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Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 177 of the OT Schoolhouse Podcast. In Part 2 of this important conversation, Dr. Savitha Sundar returns to explore what inclusive OT practice can look like beyond the buzzwords. In this episode, Savitha helps us shift from reflection to action, discussing how to align our evaluations, goals, and service models with the values of true inclusion. We also talk about building meaningful collaborations with general education staff, embedding participation-focused goals into IEPs, and celebrating small wins in systems that are slow to change. If you’ve ever asked how to make your OT services more inclusive and collaborative, this episode is a must-listen. Listen now to learn the following objectives: Distinguish between traditional “push-in” models and inclusive OT practices that center student participation in general education environments. Learn how to write IEP goals and conduct evaluations that promote inclusive outcomes for students with extensive support needs. Explore strategies for building trust and collaboration with general education teachers to support system-wide inclusion. Guest(s) Bio Savitha Sundar PhD, OTR/L. Savitha Sundar has served in public schools for over 17 years across three states, primarily supporting students with extensive support needs in self-contained classrooms. Her research focuses on the role of school-based occupational therapy in bridging the research-to-practice gap in inclusive education. For five years, Savitha served as an executive board member and later as a partnerships officer for a national nonprofit organization--Changing Perspectives, focused on promoting inclusive practices and social-emotional learning.  Savitha teaches entry-level OTD students during the summer at Texas Woman’s University and has mentored more than a dozen students in school-based practice. She also hosts the podcast Inclusive Occupations – Sharing Stories of Not Just Being Invited to the Party but Dancing. Through the podcast, she amplifies the voices of educators, researchers, and individuals with disabilities working to build authentically inclusive learning communities. Resources Inclusive Occupations Podcast  by Savitha Sundar Changing Perspectives  (Nonprofit promoting inclusive practices and SEL) Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hello and welcome back to Episode 177 of the OT school house podcast. If this is your first time listening, or if you happen to potentially skip episode 176 of the podcast, I highly encourage you to check out part one of this conversation with Dr Savitha Sundar to get the full context on supporting students with extensive support needs. Our special guest, Dr Sundar has over 17 years of experience supporting students with extensive support needs, and is committed to building more inclusive school communities through ot practice. She's also the host of inclusive occupations podcast, and has mentored numerous ot students and professionals on inclusive school based practice. In part one, Savitha helped us to unpack the history and challenges around how students with extensive support needs are often served, and what it means to rethink our role as school based ot practitioners to support them. Now in part two, we're shifting into the how we'll be talking about practical strategies for inclusive ot services, writing IEP goals that center participation and collaborating with school staff to move the needle one small step at a time to help bridge the two episodes we're going to begin with the final question from part one about how ot practitioners can start redefining their push in practices to become more inclusion focused. Now let's jump back into the conversation with Dr Savitha Sundar.    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.    Savitha Sundar     What if we provided these supports in the general education classroom? What if we put our effort in making that like OTs, the time we spend in what we currently do, don't take away any time. Don't expect adding more work to yourself. But just think about the same time if it was used in making the general education experience accessible, just recess, just cafeteria as an OT team. Can you all sit together and brainstorm? How can we make cafeteria accessible for all our kiddos in our district. How is it going in your school? How's it going in my schools? Can we all implement the every moment counts comfortable cafeteria program? So another finding of my research was when people knew the how. They always had a clear why. Why? When people knew their how, like people who were aware of these programs, you know, like a comfortable cafeteria program, or the you know, like the interoception program, or people who knew these had these tools, felt like they wanted to justify inclusion because they could do something about it using these programs. Gotcha. So I think having the tools to do it is so important for us to actually assume that role in schools. It's just that we don't know how to do it. That's the biggest problem.    Jayson Davies     Yeah, so I guess that kind of automatically leads us into our next area, which is the how part. And before I ask you how you've done this, you kind of alluded to it a little bit here. I mean, there are programs out there, I guess. But what are ot practitioners currently saying? Did you ask them in your survey? Like, how are you doing? How are you promoting inclusive practices?    Savitha Sundar     No, that was not a question in my survey, but the survey was to identify interested therapists who were willing to talk more about it. So I did identify some of my study participants from that survey, and also through a whole bunch of searching that went on for a while to select these inclusion focused ot practitioners, right? So I had a multiple case study of six inclusive ot practices, okay? And the findings were so interesting, great, great ideas. One of the themes that came out of the study was people had different conceptualization of what inclusive ot practice is.    Jayson Davies     Okay.     Savitha Sundar     Right, which sort of surprised me, given that I had very specific questions or like, access to general education, curricular, extracurricular activities, access to peer relationships. These were like the two criteria, despite that when they heard the term inclusive ot practices, or even when we had a discussion about inclusive ot practices, the most common understanding, which I think you can resonate with too, I think a lot of OTs, lot of us can resonate with, is they talk about seeing the student in the natural environment, like the portion services, yeah, okay. But. One of them said, Well, if I see my student in their natural environment, it's not inclusive ot practice at all, because they're all in self contained classrooms. How can that be their natural environment? So that was like, a big aha. Like, yeah, right. So we are working within a broken system, and we are perpetuating that system by providing ot services within like it's better than pull out services. Yeah, pulling a kid out of what is determined as LRE by the school, pulling them out of that and providing services is probably the least in the list. However, I don't even want to say that. If you want to delete whatever I said right now, take it off.     Jayson Davies     Well, it's the least restrictive. I mean, in terms restrictive to least restrictive services, pulling out a student is the least restrictive.    Savitha Sundar     Right? Right switch, okay, so if you switch to a different lens, okay? And look at it in terms of inclusion, okay, you're not going to talk about push and pull out services. You're going to talk about integrative collaborative services. Sometimes we have to give that one on one support to a student, because that's going to lead the student to make friendships with others. Sometimes we have to teach them how to use this assistive technology tool, one on one in a quiet setting, so this kid can actually learn to use it in the in the in so we can make the right recommendation to the teacher so it's used in their natural setting. Okay, so, okay, i That's why I feel like fees put this, oh, I only push in or I only pull out. We want to do focus on integrated services, where we take each person who com brings with their comes with their expertise in certain skills, or would take the responsibility to address certain skills. Can address those skills, and that can be fit into the student's natural routine.    Jayson Davies     Okay? So, yeah. So, yeah, the focus is on the outcome, not necessarily the type of service per se, and.    Savitha Sundar     Also understanding that me pulling this kid and working with this kid on using on a typing program, practicing typing program while learning a math concept in the class. Is not valuable. That's not integrative. Collaborative services. You would provide the service at a time when it's least disruptive to the students, you know, participation in their natural classroom, yeah? So weighing that, pros and cons and collaboratively as a team, coming up with this goal, like, what are the goals we want to focus on for the student with extensive support needs that will lead to the outcome we all desire for the student? Yeah? So I'm sure it's not so black and white and clear however, it's just something to it's something to think about, right?     Jayson Davies     Yeah, so play this game with me then. So for example, one of the service models that I've liked to use in the past was what I called the two to two model for I would see a student in a more traditional pull out setting, and then the next week, I would try to incorporate what I did in that pull out setting, but do that inside of the general education classroom or maybe out at recess the cafeteria. Would that be, quote, unquote, an inclusive ot model? Because the goal was in order to, yes, I did use that pull out service model for one of the sessions, but the goal was to promote the in class participation. So would you view that, then, as being an inclusive ot practice?    Savitha Sundar     In my view, yes, because you are working with this kid to be successful, to access the best quality education they can access, you're supporting with that?    Jayson Davies     Yeah, perfect, yeah. And I wanted to ask you.    Savitha Sundar     And you cannot do that. You cannot do that access by only working in pull out, because you have to know what's going on in the class. How does it translate into being functional in the class, and what are the other resources that are already available in the class that we can pull in that are even more effective than me teaching this kid. So.    Jayson Davies     Absolutely, because every time to look at Yeah, and every time you're observing a student in the classroom, you're also observing the classroom, and you're using what you know about the classroom to then adjust the services that you might be supporting during that pull out session, or whatever you you want to call it. So awesome. Okay, so where do you think the biggest struggles are then, right now, you mentioned, you know, a therapist even bringing up like, How can I provide these inclusive services when I'm when the student themselves is not included? Where are you seeing therapists have the most difficulty with providing, or maybe even understanding the practice of inclusive ot practice.    Savitha Sundar     So I don't know generally how it is with all other therapists, but the participants who I selected for the study were the ones who considered themselves as inclusion focused OTs, or. Or they supported inclusion, or they had enough stories to share about at least two students about inclusive practices, right? So these therapists shared examples of two types of inclusive ot practices, okay? One, when the student is already in a general education classroom and they're enabling access, they're making that the placement meaningful, making inclusion meaningful by supporting their access to participation in general education, content and contexts. The other the other type was, my kid does not have access to general education, peers or experiences, so I'm going to make it happen. I'm going to be the agent that supports this kid to access inclusion. I think they both are very powerful and important for our practice. So when you are in a situation where like, oh, this kid never goes to art, or because he just doesn't do anything, that he's just running around, right, and then you come in and say, Why is he running around? Let me go see well, because none of the activities given there are remotely meaningful to this kid. He likes being with other kids. He likes watching other people do art, but here you are sitting and forcing him to do art, right? So there's a range of experiences you can get. Like, participation has different dimensions to it, right? You don't have to participate. You may sometimes go to a party. You may not like any of the food, but you like you like the company of the people you know. So participation has different meaning to different people. So how can we enable that? How can we make that art lesson meaningful to this student, right? So then that becomes ot for inclusion, right? So you're providing ot with the expected outcome of inclusion. Here I have this other student. He is not able to sit and eat in the cafeteria. He's grabbing food from everybody. How can we make this it's a it's a complex problem. It takes, it takes the takes the skill sets of somebody highly trained like an OT is in participation, right? So we can, we can problem solve that with the team that I think would be include. And then there were OTs who talked about, like, here is inequity. My kids do not go to field day. They're just watching Field Day. Field Day is not accessible to my kids. Why are my kids sitting and watching Field Day? Shouldn't they be participating there? Well, they don't participate because none of the games they first of all, they were not invited. We've never invited kids from the self contained classrooms to our field day. Second of all, none of the sped team has been part of the planning. And thirdly, none of the games there are remotely designed with these students in mind. They don't know any of the staff or the kids in the playground, right?     Jayson Davies     The kids do get invited out because of those other two there ends up not being a successful experience, and therefore, next time, they're not invited out.    Savitha Sundar     Absolutely or they end up having behaviors because nothing was done to make it fun for them. They were not even considered in the planning process.    Jayson Davies     Exactly. It's such a hard because, as you're talking, the other thing that I'm thinking about is, well, going back to my example of using a two to two model, except maybe, let's just assume now that I'm using a a pull out model, strictly pull out one time a week, 30 minutes, pull out of the classroom to a degree. I just don't want us to us to let ourselves off the hook in a way. And so I don't want to say, well, all my kids are pull out, but I'm providing inclusive ot services, because my end goal is for them to be included into the classroom, into their general education setting. And so I you kind of alluded this too, I think. But go ahead, like, how do we prevent that?     Savitha Sundar     I think that's a great point you bring up, and we are at risk for this, because, in general, inclusive OT is considered as pushing services. That's the general understanding that we come from. What's inclusive ot practice is that I don't pull the kid out of the LRE, they're in the LRE, and the LRE is the self contained classroom has been predetermined as the self contained classroom, and there's a lot of flaws over there. How many of these students had a fair opportunity with supplementary aids and services, with related services in the general education environment, to try and fail before they were moved into a self contained classroom? They've only known a self contained classroom for many, many years of their lives. Okay? So it's just flawed in the beginning to start with. Okay, so when I say instead of saying inclusive ot practice, I want to say inclusion focused ot practice. So if it is inclusion focused, then the IEP goals are written with that outcome in mind, and you're not pulling a kid out of the classroom because it's convenient for you and because you have to meet your IEP minutes, and therefore this is the only time you can find to see this kiddo, and the only way I can do it is by pulling them out. Then those are not like justifiable reasons to pull a kid out, right? But if I'm say I'm pulling this kid out to go work. With one student in a particular experience, because this kid is the only kid who needs to go to science camp. And I want to have this kid part of the classroom, understanding the general classroom, understanding the science camp requirements. Then I'm pulling this kid out to get a richer experience, you know, for the purpose of them being able to succeed in beating grade level expectations. Yeah, right, so I hope that's clear.     Jayson Davies     Yeah. I mean, this is a complex topic.    Savitha Sundar     It is not easy at all to wrap your head around, but it's a process that we have to think and as a community, come up with ways to address.    Jayson Davies     Absolutely and I think it's also something, and you've mentioned this a few times now, that isn't often mentioned, or if it is mentioned in an IEP, it's more mentioned in the way that I talked about it, where it's just like, Oh, all right, that means the kid's going to be 15% in general education. But IEP teams, I think need to have more conversations about how much the student is included now, but also a year from now. What do we want their program to look like? Five years from now? What do we want their program to look like and start to I don't know is is it out of the question to make an IEP goal related to the percentage of a day that a student is included like that, obviously, is not a traditional goal by any means. I've never written anything like that, but I don't know. Is that out of question.     Savitha Sundar     I would personally put it more in terms of access and participation related, like say this student will be able to depending on where the student hears the student not even going to the cafeteria. Okay, this student is going to be able to have lunch with a peer in the cafeteria for five days of the week, or, like, three days in a week. Or you can say this kid is going to be part of science lessons for will actively participate in at least five of the 10 activities that are provided in science. I mean, I think creatively, we can come up with different goals to increase the access and participation in general education experiences. We can start with where they are already now so they are going to cafeteria. But how meaningful is the inclusion? Like, how do we want them to be right and and once kids know them and understand them, they have friends, then getting them into Gen Ed is not so scary. You know that is true. Their peers will be talking about this friend that they made and like the device that they use. It's so cool. Now I want to see how they use it in the class here. Let me show you how to use they may even explain it to the teacher. This is how you use her device. Let me show you how. So you know, it's just slowly starting from where you can to where you would like to be.     Jayson Davies     Yeah, I have so many follow up questions. I want to be mindful of our time, but I want to ask you, because a lot of therapists have come to me over the years on Instagram everywhere, and said, like, how do I provide services through a push and model without feeling like a paraprofessional? I want to get your take on that, because I have constantly told people on the podcast everywhere, like it's vastly different. The knowledge alone between what we have and a paraprofessional just immediately makes what we're doing different from a paraprofessional. But I want to get your take on how you see that.    Savitha Sundar     Yeah, it is. It is a hard question, because if the school district requires your one on one service, your individual direct services, like in some states, you're not required to say whether it's individual or group. In some states, some districts, you're required to say individual or group or consult. Some of them would just say on a on a range of indirect and indirect services. Some school district districts write it like that.     Jayson Davies     Depends who's been sued, how many times, and for what.     Savitha Sundar     Right, right, right, exactly. So based on that, I think a bigger conversation is for the team to come to terms with understanding how ot services will be provided, understanding that we are writing collaborative goals. Our expertise comes in planning the IEP and brainstorming it, and how are we going to implement that goal when we are not around sometimes you may you may look like a para educator, but you actually know the kid enough to make a meaningful recommendation in the class. Unless you work one on one with this kid, you don't know the dynamics of that process right. Sometimes that's very essential. And you don't want people to assume that you're gonna take this kid and we all walk away because you have this kid and I'm gonna go take a break or work with another student, right? That's another assumption that comes so making all these explicit in the beginning, and just like try our best to explain your role and say, you know, I want. Work with this kid, but, but my bigger goal is that they meet this goal, and I they can't meet this goal only by working with me. They cannot make this skill meaningfully applied in their day to day lives. If it's only me working with this kid, we need to collaborate on this so emphasizing that, you have to say it many, many, many, many, many, many, times to get the team on board with it, so it takes a long time, but don't give up.    Jayson Davies     Yeah, but I think the other part of that is the OT practitioner not feeling comfortable with providing that push in service sitting next to a student and that they internally feel like a paraprofessional at times. And I don't know what your thoughts on, like, how did you overcome that? How did you overcome this idea that you could be successful by pushing into the classroom and working with a student where you didn't have control of the environment, where you didn't have control of the activity, where you didn't have control of all the external things that go on in a classroom, like, how can we actually be successful in that where there's so much quote, unquote chaos because of the classroom.    Savitha Sundar     It is not easy and it's challenging, and the dynamics of the classroom, how welcome do you feel in certain classrooms, versus how annoyed they are that you are there in that Classroom, disrupting their schedule. So Many factors play in, right? So I think it's a case by case basis. I wouldn't say that. I always would push and like, sometimes I just go in and observe this kid in the class, okay? And sometimes I'm more effective by talking to the peer. So this kid doesn't feel like I'm isolating, yeah, her or him to, you know, to to listen to listen to what I'm doing, but I might just do something with the class, with the group, and it takes time to understand the dynamics of the class and to fit in, and sometimes just talk to the teacher. What is the best time for me to come in and be supportive here? And the teacher would say, you know, if you come during this time, that's when I need your help the most, depending on the goal I'm addressing, if I'm working on, say, writing, then I see like this kid is struggling so much to write. Why can't you just send this as a shared Google document, as a PDF, so this kid can work on the same assignment, but they just have to type the answers. They don't have to write it right? So I would not know that unless I'm seeing what activities they're actually doing in the class. So I go in and I observe a science lesson. They're, all they're doing is like separating these different solids, you know, magnetic versus non magnetic pieces. Absolutely. My kids in self contained classrooms can do that right now that I know what you're doing, I can tell you, I'll bring one kid in, make them sit in that classroom. You know, it doesn't even, it shouldn't even be that. But, you know, given our reality, say, I bring this kid in, and then I'm, like, trying to promote, you know, facilitate this activity. I know what is going to be done ahead of time, so I can plan it right once a week. I can do that for sure. And then you see the possibility, and then you're like, Hmm, it's not so bad, after all, we can take our kiddos, and many times the gen ed teacher is afraid, is afraid of our students. They're afraid they will do a disservice by not sending them to a self contained classroom. And that's such a wrong idea. You know, it's not as bad, as difficult as you think it is. These kids are not any more difficult or any less difficult than all kids in general. So that's true. It's just how we approach and when the teacher has a very positive attitude, the other kids follow suit.    Jayson Davies     That that's a great point, and I just want to cap that conversation off and just let everyone know, remind everyone like what I just took away from what you said was that ot in the classroom doesn't have to look like you sitting right next to the student, supporting them, like what you envision a paraprofessional doing, or like what you also envision an occupational therapist or occupational therapy assistant doing, in a pull out model, where typically we are right there with the student, but we can push into the classroom and work with the entire classroom, we can push into.    Savitha Sundar     Just the environment, the occupation, the activity, and the person, all three.    Jayson Davies     Yes, and the social aspect, of course, yeah. I mean, like, yeah. It doesn't have to look like you sitting right next to the kid for 30 minutes like that. I think that's the big takeaway. Absolutely, yeah. Now you started to bring up something that I wanted to address before we wrap up today, and that is the positive impact that inclusion has, not only for the students that we're working with, but the entire school in general. I assume that to be true, and I don't know that I have anything behind me to assume that to be true, but from your perspective, you've done some research. What is your take on that?    Savitha Sundar     So the research evidence we have is kids without disabilities either have a positive impact or no impact when a kid with a disability is in their classroom. That's what we have right now. The best research findings we have is that. That, however, if you were to expand it further from non research perspective, think about disabilities, how important it is that we all understand disabilities. It is the largest minority community in the world, and it's also the community that anyone can enter at any time. You may end up having a child with a disability as an adult, or you may end up being a teacher in a classroom, and you may find out that the student is not the typical kid that you know of. You may end up having an accident and enter into that community, God forbid. I mean the sense you know losing your skill sets is is sad. So given that reality, it's so important that the world that the society recognizes and understands the world of disabilities and how difficult it is for that community to fit into a world that wasn't created for them, and that it is a community effort to make it accessible for them. You if you know your friend, if you know your friend's strengths, if you know what this friend is good at, then you as an adult, can create job opportunities for this kid. It's so important that the gen ed community understands the world of disabilities. If we want our society to be inclusive in the future, then I think a lot of effort has to go into facilitating that in the schools, absolutely.    Jayson Davies     And there's one piece that we haven't addressed yet, and I don't think it's commonly thought of when it comes to inclusive practices, and that's the evaluation piece. And you know, we talked a little bit about earlier, I brought up that question about having a goal related to inclusive practices, but it's I mean, in order to have a goal for something, we really need to be evaluating it. So I want to ask you, how does inclusive practices, or the inclusion of students with extensive needs support work into the evaluation process?    Savitha Sundar     Yeah, so if we want to see changes in how ot services are structured to better support inclusion. We want to start with evaluating that. If our evaluation is addressing fine motor deficits, handwriting deficits, then we are going to address that area. But if you start off with a participation approach where you're looking into their natural routines, how is the kid coming into school? How are they doing what they're required to do. Why cannot they be doing it in a general education environment? How about are we looking into art and music and PE Are we looking into cafeteria experiences in our evaluation? Are we doing more of a natural routine based evaluation and looking into what are the personal challenges? How is how is the participation? Is it satisfactory or not? If it is not satisfactory, where is the biggest challenge? Is it the environment or the person or the occupation? Where can we address what can be addressed to make the best impact? So looking into every routine in their day, bathrooming or recess or dismissal, emergency drills, are we looking into all of those in our evaluation? So if we, if we start evaluating that and then identifying areas of participation needs in those areas inclusive participation needs, then we can also work on addressing those needs. And we don't have to be the only one addressing those needs, just like how handwriting does not have to be ot addressing it, right? And we always say that we are not handwriting teachers, right? And just a sensory is something that we evaluate and we make recommendations for the environment to change. Same thing with all these other areas of participation, yeah, instead of going, like, the top, the bottom up approach that we currently use, but like, what are the sensory behaviors? Oh, is he aversive to, you know, touch? Is the kid sensitive to smells? Are they auditory sensitive? Those are like they are, but then they're doing just fine in the class, you know? So, you know that that becomes, there may be one you just, you just put your focus light on the kid's problem. But if you start off with, like, here, there's no problem. Oh, there is a problem in participation. But the problem is not just in the child, but it's also in the way, yeah, the environment is.    Jayson Davies     So in your evaluations. Then do you try to point out, make it a point to point out the lack of inclusion in this student's education plan. Or do you try to find a way to observe the student in a more inclusive environment?    Savitha Sundar     I wish. I wish I still work within systems. Yes, I know. And I'm literally started this new job in a new district, so I can't come in with my revolutionary ideas and you know, like, hey, look, you're not including kids with extensive support needs. That's where I'm going to be working on. It's not going to happen over. Night.     Jayson Davies     Absolutely. And that's why I'm glad we're having this conversation, because I want to be real, like, exactly.    Savitha Sundar     Right? Yeah, so we start somewhere, right? So I started having this conversation about, how do we look at a participation based evaluation with my team? So we're going to talk about it. Okay, we need to educate our our administrator about the role of OT okay, we need to take that time. We need to put that as goals, and we need to be working on those things. And secondly, do what you can do. Yeah. So I have I work with in a school where the speech therapist and I have a great relationship, and we want to do something to to increase awareness about disability in our school. So we started, we brought it to our principal, and we were like, What do you think of us doing this program for the kids? What if we do these lunch punches? We got the approval next now, like, okay, provided your the curriculum you're proposing is approved by our district. So that's the next step, okay? And I'm just like, less than six months in this new district, so I try, in my little ways, what I can do. They had an opportunity to write a grant to do any programming. The gen ed teacher and I were the sped teacher, the self contained classroom teacher, and I were like, Yeah, let's do a program together. And we wrote up a grant, you know, just little things we can do. And also, just like, I'm going, I'm going, I'm working with this kid on communication. I'm working with her on her written expression, basically, right? So she has a device. My focus is that she's able to do a presentation in her class that is her written expression. So now I'm teaching her how to make slides to do a presentation. So every community, like every Friday, she does a presentation to her class, and she works with me on it the previous the earlier in the week, yeah. So I work with her in the classroom. Sometimes, sometimes I'm going to a quieter spot so we can put it together. And so it's just, it's just looking at that outcome in whatever little ways I can, because systems change will take a long time, but we have to start somewhere and go in the right direction.    Jayson Davies     Yeah, yeah, absolutely. And you know, system change too is something that ot practitioners, especially school based ot practitioners, we are not good at measuring that either, and we probably should be. And something that could be measured from an OT department perspective, is what percentage of our students that we support are being included in general education. And that is something that is something that we can start to measure. It doesn't take a lot of you know, it's an extra column on a spreadsheet in our caseload workload document, like it's nothing super out there, and it is something that we can actually use for data to show our administrators. Hey, look, as we're providing these ot services, we're actually helping students to be more included into the general education population, and little things like that can go a long way to getting your administrator support. So absolutely. All right. So Vita, I do want to wrap up our conversation, but before I do, I have to let everybody know about your podcast. OT for inclusive occupations. I had to throw it in there, because you are doing some amazing stuff over there, bringing on individuals, well, occupational therapy practitioners, but also the individuals that the OT practitioners have worked with to really promote inclusive occupations. And so I want to give you just a moment to to I know you probably don't like being on the spot like this. I'm sorry, but I want to give you a second to share with everyone what you're doing on your podcast.     Savitha Sundar     Yeah, I do like different seasons. Like right now I'm doing season four, and the focus of season four is to highlight the stories of young adults with disabilities and their lives and how inclusion played a role or didn't play a role, or what could have happened. How was their experience with it? And I had, I did a series with three students of an OT Dr, Deborah Schwind, and she shared about how her ot interventions were so inclusion focused, you know, the outcome of inclusion, and she helped these students, like the things that she had focused on with these students, along with what the families prioritized, and the team prioritized just their their lived experience of navigating special education and school life into being successful adults they are today, and how ot helped them in the process. And it's such interesting insights that I got from those interviews. And I just today released one episode again, you know, the perspectives of parents being a mother of a child with a disability, and how she became an advocate. She was, she's also a special ed teacher, and ended up becoming, you know, a global advocate, advocate for international like giving the resources and the training for people to support inclusion. So I think their stories are very, very inspiring to me, and I just share it with my community,     Jayson Davies     Absolutely, and and I agree they are totally inspiring just share. Sharing one, I know you had one young lady who you know she ended up being the or she now works in the cafeteria of the school that she went to. And while she was a student at the school, occupational therapy practitioner Deborah worked with her on helping to understand the cafeteria environment, and basically, kind of helped her to work her way into a community based role once she graduated, and now she's working at that school. So.    Savitha Sundar     Why don't we have a place? Yeah, why don't we have a place in high school? Why do our services continue to go down in high school? Because the area we focus is the developmental skills, right? And so we say they've like, maxed out, and others are going to take over our role. You know, sort of thing when, when they go to high school, but the needs are different. In high school, we're looking into job placements, looking into future. What can we identify as the best work opportunity for the student? How can we create the future that's a success for them? You know. So that's a real, great example of how the OT worked with her through high school to give her the real experience of working in as a school cafeteria lady staff.     Jayson Davies     Yeah. And didn't just think about the academic, you know, portion of today, but the life experience necessary for 234, 10 years from now. So 100% Yeah. Well, Savitha, thank you so much for coming on sharing all your insightful knowledge about supporting students with extensive needs, supports. It's it is something that we all struggle with from time to time, and I hope that this conversation will definitely support all those listening and know that there is a way to improve, like we're all struggling with this, and there is no one correct solution, but we can all make small steps toward more inclusive practices.    Savitha Sundar     Yes, it's just helping to row the boat in the right direction. You know, it's a collective effort the school systems are trying to with. The more research coming out, the more we know that we have been doing a disservice all these years, and now is like the how do we do it? So the educational field has a lot of work on that aspect. So what we can do is to support in the right direction and not Row the Boat backwards, right So, and we have so much potential to do that as OTs, I believe. So thank you. Jayson.    Jayson Davies     Well, thank you, and have a great rest of your day, everybody. All right, and that is a wrap on this two part conversation with Dr Savitha Sundar, I want to give a huge thank you to Savitha for coming on the podcast and sharing this knowledge. Savitha put a lot of time and energy into her PhD, and this was her topic, as you might imagine, as she shared, she's really wants to improve our ability as ot practitioners to promote inclusion for all students, especially those with extensive support needs. So at the end of the day, at the end of these two episodes, I hope you're walking away with not just insights into that, but also inspiration and maybe a few ideas to try at your own school, as Savitha really shared there at the end and got real with us. This is not easy. There are a lot of barriers in the way, but if we take one small step at a time, we can make improvements for our students. If this conversation with Dr Sundar really spoke to you and really kind of just re made you think everything you know, as it did for me, I would love for you to take a moment and share it with a colleague or maybe even your administrator team. Let this be with a colleague or maybe even your administrators. Let's keep this conversation going about what it really means to support students with extensive support needs and inclusive, affirming ways. And of course, don't forget to join us at ot  schoolhouse.com/join to get weekly updates with tips, research and strategies for school based ot practice. Thanks for tuning in, and I'll see you next time on the OT school house podcast.    Amazing Narrator     Thank you for listening to the OT schoolhouse podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 44 of the OT Schoolhouse Podcast. In this episode, Jayson hosts an OT/OTA team from the state of Michigan to discuss the dynamics of the working relationship and how to maximize communication. Mary Kleinheksel and Cait Bowen talk about the systems they have put in place to maximize communications and facilitate trust among the practitioners. We also talk about aspects of billing, evaluations, treatment planning, and how many COTA's an OT can supervise. ​ 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: Cait Bowen's Instagram Page (Cait_the_COTA) ​​ Cait's Teachers pay teachers shop ThePencilGrip.com (Sponsored) This link will automatically apply your 30% discount off your entire order!​ 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 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     Hi everyone. And welcome to the OT school health Podcast, episode number 44 My name is Jayson Davies, your host. As always, it's been great getting back into the podcast, back into the swing of things. I'm enjoying working with my A to Z school based ot course cohort. That has been a lot of fun this past week or two. And yeah, we're gonna keep this introduction short. Today we are talking about the OT OTA occupational therapy occupational therapy assistant relationship with two very special guests. The first is the occupational therapist in the group. I will mention her first. Her name is Mary kleinhexel, and she is also joined by her occupational therapy assistant, and her name is Kate Bowen. You may know her as Kate the COTA on Instagram, she and the OT that she works with are joining us today, so we're gonna get into that. But first, I do need to say a special thank you to the pencil grip for sponsoring today's episode of the OT school house podcast. The pencil grip is the original ergonomic writing aid. Writing becomes easy and natural. The pencil grip improves handwriting, helps to give more control and reduces hand fatigue. Its unique patent design gently encourages the fingers and hand to rest in the proper position for gripping the tripod grip. Unlike other grips, the pencil grip feels natural because of its ergonomic design and soft, flexible, latex free material, Get yours at the pencil grip.com and use promo code ot school house to get 30% off your entire order. All right, like I said, we're going to keep today's introduction very short and sweet. So let's jump into our interview with Mary and Kate and talk about the OT OTA relationship. Hi Kate. Hi Mary. How are you both doing this evening?    Cait Bowen     Hi, good. How are you?     Mary KleinHeksel     Hi!    Jayson Davies     All right, so I'm going to so other people know I can see you, but they can't, Mary, why don't you go ahead and share with us a little bit about your background as an occupational therapist.    Mary KleinHeksel     Okay, I have been an occupational therapist for 29 years. 20 of those have been at Jayson public schools, where Kate and I currently work together. I've done a lot of things prior to that, outpatient, inpatient, home health care, hand therapy, you name it, but I've landed in school ot as my passion. Awesome,    Jayson Davies     fantastic. And then also joining us today is Kate. Kate, how about you go ahead and introduce yourself.    Cait Bowen     Sure. This is my fifth school year as a CODA, and this is actually the only ot job I've ever had. So I started off as a social worker, and that wasn't really my thing, so I went back to school for ot to become an OT assistant, and this is my first job out of college.    Jayson Davies     Wow, so already a life or school based OT,    Mary KleinHeksel     yes,    Jayson Davies     all right, great. Well, welcome to the show. I'm so happy to have you. This is the first time that we've had an OT, ot a team, joined the podcast, and I think this is something that people, all the listeners, listeners are really going to appreciate. So I'm excited. I hope you guys are excited to share your knowledge. Yes, great. All right. And before we get started, Mary, you kind of mentioned the district that you guys work for, but geographically, where about is that?     Mary KleinHeksel     So, Denison, Michigan is a public school. It is Western Michigan, about 2030, miles east of Lake Michigan. It's in the lower part of Michigan. There.    Jayson Davies     Great and again, the main reason that we're talking today is to discuss the relationship, the working relationship, between an OT and an OT. So we're going to dive into not only the actual work skills, but the interpersonal skills a little bit, because I'm sure that's an interesting dynamic. I know I've worked with a few CODAs or OTs, and you really have to have some teamwork. And it sounds like you guys have some good teamwork. So I know there's probably OTs and as well as COVID, out there that have never had that chance to work with the other before. And I think that there may also be some people that just don't understand that dynamic. So this is going to be awesome, and I hope you guys are excited about this. So to start things off, I wanted to kick into just a little bit again the background, are you guys, district employees? Are you county employees? What? How's that work?    Cait Bowen     We are district employees as of what was it? Mary, a couple years ago,    Mary KleinHeksel     fourth year. Yeah, that they hired us on.    Cait Bowen     Yeah. Yeah. So before that, we were independent contractors, yeah.    Jayson Davies     Oh, okay. And were you guys working for another contractor, or you yourself were the contractor.     Mary KleinHeksel     We were the contractor.     Jayson Davies     Gotcha. So each of you were independent then, Yep, yeah, interesting dynamic. So then they decided that after a few years, it was worth just bringing you on board, huh?    Cait Bowen     Yeah, it's been really nice. There's some added benefits to being a district employee. It's kind of nice to not have to worry about the self employment tax situation, right?    Jayson Davies     That's complicated.    Mary KleinHeksel     yes, so I definitely prefer it being in Yeah. I appreciate our district doing that for us. Oh, yeah.    Jayson Davies     So you've been with that district either as an employee or independent contractor for a little while. Then Mary, right, right?    Mary KleinHeksel     So 16 years independent, and then the four years now I'm a district employee.    Jayson Davies     And so you're liking being an actual employee.    Mary KleinHeksel     Yes, pension and yeah, they Yeah, definitely.    Cait Bowen     Call that good stuff.    Jayson Davies     I know that good feeling. Yep, it's nice to have that behind you, I guess, or just kind of being taken care of without you having to really worry about it cool. So, and then, are you the only OT and OT a in the district, or are there others within the district as well?    Cait Bowen     So, other part time coda,    Jayson Davies     okay? And so, Mary, you also supervised that Coda as well.    Mary KleinHeksel     Yep. So it was, I came on the scene and took over some hours for another one. So I'm the only ot of the district. And then Kate took over a previous coda, who was there, like, 20 years before her Yeah, and she recommended Kate, and we interviewed Kate immediately. We're like, that's the one we did. Director. And I were like, Yeah, we were Kate, so yeah. And then Kate and I got so busy that we were both like, we needed help. So we wrote a proposal, and yeah, the district then approved our proposal for another part time. OT assistant, who we love as well. Yay, Jody.    Jayson Davies     Shout out to Jody. Great. So how many schools are in your district then?    Mary KleinHeksel     So, yeah, so we, Kate and I both work at 10 different schools, okay? And Jody works at two, okay. And so, yeah.    Jayson Davies     Great. So you guys are busy and married, that means, well, Kate, too, if you have 10 schools, you're traveling around. But Mary, yeah, cool. So we're going to get into the dynamic about all of that. The first area that I kind of wanted to talk about was kind of communication. So I have some various questions that kind of I consider fall under the communication aspect. And I think many OTs and OT A's out there have the same types of questions. So the first one is a mentorship slash supervision. Question. You know, what does that actually look like? How do you guys work together?    Mary KleinHeksel     Go ahead, Cait, you wanna? Yeah, what do you think?     Cait Bowen     Hey, so Mary and I meet once a week to just kind of go over how the week has been, anything that may have come up looking ahead to the next week, but that's really the only time during the week that we have together. The rest of the time, we're so busy with our own caseloads that we communicate through text or through email, but we save the big stuff for our once a week meeting.     Jayson Davies     Okay, and so again, going a little bit further in that once a week meeting, do you guys take, like kind of formal notes or anything, or is it just very open?    Cait Bowen     I would say it's pretty open. I usually have a list for Mary, and she's got a list going for me, and we just kind of go back and forth and work our way through our list. I give her any paperwork that I need to and vice versa, I would say it's pretty informal, though.    Mary KleinHeksel     Over coffee, we have to have coffee.    Jayson Davies     Right? I know I used to meet up with my COTA sometimes at Starbucks, like the local burger joint or something, wherever we could find a table so I get that.    Mary KleinHeksel     No, I'd say definitely informal, but yeah, we still have lists, checklists and stuff that we need to get through. And yeah, and we do, but    Jayson Davies     so do you guys, and I'm not expecting this to be a yes, but do you go over the entire caseload every time you meet?    Cait Bowen     No, no, I we would be there for hours and hours, right? So we just go over, I would say, maybe kids that have upcoming IEPs, new students on the case load, any students that maybe had a tricky week, we focus on those ones for our meetings.    Jayson Davies     Okay? So. A handful of kids that are coming up with meetings, or were tricky. Okay? And then, so actually, this is great. I didn't realize that Mary, you've been or, sorry, Kate, you've been with Mary for about five years. So I actually want to ask Mary, then, how has the guidance been similar and changed over the five years working with a new occupational therapy assistant?    Mary KleinHeksel     So, yeah, so good question. I think at first I, when Kate first came on, I went through and I made a list of scenarios of, if this comes up, we probably will do this. So then Kate didn't have to feel like she had to ask me every single time, every single question. She was questioned, she could reference that. I think that was helpful to Kate. So yeah, because there was a lot of things that Kate wasn't even sure that would come up, and she's like, Oh, it was right in there. So yeah, and if there were any questions, then she could, I mean, I'm available on phone all day long. So we make sure that we do that, but yeah, and then I just kind of, as we went, things that I felt were helpful, like Kate would be like, Oh, this came up, and I'm like, Oh, I didn't, you know, you won't think of it in every single meeting, but oh, I have these reflex integration exercises. Well, what the heck? Here you go. Or, you know, I think Handwriting Without Tears would be a great continuing ed program for you and Jody, the other assistants I go to, because that really is a treatment changer, and it was for me. So just as things come up and that I think about them, and the question is asked that, yeah, then I'll just give some guidance and think things that helped me along the way.    Jayson Davies     So every state has different legislation. And the reason I ask this is I know, as in California, we just changed from being able to supervise two ot as to three. But just like that, every state also has different guidance or different requirements for how much support you have to provide to an OTA? Is that something you went and studied before taking on an OT a or do you, I mean, maybe in Michigan, are there very strict guidelines on how often you have to meet or how often you have to talk about a certain or the cases or whatnot? Do you know any of that?    Mary KleinHeksel     I think we go by Medicaid as well. I don't know if you bill Medicaid medical, same thing. Yeah, Medi Cal. So, yep. So our Medicaid here, that really needs to be done quarterly, but I feel for best practice that if we we at least need to touch base weekly. I think that's that's very important. So I think it's just my personal preference of best practice, and I think to keep connected with Kate as well, so Kate doesn't feel like she's just out there all alone. Absolutely support, because, you know, she gets, you know, tough kid OTs too. But, yeah, she's amazing.    Jayson Davies     Great. And so Kate, then when over the past five years that you've been a CODA, how have you felt like guidance, supervision? How has it been for you? Did you feel like you needed more support at the beginning versus you do now? Do you still need the same amount of support? Or what's that feeling like?    Cait Bowen     I would say I definitely needed more in the beginning, especially as a new grad, I didn't have a whole lot of OT experience, so I relied a lot on Mary. Lots of questions. I wrote a lot of things down. I probably bothered her too much asking questions. But I feel like over the five years, I've become more confident in my job, more confident in the requirements, and so my questions are less frequent than they used to be, and I just feel more confident as a therapist.     Jayson Davies     Gotcha perfect. So then Mary, back to you. How do you keep up to date? I mean, it's kind of for both of you, I guess. But how do you guys keep up to date with who's seen what? Kids and just kind of those things that you kind of have to have a lot of trust in someone, right? But so how do you keep track of what each other are doing? Almost, does that make sense?     Mary KleinHeksel     Yeah. No, it does. So we each have our own case load. So the even the special ed Secretary will be like, this is Kate's caseload. This is Mary's caseload. This is Joy's case load. So those kids will be under Kate. Of course, they're all supervised by me, but I think it's important for everybody to have their own caseload, and I think that helps for, you know, just to feel ownership, and we believe in the relationship Kate has with her caseload, her students. It's better than I could just be coming swooping in and trying to do something. You know, I think that's important that Kate, that the OT assistant, has their own caseload as well, and of course, it's supervised by the OT. But yeah, so we when Kate first came on, she was, I. My love is all students, but I really love working with students with autism, so I kept, we have a categorical program, so I kept that. And a lot of times those are the trickier kids, and then Kate could decide when she was branching off, kind of where she wanted to go. So Kate, if you want to let him know, like.     Cait Bowen     My caseload is kind of a variety. I would say. I have students in the cognitively impaired program, emotionally impaired program. I've got some gen ed kids who just need a little extra help, some kids with developmental delays. It's kind of a variety, but it's fun.    Jayson Davies     Well, that's cool. So then you guys actually do, in a way, make up your own caseload. Obviously work together, but you guys kind of work to each other's strengths. Then.     Mary KleinHeksel     Yeah, I think so like, yeah. And if there's a tricky kid that I know is going to be tricky all around I will just keep that students, because that I just need to provide that level of Shall I save supervision or for that so Kate doesn't have to worry about getting involved in something tricky like that, so I'll make sure, I'll get a feeling at the initial IEP the evaluation, and then if that's the case, I will definitely keep that student So not to put Kate in any Jeopardy, especially. You are, though you You are amazing girl. So, yeah. So yeah, I just don't want Kate to be, have to be involved in the deposition or anything. So I will make sure that that stays in my court.    Jayson Davies     Absolutely I can hear the dog. That's fine. This is a dog. No, I always say it's a dog friendly podcast, so he's welcome to join us. I love it. No, totally fine. Oh man, it just makes me miss my dog a little bit. That's all right. So Kate, I want to ask you this. Then Mary was just talking about how she kind of, I mean, it's almost like screening, you know, and I've been in the same situation. There's certain kids that you have to be careful with, and there's certain kids you almost feel like you need to hold on to, right? Mary, you just kind of said that. But Kate, how do you go about if there's, like, one kid who you feel like you need more assistance, what is what do you do? Obviously, you would talk to Mary at that one to one meeting that you guys have. But have you ever had to go further and ask for more assistance?    Cait Bowen     I really haven't. Mary does such a good job at that initial screening and evaluation of taking any kids that might have something tricky coming up in their future. For any kids I've had that have been more challenging, Mary has always been so available to me that I've never felt like I've been alone or had to come up with a solution on my own. I know that I can just text or call Mary and she's right there to help me. And I've never had to go beyond that.    Jayson Davies     Perfect. That's great. I mean, that's nice when things work out that way. What about this? Have you ever had, because I've been in a similar situation to this? Have you ever had a parent request that their student be seen by the OT versus AOTA?    Mary KleinHeksel     You know what? In 20 years, I have not very fortunate. I am very fortunate. I know we, we have, not, we're I think we just are a team. And yeah, I just explained at the IEP that Mrs. Bellin is in this building weekly. She will be seeing your students. And yeah, and Kate does an amazing job. And I make sure the kudos goes to Kate, and the parents know that as well. So yeah, but no, I have, I have not, I think, I think it's screened out by me prior. I don't know. Yeah, I don't let it get there. No way.    Jayson Davies     That's good to hear. Similar to that. What about at IEPs? Does any? Of do, any of the parents request that the OTA be present because they're the because Kate's the one working with the child?    Mary KleinHeksel     Nope, again, that is, I know. But what will happen, though, is Kate's my, my backup. So a lot of times I'm double scheduled on, you know, on, fortunately, I can't beat the both. And I'll be, I'll ask Kate prior, and I'll be like, Kate, can you cover me on this one? And yeah, she's very willing to do that. But just for clarity, for staff, I think, for scheduling as well, that I'm the, I'm the paper pusher, and so that they need to, yeah, contact me and but Kate and I are a team, so yeah, a lot of the teachers make a comment like, Man, I want, I want Kate's job. I wanted to see the kids.     Jayson Davies     I've heard that a lot.     Mary KleinHeksel     Yeah, the deal, I don't know. I don't know, Kate, you're, yeah, you're amazing. So yeah, she just makes it look easy and sound easy.    Jayson Davies     Kate or codas, do have the fun part? You know, totally get that I've met many OTs. Or I'm like, Well, do you ever think about going back and getting the masters and doing the OT like, Nope, I'm happy here. Don't want to go to IEPs. I'm good here, right? But So Kate, it does sound like you do attend a few IEPs, if Mary's double booked, what is that experience like for you?    Cait Bowen     Yeah, I've been to a few because I don't do them often. They are a little bit intimidating to me, just because I'm not used to that side of the job. I don't work a lot directly with parents, you know. I'm just not used to those types of meetings, but Mary always does a good job of, you know, kind of outlining what I need to talk about, and it's a student that I've been working with. So in that respect, I'm comfortable talking about their progress and what we've been working on and the goals that we're moving towards. So they're they go fine. I would say.    Jayson Davies     Great. And so I kind of want to go another way. But you mentioned goals. And so how do you guys work as a team to develop goals? Does Mary, do you just look at the progress and develop goals, or does Kate have input? Or how does that work?    Mary KleinHeksel     So at our meeting, or whatever, so we'll, we'll look at the goals and the progress, and I'll I'll be like, I think this is the next, next progression, but yet, I'll run it by Kate, and be like, Kate, what do you think? Does this look doable? Does this look like because Kate will be like, yeah, no. I'll be honestly, you're crazy, and I love that. I'm like, oh, good to know. Good to know. I think we need to obtain our goals, and they need to be, you know, realistic, so, but that's the feedback, or, yeah, we it's really good. It's just a great feedback with like, Cait needs to let me know that's too much or so, but I, I'm the one that, yeah, that is in charge of developing the goals with Kate's guidance on who she's seeing. Because, yeah, it's not fair. I don't think to just slap some goals down and expect you know someone I wouldn't want that if they're so lofty that I know I'm not going to get them achieved. So I think it's important for Kate to give me feedback, and she does a really good job.    Jayson Davies     Awesome. And then, so what about the kids? So obviously, there's kids on Cait's caseload. They're also on your caseload, but you're not seeing them right, or at least not as frequently as Kate. Do you have a certain system in place for when you're about to go to that IEP? I know for me, I hated walking into an IEP for a kid that I hadn't seen in a long time. And so do you kind of have a system in place when you're in that similar situation, for a kid that's maybe is doing great with Cait, but you just haven't seen them in a while.    Mary KleinHeksel     Yeah. So Kate will give me whether she'll text me something like a sample, a work sample, she'll attach a work sample for me, or a sample of what the goal was. She just recently did. There was a typing goal. So she's like, look at the typing. Look at she'll do a lot of the handwriting samples for me, which is great, and I can see it right there. Hand it to the parents, and then, like I said at prior to that weekly meeting, make sure that I touch base with her before the IP any concerns. Like there was one girl that glasses. We didn't she didn't have her eye glasses. Oh yeah. So Kate advocated for that, saying you really need to help me with that. So we did. We went in the IEP and the physical therapist, and I, yeah, advocated to get the end it's done. So yeah.     Jayson Davies     That's funny, because I've had at least three kids where I've had to do the same exact thing, whether the kid lost their glasses, whether they broke their glasses, whatever it might be, there's always seems to be a kid that's not wearing the glasses that they need, or just haven't got the prescription updated or whatever, but yeah, it's almost like you haven't been a school based ot until you've had to talk to parents about finding the kids glasses. So all right, well, we're about halfway through our podcast for today's episode, and so again, I want to thank the pencil grip for sponsoring this episode of the OT schoolhouse podcast. The pencil grip was designed by doctor and is widely used in classrooms at home and in therapeutic settings. The unique shape of the grip is designed to be a one size fits all to help the hands of kids and adults and work with both righties and lefties. The pencil grip can be used as a training tool and then permanently for added comfort. The pencil grip fits on pencils, primary pencils, pens, crowns, markers, paint brushes, etc, so its benefits can be widely enjoyed. A comfortable hand has more control and shows improved handwriting. The pencil grip guides the hand into an ergonomic position. It relieves hand pain, reduces fatigue and improves comfort. Consistent use teaches and reinforces the proper grip and stops common problems like fist grips, thumb wrapping and white knuckling. Parents, teachers and occupational therapists widely recommend using the pencil grip. Check it out for yourself at the pencil grip.com and use promo code ot schoolhouse for 30% off your entire order. Alright, well, let's just. Jump back into it with Kate and Mary. And this next question actually comes from an Instagram follower of the OT school house, and her question is, how important is it to rely on the OT a for progress on goals?    Mary KleinHeksel     I'll let Cait answer that one.     Cait Bowen     Yeah, I write my own progress notes for my students, and then how we do it as I write them all out, and then at the end of that week, when I'm done writing them, I sit down with Mary and we go through one by one, just so that she can get a visual too, of where each student is at, how goals are going, and just so that we're on the same page.     Jayson Davies     Perfect. Sounds great. It's It's nice when you have a team that knows how to work together and things just work well, it's very, very fortunate. I like it all right. So what about services? You're in an IEP, you've gone over those present levels that it sounds like Kate really helps with. You guys have collaborated to develop some goals. And what about services? Who brings those up, or how did those get determined, or whatnot.    Mary KleinHeksel     So the frequency of service, frequency? Yeah. So we write a range. We're lucky here that we are able to write a range of time. So we can write it monthly, and then I make sure that Kate will be able to meet that whether it's no days that have one coming up in a couple days here, that kind of thing, monthly, we're not expected to backtrack and see those students. So by that we do write arrange. Kate sees students in groups, so there's Yeah. So we usually write a range monthly in there to cover that.    Jayson Davies     That's really nice to have that leniency. We don't have that here and in the district I work for. But anyways, I don't want to tear any ot OTA relationships up. But is there ever, or has there ever been a time when you guys have been in a little bit of a disagreement about goals or the frequency of services?     Cait Bowen     Have we ever had a disagreement Mary?    Mary KleinHeksel     I don't think so. Maybe over, who's gonna buy coffee? Right? My turn? No, I think no, because discharge for us is based on standardized testing. So a child.     Cait Bowen     a child, has reached a student, yeah.     Mary KleinHeksel     Yeah. So it's picking it up as soon as so it's not like, yeah, so it's based on data. I think that helps. So, yeah, I can't, I can't think of anything that we've, we've both are like.     Jayson Davies     So do you guys only, obviously, you need the data to discharge, exit, graduate, whatever your term you want to use. But what about at the annuals in between? Do you do do you keep most of the kids at a pretty consistent rate? Or do you ever decrease kids based upon you know, they're meeting all their goals? Or does that remain pretty steady?    Mary KleinHeksel     We actually do testing each year, yearly. We do. We test yearly for standardized testing. We do test yearly. So.    Jayson Davies     Is that a Michigan thing, or is that just something your district and you have decided to    Mary KleinHeksel     do? That's our district, yep. Why keep a student on for two more years if they're average, fine motor, visual motor, that type of thing. So yep, and as long as the IEP team is in agreement. So now, if it's if they're eligible under, let's say otherwise, health impairment under an OT eligibility, then we need to do a re eval if that's the case, like if that makes sense on an official form, to then make it official for a re eval. But yes.    Jayson Davies     Wait. Okay, so Reval, you like making it sound like they're different. So in my school or my district, we like one eval. Is an eval like we do it every three years for the triennial, but you're saying you'll actually do some standardized testing every year for some kids Correct. Okay? And so what does that look like?    Mary KleinHeksel     So that looks like maybe a Beery visual motor or beary motor, maybe a Peabody developmental motor. Scales for yes, so yep. So we will get standardized data and test on them yearly to show that's a good way to show growth as well. Yeah, and yeah, and you can give a test if you've given it a year the same time.    Jayson Davies     So, so do you do a full write up for that, or are you just kind of doing the standardized just to show that actual assessment in the meeting?    Mary KleinHeksel     So then I'll put that in, like, the present level, okay, of the IEP.     Jayson Davies     Okay, so not a complete write up. And that's what you're talking about for the other students, where you might do a complete report, write up.    Mary KleinHeksel     Correct which we call a re evaluation.    Jayson Davies     Okay, yeah, okay. And so how, what does that look like then the reevaluation?     Mary KleinHeksel     That has to be done at least every three years. It could be done prior, but usually it's a full team reevaluation. Do. Very few instances that OT is the only one on an IEP, yeah. So, yeah, and eligibility, we only have like 13 eligibilities in Michigan, yeah. So, yeah, I don't know if that's the case with you, but yeah, yeah.    Jayson Davies     I think that's pretty standard. I could be wrong, but I think that's pretty standard. Okay, so there are some kids that is new to me, though, is that you made it sound like there are some kids that receive only ot on an IEP that is not something in California that we do. And I an idea. I don't it must be a state thing. And so how many kids I mean, estimate, do you have that are ot only?     Mary KleinHeksel     At this point we don't have any very rare, very rare, okay, under an otherwise health impairment, such as, has to have an outside medical diagnosis, yeah, yeah. So perhaps then, yeah, they didn't test out, or they have more goals that they need for.    Cait Bowen     I think we had one Mary, and we graduated him in the fall.     Mary KleinHeksel     Yep, I think there. That was our last one prior to that, maybe one other one that I can think of, very rare, but occasionally does happen where, like, speech was on and PT, but then they both discharged, and our, our standardized testing showed that he still required or could benefit from ot service. Gotcha.    Jayson Davies     Okay, see, that's the thing in our district right now, is that there's the speech only kids, and the argument is that at least coming down from admin, is that they shouldn't have ot unless they have that specialized academic instruction, the sai, because we're supposed to be helping the student in their education, right? And if they don't have specialized academic instruction, then what is ot supporting? But I understand how every district is a little bit different, but yeah, so that's interesting to hear. What other states how things happen. So cool. All right. Well, we started down the evaluation route, so I want to go that way, and that is, how do you as a team handle evaluations, or Mary, do you do all the evaluations?    Mary KleinHeksel     So I, so I do all the initial evaluations, okay? And then Kate helps with then, if there's a student of hers, she will gather data for me for any re evaluations. I feel that's helpful, because she does have that relationship. I've had it before where I've come in, even if Kate's there, I'll sit down and the kids like, no working for you. And then Kate will be like, Come on, let's do it. And then, yeah, yeah.     Jayson Davies     That's when you got to bring the goldfish. Be like, goldfish Skittles. There you go. Does Kate ever do any actual formal assessments? I know some states allow it, as my under I know in California we can have ot as actually do some formal evaluations they are not capable of, or they're not allowed not to say that they're not capable of it. Many OTs are capable of it, but they're not allowed to interpret the results. So does Kate actually provide like, will she give the Peabody or the berry?     Cait Bowen     Yes, I give the berries, but I don't score them, so I will administer them to my students, and then I give them to Mary to score.    Jayson Davies     Okay, and so, how does that work for you guys? Do you feel like you're able to get all the data you need from the interpretations that are not the interpretations, but from the actual protocol, as well as all the information, you know, maybe the handwriting samples and stuff like that that she provides you.    Mary KleinHeksel     Yes, for sure. And then she takes notes for me. I, you know, show her what to look for. I need please comment on this, like any fidgeting or that kind of thing, you know, some clinical observations during it as well. So she definitely contributes to it as well. And that is allowed. I know. I believe our national association allows that as well.     Jayson Davies     Yeah. So then Cait, how do you feel about doing the standardized evaluations? Is it just the berry that you're doing, or are there others?    Cait Bowen     Yep, that's those are the only ones that I do. I usually do the Beery visual motor and I do the Beery motor coordination.    Jayson Davies     And those are pretty once you learn them, they're pretty simple to administer them in my sleep. I think most of us can. Personally, I don't do the berry because our psychologist likes to do the berry, and so oftentimes she'll do it, but I don't get the information until, like, we're at the IEP, and so I do, like the ravma, or, you know, the bot or something to help kind of get some of the things that I would get from the berry, but everyone does it a little bit different, right? That's right, yep. All right. So you go through the evaluation, whether or not it's a one year evaluation or three year evaluation, reevaluation, what are the steps Mary that you take after. That to make sure that Kate knows the new information based upon the evaluation.    Mary KleinHeksel     So, yeah, so I will, I'll score it, and then based on Yeah, when the IEP is or sometimes, I'll text her right away, woohoo. You know, he did it. There's been a few big celebrations. Yeah, you were on a roll. There it was live. So yeah, and it's really good that for Kate, whether her treatments working is, you know what? I mean, that's good data to drive the treatment as well. Or, oh shoot, you know, you're We're close, but we got to hang on there. So yeah, so I will definitely share that with with Kate before the IEP,    Jayson Davies     okay, and then what are so, I guess the question is like, once you have the completed IEP, how do you relay that information to Kate on the new goals, any new information based upon whether it be things that the parent told you or insight that the teacher had during the IEP or something like that. Yep,    Mary KleinHeksel     so I take notes on that IEP form. I'll copy it. We have a it's called Power School, our IEP system. Okay, so copy that document. I'll put Kate's copy at the top. I'll take notes on the back what parents said, because, yeah, we have so many we can't, can't remember those details. And then, and then we'll meet over coffee, and yeah, and right then. And then I give that document that it's Kate's document for her to keep, because I have a I have a copy in Power School electronically. And as well as I could put a copy in my my files. So.    Jayson Davies     Great. That works out. Well, then cool.     Mary KleinHeksel     It does work out. And there's that weekly meeting, I think is important a key, right? It is to keep up on everything.     Jayson Davies     And so I have a question, you have a part time Coda too? Do you meet with the part time Coda individually, or is this a group team meeting?     Mary KleinHeksel     Nope, I meet with her on a different day as well, individually. So because she's at a different school so, but fun. Side note, we're all gonna meet, three of us, actually, Thursday for Professional Development Day. Yay. We never get to meet.     Jayson Davies     Awesome. We're gonna get into that in a minute though professional development. So hold on tight for that. Earlier, Kate, you touched upon a little bit of the documentation. And correct me if I'm wrong. But Mary, you have to co sign all the notes, right, the daily progress notes. Or is that not necessarily a thing?     Mary KleinHeksel     That is not a thing in Michigan. We do not have to. We keep our own notes in our charts. But yep, there's nothing for me to sign daily here, which is, which is helpful, I think why it works so well. I do have to sign quarterly Medicaid that's Medicaid notes, yeah, but yeah, that's the only thing that I have to sign quarterly.     Jayson Davies     And so are your quarterly Medicaid notes are those also the same notes that would potentially go home on like a report card or progress report for the kids? Or do you guys not have to do that?    Mary KleinHeksel     Yeah, no, totally different. So Kate does the progress notes. I look at those progress notes, but I don't have to sign them,    Jayson Davies     okay, but those progress notes do go home to the parents versus your progress or your progress or your note that you're doing for Medicaid is separate, correct?     Mary KleinHeksel     It's just for, for Medicaid, yeah, and for, like, an audited one time. So definitely was good. We were,    Jayson Davies     yeah, they're doing a lot of stuff with Medicaid, medi, Cal, all that stuff right now. It feels like they're trying to reorganize it a little bit, and it's crazy. I mean, we use a system called paradigm, and yeah, I mean, we have to input our note every day after at the end of the day, and it takes time. And I'm not the fastest. Diaper takes a little bit extra time, but.     Mary KleinHeksel     We do as well weekly. We do our weekly Medicaid students after our session and weekly, and then I have to approve that monthly. So Kate inputs it daily, or whatever. After she sees it, she does a monthly summary, and then I approve Kate's monthly summary. If that makes sense, yeah, yeah,    Jayson Davies     that does make sense. It's amazing how things are so different from, I mean, obviously from one state to another, but I'm sure you guys have probably, well, Kate, you've been in this district forever, or since you've been in OT a but I mean, even when you go from just one district to another district, things can be so different. And of course, state to state, county to county, all that. It's crazy how different things can be. So it's kind of cool being able to talk to people from different regions. Yeah. All right. The last area I kind of wanted to touch upon is RTI and RTI again, response to intervention for anyone who doesn't know. It yet. Check out episode 42 broke it down. All there for you. It has three different tiers. We have that level one tier, level two, level three. I identify level one as being very general, very like trainings and stuff like that. Do you guys participate in trainings, both where you're the trained, being the person being trained, as well as the OT or the OT a providing trainings.    Mary KleinHeksel     So yeah, we do so our RTI, we give training to the teachers, just general classroom teachers. They say, We have students that need help with their handwriting. At that point, then we're like, try these techniques, and then we do, we are requested to do some trainings for teachers as well, just, let's say, on fine motor as a whole. So we've done that. And I don't know, Kate, have you? I don't know if you've done that with me. No, I haven't think that was at the early childhood center. So I think Jody did that. So we'll do like a parent child day, where the parents come in and we'll Devon in service on that as well, and the teachers are there. So various, yeah, so various in services for them and then for us. I think it's more of like Kate and Jody just went to that Handwriting Without Tears, conference, that type of thing.     Jayson Davies     Yeah, going to seminars and stuff like that. So what are you guys doing this Thursday for your PD day?    Mary KleinHeksel     So we are working on that special, telling Jayson earlier, our special, we have a special sensory equipment coming out. We can't quite say everything yet, but a big reveal soon. So we're going to work a little bit on that. And then that's actually in some of our schools right now, that as a program so and then, so we're going to work on tweaking that. And then preschool, actually RTI Kate came up with this fantastic idea for RtI home, home activity boxes. If you want to elaborate on that,    Cait Bowen     I can't claim the credit for the original idea, but I did adapt it to fit our needs. So we call them fancy fingers fine motor boxes. And basically they're just a box of fine motor tools that can be sent home with a student, but we rolled them out. Two years ago. I got some funding through Donors Choose, and we rolled out 35 boxes so we really focus on the younger grades. We gave one to every kindergarten teacher and every preschool teacher. Is that right? Yeah. And so the boxes were a little bit different for preschool and for kindergarten, but we included instructions inside, and it was activities like pop beads or a tennis ball mouth or putty with beads, just things that we picked out to really work on those fine motor skills, and that's been a huge help. We got a great response from teachers. For those we've actually had to make, I just made six more in the fall, and we need to make some more for the preschool. So they've been very popular.    Jayson Davies     Awesome. So do these stay in the classroom or do they go home?     Cait Bowen     We kind of leave it up to the teacher. They can use them at their discretion. So some teachers like to use them as like part of a center as kids are going around the classroom, and that's helpful if a kid is really struggling and the teacher feels like there will be follow through at home, we've left it up to them whether or not they want to send that home for a couple weeks and then send it back to school so that another kid can have it. We just kind of leave it up to them.    Jayson Davies     Okay? And then, since I just asked you about sending things home, do you guys as an OT, ot a team, send home anything like homework? Do you give the child ot homework? Do you give them things to do at home or home exercise program or anything like that.     Cait Bowen     Yeah, I actually created monthly home exercise programs or activity lists, and we send those home every month to all of our students. And I just started sending home just some extra worksheets for students, things that we've been working on in our sessions that have been kind of challenging, just some extra practice at home, cool. So we're really building up on that follow through outside of the therapy session.     Jayson Davies     That's awesome. And so you have an Instagram account? I do, yeah, are pictures of these items on your Instagram account?     Cait Bowen     You bet I have pictures of our fine motor boxes. I have pictures of some of the things that I send home, and they're also available in my Teachers Pay teacher store. So people are welcome to check those out. It's just some great i. Extra worksheets that they can send home or use in therapy or give to teachers.     Jayson Davies     Okay, so I know the easiest way to find your TPT, teachers, pay teachers account is probably through your Instagram. So what's your handle? Kate, the coda. Is it all? I can't remember. Is it just Cait the cota, or does it have underscores in it?    Cait Bowen     Kate, underscore, the underscore. COTA.     Jayson Davies     that's what I thought. Okay, yeah, be sure to follow her. I follow her on Instagram, so be sure to follow her. And if you didn't catch that, there will be a link to her Instagram on the show notes@ots.com forward slash episode 44 so yeah, be sure to follow her, and then I want to continue on the RTI route. So you talked about Mary, how you do some some trainings for teachers. We talked about how Kate will go, and the other COVID You probably do yourself, because you have to have continuing education, going to seminars, going to things like that. What about the next step, level two, kind of getting into potentially individual classrooms, doing groups of some sort. Are you guys able to do any of that?    Cait Bowen     So our level two, we do a lot of the classroom adaptive equipment at that point. So we'll push in. We'll say, try a slanted writing board. We've typed up handwriting legibility rules from Handwriting Without Tears. That work, amazing. We'll give pencil grips. We'll try different pencil weights, yeah. So at that point, we'll push in, give ideas, and then have them try that as well, before moving forward with with a pull out. Tier three for us is then the teacher is like, it's not working. Then I'll, I'll get parent written, parent permission for an OT evaluation, for a pull out    Jayson Davies     Gotcha. Yeah, cool. So I think I meant to ask you this earlier, but do you guys do a lot of treatments in the classroom, or is most of it a pull out session?    Mary KleinHeksel     So I do a handful of treatments in the classroom. We've done it both ways. We've done small group pull out, we've done push ins, we've Yeah. So I think it depends on the students. Definitely depends on the student needs. But for us, I think a quick, quickest remediation is that, is that pull out at this point, that we're able to still do that. We're pretty lucky about that. So.    Jayson Davies     Gotcha, okay, but it sounds like at the same time you're giving the teachers the material they need, at least, especially in the preschool, kindergarten level, with those boxes that you're talking about.     Mary KleinHeksel     Yes, they have, they that's, that's part of those systems that we talked about, they have to try these things first, and they find that, wow, it really did help. Wow, yeah, miraculously. So, yeah, the it's all things that we're telling them that we're doing in therapy sessions, and too, I like when they send it home, then the parents alerted that it's an issue, and they can, they can buy in before you send home a scary ot form. What I didn't know anything was a problem. Well, they'll know before then they're looped in to the process that we found that really helps too.    Jayson Davies     Cool, yeah, that's good. So I think we're getting down to the end. I want to ask each of you one more question. Don't kill me if it turns into three more questions. But for each of you, I'll start with Mary as an experienced OT. What would be your piece of advice to an OT who is starting to supervise a coda for the first time?    Mary KleinHeksel     I would say the most important thing is have open communication. That's that's huge, like just, just be open and allow communication to flow both ways. You got to be able to take things you know, have mutual respect as well. You know, Kate is not my assistant. Kate is an assistant of Jayson public schools. Just like, Yeah, I'm not necessarily my special ed directors. OT, it's, I'm Jayson. So yeah, just have mutual respect for each other. And yeah, I think that will go a long way, but that communication is key for sure.    Jayson Davies     That's fantastic. But you did mention that whole supervision weird thing. I know in the past, it's been a little complicated, because you're the supervisor, but you're not their work supervisor. You supervise the actual therapy, not the actual person. I mean, you are not Kate's boss, right? You she works for, like you said, she works for the district. It's probably like the director of special education is officially her boss, or something like that. True. That is 100% true. Yeah, yeah. And so I think that's just what I want to make. I want to just clarify, because I don't think a lot of people understand that necessarily. And it is a very unique dynamic.    Mary KleinHeksel     It is unique dynamic. I think just the name. Of our occupations. Yeah, it makes it confusing to others. And yes, I think that's perfect clarification.     Jayson Davies     Yeah. I mean, I think it even took me a while to realize that CODIS stood for certified occupational therapy assistant versus therapist assistant. I mean, right out of school, it's like, Wait, yeah, is it therapy? Therapist? What does that even mean? Like, what's the difference? And then you come to realize, then you come to realize, oh, that's why it's therapy assistant.    Cait Bowen     Yes, and I feel so lucky that Mary, from day one, has always made me feel like an equal. I have never felt like her assistant or just someone lower on the totem pole. It's always been an equal feeling, and I'm so thankful for that.     Jayson Davies     Great that's good. Kudos to you, Mary,    Mary KleinHeksel     Cait is amazing. You should see that you can own her Instagram. She is very, just talented.    Jayson Davies     All right, so Kate, a similar to question to you. You can't talk about communication because Mary just stole that one. But what piece of advice would you give to a new to an OT a new maybe they're new, maybe they're experienced, but they're kind of being supervised for the first time.    Cait Bowen     And I can't say communication. Come on.    Jayson Davies     I'll let it slide.    Cait Bowen     I just think it's so important to have that good relationship with the OT, just a place of trust, a place like Mary said, of mutual respect, someone that you feel comfortable talking to about the good, about the bad, about the struggles. I think that's why Mary and I have been such a good team. Is it's been so easy to talk to each other. And I honestly, I think that's the biggest part.    Mary KleinHeksel     Yeah, each other, anything and just be, for sure, totally brutally honest.    Jayson Davies     Scary. Sometimes. Well, that's great. It sounds like you guys have a wonderful relationship, both in work and the actual therapy itself, as well as outside of work. It sounds like you guys are doing things together, which is super cool, but yeah, thank you so much for coming on and sharing all that information. I'm sure many OTs and OTs out there listening, we'll find it comforting to kind of hear how things work, and maybe we didn't talk about too many struggles. It sounds like you guys are doing really well, but it's nice to know what a good working relationship can look like, and I think people will be able to take away a lot from hearing what you guys have had to say. So thank you so much. I appreciate it for all of you listening out there. Definitely do. Go check out Kate's Instagram. Kate underscore, the underscore coda. She has a lot of great information there, and on her home page, I believe right now, she has a link to her Teachers Pay Teachers account too. So go check that out. If you don't know what TPT is, then, I don't know what you've been doing in life. TPT is amazing. They have so many free and paid resources and yeah, so thank you so much for coming on the show. I appreciate it and    Cait Bowen     Thank you so much.    Jayson Davies     And we'll have to have you guys back on sometime when you guys have a little bit more info on the super secret sensory tool. All right. All right. Well, take care. Have a great evening, and I'll talk to you next time. Thank you. All right. And that wraps up episode number 44 of the OT school house podcast. A very special thank you to Mary and Kate for coming on the show and explaining their ot OTA relationship. They obviously have a great thing going on there. Thank you also to the pencil grip for sponsoring today's episode of the OT school house podcast. I really appreciate all of you listening through this podcast, and we'll see you next time for episode 45 of the OT school house podcast. Take care and have a fantastic week. 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 43 of the OT Schoolhouse Podcast. In this episode, I share 7 tips to help you get ready for a tough, maybe high-profile, IEP. With the help of a few personal experiences, I talk about how to ensure that you are prepared logistically and emotionally for what can be an intense 3-6 hours with the IEP team. Did you listen and feel like I forgot something on my list? let me 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: OT School House's A-Z School-Based OT Course ​ Check out the course that I have put together just for you, the OT School House community. This course is a direct response to the questions and feedback I have heard from those who listen to the show. Learn more about the course here! 10 Strategies to Help You Survive Your Next Difficult IEP Meeting Check out this blog post for more ways to prepare for that tough IEP you have coming up. ​ Dear IEP Team: Don't Call Me Mom​​​ A blog post from a parent about her feelings when attending an IEP and being referred to as "Mom"​ 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 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 the OT school house podcast. My name is Jayson Davies, and I am happy to be back with episode 43 which is the first episode of the OT school house podcast. In 2020 went on a quick hiatus for a few months. Just had to get some things done. But I'm back. I'm excited to be here with you all. And yeah, whether you're driving, whether you're at the gym. Maybe you're working on any evaluation right now and just have the podcast playing in the background. I'm sorry if I'm distracting you, but I am excited to be back, and I'm excited for you to be here with me today. In this episode today, we're going to be talking about some tips that I have, both leading into one of those tough IEPs. Some might call them high profile IEPs, as well as how to handle yourself within the IEPs. These are things that I've learned over my seven years, almost eight years now, as a school based OT and I just have some tips that I have gathered from some of my mentors. Some are OTs, others are not OTs, but have taught me a lot of skills about how to prepare for an IEP, as well as handle myself in an IEP. So I want to share those with you, but, but first, I have to say a huge thank you to every single one of you who follow me on Instagram, Facebook, and you subscribe to my email list. All of you have seen the last few days that I released a course, and this podcast was supposed to be the big announcement kind of follow up with the email, big launch day type of thing, but you guys already bought it all up. And so I want to say thank you so much for selling out my first A to Z school based ot course. Honestly, I had no idea how much you all had, how much desire I could say you guys had for this type of course. I expected to sell maybe a few of these courses, and you guys ended up selling it out. For those of you who haven't heard, my A to Z school based ot course, is an eight week live and recorded program that we're going to do on a webinar format. We're going to use Zoom, and we're going to go over everything from RTI and how to refer students and how to set up a referral program. And then we're going to dive into evaluations and how to develop an IEP, working with the present levels, the goals, the services, and then we're going to get into treatment planning and how to figure out a way to help our kids meet those goals using the services that we had. And ultimately, we're going to get into talking a little bit about graduating OT or, sorry, not graduating OTs, graduating students from that ot caseload. Maybe some of those students have just been on our caseload for too long, and they're not necessarily making progress anymore, and we need to try and see if they're appropriate to graduate, and how to go about doing that. So again, this course is sold out. This was supposed to be the podcast where I got to come on here and say, Hey, this course is available. Come and grab it. It's gonna go until Friday the registration. But it's kind of bittersweet for me that I get to say it is sold out. However, I had a lot of people that were sad that they missed it, and so I have set up a wait list for those of you who may want to get in on the next round, which will likely be during summer, and then, of course, in the fall, as people are starting to come back into their school positions. So if you're interested in potentially being a part of one of those sessions, I'm going to give you a link right here. It is, ot schoolhouse.com , forward slash A to Z, the letter A, the number two, and then the letter Z, and that will send you to a website where you can sign up for the wait list and be the very first people to know about when the next sessions open up, in case you are interested. So again, that link is ot schoolhouse.com forward slash A to Z. If you can't remember that one, just remember that this is episode 43 and go to the show notes at ot schoolhouse.com forward slash episode 43 and there will be links to all that there for you. So again, thank you everyone so much for your support and for your just excitement over this course. I'm excited the people who are in are excited the people who didn't quite make it, I think they're a little sad, but they're also excited about being able to be in future iterations of this, A to Z course. So yeah, let's just keep the excitement going and head into our topic today. All right. Well, thank you so much for hearing out my excitement about my new course. But let's jump into today's topic. I'm going to try and keep the energy up, because this isn't necessarily the type of topic. Necessarily that just exuberant energy. You know, it's one of those things that we don't always like to let's just say it's not the best part of our job, right? Those tough IEPs, right? The seven things to do and remember when heading into a tough IEP is what I'm going to talk about here. And these are things that I've learned over the course of my years as a school based ot from mentors that I've had, from mentors that are both OTs and non OTs. You know, special education directors, psychologists, Adapted PE, teachers, speech pathologists, all these people that we work with, admin, all these people have taught me something. And you know, we don't always have to rely on going to the OT to find out about our job a little bit, right? There's other people in the schools that have an impact on us. I want to start off by sharing something specific to the district that I used to work for, and that was that we worked in a smaller district, a more rural district, and it was infrequent for us to have an advocate at an IEP. Part of that is because, you know, it was a more rural area, I think. But the other part of it was that we had the mentality that as long as you have us as a team, you shouldn't need an advocate. We should be your student's advocate. We should be your advocate as a parent. We should be able to support you and what you need and your students needs in order to get that education that you need. If the parent feels that a student needs an assessment, then we're going to listen to that parent and come up with the best plan in order to support that, you know. And same thing when it comes to whether the student needed or the parent wanted, a one on one aid or an OT evaluation or a speech evaluation, right? We're going to listen to that parent and try to figure out what the underlining factors are, what's the true concern, and we're going to be that student's advocate. This policy truly started at the top and went all the way down from our special education director. She had been in the situation where she was a parent, where she sat in IEPs, and she knew what it felt like to be that parent on the other side of the table, and from that all the way from the top coming down, she was able to share with us how it felt and how we can better support families within the IEP and so we went into IEPs with a nothing to hide mentality, and I learned a lot, you know, so much that I often still get praised today from parents and teachers and other professionals and even advocates about my professionalism in those tough IEPs. In fact, at one school I work at, you know, the principal fosters a similar type of community, and thus we recently have had an advocate commend us on how well our IEP team did and how well the meeting went, and it feels good you know, when you're able to get someone who is basically paid to be there to kind of be your adversary and bring up topics that maybe you don't want to discuss, and at the end of the meeting, they're like, Wow, if this would have been the IEP team last year, we wouldn't have this, all the drama and all The craziness that we have had to go through now, and we appreciate that, and we feel like this is going to be a good year. It feels good when an advocate and a parent are able to say that at the end of an IEP. So that's what we're going to talk about today, how to make parents, how to make advocates, how to make people that are in that IEP, in that IEP meeting, feel comfortable, supported, and like the IEP team, has a plan and knows where they're headed. So let's get into that first topic. All right, so Topic number one is to introduce yourself and attend to the meeting. Be confident in your introduction when you introduce yourself, don't be looking down at your notes. Don't be looking at your computer. Don't be looking around the room. Look up, look to the parent. Make eye contact with them. Introduce yourself as their students. OT or occupational therapist, right? It's pretty simple, but too often I see people in IEPs introducing themselves while they're still looking down at the paper that they're writing notes on, or something like that. And I see advocates do this. I see program specialists do this. I see administrators do this. I don't understand why you would do this. It's not a power play. It's not going to help you in the IEP. Look up, be courteous, be kind, be respectful, and give the parents the respect that they deserve by looking up at them and introducing yourself. Now, I know some of you might be asking, because you sit in a lot of meetings with advocates or whatnot, what if an advocate is there, right? Then, how do you introduce yourself? Is it any different? And my answer to and my answer to that is, no, the advocate is there as an invited guest of the parent. You are there for the parent, right? So again, introduce yourself to the parent. Of course, do not disrespect the advocate by looking away from him or her when they introduce themselves. And of course, glance at them as you introduce yourself, because you're probably glancing around the entire table a little bit, right? Do that? Don't be a jerk, right? But at the same time. So you are there to talk to the parent, so introduce yourself to the parent. Similarly, if no one else on the IEP takes the time to do this, also encourage the parents to introduce themselves. Sometimes parents are very shy. They don't exactly know what to expect in an IEP, and they might just kind of say, Hi, I'm so and so's mom, right? But you should encourage them to say, to introduce themselves as a person, and ask them how they would like to be referred to as, right? And a lot of times, whoever's taking the notes can easily do this by simply asking how they would like to be referenced to in the notes page, right? So oftentimes we put all the participants names in the notes or somewhere in the IEP. So that's a point where you could ask how the parent would like to be referred as unfortunately, the time to be confident and attentive does not end after the introductions. Of course, you need to remember to be professional throughout the entire meeting. You know, this is not the time to input treatment notes. This is not the time to bill for the services that you provided earlier today, or to send emails. You know you need to be taking notes, maintaining attention to the meeting. You don't want to be that person that gets caught off guard when someone asks a question about sensory or someone ask a question about fine motor task. You want to be able to attend to that and answer their questions strongly and without having to ask for a repeat of the question. Right? And this doesn't just go for you, I would suggest that you have a talk with your entire IEP team if this is the case, because you don't want to be that IEP team that looks like they are hiding behind their screens. Unfortunately, oftentimes in our IEPs, the entire team, or, you know, the people that work for the school, will sit on one side of a desk, and then the parents and maybe the advocate, if they're there, are kind of on the other side, and it creates this you versus them mentality. And then to top it off, you know, everyone, quote, unquote, on our side of the table, the people that are working for the school district are all on their iPad or their computer or their Surface Pro or whatever, right? And we're all hiding behind our computer and only looking up when it's our turn to talk. That shouldn't be the case. You know, you want to be attentive. You want to be looking up. Yes, it's okay to take some notes. It's okay to have your computer out to be taking notes on that. IEP, I often am working on my treatment plan during the IEP, right? But that's one thing, versus sending emails and completely tuning out what is going on. You don't want to be that person on the IEP and you don't want to be that IEP team either. So be sure to introduce yourself confidently and continue to be a part of the meeting and be in the meeting you know, actually present in the moment. All right. So that brings us to tip number two, which I have down as seeing things from the parents perspective. And you know, this is a big one, and this is what made our IEP team so successful at my previous district, and I think now at my current schools, it's also why we're able to get through meetings pretty well, and that's because we try to see things from the way that the parent views education and the way that the parent views their child's success, but it's hard to do that if we don't know what our parents long and short term goals are for their student and also what they view as their child's strengths and also their child's weaknesses. You know, we need to ask these questions, and a lot of times we do ask these questions as part of our evaluation process, but then we should also be asking them again during the IEP, because sometimes other things come up. Maybe we just talked about speech a little bit, or we just talked about other areas, and that might jog the parents memories. So I highly recommend that you start by asking questions at an IEP. Sometimes we just want to give information, and we forget to ask for information so that we can see from the parents perspectives, their view on their child and what they would like to see their child achieve. A simple tool that I often use during an IEP is to actually ask questions of the other professionals that the parent may not know to ask, right? So it's a little bit hard to do when you're actually speaking, and I hope that other people in the room would do this if they had a question, but when maybe the psychologist or the speech therapist is is talking about their report or breaking down their report, right? It's easy for you, as the person not speaking, to take note of the parents facial cues, you know, when others are presenting and see, did the parent look like they fully understood that? Or maybe they didn't, and if they didn't understand it, what question can you ask? Can you ask a clarifying question of the speech therapist or the school psychologist about what that score on the a bass really means, or what it means that a student doesn't have the TH sound or something like that that lets the parent know that you're on their side, right, that you want to know just as much as they want to know, and that you're confident in asking the questions that they may not be so confident in asking, because they don't want to be seen as potentially a difficult parent, right? Or they don't want to be seen as that helicopter parent. But. But if we can ask the questions that the parent might be thinking, not only does it help build rapport, but ultimately it helps the student, because that means that everyone's now on the same page. Just a quick reminder before we move on to topic or suggestion number three, and that is that, you know, the parents are not occupational therapists, they're not speech therapists, they're not teachers, they're not admin, or at least not most of them, right, and they don't have the same education as us. They don't necessarily meet they don't necessarily know what standardized scores mean. They don't know that an 85 is considered average. They don't know that an 84 is below average. And so without letting them know this information or showing them graphs, it's really hard for them to truly understand the information we're giving them. They simply don't know, and they don't know what they don't know, and so they don't know to ask the questions, right? And so by, again, seeing things from the parents perspective, and asking those questions, that may be a little on the iffy side, and again, if I don't know something, then I can almost guarantee they probably don't know it, because I sit in those IEPs all the time, right? I hear it every other day, but they don't. And so we need to be on their side and ask the clarifying questions of the other professionals. And again, I would expect others to do the same to me. That would ultimately help the student and help the team make an informed decision on the best goals, the best services for this student, all right? And that brings me to tip number three, which is kind of goes back to number one, and that is, speak to the parents, not just the advocate. Again, just like when we make our introductions, we want to make sure that we are talking to the parents, and that goes throughout the entire meeting when you're going over your progress on goals, when you're going over your present levels of performance, your report, your services, your new goals, all that good stuff you should be speaking to the parents. Advocates are hired to be consultants for the student and the parents. They are not there to replace the parents. Right? An advocate does not come in place of the parent. They are there to support the parent in making decisions. So when you provide your test results and all that good stuff that I was talking about, make sure you're addressing the parent. Of course, if the advocate again, just like earlier, if the Advocate has a question, if the Advocate has asked for some clarification, don't be a jerk. Respond very politely and respectfully, but know that at the same time you are there to speak to the parent, by speaking to the parent again, you are giving them the control, the respect, to make an informed decision on their students best options, right? And if you were going about your report and you're only talking to the advocate, you're now taking away that respect, you're now taking away that power from the parent and putting it to the advocate, giving the power all to the advocate. And that's not right. I mean, I'm sure there probably are some parents and advocates that would probably actually prefer it that way, that you speak to the advocate, but in my experience, talking to the parent is the best way to continue to build that rapport, give them the trust that they need, and, I mean, ultimately, make them feel like they are included in the IEP. I think it's now a nationwide thing that at the end of IEP, you know, when they're signing, whether or not they agree or not, there's a little box that says, Do you feel like you were facilitated in your student's progress and in your student's IEP. And I don't know if I was a parent and someone was just talking to the advocate the entire time I was there, I may not feel like I was actually included in an IEP. I'd feel like my advocate was, but I wouldn't necessarily feel like I was. And let's be honest here, the parent is a specialist on their student. First and foremost, right? I know the teachers spend a lot of time with the parents, or, sorry, hope not, but I know the teachers spend a lot of time with the students, but first and foremost, that parent is the specialist on their students. So again, don't completely ignore the advocate. I am saying, do not ignore the advocate at all, but address the parent as much as possible. All right, we're at the 18 minute mark or so, and number four, we're halfway through just about this is to keep the child in mind. I don't think I really need to even tell you all this, but sometimes you need to remind others to do the same, to keep the child in mind the best interest for that student is what this IEP is all about, right? Sometimes these difficult IEPs can get a little dicey, a little emotional, a little personal, and we just have to remember to keep that child first. Don't take statements about services personally, right? If you are recommending your service, whether it be once a week or once a month, know that any statements or any questions about your service are not about you. They are about your service. The question is, why does the child require specialized ot services? Not why are you. Two as the OT recommending once a month consult for my student. Why are you recommending only 15 minutes? No, that's not the case. The question is, why is 15 minutes of service recommended for my student? And again, if you're not taking that personally and you've done all your research and all your homework, you should be able to explain exactly why we only need 15 minutes a month to support that student, or why we need two times a week to support that student. On the other side, you know, sometimes it's the administrator that might be saying, Are you sure you need that much time? And yeah, so you need to be able to explain yourself. And also understand that things typically are not personal, even though they might seem personal, right? With that said, when you're an occupational therapist, you're working in education long enough, even if you're a teacher, admin, whatever, sometimes things do get personal, and it's happened for me. I know it's happened for others, and so my quick story, I don't want to dive too deep into this. It happened a long time ago at a previous district, but I basically had a parent during an IEP accuse me of not caring about their child. This is a child that I had worked with for probably about three years or so. At the time myself an occupational therapy assistant. The occupational therapy assistant had worked with a child even longer than that, probably close to five, maybe six or seven years since they were in kindergarten. But this I was kind of new to the team, and this parent decided that she didn't feel that I cared about that child even though we had up services and we had changed goals around, and we had done so much to support this student. I mean, I think at the time we were working on assistive technology, we were doing a lot to try to make this student be able to stay in that general education curriculum or general education class as long as possible, but in the heat of the moment, this parent accused me of not caring for for her child in the middle of the IEP and as you can imagine, that was tough on me. This is with that IEP team that I talked about earlier, that I didn't feel like we needed an advocate, because we always cared about the child and we always cared about the parent and were willing to do what needed to be done for every for every kid. And then that happened, and to be quite honest, I didn't really know how to respond. I can tell you, I probably respond a little bit differently now, if I had the chance. But when she said that, I basically stood up and walked out of the door. I can't remember if I even said anything, but I know I walked out of the room, and I was probably out of the room for a good five minutes or so. I talked to, I can't remember who it was, sorry, but someone in the office outside the conference room. I talked to. Calm down a little bit, and then I calmly re, re inserted myself into the situation, back into the IEP room, quietly, sat down, participated in the meeting, as though nothing had happened. And then at the end, I made sure to stay so that I could apologize both to my school psychologist who was kind of a mentor at the time, as well as the parent, of course, and so that happened, uh, things, you know, went pretty well after that. Of course, there's always a little animosity, I guess you could call it between us for the rest of the time that I worked there because of that situation. But we were, we were able to continue working. And, you know, it worked out. I don't know if we always loved each other, of course, the parent and I, but we were able to have a working relationship, and in future IEPs, we worked together. It really helped that the school psychologist that was kind of a mentor to me, and that parent had a great relationship, and so she was able to kind of help us both stay on track, and it was really good to have that person in the picture, but nonetheless, you know, it wasn't a great situation, and I hope that none of you ever have to deal with that. Sometimes I just have to remember a quote from one of my favorite movies, and that is Oceans 11 to check my emotions at the door, because in these heated IEPs, sometimes things get a little personal, and you just gotta be prepared for it in case it happens. And think about, what would you do in a situation where someone attacked you personally? I mean, I don't know what else could happen, but being accused of not caring about the specific child, that's pretty significant in my book. So again, I hope none of you have to deal with something like this, but just know that it could happen and to be careful. So to wrap that section up, just remember to keep the child in mind, to keep the IEP team focused on the child and you. Be good to go. Alright? And so that brings us to tip number five, which I'm just going to kind of touch upon, because I know I've touched upon it in past episodes, as well as I will be touching a lot more in depth in my course, the school based OT, A to Z, school based ot course, again, check that out. But number five is to make sure that your plops, your present levels, your goals and your services all match, right? Remember, your present levels lead to your goals, and your goals lead to your services, so they all need to match. And you know, another thing is, don't blame OTs for old goals, right? So you inherit a student, but don't say it was a bad goal that the student didn't meet and blame that the previous ot didn't know what they were doing. They made a goal that's not measurable, right? That just sounds like you're trying to give all the blame to that person, and that the reason they didn't meet the goal is because of the bad goal, right? No, don't do that. Take responsibility and tell it like it is. Say, Hey, the way that the goal is measured, the student did not meet the goal. They were able to do this, this and this, but they were not able to do this, and therefore they didn't meet the goal. And here's my proposed next goal. There's no reason to make it sound like someone didn't do their job. Remember, at the end of the day, you are a district as a team, right? And so if you're throwing an OT under the bus from the previous school or even the previous school district, it just doesn't sound good, and it doesn't help in the report building, also know that it's okay for goals not to be met. I know a lot of times there's pressure to say that a goal was met, but that's not always the case. You know, we're trying to push these students, and we should be writing goals that are difficult for the student to meet, whether it is a quote, unquote, pure ot goal, or if it's an academic goal, that's a whole nother discussion, but give your honest opinion, your honest measurement of that student's progress on their goals. It's okay if a goal was not met, but just continue forward, report it and then create new goals that go forward, right? So just a quick example before we move on to number six, about keeping everything kind of in order. So if you put on your present levels that a student struggles with cutting due to poor bilateral coordination skills, right then, going forward, you would work on your goal, which I don't know, maybe your goal would then be for the student to cut out a complex design, if they've already cut out simple designs. And then your service should reflect that goal as well as any other goals that you have. And so if you think you only need to see the student twice a month to work on that cutting goal. That's all right, but maybe you add another goal, a handwriting goal or something, then do you need to see that student another two times a month to make it once a week to meet both of those goals? That's how you should be establishing that. And then as we move on to number six, it's very closely related to number five, and that is about providing draft reports and IEP documents. This is becoming more and more popular, at least in California, around my area. You know, parents, whether or not they have an advocate, are asking for the IEP documents ahead of time. They're asking for the reports ahead of time, sometimes as early as a week. Sometimes they're okay if they have it a day before, and so I've been giving this some thought, and when it comes to my reports, by all means, yes, it's it's a good idea to send home the reports in advance. I do this. I try to get it out as early as possible, but typically I do follow that sometime within a week, oftentimes, our teacher will try to set a date for us, and we'll all send it to the teacher, and then the teacher will send it home. Not gonna lie, sometimes I miss that date and I end up sending it home in an email a few days later, or in the kids backpack A few days later. But still, before the report, the only thing I would suggest to you, if you are going to do this is make sure that you put, like a watermark, a draft, on the paper, on your report, or at the top of your report, say, draft copy and make sure it's on every single page. I rarely change my report from the time that I send it home to the time of the IEP date, but occasionally I do, and when it or whether or not it does, I come to the IEP with fresh copies of that report to give to the parent and the rest of the IEP team. So again, when it comes to reports, I'm all good with sending this home to the parents ahead of time, but I do recommend putting draft on your report. Also, I am not your boss. I'm not your special education department, obviously. So definitely check in with them before you start doing these types of policies. Similarly with the plops, the present levels and the goals, same thing goes, we often will put our present levels and our goals down on a draft IEP and send it home to the parent beforehand. That way the parent comes in already, kind of knowing what they look like. We also do this with our progress on. Previous goals, so that the parent can see what progress has been made and have appropriate questions at the IEP meeting. When it comes to services, though, that's where my belief changes, and I don't think that we should send home a copy of our recommended services, and that's only because things change a lot. And so at an IEP, a lot of new information comes out related to present levels and goals, and maybe how progress on goals occurred, different areas that parents might have concerns about, different areas that teachers general education teachers may have concerns about, right? And so we may add goals or we may remove goals, and services should be reflected in those addition to goals or removal of goals, right? And so you got to be careful, because if you say a student on your draft IEP requires once a week services, and he requires those once a week services because you're working on goals A, B and C, and you need once a week services to meet goals a, b and c1, year from now. Well, what happens then, when the parent or advocate or teacher says, Well, I think we need to add a goal for number four or number five even, right? Well, then what happens to your services? Do they change as well? Because now you have more goals to work on. So as you can see, what I'm trying to allude to is that services can change a lot based upon what happens earlier in the IEP. And so it's when it comes to services that I don't necessarily recommend always sending the services home in a draft that being said in my current district, that is our policy. And I absolutely go ahead and I follow that policy, but I would just say that in my opinion, I would prefer not to do that with all that said. Ultimately, no matter what you your IEP team, your school, your district, decide to do regarding sending drafts home, you have to be flexible in IEP and you have to have the child's best interest in mind. These are things that we've already talked about. And if you have a fixed mindset, when you go into an IEP, a that's when you're going to probably start to butt heads. And two, it's kind of illegal, and that's why it's a draft. Remember, drafts can change. You are not allowed to create an IEP without the parent, right? So it is a draft. You need to be flexible and keep the child's best interest in mind. All right, those were the six, quote, unquote, I guess, kind of heavy suggestions and tips. I wanted to go over number seven is a little more light hearted, and that is to remember, no matter what the meeting will end, you will make it home in time to watch The Bachelor, to see Victoria get kicked off the bachelor, hopefully tonight and or whatever your guilty pleasure show is, I guess you could say, but tomorrow will come. The IEP will eventually be signed, right? There's only so much you and your IEP team can do eventually. There are things that are above your head, above the OT position, right, that you just don't have control over. And so you have to be willing to let those go at the end of the day and say, and feel comfortable in saying that you did the best part that you could do to make that a good IEP and to make this child success possible, right? So that's everything for today. That is episode number 43 again. Show Notes can be found at ot schoolhouse.com , forward slash episode 43 uh, almost got stuck there real quick, but we got it. Thank you. Thank you. Thank you everyone for joining me today. Welcome to 2020 even though it is already, uh, almost March, I appreciate you all always for being a part of this podcast, for listening and letting me join in on your drive to work, drive home from work, or wherever you may be listening. Truly do appreciate it. For those of you still listening, I wanted to add a little something. I really hope you enjoyed this podcast episode. This is the first episode in a while that I actually completely re recorded, because I recorded it at first, and it just, it's a hard topic to keep upbeat. I guess. You know these, these are difficult subject matters and difficult IEPs that we unfortunately have to be in. And no one prefers to be in this right? We all want to be in the classroom or in our OT room, working with our kids. None of us got into this job to go to these strange IEPs, right? But we did it. I think it's a lot better now, and I hope you enjoyed it as well. Let me know if you're still listening to this in a direct message on Facebook or Instagram or something, and give me a fist bump or something. So with that, I will see you next time on the podcast. To take care and yeah, have a great rest of your week. Bye. Bye, everybody.     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 42 of the OT Schoolhouse Podcast. One aspect of school-based OT that both therapists and administrators alike seem to be reaching for is the development of an effective and organized RTI program. One that allows therapists to have a meaningful difference in the classroom for the students and teachers. ​ In episode 42, Jayson explains how RTI has moved from being just for teachers to being for service providers as well. He talks about what an ideal RTI system looks like, how he implements RTI, and how to start moving toward an RTI model. Listen in for some excellent tips to get you started! ​ Plus, don't forget to subscribe to the OTSH Email list below to get your very own copy of the Occupational Profile For School-Based OTs discussed in Episode 41 of the OTSH Podcast! Links to Show References: ​ National Survey of Occupational Therapy Practitioners’ Involvement in Response to Intervention ​​​​Susan M. Cahill, Beatriz McGuire, Nathaniel D. Krumdick, Michelle M. Lee; National Survey of Occupational Therapy Practitioners’ Involvement in Response to Intervention. Am J Occup Ther 2014;68(6):e234–e240. https://doi.org/10.5014/ajot.2014.010116 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. Jayson Davies     Hey everyone, before we get started today, I just want to give a big thank you to medbridge  education.com for giving otschoolhouse listeners $75 off their first year a subscription medbridge  education.com offers continuing education for OTs, PTs, speech therapists and many others. And by using the promo code "otschoolhouse" on one word, not only you are getting a 50% discount, but you're also hoping to support the otschoolhouse com podcast and the otschoolhouse.com website. It's a great deal. What I love about it is that you can watch any of the first chapters completely for free before you even decide to go ahead and make a purchase. So check it out at medbridge  education.com and let's Cue the intro.    Amazing Narrator     Hello and welcome to the otschoolhouse com podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.     Jayson Davies     Hey, everyone, and welcome to episode 42 of the otschoolhouse com podcast. For you who don't know who I am yet, thank you for listening. My name is Jayson Davies, and I am a school based occupational therapist here in Southern California, where I work for a school district and I service three schools. So that's who I am. Quick introduction. I hope you'll go back and listen to some of the older episodes and learn a little bit more about me. But to get things started off today, I wanted to say just a huge thank you to all of you for listening, whether this is your first episode or your 42nd episode. I appreciate it. Everything that you all have done for me has been amazing, the emails, the support when I go to conferences and I see you all. I just love doing this. I love being there for you, and I love actually having you guys be there for me as well. Some of the emails have just been amazing, and I love it. But really, I want to say thank you, because this is episode 42 and for 42 episodes now we've been diving deep into occupational therapy, how we can support our students, how we can support the teachers and the parents that we serve. And I don't know. I just love it. I love all the feedback that I get from you all. And I hope you all are enjoying the podcast as well. One of the ways that I do know that, among many ways, one of the ways that I do know that you enjoy the podcast is through downloads, and I can see how many downloads we get over a period of time. And well, I'm excited to say that we're not quite there yet, but as this episode comes out, we will reach 100,000 downloads of the otschoolhouse podcast, which just blows my mind. I mean, we're we're 42 episodes in, and we're already reaching 100,000 downloads, and it comes out to about 8000 downloads a month now that we get and I just want to say thank you so much from the bottom of my heart. Thank you for for for basically making that happen. I mean, I put the info out there and and I bring on guests, but it's you guys who are continuing to listen. And I super like, I just gonna be more appreciative of that. So thank you. I also really, like, I was talking about a second ago. I also just love all the support that I get from you all through the emails going out and seeing you all at conferences. It's amazing. Thank you for just for supporting me honestly and the otschoolhouse podcast. I really appreciate it before we dive into today's episode in the journal that we're going to talk about I also want to give a quick shout out to Vanessa rapier and all the other OTs and OT assistants that will be attending the Utah otschoolhouse com later this week. Vanessa actually reached out to me about sharing the otschoolhouse podcast with her Utah colleagues at the conference, and so we were able to make something happen. And I just want to, again, give her a shout out, as well as all the Utah OT and OTs that will be attending the conference later this week. I hope you have a wonderful conference and that everything goes smoothly, and you just learn a lot of information that you're able to take back to your jobs and implement quickly and effectively. So yeah, I hope you just have a great two days of learning and getting to know each other at this conference. You know, getting to know who your colleagues are and where each other worked, and how you guys can support each other. So take care and have a great two day conference there and be safe. All right, so now we get to jump into today's topic, which is going to be all about RTI. And the reason we're diving into RTI today is because earlier this school year, at the beginning of the school year, I sent out an email asking everyone out there who subscribed to my email is saying, Hey, what are your concerns regarding this upcoming school year? And I was a little surprised when I saw RTI was mentioned by quite a few people trying to figure out how to get RTI into their school, how they can use the RTI model to their advantage, to not only help more kids, but also to potentially help themselves. I think a lot of people are. High on the idea of RTI because of the idea that that they're overworked, and they think maybe RTI can help them with their large caseload. I'm not sure if I already said it, but RTI is Response to Intervention. There's also RTI too, which is Response to Intervention and instruction, or instruction and intervention, however you want to say it. There's also MTSS, which is multi tiered levels of supports and systems, which RTI is basically baked into. But we're going to use the term RTI for today. And like I said, a lot of people are interested in this one, because I think there is that mindset that by by using an RTI method, I can potentially make my life a little bit easier, and ideally that is the case. It should do that. But I'm going to start up and be frank up here, up at the beginning of this is that it's hard to transition when you have a large caseload over to an RTI model. And a lot of times, you know, we think it's going to be the best model possibly, best model possible, and it's just a struggle to get there, and you have to get a lot of people on board to get there. But I'm here to tell you a little bit about what it ideally could potentially look like, and I'm also going to give you what it looks like for me at this point, as well as what it's looked like for me in the past, and kind of where I'm trying to get to with RTI in my transition right now. So I'm going to talk a little bit about that. I hope it'll help all of you out there, at least some of you that are trying to to do that transition as well, from a very heavy, if you want to call it a caseload model, you know, pulling a lot of kids out, seeing them individually, more to an inclusive RTI model. So let's dive into that. So RTI has been around for a little while now, but it wasn't until recent that it started being applied to special education and, more specifically, occupational therapy, speech and language pathology and physical therapy. And so the way that RTI works in an academic or educational model for children in the classroom, again, not talking about OT or PT, is that you have your foundation, your level one, and ideally somewhere between, let's say, 75 to even 85% of the kids in school, both general education and special education, should respond to level one supports. And level one supports really, that is your first best training. And So level one is really sending teachers and other staff to to end services to training, so that they can be the best professional that they can be when they're working with as many students as possible, really. So when you think of like a fourth grade classroom, you know that teacher is going to go and learn English, language arts strategies, they're going to go and learn math strategies. They're going to go and learn science history, all that, even physical education strategies so that they can bring back to their classroom and work with 30 kids to try and make the best possible scenario, or the best possible outcome for those 30 kids. And so that's what level one really is. Also included in level one could be like screenings. So again, those district level academic tests that that districts do you know, each class sets aside a day or a few days once a trimester to kind of go over these tests to see where the kids are, and that's data that's taken for level one RTI, so that way they know when they're planning for next year, hey, where do we need to train our teachers in so maybe math scores are on the rise, but Ela is still not not coming up. Well that way through that screening, that district screening, they know, well, we need to train our teachers more in ELA, so that way we can bring our scores up in that area. And So level one is mostly all about training. It can also be, you know, potentially co-teaching. You know, some teachers get together, and they might co-teach lessons as a way to help a a younger teacher or a less experienced teacher learn how to teach in ELA likewise, transitioning now for for level one, RTI into OT. Occupational therapists can do the same thing at a level one, level one area you know, working with the teachers to train them, providing in services on sensory providing in services on fine motor development, teaching kids, or teaching, sorry, not teaching kids, teaching the teachers the steps to handwriting, or even just giving them the resources, the available resources, so that they may make the best decision on different programs that they can use. We can do trainings at several different levels. We could do trainings at the site level, you know, on their Tuesday afternoon meetings that they meet once a month. We can get in for that. Or you can even do it on a bigger level, at a district level. You know, those Welcome back days or the teacher professional development days. Those are, those are times when occupational therapy can provide a training. Likewise, an occupational therapist could also help to set up a either school or potentially a grade level screening for, let's say, kindergartners, you know, using some sort of screening tool that every kid in kindergarten takes at the beginning of the year, and then maybe six weeks into the year to see if there's been progress with some of those pre writing lines, pre writing shapes, and then steps toward being able to write their name. Those are a way to just kind of keep an eye on all the kids, and again, that helps you then determine where you need to help the teachers help the kids. So maybe all the kids are getting stuck with squares and they're not stopping their lines on time. Well, that's an area that you can then teach the teacher on some strategies so that they can incorporate back into the classroom, all right. And that brings us to level two, and I like to think of Level Two being at a classroom level. And so now in level one, we were looking at an entire grade level, or an entire school, or maybe even an entire district, you know, finding a program that the entire district could use to teach handwriting. But at level two, we're looking more at a classroom, and I'm going to use the I might use the term small group, because in comparison to a school, you know, one classroom is a small group, per se. And so for level two, maybe we are talking directly to that teacher to find out what her specific concerns are, or his specific concerns are for the classroom. And we're going to give the teachers again, give the teacher strategies based upon those specific concerns. So now again, using the square analogy that I was using earlier, or example, you know, maybe the entire school has difficulties with the kids stopping their lines on time when they're making squares, so their squares are looking more like, I mean, squares with lines coming out of all four corners. Anyways, maybe this teacher is having some difficulty with her kids rounding the corners of their squares. And so that's a different problem than the others. Well, now that's a different strategy from what the rest of those teachers need. And so at the level two area, we could potentially go in and co teach with that specific teacher and teaching them how to teaching kids how to stop and start, versus making one long line that ends up making a square look more like a circle, per se. Again, excuse my examples, but I'm just trying to give you guys an idea the difference between level one and level two. The other thing we can also do at level two is go in and do a screening of that classroom. And when I say screening of a classroom, I'm not saying we're going in to screen a classroom, but really we're focusing on one kid that we all know who that kid is. That's not the case here. We really are going in to look at a specific concern that the teacher has in the entire classroom. My favorite way to describe this one is when teachers come to you and say, Hey, dude, I just have, I have this really wiggly classroom this year. You know, I just don't know what to do. They're all really moving and groove in and and they just can't stay in their chairs. What do I do? And you know, this isn't a child specific problem. This is obviously a classroom problem. And so I'm willing to go in, observe the entire classroom, and then meet later and talk with the teacher. And so maybe it comes down to, I try and keep it a little simple. So, you know, I try and find the three most likely things that that we could implement to affect the classroom, and oftentimes it is, you know, finding the right size chair, the right size tables, and then providing some sort of movement breaks. You know, they're trying to have them sit down for 30 minutes at a time in a kindergarten class, and that just isn't going to happen, right? And so trying to suggest different types of movement problems, you know, animal walks in between centers, or using goat noodle or something like that. But that's kind of an that is a level two strategy, and many of you are probably already doing this. You just don't realize it's a level two strategy. It's talking with a teacher about their specific concerns in the classroom and trying to find a solution for that, because if we don't do that, then, well, what's going to happen to several of those kids? They're going to end up being referred, potentially for special education, even though all they needed, potentially was a correct size chair desk and maybe some movement in the classroom that you're now providing. All right? So level two, just to kind of sum it up, it's really working directly with the teacher, a specific teacher, really, because level one is working with several teachers at a larger level. Level two is getting it down to like one specific teacher or one specific group of children, all right? And that brings us to. Level three of the RTI system, and level three, again, I'm going to kind of start off with the academic side of this. What it looks like with teachers and the way that they do things. RtI level three is for those students that have received good instruction, maybe an educational specialist has come into the classroom to co teach with that teacher on ELA strategies, and there's still a small group of kids, two to three kids, in that classroom, that still aren't getting it. Well, now those two to three kids, maybe they go with two to three kids from other classrooms that are still struggling in ELA after the same after getting the same supports. So now those kids are going to go into a learning center or some type of small group that has a focus on English language arts or the area that they are struggling on. I hope that kind of makes sense. So basically, you're taking the kids that still aren't getting the work or still aren't understanding the topic that they're being taught, even though they've had, they've been taught at several different ways, are now going to a smaller group with a focus on that area. So now, as I transition now to OT, but what this looks like for OT? Again, I'm going to stay with the square, because we've already done it for level one and level two. At level one, you know, we had several kindergartner teachers saying, my kids aren't getting the square right. And then at level two, we had one teacher who say, All right, it's getting better, but they're still rounding all their corners. And so maybe we gave her some strategies, such as using stickers or something as a way to outline stop and start points. But as she did that, she realized, you know, there's still a few kids in my classroom that just don't get it. I mean, even when we give them stickers, they they don't get it. We've tried highlighting, nothing's working. All right? Well, I happen to have a pre writing skills group, potentially, that I'm working with, and she's going to send those two or three kids that are going to come to me, along with two or three kids from Mrs. Hernandez's class or whatever, and we're all working on this one or this area, that even after all the instruction that the kids have had in the regular classroom, still aren't necessarily getting as far as fine motor development, visual motor development. And in that case, this isn't an individualized education plan. We are not working on those student specific goals. We are working on the skills that these kids need in the classroom that they just haven't gotten, and it's just a little area that they're missing a little bit. And so that group that they're coming to, it's not designed based upon, I guess you could say that child's individual needs, but because we have this group, they're able to come to that group and hopefully get the needs that they need met. I hope that makes sense. Another example of this could potentially be like a social skills group for a handful of kids who are just having difficulty at recess, communicating, understanding, feelings, stuff like that, and are getting into maybe some trouble, or, you know, they're just showing high risk behaviors at recess. Well, maybe as an occupational therapist, you could provide a a social skills group that has lunch together and then after lunch, and talking during lunch and and going over different possible scenarios, role playing, stuff like that at lunch. Well, then they go out to recess and try to implement the strategies that are worked on. And again, this isn't an IEP based decision. This is a decision that the teachers and or parents have kind of understood. Hey, this program exists for all kids who may may need it, and so they are sent to that program as a way to just to get some of those skills. And I want to remind you, this is for kids, both on or off in IEP. You know they don't necessarily need to be diagnosed, not diagnosed. Sorry, they don't necessarily need to qualify for one of the 13 conditions to get an IEP in order to be a part of this. We're not saying the kid has a specific learning disability, and that's why they're not understanding how to get the square. We're just saying that this happens to be a difficult topic for this kid to pick up. Maybe they're doing a circle or, I mean, all the other things, great, but you're seeing that they're not getting that square, and that square is impacting their ability to move move ahead onto more difficult letters and whatnot. And so they need to get that and so that's why they're coming to you for a short time again, not saying that they necessarily have a a condition or a disorder, or anything like that, that they would need an IEP for. We're just saying that they have a few skills that need to be cleaned up so that they can get back into the general education on that same area and continue to progress. So to really sum up, level three of the RTI, I just want to say, you know, this is a targeted group intervention, and it's specific skill. Or skill area. And these kids, they are identified by the staff or the parent, and again, they may not be on an IEP, the groups that we're putting together, they're not individualized. They're more skill based versus individualized based. We are giving them the strategies to help mate meet that skill and I guess I'll get into it right now by the end of RTI level three, if they're still struggling, that's when the team, or the teacher, the parent, even yourself, if you're part of that team, working with that student, may want to think about referring for special education if they're still not getting it after they've had this much support. And again, maybe this is a once a week group or or twice a month group, I don't know, but it's not part of the IEP. And so that kind of sums up level three. And now I want to get into some specific examples of what level one, two and three interventions or supports could look like all right, so let's jump back into level one of RTI. If you remember, I did say that providing trainings was a good way for level one, either doing screenings at a school or maybe a specific grade level at the school is another good level one activity, as well as conducting centers or co teaching on more of a larger scale. When I say larger scale, I'm saying getting into all of the programs, maybe all three of the first grade classrooms, or all three of the kindergarten classrooms, rather than one specific kindergarten classroom. So I want to start off by saying I just kind of brainstormed a little bit, and I think these would be wonderful types of trainings that occupational therapists could do for teachers at either a school level or district level, and that could be maybe working with teachers, paraprofessionals or even bus drivers on understanding what autism is and how it may impact that specific area, whether it be, you know, out on the playground or in the classroom or on the bus, I highly recommend that if you're going to do something like that, get in touch with an active person in that area. Get in touch with another teacher and a paraprofessional or even a bus driver and work together, because you're going to need some of their input. You can't just go and present to a bunch of people without having their input. And so pair up with one of those, those people and put together a training, and then provide that training to that that group of people. Another area you know, that teachers would love to have information on is sensory processing. 101, you know, just a very broad overview of what vestibular, tactile and the proprioceptive senses are, and how they impact so many of the skills in the classroom. Again, you don't need to teach them about what sensory integration, everything that it is and how to treat you know, that's not their role. They're not there to treat the kids in sensory integration. They're just there to know a little bit about it and kind of say, okay, you know what? Understand that when you're saying, Oh, he's over regulated, what does that mean when that gets under regulated? What does that mean and why you're not giving a kid who's over regulated a trampoline that's gonna even raise that kid's arousal level even more. You know why you're trying to give them deep pressure, things like that that can be tangible and helpful. They really go a long way when you're working with those those teachers. Another one, you know, fine motor development and its relationship to handwriting, that could be a really simple training, you know, 30 minutes to an hour that you could provide after school. And then another one that I thought of was simple tricks to keep your kids on task. You know, maybe you're going over a little bit about ergonomics, a little bit about movement, you know, simple things like that, and how to incorporate movement throughout the day to help the teachers keep their kids on task. Also in that level, one area is screening. This isn't something that I have done. I've never been able to conduct a screening at the kindergarten or first grade level. That's probably where I would do it, maybe preschool. I've never had the ability to do that because it does take a lot of work. It really does, and it's hard when you have a full caseload. But what I have done is been able to work with teachers and administrators to identify a tool, and in this case, it happened to be Handwriting Without Tears or or learning without tears, as it's now called, but I helped them to identify that tool and how it could be used. And eventually, all the kindergarten and first grade teachers were using that tool, and they were doing the screenings at the beginning of the year. So it was fantastic. And again, all I had to do was kind of put together a little bit of a training and let them know the options that were available, and the teachers, you know, they had the data showing that their kids weren't progressing in handwriting. So it was really easy for the teachers and myself, working together to share with the administrator and say, Hey, we need this program. And then the last area that for level one, again, was conducting centers on a larger scale. Scale. And again, when I say larger scale, I mean kind of doing it across an entire program. If you're doing it for one specific classroom, then it's more level two. But if you're going into each kindergarten class, you know, once a week or twice a month to work on just some developmental skills in there, that's still considered a level one activity, because you're reaching all the kids at that level. You're not only reaching a handful of them. You're not just reaching the ones on IEPs. You're reaching all the kids. All right, so level two, again, remember, as I said earlier, going a little more specific, a little more small group. And so when I say small group, again, I'm meaning like individual classrooms. I guess the best way to really describe this is when those teachers come up to you in the break room and say, Man my classroom, like, I just, they have something about their classroom, right? Like, man my classroom, they just, they just can't space. They they can't put spacing in between their words. Or, man, my class this year, they just, they're moving all the time. I can't keep them in their seats or, man, this year my class, I mean, you know, it's just, that's the perfect opportunity for this, you know, they say, Man, my class is having so much difficulty spacing. Well, that's the perfect time for you to offer, hey. Well, you know what? I understand that, you know, maybe there's some areas that I could potentially help As occupational therapists, you know, I can, I can break up the analysis a little bit and see where I might be able to help you out. And so you go into the classroom and you observe them, obviously, during a time where they're working on this specific skill or a task that includes that skill. And then you debrief with the teacher a little bit later, you know, you say, Well, you know, I was watching during writing time, and no one's using their finger to space. Or, you notice that a few kids, maybe they're left handed, and when they're copying, they can't see what they're copying because their left hand covers it up. And so simple strategy, you know, put that give them two worksheets so that they can have one on the right so that they're copying from the right hand side. Simple Strategies like that, you know that that they don't affect just one kid, they affect an entire classroom, and it's based upon your observation of that classroom. The other thing that usually that follows that as well, as, you know, debriefing with the teacher a little bit later or a consultation, is you could then also potentially co teach with that teacher, or do a small group in that classroom a center, and again, that typically needs to follow some sort of observation, so you know what help they need. And maybe so for a few weeks, you go in there and you work on that spacing. You know, every kid comes through your center in the morning, and you work on spacing for four weeks straight, and then you go back and observe again on the fifth week and say, Hey, we now have some data, or maybe they use that screening tool, and we have some data now that says, yes, that four weeks of centers did make a difference, and those kids are now progressing and spacing out Their words a little bit better. So yeah, level two, those are some decent strategies I think you could implement pretty easily, but I understand again, there are some concerns as far as time, and we're going to get into that in just a minute, but first we need to review level three. And I'm going to admit level three is the trickiest, and it's one that I have yet to master, or really even take on completely, because it's tricky, in the sense that it almost looks like what we're already doing when we pull out small groups, because it is working with a small group. However, the difference between an IEP small group and an RTI level three small group, is that in an IEP, we have evaluated the students. We have seen the specific areas in fine motor development, visual motor development, visual processing, sensory we know the specific areas that these kids need assistance with, and so we put them in a group with other students that have the same type of difficulties, and we're working on those, those skills, sometimes from a top down, sometimes from a bottom up model, but in an RTI level three group, we're targeting a specific skill in the sense, going to go back to using the spacing right Now, the spacing in between words. Now these kids, we know they're coming to us because their teacher, their parent, the administrator, whatever, said, Hey, this kid has some difficulty spacing, spacing their words still, even after we'd done so much with them. And so they're coming to this group specifically for spacing. And now we haven't assessed them. We don't know what their visual motor abilities or visual spatial skills look like, but we know they're having difficulty with the spacing of the words, and so now we have, you know, five kids maybe that we're working directly on that, and we're using a very task oriented, top down approach, you know, we're just trying to hit that one skill, because that's the area. Area that they really been identified in as needing help with. And so that's kind of how it's a little bit different. But again, you can kind of see how it looks similar and how it can be a little difficult to interpret. I guess. You know, my kid is not on an IEP, but they're going to a small group out of the classroom. You know, that doesn't necessarily always appear Correct. I guess you could say so. It is a tricky one. It is one that I have not mastered. I do think it is something that could potentially help with eliminating unnecessary referrals, per se for occupational therapy. But I do think, because your your groups need to be tailored to, you know, the screening tools that were done in level one, how else are you going to know what, what type of program to run? You need to have a screening tool. So if you don't have a solid foundation and RTI for levels one and two, then level three isn't really going to ever happen, because you have to go through level one and level two to get to level three, and so it's hard to develop a level three or even get to where you're doing level three, RTI, if you don't have a solid foundation of level one and level two. And I think that's part of the reason that I've never gotten there before, is because, yeah, I've dabbed into level one. I've helped kids and teachers in the classroom, co taught like a handwriting type of program for a few weeks, but it was never consistent and solid enough that we were able to kind of move up the ladder and eventually get to level three. So again, I started this podcast not to say that I am the greatest ot in the world, but to share with you my struggles and what I've learned throughout my school based ot career, and it's difficult, and it takes a tremendous teamwork, and you really have to work with your administrator as well as the team, including your teachers and even your parents, to get there. So that's my talk about level three real quick. But I do want to now dive into what I'm doing right now, as far as trying to help myself eventually transition into more of an RTI based model, because right now I do have a very caseload heavy model. I have kids that are once a week, some kids that are twice a week, and they're individual. And when your schedule is completely full with individual sessions all week long, you know, from bell ring to Bell, bell ring to go home, then you can't sit in RTI. And so I'm going to share with you just a few tips or a few things that I'm doing right now to try to kind of flip that upside down a little bit and get myself some more time. So stay tuned. All right, so it sounds like I'm in the same boat as many of you. You know, we have a caseload that, like, as mentioned a second ago. I'm seeing kids from the time the bell rings to the time the bell rings, basically for the kids to go home, start Bell, to finish bell. And that makes it obviously, very difficult to do. RtI level one, you can still do because you can do trainings, right? And a lot of that can occur after the kids have gone home. You can put together a training after the kids have gone home. You obviously will be presenting your training after the kids have gone home, or during a non pupil day, or whatever. But other than that, level two, level three, I mean, you have to have the kids in school to be doing level two and level three, even parts of level one. And so you kind of have to to work towards your caseload. I don't want to say reduction, because that's not the that is not the case. But in the long term, you have to be thinking that RTI is going to help reduce your caseload, in the sense that if you're doing RTI, hopefully you're going to be able to prevent occupational therapy referrals, right? And so that's kind of the goal, is to get to kids before they before they might need a referral for occupational therapy. And so have a few strategies here that we can use in order to try to work our way toward using more RTI and spending more time on RTI to be effective, so that we can do that prevent, prevent referrals. And you know, the ones that may take up more time than they actually take up to help the student. But before we get into that, I want to take a quick moment to take a break. I'm getting a little restless. Over here, my dog, TJ, over here, is also getting a little restless. He's shaking his toys and wants me to play with him. So let's take a quick break right here. Move about a little bit. Get your wiggles out if you need to press pause, take a break. Check the social media I really appreciate it. If you left me a positive review wherever you are listening to this podcast. If you're able to do that on Apple podcast or some of the other networks, really appreciate that. Or just shoot me a social media message real quick and give me a fist bump or thumbs up or something and say hi. But. Yeah, just take a quick brain break, and then we'll get back into it right now with a few strategies that you can use to facilitate progressing in your own RTI program. So all right, let's get back into it. My first strategy here is start with educating. Figure out, you know, one or two teachers that understand what OT is, and they find you as being a valuable member to, if not the IEP team. But they they just personally believe in what you have to say. They think that everything you have to say is a good idea. They've taken your strategies and use them and implemented them, and, you know, try and take it to the next step, see if they'll let you come in and observe their classroom and consult a little bit and talk together, talk together afterwards, and see if there's not some strategies that make may even better help them. I mean, right there, that in itself, right there is a tier two, tier one strategy, you know, getting into the classroom, observing and then collaborating and consulting to find out where we can improve even a step further from that. I mean, it's a level one strategy, but see if they're willing to work with you on creating an in service, you know, maybe a teacher and yourself, especially if it's like a special education teacher who has to do a lot of behaviors, maybe they're willing to do a sensory and behavior in service for other special education teachers with you, that'd be great, right? And there you go. You're starting that level one process, and by observing in their classroom, you're starting that level two process, right? Another thing you can do as an IEP team member is identify the students that are making progress and can be seen in the classroom. And I understand that we're going, you know, we're trying to talk about RTI here, but again, we're trying to flip our caseload in a way, right? And so find the kids that you can see in the classroom, that you can work with in the classroom and make progress toward their goals. That way you are getting into the classroom, you'll be able to befriend those teachers and show them the value that you do have, or that you can provide in helping those students, and not to mention, but you'll also be in the classroom, and so you can see the other struggles that kids are having, you can see the struggles that the teacher is having, and you can continue to build those relationships with those teachers By pulling the kids out of the classroom. And I'm not saying that's a bad thing. There are definitely kids that need to be pulled out for therapy services, but we miss a lot of the context that they get when they're in the classroom. And so if we can push in, not only can we potentially help that kid, but also we get to see the dynamics of the individual classrooms on campus and get to know the teachers a little bit better. Another opportunity to take advantage of is during IEPs. That can be an opportunity to show not only what we have done for a student, but what we can do for a student, and potentially even a group of students or an entire classroom. And you know, it can be difficult to show our administrators what we can do. Oftentimes, they kind of know what we're supposed to be doing, but they don't know how we do it, or what we do in the in the classroom or in the therapy room. To make that happen. So take advantage of your IEP meetings and let them know what you've been doing and what you can do and what you could even do in the future, given more responsibility in the classroom, working with the teachers. And the final strategy that I have for right now is to go to staff meetings. And I want to share a little story about that, because I've been in OT now for seven years, and I think last week was the very first school staff meeting I have ever gone to. I have obviously gone to special education meetings. I've gone to hundreds of IEPs. I've gone to occupational therapy meetings. I've gone to district level meetings, and when I was at a different district, but I think in seven years, this was the first time I went to a a school site staff meeting for teachers, and I took a lot away from it. You know, you can't know what the school is focusing on unless you're going to meetings like these, and you need to know what the school is focusing on, to know what, how you can help in that focus. And you know, if, if the entire school is focusing on math, and here we are trying to focus on, you know, language arts. Well, we're already a kind of a step behind because, you know, they're trying to focus on math. And so this week, I found out my school's really focusing on positive behavioral intervention strategies this year, PBIS, in fact, they're kind of moving from tier one, potentially up into tier two. And so I was like, hey, well, first of all, they're already talking about RTI, right? And secondly, it's, it's about behavior, and OT is inherently intertwined with behavior. And so now I know going forward, I know the topics that I need to talk about, and the areas where I. Can help out with behavior and sensory and potentially using different type of mindfulness activities and stuff like that to influence behavior, and I can have an impact on that. And so I think you guys have probably heard me say, you know, I don't I try not to bring work home, but this time, it was totally worth it, because I went to a staff meeting and I learned a lot about my specific school, or one of my three schools, and it was worth bringing work home this today because or this weekend, because now I know going forward what more I can do at the school site to help them and to, you know, kind of catch their ear on different things, how I can help them with So, yeah, that's what I have today about RTI. I hope that gives you a better understanding of the three tiers of RTI. There are some people adding more tiers, tier four. Some people do say that RTI tier three is an IEP. I think I said earlier, I don't necessarily agree with that. I think it's it's before an IEP, or I shouldn't say, before an IEP, but it is not part of an IEP. It is a general education function still. And I think OT is just getting into RTI, but I think it is where our role is going to be going even more so more on the consult slash collaborative side, versus the individual treatments, there's such a push to keep kids in the general education classroom as much as possible, and through the RTI we could potentially, through the RTI method, we could potentially do that and help out the teachers to have more strategies for the kids, and even if we're going into the classroom. I mean, you think about it, this is what RSP teachers and aides do often. They go into the classroom and they work with the kids in the classroom in their natural environment, right? Isn't that what we're all about, natural environment? And so I think that's something as OTS that we should be looking forward to and figuring out how we can provide a more supportive role in that aspect. So yeah, this is my episode on RTI, and sure, we'll talk more about it in the future, but I know we've talked a lot about it in the past, but we hadn't really, like dove into it deep to figure out exactly what RTI is. And so I hope you enjoyed that. I am really looking forward to hearing the email responses from this. I know you guys are going to have questions. I know you guys are going to have more wanting more specifics. And so I'm working on something for that, and I'll let you know more about it, but feel free to email me, let me know if you have any specific questions about this. And, yeah, just keep on going. I mean, right now I'm working on a presentation that I'll be presenting in December for my teachers. Again, it's going to be kind of that sensory processing 101, type of training for all the special education teachers, I think, at two or three schools. So that's one way that I'm doing level one, and I'm hoping to continue to build off of that. It was more at my previous district that I got to do some more level two type of the stuff, but I'm trying to get that going here. And one way, like I kind of talked about earlier in the way that I'm flipping it, is I'm looking for those students that I know that I can be assistance to them inside the classroom versus pulling them out. And by doing that, I'm going to be in the class more making progress with those students, but also seeing the concerns of the teacher and the other students and the paraprofessionals, and working with them to help the kids in the classroom on a daily basis. So yeah, that is my 40 minutes or so on RTI, I hope you all enjoyed it. This has been a great episode. 42 I appreciate you all listening. Thank you so much for helping me reach 100,000 downloads in just over 600 days. It's been fantastic, and I look forward to many more. Take care and have a great rest of your week. Bye bye.     Amazing Narrator     Thank you for listening to the otschoolhouse podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com , until next time class is dismissed. Click on the file below to download the transcript to your device. 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 41 of the OT Schoolhouse Podcast. Have you ever gotten halfway through an assessment and realized you could have saved yourself so much time if you had just done a little homework? If so, you may want to check out this episode. ​ In episode 41, Jayson talks about the AOTA Occupational Profile and how it can be better suited to meet the needs of school-based and pediatric occupational therapists. We will look at why it is important to build an occupational profile and how to best do that in the schools to save you time and energy! Plus, subscribe to the OTSH Email list below to get your very own copy of the Occupational Profile For School-Based OTs discussed in Episode 41 of the OTSH Podcast! Links to Show References: OT School House - School-Based Occupational Profile Use this link if you would like to read more about the OT School House Occupational Profile for School-based OTs​ American Occupational Therapy Association - Occupational Profile Use the link above to head over to AOTA.org and download AOTA's version of the occupational profile document American Journal of Occupational Therapy - Occupational Therapy Practice Framework ​ Occupational Therapy Practice Framework: Domain and Process (3rd Edition). Am J Occup Ther 2017;68(Supplement_1): S1-S48. DOI: 10.5014/ajot.2014.682006. 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 episode 41, of the OT school house. My name is Jayson Davies, and I am your host now and forever. Thank you so much for joining me wherever you are today. I really appreciate it, whether you're at the gym in the car on your way home from work or maybe you're on your way to a conference in a plane. Just thank you so much for joining me today. Today, I have something really special that I want to share with you all after we take a look actually, at the occupational therapy practice framework published by a OTA. Of course, you can get that for free on the Asia ot website. You don't even actually have to be a member of a OTA in order to access that one. It's one of those, like powerhouse articles that they want everyone to have access to. So it is free. So we're going to look at a small section of the otpf today, but first, I want to start off by sharing a little bit about what's going on with me, as well as ot school house as a whole. So first of all, you might be able to hear it a little bit in my voice, but I am trying to get over this nagging cold that's just been kind of having me struggling to stay awake and struggling to get stuff done for the past week or so, and so I'm trying to get over that, but I'm here being optimistic and just trying to get some stuff just put down on the mic so that we can have another great episode. So we're gonna get through it today. Please excuse my voice, but we'll get through it today, next time, we'll come back stronger than ever. But even more so, I want to say that you know this, this start to the 2019, 2020, school year has just been a little bit of a struggle for me. There's just so much going on. You know, I've got a large workload, caseload, whatever you want to call it, and that's another episode that I want to have with us at another time. But, you know, it's just been a lot on my plate at school, and then between that and some other roles that I've taken on, be it at OT or just with the OT school house, man, it's just it's been a little strong. It's been a little bit a little tough for me this, this past past few months. So I just want to put it out there, but I want to say thank you so much for all of your support. I appreciate all the emails, all the Instagram shares, all the Facebook posts that you guys I mean, I I need to take a picture of this, but I've got a little wall going on here that I've started just with some of those emails that you guys send, or whatever that say. Thank you, just because it keeps me going, between you guys and my wife and the support that I have around me that just keep pushing me to do this, sometimes it's a struggle. After coming home from a long day of work and hopping on the mic, I love doing it, but sometimes it's a struggle to get started. Once I get started, there's no stopping. But yeah, it's just been a little a little tough this past few months at work and with everything going on. But with that said, I am working on something very special for you all, actually, and I can't wait to have this done. It's going to be an actual webinar. Course I'm putting it together. I'm hoping to have it done by January, it's gonna be somewhere around eight videos or something like that, and it's gonna be all about school based ot it's gonna be great for you guys, and I can't wait to get that out and share more information about it. I'm just not ready to do it yet, but hopefully come January, I'll have something super special for you, and you guys will be super excited. I can't wait to share it with you all. Yeah, I've been working on it for a while now, and it's going to be awesome. So with that, we are going to jump into the occupational therapy practice framework, also known as the otpf, from the A OTA, and as ot we're going to look at a very small section of it. Some of you who have subscribed to the OT School House website on not just the podcast, but also the website, you've already, at least, probably seen it. You may have you may have downloaded it. You may have skipped over that. A lot of people I know join the website to get the gray space paper. Another thing I haven't mentioned in a while, but it is a paper that you get for free when you subscribe. But the other thing, or one of the other things that I also give away for people who subscribe to the website, is called the school based occupational therapy profile. And so that's what I want to jump into today, the occupational profile, and what that is, what it looks like, why we do this and how it can help you and your practice in your evaluations and moving forward into your treatment. So we're going to get into that right now. But first, I want to review just what the otpf, the occupational therapy practice framework, says about the occupational profile. All right, so many of you are probably familiar with the concept of an occupational profile. You've heard. Of it. You kind of know that it's a snapshot, if you want to call it that, of our client or of the student that we work with. But I want to go a little bit deeper first by starting off with what the otpf actually says about an occupational profile. And so I'm going to read this verbatim real quick from the otpf, and it says that the initial step in the evaluation process which provides an understanding of the client's occupational history and experiences, patterns of daily living, interests, values and needs, the client's reason for seeking services, strengths and concerns in relationship to performing occupations and daily life activities, areas of potential occupational disruption, supports and barriers and priorities are also identified, and that is within the occupational profile. So it really is this all encompassing picture of what's going on with our student, what are the strengths, the weaknesses, what is also going on in the world of that child? You know, what's going on in the classroom, at recess, at lunch, things like that. What does this child need help with accessing? You know, there's a difference between this is where we get into that medical versus educational model. As school based OTs, we are paid by taxpayers. I mean, if you go all the way up the steps, right? And so there are some specific areas that we are to look at. We're not a medical based ot we are looking at the student's ability to get to the educational curriculum. So that's something that we need to take into consideration. The Occupational Therapy profile. You know, one thing that they do say in the otpf again, is that just because the student may be your client doesn't necessarily mean that all the information has to come from that client or that student. It says that you're allowed to get other information from the family, friends or other permanent people in that that person's life. And so again, not just getting information from the student. Of course, if this is a I don't know, a kid, maybe older than third grade or around that age, you can get information from them, but you should also, again, get information from the parent, the teacher. Maybe there's noon duty aids, or a recess or lunch aids, a principal, anyone who has some input on the student that can help you develop your occupational profile. So I'm going to go into some of the categories right now that they actually have on the A O T, A occupational profile. They have four sections titled client report, environment, context and client goals, and in these areas, you know, we're asking, Why is the person seeking services and and what things are they successful in, versus what are they not feeling successful in? What are some of their values and their their occupational history, their life experiences, and then also performance patterns, such as the routines, the roles, their habits. You know, all those things that we look at, are they able to succeed in these, these important aspects of their life? And then you start to look at the environmental factors, and that's, you know, the physical factors, such as, you know, where they go. Can they access the buildings? Can they access the school environment? Can they access the playground, and then also in their social environment, you know, what are their social skills potentially look like? What does their their network look like? Do they have friends? Do they not have friends? Are they scared to come to school? Potentially? What does that social environment look like? And then you also have their context, cultural, personal, temporal, and one that I really appreciated when I saw this is virtual. Obviously, virtual is a huge context. We're using a virtual platform right now as you listen to me. So the virtual thing is coming. Telehealth is coming. It's already here, actually. So virtual is something that we definitely need to look at. And then, of course, client goals. And you know, we wouldn't have a job if it didn't come down to client goals. And we're going to get a little bit deeper into the client goals in a minute, but I just want to say that is somewhere that we definitely need to be looking at. And I think that's one area that sometimes we forget to really look at. We kind of think, What is our goal for this? For the person, but we need to be considering what their goals are. So yeah, we'll get back to that in just a minute. So those are the areas that a OTA really thinks that we should look at when we're when we're conducting an occupational profile. But as I read it and I look at it and again, all of you can access the A Ota otpf online. It is a free download for anyone. You don't have to be a member to get this one, because they really, I mean, it's basically mandatory if you're in some sort of medical field, because I believe it's a requirement to get reimbursement. Is using the occupational profile. Of course, being in schools, we have a kind of different mindset, like I was talking about earlier. We're. Funded by the taxpayers, not necessarily funded through insurance, but we still need to take into consideration this occupational profile. But again, if you've ever seen it, if you haven't, I encourage you to go look at it, because when I read it, when I look at it, it doesn't feel like it is as applicable to what we are doing in school based occupational therapy, as well as in pediatric occupational therapy, because things change when you're working with a child or a student. You know, this is a very young mind that we're working with, and oftentimes, I mean, all the time, there is someone else, there are other people that are often giving us information that are that is not the child. And so when I look at the occupational therapy profile from a OTA, I kind of see this, this picture. I kind of get the mindset of a therapist talking to the client and getting a one to one relationship with them, and getting a lot of information from that client, maybe some record review, but it doesn't really have the tone of getting everything from all the people around the child and student and so actually, I've had this for a while. Like I said earlier, I developed it about two years ago, but I want to make sure that you all know about it and have access to it, because I'm not, because I'm now going to go over kind of my adaptation for this that I created. And it is, I call it the school based occupational profile, because I just adapted it slightly to make it more school based relatable. And, you know, I do want to share this with you all, and so I didn't make huge changes. I just made it seem more appropriate for school based and pediatric therapists and models. So I'm going to share that with you right now, actually, and you'll see there's not a lot of changes, but there are some significant, small changes, all right, before I get into that, I do realize that many of you are very visual and that you like to have something in front of you when someone's talking about something. So before I get into the details of this, I do want to let you know that you can get this occupational profile for school based. OT is completely free. All you have to do is go to OT schoolhouse.com , forward slash episode 41 if you're on Apple podcast or some of the other platforms, there's a show notes link right there. Just click on that. It'll take you there. You'll fill out the form which subscribes you to my website, which is just for emails and such, completely free. And you will actually get a link in your email about how to access the this form that I'm talking about. So if you want to press pause here real quick, get that and then come back so you have it in front of you. Now is the time to do that otherwise. Go ahead, listen on, and I will share again at the end of the episode how you can get access to it. So let's jump into it. So just like the occupational profile from a OTA, I have four separate overarching categories, I guess you could call them, and that is student history, environment, context. And instead of client goals, I said priorities, just because I like that word a little bit better. And there are so many different priorities coming from different people. And you'll see when I get down to that, why I broke it down into priorities. So first, within the student history, there's five different kind of questions, slash areas to look at, and the first one is, who's referring the child for ot services, and what are their concerns related to school engagement? So that's the first thing we need to know. Who is saying, hey, this student needs to be referred. Is it the parent? Is it the teacher? Is it someone else, the principal, the assistant principal, maybe it's coming from a counselor or school psychologist, and what did they what did they see? Obviously, a teacher or a parent is going to see something that's so much different than a school psychologist who has done like standardized testing with the student, and maybe they saw some visual motor skills that were lower while the vision processing abilities were high, and so they say, okay, maybe there's some fine motor delays there, versus the teacher might say, you know, their handwriting is just horrendous. Or maybe it's the parent that's saying he just can't get to school in the morning. We can't get him up. We can't get him moving. He's like, terrified of coming to school. Whatever it is. We need to know who's referring that student, or maybe it's the entire team, and they all have a general consensus of a concern, and we need to know what that concern is, because that's what we're, in theory, really going to hone in on, on our evaluation. The next area of that is, what are the students strengths in school? So what can the student do in school? What is he capable of doing independently or with very little assistance. Keep in mind that, you know, a lot of kids need help with something, and just because a kid needs a little bit of help with cutting doesn't mean that that can't be a strength relative strengths versus relative weaknesses. But again, strength based approach so that what are the students strengths? The next item I put here, again, under Student history, is, how does the student feel towards school? What does the student enjoy about school? You know, that's something important, whether it comes from the student or from his teacher or the parent, again, anyone around the student. What does that student enjoy? Does he enjoy? I'm going to use he just because it's easier for me to stay on one track, but does he enjoy going to recess, or does he like Is he scared of math? Does he enjoy reading, but not like writing? What are the areas that the student enjoys and again, is he able to enjoy school as a whole? I often say, as educators, you know, our first job is to get that student to want to come to school, just because, you know how much, how much work are we really going to get, or how much learning are we really going to get out of that student if they just hate and dread being there. So what does the student feel about school? The next area is occupational and medical history, both inside and outside of school. Often, you know, we look at the vision and hearing screening that is conducted, but we need more than that. You know, we need to call the parent and say, Hey, what's going on? How was that child's birth? Was everything normal at that point? Has the student gone through any therapy? Has the student had any traumatic events in their life, surgeries, extended periods in the hospital, long sicknesses, or maybe there's a death in the family, or something that can have that that just mind changing experience. Maybe it's a specific diagnosis that we would never have found out just by looking at just other reports within the student's educational records. So we need to call the parent. We need to find out some occupational and medical history. Occupational history, you know, has a student, did they meet their developmental milestones on time? Are they mostly independent at home, getting dressed? Are they able to do that thing, those types of things, or do they need a lot of help? Obviously, of course, we're looking at school based occupations, but some of those occupations that we find out about at home kind of gives us a more rounded picture of the student, and it might lead us to kind of have some ideas about what might be going on if they're having difficulty sequencing at school and they're having difficulty figuring out how to put their shoes on the right way and how to tie their shoes. Yeah, you know, there might be a correlation. It might be something going on that's affecting both areas, all right. And so the last area that I have here under Student history, that we really need to look at is school related history. And you know, that includes everything from RTI services response to intervention or MTSS, if you want to call it that, what have they interacted in in school? What have their IEP services and goals look like? You know, what types of services do they actually receive? Are they in ABA or do they receive ABA services? Do they have a one on one aid or not? Do they have goals related to fine motor skills, or are their goals more academic and sense? How old is the student? When did they first start school? Have they been in school since the preschool age? Or did they not start until they turned five in kindergarten? All these things are important also. Did they have an IFSP or, I mean, maybe that can be a little hard to find out, but the parent will be able to tell you, did they have an IFSP, and why, and what was the basis around the IFSP? Did they have a diagnosis already? All these things are school related history that are so important also, you know, has the student been held back a year for some reason? And if so, why was it because of grades immaturity? Why did the parent or the school decide to do that? Those are all very important school related information, also grades. You know, those can be a little hard to track down sometimes, but if you can get either most recent grades or current grades, all that that helps in developing your report and mindset for what this student potentially needs help with All right, so that wraps up the student history portion of the occupational profile for school based OT, but it leads us into the environment factors. And again, this is going to look at physical environment as well as social roles and expectations. And there's a reason we look at physical environment and their social roles after we do the student history or look at the student history, and that's because and that's because, again, up in the student history, we looked at, why is this student being referred for services? And so that's the real important part, right? So maybe it all has to do with desk work. Then when it comes to the environment, we really need to see that student at their desk doing desk work. And what is the concern, and what does the environment look at look like at their desk, you know, is the chair the right size? Is the desk the right size for both the student and the chair? Is he able to see the board, or is he is his back to the board and he has to turn around to look at it? What are those factors in the classroom that could be preventing this? Student, of course, when we also go back and look at the medical history, there might be something there as well. You know, depending on the diagnosis the student may have, maybe they have auditory sensitivity, and so we need to make note of how loud it is in the classroom, or what's the visual field of sight for that student, what is he seeing every time he looks up? Is he seeing a rainbow on the wall that's just distracting the heck out of him, or is he looking up and seeing the whiteboard and being able to focus on that? Maybe there's a concern out at the re out at recess, and so we need to look at the recess equipment. Is the student able to access the recess equipment? Maybe there's adapted tools that the student is already using. We should be able to note this. We shouldn't be going into an IEP and having to ask, Oh, does the student already do this? Have you tried this? No, we should already know that. We should have asked the teacher already, or the principal or the parent, has the student ever tried adapted pencils, adapted scissors, pencil grips, whatever. You know, there's so many things out there that we can get by having conversations with people in the other area of the environment is the social roles and expectations, and again, both in class as well as outside the classroom, what is the peer and adult interactions like in that classroom? Does the student isolate himself or herself from others, from the teacher? You know? What are they able to Who are they able to get help from? You know, teachers will often teach a student to ask a peer before they come up and ask the teacher, so, is that happening? Or does the student refuse to talk to anyone around in the group? Are they able to follow directions? If so, how many directions are they able to follow? Can they simply get up, push their chair in and go line up. Like do they need multiple cues to do that? Or is that something that they can do with one cue? Also the difference between a novel and a familiar direction. You know that one that I just mentioned, getting up, pushing your chair, going lining up. They've been doing that since kindergarten. But what about something new? I don't have something off the top of my head, but there's always so many things going on that are new to a classroom, you know? And so we need to, hopefully we can see that during an observation. The next area is context, and this is an area that gets a little more personal, you know, we're looking at the cultural context, personal context, temporal context, and again, virtual context. And so cultural is one that's a little tricky to get into, but there are things that we can ask our parents and our teachers about. And when I say cultural, I don't just mean like the student's background, but also the culture of the classroom. What does that look like? Do they have a good culture? And this kind of goes in with the social roles and expectations. But again, are there classroom jobs and things like that going on, or does the teacher expect the student to be at their desk all the time, personal context as well? You know, just kind of this kind of goes back a little bit to the history. But you know, what does the student like dislike at school? Things that just kind of odds and ends that you kind of want to get from a typically, that'll come from a student interview, if you can get it. And then there's the temporal factors, you know, what is the student's age at this time, as well as their developmental age in relationship to their peers. You know, do they seem immature or very mature? Do they enjoy talking to their peers, or do they need the structure of talking to an adult? And then the last one is virtual context. And again, this is just becoming so important to look at. How are students able to use and interact with virtual components. You know, a lot of times I see kids getting put onto a computer, and they don't have the attention span to either a not press a button until after the question has been read to them, or B, they just like spam everything. Or they don't even know how to get like to the actual program that they're supposed to be on. And so that takes a lot of a lot of assistance. And do they have a one on one aid to help them with that? Or do they have a teacher that has a small enough class to be able to help them to do that? Is there something that you as the OT can help them with virtual Of course, we're seeing it so much more in schools, and it's a trend that we're going to have to start getting used to, all right. And so the last area of this one pager, the occupational profile, is priorities. And in the OTs version of the occupational profile, they just have it as client priorities. But here, I thought this was extremely important, and so I really broke it down. I broke it down into three specific sections, and that is student priorities, parent priorities and teachers priorities, because everyone has a different priority, it seems like. And you know, like I was saying anywhere around third grade, even even slightly younger, if they're. 30 into what's going on, a student can give you their priorities for school. They can tell you what they like, they can tell you what they don't like. They can tell you what's important to them and probably what's not so important to them. Even kindergarteners can do that for the most part. But as school based OTs, and generally, as any ot working with students or kids, we also, of course, have to take into account the parent priorities. And what does the parent want for their student? What is important to that parent? Does the parent care that their handwriting is messy but legible? Does the parent not think that their handwriting is legible at all? Does the parent see them not able to access the curriculum at all. Or do they see them? You know, they're doing okay and PE they're doing okay in math, but language arts are just they're just not gonna they're just not getting it, and they don't understand anything. Same thing with the teacher. What do they see? What do they see as a strength? Do they see this student as being able to learn in the classroom? Or do they feel already at this point, when the student's being referred, that they're at their max and they need help, maybe? Do they think that the student needs to be potentially worked individually with? Or does the teacher have priorities such as maybe us coming into the classroom to teach them strategies? The reason it's so important to start here at the beginning of our evaluation, getting those priorities is because then we're more likely to have success at the end, when we know what they're looking for, and we know what type of treatment or what type of help those people need, maybe again, the parent their priority is To keep that kid in classroom, in the classroom, and the teacher's priority is to say, or they're saying, I need help. I need the resources in order to help this kid. Well, then why are we going to then go into the into the IEP and recommend that the student be pulled out? I mean, the parents priorities are to keep the kid in in the classroom, and the teacher says, I need help, so why not go with some sort of collaborative model in the classroom, and then maybe the students priorities are recess. But you know, of course, that's why the occupational profile is so important, to get everyone's priorities. Because, of course, the kid may be a kindergarten, third grader student, so we need to get the priorities of everyone, and we need to take those in mind when we're writing up our evaluation and making our recommendation for goals and services. All right, I hope that makes sense to everyone. I know you may not have it right in front of you right now, but this is free on my website, and it's going to continue to be free, and I want you all to have access to it. So in order to get that go, ahead and head over to OT schoolhouse.com forward slash episode 41 that is the show notes for this episode. I will have there a little form for you to sign up and access the occupational profile for school based OTs. And if you are already a subscriber to the OT school house and you're just like, Man, I need to get my hands on this. But I don't remember going to your email first and just type in OT school house, it'll be actually a link in the first email you ever received from me. So if you can find that, then go ahead and click on the link to get your freebies, and you'll be able to access it. If you can't find that email for whatever reason, go ahead shoot me an email. I will respond to you with a link in order to get that download. Again. It's called the occupational profile for school based OTs, and you will be able to access that at ot schoolhouse.com , forward slash episode 41 Yeah. So that is the gist of what I wanted to talk about today. I do want to really reinforce that this occupational profile should be the first thing that you do when you start an evaluation. You know, you get that referral, that assessment plan, and you're like, all right, I got 60 days to get this referral done. Ideally, of course, ideally, trust me, this doesn't happen to me very often, but ideally, you start working on that occupational profile in the first week, you call up the parent, you send the teacher a questionnaire if you need to, or you somehow get them on the phone. I know they're busy, but you somehow get on the phone with them, or stop by their classroom and find out what those concerns are. Is because too often I've been in the situation where I've done it backwards and I've done maybe the bot, you know, I do the bot too. And I'm like, Wow, this kid did really well in the bot too, because I didn't get my occupation or profile first, and I didn't realize that fine motor skills weren't the concern. Oh, well, duh. Why am I doing the bot too? If it's not fine motor skills and visual motor skills is a concern. No, I went ahead. I go through I talk to the parent, I talk to the teacher, and I find out, Oh, it all has to do with sensory regulation in the classroom. Student can't focus to save their life. And now, well, I'm going back and I'm doing something different. Now, I'm pulling out the SPM, or the sensory profile, and I'm going into the classroom and I'm. Looking at the observations that I should have done two weeks ago, and if I would have done that two weeks ago, then I would have saved myself a little bit of time with the bot. And so that's where this occupation profile can really help, not only to, you know, get it right, to help the student the most, but also to save you time, to save your energy, and to help you figure out what the next step should be, because once you know what that student's history is, once you know the environment that they're in, once you know all this context about the student, as well as the priorities from the parents, the teachers, the student, and of course, don't stop there, if you if you need to, you know, go to the assistant principal, Principal, counselor, psychologist, whoever's making that referral, you need to get them some input from them and get those priorities and then figure out, okay, what tools do I need to use in order to figure out where the concern is or the depth of the concern? It'll save you a lot of time. It'll help you get the best evaluation possible. And, yeah, I mean, it's just the way that I believe an evaluation should actually happen. And unfortunately, we get pressed for time, and sometimes we end up doing it backwards. And yeah, it's, you know, I'm not gonna sit here and say, Don't do it. Don't do it the other way. I mean, I'm gonna say, hopefully you can do it occupational profile first, but overall crunch for time. I've done it backwards, but just trying to tell you in advance, it it hurts. Sometimes when you do it that way, you end up doing more work than you need to, and then you're doing the evaluation, or you're rewriting the evaluation because of new information that you got that you didn't have before you started. So, yeah, I hope you enjoyed this. This is this episode was all about the occupational profile, specifically for school based OTs. It does overlap a little bit with pediatrics, but yeah, I hope you will go grab it at ot schoolhouse.com . Forward slash, Episode 41 it is just a one page form that you can print out and use it over and over again. Just put it on your clipboard when you go in for that observation and start to get some some notes from the teacher and and have it there when you call the parent. Yes, I do absolutely believe that you need to call the parent, or at least at the very minimal, send home some sort of questionnaire that helps you out with getting some of that information, even if it's an electronical questionnaire that you can email out, but you need to somehow be getting information from the people that are involved in this student's life and school education. So yeah, that's all I have for you today. I hope you appreciated this podcast episode, it's been a pleasure being here for you all. I can't wait to see you all again in two weeks for another episode. So take care. Have a great week. Two weeks, and we'll see you next time. Bye, bye. Thank    Amazing Narrator     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 40 of the OT Schoolhouse Podcast. In this episode, Jayson hosts the OT Dad, Billy Hatridge, to review an article titled "Hand Strength, Handwriting, and Functional Skills in Children With Autism" by Michele Alaniz, Eleanor Galit, Corina Isabel Necesito & Emily Rosario. This is a 2015 article from the American Journal of Occupational Therapy. ​ 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: Visit Billy's website TheOTDad.com to see what he is up to. Be sure to check out his videos where he provides some quick handwriting tips using the Handwriting Without Tears methods. ​ Michele L. Alaniz, Eleanor Galit, Corina Isabel Necesito, Emily R. Rosario; Hand Strength, Handwriting, and Functional Skills in Children With Autism. Am J Occup Ther 2015;69(4):6904220030p1-6904220030p9. DOI: 10.5014/ajot.2015.016022. (Link to AJOT) 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 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 the OT school house podcast. My name is Jayson Davies, and I am your host now and forever. Of course, today we have reached episode 40. It's fantastic. I'm excited because, I mean, we're on episode 40 every time we kind of hit that milestone with a zero at the end, you know, 10s. It just feels really good. And so I'm happy to have all of you joining with me. I'm also excited today, because my wife and I, we went out and actually adopted a puppy. His name is TJ, because he's from Tijuana, I'll have to put a picture of him up on social media so you can all meet TJ. But he's been a handful getting to start training him and all that good stuff. So I've been a little lax on the OT school house, responding to emails a little bit. It's been a little crazy around here, but thank you for your patience, and I will have to introduce you all to him. You might be able to hear him walking around in the background. He's still a little anxious, so he's hovering around us. But anyways, today I am welcoming on a new friend of mine from Arkansas. His name is Billy hatridge, and he actually reached out to me with an article about handwriting and autism and how they go together. And you know, I thought you guys would probably like to hear it, so we're actually going to review that together today. The article is titled hand strength, handwriting and functional skills in children with autism. And so we're going to go over that here in a minute. But I do want to let you all know that Billy is a man of many hats, and today he is putting on his autism specialty hat, as well as his handwriting without tears certified hat, if you want to call it that. Billy is also the blogger behind The OT dad.com as he'll share a little bit more at the end of the episode. Just want to let you all know that you can go there. He has some actually pretty cool blogs. He kind of, well, you know what? I'm not going to share it. He does share with us a little bit about his story right up here front at the beginning of the episode. So have a listen. I hope you enjoy a little bit about the article. There's a link to the article. It is an Asia article. So if you're an A OTA member, you obviously have access to that. And there will be a link in the show notes. You can go to OT schoolhouse.com , forward slash, Episode 40. And yeah, it'll be really simple to pull up the actual article so you can read it for yourself, or just take a look at the charts and highlights. So without further ado, let me introduce to you Billy hatridge, occupational therapist from Arkansas. Hey there, Billy, how are you doing this afternoon?    Billy Hatridge     I'm doing good. Jayson, uh, thanks for having me.     Jayson Davies     Yeah, of course. You know, this is the first time that we're going to have a guest on today to share with us a little bit about a about a journal article. And so I'm happy to have you on so we can kind of do a little give and take about what we learned and what we liked or didn't like about this article, which is kind of cool thing that we get to do here on the podcast today. Yeah, I'm excited. Yeah. So before we jump into the article, why don't you go ahead and introduce a little bit about yourself in the OT world.    Billy Hatridge     Alright, my name is Billy hattridge. I'm an occupational therapist in the public schools of Arkansas. Been doing this for about six years now, 2015 I became a certified autism specialist to the International Board of continuing certification, continuing education standards. It's a mouthful, but then this year, I became a certified through handwritten about tears, and so I supervise a team of four OTs. We cover seven school districts which some of the secrets are real small. Might have like two or three kids in the whole district. We're talking about mountains in Arkansas, so it's a lot more driving than treatment some days. But yeah, it's good. I enjoy it. Wow. Okay,    Jayson Davies     so out here in California, we can actually only supervise it. Just got raised from two to three occupational therapy assistants. But I know from my experience, the more assistance you have, the more meetings you end up sitting in.     Billy Hatridge     Right it is, you know, this, this career change happened for me about a year ago when I went into just a supervision role. So seeing how different therapists do different things, as far as their treatment, as far as their approaches, and then being able to be involved in plan care, that means students, but the end of the work week, it's a lot more just reading through documentation, meeting with OTs and being in those IEP meetings. So that takes a majority of my work week.     Jayson Davies     Yeah. Alright, so today, we're here to review an article. It's called hand strength, handwriting and functional skills and children with autism. And if I remember right, this was from 2015 And real quick, just to give them their credit, the authors are Michelle Allen, is Eleanor, galit Marina, Isabel necesito and Emily Rosario. So I'm sorry for any of you, if you're listening and I slightly mispronounce your name, but they are the primary authors on. This research that we're about to look at. So, Billy, what, what did you or what drew you to this article?    Billy Hatridge     Well, you know, I mentioned earlier, you know, the certified autism and handwriting specialist. So this was like, right in that niche for me, in terms of both of those areas, because a lot of times, in my clinical view, I kind of separate those two. You know, I have my Spectrum caseload here, then I have my handwriting here. And so to see these two combined and see kind of the correlations that they found within the study was that was pretty insightful.    Jayson Davies     Absolutely. And so I'm going to let you review a little bit. I mean, oftentimes when we talk about articles, we kind of look at that Pico. And so what kind of population do they have in this article? Well,    Billy Hatridge     the population is looking at, you know, kids between the age of four and 1024, of those being typically developing, and then 27 of those children being on the autism spectrum, and several of their their typically developed children, I do believe, came from children of the staff there at the facility, is that right?    Jayson Davies     Yeah, I believe so. And then the kids with autism were actually kids that they were treating at the clinic, very much a a population that they had access to.    Billy Hatridge     Right? And and I know that they're talking about how they they kind of excluded several kids on the spectrum due to limitations in comprehending the instructions and the communication and the ability to to participate in the testing protocols that they provided.     Jayson Davies     Absolutely. All right, so that's kind of the population that we're looking at. And so this study, we didn't actually look at an intervention, but we did look at comparisons, and if you'd like to talk a little bit about what what they're what they were comparing.    Billy Hatridge     So what they're looking at was the pinch and grip strength and its relationship to handwriting and functional skills between both typically developing children and children with autism, and trying to figure out if there is a correlation between things like grip and pinch strength, and then the ability to write legibly and to be independent in those activities of daily living.    Jayson Davies     Yeah. And, you know, looking at 2015 when this research was done, you would have thought that maybe they had some norms as far as pinch strength and grip strength by time you got to 2015 you know. But when it came to children that with autism, they really didn't find anything as far as consistent scores or norms for kids with autism. In fact, I think some of the articles that they mentioned, like everyone was using a whole different way to measure this, and so there was no consensus on even how to measure grip strength. So they did reference that, I'm not going to go into detail, but they use, they used, a consistent way of measuring the kids strength, both with the the dynamometer and the pinch mechanism that they use. So,    Billy Hatridge     right? And I think we see this trend a lot in especially our OT literature, right is there's not enough evidence to back up kind of what we're suspecting. And so more and more research like this needs to be done, because one of the things they said here was that there's not consistent, reliable information on pitch, pinch strength norms for children. That's crazy to think about it, right. Like for us as OTs, we do so much pinch activities in the schools. And for this one, say, look, there's not enough reliable information on even knowing what those norms are. You know, if I were to sit down and test a kid on their pitch drink, I wouldn't have a clue. Wouldn't have enough evidence to base that off of and that's not just autism.     Jayson Davies     That's just kids in general. Yeah, that's just kids in general. That was just a typical population.     Billy Hatridge     So that's kind of amazing to me that, you know, it's 20, this 2015 Now I'm curious what that you know how much has changed, but in 2015 you know, there just weren't pinch norms for children, typically developing children. So.    Jayson Davies     Yeah, surprise, surprise. So going a little bit deeper, what other outcomes did they use to kind of look at the correlation between pinching and grasp, as well as the handwriting legibility.    Billy Hatridge     So, like I mentioned earlier, with the strength, they use the Preston Jamar hand and not dynamometer, and then the pinch meter, you know, those are the Patterson medical brand stuff there that was just to get their measurements. And then they use the VMI motor coordination sub test to look at the pencil control. And I think that was kind of the big, you know, standardized norm referenced paper protocol that they used. And then they used the etch the evaluation of children's handwriting for the handwriting legibility. And then they had created a questionnaire to get the ratings on the ADLs.     Jayson Davies     Which that was a parent completed in house, created parent questionnaire, basically.    Billy Hatridge     And said 27 items on that. And I kind of wish they had described that a little more in detail, since it wasn't that they made in house, just. Kind of know what that looked like specifically.    Jayson Davies     But yes, I agree. And maybe, maybe after this podcast, someone will reach out to us and say, hey, I can share that with you. We'll see. But if that happens, we'll be sure to get it out as easy as as easily as we can, if possible. So let's talk about a little bit of the outcomes then. So when it comes to strength, we already dipped into that just a little bit. But what else did they find?     Billy Hatridge     So one of the big things for me that was shocking in terms of their their out outcomes, was that the pinch strength did not have a correlation with pencil control, that it was the grip strength that had a bigger impact on writing legibility and pencil control than the pinch did, and that was for both the typically developing and then the children with autism. And I think that for us at school, OTs fall into that trap of when we're working on that pressure, we use so many pinch based activities. And you know, their study here is kind of showing that it's a lot more based on just that whole hand grip strength in terms of that pencil control, and that was my big takeaway from that, just in terms of what I do on a daily basis.    Jayson Davies     Yeah. And I believe that was on the VMI, right?    Billy Hatridge     Yes. That was on the motor coordination on the VMI. That's where they found that, yeah.    Jayson Davies     And if I remember right on the edge, they found that grip strength overall correlated with the edge scores. And they looked at the upper case, lower case, and numbers on that those sub tests, but they found they in just the group with autism, that grip strength did not correlate with the legibility of writing. And so again, same thing, like you're kind of talking about a little bit of inconsistencies between whether or not it correlated with typical kids versus kids with autism.     Billy Hatridge     They made quite a bit of mention when they talked about the limitations of the study, about how complex both handwriting and autism are, because, you know, as we know, OTs handwriting is not just motor there's so many more elements to that there's a sensory elements, just visual elements, and so they're only able to Look at those that one specific category with the handwriting. And so the fact that grip strength correlated with the typical peers, but not with those with autism, definitely shows that, you know, there's a lot more things influencing that handwriting when it comes to to autism, as far as the the eligibility of the writing.    Jayson Davies     And you know, that kind of goes with the whole As occupational therapists, we have, you know, this PEO model, we have other ecological models that take so many factors into place. And we can't just look at grip strength, or just look at their pincer grasp or something, you know, there's so many other factors that come into play. Cognition, you know, is a huge factor. And they tried, if I remember, right, they tried to account for that as much as possible by making a cut off, or, if you want to say exclusion criteria. But even then, I think I remember the limitations, that there was still a correlation between understanding of the task and and overall grip strength. And so you just see the kids, of course, you know, if they don't understand how to do this, how to use the dynamometer, then you know, is their strength really going to be right? It should be.     Billy Hatridge     And that was one of the big things they had mentioned right was, was the children's inability to follow the directions to the T and that impact on especially the getting those grip and pinch strength.     Jayson Davies     Yeah, one thing that really stood out to me, and as far as the strength, was that the hand and pinch strength patterns were similar in the sense that, you know, kids with autism, as well as typical, typically developing kids both increase their strength as they got older. However, the kids with autism were always lower at the same age. And they were also very inconsistent. You know, they were doing the average of three scores when it came to grip strength. And the kids with autism were just like all over the place as far as their inconsistent ability to provide a similar score each time that they were tested. And so that's, that's pretty, you know, influential.     Billy Hatridge     And I think that's one of the tricky parts about, you know, doing any kind of study with children on the spectrum. And anyone who's worked in that population knows that minute by minute, it can be a very different kid that you're working with. You know, consistency in these kinds of tasks can be very tricky when working with those, those types of kiddos. So, yeah, yeah.     Jayson Davies     So that kind of sums up the article. I think. Going forward, what are you taking from this article and implementing as your role, either as an occupational therapist, providing the therapy, or even when you're working with your assistants?     Billy Hatridge     Can I stop you there real quick? There was something I want to jump on in the limitations, that they had mentioned, and they had said here that they did not complete any visual perceptual testing. And so they know that they're limited in their interpretation of the the handwriting part because they didn't do any visual testing. And I was wondering why they didn't go ahead at least do the visual perception subtest. You know, it's two minutes. It's not going to take that much extra time. They're already doing the motor coordination test. And so, you know, one of the the writers is listening in, I would definitely like to know, you know, Shirley had talked about it and why they had left that out, just to kind of be able to get, get those numbers on the on the visual perception part.    Jayson Davies     Yeah, and you know, that also talks to what we do going forward. And you know, we need to make sure that we're doing a visual perceptual test with with the kids. And of course, they also didn't do the visual integration part of the actual test. They did the motor coordination, but not the actual part to see if kids can copy, you know, overlapping circles and all the good stuff that isn't that one, for those of you who aren't as familiar with the VMI coordination. What that is, it's almost kind of like tracing or staying within the lines or something. So it's very all the material is right there for you. All they were really testing was, is that that really pencil control and they stay within the lines? So, yeah, definitely, I see what you're saying there. It would be nice to know a little more visual perceptual skills and visual motor tasks for these kiddos.    Billy Hatridge     So moving ahead for our OT practice, I think the takeaway for this study has more to do with the handwriting interventions than it does with the autism. The study found that there wasn't as big of a correlation with students with autism when it comes to grip and pinch strength, there's a lot more factors to focus on there. And, you know, with autism, there's so much in the grand scheme of things that you addressing. But when it comes to the handwriting, you know, we have more and more and more kids are coming to our caseload who that's the that's the point of what we're doing with OT, it's going to be kind of backing away a lot from those pinch activities, the fingertip activities, and working more on just building up that general hand strength, I think, because I'm looking at their implications here, and it's, you know, grip strength correlates with pencil control, grip strength correlates with hand ability. Grip strength correlates with functional abilities. And so it all comes back to this, the strength of the hands. And so definitely gonna get my kids out there monkey bars a lot more, I think, in terms of the handwriting instruction, those kinds of activities.     Jayson Davies     So definitely I love it some of those more, more child friendly occupations, you know, not just sitting at the table, working on pinch and working on just handwriting, handwriting, more handwriting. So, right, yeah, I definitely think you're right about that. Alrighty, man. Well, I think that kind of sums up what we're talking about today. Before I let you go, I want to give you a chance to let people know if they have any questions for you, specifically where they can get in touch with you.     Billy Hatridge     Yeah, so the OT dad is my social media handle, and that's for, you know, Instagram, Pinterest, Facebook, the whole shebang. I have a website or blog, more specifically, the OT dad.com and, you know, I found working in the schools, our communication with parents is very limited, and so I kind of created up the Facebook page to help share resources and links and articles with my parents, and then it kind of grew from there. And so, yeah, if anybody wants to reach out to me and see what I'm doing over there, they're more than welcome to I said handwriting and autism is kind of my, my passion project, so I love talking about it.     Jayson Davies     Awesome, man. Well, thank you again, so much for coming on and sharing this article with us. We really appreciate it, and I hope to see you again soon. All right. Well, thank you, Jayson. Talk to you later. All right. Well, thank you everyone for listening to Episode 40 of the OT school house podcast and a special thank you to Billy hatridge for coming on this show. Again, he is from the OT dad.com and he's actually the one who reached out with this article to me, and it was great to have it. I hope you all enjoyed and learned a little bit about handwriting and autism and hand strength. So it was great. I hope you're enjoying this little Journal series that we're doing here on the OT school house podcast. And yeah, take care. Have a great week, and we'll see you next time on the podcast. Bye.    Amazing Narrator     Bye. 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

As school-based OT practitioners, we’re trained to focus on student goals, classroom participation, and meaningful occupations. Unfortunately, federal privacy laws are often an afterthought. While most of us learned about HIPAA in OT school and its rules about protected health information (PHI), working in schools introduces us to the lesser-known Family Educational Rights and Privacy Act (FERPA). Though they sound and seem similar, these laws serve different purposes and apply in different ways. Understanding which privacy law we need to follow affects how we document services, share information, and even where we provide therapy. I learned this firsthand when questioning whether or not a shared OT/SLP therapy space was legal. What I discovered changed how I viewed privacy in schools. While HIPAA may prevent shared therapy spaces, FERPA does not. And as it turns out, most school-based OT practitioners are governed by FERPA, not HIPAA. So, let's explore the key differences between HIPAA and FERPA and get an idea of which one applies to school-based OT practice. What’s the Difference Between HIPAA and FERPA in school-based OT? HIPAA in a Nutshell HIPAA (Health Insurance Portability and Accountability Act) protects protected health information (PHI) held by "covered entities," like healthcare providers and insurance companies. HIPAA: • Applies to clinics, hospitals, and medical providers who bill electronically for health services • Requires safeguards for PHI and limits on information sharing • Does not apply to education records protected by FERPA (This is possibly the most important line in this article. Keep reading for more details) FERPA in a Nutshell FERPA (Family Educational Rights and Privacy Act) protects the privacy of student education records in schools that receive federal funding. That includes your session notes, evaluations, and progress logs if they are maintained by or for the school. At a high level, FERPA: • Applies to public schools AND private institutions receiving federal funds • Grants parents (and eligible students) rights over access, amendment, and disclosure of educational records • Protects students’ PII (Personally Identifiable Information), which refers to information in educational records that can identify a student, such as name, student ID, disability status, or educational performance. • Covers OT documentation if it's part of the student's educational file In schools, FERPA protects PII in education records, even if that information overlaps with what would be considered PHI in a clinical setting. That means your therapy notes, student emails, and progress logs aren’t PHI. Instead, they’re PII, and FERPA is what governs them. According to Joint Guidance from the U.S. Departments of Education and Health and Human Services (2019), when a school receives federal funds and maintains student records, those records are considered FERPA-protected education records, even if they contain medical information. So, even if you bill Medicaid, as long as the documentation is kept by the school and not a private clinic, FERPA applies, not HIPAA. See page 8 in the joint guidance above if you want to see how it is noted in the official document. Additional helpful references can be found at the end of the article. What Is Protected under FERPA (and What’s Not)? It’s vital to note that FERPA protects records and disclosures, not student visibility. Thus, students receiving services in school settings do not have the same level of anonymity as in a medical clinic bound by HIPAA laws. So, what's protected then? Protected Under FERPA: • OT evaluation reports and therapy notes stored in the IEP system • Progress monitoring logs and data sheets • Emails with school staff about a specific student • Student information discussed in an IEP meeting • Records used for Medicaid billing (if maintained by the school) Not Protected (or Not a Violation): • A peer noticing a student walking with the OT to the therapy room • A bulletin board sign that says “Therapy in Progress” (without student names) • A student saying, “I have OT next” in front of others • Shared therapy rooms when conversations related to PII are kept confidential What FERPA Violations Might Look Like Here are some practical, real-world examples that could lead to a FERPA violation: • Leaving a printed report on a shared copier or a teacher’s lounge table. Although FERPA allows you to share PII with teachers, it should only be shared with teachers who have a current interest in the student’s education. • Sending student info through a personal email or an unsecured platform • Recording a therapy session and sharing it without written parental consent • Discussing a student's diagnosis or progress loudly in a hallway or staff meeting • Using a student’s full name and details in publicly visible documents or shared drives • Posting a picture of a student completing a therapy intervention on your Instagram, even if their face is not shown. These examples all involve either improper disclosure or storage of identifiable student information. Using your personal computer for work may be the easiest way to lead to a FERPA violation. Practical Tips to Stay FERPA-Compliant 1. Use school-approved platforms for email, documentation, and file sharing. 2. Avoid discussing students in public areas or with staff who aren’t part of the IEP team. 3. Lock up physical records and password-protect digital ones. (with 2-factor authorization when possible) 4. Don’t store student files in personal cloud apps (like your personal Google Drive). 5. Use initials or pseudonyms when collecting data that might be viewed by others. (The same applies if you are putting any data into AI) 6. Get parent consent in writing before taking photos or videos for any reason. Common Questions from School-Based OT Practitioners: "Who oversees FERPA, and can schools get in trouble for violating it?" FERPA is overseen by the U.S. Department of Education, specifically the Student Privacy Policy Office (SPPO). While families can't sue for FERPA violations, they can file a complaint. If a school is found out of compliance, the Department may require corrective action or, in rare cases, withhold funding. Even without formal penalties, these issues can erode trust. That’s why understanding FERPA matters for school-based OT practitioners. "What if I’m contracted through an agency, not employed by the school?" You still must follow FERPA if you are acting on behalf of a public school. Your documentation and actions are covered by the same laws as school employees. "Does HIPAA apply because we bill Medicaid?" Not necessarily. According to federal guidance, FERPA supersedes HIPAA if the records are maintained by the school and used for educational purposes, even when Medicaid billing occurs. "Can I post a faceless picture of a student on Instagram to show a cool treatment I did?" Maybe, but proceed with caution. Even if a student’s face isn’t shown, other elements (like unique clothing, assistive devices, or the setting) may still make the student identifiable. FERPA protects personally identifiable information in education records, including photos linked to educational services. Unless you have written parent consent and district approval, it’s best to avoid posting any images that include students, even if their faces aren't visible. Instead, consider using a reenactment, a staged photo without students, or a graphic/illustration. I always look at it from this perspective. If I were browsing Instagram or TikTok and found my child's OT account, I would be furious if there was a picture of my child. And as every parent knows, you can recognize your child without seeing their face. Wrap up: It's a FERPA World Navigating student privacy laws as a school-based OT practitioner can feel overwhelming, especially when you’re balancing your clinical background with the rules of the education system. It’s no wonder there’s so much confusion between HIPAA and FERPA, since we were trained under one, but in schools, we’re governed by the other. The good news is this: you don’t need to memorize every federal statute. You just need to understand the basics: • FERPA protects student education records and personally identifiable information (PII). • HIPAA usually doesn’t apply in public schools. • If in doubt, always err on the side of confidentiality and check with your district. From shared therapy spaces to documenting services, knowing when and how FERPA applies helps you to protect yourself, the child, and the district. Plus, when someone asks whether HIPAA applies in schools, you’ll be able to answer with confidence (and maybe even share this article). Thanks for reading through this article. I hope it helped. 📬 If you'd like to know when I publish future articles about school-based OT, be sure to subscribe to the OT Schoolhouse Newsletter. I share tips, research updates, and evidence-based practices for school-based OT practitioners every week. References: • U.S. Department of Education & U.S. Department of Health and Human Services. (2019). Joint Guidance on the Application of FERPA and HIPAA to Student Health Records. • U.S. Department of Education. Student Privacy Website – Central resource for FERPA regulations, FAQs, and guidance. • Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g; 34 CFR Part 99. • Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191; 45 CFR Parts 160, 162, and 164. • U.S. Department of Education. FAQs on Photos and Videos under FERPA – Official guidance on handling photos and videos in educational settings.

About once a month, I receive the following question: "Do you have any data sheets I can use to track IEP goals?" For years, my answer to every email about this was a quick link to Teachers Pay Teachers.  In fact, I even shared this tip in my A-Z School-Based OT Course. For a long time, TPT proved to be a fast, convenient, and free way to find plug and play IEP data sheets. However, with Chat GPT and Gemini providing quality AI content for free, I had to give AI a try and see how it would do to help create data sheets. In this article, I’ll walk you through why I used to recommend TPT, why that changed, and how you can now use ChatGPT to quickly generate tailored, HIPPA/FERPA-friendly data sheets for your students. Why I Rarely Created My Own Goal Data Sheets (Until Now) To be honest, I used TPT for data sheets because it felt like too much work to create a new data sheet for every student. Between writing evaluations, attending IEPs, and delivering services, there simply wasn’t time to reinvent a new custom data sheet for each kid. The effort didn’t seem worth the outcome . As such, I’d usually end up reusing a generic sheet, scribbling changes in the margins, and hoping it would suffice. In the years I did take time to create my own data sheets for kids, I found that I would use them until their IEP came up, but would then forget to update them afterwards. As such, I would often download and print many copies of a few TPT data sheets to stash in my desk. That way, after each IEP I could grab one, write the student’s name on it, and place it in their file. At the end of the day, the time saved using TPT data sheets simply outweighed my need for data tracking sheets to be specific to each student’s IEP goal. Then Came ChatGPT When ChatGPT first came on the scene a few years ago, drafting IEP goals and creating data sheets was one of the first tasks I gave to the AI. At that time, the new and exciting Open AI tool was nearly useless for data sheets. The chatbot could draft an IEP goal, but it would become very confused if you asked it to create a chart or table. Today, though, that is a different story. Even with the 100% free, no-email-required version of ChatGPT. Now, with a single, well-crafted prompt, you can generate a student-specific goal tracking sheet in five minutes or less. I pulled a goal from the OT Schoolhouse Goal Bank  and paired it with this prompt to generate a data sheet that I could copy and paste into a Google Doc. Please create a print-ready data sheet that I can copy into a Google Doc and give to a teacher to track an IEP goal. Include the student's Present Level of Performance, the annual goal, and all benchmarks or objectives. Also include a separate summary table for tracking progress over time. I then gave ChatGPT that prompt and the goal information. Within a few minutes (Starbuck’s WiFi was very slow), Chat GPT created the data sheet you see below. From there, all I had to do was copy and paste the AI output over to a Google Doc. Tips for Pasting the AI Output into a Google Doc Copying the AI-generated content into a Google Doc took just seconds. There is even a little “note” looking button that you click to quickly copy the entire output (See the video below). From there, I made a few tweaks to make it visually clean and easy for educators to use. Here’s a step-by-step walkthrough: Switch to landscape mode : Tables tend to display better in this format. Clean up unnecessary formatting : ChatGPT often includes horizontal divider lines you can delete. Make your tables visible : In Google Docs, click on the table, choose the three-dot menu, and bump the border thickness up to 0.5 pt to make lines visible. Resize and customize : You can easily adjust column width or add/remove rows based on the goal complexity. Organize it your way : You might want the goal objectives grouped separately from progress notes, or you might combine both into one table depending on your preference. Click here to view the formatted Google Doc This quick customization process helps ensure the document looks professional and fits your data collection style. Why This Is Now My Go-To Recommendation Let’s be honest, documentation can feel overwhelming. That’s why I wanted to share this with everyone. There are many things we cannot or should not use AI for, but for the creation of data sheets, using AI is quick, customizable, compliant, and easily accessible. Plus, the flexibility means you can create as many variations as needed: goal-specific sheets, daily or weekly tracking versions, or simplified classroom check-ins. Watch It In Action Want to see the process for turning a goal into a data sheet from start to finish? Watch the video below to see how I use ChatGPT to create a goal-tracking sheet in under 7 minutes. Final Thoughts If you’re spending more than 7 minutes creating data sheets for each student and are open to using AI, give this method a try. ChatGPT has made it easier than ever to build personalized, printable tools that save time and improve documentation. After you give it a try, shoot me an email at Jayson@otschoolhouse.com  and let me know how it works for you. Until next time, 👋 Jayson

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 176 of the OT Schoolhouse Podcast. Ever wondered how school-based OTs can meaningfully support students with extensive support needs?  Supporting students with extensive support needs has long been one of the most challenging and under-resourced areas of school-based OT. In this first of a two-part episode, Dr. Savitha Sundar joins Jayson to unpack the history, systemic influences, and practitioner struggles that shape how services are delivered in special education classrooms today. From redefining outdated language to exploring how friendships and peer modeling can shift trajectories, this episode is a powerful reflection on the ethical and practical realities of inclusive education. This episode sets the foundation for building more inclusive school communities—and why occupational therapists play a key role in leading that change. 🎧 Stay tuned for Part 2, where we’ll move into actionable strategies and systemic shifts. Listen now to learn the following objectives: • Learners will reflect on the historical and systemic factors that have contributed to the segregation of students with extensive support needs in school settings. • Learners will identify challenges OTPs face when serving students in self-contained classrooms and how these challenges impact practice. • Learners will understand the evolving terminology and research around inclusive education and how it relates to the role of school-based OTPs. Guest(s) Bio Savitha Sundar PhD, OTR/L. Savitha Sundar has served in public schools for over 17 years across three states, primarily supporting students with extensive support needs in self-contained classrooms. Her research focuses on the role of school-based occupational therapy in bridging the research-to-practice gap in inclusive education. For five years, Savitha served as an executive board member and later as a partnerships officer for a national nonprofit organization--Changing Perspectives, focused on promoting inclusive practices and social-emotional learning.  Savitha teaches entry-level OTD students during the summer at Texas Woman’s University and has mentored more than a dozen students in school-based practice. She also hosts the podcast Inclusive Occupations – Sharing Stories of Not Just Being Invited to the Party but Dancing. Through the podcast, she amplifies the voices of educators, researchers, and individuals with disabilities working to build authentically inclusive learning communities. Quotes “It's so meaningful, the power that a little bit of social presence can bring to education, leisure, and play skills. And that's just really powerful.” -Jayson Davies, M.A., OTR/L “I got 186 responses. And nearly the majority of the OTs said that at least 40% of their caseload are students with extensive support needs.”  -Savitha Sundar PhD, OTR/L “The need for us to recognize that it's the support needs of the student that is where the focus should be and not on the student's disability…then our intervention will also focus on the environmental factors, not just the person's inability to do things."  -Savitha Sundar PhD, OTR/L Resources 👉 Inclusive Occupations Podcast by Savitha Sundar 👉 Changing Perspectives – A nonprofit supporting inclusive practices and social-emotional learning in schools. 👉 Every Moment Counts – Structured approaches to promoting social participation and comfort for all students. 👉 NTACT:C Predictors of Post-School Success – Evidence-based practices that improve post-secondary outcomes, including the role of inclusion and goal setting. 👉 Effecting Change in School-Based Practice: Fostering Social Inclusion in a Co-occupation Program (OT Practice Article by Dr. Sundar - AOTA membership required) 👉 Interventions and measures of social inclusion for students with extensive support needs in K-12 schools: A scoping review (Article by Dr. Sundar -Journal of Intellectual Disabilities) 👉 Interoception Program-guide for mindful self regulation 👉 Sensory Integration Program - Ayres SI  Episode Transcript Expand to view the full episode transcript. Jayson Davies    Hey there, and welcome to episode 176 of the OT school house podcast. I am your host, as always, Jayson Davies, and today, we are diving into a topic that many of you have reached out to me about over several years, and that is how we as school based ot practitioners, of course, can better support students with extensive support needs now, whether it's figuring out how to provide meaningful services in various types of classrooms, or feeling unsure about how to write truly inclusive goals, or maybe even just wondering how to make a bigger impact within our schools, this is a challenge that has weighed on school based ot practitioners ever since I got into the field, and probably for much longer than that. That's why I'm thrilled to be joined today by Dr Savita Sundar. Dr Sundar is someone who I have known for several years now through the OT school house, but she recently completed her PhD, and she has a lot of information to share with us. Savita has served in the public schools for over 17 years across three different states, so she has seen what school based occupational therapy can look like in various areas. She has primarily supported students with extensive support needs, as she'll share in a little bit during her time as a school based ot both in practice and through her research, Savita has put a spotlight on bridging the research to practice gap and inclusive education through occupational therapy. In addition to her role as a school based occupational therapist, Savitha teaches at Texas Woman's University, mentors emerging ot practitioners and hosts the inclusive occupations podcast, where she helps to share the positive impact inclusion can have on individuals. Now our conversation ended up being a little bit longer than we thought it would be, but that's because we had so much to talk about in this episode. So in this first episode of a two part conversation, Savitha is going to lay out the foundation for what it really means to support students with extensive support needs, not just clinically, but also ethically and systemically. We talk about the history of segregated services, how peer interactions and friendships can reshape outcomes, and what we need to reconsider in our own training and mindsets. It's the kind of episode that invites reflection and re imagining. And then in Episode 177 part two of our conversation, we'll discuss more the practical application of supporting students with extensive support needs to promote inclusion. Now this is a topic that I've wanted to address here on the podcast for a long time. It is one of our most requested episode topics, and I am thrilled that Dr Sundar was willing to have this real conversation with us. So let's welcome Dr Sundar to the podcast and go ahead and get started.    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    Dr Sundar, how are you doing this afternoon?    Savitha Sundar    Doing great. Hi, Jayson, so good to be here.     Jayson Davies    Hi. Are you getting used to that doctor in front of your name yet?     Savitha Sundar    Not completely. Since I'm still a school practitioner, I go by Ms s with most of my kids, it's a little like, I have to get used to this.    Jayson Davies    Yeah, it's not very often.    Savitha Sundar    Yeah, has its value. You know, sometimes use that, but I have to get used to it and comfortably.    Jayson Davies    Yeah, it's definitely more for the conferences and the podcast and the webinars of the world than it is for working with our kids in the school. So I imagine it will take some time. But yeah, thank you so much for being here. Really happy to have you and really excited to have this conversation with you about supporting our students with extensive needs like this is something that a lot of people have questions about. A lot of people feel very uncomfortable, and I think we're going to talk about that. So I first want to ask you is how you or why you decided to go down this route of researching the support that occupational therapy practitioners provide to students with extensive support needs.    Savitha Sundar    Yeah, that's a great intro question, because, you know, it happened very organically for me. I started in school practice. I always wanted to be in pediatric practice, and I entered school practice probably of my 20 years, as in 24 years as an OT I've spent the majority of them in school setting, and I happened to be placed as a as a contract therapist who was dependent on a visa sponsorship in a program in the Bay Area. When we moved to Bay Area in 2012 No 2008 in this program that exclusively is. Supported students with extensive support needs. So in the Bay Area California, we have the county programs, and I'm not sure if it's the same in Southern California as well, but a lot of big school district big urban communities have this system where students who have high support needs are usually supported by an external program, because the school districts may be relatively small, or they don't have the resources. So they combine several districts, and they create these programs where they get more funding from the federal government, and they end up giving them more services and, you know, supports and all kinds of things, and that was the justification for them to be moved into a separate program outside their home school. So when I worked there, I, you know, did my traditional ot stuff, whatever, you know, we've been trained to do. And just over the course of time, I happened to be working with some of these amazing teachers who went out of their way to enable friendships for kids in their self contained classrooms. They connected with a gen ed teacher, they arranged for peer buddies. They did all these things. And every time I saw my kids in that space, I felt like I saw a different side of them come out, you know, like they showed us things that you know, that we never got to see in our regular school day. And I'd like to share this one story that I think is very powerful, because it was my turning point. So in one of these self contained classrooms, the K 2k, to 3k, to two self contained classroom, we had a student. We had tried a lot to get him to feed himself, and over the years, he had started with us in preschool, and he wasn't walking, he wasn't using any communication, wasn't touching anything. He'd come a long way, but all the way up to second grade, he wasn't feeding himself. Wasn't a motor problem. We couldn't tell if it was a sensory issue that we hadn't detected yet, but when some of his peers came into the classroom. He adored those girls, the older girls, who came into the classroom to partner and play with our students. And when one of the girls came in and saw him with his food and said, Oh, Jimmy, you have yogurt. His name is not Jimmy. So Jimmy, you have yogurt. I have yogurt too. Let's eat. And so she just sat next to him and started eating. And then he started feeding himself like he's been doing that forever. And we were like, and we were like, Oh my gosh. So this kid knew all along. He wasn't eating at home, he wasn't eating at school. It was one of his IEP goals that he would feed himself. And here he was just out of that peer pressure, or, you know, just to feel like he belonged to this, this group, he started feeding himself, and it was an aha moment for me. And then I couldn't unsee it, like I saw so many situations where kids, we were trying to walk them in their Walker to go one place to another, but when they were in the playground, they were automatically geared towards people they were attracted to. And, you know, there were some kids who were just more friendly with our students in the in the SDCs, and they would try to respond to them so much better than they did. So that became my focus in my practice. I tried to bring in peers to be part of my therapy sessions. I started doing groups with Gen Ed peers whenever I could. Wasn't always possible, and then moved on to and there was a lot of support and encouragement to do this as well in the in the school. So that was my understanding of inclusion. I'm going to make these pure relationships possible for these students with extensive support needs. And I felt that was the most meaningful thing I can do to them, for their future and even for their present, to build a community that understands them and that can, you know, create a better world for them, basically. So that's how I started. My interest in this population, inclusion and extensive support needs came, and I'm sorry I probably gave you a long winded answer to this.    Jayson Davies    No, it's a great start. It's a great start, and it makes me think of the OT practice framework, right? Like we have these various occupations that we always talk about, play, leisure, education, ADLs, all that fun stuff, but, but we don't always consider the social aspect involved with each and every single one of those occupations. And it's so meaningful the power that a little bit of social presence can bring to education, to leisure and play skills, and that's just really powerful.    Savitha Sundar    Yeah, definitely.    Jayson Davies    Okay, as I mentioned, as we kind of, we're just getting started. A lot of therapists have, it's almost to a degree, it's an ethical conundrum, because, you know, we are ingrained, especially over the last 1015, years in OT school, about the power of inclusivity and inclusion. But then we get into the real world, and we do see these programs like you were talking about earlier in the Bay Area, down here as well in Southern California. I know it exists across the country. Century, where these students are in a separate classroom, sometimes they're in a complete separate school, because, as you mentioned, Wright county programs are often in like one school, and sometimes kids have to ride a bus an hour to get to those programs. And so I guess the question here is, how did it make you feel when you transitioned from student into these programs and started to understand this difference from what we have been taught in OT school? And then, you know, obviously you just talked a little bit about your experience. But then let's start to move on to Okay, well, what you were going to do about it, but first, I just want to get your idea of like, idea of like that first time you realized that these inclusive practices weren't exactly happening. How did that make you feel?    Savitha Sundar    I think as new practitioners coming into the into practice, we're really very focused on getting a job and keeping that job. Okay, yeah, we yeah, we don't want to go in and rock the boat and do anything like, Oh, my ot program taught me this. And I'm not, I'm not going to do this handwriting practice. That's not what OTs are for. I don't think in OT school, they really gave us any training on how to teach handwriting to kids. We learned it over the course of our practice. We found that this is a big need. And then we attend all these continuing ed courses, and then so we come with that mindset into practice. And I was the same too. I wanted to come in. I wanted to feel like I fit in and I belong, and people liked me, and they listened to me and everything. And once you get comfortable in that position, and then you see this very important need, and you start addressing it in a very natural way. And then everything falls in place. This is what I went to OT school for, right that I address the social environment, that address the physical environment, that I address the activity, the occupation. I don't do a task analysis. I do an occupational analysis, which includes us looking into the personal factors, the environmental factors, the performance, skills, the performance, you know, the roles, rituals, habits, all of those areas we look into the whole picture to see how a person is successfully participating in an occupation. And when we try to include a student in an environment that has the best opportunities for them, then I think that ot lens just comes in, and it's like, this is my role in schools. You know, that was my aha moment, and that's what led me to sort of obsessively pursue this area, like I spent five and a half years in my PhD looking into this area. How can I make it most meaningful to myself and to my ot practice? Because it just feels so right. And a lot of therapists resonate with me, and a lot of therapists are like, Oh my gosh, this is just doesn't make any sense. So I feel like this both these perspectives, but to me, it feels like we try to articulate our who we are in schools, right? Or we're not motor specialists. We're not handwriting specialists. We're not, you know, there's no, no role that really pulls in all our skills and our resources, you know, and to enable inclusion, to be an access professional, that pulls in all our true ot background in place, and it's just like a big wow. This is what we need. We should be doing. And I guess so it's a journey.    Jayson Davies    No totally understand. And one of the things that I've been kind of talking a lot about recently is the idea that it's like a blessing and a curse, that people don't know what we do in the schools, because it's a curse. No one knows what we do. But it can also be a blessing, because we can be the one to show them, and a lot of people don't know what OTs do, and therefore whatever we do is what they're going to know as OT. And so I think you know that's that's the blessing of it. If we want it to be handwriting, then we can focus on handwriting, but if we want ot to be about more than handwriting, then we can show them that OT is more than handwriting. So.    Savitha Sundar    And every school district is so different. I worked in so many different districts now in so many different states, and every school is so different, and some administrators have already set the stage with OTs role as fine motor and handwriting, like every other area is taken by somebody else. So it's so hard when you are put in that position to convince the administration no we can do more. So it has to happen both ways. You know, the admins have to be open to learn what else OTs can do, and OTs have to kind of do the uphill battle for a while to show them what else we can do. So yeah, and people have huge caseloads and they don't have the time to do anything except check off IEP mandates, then it's very, very hard.    Jayson Davies    Yeah, yeah, all right, continuing down supporting students with extensive support needs. At what point did you start to think to yourself, Okay, I am starting to support these students. I am seeing how I can support. Whether they're in a county program or if the district hasn't been housed. But at what point did you think to yourself, like, hey, there's got to be research about this, or, oh my goodness, there isn't research about this. And what did you start to figure out as you were looking into that research?     Savitha Sundar    Yeah, so my friends and I have always struggled with this. Any conference we go to, they tend to talk about the kids who are not the kind of kids we see in our county programs, right? Okay? And they tend to talk about the sort of the higher functioning as it was called before, or the low support needs students, as we call rightly better now, the focus has always been on we never found anything that really catered to the students. Like I went, I wanted to go get my si certification, and I went there, and the whole we were, like, getting so many referrals. This is back in 2012 so many referrals for addressing sensory needs. And then I'm like, Okay, I need to understand more about Si, and I go take the training and and the whole of Si, the IRS si training focused on students, I mean, kids who had milder who didn't have cognitive disabilities or didn't have intellectual disabilities. That was the focus of the training that I went to. And so it just puzzled me. Like, why is there so little focus on and when I looked into the literature, there was one article from 2004 that talked about OT and students with severe disabilities. So OT and students with severe disabilities in the education context, I could not identify an article at all in my entire like, I've done a lot of literature search, and over the years, we just could not find anything with all these three combined. They talk about it in terms of, like a diagnosis. You can see OT and autism, OT and intellectual but then you know, intellectual disability is also a range. Autism is a range, right? The kids who are the districts are not able to provide FAPE and send to accounting program, those kids, the ones on the ends of the spectrum, are we focusing on them? No, and that just really made me feel sad, because those 100% of my caseload were these students. So did I your question?     Jayson Davies    Yeah, and you brought up a great point too, because, like, I think probably just about everyone listening to this podcast episode right now has been in a professional development training where, in the back of their mind they're listening to a speaker and wondering, does this program support the kids that I work with and we, I think we've all been there, right? We've been listening to a training, whether it's handwriting training and executive functioning training, no sensory processing training, whatever it might be, but we just kind of have that, that little inkling in the back of our mind, like, is this training for my the population that I work with? And that's really hard when you come to grasp that you're in a training and it's not actually for the population that you work with, it kind of lets you down a little bit totally. So I totally understand that.     Savitha Sundar    And the other thing is, the medical model with which we have been trained over the years makes us want to only address the student. And the whole IEP, the whole of special ed, is set up to retrofit these kids into general education, right into the normal world. So the world was not designed with people with disabilities in the first place. Only very recent. Only 50 years ago, we started including them in our educational system, so you can and when, and all our services, all our training, has been in that deficit focused model. And I think OT is very progressive in that way that we are probably one of the few that really look into the person, the environment and the occupation when it comes to participation, right? So yeah, the thing is, we can't if we identify these problems there in the environment, and we have very little control over what we can do in these environment and these systems, right? So maybe that's why, yeah, don't talk about it much?    Jayson Davies    Yeah, before, I want to get more in depth into our conversation today, I do want to ask you about a topic, or just it's not really too much of a topic, but I want to know how you came up with a specific language that you did. You used the language students with extensive support needs. And I want to ask this because I think you know it's, it's kind of commonplace right now to be very careful about how we use language, especially in IEPs, and when we're talking about students with disabilities. And so I wanted to ask you, did that come from articles that you reviewed within OT, outside of OT? Did you make it up on your own? Where did that come from?    Savitha Sundar    All outside of OT, for sure, education, all the research that I the information I could get for my research, was all from education, educational psychology, educational literature, was where I went to. And we used to use the term mod severe in California. So when I started my PhD in 2019 The term was still. Severe disabilities, right? And then as I went along, I think the awareness also increased, and the and the need for us to recognize that it's the support needs of the student that is where the focus should be, and not on the student's disability the students functioning from saying high functioning or low functioning to high support needs or low support needs and high support needs that places the need for change outside the individual, then our intervention will also focus on the environmental factors, not just the person's inability to do things. Yeah, so I think that's why the term is used now a lot in the literature. I think that's the most so the way it's defined in the literature was, I think in 2017 tob came up with that definition, and she says there are students who it's not a very crystal clear definition, either, but this is what we're trying to use in the literature, in research with this population, mostly students who may have a diagnosis of autism, intellectual disability, or multiple disabilities, who tend to have needs across multiple domains of school participation, and who most often will qualify for their state's alternate assessments based on alternate achievement standards. So and they represent one to 3% one to 2% of the 53 million students who are educated in the American public school system, a very small percentage.     Jayson Davies    Wow. So, yeah, okay, very small percentage.     Savitha Sundar    This is, this is what I wanted to say. So when I started, 100% of the students I supported were that one to 3% of the population. So I wanted to find out, how is it with other OTs? Do they only work with kids who are in general education settings, or they work little bit with kids who are in self contained classrooms? What does your caseload look like? And I put out a survey on Facebook, and it was just a one question survey, mark one of the five options, what percentage of your caseload involves students with extensive support needs, and this is what I mean by extensive support needs, and the kids who also spend I also added the fact that they spend the majority of their day outside general education settings, and in a day or two, I got 186 responses, and nearly the majority of the OT said that at least 40% of their caseload are students with extensive support needs. Wow. So. And then I did an IRB approved survey, and I had 156 OTs who took that survey, and the result was exactly the same. And if, when I go to a presentation and I put that question among the at the audience, and it's very similar. And I look at my own caseload now, more than 50% of the students I support are students with extensive support needs. So I mean, the rationale is so different from in different places, but they tend to have IEPs, and they have a more explicit, obvious need for ot sometimes. But then again, ot comes like, okay, they are too severe to benefit from ot because we're working on handwriting, and therefore this is not something that we can address, or they are too high functioning. And then we don't work with the kids who are in gen ed classrooms, and we only work with kids who are in self contained classrooms. So what lenses do you look at? How you provide services is where the determination comes?    Jayson Davies    Yeah, wow. So a good majority of us are working with these students, yet many of us are probably also questioning how we're actually supposed to be supporting these students. You mentioned your survey, not the one question survey, but the follow up survey that you did, what was some of your goals with that and what were some of the outcomes that you found from that survey?    Savitha Sundar    So the survey study was looking into both special education teachers who work with students with extensive support needs and OTs who work with students with extensive support needs, looking at, what do you like? The main question of the survey was to find if there is a relationship between attitudes and efforts. Like, if your attitude towards inclusion of these students is high, then is it likely that you would have more put more efforts to support inclusion in your school? That was my big question. But part of the study was all these other questions. And one of the question was like, What do OTs work with this population? What do you address with this population? And the results were not surprising at all. The majority of them mentioned fine motor handwriting, and then it went on to sensory self regulation, sensory regulation, and then moved to ADLs, and then social participation. And then they were like, vocational, pre vocational. All of those were some of the little bars in the findings. So we the what, what I was hoping I would know, or what I didn't know is if these are the areas, and it was an open ended question, like, what do you work with your students? And then, you know, based on their. Responses. I categorize the responses, and what I don't know is, how do these engender access to lesser restrictive environments, right? How does it give you how does, how do you addressing fine motor lead to the desired outcome that you expect from the student? How does it lead to inclusion? That's something we don't know, right? And if we don't even know if that's a focus of our interventions, maybe therapists work on it with a purpose, like, okay, so this kid is in the general education classroom, and they're supposed to put their things in the locker, and therefore we need to work on opening and closing the locker. And so I'm working on this fine motor skill. Then I understand this is for the purpose of inclusion. Yeah, right. But if you're just working on stringing beads, or you're working on your pencil grip, or you're working on handwriting, for that matter, right, making all the letters legible, how does that lead this kid to access grade appropriate knowledge and express grade appropriate understanding of grade appropriate content.    Jayson Davies    Yeah, you know, and I've struggled with this too, it's like, Well, are we working on a skill? And is that skill or, I mean, I'm working on a skill. Is that skill going to support inclusion? Sometimes I think about that, and sometimes I'm not purposefully thinking about the inclusion aspect. And I talk about that because should we be, should we be either a, creating specific goals related to inclusion, or B, at least, at the very least, be writing our goals, to a degree, with the idea of inclusion in place. I don't know if you have thoughts on that.    Savitha Sundar    Absolutely, and I think the whole special ed team should be working on that. So special education and related services are there to support this kid Access General Education, environments and experiences. That's the purpose of, I don't think you would disagree with me, or anybody would disagree with me. And I like to use, okay, and you may have, I don't know if you've already, I think somebody in your podcast also shared this, the National Association for transition, the ntac, or National Collaborative for transition, something. So the N taxi, the collaborative, whatever, I'll share the information with you. So they have come up with this in school predictors of post school success, right? You know what I'm talking about, right? So if you look at those predictors, there are two of them that are research based across education and employment and independent living. One of them is goal setting, and the second is inclusion in general education. Those are the only two research based across all three areas, and so far, there is no research that says there is a clear advantage of a separate class over a general education classroom for a student, for any child, including students with extensive support needs. And I mean, I always know as a researcher that no research is 100% everything is very contextual, very situational, but it's something for us to consider that this is a good and, you know, I I've been looking for an analogy to explain this, and this is the closest I can come with. You can take a plant, right, and you can put that plant inside the house. You can take a plant that's supposed to be outside and put the plant inside the house. You can give it artificial light, you can give it all the fertilizer. You can do everything, but unless you put the plant where it has to be, you can never meet the needs of the plant in a different setting. And the other analogy I came up with is it's from a Buddhist it's from a Buddhist saying where, like wisdom and compassion are two wings of a bird, without which the bird will fly in circles. And the one I use is access and placement are like two wings of a bird without one, the bird will tend to fly in circles. So if you are providing placement but you're not providing access, meaningful access and belonging, then that's not inclusion. And if you're providing access in a self contained classroom to grade appropriate instruction or whatever. That also is not inclusion, because by the nature of the program, a student is not exposed to what a child without disability will will be exposed to, will get just by the nature of exposure, it's coming from presuming that these kids just because they cannot tell you what they know, we assume that they don't understand, but our job is to give them the knowledge and give them the tools to express themselves most effectively, most functionally, right? So I think, yeah, I almost forgot your question, but that.    Jayson Davies    That is totally fine. Who? No, no, no, you're fine. My favorite IEP, my favorite part of the IEP, and I say this somewhat sarcastically, is that little piece that says the percentage that a student is in general education and in those programs that I've worked with, you know, the county programs, or even the in house district programs that operate similar to county extensive support needs program that you were mentioning earlier, there always has to be that percentage that the student is in general education. And for these programs, it would often range from like zero to 10% and if it was 10% the 10% usually referred to the time that the classroom was in the cafeteria and the time that the classroom was at recess. But if you look a little bit more in depth, you would find that yes, the classroom was going to the cafeteria with their general education peers. However, the caveat is that they were sitting at their own table. They were in the cafeteria, but they were definitely not part of the cafeteria. And same thing when you go out to recess, yes, they're out there with their peers, but they're still kind of have their own little area out at recess.    Savitha Sundar    They play with higher educators and teachers     Jayson Davies    Exactly, exactly. So I guess my question here is, what does authentic inclusion look like in a school setting, beyond just having the student in the same area as the general education population.    Savitha Sundar    Authentic inclusion must address all three dimensions of inclusion, which is the physical dimension, physically being there, second, socially, having A sense of belonging, where others know about you. And when it comes to kids with communication challenges and social challenges, I think the bigger step has to be taken. You can't really meet in the middle. And we've tried a lot pushing our kids to come to the middle. A lot of times the gen ed kids have to come a little bit further beyond the middle to reach to our kids, and that's the nature of society. That's that's the society we live in, and that's the society we want to be in in the future too, right? So authentic inclusion will take efforts addressing that social dimension of belonging. Okay? Everybody understands the student. The student has friends, people know them by name. Being in the cafeteria like, that's the thing, right? We can always come up with excuses. We don't have enough staff. We don't have enough, you know, money, to make this happen. And, you know, oh, the Gen, ed community is not going the parents are not going to accept it. All of these excuses can come in. It's very easy to say no, because you can always cite a lot of reasons, but if you say yes, you may not get 100% but at least you'll do a little bit better. At least two students will have the opportunity, and then you'll see how that works out, and then you'll be inspired to bring in more peers are such powerful resources in the class, you know, they can do a lot for us, and I've also seen a lot of students don't even appear to be students with extensive support needs, because they've always been in a general education setting, and therefore they don't exhibit that kind of a need, because it's just it's I've heard this from experts, and I have seen this myself. I can look like that is why this whole continuum of placement, least restrictive environment statement, all of this is so subjective to interpretation, right? So what the same student can be in in Texas and can be fully included, and the same student can be in Oregon and be in a special education classroom. I'm just giving an example of two different states, but, you know, or in the same same state, you can be in a different district and be fully included, because the team feels that's the LRE, whereas in another place they feel like, oh, we have, we have a really nice program, a really nice, self contained a special education program with all the resources, and you market that program for The kids. So it's really not the students need. It's what we are capable of doing or our mindset that is 100%    Jayson Davies    true, and the fact that the LRE is not really well defined and can change from any given IEP to the next IEP sometimes too, like I could, I could manipulate and like what the LRE means for any specific situation that I really need it to mean.    Savitha Sundar    Yeah, yeah. We need to acknowledge that. You know? We need to acknowledge that, yeah.     Jayson Davies    So, yeah, okay, so sorry, really quickly. First was physical location. Second was social inclusion, and what was the third one?     Savitha Sundar    Then third is academic inclusion. So when you they must be able to access the same content that their peers access, right? So we don't even present like a kid who has extensive support needs often is learning the alphabet all the way up to high school, right? Because we don't. Know what they know, what they are capable of knowing, true, right? What if we provided these supports in the general education classroom? What if we put our effort in making that like OTs, the time we spend in what we currently do? Don't take away any time. Don't expect adding more work to yourself. But just think about the same time if it was used in making the general education experience accessible, just recess, just cafeteria as an OT team. Can you all sit together and brainstorm? How can we make cafeteria accessible for all our kiddos in our district? How is it going in your school? How is it going in my schools? Can we all implement the every moment counts comfortable cafeteria program. So another finding of my research was when people knew the how. They always had a clearer why. Why occasion when people knew their how, like people who were aware of these programs, you know, like a comfortable cafeteria program, or the you know, like the interoception program, or people who knew these had these tools, felt like they wanted to justify inclusion because they could do something about it using these programs. So I think having the tools to do it is so important for us to actually assume that role in schools. It's just that we don't know how to do it. That's the biggest problem.    Jayson Davies    All right. And that wraps up part one of our conversation with Dr Savitha Sundar. I hope this episode sparked some new insights for you and maybe some new thoughts about your students, your role, and maybe even the system around you, as I mentioned before. And part two, we'll move more into the practical strategies and what it can actually look like to support students with extensive support needs through inclusion focused ot services. We'll also talk about goals and how to promote participation and even collaborate with General Education staff in meaningful ways. So if you enjoyed this episode, or even if it was almost a little hard for you to listen to, because, you know, these conversations are so difficult and they must be had, even if they're not easy, then I want you to be sure to subscribe to this episode or subscribe to OT school health podcast, so you get notified as soon as episode 177 comes out, because in that episode, we're going to talk about more of the how to move forward stuff. So with that, be sure to subscribe to the podcast, and if you're listening on Apple podcast or on Spotify, please leave your thoughts in a comment. We would love to connect with you and learn more about how this podcast is supporting you now, and also how we can support you in the future. Be sure to also head on over to OT schoolhouse.com (http://schoolhouse.com)for more information about how you can support your students with our weekly newsletter at ot school house.com/join (http://house.com/join)I hope to see you over there on the website, as well as in Episode 177 of the OT school house podcast. Take care.    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 (http://otschoolhouse.com)Until next time class is dismissed. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

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