listening to the OT schoolhouse podcast for more ways to help you and your students succeed right now. Head on over to otschoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 28 of the OT Schoolhouse Podcast. In this episode, Jayson interviews School-based occupational therapist Danielle Delorenzo. Danielle is originally from New Jersey but made her way out to California via an unsuspecting vacation. Upon moving to California, Danielle was shocked at the number of Individual Educational Evaluations (IEEs) that occur and soon found herself on both sides of the table at IEPs. Listen in as Jayson and Danielle provide an introduction to IEEs and how to prevent them, defend against them, and even conduct them as an IEE provider. ​ ​ EARN PROFESSIONAL DEVELOPMENT You can earn 1.00 unit of professional development by listening to this podcast and purchasing the episode 28 podcast PD opportunity here. ​ ​ Objectives for this Professional Development Podcast ​ Listeners will: 1. Learn the primary reasons that lead to parents asking for an Independent Educational Evaluation (IEE) and what they can do in an attempt to prevent IEEs 2. Understand what an IEE looks like in a real situation and learn how to approach an IEP meeting when an IEE is being presented 3. Learn the basics of providing and conducting an IEE as an outside evaluator. Links to Show References: Have a question for Danielle? Visit her website at MorningswithanOTmom.com ​ Understoood.org – “Independent Educational Evaluations (IEEs): What You Need to Know” ​ U.S. Department of Education – IDEA Law Disability Rights California - "How to Obtain an Independent Educational Evaluation at Public Expense" Riverside County Special Education Local Plan Area: Independent Educational Evaluation Guidelines California Board of Occupational Therapy FAQs American Occupational Therapy Association: Occupational Therapy in School Settings Fact Sheet Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.     Jayson Davies     Hey everyone, and welcome to the OT school house podcast. This is episode 28 I want to say a special shout out to everyone who was down in New Orleans for a OTA, unfortunately, I didn't make it this year, but I look forward to seeing all of you next year in Boston. I hope everyone made it home safe, and if you didn't go, I hope you had a fantastic weekend and are still having a great week. In episode 27 of the OT school house podcast, Scott Harmon and I briefly touched upon iees, or independent educational evaluations, and how he, through his clinic, provides iees for school districts on a contract basis, for the schools and for the parents who request them. Moving into this episode, we're going to actually dive into iees a bit deeper with a good friend of mine, Danielle de Lorenzo. Danielle is a fellow school based occupational therapist who not only has experience with preventing and defending against ies, but she has also actually conducted many of her own ies herself or other school districts. We're very fortunate to have Danielle joining us today to talk about ies and allowing us to provide you with one hour professional development in the online distance learning category. You can learn more about how to earn that professional development unit by heading over to the show notes at ot  schoolhouse.com forward slash episode 28 for this episode, or at ot  schoolhouse.com forward slash PD, and where you can find any of the other seven episodes that we offer professional development for, because today's episode does qualify as a professional development podcast. We do have a few objectives that we want to go over, and that is that you will learn the primary reasons that lead to parents asking for an independent educational evaluations, and what you can do about it and attempt to prevent these ies. You also understand what an IEE looks like in a real situation, and learn how to approach an IEP meeting when an IEE is being presented. And last but not least, you'll learn the basics of providing and conducting an IEE as an outside evaluator. Again, be sure to head over to OT schoolhouse.com . Forward slash episode 28 for all the show notes on this episode and to earn your professional development and now, as we dive into our interview, I want to say a quick thank you to doubletimedocs.com for sponsoring this episode of the OT schoolhouse podcast. Doubletime Docs is a software designed to help you write comprehensive ot evals in half the time. Use promo code OTs H 20 to get 20% off your first order of evaluations now. And with that, please, welcome to the show. My friend and fellow occupational therapist, Danielle de Lorenzo, hey, Danielle, and welcome to the podcast. How are you doing today? I am doing well. How about yourself? I'm doing pretty done well, enjoying our Monday off from school based. OT, yeah, today off too, right?    Danielle Delorenzo     I absolutely did awesome.    Jayson Davies     Well, real quick, I know Danielle because she's a fellow occupational therapist down here in Southern California, works at a district a few cities over, but not too far, and she's actually doing some really cool stuff. And we're gonna get into that a little bit, but first I'm gonna let her actually give you some background, you know, kind of how she became an OT and what she's up to these days.    Danielle Delorenzo     So I am from New Jersey, and I started out as an ABA therapist when I was 18, and I met some pretty amazing people in early intervention, fellow OTs and PTs and speech paths. And I think when I met the occupational therapist, I fell in love with what they were doing and what they were all about, and I knew that I had to go back to school to become one, and I did.    Jayson Davies     Wow, so you weren't. It's funny, because everyone when they get into OT, there's very few people that are like, I was a junior in high school, and I knew I was going to go to OT, right? And so it sounds like you were kind of, you were in the therapy realm, but you weren't necessarily OT.     Danielle Delorenzo     At first, I didn't even know occupational therapy existed or what it was. And when I was in and I was in early intervention at that time for about seven years, and I was a supervisor, as in, like, doing ABA therapy, and that's when I started working closely with OTs, and I was like, What do you guys do? And it was when I realized that I was doing a lot of sensory based techniques without even knowing it, and then having that behavior background, and then learning about the whole sensory aspect of what occupational therapist did. It was like, it was like, my calling was like, I knew I had to do this, and I was like, I wish somebody would have told me when I was in high school, before I got to college, or I would have got to hear about this amazing profession that no one still to this day, I feel like is. This understands what we do. It always requires further explanation, of course, but, but, yeah, it was, I didn't even know it existed, and I was like, this, this is amazing, but imagine eight years. It took me seven, eight years to find it.    Jayson Davies     Wow. So were you? You weren't a BCBA, though, were you?    Danielle Delorenzo     I was not. I was contemplating becoming a B, C, B A, until I found occupational therapy. And it was I, it was a very my, my company at the time, they wanted to pay for me to go to school to get my B, C, B A. I was in Philadelphia, and it would have been great, but I decided to still work as an ABA therapist, and I went to school at Philadelphia university that's now Thomas Jefferson. They are the Falls campus. So it was a weekend program that allowed me to still work and go to school. So three years, and then I started doing OT and early intervention in the schools right out of grad school.    Jayson Davies     Wow. So we got lucky. You came to the OT side rather than the    Danielle Delorenzo     cool, still, the best decision I ever had, but the behavior background comes in handy that I can ever express, I bet.    Jayson Davies     And we love our abas here. Yes, it's a blessing when we can work together with other types of therapists and love abas. I know me too. So how did you work your way out here to California then?    Danielle Delorenzo     So interestingly enough, my father, who is retired, is a writer in his hobby, and himself and his business partner, Maria, they had a documentary that they were working on about a group of dancers in Brooklyn, and the film actually got entered into the Riverside International Film Festival. So we got to come out here in 2015 for the first time to Cali for 10 days. And my husband and I just traveled all around and literally went back and was like, we should move here. Like it snows all the time. It's breathing. We didn't have any kids. We were about to try to buy a house back east, and we were like, so should we're young. Let's just honestly, we woke up every day for like, a month, and we're like, do you still want to move? And we're both like, yes. And literally, move that summer, best decision we ever made. We're never going back.     Jayson Davies     Wow, yeah, that's pretty cool. And so you were already an OT, though, before you moved, right? I was already an OT and moved you had to do the whole license switch over.     Danielle Delorenzo     I did. I My first job was a contract position with the east valley SELPA. So they helped me, kind of just they put me in touch with it. But it was actually one of the easiest license transitions I've ever had. Moving from Pennsylvania to New Jersey was way harder than New Jersey to California. Oh, okay. It went very smoothly. I got it all worked out, and then I immediately started working about five days after I arrived here.    Jayson Davies     Wow, that that worked out pretty well. I've heard some people have a lot of difficulty with their transferring of license, or when they're trying to get multiple licenses for telehealth or something, it can take some time, but yeah, sounds like you had it all figured out. Cool. Well, let's jump into today's topic, actually. And today we're going to talk about assessments, but more so we're actually going to talk about iees. And from my pre conversation with Danielle, it sounds like ies are a little bit different across the country, and so I'm excited to hear a little bit about ies and the assessments, and I'm going to let actually, I'm going to let Danielle introduce what the term ie even stands for, for those of you who may not know.    Danielle Delorenzo     Okay, so IEE is an independent education evaluation. And as you know, as the idea states, what it is is, you know, every parent has the right to an evaluation at the public expense. So at any point in time, they can ask for an OT eval, a speech eval, a T assessment, psycho educational assessment. And then, in addition, a parent has the right to ask for an independent evaluation if they disagree with the current assessment that has been done on their child. However, it is up to the district as to whether or not they are going to, in fact, grant an IEE, pay for an IEE, or support the district's evaluation, or whatever that whoever they hired to do that evaluation. So it's kind of very interesting, because I didn't realize I ease even existed until I came to this side of the country, because I they never really got that to that point in my experience back on the east coast. So this was a whole new world to me, the independent education evaluations.    Jayson Davies     Yeah. And some of the terminology that often goes along with iees isn't good terminology, words like advocate, lawyer. What are some of the ADRs, Alternative Dispute Resolutions, things that just don't sound so friendly sometimes are associated with iees. And yeah, yeah. And so you're doing so you work at a school district right now, currently I do, and you're also doing ies, kind of not as part of the school district job, but potentially on the side a little bit.    Danielle Delorenzo     No. So whenever you work for a district, you are not able to do an IEE for that district. However, a fun fact is, let's say so there are three occupational therapists at my district. If they let's say I did an evaluation and the parent asked for another assessment, we could essentially have another therapist from our district do that evaluation. But as for a public, like private, like another outside agency, you have to do it for district, a different district than where you're fully employed. So I'm on the IE list for the Riverside SELPA San Bernardino City, couple other districts all throughout and I really I'll do it on my time off, or a lot of the schools have different, varying breaks, so they don't happen too often, and the factors surrounding them vary so much that it's definitely not something you could depend on. It's more of like a pop up random like oop, there's a phone call now it's going to see if it's going to be an IEE, because sometimes it takes several phone calls back and forth, because it is the parents right to choose who they want off of a list of the district that is offering the IEE. So essentially, it's just a matter of a waiting game to see if you are the name that they pick, and then if they actually, in fact, move towards the IEE, because sometimes mediation occurs to where it's not needed.    Jayson Davies     Yeah, and is it true that they have to take it right off the list? Because I've heard of some people where they just kind of go and pick their own evaluator and say, yeah, thanks for your thanks for your list of these OTs. But I'm gonna go with so and so.    Danielle Delorenzo     So I think it varies from district to district as to how that IEE actually comes into play, which is why it makes it so varied and so different depending on the circumstances that the IEE has come about in the first place. Typically, an IEE comes about because some trust was broken. Something occurred, maybe a procedural issue, time issue, something happened where parent is not happy. District wants to make parent happy. How do we offer a free and appropriate public education offer, which would also include iees or an assess, or an assessment, at least, for sure, because you're denying FAPE if you don't move forward with doing any assessment when concerns arise? So it's there are things that occur behind closed doors that are well above therapists and psychologists, you know, like our above our pay grade. But I think in the simple terms of it, it should, it should go about where there's a list you should pick off of that list. But I think there are always exceptions to the rules, as we all know in the wonderful world of special education, from a school based perspective.    Jayson Davies     Absolutely, and it's always, it's always frustrating when you know you put your effort into this, what you think is a great assessment, and then it just gets you know, you go into the IEP, you present your results, you go over the occupational profile, the standardized test, informal observations, and that stuff. And then you get to your the end of your assessment, and you know, maybe you say, Oh, I think that this student needs one time a month, OT or No, ot at all. And they're doing fine, and then at that point, the parent, the advocate, whoever it might be, gets a little quiet sometimes or vocal, but a lot of times, I don't even know that there's been an IE requested, and because it doesn't always happen at the IEP meeting. Do you experience that?    Danielle Delorenzo     I do. I think that. You know, I think it can happen at any time. So I've experienced it where I've handed an assessment to a parent, they flipped to the back of the page, and before the IEP even got started, they already asked for an IE because I. Not recommending services or not recommending enough services. And, you know, we all know there are rules to follow in an IEP, you have to be able to go over present levels, present levels, drive goals, goals, drive services, services, drive placement, and so forth. So, you know, sometimes you have that happen, or then you have you go through the whole entire thing. They get real silent, you leave, and then all of a sudden, there's an IE meeting, and you're like, oh, okay, luckily at this district, we are very, very aware and in tune, but that's because we have worked very hard on our prevention and education to our teachers and our administration as to what our OT policies and procedures are. I don't think that's always the case, especially when you have districts that hire contractors. So that also leads in a whole nother ball game, because if you don't have your own people, then you're entrusting another agency, and then you have a parent saying that that's not okay. So then they just go out and do something else, and then all of a sudden you find out that you have X amount of comp hours that you have to do. Because sometimes I ease happen and settlement agreements happen, and you don't even know about it until you get an email or somebody's like, hey, this kid now has to be seen for 30 hours in this amount of time. And you're like, but I didn't even recommend occupational therapy. I'm so confused. And I think especially after this training, our, you know, our lawyer is phenomenal. She gives these great trainings, and it was a favor over faith training. And I have to say, you know, she says an expression, is this the hill you want to die on? And I really like that phrase, because it's not about favor over faith. What it's a matter is, you know, if you could get your assessment in a little bit earlier, because the parents requesting it, do you do that? Because it's just going to help the build the bond and the trust and make it move forward and possibly end up where they'll end up, you know, having this awesome collaboration. Or do you fight for those like extra days, because it's in your within timeline, and you really have to assess each situation individually, hence the IEP of by nature. But I think the most important thing is, when you're doing your report, every report that you write has a chance to go to court, and when it goes to court, your name, your license, your experience, it becomes a public document. So we owe it to ourselves, because we've all worked so hard to obtain this license. You know, we are the experts, and when we go in, we have to be able to express what our findings are to parents that might not be ready to hear what we have to say. And that's and that's important, to be able to separate those emotions so you can remain cool and collective and report your findings that you know you did a good as long as you know you did right by your student and you did best practice, you will be just fine. However, it's when maybe not everybody else on the IEP team was making those same decisions. Or because if one procedural error happens, unfortunately, sometimes it doesn't matter how great our reports are we might end up in an IEE when it has nothing to do with us. Yeah. So that's, I think that happened everywhere, yeah. And it's going back to that prevention. How do you stop it before it even starts?    Jayson Davies     Yeah? And it's funny, because we ended up being in a lawyer training the same day with different lawyers. But right, one of the takeaways that I had was that, just like you were saying, you know, it often comes down to the parent says, hey, I want an IEE, and we'll just say it's an OT, for today's sake. And then the school's like, actually, we think our report is pretty darn good. We're not going to grant you their IE, and they come back, the parent comes back with their advocate and lawyer and says, Well, if you're not going to grant us this IE, then we're going to start pointing out all these missed sessions. We're going to start pointing out all these little clerical errors almost in the IEP that can then be even more difficult for the district to defend. And so they're like, Sure, we'll give you an OT IE. Tell us who you want to do your IE. And so you're right, it kind of you could have a good report, and it doesn't matter, because they have the right to request an IEE, no matter what that said. Another takeaway, the last one I'll talk about right now, it was that they could not request an IEE until the district has done an assessment.     Danielle Delorenzo     Absolutely or even, which is interesting, because this came up at our training too. And it was a fake scenario about, first off, I almost, I almost had a I had to, like, stop myself, because when I was listening to the scenario, I was like, Oh my gosh, I hope this never happened. So, so the scenario was, Mom requested an assessment. OT made an assessment plan. Further along the meeting, when it got heated, ot went to hand mom the assessment plans. She said, No, I'm going to have somebody else do it outside. OT ripped up the assessment plan. So now I'm like, jumping out of my chair because I'm like, never, ever rip up an assessment plan. You know, especially with these new court cases that have been coming up, we have to show, without a reasonable doubt, that we are trying to do our due diligence over and beyond to get this child assess. So instead of ripping up that ot assessment, what the OT should have did was present it at a different time. Keep presenting it. Present it as much as they possibly can, because then if the mother went and got another eval and didn't sign that when it went to court, that would be findings where we wouldn't have to reimburse now, if we rip up an assessment plan, we're absolutely denying fate, because we denied the chance to be able to assess in the first place in the suspected area of disability.    Jayson Davies     Exactly. Yeah, it's the district's responsibility to assess and whether or not the parent agrees to it, oh, I should say, if they don't agree to it, is then the district's responsibility to actually file yes a case against the parent saying, hey, State of California, we feel that this assessment needs to happen. Basically, you know, it rarely comes down to that, but that's, that's what would actually have to happen. So when you rip up that assessment plan, it's like, you never offered.     Danielle Delorenzo     Exactly, and then you're gonna end up probably having to, oh, or even more, because you've denied FAPE, and then it's just like, ah, then you're in that hole. Well, it doesn't really matter what happens or what's supposed to be right at that point, something, a mistake has already been made. Unfortunately,    Jayson Davies     absolutely, all right, so let's jump into the next area. We're gonna talk about being on the side of an evaluator of an IE. But first, let's talk about kind of defending yourself against an IE, you know. So you're the occupational therapist you gave your report, you know, two months ago, three months ago, however long it took to do the IEE, and now you're sitting in this room again with another occupational therapist sitting, you know, around the table with you, and they're presenting their own IE, what are some of the things that you know you need to remain calm, obviously. But what else can you do when an IE is being presented about the student first?    Danielle Delorenzo     And the most important thing that I like to do is I like to look through the report. Most often you're getting it right there, so I'll skim it and I'll look at the observations to see number one, if they actually saw the child within a school setting. So often, a lot of these iees have never even set foot in the classroom. So our lawyer has instructed us to ensure that we have questioned the amount of time that the outside assessor has spent within the classroom, and note that in the comments section of the IEP, so if it does go to due process, she has more of a leg to stand on defending our skilled observations. That's why it's very important to write skilled observations everywhere in every assessment, because that makes it way different than a teacher's observations. Yours are your specific skilled ot observations. So in addition to that, how many days did they take for testing? How long were the testing sessions? Where were the testing sessions? And also ask them why, if they are recommending services, why that is the what was their rationale, and if it fits within a school based model, you know, we have our OT PT guidelines that specifically express how educational OT is very different than medical based occupational therapy. Yet, a lot of IEE recommendations fall along the lines of clinical recommendations in addition to clinical therapists completing these IE, so if you are able to touch on a few of those points, it helps just defend how your assessment is a true assessment of the child in their educational setting, because That's what an educational occupational therapy assessment comes down to, is the child able to access all areas of their education, and do they need any support in those educational occupational therapy related areas of the core curriculum, like and how they can do that. So a lot of these assessments have a lot of stuff in. Between and are very theatrical, but when you can cut it down to the core, why do they need this much therapy? What? How do you know they weren't accessing it by this, if you weren't even in the classroom and so forth? So really, just think about all of this. Is this could go to court. So what do you want in that legal document, as how you defended against somebody that's challenging they're not necessarily. Got to remember, it's not challenging your report. It's taking an outside view of what you see. That's what an IEE should be going into the school, taking everybody's things out, and saying, Does this kid need ot or not in a school setting, and what would help them you know?    Jayson Davies     Correct and, and I don't want to make it, you know, we're not bashing against iees. This is why we're going to get into the second part of this IE, where Danielle has actually presented several ies, and so she's going to talk a little bit about that side. But it's just kind of the nature of these meetings, they have a us versus them mentality,    Danielle Delorenzo     they do. And that's sad. That's so sad.    Jayson Davies     Yeah, and it's great. I've been in, I've been in a few ies where, you know, the the findings come back, and the parent requested a psycho educational, a PT ot speech, and 95% of the reports like they mesh. They were their report sounded very similar to my report, right? And, and the findings were similar. The recommendations were similar, and, and so that does happen does, but occasionally you get some of those meetings where it doesn't happen like that, and these the the evaluators often come in and they have, well, they have recommendations that sometimes seem a little over the top, to put it that way, and it sometimes just doesn't seem like they really have necessarily a school based model in mind when they're talking about their evaluation and the recommendations, right?    Danielle Delorenzo     And, you know, I think, unfortunately, in my experience here in California, I've been on more of those, you know, us versus them. And then when I actually get the iees, like, when I had one with a psycho Ed, they were like, the everything that everyone's doing is great. I love this. And I'm like, see like this. This is how you build that continuity of care and build trust, because there's a reason why the parent is asking for another evaluation in the first place. So whether it is the district defending yours or having somebody in and come in depending on the circumstances, I think as long as anybody who's doing iees Has the mindset of, I'm going to go in here and give this independent, clear assessment of where this kiddo is and what they need to succeed, whether that Be OT or not, and try to bridge that gap of that mistrust to maybe put a little bit more confidence into the district. Now I've also had it where I've had to do an IEE, where certain people weren't recommending and then I recommended some type of service, and then ultimately you just report and you leave. It's then up to the district and the IEP team to determine what the level of service, what the goals are. You can make any suggestion that you want, but your job is to report out and then say what you think would be great, and then that's it. Your job is done. Yeah, that's true.    Jayson Davies     So I want to take a quick step back. We talked a little bit about defending an IEP, but also like going back to even before that, preventing and one of the things that you can do, and I think some people will have, they get very attached to the reports, and they're afraid to make a revision to the report, and remember that you can make a change. Say, you get to your IEP and something's not right in your IEP, you can make a revision to your evaluation and work alongside with the parent to make it okay. I'm not saying to change something that you know is right, but you know you're going through your report and there is something that isn't quite right, you can say you're right. That's not quite right. I will make a correction to my evaluation. We will put on the IEP that this was revised on this date, and then give it to the parent. And even just by doing that, you can build trust with a parent, which then can ultimately, potentially prevent an IE, yes.    Danielle Delorenzo     Absolutely. I mean, I don't think people realize it really can come down to those minimal, literal clerical errors that sometimes are the reason why we end up in this mistrust in the first place. I have been. To so many IEPs or reports have different names on it or different standard scores, but you're absolutely right. Own your mistake. That's what builds trust. If you've made a mistake, own it, revise it and submit it with the changes that are appropriate, because then a parent is going to see you as a human. They're going to see you as they're not going to sit there and keep defending something that is inaccurate. It happens. It's mistakes, like we're all it's all human error, you know. So I think that the most important thing is to just own it, and what can you do to move on? I think so often we try. I've seen in the past districts try to move forward without owning what they've done and and that's going to lead to more ies and things that are even bigger than ies, you know what I mean? And I've seen things really de escalate when people just start to talk and build those relationships and say, Okay, this might have been wrong, but let's try this.    Jayson Davies     Absolutely so I think we've kind of covered that. I mean, are there any things in a report? I guess maybe a few things that absolutely need to be in your report to try to prevent one of those kind of more clerical errors.    Danielle Delorenzo     So, you know, for us, we made this template where everything that has a name or an age or a score is always highlighted in yellow. So anytime you go to type that in, it has to be different. We also don't copy and paste art. We start a brand new template with each new child, because that just automatically eliminates the fact that you could duplicate any information. And then, in addition to that, I think what's super important is, you know, having skilled observations, putting the dates. And then the other thing, that's just something really nice, to make sure you're right. Your assessment the date the assessment plan was received, within your template for that, because then what it shows is that it was already within the timeline that it allotted. Because sometimes parents like to cancel IEPs and push them past their timelines. But if you try to give yourself some grace and try to set up like those three IEP meetings with ample amount of notices for those conference notices to go out. You're already saying like, Hey, I have this amount of time. I'm filling in those blanks. Also, you know, typically when you are either recommending or not recommending services, that's the other thing that we put in highlighting. Because sometimes I've seen reports where they don't recommend services, but in the report it says recommending services. So I've seen no so I've seen a couple, but like, it's, it's template errors, it's cutting and pasting errors. So I don't do it, and honestly, it's it. It eliminates the those clerical errors. And then I always follow along on the computer, and when I'm reading it down, and if there's an error, I make a change, immediately, take all my copies back, reprint it right there, and re sign them all. And when I know they're official, because you know what happens.    Jayson Davies     Absolutely and even what you just said, make sure you're signing and also, most recently, in our district, we've started dating, making sure that we date where signature is as well. Yes, so All right, so moving on. Then, now, kind of flipping the role to an IEE administrator or evaluator, I should say, yes. What? Let's start with, what does someone need to do in order to be an IEE potential evaluator?    Danielle Delorenzo     Okay, first things first, you need professional liability insurance. That has to be your step one, because everybody who asks you to be an independent contractor via an IEE will ask you for professional liability insurance. So the real cool thing is, if you're an A OTA member, I think it's around $200 a year through marsh and pro liability. So you could get that real easy. The next thing is, you're gonna need your own assessments and your protocols, because you know you have to have them. Now, is it expensive? Yes. But after you do 203, I ease all of your equipment is paid for. And then you have your assessments for life. They're not going anywhere unless somebody comes out with an amazing new motor test for school based besides the, yeah right, the bot three. But you know, I think your standard assessment, so your bot, your ravma, your ths, your handwriting, you know, the handwriting without tears, check readiness, the Peabody, all the sensory profile, sensory processing measure. I prefer the sensory processing measure over all of them. I just really. Like how they break it all down and apply it to different school areas, as well as having, like, your own informal assessment tool kit, that's another important thing. So when you have these kiddos that are more on the severe, profound side, you might be looking at a multi sensory level. So you want to make sure that you have a variety of sensor like different tactile inputs and other stuff like that, such as, like bubbles, different materials, sand, like that, stuff, just so you can get an informal sensory eval from that, which can really go a long way when you're looking at those foundational skills that are necessary for them to access their education. And you know, even though you might not be recommending services, you could be recommending an amazing program that the teacher can follow through with to help support those foundational skills.    Jayson Davies     See. So we got the insurance, getting some assessment protocols, what else?    Danielle Delorenzo     So we need a template. So you have to have your own template. Now, it took me a couple of years to really narrow down my template, and I feel very happy with it. And why I like it is because it encompasses everything. See as an IE, you could do whatever you want, you can put whatever information you want to include, or you could not include, but what you're trying to do is get that occupational profile of that student, what their areas of concerns are, what goals they're not able to meet, and what areas of their education they cannot access. And I think having a nice template, I like to use some color in it. I like to make it clear. I like to give I don't like it to be overwhelming, so like I try to keep my I ease to under 20 pages. But I also will add informal checklists, tools to grow. Has some amazing early skills, childhood checklists, and like, K through six checklists, those are really good informal assessments. So I like to add those and within your template, your own parent questionnaire and teacher questionnaire, just because that's pretty much, you know, especially if it's a home kid OT, because either way they're going to be having a home hospital teacher or the teacher at the school, we Need a rate sheet. You have to be able to give an overview of your hourly rate if you're going to be all inclusive, if you are going to go per hour, if you're going to charge for mileage, what your phone rates would be if you're going to attend an IEP via phone. And lastly, it's I like, networking, because I ended up on the riverside SELPA via like, three different connections that led me to somebody, that led me to somebody that was like, Oh, hey, I know this person. You're I'm gonna do an email. So    Jayson Davies     if you're gonna be an IEE evaluator, that's kind of like being an entrepreneur. And so just like any other having a business, even if it's just, you know, a few ies a year, you have to network so people know who you are, that you exist and that you have, that you're producing good reports. And like, like Danielle talked about earlier, there's a provider list, and if you're not getting selected, even if you're on the provider list, and you're not getting and you're not getting selected, then, well, it's not going to help your cause. But if you network, you know, because a lot of times people aren't just getting an OT IE, and so maybe they're getting a psycho educational IE, then that person who's evaluating the kid says, Oh, you need an OT one. Oh, I know. You know Danielle. She's good with she does really good ot evaluations, right?     Danielle Delorenzo     Yeah, and that kind of happened in Palm Desert. I got a random call that said, you were recommended. I wasn't even on the Palm Desert ie list, but somebody heard about me. I don't know how, but they called me up and they were like, we've heard that, you do, I ease, and they asked me a bunch of questions, and that was that. So it's, it's, I don't ever know how people get back to me, but, you know, I was an IEE for the district that I am working at now, when, after I left the district. So after I left them, they still wanted me to come on board as an IE. So that's what I did for them there, until I became you know that happens.    Jayson Davies     But that means that they liked you as an IE evaluator. I'm sure they're gonna like you as a as an OT there. So good earlier, you mentioned skilled in skilled observations. Yes, as an IEE, you can get on campus and do all the observations you need to do, absolutely.    Danielle Delorenzo     All you have to do, really, what, how I go about doing it is I contract the district office. I like to do a chart review. I think it's insane that iees Don't do. Chart reviews. I was told that I was one of the first ies that have ever reviewed charts. And I'm like, Well, I don't know the kids. So how else am I going to know them? Unless I look at their previous, you know, did they get ot before? Like, you know, it's just like a regular assessment. So if you contact the district and you say, Hey, I'm going to be setting up visits at this schools. You set it up at the school, you set it up with the parent, you set it up with the dates, and you go and you pull them out, and you get an area at the school, like that's it's almost like they don't they shouldn't have to come to you. Is it like you need to go to their setting? That's what you're assessing, not how well they can do in your office. You know what I mean. You're assessing how well they can do in their natural academic setting.     Jayson Davies     Yeah, and just because they don't have to go into the school to do an evaluation, I would say that as an IEE, you're more likely to be well, you're gonna have some more credibility among the IEP team, if you have gone into the school and seen that kid, and potentially even, like she said, do the actual assessments on campus, because that is the closest thing to the natural environment that they're going to be in. And so, yeah, that makes sense to me. I like that you do that, yeah.    Danielle Delorenzo     I mean, I just, I don't really understand how you can't do that. It doesn't make sense to me. So that's why I feel like, anybody who's ever asked me, like, how, like, that's, that's my proto and I talked to the teacher, I talked to the parent, I, you know, and that's, that's who, whoever they give me permission to speak to, I will speak to. And then the other part that I like to include is I'll have a section that has educational recommendations, and then I'll put in parentheses specifically related to the educational setting. And then I'll put non educational setting, because a lot of the times I will get severe, profound kiddos specifically. And if you couldn't tell that is my love it's my favorite practice area, I have been working with that population since I was, oh gosh, years, over 18 years. But you know, there are some medical options for these kiddos that maybe the parents don't know about. So as an IEE, you can still educate, you can still empower. You can still say, Hey, I know this clinic that takes this insurance, and maybe they might, you, maybe you should get, like, a, you know, a kid that's in and out of the hospital, maybe some home. OT, home. PT, for transferring for your tub, your shower, like that stuff. And I think that's where to, you know, a lot of the times these parents are like, they're not giving me OT, but they need help. Yes, you're right. They do, but not in an educational setting. So an IEE can really help divide that and say, Hey, listen, look, here's from an educational setting, but listen, what you can do on your own time. Stuff that the school is not responsible for is x, y and z. That makes    Jayson Davies     sense, and that's cool, because as as an independent evaluator, you can do that, versus as a school based therapist, if you come in and do that, you're probably gonna get some interesting looks.    Danielle Delorenzo     You're not allowed to do that really. Let's just, let's just be for rank. You have to be like, and maybe you should consider the possibility of maybe talking to your doctor like you can. It's so hard to help when you are in a school district wanting to give recommendations outside of a school setting. We all have that medical background by nature, by our trade, by what we do, and we all know those kids that we would love to get in a clinic and be like, I can help you.     Jayson Davies     Yeah, well, plus, we're the ones who know that clinics actually exist, versus a administrator or a teacher that doesn't have a kid with special needs and so absolutely. Alrighty, well, is there anything else you wanted to talk about?     Danielle Delorenzo     Ies, you know, I think my biggest thing about IEE is that what I would love is to see ies looked at as a more positive type of intervention, where, if you're getting an IEE, then this is a situation that really needs for some relationship building and for some trust to be re established, and you can really help bridge that gap together. And I think most importantly, you know, as I like to call us educational occupational therapists, you know that that's my thing, because you know that that way people really start to see us as components of access to students education, rather than you're going to put my kid in a clinic and make them better, and they're going to be able to do great at school, and it's like, there's we could do so much more. And you know, that's why I think it's that prevention, and it's that RTI model, and if we are using a lot more respect. Response to Intervention and following that MTSS multi tiered system of support and educating our administrators and our principals and our teachers as to what OT is, what we do, and even just that phone call, because, you know, right before an IEP, hey, I got a parent that might need ot, let's figure out how we can do this. Let's just talk. Sometimes it's just a simple phone call or an email that says, hey, let's talk about some things before it even gets to an IEP. So I think if I could leave everybody with a message of just trying to look at iees and a little bit of a happier light and just really focusing on all the things that you could do before, and know that even if you've done everything, it still might not be your fault as to if it does end up going to an IE. And know that like, you got to separate that personal nature, because it hurts. It hurts to get yelled at by a parent. It hurts to get told that you don't care about a student, or that your report is horrible, and I don't know what I'm talking about, but you have to realize that there is something that is going on that is much deeper than your report, and it has nothing to do with your report. You are the expert. Trust your schooling, trust your judgment, and do best by those kids and make sure to do a lot of mindful practices when you do have those high, intense situations, because it's not about you, and you just got to keep bringing it back to the student.    Jayson Davies     Yeah, and the lawyer will tell you exactly the same thing, that you're the professional, and you know, they they're not an OT. The lawyer is not an OT, the judge isn't an OT, the parents, not an OT. But if you don't see yourself as a professional, then no one else will. And so you absolutely, you see you completely view yourself as a professional and be confident in your report. Absolutely. So great. Well, Danielle, it was great having you on the show for people that may want to reach out to you. Do you have a website?     Danielle Delorenzo     I do. It is mornings with an OT mom.com , and it's the same handle for Instagram and Facebook. Awesome.    Jayson Davies     And you'll see us every now and then the OT school house. We give them a give Danielle a shout out over it, with an OT mom. So be sure to find her on on Instagram. She has a little one, and she's taken care of right now, but she she takes some time to put some post out there for everyone. So thank you so much, Danielle, for coming on, and we'll see you next time.     Danielle Delorenzo     Yes, thank you so much for having me. This was super fun. Take care. Bye.    Jayson Davies     Hey there. It's Jayson again. Thank you for listening to the OT school house podcast, a big special. Thank you to Danielle de Lorenzo for coming on the show and sharing everything she knows about iees and how we can prevent, defend and even conduct them. Be sure to check out the show notes at ot  schoolhouse.com forward slash episode 28 and also there you can learn how to earn one unit of professional development for listening to this podcast. Until next time, 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. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast