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Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 167 of the OT Schoolhouse Podcast. What do you think makes handwriting fun and effective for kids? In this episode, we dig into strategies that don’t just teach handwriting but make it enjoyable for students.  Dr. Beverly Moskowitz, the Size Matters Handwriting Program creator, shares her 48 years of expertise to show you how to empower teachers, build student buy-in, and integrate handwriting practices across the curriculum. From understanding key concepts like "Super C" letters to using engaging tools like stars, dice, and even spaghetti and meatballs for spacing, this episode is packed with practical, research-based tips. So, grab a notebook and join us as we explore the art of handwriting in a way that's as impactful as it is entertaining! Listen now to learn the following objectives: Learners will identify at least two handwriting strategies that could be embedded in all content areas across the curriculum. Learners will identify at least two handwriting strategies you can use to increase student buy-in and teacher retention in the classroom. Learners will understand the benefits of structured and Adapted Material Guests Bio Beverly H. Moskowitz, DOT, MS OTR/L FAOTA, has over 48 years of experience as a pediatric Occupational Therapist, making significant contributions to the field. She holds a BS in OT from the University of Pennsylvania and both an MS and DOT from Temple University. Dr. Bev is the author of the Size Matters ® Handwriting Program, proven effective in promoting legibility and widely used across the U.S. and internationally.  In 2010, she founded Real OT Solutions ®, which provides effective, affordable solutions for therapists and educators. She was inducted as a Fellow into the American Occupational Therapy Association in 2015. Additionally, Dr. Bev is a national lecturer and offers professional development workshops to teach best practices and time-saving strategies for therapists. Her commitment to mentoring and research continues to influence the field of occupational therapy. Quotes “You have to have concepts and strategies that happen all day long in all content areas because writing does happen in social studies, science. In math, the kids are writing. So you wanna remind kids about the best practices in handwriting so their writing is legible there too”  -Beverly H. Moskowitz, DOT MS OTR/L FAOTA “Our job is not to give teachers more to do. They have plenty. But we wanna give them strategies that they can embed handwriting across the curriculum, make it easier for them to do so, build that buy in with the kids so that there's follow through.” -Beverly H. Moskowitz, DOT MS OTR/L FAOTA “Kids love feeling like teachers, and they love catching you when you mess up. When you intentionally mess up and let them critique you, it builds their confidence and ownership over their learning.” -Beverly H. Moskowitz, DOT MS OTR/L FAOTA Resources 👉 Youtube Live Version 👉 OT Schoolhouse Collaborative 👉 SMHP Resources   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 there. And welcome to Episode 167 of the OT school house podcast, as school based ot practitioners, we know that telling or even politely asking kids to quote, unquote, write neatly is never enough to fix their messy handwriting. Instead, to support handwriting development, we need an established plan effective collaboration with teachers, and, of course, the means to help our students build habits over time. Luckily for us, today, we are joined by an OT who has put in a ton of hard work to help make this easier for us by developing a roadmap for achieving such a goal. In today's episode, I'm sharing a sneak peek from one of over 30 professional development courses inside the OT schoolhouse collaborative, our professional development and resource hub for school based ot practitioners. You're about to hear one of my favorite ot practitioners, Dr Beverly Moskowitz, as she shares what works and what doesn't work when it comes to supporting student handwriting skills in her course win over teachers and kids with proven and fun strategies to improve writing. What you're about to hear now is the audio version of Dr Moskowitz course, and you can watch the video version using the link in the description below. However, if you would like access to the full a OTA approved version of this course, complete with access to the slides, resources and yes, a certificate of completion for your continuing education needs, you can do that by becoming a member of the OT school house collaborative in addition to accessing professional development courses, ot schoolhouse collaborative members also have access to exclusive ot school house handouts, our school based ot research library, an interactive IEP goal bank, and my favorite part, our monthly live collaboration hour calls, where You can ask your most pressing school based ot questions without the fear of being judged by parents, teachers, administrators or even other practitioners if you're looking for mentorship and resources related to school based occupational therapy, the OT school house collaborative is your place to be if you haven't joined the OT school house collaborative yet, this is The perfect time to do so join me and hundreds of other new and experienced ot practitioners inside the collaborative at ot  schoolhouse.com/collab , also leave a link in the show notes to help you get there. Alright, enough about the collaborative for now. Let me introduce you to Dr Moskowitz, Dr Bev, as she is often referred to as is an experienced pediatric occupational therapist and the creator of the Size Matters handwriting program. Beverly brings over 48 years of experience and is the founder of Real ot solutions, a company dedicated to providing engaging, practical solutions for handwriting improvement. As a long time school based OT, Dr Moskowitz has leaned into our experience as a school based ot as well as the scientific research to develop and publish the handwriting program now used around the world. In this course, Dr Moskowitz will walk us through concrete steps, valuable tools and interactive games to win over both teachers and students, from Star worthy letters to the innovative Alpha triangle. We'll explore a variety of methods designed to make handwriting not just better but also enjoyable for the kids. So without further ado, let me hand the mic over to Dr Moskowitz as she helps you to win over teachers and kids with proven and fun strategies to improve writing.    Beverly Moskowitz     Well, hi everybody. I wish I could see I can I trust that you're there? Thank you so much Jayson for inviting me to be a part of the OT school house collaborative. As Jayson said, I am a seasoned ot doing this for 48 years, and I'm the author of The Size Matters handwriting program. So I'm delighted to share this with you. Aside from the fact that I have created this program, I truly believe it's the future. I'm a very grounded therapist. You have to teach handwriting, but it's not a bad form. Letter size is that variable that will make the biggest difference in the consistency and therefore the readability of the page, and we have the research to prove it Now this, this short one hour course is not going to go over the research. If you want to learn more about that, you can. I'm going to show you where you can find it, on the website, if you want to download it, if you want to learn about it from me personally, I'll share how you can do that too. But right now I'm going to share with you that yes, I am Beverly Moskowitz, and thank you again, Jayson, for inviting me to speak today. So here's our learning objectives for the next hour. At the end of the time, you're going to be able to identify two to three smhp, and that's our shorthand for size matters, handwriting, program concepts and strategies. That can be embedded in all content areas across the curriculum. The research shows it's not about 250 minutes of practice in a workbook a week. Anyway, you have to have concepts and strategies that happen all day long in all content areas, because writing does happen in social studies, science, in math, the kids are writing. So you want to remind kids about the best practices in handwriting so their writing is legible. There too. You're going to be able to identify two to three smhp concepts and strategies to build student buy in and teacher carry over and gosh, I can't emphasize that enough, it's, you know, people that say, I'm not a handwriting therapist, I'm not a handwriting teacher. I gotta say to you guys, first of all, get over it. We are. We are because we're about function in school practice. We're about function participation. And one of the skills that kids have to do in school is to write. And we, more than anybody else, can identify those concepts and strategies that are doable for teachers. Our job is not to give teachers more to do. They have plenty, but we want to give them strategies that they can embed handwriting across the curriculum make it easier for them to do so, build that buy in with the kids, so that there's follow through. So I'm going to give you a few suggestions for both of those. So we're going to start with the key concepts. There's eight of them. In fact, I should share with you. This is a concept driven approach. You can get started tomorrow with your knowledge alone. Now we have materials. They make it easier for you. They make it more consistent. If you're using smhp in a school setting, a classroom setting. But you can certainly get started with your knowledge alone. And you can even make some of this stuff, and I'll share with you how you can do that in your setting. These are the concepts, writing lines, letter lines, Super C, starting points, touch points, letter size, stars and dice, spaghetti and meatballs. After that, we're going to talk about how to build student, buy in, teacher, carry over. So the first concept is that of writing lines. I don't care if it is April, yeah, I don't care what month it is that you introduce, size matters to your school. We always make sure that we're on the same page, literally naming the writing lines. And I'll say to kids after I put these lines on the board, on your smart boards, Promethean boards, whatever you're using. So what do you guys call this line and you'll hear things like the grass line, the ground line, the foot line. There are programs that have a descender line below here. They call that the foot line. This became the knee line. Size matters. Is a very plain and simple program. We call this line the bottom line. So I asked the kids, and with it, be okay if we just call the bottom line the bottom line. I asked them, What do you call this line? And you'll hear things like the hat line, the headline, the skyline. I mean, there's a zillion names for it. And I say to the kids, if it's okay with you guys, could we just call the top line the top line, and I'm cool with this either being the dotted or the middle line. It's important to establish a uniform terminology for the writing lines, because touching the writing lines in all the right places determines whether or not you made your letters the right size. Now, along with that, concept is that of go lines and finish lines. Go lines are green lines down the left side of the page, the paper the desk. Finish lines are checkerboards down the right side of the page, the paper the desk. And we're talking about teaching the alphabet for not for submitted characters who go right to left, but for those of us who write left to right. I prefer a finish line to a red line because it implies dynamic movement. We're moving toward the finish line. So yes, movement toward the go line, it would be considered backward movement. Movement toward the finish line would be considered forward movement. And we talk about that in the directionality of making certain letter lines, the top of seven, the slant in R, the hump in H, those letter lines are made in the direction of the finish line. They're considered forward moving. Letter lines. By contrast, the bottom of G, that little hook, that first diagonal in K, the diagonal in Z, those letter lines are made in the direction of the go line. They're considered backward moving letter lines go. Lines and finish lines are terrific visual references. If you have kids with reversals, if you have kids with dyslexia, dysgraphia, they give, give the kids that directionality, queuing that they need to make their letters properly oriented. You can put go lines and finish lines on desks if you wanted to use highlighter tape for the green line, I caution against using floral tape. Learn that lesson the hard way. It will stain your sleeve. You can buy checkerboards from Amazon. You can make a checkerboard. Get some masking tape and a Sharpie, make a little checkerboard that will help your kids remember the directionality of movement now go lines and finish. Lines are cute for your younger kids, not so cute for your older kids. Know that they eventually morph into your left and right margin lines, but don't expect that anybody knows what they are. Ask the kids, you know, why that line is there, they're going to be like, no, okay, so you want to say to them, that's because all of your writing has to begin next to your go line or your left margin line. And if you have more than three letters to write and you see that right margin line coming up, you're going to go the next line. If you're making a list, you're going to make your numbers to the left or outside your left margin line. Okay, the next concept is that of letter lines, and this year is where we name them. We have standing tall, letter lines, lying down. Letter lines. We have slant ones, they go forward and backward. Clock lines that wrap around an analog clock from 12 to six or six to 12. Sure hope you have some analog clocks in your classrooms, frown lines that go forward and backward. And I would often do this exercise just to entertain myself, because invariably, here's what you see when you ask a child to find, can you find me a letter that has a standing tall line in it? The kids are going to look all over the place like it's going to jump out of thin air. Okay, that's how you know that they never noticed the alphabet strip above the board, the one that's on their desk. Basically, they think that's for filing their nails. Any of the posters that are in the room, it's it's white noise. So you might want to introduce your children to those awesome references your teachers have taken time to hang up during handwriting instruction. Time, you can ask kids to identify different types of letter lines if you have something like that in your school, and we'll talk about if you do or if you don't. Now, Super C is our superhero. He is a letter line, but he's so important, he's given his own status as a key concept. So there are five upper case letters that are super CS, C, G, o, s and Q. There are seven lower case letters that are super CS, A, C, D, G, O, Q, s and he comes packaged with a little extra drama. We always identify what letter size a letter is. And then we say, but not only, and that means that it starts with the C formation. So how are you going to remind kids about what a C formation is, so they don't make that backwards parking back to your go lines and finish lines, and think about, what does superheroes do? Well. They save us, they protect us. So like any superhero, Super C is going to go back to go first, to make sure there's no stragglers, nobody left behind. Gather up all those stragglers before he continues on his way. That's the supersea backstory, but that may be the story, the visual, the kinetic, motion that kids need to live, to remember to always go back, to go before they head forward when they're making Super C letters. The next concept is that of starting points and initial lines. So starting points are indicated by a green dot, a little directional arrow. Initial lines are the lines that emanate from the starting point. So in this little excerpt from the therapist manual, you can see that all the letters start on a line. The initial line for uppercase, A is a backwards slant for uppercase. B, it's a standing tall for Super C, for C, imagine that it's a Super C letter. It starts at the top line. In fact, all letters at the Size Matters hand running program start on a line. Remember I said that? So let's talk about initial lines. Where does what's the initial line for upper case? F? Give you a chance to think about it. Oh, you are correct. It is a standing tall for uppercase V, it's a forward slant. How about Z, it's a forward lying down. G, it's a Super C, okay, now it's going a little bit tricky. How about lowercase F? Where does it start? What's its initial line? It's an exception. It starts below the top line. Its initial line is a backward frown. How about lower case? A, Oh, I hit the button too fast. It starts between the dotted and the bottom line. Its initial line is a forward lying down. Listen, I don't even bring those letters up until I get to it. You got one of those letters in your name? You got to it, but I drill consistency of size. Size matters is not a font. This is a very simple letter creation. Everyone's going to stylize on their own. I don't know if you're writing the same way you learned when you were in kindergarten. I know that I'm not. I learned ball and stick kind of writing everyone's going to stylize. You don't need to teach a stylized font if they eventually decide that they want to put a little monkey tail at the bottom of their tea that's okay, as long as they're touching the bottom line. How about number eight? Where does eight start? And what's its initial line? Well, it starts at the top line and it's a Super C. Number Three starts at the top line and it's its initial line. Is a clock line, lower case r starts at the dotted line. Its initial line is a standing tall. Okay, you can figure this part out. The next concept is that of touch points. And when I say touching, I don't mean getting really close. There cannot be any air between your pencil point and the writing line, and you can't be poking through the line either. Has to be a nice, clean intersection. Now, before we had a pandemic, I used to go up to kids and say, so am I touching you? How about now? Bring my finger closer and closer to the nose. Now I touch my own nose. Am I touching? Am I touching? How about now? Because touching means touching. So we actually count how many times letter lines touch writing lines. C is easy. It touches at the top. It touches at the bottom, two touch points. Now note that their red arrows indicate when letter lines touch writing lines, blue arrows indicate when letter lines touch other letter lines. So bees a little bit trickier you could say. And I hope you can see my cursor, touching, touching, touching, touching, touching, and tell me it has five touches. I would be cool with that, unless your child made that be and their first clock line started down here, you're going to say to those kids, so your clock line has to touch the top line. Now you're going to count that touch point. Or if they start their B and there's a gap they started over here, your clock line has to touch the standing tall line. This is a bit of a gray area. It's most important that you're consistent with yourself that said, if your kids letters are unrecognizable, it may well be because the touch points aren't there. So that's when you want to get fussy about making sure that all of the touch points are accounted for. Okay, but the biggie is the rule for letter size. So you call these letters, over time, tall letters. There's some programs. They call them your giraffe letters. I'm pretty sure that a seventh grader is not going to find that as cute as a kindergartner. We call them size one, size two, size three. That's what we call our different sizes. So the rule for size one letters is this, I like to say it's package is a song and a dance. I'm going to sing and dance for you all right now size one letters, they have to touch the top line, they have to touch the bottom line. They can't go higher. They can't go lower. They can't float in the middle. My friends, I did not tell you that. It was a great song and dance. And dance as a sound bite. You're going to say a zillion times a day. And touching means touching. So make your writing lines on the board. Make a pink rectangle. That's our color for size one. Make it exactly. Touch the top and bottom line. Teach the kids the rule, and then I make a perfect letter. I point out all the touches, touching, touching, touching, touching, touching, touching. If you make a letter like that, I'm going to give you a store. I wonder if I can do that again. Do you think I can? I can't. I make every single one at a time. Errant looking a I've ever seen the kids make, and one at a time, I asked the kids to critique me. Is it star worthy? They go, No, you say, why not? I'll say, well, it's too tall. It's too long. This one is floating. This one's not touching over here. This is not touching on the on the dotted line. Finally, touching, touching, touching, touching, touching, touching. That's how you earn a star. All your uppercase letters are size one, and I don't care if you come to me in ninth grade and know that the research shows that you can still make improvements in handwriting through ninth grade. And that said I had a colleague share with me before and after results of a client who had a stroke, the change was remarkable after a few sessions, and that client was 92 so I don't know. I think you can make changes in handwriting way beyond ninth grade, but I don't care what grade you you start always go back to the upper case alphabet, because the rule is the same for every single one, they have to touch the top line. They have to touch the bottom line. They can't go higher. They can't go lower. They can't float in the middle. Now, after you do your upper case letters, your size one upper case letters write words that are commonly found in upper case letters, and a good source for that, or signs. Look for signs in and around your building. It may say, It probably says, exit in all capitals. Principals office may be in all capitals cafeteria. Look for signs in and around your neighborhood. Your school name may be above the front door on the lawn. Use words that the kids will recognize they practice writing them in all uppercase letters, making each of those letters star worthy. After you do that, you move on to your size one lower case letters. There are only seven of these. I do not teach B and D at the same time. I teach B as part of the BLT and as before, make the lines on the board, make your pink rectangle. Review the rule, make that perfect letter point at all the touches. Then you say, you think I can do that again. Okay, the kids are starting to get wise to you, because now you can't, yeah, listen, if there was more screen here, I can make 20 more errant looking ds. And now you ask the kids, so how do I do? And the kids go, terrible. You say, Why? It's too tall. This is too high. This is too low. This is floating. This is not touching. It's not touching here, finally, touching in all the right places, touching, touching, touching, touching. Way to earn a star. But not only, and this is where, in United chorus, the kids should, should yell out. It's also a Super C, meaning it starts with a C formation after your size. One lower case, you're moving on to your size too. And here's the rule, they have to touch the dotted line. They have to touch the bottom line. They can't go higher. They can't go lower. They can't float in the middle. Gosh, I hope you weren't expecting more. It's a sound bite. You're going to say a zillion times a day. Now there are 14 size two letters. I do not consider the.in lowercase. I part of the body. It's the standing tall part that has to touch the dotted line in the bottom line. Yellow is our color for size two. Make your lines on the board. Scan some adapted writing paper onto your smart boards. Yellow square indicates a size two letter, and then you're going to make a perfect one, pointing out how it touching in all the right places. And then the question, do you think I could do that again? And the kids go, No, you're terrible at this, and you are, and you're intentionally making every single a you there, they all look like A's, right? Every single one of them looks like an a and I would venture a guess that if you looked at your children's printing letter by letter, you could figure out what they were. It's in the context of the whole but it's a mess. That's how you know it's not about form. It has to be the consistency of size. So let the kids critique you. Finally, you're going to make one that's touching in all the right places. Way to earn a star. But not only, and I hope that you're all saying it's also a Super C. Okay, here's the rule for size three letters need to be sitting down. Size three letters have to touch the dotted line, have to go below the bottom line. Can't go higher, must go lower. And if it has a belly, it has to be sitting on the bottom line. Okay, I don't know if you were looking at the screen when I was doing this, but I was doing my little dance with my hands. Here, there are five size three letters. Oh, I don't know why they're not populating G, j, p, q and Y. It'll probably populate the end of the slide. Blue is our color for size three. Make your rectangle so it starts at the dotted line and goes below the bottom line. Make a perfect G, pointing out all the touches, touching, touching, touching, going below. And then, do you think I could make another one. Then go nope, and Oh, there they are. There's the five size three letters. The only one without a belly is is j. And now you're going to make everything you've ever seen the kids do. Okay. Again, they all look like G's. But are they star worthy? Let the kids critique you. You know, when you teach the kids the rules, it's as if you gave them the answers to the test. Now the kids can score you. They can score themselves. And best practice, research shows that when kids have the ability to self monitor, you build the buy in. You are giving the ability to self monitor to them by teaching them the rules they can score each other. Oh, now you can build pure mentors, finally touching in all the right places. Way to earn a star. But not only it's also a Super C, okay, the next concept, well, you've heard me talk about way to earn a star. The next concept is stars and dice. Stars and dice both a concept and a strategy, and that's going to lead to the kids feeling empowered teachers being able to carry over these concepts throughout the school day and being able to embed it across the curriculum. So I've used the word star worthy. Letter lines have to touch the writing lines in all the right places. At this point, we are scoring for size only. And in fact, this is a research study that I'm looking to launch anybody in a doctoral program, contemplating a doctoral program, looking for a research study, please reach out to me a whole bunch. We already have more research than any other program out there, and we're not done so there's several studies in development. We have six published studies already, but I am already in talks with several universities for more studies, and this is one of them. You know, all of the hand running assessments out there. The ths, the test of handwriting skills, is the only standardized one. The rest are normal criterion referenced, relatively easy test to administer. It's a horrible test to score. You can be sitting there for 50 minutes trying to score it. The other ones aren't, aren't much better. My contention is it really it's about size. Stop with your millimeter ruler. Who cares if once you score for size, you get enough information that you can then have that child redo that same baseline writing sample, their name, upper and lower case, alphabet, a grade level sentence. Score it for size. After a period of intervention, you will see a market difference, and it will take you seconds to score clinical utility. That's important. So at this point, we're only scoring for size. Let's prove that, let's, let's do a study and prove that we have a valid outcome measure using just size. So for instance, suppose a child wrote three letters, aaa, ABC, dog, and all of those letters were the right size. They got a score of three out of three. That's a perfect score. However, if their letters are not the right size, or maybe they made them the right size, but they made them the wrong way. So maybe instead of using two slant lines, and I'm hoping you're looking at me in the screen, if they instead of using two slant lines for an upper case A, they're using one standing tall, one slant line for an upper case A, you're gonna play the dice game see if you can straighten it out. Suppose they started their letters at the bottom, instead of starting them at at the top, the top odd line or the dotted line, they're going to play the dice game to work on, starting from the right place. And that said, my friends, oh, it's time to play the dice game. The dice game determines practice whatever the kids roll is, how many times they have to make a star worthy letter? If they roll a five, they have to make five star worthy letters. If they make five letters and only two are star worthy, they're still making you that letter. They're going to look at you cross side, really. And I often say to them, Do I look like I'm kidding? No, you have to make star worthy letters. And if they roll a one, imagine that they only have to make you one. So suppose they wrote the word Monday, and it looked kind of like this. I'm going to give a star to OT. Overall, these letters are the right size. So there were six. There's two stars if you need a percentage, there you go. I'm going to underline M, N, A and Y. Those letters are not the right size. They are not touching the writing lines in all the right places. I'm going to play the dice game with each of those letters. Also going to underline D, while overall it's the right size. You'll notice there's a gap between the Super C part and the standing tall, and I'm scoring for size so they get a star. But now when I play the dice game, I want to fine tune it. I want to close that gap. I want to make sure that all parts of this M are touching the writing lines, same thing with the Y. And that said, my friends, if your children, especially if they are in higher grades, higher grades could be second, third grade on up, if they continue to make that upper case a, okay, look at me if they continue to make that upper case a with a standing tall line and a slam line, but it's the right size, I'm gonna tell you to move on. They just created their own font. And it's not about letter lines anyway, we teach them, but at a certain point in time, you need to move on, because it really is not the most important thing. It's the consistency of size. Suppose the only way they don't reverse upper case N is by starting at the bottom, going up forward, slant up on teaching starting at the bottom, because it's not about starting points either. So this is a very grounded approach here. We really don't it is the consistency of size. We are not that concerned with letter lines. We teach them, but we have to be grounded, practical realists. It's consistency of size. And if you think about a cursive starts at the bottom. A lot of submitted characters start at the bottom. We're hung up on starting at the top. That's not the most important thing. Okay, after that, we teach spacing, and we call that spaghetti and meatballs. That's our concept for teaching spacing. I strongly suggest that you not get hung up on space until you get 80% accuracy and size and you will. And then we talk about inside space, in between letters, a little spaghetti. Outside space, a big, fat meatball. So at this point in time, I walk around with colored pencils. If it's a young child, I'm going to leave that point dull. If it's an older child, I'll go to sharpen that pencil. I use yellow for my spaghetti. And if there's still room, I'm still making spaghetti. Now I count all my potential spaghetti spaces, FYI. If you have a six letter word, you have five potential spaghetti spaces. If you have a three letter word, you have two potential spaghetti spaces. So you can count up all the letters in your words. You know as it was, all the spaces between your in your words. Count how many of those issued single stars and there's your data that's pretty easy. Meatball spaces go outside of your words. So now I take my red colored pencil and I draw a little meatball in between all my words. If they didn't crowd the right margin, give them a free meatball. If they properly aligned down the left margin, give them a free meatball. But make all your meatballs the same size so they the kids can see, well, this one was overlapping star, those places where there was room for only one meatball, not a meat loaf. And there's your data. Kids love this concept, and that said they cannot score themselves for spaghetti and meatballs unless they swap out their pencil for yellow and red ones, because then it's unreadable all over again. Now it's all lined up, and you can't figure out what they wrote, so make sure that they have that handy when you're ready to score for that. Any questions on the concept so far? Or you know what? We can leave the write your questions down in the chat box. Let's catch up with them at the end of the presentation. If that's okay, that is perfect. Bev, go ahead, yeah. Okay. So let's talk about pushing into classrooms contextual collaboration, working within the context of whatever subject the teachers are covering. So suppose there is a handwriting instructional time good for you. So you can ask the teachers, can I come to your classroom? Oh, we already have a handwriting curriculum. Size matters. Can play in the sandbox with with any handwriting program. In fact, if your schools are embracing the science of reading curriculum. We are the science of handwriting. So there is a way to work together with those people or any other handwriting curriculum. No worries. Just ask them what the letter of the day is. We're going to come in and maybe do a lesson. On letter lines. So we can use the similar language. Can you find any letters with different types of letter lines? And then whatever the letter of the day is, make a perfect one. Now you're going to teach the kids the rules. I'm sorry. I should have said that. Teach the kids the rules, make that perfect letter, pointing out all the touches. And then, well, you know where this is going, you're going to make a series of really bad ones, because they all look like G's let the kids critique you. They love this part. Little kids love feeling like teachers, and they love catching you when you mess up. You are intentionally messing up. They're so empowered by that that the kids tell you why. It's not stir worthy. You're going to look crestfallen during language arts, walk around with dice. For all those teachers that may say to you, may or may not, say to you, I listen. I believe in handwriting. I don't. I don't have any time in the day. Can you walk around with dice is what you're going to say to them, because when they're walking around, they can stop by somebody's desk, point to a letter or or a word, something that you've covered already, the letters that you've covered, if all the letters in the word have are ones that you've covered the whole word. And then ask the kids to have to do, is it star worthy? And now the kids are going to go, Uh, no. You say, Well, why not? What? What size is upper case, a and, and what's the rule? So you're now, you're singing and dancing with the kids. Suggest they pick out a die that's calling their name. Listen, my dice game has 24 die in it. They're four sided. They're six, 810, 1220, fasted to die. I say to the kids, if you irritate me, I'm going to give that to you on purpose. You're going to be there all day. Uh, they're sparkled. They're iridescent, marbleized. Some of them have the pips, a little dots, some have numbers, some have sign language. They're adorable. And if you have any dice in your classrooms, they're just as cute. So go scrambling through your board games that you're not playing anymore. Get those dice together. The kids roll the die and at the bottom of the page, the back of the page, or another piece of paper entirely. You can sneak in some practice. Now, listen, if you stop one child, you better believe the child next to him, behind him, across the room, saw that interaction, and they're thinking letter size, because they know they could be next during any subject. I'll use the magnetic rectum square board. So this is a wipe off board, and in truth, is not magnetic. I have to always tell everybody it's Ferris back. It means it has iron chips so that magnets stick to it. But we have a lot of itinerants, teachers, therapists, maybe amongst you out there, you too that go from class to class or school to school. So in order to make it lightweight, it's Ferris back comes in a tube, so you can carry it, you can staple it to a a bulletin board, thumb tack it. It works best if you back it up to a magnet board. It comes with little white thumb tacky magnets, and then you use the pink, yellow, blue. It has 25 magnets to, you know, right to cover up a word right on the board. Cover with the magnets. Right on the magnets, they're all wipe off surfaces. It's a great way to introduce new concepts, vocabulary that's integral to a lesser we got a unit here on on weather for all grades. And I apologize. I realized that I did not put this slide into the handout. So if you want to take a screenshot, I'll wait a minute until I populate the whole screen, or you can just take notes here. But for all grades, a dish issue adapted writing paper at different grade levels. So in pre K, the distance from the top to bottom line the ruling should be an inch and a half. Skip space refers to the space between a set of writing lines that should be an inch. In kindergarten, the distance from top to bottom line is an inch. The skip space should be five eighths of an inch. First grade, three quarters of an inch with a one half inch skip space. Second grade, half an inch from top to bottom with a 3/8 inch skip space. Third grade, adapted paper. First of all, it's the same ruling as regular ruled paper. What makes it adapted is that it has a well, our paper has a thicker bottom line. Stopping is harder than starting. We give kids an extra chance to get it right, and it continues to have that dotted middle line. So that really helps distinguish the sets of writing lines. And here's how beautifully this all works with size matters. So suppose Jason is in Jason, you're in first grade, and you're doing an amazing job with those size one letters, their size two letters, size three letters. I'm doing my happy dance, Jayson, I believe that you are ready for second grade paper. How do you feel? I. He feels fantastic. I don't know where he    Jayson Davies     is. He's dancing. Oh, he's    Beverly Moskowitz     dancing. Is the right is the right response? Okay. Again, every little kid likes to feel like a big kid. I've graduated Jason up and sitting next to him is Abdel. He says, Well, how about me? And I say, you are so close, good buddy, what are we thinking about those size two letters? What's the rule now, once again, we're singing and dancing. I'm going to come back in a couple weeks. I I believe that second grade papers in your future. This is a huge motivator. The kids want to graduate up, and a lovely thing that you can do for your teachers is to give them reams of two sided first, second, third grade paper so they have it available during any subject. Here's a great way to build that connection with your teacher all. Imagine this. The kids walk in in the morning, they hang up their coat, their book back and their cubby, they grab a worksheet, and they have to solve the puzzle. So looking at these O, W words down here, which one is the first one, I know you're saying to yourself, that's plow, and the second one No, and the third one snowy, the fourth one grown. Show how listen. It's a combination of the number of letters and letter size. The kids solve the puzzle, then they have to write the words. And for anybody who's been confronted by a teacher when you showed up their classroom, who has said to you, who are you taking? I don't think anybody I want to come in? Okay, this is a way to win over those teachers. Create a worksheet because they're going to go, actually, that was pretty cool. You just supported curriculum so they can write their letters. Eventually, this could be a job given to kids that they they create these worksheets for their classmates. Uh, you can play games like Simon says, Be a letter line so everybody knows how Simon Says works. So imagine this. You want to have go lines and finish lines. The kids are all facing the front of the room. Here's your board right here. Maybe you make posters, get some foam core. Make a big green stripe, put it on the left side. That's your goal line. You have a checkerboard. Put it on the right side, that's your finish line. If you don't have a setup like that, maybe you get some easels and you make your go lines and finish lines. You project. You know how you make each other do each of the different letter lines. For instance, when Simon says, Be a standing toe line, you have to stand or sit. If they're sitting really straight, like a statue. Simon says, Be a lying down line. You're going to place your head on the desk, or for feeling really playful, you can lie down across your desk, on the floor, on the on the window sill. Simon says, Be a slant line. Now Simon is going to either to ask you to be a forward or a backwards slant. If you're a forward slant, you're going to lean toward the finish line. If you're a backwards then you're going to lean toward the go line. And remember, you know how Simon works. He says, Simon says, Be a forward slant. Simon says, Be a backwards land. Simon says, Be a forward stand. They they look like cuckoo birds. Okay. And then you finally say, um, be a forward slant. Okay. Now everyone starts to move them, but Simon didn't say they're out. Simon says, Be a Super C. Now this is a little bit more challenging. You always have to face the finish line. That's the direction you're going, put your hands up in the air and bend over so that your butt is pointing toward the go line. You like to pair that you're going to want to pair that with. Simon says, Be a clock line. So you're going to continue facing the finish line, hands up in the air, and now you're going to bend backwards so your belly is toward the finish line. Simon says, Be a supersede. Be a be it. Simon says, Be a clock line. Because, okay, the kids are going back and forth and they're all giggling and and that's just a fun way to reinforce letter lines. Simon says, Be a smile. Simon says, Be a frown, be a smile. Oh, you missed it. Okay, that's a fun game to play. Moving back to how else you can bring these concepts into your classroom? Volunteer to be a center. I was in a school that didn't believe in handwriting practice, handwriting instruction in kindergarten, I'm like, really love you center. So I became a handwriting center. It's very popular center. Everyone want to the truth is, kids want to learn the rules. They want to please you. So that enabled me to model language strategies that the teachers could use. And centers are a great time to play with the different concepts. So I'll go over a few of these. Center time games, dissect and tally. You want to find letters with each type of letter line. Maybe you want to find letters in different count up all the different letter lines in a student's name. How many of each type of letter line i. Play directional games where you reinforce that positional movement. Moving toward the goal line is backward, moving toward the finish line is forward. Get sentence strips from your their school, issue ones, I'm I'm pretty sure that your school has them. And then open up your literacy, social studies, science books, and then, using pink, yellow, blue markers, crayons, colored pencils, the kids are going to graph a phrase, a sentence, a word, and then trade it with their neighbor, make it something that's that's meaningful, language, that's meaningful to solve the puzzle and then write the sentence again, both creation of the puzzle and then solving your neighbor's puzzle can be a fun center game. Use the magnetic director, square board. We call it the MRB because that's such a mouthful. Use the the MRB to graph kids, names, high frequency words, word wall, words, play snowman. So what is snowman? Let's go look familiar. So you use the MRB, and you cover up, you write the words, and then you cover them up. And as the kids guess a letter, or they guess a wrong letter, you draw more and more parts of the snowman. If they get it right, you can write on the magnet, or remove the magnet if they get it wrong. Well, you know where this is going. The idea is to solve the puzzle before the sun comes out, because that will melt your snowmen. Play ransom notes. Or this game requires a little bit of prep. You want to gather some samples of writing from children, and you're going to cut them into individual letters. So looking at the, you know, the old time ransom notes, where they cut and paste in, okay, that's what we're going for here. Okay, so looking at the word yarn, what would the score be? Now, your denominator, there's always going to be fraction. Your denominator is already, always the number of letters. There's only one star. Here's your score. Looking at the word string as it's written, what would the score be? Well, how many of these letters are in stars? Now that n is not beautiful, but I'm scoring for size. I will play the dice game on end to try and make sure they trace that what's going to be a forward frown better. But there's the score, three out of six. Wooly, oh, that came with the answer. Okay, two out of five. Okay, there's plenty of games where that came from. Letter, line equations. Oh, this is a pre download from my website if you want to, if you want to print out the letter line equation card. But imagine if you had a standing tone, three lying down lines. What letter would you be making? Oh, you guys are so smart, and you didn't even have to say it out loud. Okay, the upper Casey, uh, letter blocks. Now, some of these centers we actually do during my live courses, so we we create this material, but you can make this in your in your schools, as is get those sentence strips your school issued ones are often an inch and a half from top to bottom line. The ones that you get from Staples, or like, an inch from top to bottom line. So, so whatever your your sentence strip is, you're going to use that measurement to make your size one, two or three blocks. You can take a sheet of construction paper if you want, or, even better, get those phone sheets, because they're more durable. They're not going to rip so quickly. And then you're going to make top and bottom lines thusly. So, if you're a pre K student, make the distance from the top to the bottom line four inches. The distance from the dotted line to the bottom line two inches. Kindergarten top to bottom line will be two inches. Dotted Line to bottom line. This, this, this is, yeah, this is if you're going to be making those the pink, yellow and blue squares and rectangles. If it's an inch, the distance can be a inch and a half top to bottom, or three quarters of an inch. If you're in second grade, you can make smaller ones an inch from top to bottom, and then get your pink, yellow and blue construction paper. Or better still, if you can get foam sheets, and these are the dimensions that you're going to be making. Your pink rectangles are going to be four inches by two inches. So you're going to, you know, make lines. The kids can help make this. Use your the Alpha triangle. I don't know if you know, if I should show that to you. This is the alpha triangle. I'm holding it up, so look, look at me. Okay, this will help you to measure it. And when the kids are drawing lines, they can put their hand above it and not get their fingers in their way. Help cut them out. Alpha triangle there that can help you to measure it. And then you can store these. Create a little envelope if you want, or just use an envelope to store all your shapes in it. And then, when, before any kind of writing activity, if there's language vocabulary, the kids would pull out their, let me just go back and show this. They'd pull out their white foam sheet. They'd pull out their pink, yellow and blue their envelope with their pink, yellow and blue squares and rectangles, and they would graph it on the phone sheet or the sentence strip. And if your principal is on board with this, perhaps you could encourage them to identify a wall outside of their office as the wall of fame. Once kids have mastered letter size, they get to write their name on a sentence strip, hang it up on the wall. It's a real status symbol. You know, everybody likes to have their name on, you know, in lights. That's kind of what you're doing. You're giving them the opportunity to also have their name in lights. Let's talk about copying. Okay, so that was some ways to build the buy in. Let's talk about build how to promote copying, because it's another issue that we often get referrals for. Kids are missing their bus because they weren't done copying the homework, or they copied something down, but there were so many errors. You couldn't read it. They couldn't even read it. They know. They didn't know what they're what the assignment was. So knowing when you're teaching copying, this is the smhp approach to copying. There's a visual, auditory and oral component to it, and here's the strategy. So first the visual part, direct line copy. That means that the prompt, whatever is they're copying, is on the paper right above the lines they're going to be writing on. So everything's within the same visual field. They basically don't have to move their eyes. That's followed by a near point prompt, which is at the end of the desk. And I'm amazed how many times I'd go into a classroom and the kids kindergarten first, they're expected to copy something against to the far end of the desk, and you're asking for a gaze shift, or the prompt is off to the side, and now you're doing a lateral gaze shift, where the medial, lateral muscles of the eyes are expected to the excursion is different lengths. Okay, start with direct line near point at midline. It's now at the center of the back of the desk, or a little bit further away, even further, and then now it's at the board. So that's the sequence of copying distance that goes into this rubric distractions refers to what else is on the prompt. If you wrote on the chart, is just copying a single sentence from a problem. Might not be anything else on the paper, but maybe they're copying out of a book, and now there's a graphic or some other things that they have to copy now they gotta pretend they don't see it there. Maybe there's a lot of that kind of distractions. Maybe there's something that's written there, but it's a whole different context. It's not related to what they're writing, or maybe they are copying a sentence out of a paragraph, in which case the prompt is embedded in terms of visual cues. Is the prompt on the same kind of paper that kids are going to be writing? The writing on first grade adapted paper. The prompt is on first grade adapted paper. Maybe they also have a near point, a sample of what letters look like. Maybe they have an alpha triangle nearby, or you have a desktop alphabet strip that they've been referencing and they haven't destroyed at this point in the year. I just the same type of paper, but there's, you know, it says the same type of paper. Maybe the prompt is on third grade paper and they're writing on first grade paper, or vice versa, and there's a near point Q. Maybe it's the same type of paper, but there's no near point Q, no point, no reference. Maybe the teacher just wrote on the board and there's no lines at all, but you're giving them an alpha triangle, maybe they're writing on the board and they have nothing to reference. So maybe there's that. And then the other thing to reference when it comes to understanding copying is chunking. So chunking is language that teachers use when they are promoting fluency in reading after they teach kids how to identify individual sounds at a time, they teach them to blend those sounds, consonant blends, or consonant, vowel, consonant. Now we got phonemes, so that helps them to be faster and more accurate. And know that this is part of the written language production standards. If you don't know about that. You don't know about it yet because it's brilliant, and not in this short course right here, but you can download it from my website and learn about it. So chunking, it's divided into the number of letters that you copy at a time before you have to look back up to the prompt, or the number of words you have to copy before you look up to the prompt. And. 10 now, if the word is chunking, for instance, I see a C, I write a C, I see an H, I write it an H, I see a that's not very fast. I'm copying one letter at a time. But if I can see groups of letters, C, H, U, and then I write C, H, U, and then I look back up and I go, N, K, I'm doing three letters at a time. So no, the strategy to help kids, the the auditory and the oral strategy is to say it when you read it, say it when you write it. You kids need to hear it if they if you can't hear them, they can't hear themselves. So you may want to make sure they are sub vocalizing using that one inch voice. And now you watch their gaze shift. They look up. They say it when they read it. They look back down. They say it when they write it. Note how much they wrote before they look back up again. You're going to reach in with your red pen and you're going to scoop it. So this child wrote the words if the and then he looked back up. He wrote the words W, the letters, W, O, R, then he looked back up, D, S, then he looked back up. So if words are familiar, it may be possible copy 234, words at a time. If a word is especially long or it's new, they maybe just be copying 234, letters at a time. And then you go back and you tally how many individual letters do they cut copy a time? 1234, you're going to put it onto the rubric. So going back to the rubric, this prompt was on the board. So it was far point. There was nothing else on the board, no distractions. It was an online prompt. They the teacher wrote on the board, and there were no lines there. And then child didn't have an alpha triangle handy. And then I'm going to put all those tally marks underneath chunking, so that I know now you have data. Now you have data to use when you are scoring somebody's copying skills in terms of pushing in the student workbook is really helpful. If your school adopts a handwriting curriculum, they adopt size matters in the beginning, lots of practice on making different types of letter lines starting on green, stopping on red. Those are your standing tall lines, your slant lines. Sometimes note that the green is at the bottom because you have you can have some slant lines that go from bottom to top. Your Super C lines, smiles and frowns go forward and backward. Clock lines can be counterclockwise. Teach the kids about Super C and starting points and initial lines touch points, and then the rules for letter size one, two and three, and then stars and dice. And then you get up to an actual practice page. Looks like this in the Student Workbook, identifying the letter size. What size is uppercase F? Well, I don't make it hard, the entire alphabet is in pink. There's a pink box here. It says size one you're going to do the song and the dance. Identify the different types of letter lines. How many standing tall, lying down, or slant lines? And sometimes the answer is none. How many touch points are in there? Look at the purple letter. Count, touching, touching, touching, touching, touching, touching. Six mark, the starting point on the big purple letter. Trace the initial line. Which letter is star worthy and why are the other ones not? This is everyone's favorite section on the page, because they all look like F's. Only one of them is star worthy. The kids have to tell you why the other ones aren't. Do a little trace it, make it inside the long letter box. The kids play their own individual dice game. They rolled a four, they make four, they stop and score themselves. Now they can swap books with their neighbor, if, as long as they're kind and they roll the dice until they finish up. The lines. Note the Go lines and finish lines are here. There's a little coloring section. Note that the coloring sections are two frame stories. Starts on the upper case page. This is a frog catching fish. Ends on the lower case page. It's fish chasing after a frog, and they're intentionally detailed, even though I tell you that the the student workbook is a kindergarten level book, we don't write that anywhere on the book, because we do have older kids that are working at this level. The first year that schools districts adopt size matters, we encourage workbooks for kindergarten also, but the just the same. The cartoons are detailed because I'm promoting this, and if you're looking at my camera, I am promoting that mobility at my IPs, that push, pull movement, not this. So you just want them to call it cut. Just color in his foot, just color in the fish and model that movement. And if the kids need more practice, there's a series of activity books, 18 activity books that practice. Practice each letter inside of letter boxes. So that said. Now, are there any questions?    Jayson Davies     Well, there you have it, the one and only. Dr Bev, thank you so much. Dr Moskowitz, for sharing all of your valuable knowledge with us. We really appreciate it and just all the things that you are doing for well school based ot practitioners, but also other ot practitioners and the families that we all serve, and also thank you to well you for tuning in and enjoying this episode. Hopefully you enjoyed it, and if you did enjoy this learning experience and would like to earn a CEU for this course and dozens of other school based ot courses just like it. Please be sure to check out the OT schoolhouse collaborative at ot  schoolhouse.com/collab as an extra. Thank you for tuning into this special episode. You can use promo code podcast 167 to save 25% off your first payment of the OT school house collaborative, again, that promo code is podcast 167, all one word, no spaces, and it's the numbers 167, not spelled out. Podcast 167, really appreciate you tuning in today. I hope you enjoyed this one. I hope you are able to take some of these techniques that Dr Bev talked about today and implement them into your practice as soon as possible. Again, learn more about the OT schoolhouse collaborative at ot  schoolhouse.com/collab where you can earn your CEU for listening to this episode. Thanks again for tuning in, and we'll see you next time on the OT school house podcast.    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. 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

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 168 of the OT Schoolhouse Podcast. How can two school-based OTs have identical caseload numbers but vastly different workloads? This episode promises a fresh perspective on evaluating the true demands of our roles, focusing not just on the numbers but the actual time commitments involved. Join me as I introduce a new series of short, five-minute episodes designed to provide quick, actionable insights tailored for the OT Schoolhouse community. Together, we'll explore: • Misconception of measuring your caseload vs another • Understanding the significance of workload in daily practice • How different treatment frequency impact your workload • The implications of the 24-hour treatment threshold • A shift in OT conversations from caseload to workload So, let's break away from the norm and start asking the right questions to truly reflect the demands and responsibilities of our roles. Share your thoughts and let me know if this new format resonates with you! Do you know your workload? Resources 👉 Grab your caseload spreadsheet and identify your workload here. Episode Transcript Expand to view the full episode transcript. How many OT treatment hours are possible in a week   Jayson Davies    The schoolhouse community. What's happening? It's just me today. This is going to be what I hope will be an ongoing series of just quick, five minute episodes that I hop on here and do very, very briefly. One of my favorite podcasts that I listen to, they do this from time to time, and I really appreciate these short, actionable, kind of just to the point episode. And so we're going to try them out here at the OT school house and let me know if you enjoy them. So reach out to me via email or comment wherever you're listening to the podcast, or the Spotify Apple podcast, wherever it might be. Just drop a review or comment, whatever you can do and let me know if you enjoy these. So yeah, I'm just going to kind of go into it, because I don't want to spend too much time here dabbling around. So today I want to talk a little bit about caseloads and workloads. If you recall a few episodes ago, I kind of made this my focus for 2025 I just kind of wanted to re emphasize the difference between measuring your caseload and measuring your workload, and why, as school based ot practitioners, we need to get away from like that first question, sir, what we need a new school based ot like asking what's your caseload and comparing our cases, because you might ask someone what their caseload is, and they might say their caseload is 50. Now for the sake of this this argument or this discussion, we're going to assume that your case is also 50, right? So when you ask this other school based ot practitioner whether it's an OT or a CODA, and they say their caseload is 50, you are automatically comparing yourself, your caseload of 50 to their caseload of 50. And you're probably thinking, Well, my caseload is probably pretty close to yours, right? But that that might be true, but it also could be completely untrue. And what I mean by that is your caseload, which might be 50 kids at 30 minutes per week, and their caseload, which could be 50 kids at 30 minutes per month, are vastly different, right? You still have 50 IEPs to go to both of you on a given year, give or take, right? You still got 50 progress reports potentially that you need to do. However, when you break this down, your 50 kids at one time a week for 30 minutes comes out to 25 hours of sessions per week. And that other ot practitioner who has 50 kids, but it's 50/30, minute per month sessions, has 25 hours of treatment sessions per month. That breaks down to about six and a half hours per week. That's a big difference, right? Six and a half hours per week versus 25 hours per week, that that's huge. And maybe another ot practitioner has a caseload of 50 kids, just like the two of you do, but they see most of their kids every other week for 30 minutes. Well, now you're looking at 12 hours per week. So this is just why the idea that we are calculating our caseload by the number of kids we see just doesn't work. We're not comparing apples to apples and and this could be the same thing within your district, right? Like maybe you have five ot practitioners within your school district or your county of Education Office, whatever it might be, and you all have 45 to 50 kids. However, one of you leans more heavily on using a consult model, and two of you lean heavily on using a weekly model of treatment services, and the other two kind of tried to go the bi weekly route with a lot of kids. Not to say that you probably have like a mixture, right? You don't have all kids that are one time a week, but on average, maybe you lean one way more so than another. Therapist does well, your cases on paper, and as the district might see, them looks very similar, right? You all got 45 to 50 kids that that's pretty equal. That's pretty even, but when you actually break down the work that those 45 to 50 kids take, it is very, very different. So I guess my point today is, I think we need to stop asking one another, hey, what's your caseload, and instead start asking one another, what's your workload. How many treatment hours are you providing any given week? Or maybe you want to calculate it by month, whatever it might be, but we need to start keeping track of that number, the amount of time that we are spending in treatment any given week. I don't want to go too far into this in this episode, but if you're looking for a number, my number tends to be around 24 treatment hours per week. I think that is kind of the tipping point for school based ot practitioners. Anything above 24 hours per week becomes very unmanageable. You don't have time for evaluations, for IEPs, for any sort of RTI or MTSS involvement, basically you are just doing treatment. I mean, kids are only in school for about 30 to 32 hours per week when you calculate it all together. So that's about six hours per week that kids aren't in school, that you're also not providing treatment. And then your other time is spent, obviously, and documentation, meetings and whatnot. So So yeah, again, just, let's stop asking one another what our caseload is, and move on to asking what in one another, what's our workload, and how much time are we actually spending on treatment any given week. And then we can also ask what we're spending outside of those 24 hours, or whatever it might be, what else are we doing? I think that's a very important conversation that we're not having. So with that, I'm going to sign off on this very first five or so minute episode. Very little editing here, but yeah, again, let me know if you enjoyed this short little tidbit episode. I think it's going to be fun for me. I appreciate it. Sometimes, just not having a guest and and just talking for a little bit, it's going to be fun for me, but I want it to also be beneficial for you. So let me know, email, text, comment, concern, whatever it might be. Let me know any way you can, and I'd be happy to continue the song for you. Take care. Bye. 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

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 171 of the OT Schoolhouse Podcast. In this episode Jayson teams up with guests Karen and Heather to get into the transformative world of Psymark—a digital tool designed to revolutionize school-based occupational therapy assessments. Karen’s journey from school psychologist to a tech innovator, alongside Heather’s experience as an occupational therapist, offers listeners a deep dive into how technology is reshaping the way we monitor and support students' visual motor integration.  Discover the magic behind self-scoring iPad assessments that promise to simplify processes, provide teachers and therapists with precise insights, and potentially reduce referrals, all while laying the groundwork for essential interventions. Join us for an exploration of cutting-edge strategies making waves in the field of occupational therapy. Listen now to learn the following objectives: Learners will recall the components and purpose of the Psymark tool Learners will identify the specific visual motor assessment areas that the Psymark tool evaluates  Learners will be able to indicate some of the initial research and data analysis of the psymark tool Guests Bio Dr. Karen Silberman leads the team at Psymark after an extensive career in education serving as a teacher, school psychologist and special education director. Karen has presented at numerous conferences including AOTA, NASP, and CASP. As the mother of a child who struggled with visual-motor issues, she has an enhanced understanding of how visual-motor problems can impact families of children with learning differences. Heather Donovan earned her Master’s in Occupational Therapy from USC in 2012 and spent the first seven years of her career at a private pediatric clinic, gaining valuable experience in early intervention, insurance-based, and school-based practice. In late 2019, she transitioned to her current role as a school district occupational therapist at Mountain View School District in El Monte, CA. Through this position, she collaborated closely with Dr. Karen Silberman, and after Dr. Silberman’s retirement, Heather began beta testing and consulting with Dr. Silberman and the Psymark team. Quotes “Our first study was looking at differences between paper, pencil, finger, and stylus. And so, with that, we were kind of surprised at the results, but the results showed that there was no significant difference between paper, pencil, finger, and stylus.” - Karen Silberman, Ed.D., LEP “There is an overall accuracy score, and that is made up of scale, rotation, line consistency, and noise. So scale and rotation, everyone understands. Line consistency is how close the line that the person drew is aligned with the given line. Noise are those extraneous lines that are outside. “ - Karen Silberman, Ed.D., LEP “If they're newer, then maybe  I'll do all three. But if it's a student that I know that I'm really focusing more on the letter formation, then I'm gonna use the letters. In motor cases, I tend to use the letters more than the shapes and numbers, mostly because I see the shapes tools are great just looking at underlying visual motor skills.” -Heather Donovan, MA, OTR/L “We saw a 48% increase in kids in the proficient range for their visual motor skills.” - Karen Silberman, Ed.D., LEP /L Resources 👉 Karen Email 👉 Heather email 👉 Youtube training 👉 Psymark Website 👉 Instagram 👉 Linkedin 👉 Facebook 👉 Threads Episode Transcript Expand to view the full episode transcript.   Jayson Davies     Hey, OTP, Have you ever wished that your assessment tool, like the BOD or the VMI or any other tool that you use would just score itself? Well, that's exactly what we are discussing in this episode today. I'm excited to introduce you to a new tool that just might redefine how we assess visual motor skills. Seriously, this is one that I hope you actually look back on and get to say I am so glad that Jayson shared this with me, because honestly, I really do think that this is going to change the way that you do things. I also think that this is a tool that's going to change the way that all assessments do things. I was first introduced to the simmark app way back in 2019 at the OT Association of California conference, but now it is officially ready to help save ot practitioners and school psychologists and probably a few others, including teachers, time, energy and headaches. Even better, it can help us work with teachers to assist students before an IEP is even needed. Think. MTSS, right. Well, to help share all of this, I am joined by Karen Silverman, a former elementary teacher turned school psychologist, and Heather Donovan, an occupational therapist who's been in the trenches of school based practice and also who actually went to school with me back at USC together, Karen and Heather will help to share exactly how and why this iPad based tool is changing the VMI game. Specifically, we will discuss what the simmark tool evaluates, how you can use it as part of your evaluation, and how you can use it in an MTSS program to screen entire classrooms and provide supports to the teachers. So stay tuned as Karen and Heather share their research backing the SCI Mark innovation and how you can implement these tools to support your students and teachers. Let's dive in.    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     Karen and Heather, welcome to the OT school house podcast. I hope you're both doing fantastic, Karen. Let's start with you. How are you today?    Karen Silberman     Hey, I'm great. Thank you, Jayson, so much for inviting us to the OT school house. It's really an honor for us to be here with you today, and we really appreciate it    Jayson Davies     absolutely. It's great to have you as well. Always great to have someone who's not an occupational therapist on this show. It's always fun. I'm sure we will learn so much from you today, but we also have an occupational therapist joining us today. Heather, Heather, how you doing today?    Heather Donovan     I'm doing great, and I'm so excited to be here as well.    Jayson Davies     Awesome.Well, thank you so much for joining us. I'm excited this is going to be about 45 minutes or so that we're just going to have a good time talking about visual motor integration, talking about copying and drawing and all the fun stuff that we know goes hand in hand with school based occupational therapy. So to get us started, I want to give you both a moment to introduce yourselves just a bit. And going back to Karen for a second, I already kind of gave away the spoiler that you're a psychologist, but why don't you tell us a little bit more about yourself,    Karen Silberman     right? So thanks, Jayson, I started my professional journey as an elementary school teacher. So I taught all grades from first through sixth, and then I transitioned to become a school psychologist. And over that period of time, I also had kids of my own, and I had one of my sons who had visual motor problems, and that I saw a lot of impacts with his learning. And it was a, really a shock to me as a teacher, that I had trouble teaching my own son how to how to write, and that's really when I first became familiar with OTs and I can honestly say that an OT was one of the first people who really understood how to work with him and how to to help him with his needs, because he didn't fit into traditional categories. So anyway, after becoming a school psychologist, I kept going to school and moving forward in my career. So I got a doctorate and then moved ahead and became a program specialist and a director. Then I got to retire, because at the same time, we've been working on creating the tests, and I got to retire and devote myself full time to sim. So we're our goal is really in bringing accurate, self scoring, visual motor tests to practitioners in the field.    Jayson Davies     I love that. And yeah, I know I was introduced to Cy Marc several years ago when I first ran into and it was just kind of getting started before it was commercially available. And I just knew that the idea was fan. Fantastic, and that was before AI was even like kind of a thing. And now that that aspect of self scoring that you say that's huge right now. So we'll get more into that in a moment. But, yeah, I'm excited to talk about that. So Heather, welcome. It's great to have you and share a little bit about a your experience as an OT and also kind of how you fit into the Cy Marx story. Well,    Heather Donovan     I was actually in, you know, Jayson class at USC, and we graduated together back in, I think what 2012 seems like forever.     Jayson Davies     Think so too long ago now.    Heather Donovan     And, you know, I immediately started working at a private pediatric clinic, and I stayed there, I think, for about eight years, and it really was a great place to start my career. Lots of training and mentorship. I gained valuable experience in multiple settings that really shaped the therapist I am today. And then a position opened a school district job that I started at the end of 2019 and that's where I met and started to work closely with Dr Silverman. And then after she retired from the district job, she approached me about being a beta tester for simmark. And since then, I've basically been involved, like on a volunteer basis for the past two years, and my role has largely just been in formal consultation when I have time, of course. But similar to you, I recognize that the cymarg tools had so much potential, and I was really happy to be a part of it, even in a small way. And then more recently, I was also to I was fortunate enough to be involved in the pilot screener program for TK students in my school district.    Jayson Davies     Fantastic, awesome. Well, thank you both for introducing yourself for a minute. I want to jump back to Karen and we're going to dive deep into cymarg, but I do want to give you just like, what is that elevator pitch? Right? Like, the first time you meet an OT the first time you meet a school psychologist. You kind of gave us a one liner a moment ago. But if you had a whole, you know, 45 seconds, how do you pitch sidemark? What is it? What's the purpose? And, yeah, just go for it.     Karen Silberman     Okay, so what we have created the first ever Digital Visual motor tests on iPads that are self scoring convenient and give results in nine different areas within minutes, and the larger sort of pitch to this is right? We have three tools right now. They are shapes, letters and numbers, and these tools are for the purpose of them is to to do progress monitoring. So these are really progress monitoring tests. The exciting piece is that this year, we are coming out with two new tools. One is a screener, which occupational therapists are that we've talked to are very interested in because what the tool does is help to give scores within broad groups. So finding out where the child is, are they proficient? What range are they falling in, or are they in the intervention range? And with that, then they will also get interventions that that are can be used, and it's really a tool thinking of kind of MTSS or RTI to help prevent those referrals to OTs who are already overwhelmed, right? So, so that's our goal with the screener. Then later in the year, we will be coming out with standardized, standardized shapes test that can be used. So again, it's self scoring, and we're looking at standardization for ages four through seven. So we're super excited about this. And 2025, is we're looking forward. It's going to be a great year for Cy Marc, awesome.    Jayson Davies     I am definitely going to like tune my inner Mark Cuban right now and feel like I'm on Shark Tank and ask you some follow ups here, because you mentioned self scoring. How is it self scoring? Right? Like, we're very used to using the VMI, the berry, VMI, the bot, but those obviously are not self scoring. So how is this tool self scoring, right?    Karen Silberman     Well, so this kind of gets into how we developed in the first place. Because just to kind of back it up a little bit, this actually started when I finished my doctorate, and one of my professors approached me and one of my fellow students and said, we want to do research. But then so we said, Great, yeah, let's do research together. And when we started looking into it, we said, you know, why are we still using rulers and protractors to score when there's this incredible. Technology that does everything else. This was years ago. Jayson, this was years ago, and so so with that. Then we both have kids that are techies who are now adults and working in technology. And we went to them and said, Is this even possible? Is this a possibility? And they were like, Yeah, easy peasy. Nothing has been easy peasy, right? Nothing has been. But so your question of, oh, how is it self scoring? It's highly complex, actually. And we got a patent in 2021, for this. So I wish I could tell you, in a quick, easy sense, oh, this is all it is. No, it's actually super complex to talk through the scoring. What I can tell you, though is that it's taken a lot of iterations and years of work to put this together, to make sure that the scoring is accurate, and the scoring in all of these nine different areas. So it's complex and it's but what we want for you to see on your end is to make it look like it's easy. Because when you see it, it looks like, Oh, that's easy, right? Oh, I'll just copy these shapes, and then, oh, there are the scores. There's a lot happening on the back end that are is measuring each, each piece of what, what the examinee is doing, so that it's measuring the speed, it's measuring how far away your line is from the line that's given it's measuring the rotation and the scale, like all of these pieces are being done simultaneously.     Jayson Davies     Yeah, yeah, it is quite a feat. I've played around with it a little bit, and I think we'll go to Heather with this next question to kind of give us an idea of what it actually looks like to use. I don't even know if we've mentioned yet that this is an iPad app, or a series of iPad apps. So everything is done 100% on the iPad. And so Heather, if you want to kind of, really briefly, kind of, I guess, almost in a way, share the experience of an occupational therapy practitioner using this tool. Like, what does it actually look like for the OT to use it?    Heather Donovan     Well, basically it's like an app, you click on, you open, you enter in the student's demographic information, and then, and the first page has a lot of other information, like on how to use it, and updates and all that kind of stuff. But basically, when you start the assessment, it's very plain and very easy. It's like the top part of the iPad has a shape, and then you just prompt the student to copy it below, and then you hit Next, and you do that until the assessment you get through all of the test items. And it's incredibly short and brief and easy to use. That's basically how I would summarize it? Yeah,    Jayson Davies     I mean, the copying a shape that is on the top of the page to the bottom of the page sounds very familiar to us who have used many tools, but obviously it's very different in the sense that we're not using pencil and paper. One thing that you said you copy it right, but I didn't hear you say was, is this using a stylus? Is this using a finger? Does it matter? Does it have to be an Apple pencil because it's on an iPad? What about that?     Heather Donovan     Well, it's funny, you should ask, because that's been a big discussion point in some of our meetings and talks, because, interestingly enough, they did kind of a study looking at using a stylus and using their finger, and what they showed the results were the same. So which I thought, well, then you're really you're eliminating the tool use part of measuring the visual motor skill. So in a sense, like when you're using your finger, you're really looking at the ability to copy the shapes, versus managing the tool and the grasp and all those other things that also goes into writing. So then it's kind of like, I just thought that in itself, I told I told Karen. I was like, That is actually a really interesting finding in itself, that the there was no difference of using the stylus versus the finger. So when it comes to use for me, I'll be honest, like, I really it's a case by case basis. Like, sometimes I'll have them use their finger, and sometimes I'll have them use the stylus, depending on what I'm trying to look at when I'm using it as a progress monitoring tool.    Jayson Davies     Interesting, interesting. Like, I'm currently, I know if you're listening on the podcast, you can't see this, but I currently have a right, right stylist in my hands, which hands, which I don't know, it's just sitting on my desk. And I was like, Oh, hey, I'm gonna play fidget with this. But anyways, Karen, do you want to add anything to that, whether it be your original intentions or kind of what you're seeing now, actually.    Karen Silberman     You know that was our first study, because we thought we Why move forward? With this, if we're seeing these drastic differences. So our first study was looking at differences between paper pencil, finger and stylus and so so with that, we were kind of surprised at the results, but the results showed that there was no significant difference between paper pencil, finger and stylus, and so that's why we're saying, Yeah, you can use either your finger or or the stylus. What? When I get into this a little more later, but Heather and I were, we actually worked with some TK teachers in the Mountain View School District. Mountain View wanted to use our tests as a screener. And said, you know, we love these tests. Can we just give them to all of our TK students? And we said, Yeah, great, absolutely. And so, so Heather and I collaborated on that, and so we had the teachers do the testing and then talk to them about, you know, what, what did you find with this? And the teachers decided, together as a group, we want all the kids to use just their finger. Wow. Okay. And so we said, okay, that's fine. And so then with the results, when we asked them how, how did the results match what you're seeing in the classroom? They said, Oh yeah, this is, this is exactly what we're seeing in the class, where those kids who felt in the intervention range, yeah, those kids definitely need support. Those kids who are proficient are good. We have some kids though that their handwriting is not very good, but we're How come they did well on these tests, right? And so then we could talk to them about grip like, this isn't really a visual motor problem so much as how are they holding, right? So it really prompted this whole other conversation, yeah, with them. So that's kind of a longer answer, but that's what we're finding, is that it's really because our tools are looking at that visual motor piece, and so is it really a visual motor problem, or are there problems with grip?    Jayson Davies     Right? That's exactly where my head was going as you were talking right. Like you think about the other tools. You have to use a pencil, unless you're going to put, like, finger paint on someone's finger or something. I'm like, let them paint right like, you have to use a pencil, and therefore you are no longer segmenting or focusing in on the visual motor aspect. There's so many other aspects going on, and so that could be a limitation. We all you know, think about tests for other purposes, but you think about the motor free visual perception test, but here it's still motor right? You've got to use your finger and you've got to do that, but you're reducing one factor in getting a true visual motor score, as opposed to a fine motor, visual motor score, or whatever you want to call it. So interesting. Very, very interesting. Heather, have you ever tried this like, Have you ever used had a student use it with their finger and then a few minutes later try it with the stylist to determine if there's a difference?    Heather Donovan     Not like, a few minutes later, usually my sessions are I'm limited on time, so it's kind of like, you know, let's move on to something else. The other thing that I've talked to Karen about, too, is the importance of generalizing the skill. So it's kind of like, I want to see like they're showing me this on the iPad, but then can they generalize that to the paper? So I'm always making sure I'm using kind of a combination of both to look at that. But to the point of your question, it would be fascinating to kind of play around and see that more, but I haven't done it myself.     Jayson Davies     Yeah, obviously the research that you both shared a little bit about earlier shares that in general, the vision visual motor skills are are similar, but for an individual child, right? If we do that visual motor test, and they do come out average, and then we kind of have that inkling, hey, maybe it is the pencil grip, or maybe it is their fine motor skills that are impacting them. We could almost do the same test now with a stylist, and that would be very interesting results to take to an IEP meeting and say, hey, look, we did this with just their finger. They did great. As soon as we involved a pencil. Not so much. And so now we kind of know which way to lean when it comes to IEP goals and interventions and all that fun stuff. So fantastic. Karen, is there anything else you want to share before we kind of move on about the development and kind of where, where it started? I'm sorry, the started from the bottom. Now we hear kind of lyrics came into my head just now. But anything else you just kind of want to share about the development or kind of the background behind this?    Karen Silberman     Yes. Well, what I can say, let me, let me think about it, but, but with this, what I can say is that research has really always been at our core, that that's how we started, and so that's that's always been where we are with the development of it too. We started. We started as school psychs thinking, Okay, we're gonna create a test that's, you know, on the iPads, self scoring, thinking about school psychologists honestly, like, okay, great. And then we took it to conferences as research and school psychs and other parts of the country said, we don't do this kind of testing. You know, our OT does the all the visual motor testing. So that's when we started talking to OTs and going to OT conferences. And the OT said, Yeah, we love this. This is great. And what we really do is work with kids, with letters and numbers like, that's what we do, generally. So can you create tests for letters and numbers? And so we said, Yes, we can, right? So then, so we created those tests, and with those, then we also involved another occupational therapist, Heather has been really fabulous to work with, and has done a lot of consultation with us. Kimberly Coates is another one who has worked closely with us, and she actually designed the font for our letters and numbers so and we got recommendations from them on what letters we should use. So it's a it's a mix of letters that involves all of the important lines that you're looking at, vertical, horizontal, you know, diagonal circles. So we work closely with them. So that's how we then created letters and numbers. We brought that out, but then the next thing we heard was like, you heard from Mountain View. Then we started hearing from a number of districts and different agencies. Like this is great. We just want to use it on all of our kids. So can we do that? So we said yes, but what we found out was the teachers really couldn't understand the results, because OTs and psychs are used to looking at a list of numbers and being able to interpret that, but teachers look at it and say, That's interesting. Now what right? So with that, then that's where we went to the screener. So that led us into the screener so that teachers would have this ability to use it on their whole class, and they could develop it or create, you know, use it with their whole class. So that's an in Mountain View. That's where we started working with them that way. There are now a couple of other districts that we've done the same thing with, and so with that, then, right now, it's been all by hand. We're going through the numbers and then creating groups for the for the teachers, and then giving them interventions, because that's what they were asking for. So I can tell you, from the cymark end, we're always listening to our customers. We really want to know what people think of it, what they're asking for, and then coming out with it. So then later this year, we will have enough data so that we will be able to standardize because people have been asking that really, since the inception, fantastic. Is it standardized? You know, that's always the second question. And so we will be coming out with that later on this year. We're looking at probably late summer, when the standardization part, yeah, so that will be ages four through seven. So it's been a journey, I can say. And it hasn't been a journey. It's something. When you create something and you put it out in the world, you may think you're doing one thing with it, but then how people actually use it and what they want like it, you know, we we really have listened, because it hasn't been the path, honestly, that we necessarily thought at the beginning.    Jayson Davies     Wow, yeah, I'm excited for the standardization. I honestly, you told me about this, what, maybe about four months ago or so, that you're kind of going down this venture. I didn't think it would be relatively soon. I thought I'd take a lot longer. So congratulations on that. Let's talk about that, though, in a I don't know, in my interactions with especially school based occupational therapy practitioners, I know your your people are definitely more than just school based ot practitioners. But to some degree, there is this idea that we don't. Need standardization tools, then, you know, let's not get into that discussion. But that is still great that you're doing it. Because, I mean, even if it is standardized, you can, you know, you'll still get data from it. But you talked about there being nine different aspects that this test looks at. Can you share a little bit more about that, and maybe briefly, at first point out, are you looking to standardize or get standardized scores for all nine or just a few?    Karen Silberman     Yeah, we are looking at all nine different areas. So with that, then the different areas that we have so there is an overall accuracy score, and that is made up of scale rotation, line consistency and noise. So scale and rotation, everyone understands line consistency is how close the line that that the person Drew is aligned with the line that was given noise are those extraneous lines that are outside. So I like to say that, you know, when you ask a child to draw a circle and then they make a happy face, so it's those which everyone any OT, I'm sure, as a psych, I saw that, so you see that. So those are the pieces that make up the accuracy score and and so you can see all four of those. The other parts of it are those we give right now as raw scores, because that we find as being more helpful to people. So it's that contact time, how much time was your finger or stylus in contact with the iPad. It also measures speed, so in centimeters per second, and it's measuring the line speed consistency. So was it back and forth line? Or, you know, were they going back and forth a lot, or was it a really highly consistent line? So these are some of the, you know, the overall scoring that we're we're looking at. So definitely the accuracy score and those pieces that make up the accuracy score will all all be standardized. What I can say is that we will still have available the progress monitoring, which is not standardized. Because, yeah, I've heard from ot some of them, you know, they say, Oh, we can only use standardized measures in our district, whereas others say, I don't care about standardized. So, yeah, exactly so, so they can use either or, and everyone understands the numbers with standardization. When it's not standardized, it takes a little more time to work through that. That's what that's what we're finding.    Jayson Davies     Yeah, wow, I just again. It kind of blows my mind, because we're so used to scoring tools by hand, by eye, maybe with a little clear layover that tells us if something is a centimeter you know, away from the line. And it's just amazing, because not only are you able to get quote, unquote like the accuracy scores, but you're able to get so much more information than just whether or not the shape looks like the shape is supposed to look like you're getting so much more than that. And again, that's something that you know you'd only get with with technology really quickly. Karen, yeah, sorry, when you first thought about this app, what were you hoping that it would be able to do?    Karen Silberman     Well, we had the idea that it would be self scoring and give people really precise information that you can't get, because here's the reality, and I can't speak for OTs, but in general, school psychologists, I don't want to throw anybody under the bus, but me right when you're out There assessing so many kids and you've got the the VMI, and it's just like, okay, you know the one zero, yeah, it looks right. It looks right. Hey, I'm, I'm guilty of that. And so, so there's the eyeballing approach. And so we thought, is this and and honestly, for school psychs, it's kind of like, okay, I did that. I had to get that done. So is there a way where we can provide people something that's really precise, very accurate, and is helpful? I mean, that's all. That's our bottom line. Is this helpful to the practitioners, which will then be helpful for kids, because visual motor has real life consequences for people, as I saw with my own son, and so any tools we can have to really better understand that to be able to support our students and our clients that way. Okay, that's, that's honestly our aim, so, so that that's where we came from, we didn't come from, and we want to have nine different you know, that was all through, honestly, it was through testing. We've done years of testing and looking at data and like running through it and running through it so so many times, that's where all of that came from.     Jayson Davies     Yeah, wow, wow, yeah. It just baffles me what we can do with technology. But it takes someone willing to go out there and spend 567, years making that happen, because it does take time. We appreciate it. Thanks. Going to Heather. Now, how does the use of digital tools like sidemark or or others, if you want to speak to anything else that you that you've used, how does that enhance your assessment process? Or has it changed the way that you've assessed? Is it still pretty similar? You just swap out one tool for this using sidemark? Or how has it basically improved or changed the way that you do evaluations?    Heather Donovan     Well, you know, I think having any assessment that is more efficient and quick to administer is great, but then the scoring piece kind of, what Karen was hinting at, is really the big one, right? Because I did a time study recently, and I think I spent 60 to 90 minutes a week scoring assessments, you know? And it was just, well, that was, that was during that time, it was very evaluation heavy time of year. But it just made me think, I'm like, Yeah, imagine if these things just score themselves much easier. And I do know that a lot of assessments are moving in that direction, right? Like, I think, like the Q global, like, you just enter it in and it scores, that kind of thing. So as far as this tool, you know, enhancing the assessment process, I would just say, like, having something that is more efficient and more accurate, of course, enhances it right so, and I describe it as, we all have our toolbox of assessments that we use, depending on what the you know presenting concerns are, and that's this is just one to have On your toolbox right as part of that assessment process. And if it's quicker and easier than some of the others, then I'm all for it.    Jayson Davies     Yeah, yeah. And really quickly, remind me again, like when it's self scoring itself, does it take, like, you know, 30 minutes to process everything, or is it pretty darn instant?     Heather Donovan     It is pretty darn instant. I mean, I think it depends on your internet connection, because there's got to be that communication back and forth. But yeah, it's, it's pretty, pretty instantaneous. Yeah, wow.    Jayson Davies     So are you able to save those results or email them to yourself so you have them for later? Or how do you kind of, obviously, we don't write up our evaluation like in the moment that we see the kids. So do you just email it to yourself or?    Heather Donovan     Well, it's in the app. So I just Yeah, and I don't know Karen could probably speak to because that's the other thing. She's already mentioned this but she is, she's definitely, she's right that they take the feedback from what people say. And I say that because she's constantly they're making changes, but it's for the better. So she's like, how can we make this easier for people? So So, yeah,    Karen Silberman     yeah. So you can upload all of that, so just to let your listeners know too, the results that you get, it takes, typically three to five minutes. And so you can, as you're waiting there, it's scoring as long as you have Wi Fi. So you have to have Wi Fi to enter the demographic data and save that, and you have to have Wi Fi to score. So if you're in a location, because I know some districts I worked in, maybe there was Wi Fi at the district, but then it was really hard at schools. So as long as you you can administer the test without Wi Fi, and it will save that data. So then when you get to Wi Fi, you can score it, and once, once you score, it, it takes three to five minutes for scoring. So part of what comes up with the scoring is you get a graphic display. So we have two graphs, one one for the individual test results. So that's a bar graph, so you can clearly see differences in the scoring. And then the other one is a line graph, because it's progress monitoring, so you can see over time, how that student has done in all the all the different areas. And they're color coded, so we chose colors that people, even with visual problems, will be able to see. So. So that you can you can see, oh, what the accuracy score is. That's blue up here on my line graph. And you can highlight which areas you want to look at. So that if you're in an IEP, or if you're meeting with a teacher or parent, you can quickly and easily show them on the iPad what the results look like, but you can also download that so that all that information can be downloaded into your report from the iPad.    Jayson Davies     I love that. I just think that it's so nice that you can, like, go to an IEP and just copy and paste that, that bar chart into the IEP, and then a year later, if you are you know someone who does little like one, two page annual reports, like just an update on their goals, you can show you know the progress over time with a little chart from there. So that just makes our lives a little bit easier, and it also helps the parents right? Like we talk about data all the time, but I just find that at the end of the day, ot practitioners, we're getting better, but we're still not the best at showing data. A lot of other people are better at showing data than us, and so anytime that we can easily show data that that is just fantastic. All right, we're going to get into the interventions. But Heather, when you're using this tool to kind of look at the progress that a student is making. Are you typically using all three? Do you feel that you need to use all three, the shapes, letters and numbers? Or are you just kind of picking one or one or two? Or how does that work for you?    Heather Donovan     Yeah, no. So I it depends on the kid and their age, or, kind of like my experience with them, if they're newer, then maybe I'll do all three. But if it's a student that I know that I'm like, really focusing more on the letter formation, then I'm going to use the letters. In most cases, I tend to use the letters more than the shapes and numbers, mostly because I see the shapes tools are great just looking at underlying visual motor skills, right? Whereas for the letters, I'm really tracking the progress of that student's ability to form letters, if that makes sense.    Jayson Davies     Gotcha. And remind me again, how many earlier you talked about, like trying to figure out what letters to use and whatnot. And so how many letters does it go through? Does it go through the entire alphabet? Or Yeah. So    Karen Silberman     we have 16 different letters, and it's a mix of upper and lower case. And so with that, we did go to Heather and Kim and ask for their advice on what they what they advised for us. And so we we picked the letters that that they were advising, so it's a mix of these, but we didn't want to have, we didn't really want to have this wrote a, a, b, b, really. So we we wanted this nice mix, so it could really look at different letters, but give you the information that that you need so that the test itself is giving you this, this look at the child and what their abilities are, without having it a really tedious, long test for the child to sit through. So we have 16 different letters, and then we have the numbers zero through nine.     Jayson Davies     Okay, and kind of a follow up on that. Then we talked about the assessment piece, like the nine different areas that it's looking at. Are we finding in general, or do we not know yet if a score, if a child scores, you know, a certain score on the numbers, they're likely to score similar with the letters. Do we have any data on that yet?     Karen Silberman     Well, you know, so we do have other schools and districts that are using this as screener tools, and so we are getting a lot more data now that that is coming in, which is fantastic for us. I would say overall numbers for kids tends to be kind of an easier test. And kids tend to be, you know, you're seeing slightly higher abilities, and in the on the numbers test letters would run a close second to that shapes like Heather talked about is really tapping in. There's more cognition involved in shapes. And so with that, then you're really tapping more into those underlying visual motor skills. And so when you give all three, then you are I think it's a really nice look at kind of overall how the child is doing. And so that's, that's what we have been using with as screeners, like they, they give all three now when Heather and I work. Together in Mountain View the district, they wanted just letters and numbers to start with. And so the teacher started with letters and numbers to look at that. And then the interesting thing about that experience was in meeting with the teachers, and this is really, I think this is very unusual. Jayson, the teachers were so excited about it that they asked to give the shapes test. So this is not typically what teachers want to do is do more testing. But they they were really excited about what they were seeing with the kids, and so they said, Can we give the shapes test too, so that we can see that part two. So what, what we saw, though, with with that, with that group of teachers, was overall, broad success. So all of the kids did better that after, after eight weeks, we were seeing this, this wonderful success with the kids. The teachers wanted to continue it another four weeks to finish out the year. So we did that. So after 12 weeks, what we saw was kind of like all boats rose. Everybody did better. The exciting part about it, though, was we saw 48% increase in kids in the Proficient range for their visual motor skills. And so it was really a great success with that.    Jayson Davies     So first of all, two comments, and I think we'll, we'll head into the screeners versus the interventions next, just because that's where we're already going. First of all, I did not think that the shapes would potentially be more challenging to a degree, it almost sounds like more cognitive load than the letters and numbers. You almost think about that being opposite given the developmental stages of writing. So that's very interesting. But I guess by time you get into kinder, first second grade, kids are doing a lot of, a lot of writing, of letters and numbers and maybe less shapes at that point.     Heather Donovan     Well, and yeah, and I'm sorry, I just want to point out, though, when we're talking about the shapes assessment, you know, like, some of those shapes on the VMI, they're not, we're not talking Like, triangle, square, circle, you know, we're talking they get to some pretty complex shapes that some of these students have never seen before, but that's kind of the point, right? You're trying to see if these students can look at something they've never seen before and then copy it, you know? So I think that's why that particular assessment is probably more challenging.     Jayson Davies     Makes sense.    Karen Silberman     Well, yeah, she's exactly right. And it was done intentionally. Jayson, so the shapes test was intentionally created so that we do have a higher ceiling than, like the VMI, where the VMI, I mean, I was a psych at the high school for a period where I, I did not use the VMI on those kids, because it just it couldn't give me any more information, so I used other measures with them. But what we did was create this higher ceiling so that this can be used on on an adult population, so that if you're looking at someone with Alzheimer's, or, you know, other kinds of issues that could be coming up, we want to be able to target those, those higher ages and kind of more ability, so that as people Age, then it's still a strong tool to use, yeah,    Jayson Davies     the, I think it was the very last tool of the ravma still haunts me, like the 3d l looking shape, whatever it is, yeah, so that that's great that you were able to raise that ceiling. I think that's important. You want to be able to show true ability and not max out at a 3d square or something like that, which kids actually do work on sometimes in school. So awesome. All right. Well, let's lean into the screen, air tools. I feel like you've already teased this a lot, and we talked about a little bit, but I'm really excited, especially Karen, by what you were saying, where you've already seen teachers using this they want more, and that everyone is showing growth. So I think let's start with you mentioned that it includes letters, shapes and numbers. Does it include the whole gamut, or is it like a subsection of those,    Karen Silberman     right? And just to be clear, so the screener we had hoped it would be available. Now it's because I said it's really complex to create this stuff. We've actually had to push it out. We're looking at a March 15 date. Now I'm not sure you know when this airs, but that's, that's when we're looking at the launch date for it. Um. Um, the screener tool does involve letters, shapes and numbers. It's all three in the test. And with that, then the teachers will get or OTs. Actually. OTs are really interested in this too, and we have had OTs who have gotten so frustrated with their referrals that they've gotten. They said, we're just going to take the simmark test before we created the screener. We're going to take this and give it to all kindergarten students, because I'm so tired so but then it's, it's a lot for them to, you know, take in all this data and and then really look at the whole class, so we've helped them on that end. But what the screener tool will do is to do it automatically in the app. So what you'll get is, for each child, those individual results. So what range is the child falling in? And then it will explain that range. It will explain this child's strengths and weaknesses, and then it will give interventions. Now that the interventions, and this came directly from being asked by teachers. Okay, this is really interesting, but now, what do I do? Right? And that's why having Heather there was so incredibly important, because what, what we did in Mountain View was Heather. Could say, these are the interventions I recommend for all, all kids, you know. But some teachers said, Okay, I'm going to use these just with my intervention group. Some teachers said, I'm going to use it across the board. The exciting news we saw, you know, like growth with everybody, but the interventions are not super complicated. They're things that teachers can put in place, but it is targeting for that child, those individual results. So if they're having problems with rotation, it's going to give an intervention that directly works on rotation or scale, whatever it is, and then they can see their whole class list and say, Okay, this is how everybody did, and look at it that way. Or they can go in and look at individual results,    Jayson Davies     wow. Okay, I was going to ask you that then, okay, does it give you, like a whole class picture or individual, but it's both. It's both. It's both. Wow, yeah, sorry. I'm processing all of this right now because occupational therapy practitioner, I'm going to focus on on that, obviously, because that's who I know when I talk to you. Have two very different trains of thoughts when it comes to screening processes. And I'm sure both of you have kind of learned this over time, right? You have some people who think of a screening as almost a precursor to an evaluation for an individual student, and then you have the other, the other train of thought where a screening process is like the entire classroom, it's for a larger population, not an individual. And I lean toward that second aspect, where a screening is designed to be for an entire population. And so when I talk about screenings, I often talk about an occupational therapy practitioner going into the classroom and kind of getting a general sense of the entire classroom, not an individual student. So I like this because as an OT consulting with the teacher, if they've done this tool, they can a send me the results for the entire classroom, and I can provide general strategies. But if they they being the teacher, screen the entire classroom, they now have some data to share with me about an individual child as well if an evaluation is warranted, therefore, I am not needed for the screening process, per se, only to help them with the interventions which we're going to talk about in the moment. It sounds like Heather's already done some of that, but it takes out that need for me to go in and observe Johnny right like before he's on an IEP and kind of determine if he needs an OT evaluation. It's kind of this tool, to a degree, does some of that. So yeah, I know there's no real question there, but I'm just kind of giving my thoughts as to what I'm thinking about as thinking about as as an OT practitioner. I don't know if anything I said led to something you want to say. Well,    Heather Donovan     I wanted to I, you know, school districts, they use these kind of tools for other areas, right? Like, I ready Dora Adam to monitor things like reading, literacy, math. It highlights all these different areas on what they can do. And all these tools kind of come up with interventions, right? The intervention groups and who needs to work on decoding versus comprehension, and so it's, I just kind of see this toll similar, but looking at the visual motor skills side of it, right? So that's kind of how I would how. Yeah, I guess that's kind of how I visualize it being used. Yeah,    Karen Silberman     yeah. I mean that that is what we're looking at. And when we talk to school districts about it, we talk about research. Like I said, we are always going back to research. So the research, there's a high correlation between visual, motor skills and reading. So if a child is having visual motor problems, then there may be other kinds of problems with reading. This is also we're looking at this correlation in that in the state of California, starting this fall, all districts will have to give dyslexia screeners. So this we're looking at Cy Marc as being a tool that can go hand in hand. So we're looking at the teachers can look at dyslexia along with we're not calling it dysgraphia, but it's really like we we know that these two pieces go hand in hand, and so, so it's really giving that information about the individual child, but also, like as a group, how are people doing? And also, I think what's important to know too, is that our what we're looking at for our norms too, when we come out with the standardized version is that this will be post COVID, you know? So these are all post COVID norms. The norms from the VMI are the most recent ones are from 2010 and so when you look at like, Okay, what, because we, what we've seen, too, is a change in kids, visual motor skills, even since COVID And so our our norms are going to be very, very accurate in terms of what's happening now.    Jayson Davies     Wow. And Mrs. Smith or Mr. Johnson will like, immediately know whether or not the students one standard deviation, two standard deviations, or however you want to, in the 25th percentile, 17th percentile, whatever it might be. And the occupational therapy practitioner can work with the teacher and say, hey, if they're in the 25th to 40th percentile, use the interventions. If they're in the 10th percentile, let me know. Contact me. I want to be more impacted. Yeah,    Karen Silberman     and that can be, that can be up to the OT or the district however they want to manage it, but it will show those kids who, yeah, the intervention ranges that lower 10th percentile. And what Heather and I saw was that lower 10th percentile, Heather already knew most of those students, right. Wow. So, so, yes, so that's, that's what we're we're aiming for    Jayson Davies     quick side note, how often do you hope or think that you might be able to update norm?    Karen Silberman     Well, because we're the data is being collected constantly, then the norms, what we're looking at is really probably every year or two years that the norms can be updated, because as that data pool grows, then it will, you know, they will shift slightly, right, slightly, so we're not going to make changes for really tiny differences. But that that's another benefit of of the technology, is that we have this constant look at the changes, and so we can look at while the data is there's we're really highly aware of privacy, and so it's all disaggregated. We're not looking at any individual child or person, but we can look at the data as a whole, and then be able to see how how different ages are doing, and we will be able to compare that over time.    Jayson Davies     That's just mind blowing when you when you consider that or compare that to traditional pencil, paper assessment tools and whatnot, and a lot of tools end up, I don't want to say they die, but they end up no longer being used because they don't have updated norms, or the fan base is very frustrated that they haven't updated norms, and so that kind of is going to, for the time being, completely eliminate that difficulty with you, because you can, with sign market can, you can update it as necessary. So. So fantastic. Wow. I want to get into the interventions, but before I do anything else related to the screening process that we haven't covered.    Heather Donovan     So one of the things that I had brought up was, you know, the administering the test super fast, administering the scoring super fast, entering the demographic data. That's what was kind of the challenge for the teachers, right? They don't have like to like as an OT or assessing one student at a time. It's easy, you know, to enter that stuff in, but for a teacher to have to enter it for all of her students, that's a lot. And so I don't know if, Karen, you want to speak to some of the ways you're addressing this.    Karen Silberman     Yeah. So again, we're always listening and, and we're looking for stops, right? Like, what is the stop? What? What is the challenge here? And, and so it became apparent to us where, whereas OTs and psychs, we're used to entering demographic data for individual kids, but an entire class for a teacher is really time consuming, and especially if we want a whole all TK or all all tk to second grade teachers. So what we've done is that we would, we've developed a secure tool for districts to upload their data, so that will be part of the screener as well. We're going to have a toolbox that comes out with the screener, and part of it is that they will be able to upload their data all at once into a secure portal that then is sent to our team to download that data so that they when the teacher opens her iPad, her students are already there. They're already there, ready to go. So the easiest way to do that is to work with the tech department in any district so that we can upload that information. First, get the teachers ready to go, and then they will they will be able to access their their students. The other thing that we've added in to the screener is that teachers will be able to then after their school year is over, they can delete that class so they can bring a new class on board, but along. So that's one of the pieces that will come with the screener. And as I mentioned, we'll have a little toolbox. Because the other piece that we're finding is it's great. I love going out and training and being there in person and working with people in person. But the reality is now we have people in Rhode Island and in Massachusetts. And, you know, like, I would love to fly to all these places, but it's just really not feasible. So, so what we will put out with the toolbox, is what we're working on is, so when you first open the screener, it will have kind of an intro into this is how it works, but it will also come with a little training video, and then the ability to, you know, all their data will be uploaded. So we have all of these pieces, and they'll get a manual. I forgot the manual piece, so there will be a manual, like all of these pieces set up for teachers to be successful or OTs. Because, honestly, what I mostly have on my list of people who are, I've got a waiting list for the screener, are OTs. So we've got a lot of OTs just waiting to get this going in their districts. Yeah,    Jayson Davies     I think you're going to have a lot of OTs that that test it out, love it, and then fight hard for for the teachers to start using it and the districts to start using it. I'm assuming this can work both ways, but you can either pass one iPad around or log into several iPads and have all the kids take it up once. Or does it need to be one iPad kind of be passed around.    Karen Silberman     It's really it. So what? It isn't? So I should clarify this. It's not on the kids iPad. So if you have a class where, oh, all of my kids have iPads, it's not, it's not, it's really not for the kids to have. It's on the teacher's iPad. So the teacher's iPad. So maybe the teacher, and if she has an assistant, then they have it on their iPads, and they do what we've done with the testing, because I have a school that said we really need help with the testing. So we went in, helped with the testing. And again, at this point, we can do this, because we're, you know, yeah, but with that, what we found is you need to have a small group, so a group of kids, maybe three, maybe four, depending. I found, you know, kindergarteners can be well, like we saw with your son, right? They're very, very busy. And then you you have them go through the testing that way. Yeah. Yeah, so it's very fast for the kids. The kids have no problem with it. And I can say too that with our tests, we have OTs that have said, this is the only test where I've gotten any kind of result where if the kids who maybe are in the specialized autism program where they're not using any kind of pencil or paper, they refuse and have all kinds of behaviors. They can give them the iPad and get some kind of results to see, you know, how, how the child is doing. I love    Jayson Davies     that, because I kind of envision right like a paraprofessional or even the occupational therapy practitioner coming in, potentially sitting at the back table and just kind of one kid at a time, really quickly comes over five, seven minutes, whatever it takes, next, next, next, maybe it has to happen in three different sittings, but relatively quickly still. And to be honest, as an occupational therapy practitioner, I would probably be happy to help a teacher get this done, because I know the impact that it will have on potentially reducing my referrals. It might allow me to better support the teacher, so that I can again reduce the referrals that I get and help more kids at the same time. So with that, you did talk about some of the treatment piece side of things. And so when you get a screening results back, it sounds like you get a individual screening for individual student, but you also get the full class screening results per se. So when it comes to the interventions, is it more based upon the full class? Is it more based upon the individual or both? No,    Karen Silberman     it's individually based. So the the interventions were developed and actually ran them by Heather and our other OTs, who are, who are advising us. And the interventions are, are specific to the individual child. And I can say the interventions, though, are things that you could do with the whole class that they're nothing, they're not what an OT is going to pull out and do, like, really specific, but it's specific enough for that child where this is where they're having trouble. So this is an intervention that you could do with the trial,    Jayson Davies     gotcha very cool. And, Heather, I don't know if you have anything to add, kind of just what it's looked like for you. As OT,    Heather Donovan     yeah. So one of the things I noticed with the tool is, I don't know that a lot of the other assessments look at speed, right, the importance of and how that impacts. And what I noticed is that a lot of my kids, I'm like, they are just too fast, you know, and there's a lot of nuance reasons for that, like it being non preferred, or they have a hard time with mid range control or grading force, and, you know, they're just wanting to get it over with. But still, it made me realize, well, yeah, these kids are all just kind of rushing through. They're not going to get that distal control. So I say this because then it made me design more interventions that work on getting kids to slow down right. It's just and really working on that precision, the start stop. And then I also I did it on a larger scale. So I, once a month, I go into all the SDC classes and do like a full class lesson. And so this last month, I did it and targeted going fast and slow, and teaching them we really want to go slow, you know, when we're starting with this letter formation. So that's just one thing this tool pointed out to me that I hadn't really looked at, was the importance of speed. And so now I'm starting to get kids to try to slow down a little bit when they're working on those early, pre writing and writing skills.    Jayson Davies     Again, I just think this is going to be amazing. I think the data that you all are already getting and the data that you're going to get going forward is going to be amazing. And Karen and Heather and the others that are on the team, I hope that you will like, go to OT and go to a OTA and like present some of these findings, because I think it would be amazing to see Heather talking about, well, see this student scored really low on this and this and this, but they were high on the speed and kind of see some of the correlations that exist. And I think it's going to be a data that we've all wanted for a long time, but but have never been able to actually see because we didn't have a tool, a tool to do it, and now we have that tool, so I can't wait to see what comes of cymarq, and the future of cymarq, and how it evolves over time. And so Karen and Heather, I want to thank you so much for being here. Really appreciate it. And Karen really quickly, we will definitely post a link to the YouTube video that kind of gives a short, you know, intro or an overview. It really just kind of shows you what it looks like when you're in when you're in the app. But where can everyone go to learn more about cymar? Right?    Karen Silberman     So I am going to jump in here because we do have, like I've said before, we have, we're based in research. So I want to give some hot off the press findings that we have, too in research. So with that, we are conducting a concurrent validity study, and with that study, we are finding a moderately high correlation between the simmark tests and the VMI and so with that, it's really showing that like it's this growing body of evidence where, yes, this is a tool that is commensurate, or better than than what's available now. So very excited about about that. And then we would love to hear from your listeners. They can email me directly at karen@simmark.io , we're happy to give them a free 90 day trial of progress monitoring. If they're interested in bringing the screener to their districts, we'll also provide them a free trial. So with that and research, I keep coming back to that if they're interested in doing research, we'd love to join with them. In fact, we have an OT who went to one of our trainings, and she is now, she's in New Mexico, and she's she's doing research with us, so we'd love to do that too. So just go to our website@simmark.io we're also on LinkedIn and Instagram and Facebook. We post every week. So we'd love to have you follow us and connect with us. So yeah, we'd love to, we'd love to have more OTs join us and also listen to their feedback.    Jayson Davies     Fantastic. Well, thank you both. We really appreciate it, and we'll definitely stay in touch and learn more.    Heather Donovan     Okay, great. Thanks, Jayson, thanks. Jayson,    Jayson Davies     thank you. All right, and that wraps us up for today. Please help me to thank Karen and Heather one more time for introducing us all to cymar if you want to learn more about the simmark tools and screeners, you can check them out@cymarq.io I've also linked in the show notes to a video on YouTube that provides a two minute demo for the testing and scoring using the cymarq apps. After recording, Karen also reached out and wanted to give a big thank you to therapro for helping them to roll out cymarq. Therapro has additional webinars that show exactly how the simmark apps work. I highly recommend giving them a watch. I believe there's two of them from back in 2024 and yeah, it'll just really give you a chance to look and see what the app looks like. As always. Thank you for tuning in. I hope you feel as inspired as I do by the potential of these digital tools to make what we do more efficient while also providing us with more usable data. There were some things here with cymarq that it can do that we would never be able to do with the VMI. And if you're excited to use the simmark apps for your evaluations, for your screenings, to help your teachers, be sure to forward this episode to an OT colleague so they can learn about it too. Thank you once again for tuning in, and we'll see you in the next episode.    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

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 175 of the OT Schoolhouse Podcast. In this episode, Jayson discusses the often misunderstood role of school-based occupational therapy practitioners. He emphasizes the need for OT practitioners to advocate for their diverse skills beyond handwriting instruction, highlighting the importance of collaboration with teachers and administrators. The conversation explores teacher and administrator perspectives on OT services, the value of collaboration, and the challenges faced by OT practitioners in schools. Jayson encourages listeners to find ways to support teachers and improve the perception of OT in educational settings. Takeaways School-based OT practitioners are often seen only as handwriting instructors. Teachers value collaboration with OT practitioners to support students. Many teachers want to see more OT involvement in classrooms. Administrators may not fully understand the workload model of OT services. OT practitioners need to advocate for their diverse roles in schools. Collaboration can lead to better outcomes for students. Teachers appreciate OT support in their classrooms. OT practitioners should provide practical strategies to teachers. Understanding teacher perspectives can improve OT services. Advocacy is essential for changing perceptions of OT in education. Quotes “Seventy three percent of teachers said that they really want to see collaboration happen and that they actually think that collaboration with OT practitioners help their students.” -Jayson Davies,M.A, OTR/L "I know it sometimes gets tiring feeling like we have to advocate all the time, but everyone has to advocate all the time until people understand what they do.” -Jayson Davies,M.A, OTR/L "OT practitioners, you know, we we aren't always understood. However, we can change that. We can do a lot to change the way that OT is perceived, and the teachers actually want that.” -Jayson Davies,M.A, OTR/L Resources 👉 OT in school-based practice: Educator satisfaction with understanding of services before and after targeted training 👉 Teachers’ perceptions of the role of occupational therapists in schools. 👉 Elementary teachers’ perceptions of the value of collaboration with school-based occupational therapists 👉 Workload model in school-based occupational therapy practice: Administrators’ perspectives. 👉 Perspectives of school-based occupational therapists 👉 The perspectives of educators on school-based occupational therapy Episode Transcript Expand to view the full episode transcript. Jayson Davies     What's happening at school based ot practitioners, welcome back to another episode of the OT school house podcast. If my numbers are correct, I believe this is episode 175 so thank you so much for being here. Really appreciate it. Whether you've listened to one episode, or this is your first episode, or you have already listened to 174 episodes, anywhere in between. Thank you so much for being here. Really appreciate it. Today is just gonna be me, and I'm talking about a subject that I think a lot of us have dwelled over in the past, and that is the idea that nobody understands what we do as school based ot practitioners, that everyone believes that we are handwriting instructors and that our role is to find one student in a class or maybe a few students in a classroom, take them to another room, support them in that classroom, bring them back and have them magically improved their handwriting overnight. You know, as a school based ot practitioner yourself, you know that that is not the case, and today I'm going to flip the script a little bit. I've done some digging into the research, and I have some things that I think will help you out a little bit, especially if you're in a little bit of a funk. I think these articles will really help you kind of see the light at the end of the tunnel, per se, or see how others, such as teachers and administrators actually perceive us as school based ot practitioners, rather than the way that we often ruminate about how practitioners or sorry about how administrators and teachers think about us as just the handwriting instructors. So I've got about five different topics here today that I want to go through. We're going to go through each one a little bit. I've got some research that I'm going to tag in at times throughout this episode. But first, let's go ahead and jump in to the intro music, and when we come back, we'll dive into the real ideas that teachers and administrators have about school based ot practitioners.    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     All right, we are back. We're going to start off with a quick debunking of the myth that teachers just want us to grab kids and take them off to the OT room and bring them back, magically able to, you know, improve their handwriting. And the truth of the matter is, is that there's research that shows that that is not true at a more broader base. First of all, teachers do value occupational therapy. They do, and I think most of us do know that, maybe some more than others, right. Some teachers are more outward with their emotions about how they appreciate school based ot practitioners, where others are more reserved, and maybe we don't have as good a communication with them, and so they don't share that appreciation. But there is research out there, especially within the last 10 years or so, of OT practitioners being appreciated by teachers. Now the more important part of this research is not just that they want or that they appreciate us as ot practitioners, but even more so, the important part is that they want more collaboration from us, which I don't think a lot of us think about. We think that teachers just want us to make their lives a little bit easier by taking a student who is sometimes a distraction in the classroom, and help them one on one and bring them back, right? But that's not the case. We are hearing from teachers that they want us to collaborate. They want us to come into the classroom model what works, and to show them what works, so that them, as well as their paraprofessionals counterparts, can also support students in the classroom, for example, Benson, majestic, majestic. There's a few names here that I'm butchering, but this article from 2016 found that teachers clearly see ot practitioners as valuable team members, but challenges like time and scheduling often prevent the collaboration that they actually want. And so they also are realizing that as much as they want us to collaborate with them and as much as we want to collaborate with them, there are some barriers in the way that prevent that, like scheduling and caseload demands. EdX 2021 study found that 73% of teachers said that they really want to see collaboration happen, and that they actually think that collaboration with ot practitioners help their students. However, only about a third of them said that they actually are able to collaborate often, again, showing that teachers appreciate collaboration but understand that it's not always the most simple thing to do. So then, what are we to do with all this knowledge? Well, first of all, let's stop getting down on ourselves about teachers not understanding what we do, or just thinking that we are handwriting instructors. They do value us, and they do want more work with us, but they also understand the time constraints and the caseload constraints that we all have are preventing that collaboration. So from here on out, maybe we start to kind of assume that as a truth, as opposed to teachers not appreciating us or just seen as the handwriting coach or teacher, we'll get more into the whole scope of occupational therapy in a minute. But I think that we need to start almost instead of defaulting to a pull out model, maybe we need to start defaulting to more of a collaborative model. Now that we understand that there is research out there a few different research articles that share, that teachers actually appreciate their collaboration, let's confidently go into those collaborations and work with teachers. Let's kind of default to collaboration. And you know what? It might surprise a few of your teachers. It might even surprise yourself a few times when you do this at first. But let's aim from a strength. I guess you could say from a position of strength, and say, You know what, I'm going to collaborate. I know this might be a little tricky, but I'm confident in my ability to support the teachers that I serve, and I'm going to do that. And you know, it may not be easy at first, but once you put in those reps, that rep with one teacher, collaborating with them, week in and week out for a month, you will start to see progress in your ability to effectively collaborate with teachers to make progress for the students. All right now diving into the second myth, or the second problem, if you want to call it that, is that we sometimes believe that either a teachers only see us as handwriting specialists, that is it, and that's all they'll ever see us as, or B. We sometimes assume that they know everything there is to know about our role in OT or the school based model, and they think that, or we think that they should know that we are executive functioning specialists, and that we are ADL specialists, and that we can support sensory processing difficulties and all of that. But in actuality, that's simply not the case, because occupational therapy practitioners, everyone from me to you, I mean, I'm generalizing here, but even all the way up to your state organizations, all the way up to our national organizations with a OTA and everyone in between, we have not done the best job at getting the word out there. And I know it sometimes gets tiring feeling like we have to advocate all the time, but everyone has to advocate all the time until people understand what they do. So I think it is a little bit on us, but it's also on the programs that teachers learn from and administrators learn from to be a part of the solution. Here just a few different points from the research, just at all from 2023 show that targeted education sessions significantly improved. Teachers are standing of the OT role. What that means right there is that we can provide little me in services, if you will, for the first grade team or for the K through four team, or for our entire school, or maybe even if you're lucky, for an entire school district, and share with them what you can do beyond handwriting and sensory processing. Share with them what you did in one class at a school that maybe they aren't even at, but how you improved that classroom and how you supported that teacher and the kids. Share with them what you are doing, and they will better understand how you can support them. Another article from 2020 This is from Aria and her colleagues. Sorry, there are some names here that I'm sure I'm butchering, but I want to get this knowledge to you, and I'll be sure to link to all these articles in the show notes. But what this team found is that even special education teachers often received little or no training about school based occupational therapy when they were in their program to learn how to be a teacher. And you know, it makes sense, right? The people that are teaching those people, the teachers and the administrators, are other teachers and administrators, the same way that the people teaching us in our OT programs are OTs and OTs and other people related to occupational therapy, we don't fully understand what it means to be a teacher or an administrator, and the teachers and the administrators don't fully understand what it means to be an OT practitioner. So how do we go about changing that piece of it? This is a complicated one, and one that is going to take time, but it is one that I know some people are already taking on. One of my good friends, Danielle de Lorenzo, over at mindfulness in motion. She was actually being a guest lecturer, I think even multiple sessions, not just like a one time thing, but she was providing instruction at a local teaching university, or teacher University, places where teachers went to learn how to be teachers. So that is one thing that we can do. I think another thing that we can also do is start presenting at teacher conferences and administrator conferences. That is something that. I made one of my goals for the next few years is to continue to go to OT conferences, but also get outside of OT conferences and go present to teachers, administrators, maybe even parents. I think that's going to be one of the best ways that I can support all of you, is by helping teachers and administrators better understand our role. So take every opportunity you can get to teach through short tips at staff meetings, through handouts or even casual conversations at the PTA meeting for your own kids, if you go to PTA meetings for your own kids, or whatever it might be, frame ot services in a way that you want ot services and entire MTSS classroom type of services to look like. We need to start talking about ot in a way that we want ot to look like. Otherwise it's going to continue to look like the way that it is right now, at whatever school you support, all right. Now, I want to stop talking mostly about the teacher perspectives of school based occupational therapy and start moving over to the administrator side of school based occupational therapy, and how our administrators, from assistant principals and principals to maybe even the special education director or other people at the district level might think about school based occupational therapy, and I think that we as a school based ot practitioners, often perceive administrators as trying to cut costs, save money, trying to provide the least valuable service as a play on the least restrictive environment, but I think that we have to Flip this a little bit. Yes, administrators are focused on the cost of education. That to a degree is their role. It is their job to balance the cost with the impact of services, right? So we often may think that, oh, they only care about students who have IEPs and making sure those service minutes are met. Well, if we feel that way, it might be, because if you talk to administrators, it's kind of true that is their role. Their role is to make sure that IEPs get done the way that they are supposed to be done, and they have to do that within a certain budget. However, from our perspective as occupational therapy practitioners, we need to show them how the type of services that we provide can be cost effective at different levels of service, whether that's a one on one service, a group service, or maybe a larger MTSS class wide or grade level wide service through collaboration, administrators have a tough job, just like every other person within public education, like it is no different from if you're talking about people all the way at the top, the superintendent, down to the district administrators, to your school site administrators, and then going down from there, teachers and paraprofessionals and every single person that works on that campus to Make It Happen, from the custodians and the lunch people, everyone, right? It all takes a village to support these kids, but there are budgetary constraints. That doesn't mean that that is the only piece that administrators are looking at. So what this means for us is that we need to help administrators better understand the value that we can provide as ot practitioners, and the way that we do that a few different ways, showing that our IEP services are actually effective, and maybe showing how our services are even impacting other measurable items, such as scores on other tests. How are we having an impact on standardized testing, not just on ot tests, but on the reading or mask, course, if you can show that mind blown, administrators will be happy to support you. The other way that we can potentially show data that is good for occupational therapy is that if we go through an MTSS route, if we can somehow provide data that shows that MTSS ot type of services or collaboration, can reduce the resource requirement for evaluations and individual services and IEPs and all the time management that goes with serving IEPs. There's a lot of things that people don't like about IEPs. Like the meetings. You probably don't like the meetings either administrators don't like the meetings, because that's five professionals getting paid to sit at a table when, in theory, those people should be getting paid to provide services to the students. So if we can show them that our OT MTSS services, or, you know, with your speech friends and PT friends, can show them that all the MTSS services can reduce the number of minutes that we spend in meetings. Well, there's that data that you just might need to show administrators. Hey, MTSS is a good idea. A recent survey from bully a Barry and pot Finn This is 2025, so very, very recent just came out, found that while. Administrators value ot services. Many aren't familiar with workload models that account for the ways that we contribute. And you know, as you all know here at the OT school house, I am a big, big advocate for the workload model, and unfortunately, it's just like occupational therapy services as a whole. Administrators don't know about it because we haven't brought it up to them. I mean, a lot of OT practitioners don't fully understand the workload model, and until we fully understand it and can share it with our administrators, they won't fully understand it. So it's not like they're going to OT school learning about this workload model. We have to share it with them so that they understand it and so that they can help us. Help them help us. I mean, it's like a win win win circle going on. If we help them, they can help us. So yeah, to wrap this all up, if you get one thing from this podcast episode, and I hope I have kept it pretty short or short enough for you, I should say I want you to understand that teachers and administrators aren't against us. They may not fully understand what we do. They may be in a budgetary or time crunch, just like we are, but that doesn't mean that they don't want to work alongside us. There is research out there, especially more recently, that shows that teachers want to collaborate with us. They get value from working with us. They appreciate us coming into their classroom and working in their classrooms and showing them and the paraprofessionals and the kids how to work with one another. And I think that's valuable, and I think that is something that we haven't had for a long time in school based occupational therapy, and we just felt like teachers wanted us to take that one behavioral child out of the classroom so that they could have a break. But that's not what the data is showing us. The data is showing us that they want us in the classroom, and whether that's working with a single kid in the classroom, a group of kids, or even their entire classroom running a 10 week handwriting instruction program or supporting an interoception program where we teach kids how to better understand their body, the teachers want us in those classrooms. Similarly, administrators, they don't always know what we do when they don't always understand how our role can impact the entire school, or, more importantly, sometimes their budget. But if we can begin to show them, then they'll be able to fight for us and fight for potentially more ot practitioners on campus, or a better use of our time than sitting in meetings for way too many minutes every single year. So at the end of the day, teachers want our collaboration. They are open to learning more, as are the administrators, and they are looking for support for the students who need it most, and if we can provide that, they will appreciate it. All right. So the final thing that I am going to leave you with today is a little bit of a challenge, and I just want you to find one small way to step forward, maybe offer one quick sensory strategy, or share a visual schedule idea that the teacher can do in the classroom. And I've been saying this for a long time, but teachers don't need more work. Teachers need more support. And so let's get away from just telling a teacher how to do something and actually going in showing them in the moment how they can do it, because if we solve that teacher's one problem in that one moment, they are more likely to carry out that same action or similar action that we showed them at a later time when they need that support going forward. So with that, I'm going to go ahead and let you enjoy the rest of your day without me in your ears, but I really appreciate you coming in and listening to this episode again, solo episode, just you and I today, but I hope you appreciated that I will post a link to all the research that I talked about today, and then a few extra articles that I found on this subject of teachers and administrators perceptions on school based occupational therapy. You can grab all that over at 175, or by clicking on the show notes link wherever you're listening to this episode. And yeah, I I just really hope that, especially if you're a little down on school based ot right now in your professional career, I hope that this episode just helps to lift you up a little bit and make you feel like, you know what? Yes, ot practitioners, you know, we we aren't always understood. However, we can change that. We can do a lot to change the way that OT is perceived. And the teachers actually want that. The teachers want to see how we can support them. And you know, there will be teachers who just kind of want us to stay in our handwriting Lane from time to time, but more so teachers want to see all the different ways that we can support them, not just one handwriting or sensory processing strategy that we have for them. All right. With that, I will see you next time on the otschool podcast. Take care and have a great rest of your day.    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 27 of the OT Schoolhouse Podcast. Have you ever thought about seeing clients on the weekends or maybe during summer? Do you have a dream to be your own boss? If so, this episode is for you. In episode 27, Jayson interviews Scott Harmon, OTR/L, on how to start a therapy practice from the ground up. We talk about why many therapists turn to starting their own practice, as well as some of the practical steps you can start with if you want to do the same thing. Scott owns two of his own private OT, Speech, and PT clinics for many years now and he now shares his wisdom via the Start A Therapy Practice Podcast, the StartATherapyPractice.com website, and The Academy of Private Practice. Listen in to learn more about how Scott started his practice and how he recommends you start as a school-based OT. Links to Show References: Quick reminder: Links below may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you The below references were mentioned throughout Episode 27 Start a Therapy Practice Website (Special page just for the OT Schoolhouse Community) Use Promo Code "otschoolhouse" to get $100 off your access to the Academy of Private Practice! Start a Therapy Practice Podcast (Apple Podcast) Free Forms from Scott The Academy of Private Practice This is Scott's advanced paid course that is guaranteed to help you start your own private practice! (Use Promo code "otschoolhouse" for $100 off) Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript.   Amazing Narrator   Hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.     Jayson Davies     Hey everyone. Welcome to episode number 27 of the OT school house podcast. My name is Jayson Davies, and I am your host, and let's get this podcast started off right, because it is April 2, it is ot month. So also summer is right around the corner. We're only a few months away from that as well. So we got a lot to celebrate today, this month, going forward, everything's looking good. I hope you all are having a great start to your April and that everything's just going wonderful at your schools. In fact, I actually want to kind of give a little call to action. I want to see what you all are doing for ot month. I'm putting together a few things that you'll see throughout the month on Instagram, but I also want to see what you're doing, so tag me in a picture on Snapchat, or, sorry, not Snapchat. I don't use Snapchat. Tag me a picture on Instagram or maybe Facebook. Let us know what you're doing. I'd love to see if you're putting any flyers up, or if you're doing any little events on campus, or maybe on a college campus, you're doing something if you're a student. I'd love to hear it, love to see about or, wow, I can't even say that, right? I'd love to see it, or love to hear about it, that'd be really cool to see. Today we're doing something a little bit different. So I first want to say thank you for clicking to press play on this episode. I know the title's a little different than some of the other titles we've had. You know, we just had two really great podcasts on sensory integration, and now we're going to kind of turn the corner a little bit like I said, this is ot month, and summer's coming up, right around the corner. And so for some of you that may be interested in having your own, you know, either not necessarily a full clinic, but you know, see a few, a few patients on the side, or something, this is going to be the perfect podcast for you today. Today we have on special guest Scott Harmon, who is the host of the start of therapy practice podcast, which can be found on iTunes or anywhere else. Podcast can be found. Scott is also the face behind started therapy practice.com where he helps OTs pts and speech therapists start therapy practices, whether it be from the you know, just seeing the first few clients all the way up to building a clinic. He actually owns two clinics down in Arkansas, so he's here to talk a little bit about that today. Can't wait to share this with you real quick before we get started, be sure to check out the show notes at ot  schoolhouse.com . Forward slash, Episode 27 and with that, we're gonna get started with this episode. I can't wait for you all to hear it. Here is Scott Harmon from started therapy practice.com . Hey Scott, welcome to the OT school house podcast. How are you doing this evening? Jayson, I'm doing good. How about yourself? Not too bad. Can't complain. It's been a been a cold few days here, but it's very nice. How's it over there? Are you in Arkansas, right?     Scott Harmon     I am in Arkansas. And then you say cold few days in Southern California.    Jayson Davies     Oh, very bad. Yeah. Well, I mean, we had some snow in places. We don't usually get snow, but I've heard you guys have had some cold down there as well. Is that true?     Scott Harmon     Just a lot of rain. You know? I told somebody today I saw an old man pairing off animals and followed them into a big boat. Get worried.    Jayson Davies     There we go. Everyone. Pack up your bags, right? So, well, I'm really happy to have you on the show today, and I'm glad you're actually the one who reached out to me about being on your show, which was awesome, but I'm glad to have you here, because I think I might have told you already, but I actually came across your website. It's gotta be like, three years ago now, before the OT school house even existed, when I was thinking about starting a private practice. And so it's, yeah, it's just crazy how the world kind of spins. OT is a small community, and it is what it is, yeah.    Scott Harmon     It's kind of cool. Yeah. Well, I'm glad, I'm I'm glad you stumbled across me. So yeah, it's it. The technology is, I'm a little bit older than you, so the technology always floors me. When somebody says, hey, oh, you have a podcast. You know, they reach out to me somehow. My it was, it was funny here not too long ago, my grandma, who's 92 she she needed some OT, and so she lives in Missouri. I'm from Missouri originally, and so there's an OT who does home health down the road from her, who was, who's providing the OT. So she came into my grandma's house, my aunt's there, and they just got to talk. And that's what you do with home health, right? So the OT mentioned that she wanted to start a practice, you know, she wouldn't start her own practice there in the small town that I'm from. And so my aunt, she said, Well, you should, you should look up my my nephew, he might be able to help you. And so she started putting two and two together, you know, the last name Harmon? And she said, Is your nephew? Scott Harmon? And she's like, Yeah. And she's so honest to his podcast all the time, like, Wow, what a small world. What a great use technology.     Jayson Davies     Yeah, what I'm gonna usually, I wait till later. But for this, I mean, you have a podcast, you have started therapy, practice, com, you have the course that you have over there, as well as many blogs and stuff. What's been the coolest thing that has happened for you? Like, one of my cool things was someone from like, Macau China reached out to us and was like, keep doing what you're doing. That's awesome. I mean, that sounds like a pretty cool story you just shared. But is there another one where you're just like, floored by what has happened because you have a website?    Scott Harmon     I think it's, it's somewhat, it's the everyday, not the everyday things, but it's the things where just which is the total reason I did this, starting a starting a podcast about starting a practice, was therapists who reach out to me and just ask some of the simple questions, or the questions that I think have simple answers, just because I've done this for a While. But when a therapist reaches out and asks that, that simple question, and I'm able to help them through that, that situation or that with that answer, that always kind of floors me, like, Wow, you really didn't know that, not that they're dumb. They just didn't they didn't know what. They didn't know know what questions to ask, really. And so here recently, I had one of my classmates from ot school. She She started a hand therapy clinic, not up the road from me, you know. And, oh, she's probably an hour for me. And so she got online and started, how do you start a therapy practice? Well, that's exactly why I chose, you know, the website how to start? Yeah, because what are you going to type in? How do I start a therapy? Yep. And so she comes across me, and she Facebook messaged me, and she's like, Scott, I want to start a practice. And who do I come across? I come across you. So we're kind of in conversations about her starting her own hand clinic, which is that's, it's small world, big world kind of thing. That's that floored me.     Jayson Davies     Yeah, yeah, it's just the OT community is definitely tight knit. We're closed, we're friendly, we all get along. Pretty cool stuff we got going on, yeah? So let's take a step back, and we kind of already skipped the whole Who are you part and so, so Scott, tell us you owned, obviously started therapy practice.com you do everything there with the podcast, but obviously you were, you had a practice before you started that website. So share with us a little bit about how you started the practice.     Scott Harmon     Yeah, yeah. So I did out of OT school, which I've been an OT for 25 years now, which is hard to believe, because I'm only 30 years old. You know, that's.    Jayson Davies     Five year old product. Yeah.    Scott Harmon     No, I've been around the block a few times so out of OT school, I worked developmental preschool for 12 years, and I was driving almost an hour one way to do my work, so I got kind of tired of that. And as we had a growing family at the time, I've got six kids. So at that time, I probably had four kids, and they were really young. So we, at one point, we had three kids under the age of three, which there's, you know, several months out of my life I don't remember, because you don't sleep, I'm sure. So as as the family started growing, I got, I got to where I was, like, you know what? I don't want to drive one hour, one way to work, you know, on the road, two hours a day. Plus, what if, you know, something happens at home, I'm that far away from the house. So I floated the idea to my wife, who is also an OT about starting a clinic in our hometown, which we don't live in, a big town. We live. Our hometown is five to 7000 people, so there's not a lot of people. Now we're only 20 minutes away from a bigger town, so I floated the idea to her. So we just started, we started praying about that, and started thinking, Could this happen? Could would this work? And started asking around, do you think this would work? And that's that kind of got us on the road to that. So we pulled the trigger on that, and, and, and, you know, we rented a space and started a clinic, and my wife was the clinic for a little while, because she was staying at home with the kids. She was she was answering the phone and being a therapist. She was able to speak the language and make arrangements if somebody had had questions about what we provided or setting up therapy.    Jayson Davies     So she was really so she started the business. You were just the employee,    Scott Harmon     that's it. Yeah, sounds fair. Nothing's changed. Jayson still the same, and I wouldn't have it any different, any either. So, yeah, no, but we collaborated, obviously, and started to practice. But it was, what was interesting is. Uh, speech therapy was the first need for somebody who reached out to us. So I had to, had to find a speech therapist to hire. And eventually we found a PT to hire. So we provide OT, PT and speech and we did that. We started in 2006 so, and then we branched out and open it a second clinic in that in that bigger town that we're closer to, that we're close to, and we started that a few years after we started our initial clinic. And so now it's, it's, you know, every day, every day is new and different. But, yeah, I wouldn't have it any other way. Now my my older kids are able to help us out in the clinic. And it's there's benefits of having my own practice that I didn't even foresee, because now my kids are learning skills by helping us in the clinic. And it's, it's benefit on top of benefit. It's been a very it's been a huge blessing for my family to have come this far with it. So it's, that's, that's how it began, began, how start a therapy practice began. Is one of the one of my wife's students, or not students, but they went to OT school together. Wanted to start our own practice in the northern part of the state, and she knew we had to practice, and she wanted to come down and kind of spend half a day and ask me questions about how to start a therapy practice. So her and a few of her colleagues, some fellow therapists, came down and hung out with me for half a day and took the tour and just asked all kinds of questions. And at the time, I was listening to a lot of podcasts, and so I had created a little bit of margin, little extra time in my day at the clinic. And I'm not one just to sit there and watch the world go by. I was like, well, maybe I could start a podcast, and just maybe people would be interested in starting a therapy practice. And these people seem to gain a lot of knowledge just by asking me questions. I could kind of do an information dump, you know, on on this podcast. So that's what started the the podcast, start a therapy practice podcast. And I think it's been five, maybe five or six years. I can't remember. It was 2018.    Jayson Davies     Really? So the podcast came first?    Scott Harmon     The podcast did come first. I Well, that you have to have that, yeah, at that point you had to have a website for your podcast. So,    Jayson Davies     so you had a makeshift website to, kind of yes, the podcast, basically, that's it.    Scott Harmon     That's what I did. And that was in 2013 I'm pretty sure, yeah and yeah, so I guess that's five, six years. Yeah, later that. It's hard to believe it's still doing it, still loving it, still I love doing the podcast. It's I'm trying to find somebody to do a little more editing on it. My kids have edited, edited the episodes for me in the past, but you, being a podcast owner, know that the devil's in the details, and you want control of exactly what you sound like.    Jayson Davies     Yeah, yeah. And it's a little almost too much control. Sometimes you know you're you're deleting. You go back and forth. Wait, do I delete that little pause, or do I leave it in there? Do I delete? No, okay, I'll delete it.    Scott Harmon     That's it. Yeah, you sweat over the over that, and people probably, they wouldn't know the difference, dude, I do. Yeah.    Jayson Davies     So if you've had to estimate, how many people, how many clinics do you think you've helped start up over the years?    Scott Harmon     Wow, that's a good question. I wish I knew that, if you're listening right now and you started a clinic, email me and say, Hey, I started a clinic, Scott, and after I listened to your pot, that'd be    Jayson Davies     cool, right? I'm sure you've helped. I mean, hundreds probably. I mean, I would hope so.    Scott Harmon     I mean, if the Academy of private practice is my membership side of start a therapy practice. And so I would say, you know, just estimating, there would be at least 100 you know, yeah, hopefully they've started a practice because of me. So that's, yeah, that's fun to think about.    Jayson Davies     I mean, I'll do this for you, because I didn't know anything about OTs being online at all until I did come across your site. And no, I didn't start a therapy practice, but I did start the OT school house, and that was in part about knowing that something that OTs were going online to look for stuff. Yeah, and so I'll give you a little shout out, because I did get a lot of information. You had a lot of free information on your website. And I you had your kind of your your template of how to keep track of therapy notes and stuff like that. And I was like, whoa. Like, that's super cool. And so that inspired me a little bit and other stuff that you had on there. So I'll say thank you, and that you helped me start ot school house. So thank you.    Scott Harmon     I appreciate that. That's. Definitely humbling. Thank you.     Jayson Davies     Yeah, so let's dive into a few questions. If we can't help anyone out there who may potentially want to start a practice, a lot of school based OTs, I feel like we get a lot of questions about burnout and OTs get burned out. And so why do you see people wanting to start, start a private practice?    Scott Harmon     I think there's, there's different reasons. One of them can be burned out, just like you said. They're like, I can, you know, I'm going to invent a better mouse trap here. I don't, I don't have to put up with this over here. So they might be disgruntled with where they're at, or just burn out. I have some therapists who come to me and say, You know what, Scott, I've been out of therapy for a while. Maybe they had a child and stayed at home for a little while with their child, and the thought of, you know, working full time for somebody, doesn't appeal to them. So maybe they try to they're interested in seeing just some clients on the side, and that that necessitates starting a therapy practice, even if it's just small. They've seen a couple of clients, it still started a therapy practice. And that was that's very much who I am trying to target is not that franchise type therapist who wants to start multiple clinics. We might get there. That's what I do, but it's very much targeted to that solo therapist who's just like, You know what? I want to dip my toe in this, or maybe I do want to open my own clinic. And that's, that's kind of, that's kind of my wheelhouse right there. I really like speaking to those therapists and helping them get that off the ground. But, yeah, there's certainly different reasons people are motivated to start their own practice, but a lot of it is an OTs. I think especially are this way they would like to have control of how we provide our therapy, because it is so individual, individualistic as far as what we're trying to do and what we're trying to provide and to I remember working at the facility that I was working before and there. You know, every place has rules. You just you can't just do anything you want. You could certainly ask. But I remember when I first had my clinic, and so OTs, we like swings. And so I walked in, you know, walked in there, and I said, I can hang a swing anywhere I want. And I was like, if I wanted to hang a swing in the waiting room, I could hang that appealed to me. So, yeah, there's different reasons. I think.    Jayson Davies     Yeah, no, I think, like you said, everyone has their own reason. You were a school based therapist. You weren't not employed by a school district, right? But you did work in the schools, correct?     Scott Harmon     I have before, so we've done school contracts through our clinic before, and so it's been a it's been a brief period that I have been a school therapist, but yeah, I've done enough of it to speak the language. I guess.     Jayson Davies     You know what an IEP is, and you know how to get through all that stuff, exactly. So if there was a school based OT and they kind of were thinking, hey, summer's coming up. What could I potentially do it? Could I make a few extra dollars through seeing some private, private, uh, patients? What would you recommend? Kind of that first step that they really do.    Scott Harmon     Get a business card. There you go. Get a business cards. The I just did a solo podcast episode on getting a business card and what to have on a business card. But it's a very tangible thing that that you can always carry around with you should always carry around a business card, because when you run into people, you're gonna have a conversation. You know, hey, what do you do? I'm gonna I'm a school based therapist. I'm a school ot here at the school. Oh, really. Well, my child has has autism. Oh, okay, then, you know, the conversations off and running at that point, they can't stop at the business card. Your business card has to point somewhere. So it nice to have a website, but if you're a school based therapist, and you're like, I don't, Scott, I don't want a website, but, you know, I don't have time for that, at least a business card. And then, you know, obviously that's got a way to get a hold of you. I think people, I think your potential clients, get confused on the steps that it takes to get the therapy. Now, some states have more regulations. California has a few regulations about getting therapy, whereas other states, like Texas and even Arkansas, where I'm at, they don't have as many regulations. So you might just be able to set up therapy with a client during the summer and they pay you cash and you don't have to do any. Anything. It might just be word of mouth. Hey, Jayson is an OT and he'd be willing to see your kid this summer, and then you might be off and running, but you got to make some connections, and you got to have a way for people to get a hold of you. So I would, I would certainly. I mean, if you can have a website, you need a website, you know, even if it's just a one page website, just to let people know who you are and what you do.    Jayson Davies     And to be honest, it's too easy to create a website nowadays not to have one if you're going to do something that simple, you There's ones out there that you don't even have to pay for, and you can put your information out on So, so definitely do that. So again, still talking about that one person that may want to go out during during summer and maybe get a few clients. Do you think they need to go full force into it if they're going to do it? Or, like you're kind of saying a second ago, just dabble with a few students, one or two students for the summer, and then go back to school based OT.    Scott Harmon     I think it's, you know, people are in different situations, but from I can give myself as an example here, and my wife too, in that, as I was working at the developmental preschool, I took some clients on the side as as contract. And so I contracted with our State Department of Health to see these clients, or you might contract with your state early intervention program, which is, I don't know if I would recommend that there's a lot of there's a lot of paperwork early intervention, but you know, you can, you can put your services out. My wife contracted with the State Department of Health to see adults. She was doing she's she was a pediatric therapist at the time, and she really had fond memories of her she also did a level two field work at the the VA. So she really enjoyed her time at the VA, and she missed treating adult clients, so she started seeing a couple of after, after work clients through the Department of Health. And she she loved treating stroke patients, and so she did that on the side that was really dipping our toe into the world of private practice. And so the next step after this, you know, you're kind of getting used to the idea. So then the next step is to go find a client all on your own who's willing to pay you, maybe cash out of their pocket for therapy. There's there's sort of a barrier or a mindset that a lot of people have that insurance should pay for the therapy. So to get beyond that is difficult, because once you start down that road of accepting insurance as payment, that is kind of a whole new ball game. You know, there's a lot of hoops to jump through to get credentials with insurance. So if you're just wanting to see kids for the summer, and you don't want to do that through a clinic or through another outpatient facility, you're probably kind of relegated to, you know, accepting cash payment. So then you have to convince, you know, your potential clients, why that's a good move for them. You might have to, you might have to think of some good reasons why they it's okay to pay cash out of pocket. And some of those might be, you know, what? We could access your insurance. But what's your deductible? Oh, you got a $2,000 deductible. You're not going to eat through that in summer therapy, so you might as well pay me cash, and I'll do you know, you can get a Well, some people call it a super bill. I don't like calling it a super bill invoice, because it sounds terrible, doesn't it? Who wants to pay? I don't want to pass.    Jayson Davies     Like an evil villain.    Scott Harmon     You're gonna charge me a super bill that's gonna be terrible, that's gonna be a lot of money, but no, you can you can tell people, Look, you can pay me cash, and I will give you an invoice with the CPT code, the diagnosis code. You can turn that into your insurance. Insurance can reimburse you for that, so that way you don't have to be on the hook for all of this therapy. Now, you're going to pay me cash. You got to pay me all of it, but if you want to get reimbursed from insurance, you certainly can seek that out on your own. And I will help as much as I can. You know, I'll give you a copy of the evaluation report, of the progress notes and whatnot. But that's that's one way around that. And over at start a therapy practice.com in my if you click on Free forms, there's a, there's a super bill template you can use for free over there if you're if you're interested in doing that.    Jayson Davies     I had never thought about that, but that that's a good idea, because that was one of the things that I did get hung up on when I was thinking about doing it. Because basically, all these questions I'm asking you, let's be real. They're all about me, I mean, but no, I mean, I kind of had different ideas. I was like, sitting around, you know, and like, I want to do something over the summer, and I had never thought about, like I was hung up on cash. I don't have the. Ability to take insurance. So who's going to who's going to come see me when I can't take your insurance? But you just kind of gave away around that. And it might, it might not work for everyone. I don't know all that good stuff, but if it works for a few people, awesome. So.     Scott Harmon     Yeah, and I think you at least have to give parents, if parents need the option, you know if, if they're really seeking that out, and they know that Jayson is an awesome school therapist, and their child needs an awesome school therapist. They've, it's just for summer. Well, that that's a good that's a smart connection to me, you know, and you're willing to come to the home a lot of a lot of clinics, practice owners, they don't want to go to the home. I don't want to go to the home. I mean, I've got a nice clinic. I want you to come to my clinic, but you, you don't have a clinic, and you're willing to go to the home, it seems like a good critic. So they you might actually be doing that parent a favor and maybe even a disservice if you don't offer them that.    Jayson Davies     potentially. So let's say I find the client. What would you say are a few things that kind of got to be in your private practice OT bag?     Scott Harmon     Hmm, okay, so I think if you're if you're charging them cash, if they're paying you cash, education is a big part of that. Why do why should they pay you cash when they can go to the outpatient clinic and they're going to access insurance? Well, first of all, you can come to the house. That's, that's a that's a big plus. Second you they can get reimbursed from their insurance if it's going to be out of network. So though they're going to need to see what that's all about, also in my free forms, is sort of, is it's a checklist. So what I found was parents would ask me, Hey, your your your clinic's not in network with my insurance. What can I do? Because I can't find anybody who's in network with my insurance, and the reason for that is because your insurance stinks, because they don't like therapy, and that's why we're not in that nobody's in network with your insurance because they don't pay for therapy very much. So what I what I had created, was a checklist to give to parents and say, Look, I'm not in network with your insurance, so I can't call your insurance and check on benefits. Here's the questions to ask, and so I just created that and print it off, and it's in my free forms at the website. So I give that to them, and then the key there is to follow up. The money's in the follow up, you got to call the parent back. Hey, did you call the insurance? What did they tell you? They told me they're not going to pay for therapy at all. I hate to hear that. Well, you know, I'm willing to see your child. You know, I would probably recommend twice a week. But you know, if you're paying out of pocket, let's just start with once a week. Let's just start see how it goes, and you can cut it off and let them know they can cut it off anytime. You know, because I think some parents are like, I'm gonna, I'm gonna be on the hook for twice a week for three months this summer. That's gonna they start racking up the numbers. You know, I can't, I can't afford that. So start small, and then go from there. That's, it's one option to give them.    Jayson Davies     Gotcha. And so what about evaluations is, is it required? Do you need to do an evaluation before you start to see a kid in a private practice.    Scott Harmon     So there's probably some state regulations that you might think aware of each state have so that would call your licensing board and say, Hey, what's what's the regulations for me doing private practice? As far as, Do I need an eval, an initial evaluation? Do I need a prescription? That's a big one, don't you know, are you? Do you have to have that prescription from the doctor? Some states you don't have to have a prescription, then you're good to go. If you're accessing insurance, you're probably going to need a prescription. But if it's cash, and your state doesn't require it, you don't need a prescription. I would do even if our state didn't require which, honestly, I don't know if our state requires it or not. I just, I go by the strictest guidelines or regulations, which is our state Medicaid. So Medicaid requires an initial evaluation. So we always do an initial evaluation, even if they're paying cash. So I would recommend that evaluation just, I mean, you want to get the baseline scores of a standardized assessment to see where you're at. That way, when you work your OT, you know, you work your therapy magic, you can say, hey, we were here. Now we're here, and that's because you decided to come see me for OT. That's, that's, those are two good reasons to do an initial evaluation.     Jayson Davies     Yeah, so I mean, that might mean that someone who's going to do this over the summer, they need to go out and purchase an assessment or two, a kid or two. Maybe, I don't know, what are some common evaluations you use over in the clinic?    Scott Harmon     Well, we. For that there's, there's some options there. So if you're close to a university, sometimes we borrow tests from a university. So I mean, we have a lot of evaluation kits at our clinic, but there's some that are kind of obscure, especially when it comes to speech tests. So sometimes the speech therapist will, you know, we're, we're in the same town as the university who cranks out therapists. So the speech therapist will call them and say, Hey, can we borrow this test kit? Sure, come on over and get it. You can borrow it. That might be an option, you know. So you might not actually have to be out any any money on a speech kit. You don't want to abuse that you know, but it might be something that you can look into if you're doing kids. I mean, I have sort of moved away from the Peabody two, and I like the Mullins. I like the bot bought two. Are they on the bot three?    Jayson Davies     I don't think so. I'm still using the bond too.    Scott Harmon     Think they're on the bot three. So the melons is for a little bit younger crowd. You know, you're probably zero to five, and your bots gonna be probably five years and up. Those are probably two of the main tests that I would recommend. If you do, you know, a lot of parents might be, you know, an OT world. They might be concerned about handwriting. So then you can look at the ths handwriting, handwriting Test, test of handwriting revised, I believe it is    Jayson Davies     the th or, yeah, the thsr test of handwriting skills, revised.    Scott Harmon     We have that one. The VMI is a good, you know, is a good test. It's probably some of the, I'm sure it's some of the same tests that you're using there.    Jayson Davies     Absolutely, yeah, bought ths, VMI, ravma.    Scott Harmon     Now, if you go buy all those, I mean, the Mullins itself is almost $1,000 so you can, you go buy a bot kit. It's been a while since I bought mine. You probably three $400 yeah, you're you could be out some money.     Jayson Davies     Yeah. So you're probably best to buy them as needed, and not don't go out and spend buy them all. And then next thing you know, you're a few $1,000 in debt already. You haven't even seen your first first kid.     Scott Harmon     That's it. Yeah, and yeah. And you want to know that you're going to try this for the long haul. You know, if you're going to do this every summer for the next 10 summers, it might be a good investment, and it might be something that your ot buddy in the next town, you know, they're not competition for you, but maybe they'd go in have these on a on a bot kit. You know that you could split that up.     Jayson Davies     There you go. In fact, that actually kind of brings up something that I'm seeing out here in Southern California. I don't know if you've seen it out there, if anyone else has seen it anywhere else, but there's starting to be places where you can almost rent a space in a therapy gym. And so you are your own contractor, and you are renting out a space from basically another therapist to use their gym to see a few clients. Have you seen that yet?     Scott Harmon     So when you say gym, are you talking more gymnastics gym or an actual therapy gym? Well,    Jayson Davies     actually, both. I have heard of people going to a gymnastics gym, but I'm talking more about a therapy gym. So it's almost like a hair salon. You know, where each hair salons their own individual entity, basically, but they all rent the space. So you might have four therapists there in a small type of clinic, but they none of them actually own the clinic, and they're all kind of renting space to work there. Have you heard the heard of this?    Scott Harmon     I like the idea. I've had that idea over the years. But what's kept me from doing something like that is, in my mind, you sort of has to be a metropolis to pull that off. You know, you'd have to have some flow of kids, which, like I said, I live in a small town. I couldn't eat that off. I mean, you might. I guess you could run other things through there. You know, you could work if you're doing gymnastics. There's a friend of mine. He owns a gym, gymnastics gym in the town, the bigger town that you know that we have our clinic in, and it's a huge facility. So I approached him, even before we opened our second clinic, and I said, Hey, what would you think about me opening, you know, a therapy clinic inside your gymnastics gyms. And we talked about it went back and forth a little bit, but he was, he wouldn't, he didn't want to do it. That was fine. But, you know, at least I approached him with the idea. So if you're talking about, like, you said, like a salon type of right of arrangement you're renting a chair in a salon. It could be the same concept for renting your therapy space. And I do suggest that in when I talk to potential practice owners they want, they're thinking about, I'm like, Well, think about sub. Seen in somebody else's space? Yeah, you know, if somebody has a gymnastics gym or they have, you know, Pts do this quite often. They'll approach a gym, you know, for adults, and they'll say, Hey, can I sublease some space here? I actually have a PT who subleases space in our pediatric facility. She's in a she treats adults. She does is it called Red needling. I think that's what it's called. And she needed a space in in our small hometown here, dry needling. I'm sorry. I'm thinking red line, red line. There's two different PT treatments there. So she does dry needling, and she does that after hours in our pediatric clinic, so she's she's done that. She's subleasing for me, and everybody wins.    Jayson Davies     There you go, Yeah, and like I said, I You're right where you need that steady flow. This was down in Orange County, California, where I've heard about these clinics where multiple therapists are all kind of subleasing a time and a space in there. However, a recent therapy friend of mine was actually talking about a contact she has who is doing exactly the other side of it, where she's paying not too much. I want to say it was like maybe $10 to see a kid in a some sort of gymnastics gym or something. And so she had worked out this deal that basically she's paying $10 an hour to see a kid in a gym that she obviously doesn't have to pay for all the mats. She doesn't have to pay for everything, and I don't know what she has access to in there. It's obviously not going to look like a world class sensory integration type of gym, but there's going to be a lot of good stuff in there. So that might be an option for anyone out there that.    Scott Harmon     I think that's a great option to approach some facility that you're that you think I could treat somebody in here and this would be awesome, and approach them and say, give them, give them some options, and say, I could pay you per month. I can pay you off the top per for each kid. Like, there's a big trampoline, indoor trampoline park in our town, you know, Oh, that'd be fun. Could you could do you, could you could do groups in there. You could do, you could say, Look, I'll you could rent the whole facility for an hour. And then, you know, do some group therapy, it's really you have to, you know, to use the cliche of thinking outside the box, but to come up with some different ways of maybe subleasing or using a space that that would be conducive to therapy, like the there's a community center in our in our town, and they, they have a room that they'll charge you $25 I think it's just like half a day. $25 for a half a day. Can't be that huge room. And downstairs, they have basketball courts. They have an elevated track. You could do, you could do therapy in you know, they do, like, exercise classes in there. Why couldn't you do therapy in there?    Jayson Davies     Yeah, good idea. So, like you said, you you've dipped and dabbed in a little bit of school based. And you know, some of the culture, you know, some of the things that go on with school based. And one of those common things, and they seem to be on the rise, at least here in Southern California, as I ease and so what do you know about potentially being an IEE, independent evaluation, if you want to call them a provider, I guess, or an evaluator?     Scott Harmon     Yeah, yeah, we've done that in our in our clinic. I did one here fairly recently, but it was, it was two hours away. It was, it was not a it was not a district that was even remotely close to us. And my thinking was there when they approached me, is you're far enough away that the optics of this are not going to hurt me if something goes bad. And because I had, and did you tell me, from your end, the image I had me coming in as a independent evaluator is I'm the gunslinger. You know, I might be perceived as the bad guy here, coming in, evaluating this child, because something has not gone quite right. And yeah, in our instance, it was. There was a lawsuit pending. So we were the independent evaluator in this lawsuit action that the parents brought against the school. So I really had to think about you really have to think about how that's going to look, as far as perception, and then how that potentially could come back on your reputation, right, wrong or indifferent. You have to think how that's going to play out after you do that evaluation, after you sit in on that IEP meeting, what's mom and dad going to say to the school district? How is that going to play out in the lawsuit? And so I would be interested from your side of the table, how that's perceived from the school based therapist.     Jayson Davies     So. We get both sides of it, because it really depends on why the EE, why the IEE, is really being held, and also who gets to pick the IEE provider or evaluator? Because sometimes the district says, okay, yep, here's a list of people that we have on contract with. Go ahead and pick one, and typically those are IEE providers that the district likes and will have no problem with. But then, every now and then, there's that IEE provider that comes in, that the parents advocate knows and they're coming in, and those are the ones where it gets a little dicey up in the air, and people get, you know, nervous, and everyone's kind of well comparing ot reports. You know, it's like, this is my school based ot report. Well, this is my clinic based ot report that's that's in schools, in and what is what, and all that good stuff. And it's unfortunate that it happens, but the reality is it does, and so it's kind of got both sides. And I think we're going to have another podcast about this soon, but just talking about we need to just keep the child in our best interest. And I think everyone is doing that, and as long as we can do that, and you come into an IE meeting with that in mind and that this report is about the child and not about me versus you, him versus her, District versus parent, then we can all be civil about it and make amends and figure it out what we can do to best help the kid. And I think that's the route we should take. Does it always go that way? Not necessarily,     Scott Harmon     yeah. Well, and I think as therapists, we really have to be careful whatever side of the table you're on, to not let, not let the parent in that situation, or the school for that matter, draw you in for to bad mouth one side of the other. We, as a therapist, you have to take the high road there, because you have to be there has to be some sort of sanity in that situation. And the therapist, the OT is in the perfect position to play that, that role. We don't want to. We don't want to bad mouth our our co workers, our fellow therapist, or really the administration or the parents, for that matter. Do we want to do like you said? We want to do what's right, but by the child, and we want to bring light to that situation, and not so much heat, because those situations can be contentious. In the situation I was in, the mom was, was the wild card, and she was, she was explosive. It was, it was a difficult situation, and so I honestly, I just, I said, I gave my report, and I sat back and watched, you know, if they asked me a question, I would answer it. But I was not putting my nose in that situation, because I really, honestly didn't know the history that much of the situation. I came in as an independent evaluator, did my job. Kind of got out. If they asked me a question, I'm going to answer it honestly, give some suggestions. But yeah, they can get, you know, they can get heated. Yeah, yeah.    Jayson Davies     I've been pretty fortunate to not be in too many of them, but I've heard many stories, and yeah, I wouldn't, I wouldn't wish it upon many people like at all, because that is just not not a good situation or not a fun situation. But if we can keep the kid at heart, I'm sure we'll all be good going on. What about contracting with districts most so with school based therapists, there's a wide variety of the way that we work for the school. Some of us are directly employed by the district. Others are contracted through a third party agency, through maybe even a clinic like yours or something, to work at a school district. That may mean going to the school, or that may mean that the school busses kids or has their parents bring them after school. But still, some people, I think, are trying to be their own contract and contract their own services to a district. Have you ever experienced that? Or did that yourself?    Scott Harmon     Yeah, it was, it was my goal, when we first started our practice, our clinic, to not need, not have to have a school contract because they're in our state. It's a rural state, you know, it's very there's very rural school districts, and so school districts, the smaller ones, especially, will will contract out that therapy, or at least part of it during the year, so that there's opportunities out there. And we've had those opportunities throughout the years of providing the school contract, what I had determined pretty early on was I didn't necessarily want the school contract for this for the school in the same town that my clinic was in, because for. Couple reasons there could be some conflict of interest there. Yeah, you know, because honestly, the first, well, actually, the second location that we were at, we kind of outgrew our first one. We were right across from the school. I mean, you know, I could just right across the street from the school.    Jayson Davies     That's got to be hard to turn down parents.    Scott Harmon     I'm sure. Well, it was, it was one of the I had to bid on that school contract when it came open. We didn't get it. I knew I had outbid anybody else, just but I didn't, I didn't get it. Now, looking back on it, I'm thankful I didn't get it, yeah, because what can happen as a school based therapist is, I mean, it doesn't have to happen, but it could happen that I got, I got, or a therapist that I hired would get some sort of reputation in the school. Well, then it's, it reflects back. It's a small town, you know, word gets around, then it gets back to, well, that's that, that's our clinic doing that, and don't go to see them because they did this in the school. So we've avoided that because we didn't get that contract in the same town. Now that being said, I've got, I've got school contracts in different towns that my clinic are not in, and that that works out fine. And and it's not to say it couldn't work out fine, but then you also have, if you're in the same town, getting that that school contract, and you have a clinic in that town, there potentially could be conflicts of interest, or perceived conflicts of interest, yeah,    Jayson Davies     for what, one of my colleagues actually was just sharing a story with me, the other I don't know, a week or so ago about how a parent of a student that she saw in school, actually, I don't know if she stopped her in the parking lot or asked her she would see the same kid that she sees in school privately. And she, you know, she kind of did what you did. She thought about it, but she's like, No, that's that's a conflict of interest. I can't do that. Where does it turn from school based to home model based, or whatever you want to call it? And she absolutely just kind of said, Sorry, I can't do it. It's too close to too many lines, and had to turn it away. So definitely have to keep that in mind when, when you're a school based therapist, potentially trying to get some extra work, yeah.    Scott Harmon     And I would say that for any, any therapist who are listening, who, who are not doing school based therapy right now, and you have the key notion of, well, I know the school down the road, they have the contract coming up. I'm going to bid on that, because I can be my own private practice and have a school contract. If you have not done school based therapy, you laugh because,    Jayson Davies     well, maybe that's why they're listening to this podcast.    Scott Harmon     You don't want to, you don't want to go, you don't want to do that if you haven't done school based therapy, and think I'm gonna, I'm gonna start my own private practice by getting this contract, that it's a good way to get a bad reputation.    Jayson Davies     All right? Well, obviously, part of the reason you're on this podcast, we kind of were touching on at the beginning, but I want to go back to it, is you have this fantastic resource available online, and it's, I think it's opening up soon here, and so I want to give you the opportunity to kind of share. We've already talked about a lot. You've already given a lot of great value. But what? What do you go further into detail in this academy you have?     Scott Harmon     Yes, thank you for asking. So the Academy of private practice, after I'd started the podcast and the website, you know, people, people wanted more. They wanted more. More of me directly, as far as some some hand holding, they also wanted some more resources, and so I created the Academy of private practice. For that reason, it opens the first quarter of each month. So four times a year it opens. So the middle of that first month of the quarter, you can enroll into the Academy of private practice. I only open it four times a year, and really it's only open the enrollment period is like five days. So that helps me control the flow of new new, new therapists coming in. So I can give everybody personal attention in the Academy of private practice, there's video lessons, there's resources that one the relevance here of talking about getting school contract, there's there's a an RFP in there, there's a school contract in there. So as I've you know, contracted with schools. Some schools, they don't have a contract that they've created to contract out therapy. That's kind of crazy to me, but I've come across that, you know, I've had a school district say, you want to see some kids for us, sure, and I'll say, Send me the contract. We don't, we don't have one can. So, yeah, I've created the school contract. Over the years, and just some kind of some cover paperwork of what to put with that. But then, not only that, but also how to find school contracts, how to find what they call RFPs. I didn't know what an RFP was when I started my private practice. Is a request for proposal. That's common government like, but yeah, if you, if you don't know, you don't know, and if you don't know the terminology to get on Google and search for that, or the different websites of where to find that, or how to approach a school with that notion of, hey, do you have any RFPs or how to find that? Over the years? I'm like, Well, how do I find when these schools are open for an RFP. So that's one aspect of the Academy of private practice. That's one lesson in there. And then there's some paperwork that goes to back that up. But not only that, if somebody wanted to open, you know, a brick and mortar clinic, I've got, I've got some lessons on that. And then what we do once a month is we have masterminds. So members of the Academy of private practice, they're invited once a month, the fourth Thursday of every month, to set in on a mastermind, and you bring your questions, and we all help each other out with answering those questions. And I've learned a ton from that I'd love doing mastermind, because I get to help, but then I get to learn from these other practice owners. And want to be practice owners in their ideas of how to start a practice, how to grow a practice. Of I get to learn too, and it's a great benefit for for me. And then the other therapist also, of course, we got a private Facebook group, everybody, you know that's everybody's on Facebook. So we're we're over there also. And then for Academy members, I offer a consultation with me. So actually, I, just before you and I jumped on this call, I got off of a call with an Academy member. Her dilemma was she was in a 300 square foot space. She has some contract therapist working for her. She she's really she's going moving up in size 1000 square foot. So her question to me was, how do I get she's doing a lot of home health clients, a lot of early intervention. How do I wean myself off early intervention and home health and get more kids in in the clinic, because I got a bigger clinic now. So we had that conversation. I gave her some some ideas that have worked for me over the years on how to, how to help her out with that. So that's a benefit of being a member, is you get to schedule time with me and work over some things. So there's, and it's, you know, I'm putting sometimes we do a book club, like, hey, let's read this book and talk about it. We'll do that sometimes. And it's, it's, it's a lot of fun. I've really enjoyed the Academy of private practice and helping out therapists, you know, start their own practice. And if they have more questions on that, I'm sure you can maybe put a link over there on the show notes. Maybe.     Jayson Davies     It'll be everywhere. It'll be on the show notes. It'll be if you're listening on iTunes, if you just kind of scroll up a little bit, it'll be right there. It'll be everywhere. So be sure to check out, start a therapy practice.com , and remind them all again, once more, of the name of the actual Academy.     Scott Harmon     Yep, it's the Academy of private practice. And I also want to tell everybody if over at start of therapy practice, com, if you go to start a therapy practice.com , backslashot school house, I've got a special checklist for you if you're interested in starting to practice. This is, I call this my super duper start a therapy practice checklist, and it's you can't, you don't find it on anywhere else, on my on my website. This is not, this is not one of my freebies that I give away on the freebie page. So thank you. Yeah, do that just, just for your listeners there. Jayson.     Jayson Davies     Thank you so much. So that was startup therapy practice.com , forward slash ot school house. That's it. Great. We will, of course, obviously link to that as well, make sure everyone can find that. Oh, man, you answered like, I had a lot more questions, and you answered like all of them. So I've got nothing left. Is there anything else you want to kind of give a shout out to or or say anything else tonight?     Scott Harmon     Well, I appreciate the opportunity to be over here. I've listened to you for a while now. Jayson, you do a great job on your podcast. And you know, if people want some some more podcasts to listen to, it's they can search, start a therapy practice on iTunes. Stitcher and your other podcast players, and that way you can kind of see what I'm up to. I think, at last count, I don't know, I'm up to around 90 different episodes. So if you want to listen to the first episodes of the podcast and start there, just know it gets better from there. I had to start somewhere, right?     Jayson Davies     That's absolutely the hardest part is, is getting, getting to starting. That's it. Yes. Well, Scott, thank you so much. We appreciate you taking your time out of the day and come. It on I want to definitely recommend to everyone on here, if you are even thinking about starting a private practice, whether you just want to see one client, or work your way up to 100 that's the place to start out. That's where I kind of started out a long time ago, I never got around to actually starting my private practice. For everyone out there, go over there, sign up, get if nothing else, he has so many freebies and a special one just for you, so be sure to head on over there and guys, yeah, thank you, Scott, and we'll talk to you next time. Yeah, we'll talk soon. Hey everyone, thanks for listening. This is Jayson again. Thank you. Huge shout out to Scott Harmon from start of therapy practice.com for taking the time to come on here and share with us everything that he does and how he helps our Occupational Therapy community to get started with our own practice. So the reason that today's podcast was, you know, in April is because summer is coming up. So if anyone is interested, and you know, potentially seeing some clients during the summer, I highly recommend that you check out Scott's website. Started therapy practice.com . His podcast, started therapy practice. Podcast, and yeah, you know, he's just a great mind, great resource. Definitely check it out with that. Be sure to check out the show notes over at ot  schoolhouse.com . Forward slash episode 27 we do have links over to his website there. It's pretty easy to remember start a therapy practice, but if not, we do have those links over there, so check that out, and we will see you next time on the OT school house podcast, take care. Bye, bye.     Amazing Narrator     Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. 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Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 26 of the OT Schoolhouse Podcast. In this episode, Jayson interviews Dr. Kelly Auld-Wright, OTD, OTR/L, on how to go from sensory evaluation to treating a child using sensory integration and sensory strategies in a school setting (You know, without the whole gym setup). Kelly starts off right where Dr. Zoe Mailloux left off in Episode 25 and explains what type of patterns we should be looking for and what to do when we see those patterns. Listen in to learn more about Kelly and how she uses sensory integration treatment and sensory strategies to benefit the students she works with. Image retrieved from: https://indonesiaexpat.biz/wp-content/uploads/2014/06/Figure-1-The-Pyramid-Of-Learning.jpg Links to Show References: Quick reminder: Links below may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you The below references were mentioned throughout Episode 26 Websites CL-ASI.org (Get 5% off Module 3 using promo code: OTSCHOOLHOUSE when booked in March of 2019) University of Southern California courses in SI SPDstar.org (Lucy Jane Miller) Articles Interrater Reliability and Discriminative Validity of the Structural Elements of the Ayres Sensory Integration® Fidelity Measure© Efficacy of Sensory Interventions on School Participation of Children With Sensory Disorders: A Systematic Review Books and Items Sensory Integration and Learning Disorders (Starting at $37 on Amazon) Peanut Ball (~$15-$20 on Amazon) Virco Rocker School Chair Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the otschoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.     Jayson Davies     Hey everyone. Welcome to episode number 26 of the otschoolhouse com podcast today, we are talking again about sensory integration, except we're going to talk a little bit more about the treatment side of sensory integration. Last week, we had on Dr Zoe Mayu. Definitely recommend that you go back and listen to that. Sorry. Not last week. Two weeks ago, that was episode 25 highly recommend that you go back and listen to that episode, because we talked a lot about sensory integration evaluation and well, I'm also going to, you know, pitch myself a little bit and say, Please do subscribe to the show so that you don't miss any future episodes. We do an episode every other week or so, and we really appreciate having you all around also. I don't know if you can hear it in my voice, but I have a little bit of a sore throat right now, so I'm going to try and keep this short and get us on to the interview. But first, I did have a few questions about how to access the show notes for the for each episode. And just to let you all know, you can simply type in otschoolhouse com, forward, slash episode and then the episode number to access the show notes. So you can do that on your URL address on any browser. So for instance, the show notes on this episode is going to be at otschoolhouse com forward slash episode 26 or you can actually go to our website and click on the podcast tab and find each episode on that tab, all right. Well, getting into today's episode, we have a very special guest here to talk about the treatment of sensory integration within the schools. And we're very lucky to have Dr Kelly, alt right. She has her OTD, and she's here to talk about how she uses the sensory integration model to treat students in schools. I have been very fortunate to work alongside her for the past almost year in our current position, and gotten to see a lot that she does within the schools to use sensory integration that some people may not be able to do because they don't have a clinic. She figures out ways to do this within the clinic, and it's really cool to see. I'm really excited that I've been able to learn from her a little bit this year, Kelly has done some research in sensory integration, and at Los Angeles Unified School District. She actually worked in one of their clinics and would work with other OTs and trained other OTS in how to use si within the school. So we're very lucky to have her, and I'm just gonna let this go into the interview, and you'll get to meet Kelly aldright. Here she is. Hey Kelly, welcome to the OT school house podcast. How are you doing this evening?     Kelly Auld-Wright     Hi, Jayson. I'm doing well. Thanks.     Jayson Davies     Great. Well, I'm happy to have you. I was just, I just kind of finished telling people how we work together now and how it's super cool to work with you. And, yeah, it's just pretty cool to have you as part of the podcast. So before we kind of dive into everything, give us a little bit of background about how you became or how you came into the world of OT, and what you've been doing in OT.    Kelly Auld-Wright     sure. Well, I grew up in a family with special education teachers. My dad was actually the principal of a school for special needs as I was growing up, so I spent a lot of time around children with special needs as I aged and in high school, I did a student project on cerebral palsy, and became really interested in some of those aspects, and looked at physical therapy with it. And I was actually pre med going into college, I was a neuroscience major, and I thought I wanted to be a doctor, and I realized that you had to give up a lot of your life in order to do that. And wasn't quite fitting with my you know, how I like to live. I like to have a good life, work, balance. And so my dad actually said, Why don't you look at OT and I can't even really remember how it clicked, but I looked and I thought, this is perfect. And I remember that first day of otschool thinking I really just found that right fit for me. So that's how I got into it. And I've always had a passion for working with children, especially children in the schools. Given my background growing up and I started out at pediatric therapy network in Torrance, where I got a lot of mentorship and training and sensory integration, and we worked in both school settings and clinics. So I got to see both. And then from there, I went to Los Angeles Unified School District for a number of years, and now I'm with you over at Gino.    Jayson Davies     Yeah, having a good time working together. And I think I actually might have reference referenced you in the past on this podcast, actually, because I remember, I remember, I think, talking about how I was super excited to be working at the school where I was going to be working with someone who had a lot of sensory integration background, as you know, kind of that, that kind of fell apart a little bit, and now we're back at different schools, but, at the same time, I think I actually referenced you some time ago, so that's kind of cool that. And again, I'm just glad we're able to do a podcast together. Super cool. So you obviously said that you've had some background at PTM with some sensory integration at Los Angeles Unified, they do school based services. Well, I mean, they're just so big, it can't look like any other school district, really. So can you explain a little bit what school based looks like in Los Angeles Unified?     Kelly Auld-Wright     Yeah, you know the OT program. Lisa test was really interested instrumental at LA Unified in developing the OT program there, and I think it's really unique in that we had, and I don't know how many they have now, but when I was there, there was at least 20 clinics that did that were at school sites where we did provide sensory, integrative based treatment. And what would happen is the school therapist would evaluate the child and would when they're they were deciding what the service needs were, they would they could consider clinic in addition to the school based and so if we thought the child required clinic, the child could go during the school day, and if the clinic wasn't at their site, they would actually take the bus to The clinic and get their service and then come back to school. And we had a lot of built in supports to make sure that system ran really well. I was a clinical advising therapist there, so I helped people make those decisions and really hone in on their evaluation to make those determinations. And we also had some embedded courses throughout the district called clinic to classroom to really help therapists learn about applying sensory in the school setting.     Jayson Davies     I want to dive more into that, because I know a lot of people. I get emails, and a lot of them are about types of in services they can do. So what are different types of in services you've done?    Kelly Auld-Wright     Oh, man, quite a few. So we've done some outside, you know, within our profession, at Otac, I presented with my colleagues at LA Unified about some sensory there, within the district. The course that we offered was for OTs, and it was usually when they were in their second to third year of practice, or new to the district, and we would go over, you know, basically, all the foundational things related to sensory processing. They would do a case study where they were looking at different their student and trying to just implement some sensory based treatment in the school setting, not the clinic, but the school itself, and then measure the progress based on that. And so we really tried to be data driven with it. We did do some in services to teachers and staff the you know. So that was we had that ability unified to to do that, and teachers could get paid on days off to come to end services, things like that. So yeah, we had, and there was a lot of time in our schedules that allowed for us to collaborate with the teachers, so they really understood what was going on.     Jayson Davies     Yeah, and it sounds like you were almost in the specialty realm where you really focus on the sensory side of things. Is that kind of true? Or did you?    Kelly Auld-Wright      I was a yes, we called them a clinical advising therapist, and it was really, I helped teach in that role. I helped teach the course. But then also I did help. When a therapist was like, help, I don't know what I'm looking at, and so I would come out and we might co treat, or I would help with their evaluation so we could make some recommendations that we thought were fitting related to that.     Jayson Davies     Yeah, and that's super cool because, I mean, it's not very often in a school district that I've seen or heard about where you get that type of mentorship. I mean, we Yeah, to hear that you had, you were providing an in service to other OTS like that doesn't happen in school districts usually, either they send us out to a training, you know, a full one day training, or they allow us to go to the OT Association of California conference. But it's not very often that you have an own, your own in house ot to kind of go talk to about stuff like that. So.    Kelly Auld-Wright     Yeah, it was a really, it's a really great for for new therapists, and just therapists we had. There was a lot of continuing education and support embedded within the model there. But there were also 100 and something OTS there. So there were, yeah, there was a need to kind of get us all on the same page.     Jayson Davies     That is true. It is a very unique program in the sense of how big it is. So,     Kelly Auld-Wright     yeah, yeah.     Jayson Davies     Alrighty, well, we're gonna kind of jump in now to our topic for today, which is really cool, because for the first time in the otschoolhouse, Comcast, we're kind of doing a part one, part two, because two weeks ago we had Zoe on Dr Zoe Mailloux, and. She talked about some of the evaluation procedures for assessing and sensory integration, and now today, we're going to talk a little bit about the treatment side of sensor integration. Before we get quite into that, I want to do a quick review. And if you could give us a quick take on the different senses that in sensory integration we really focus on.    Kelly Auld-Wright     So when we're looking at sensory integration, we really place a high emphasis on the taco probe and proprioceptive and vestibular systems as those form the foundations for all of our learning and behavior. So if you think of it like a pyramid, and sometimes it's helpful to just if you look, if you look up the pyramid from the Alert program. Actually, it's a really nice visual of what we're talking about. When we're looking at sensory integration on the bottom, you have that tactile, proprioceptive and vestibular input. I think you can even just Google sensory pyramid, and it will come up, and it's been used quite a lot. And then as those integrate, then you then you've put your layer on of the visual and auditory information. But when you're looking at it approaching an assessment and looking at from sensory you really want to do an adept in depth analysis about what's going on with the child's tactile system, their proprioceptive system and their vestibular system, because if one of those little blocks is off. The whole pyramid will be off,     Jayson Davies     Yeah, and we'll be sure to find that for everyone and link to it. But I think I've seen that before. And yeah, it's, it's a good one. So what a Where does Praxis fit into all all those sensations?    Kelly Auld-Wright     Well, if you can't feel your body, then you don't know quite what to do with it, right? So Praxis is an outcome of good sensory integration. It's a response to being able to move your body and figure out how it interacts with the environment. And so how I think of it sometimes is, you know, Praxis is just having the idea figuring out what to do and how to do it, but if you're not getting the right feedback from your body, you're not getting the right feedback from your environment, and interacting with your environment, then becomes much harder    Jayson Davies     when you're saying that. One of the things that kind of came to my mind was that whole sensory versus behavior, but we never use the word praxis, or very rarely, because it's not a key word, like sensory is how? How much do you think Praxis also plays into that? Well, it kind of looks like a behavior, but maybe it's poor praxis.    Kelly Auld-Wright     It's huge. It's huge. Because what happens if, if I sit you in a room with this, with the subject content, that's very hard for you, you know? You try to figure out ways to get out of it. You know, I am not somebody that likes to learn about the mechanical aspects of things. And so if you sit there and start talking to me about how to put a computer together, like I'm going to start having a lot of different kind of behaviors. It's, you know, I don't know what you're talking about, and it doesn't work for me that way. But, you know, I think really when you're looking at sensory or behavior, you know, one thing that really gets overlooked in the school system is really looking at the sensory perception pieces. Is, how is, how does the child actually perceive and feel tackling or vestibular input or proprioceptive input, we get a lot of referrals for that reactivity or modulation to the kid that looks hyper, the kid that's running around that kind of stuff. And I went to a training last weekend, and it was with Suzanne Smith Rowley, who's just amazing, if you ever have a chance to hear her speak on sensory integration. But she was talking, she put it in a really good visual for me to understand in terms of, you know, and I not that I didn't understand, but it's just, I think it's a good way of explaining and teaching. This is that when you're looking at your tactile, your visual, your proprioceptive, your vestibular, auditory system, so you have those senses that you're looking at. And so if I take away your sense of touch and you're sitting in the classroom, what might you do? JC, to get information about your environment. If I take away your sense of touch.    Jayson Davies     I would think a, either I would touch nothing because I just don't feel it or B, I would, if I had a little bit of sensation, I would go touching everything, just to kind of see what something that feels like, right?     Kelly Auld-Wright     So you might be trying to touch everything. You might be compensating with your other systems too, right? You might have to use your vision too,     Jayson Davies     Yeah.     Kelly Auld-Wright     You might have to use your proprioceptive more to push on your body to feel where it is in space. You might use your sense of movement more to tell you about where you are in space. So you take one of those senses away, you know, just as somebody who's blind, who has really good hearing, your other senses start to try to compensate, to give you the information you need about that environment. So if you take it. Child's, you know, tactile or proprioception, their sense of their body away, they might start moving a lot, because they're trying to get some information that tells them where they are in space in general. So I always go back to when I do an evaluation is looking at the perception pieces first, because if one of those is off, it's easier for me to to target and treat, I think. And if you think about it, if you didn't look at that, and then you just hand the kid a fidget, you know, and you say, well, sensory didn't work, you know, you didn't really do sensory justice in that, in those occasions. And I think that's what tends to happen. We just throw a sensory strategy at them without an assessment. And, no, it didn't work. All right, move on.     Jayson Davies     Yeah, absolutely. And that's why our last podcast was Zoe was so important. Everything she said was spot on, and where we kind of left off, I think, was after we're doing the evaluation, a sensory integration type of evaluation. How do you go from there? Like, what do you find out from that evaluation? What are you able to pull away from that that then helps you to to start treating?    Kelly Auld-Wright     you know, I look at so I'm sure Zoe talked about the sensory integration and Praxis tests, because those are the gold standard for for doing it. And to me, if you can have a sip, if you can do a sip, that's like having a blood test. You know? It really tells you details about what's going on. If you're using other tests, you have to do more of a piecemeal approach. Understanding the SIFT really helps you understand the theory and the application. So the sipped patterns that were identified, and most recently in the article by Doctor Mayu and others in 2011 has the patterns of sensory dysfunction that come out of the sip. And these are patterns that time after time after time again when they've run these factor analyzes on the Sith, these patterns turn up. And so the patterns we look at are visual Praxis difficulties with visual praxis, difficulties with stomatal praxis, difficulties with vestibular and bilateral integration and then tap reactivity issues usually linked to tactile defensiveness. So those are the categories. And I always, when I'm trying to teach and learn about sensory I say, learn it in the boxes first, and then everyone's going to deviate from it eventually. So you know, as you're learning something, try to put try to put the things that you're seeing into these boxes and see where you're getting the most hits in terms of the patterns that you're seeing. So if you don't, you know, if you have a sip, you can kind of, you can look at the clusters on that, which will help you lead you the way. If you don't, then you're going to take your information from your various assessments and try to pull it together. So if you're not using a sip, you should definitely be using clinical observations of sensory function. And so you're looking at, you know, sequential finger touching. You know, are they able to touch their fingers to their hands? If they can't, then you might be wondering if there's some tactile and proprioceptive perception issues because or they have to look at their hands in order to do it. Those, you know, if they can't put the the sequence together, you might put it with sequencing or Praxis issues. So you kind of have to piecemeal. And one thing I found interesting over the weekend at the course I was that is that people were presenting the the sips that they did, but they had also given the bot with it. And I had always kind of looked at manual dexterity, for instance, is as a test that would tell me a little bit about some tactile perceptions. Because my hypothesis would be that if you don't feel your hands well, you're not going to be able to manipulate items well with your hands. And what I found interesting is that they had some issues turning up on the SIFT that were really analyzing the sensory function. But the bot was coming out average, except for bilateral coordination. Bilateral coordination was actually more would always show up on the bot as an issue. So it made me kind of think, okay, like, that's, that's why you kind of want the more information, you know. And I think a lot of us will give the bot, and we won't give those other, you know, you'll give the the fine motor integration, manual dexterity, then we just kind of stop.     Jayson Davies     Yeah, I was just thinking the same thing.     Kelly Auld-Wright     But when I was at PTM, when I was first learning about sensory in the schools, you know, they would always say, give the whole give the whole thing. You know, not necessarily the strength part, you know, that running part, but the bilateral coordination and balance is a piece that we often omit that is very interesting to look at, especially because the balance has. Some eyes open, eyes closed, that really tell you more about the body and space, if you if they're consistently doing worse with their much worse with their eyes closed. Or, you know, how do they move when they try to balance those kinds of things? So I understand that a lot of people don't have access to a zip or don't have the training. So I get it. I'm in the schools, and I do it too. I have to piecemeal what I'm doing and make my best educated guess about what pattern I think the kids falling into. But that's where you start, you know. And as you start to treat the kid, then you might see, are they making changes using the approach that you're using, or are you seeing some other things and other systems that you think you need to target a little bit more. And that's, that's therapy, you know,     Jayson Davies     Absolutely.    Kelly Auld-Wright     We get kids in for visual motor, and then you're like, Oh, this is a visual motor. This is that, you know, there's something else going on here, you know, yeah. So I always say to, you know, you just do your best to make those clusters and figure it out from there.    Jayson Davies     So you talk about these clusters, and you kind of gave them a name, but if it's possible to kind of quickly go over them, what would visual Praxis kind of look like?    Kelly Auld-Wright     Someone with difficulties with visual praxis? So it's kind of how you take the visual things in your environment. Could be 2d or 3d and how you organize them in their respective space. So, visual praxis, packing your suitcase, getting all your things into your thing. So organizing your desk, being able to put the books on the left the other things on the right, being able to, you know, just draw geometric figures, if you're looking at the design copying, which would be most, most akin to, you know, like VMI, or the those things building so if you you know kids who can't imitate block structures, putting those things together, those kinds of navigating your space in general, you know, knowing what's up on top, under, over, around. So that would be more visual praxis, putting those visual things together and how they orient in space. The Somato somatospraxia is really, that's, that's the outcome of your tactile and proprioceptive systems, and it's related to praxis. So kids with Somato dyspraxia always uses the head that looks a little bit clumsy. They might push too hard on their writing tools because they need more feedback. They have a hard time figuring out how to form a letter imitate body movements, you know, just follow regular classroom routines, even, and novel routines. If something's novel, it's just lost, you know. And you know, in there, those are the kids who might kind of appear slightly rough in their play, because they don't have that good perception of where their body is, sometimes vestibular proprioception, bilateral integration and sequence. That's a mouthful, vbis, as we call it, for sure, these are your kids who are under responsive to movement, and it's impacting their postural skills, how they can sit upright in a chair, as well as their ocular motor skills to follow and track items. So somatodyspraxic Kids tend to have be more apparent often, you know, and the kids with the five vestibular issues sometimes tend to be more subtle, so they have a hard time copying from the board tracking with their eyes and their reading. They might get lost a lot. So they might be able to say, do two or three jumping jacks, but as the pattern continues, you'll see that they lose that kind of sequence and rhythm. So keeping like the rhythm with things is difficult. Anything bilateral, select, cutting might be difficult. Obviously, sitting upright in their chair, it's like, I kind of explain these kids sometimes look like gravity is just weighing them down. It's really hard for them to stay upright in space and say, and then they're just kind of propping their they don't have the postural skills so their elbows on the desk, and it's like their hand is just holding up their poor little head to gravity. Gravity is just too heavy for them.     Jayson Davies     Yeah.    Kelly Auld-Wright     Don't want to put a weighted vest on those kids.     Jayson Davies     What's that?     Kelly Auld-Wright     You do not want to put a weighted vest on those kids?    Jayson Davies     Well, since you you brought it up, weighted vest. Who? When is it? When do you use a weighted and or more the proprioception type of vest?    Kelly Auld-Wright     I prefer the pressure vestibular insulin. I think it's an more even pressure around the body. And so, you know, I think they're really more warranted if you're looking at a kid who has some pro. Receptive difficulties or tactile and because you know then that they are not feeling their body in space, and so you're giving them this strategy to feel, to help them feel their body a bit better, which can then lead to less of some of the seeking behaviors you see in the classroom. The other reason you might use it is a kid who has tactile defensiveness and those that's the another pattern, one of the patterns, which is the reactivity pattern, and is that tactile defensiveness is highly, highly tied to difficulties with attention. And you can imagine if you are so defensive that anytime your shirt moves, it alerts you that it's going to be hard to pay attention you're that sensitive to that input, so the weighted vest, or as I prefer, the pressure vest with those children, might be more effective. But I think that's why, if you actually look at the research out it's not really, it doesn't show any like strong effects, especially with kids with autism, you know, and I think that's because they're just taking, well, this kid has autism, and let's try the pressure that you're not tying it to that underlying sensory system, of why they might need that specific tool. And so then the studies come out, but saying they're not effective because I think, to me, it's actually a sample here, because they didn't have the right assessment to make those determinations.     Jayson Davies     Yeah.    Kelly Auld-Wright     The other thing though, the research is showing, though, that the weighted vests, the more effective ones, have been with children with ADHD, and so that it actually gives them that that deep pressure input to relax their nervous system a bit more. So that's one area that you know, if you have a kid with ADHD, I mean, they tend to have some proprioceptive issues.    Jayson Davies     Make sense, yeah, yeah. And, and last week, I referenced to a study. We didn't talk about that specifically, but there was one study that I referenced to In last episode, and so I'll repost that, that specific study that does talk about how pressure vests have been shown to work with kids with ADHD more so than autism,     Kelly Auld-Wright     yeah.     Jayson Davies     All right, so we kind of got our patterns down. Now, how does that guide us? First? Let's kind of start with right now. You have a sensory clinic at the school that you're at, so if you do have an actual clinic that you can use with swings and all that good stuff, what does treatment look like?    Kelly Auld-Wright     Well, if you're if you have a clinic, I would refer you to the fidelity measure    Jayson Davies     we talked about that last week. Yes, a little bit     Kelly Auld-Wright     Really, to follow those principles of fidelity to air, sensory integrative intervention. And so if you're using a clinic setting, then you want to try, you know, and you're using that sensory integrative approach that that, that's your, you know, formula there of what you're doing. And I think that's kind of its own advanced area of practice. But I think where most of us are suppose we don't have a clinic. And so in that, in those situations, you have to be more creative with you with your tools, and what we call the affordances that that tool allows you. And so a scooter board offers you many different affordances, right? They can sit on their bottom and scoot on their bottom. They can lay on their stomach and pull with their arms. You can lay them on the back and have them pull a rope. And so if you go back to actually, one of jeannie's original works, the sensory integration and learning disabilities, she has a chapter in there about teaching treating Somato dyspraxia, which is rooted in tactile and proprioceptive perception issues, and she lists 30 different activities you can do on a scooter board. So     Jayson Davies     Wow.     Kelly Auld-Wright     We can get a scooter board. We can find some space on the playground, in the auditorium to use a scooter board. So there's no reason you can't apply her theory, you're not doing fidelity to air, sensory integration and intervention in terms of having that clinic setting in the environment like that, but you can do most of those treatment principles with a scooter board. If you look at it, you can still be child directed. You can still provide multiple areas of sensory input. You can still get an adaptive response. You know, these kids can still get input to their bodies that get them more organized their play, can expand their posture, can look better, all that stuff. So I think don't get bogged down with that. You need a clinic. Because you can do, you can be very creative in what is, what the tools will allow you to do with them. Absolutely, yeah, and that kind of ties right into where I wanted to go. A little bit is like sensory integration versus sensory integration based resources and interventions. I mean, we all as school based therapists, sensory diets. You know, we kind of do stuff like that. We help collaborate with the teachers, give them ideas of what they can do in the classroom. It seems like everyone now in schools, not just the OTs, like, just attached to this word sensory. And it's crazy, because we're, we were the ones that kind of started with sensory, and now, like, sensory has just taken over in the schools. How did, like, how do you think that happened? Well, I think people are looking for answers, you know, and oftentimes, you know, it's sensory so vague to a lot of people that they just want to, you know, throw it out there, and different people use it different ways. So a behaviorist talks about sensory and stereotypical, you know, behaviors and those things in different ways, and the psychs in different ways than how we talk about it. And so I think that the way to start is having that evaluation when you're at an IEP and really breaking it down and explaining what you were looking at and what the theory looks like. So I think we just have to be a lot, really proactive in our education about it. And you know, when we are at the table at the IEP meetings, do a better job explaining what we're looking at and why.    Jayson Davies     Yeah, and so we talked a little bit about the scooter board using the pressure vest. What other types of SI based interventions do you incorporate into your practice?    Kelly Auld-Wright     And I love a therapy ball. You can use it for a child who has vestibular postural issues. So I might start with them prone on a ball. And we all kind of people will do prone on a ball to get puzzle pieces or but it's how you vary the intensity of how you're using that ball. So if I have a child who's under responsive to vestibular input, we're not just slowly rocking back and forth on the ball as we get that puzzle piece. You know, I might be oh, we're gonna blast off, you know, 10, nine, eight, and really intensely pushing them forward and pulling them back and starting to to get them to use their body too. Can they push off the ground with their arms to get it back? Can they do I have a pillow? Can I roll them off of it, into it to really get that kind of intense input for that vestibular system, the more intense if a child will handle it, going backwards, over, over the ball. So, you know, putting a puzzle piece on a chair behind them, having them sit on the ball and rolling completely upside down to reach that and come back. And I'm just saying puzzle piece, because that's, I don't it all depends on what the child's interests are. We're still occupational pieces. Yes, you know that it kind of, you know, I think we all have one, but so you you know, I've taken the ball and stabilized it between my legs and had the chub jump on it, you know, I've had them. You know, you can do the bouncing on the ball, especially for the kids who with their vestibular systems, where it's really the otoliths which respond to vertical movement of gravity. So giving them that quick changes in that vertical movement, you can see the child who is sometimes hunched over immediately get that, that nice extension that they need against gravity. So doing a lot of vertical bouncing, kind of activities while they're targeting or, you know, whatever other needs they have, if they have fine motor needs, I'm a huge close pin person that's bringing those into my sensory based activities to work on the fine motor in the context of that Dizzy disc is something that I used to love to have. I left mine. Mine had to go get returned to LA Unified. But we all got dizzy discs there. And you know, so you could, well, you could do the spinning. If you don't have a dizzy list, you can use the office chair if you're trying to really get that rotary movement. And you know, you always want to be careful with it. I have a pretty good idea of how intense I can spin or not spin, because I've looked at their post rotary nystagmus. So if a child after you spin them 10. 10 times in 20 seconds, their eyes, or the reflex, is only there one to two seconds. You know, you know that you can go pretty intensely on that spinning because they're not really feeling that movement. But if you spin them around, and their eyes are going back and forth, back and forth, anywhere, for me, anywhere from six seconds and above, then I'm a lot more careful how intense I'm spinning them when I'm doing that, because I know that they're going to register get dizzy and possibly sick. But we have, most of my kids don't feel it, and I can go pretty intensely on that. And I think therapists, especially when I was at my previous district, in my role, when I would go out to see how they were incorporating that vestibular in their school based treatment, they were afraid to go intense. And so yes, you have the ball, you have the scooter board, you have the Dizzy disc or whatever. But it's not just slight thing, it's intensity varying how intense you're giving that input while they're on there, and spending, if you have a 30 minute session, spending 25 minutes in those sensory based activities before you, and then five minutes at the table, you know, just really, really working on that consistently. And to be honest, I can work with, you know, a lot of kids, I don't get the behaviors I don't get, you know, because you're giving them that input their body needs. And, um, you know, they sit all day in the classroom. So, you know.    Jayson Davies     Move, yeah, yeah.     Kelly Auld-Wright     Figure out how that body works, you know,     Jayson Davies     Yeah. And so I want to touch on that. But first, the other day, in an IEP, I was sitting there, and yes, I have some sensory integration background, but I don't know it as well as you know other people do. And so I had the parent ask me, and I did do a PRN post rotary nystagmus, and it was basically absent. I did it on the office chair, and I was explaining that, that to the Father in the IEP. And the father's like, Yes, I know that. But if he closes his eyes, he gets dizzy. And so, you know, I was, I was explaining, I mean, I did it 1020 spins, and he was just like, more and more. And obviously I didn't being limited in my si experience, I didn't really do a whole lot of eyes closed activities with him, but the dad had a question about that, and I didn't exactly know how to answer. And from your point, does that eyes close position affect the the PRN, or even just the vestibular at all.    Kelly Auld-Wright     Um, it's, you know, it's a reflex. So, no, it shouldn't. If they're, you know, closing their eyes or not. I'm wondering if, when his eyes are open and you're spinning him, though, if he's fixing them on something,    Jayson Davies     that's funny that you say that, because that's the other thing that I think the dad brought up is like that. You can almost see him looking out the corner of his eye, fixating on something,    Kelly Auld-Wright     Yeah. So in that case, he's he this is, to me, a child who probably has a really, really strong visual system, and he's using that to override the vestibular, you know. So here, so you know, if you, for instance, ice skaters, when they spin, they're fixing their eyes on something so they're not coming out dizzy because they're, oh, they've learned to override that system. So I think if he is really getting dizzy, you know, and you could try eyes closed and see if he gets up and looks dizzy. But, yeah, I guess the question is, was what? What was the functional, you know, you obviously in isolation? PRN, no. PRN, whatever, you know, yes, yeah, you know how, what was the end point that you were?     Jayson Davies     There's a lot of this kid, oh, I mean, he couldn't catch a tennis ball. He's a six year old, and couldn't even, like, attempt to catch a tennis ball. There's some bilateral stuff definitely going on. And so I definitely recommended some services for this kid to work on some vestibular bilateral stuff going on. But everything that you just said, like when I brought up that limited information, what you said was kind of exactly even the dad actually said he had done research, and he said the same thing about ice dancers, about how that's what they do. They fixate on something, and that's what he noticed also in his son, that he was fixating on something. So thank you. You just helped me.    Kelly Auld-Wright     Yeah, but it's the PRN isn't the only measure, right? You know, because that's a really volatile measure. It was, you know, it's, it's hard to get it doesn't? It's not always quite accurate, you know, I always look at it as a judgment, but you're also looking at other physiological responses. And then the other thing. He's like, with him, you know, what was his posture like? What were his bilateral skills? Like you mentioned the ball, that's feed forward skills. Being able to catch a ball is a direct outcome of, you know, your vestibular system and its ability to tell you about your body and space and time. And so those are the, you know, if that was my school kid, you're putting those into that, that pattern, right?     Jayson Davies     Yeah, absolutely. And that's kind of think that's what I came kind of came to, but that whole fixating on something, I didn't realize that and, and that's something that, if a kid can pick up on you, like you said, you may not see the PRN, but that doesn't necessarily mean that there isn't a PR, and it just means that that kids learn to adapt,     Kelly Auld-Wright     Yeah, and that's why you can't use it, any of these things in isolation, right? When you're when you're looking at it, you have to have multiple observations that lead you to that hypothesis of what's going on. And I always say appears to, seems as if you know my hypothesis, I believe you know, seems to have issues. You know, because it's not, it's not conclusive. You know, we're making it. And I always tell parents at meeting, you know, I'm using this information to make an educated guess about what I think is going on. And it may be right and it may not, you know, and so, but we're going to try to treat it this way for now and see what happens, you know, yeah.    Jayson Davies     All right, so taking one step back, one of the things we were still kind of on was si based interventions, and I kind of want to touch really on sensory diet. Do you work with teachers to build sensory diets. Or do you prefer more of kind of a general teach the teachers general strategies that they can use with all their kids?    Kelly Auld-Wright     Um, I think you're always doing a little of both. You know, the follow through for a sensory diet is never really great unless the child has a one on one, you know, and that's just, you know, the nature I think, of the beast. So, you know, you do want to work with the teacher on embedding strategies into their classroom, and those, you know, self regulatory strategies that all kids could benefit from. You know, there's a lot of asking for sensory diets, and not a lot of research, or any that you could really find about a sensory diet. I don't know how often I've seen it be that effective, because I, you know, so I actually like, I hate to write them, but I will do them if I have to, because, you know, but I think it needs to, you know, there's, there's some theory, you know, there's a lot of people that believe that if you are doing a sensory diet, then you need the OT should actually be following up weekly on that to see What strategies did you Use last week? How did it work? You know, what should we do that? Because, like, as we know, one strategy doesn't work all the time. It changes. And so you can't just say, after five minutes of work, he needs to go do this. After 10 minutes he should do this, you know, because it's different. And so when I do write a sensory diet, I tried to educate the teacher and the aides in the classroom about the students arousal level that you're really looking trying to look at their arousal, are they too excited, or are they too sleepy, or are they just right, you know? And then I tried to pair the sensory strategy that they could use for that arousal level. And I try to pick points of their day. So if you're in centers and the child has a low arousal level, you could have them stand up and jump as they're reciting the time stables, or spin around in 10 circles. And you know things. And I think we need to be better about how helping the teachers incorporate movement with learning in those aspects, you know. So I almost Sometimes I wish I could just be a co teacher with right, you know, and just sit in the center and say, hey, oh, okay, it's time for times tables. Everybody up, you know, jump 2468, you know.    Jayson Davies     Wouldn't that be so cool? Like, honestly, I want to totally pause on this conversation that we're having. I am not even gonna lie. I have thought about, like, if I could, you know, just almost be like a paraprofessional in a classroom, yeah, like, you know, just kind of be an OT but be in one classroom, just like kindergarten classroom, like all day, every day, to help the teacher out with, like, incorporating movement and and regulating arousal, basically, like, that'd be so cool. But anyways, kind of cut off there. But I think that is so cool. And I think. Right on. I personally also, I like to give the general strategies, kind of like what you're talking about, teaching the the teacher, how to look for the arousal level, and not just always going with the same movement activity at the same time every day. Because often that's yes kids will, they'll be like, Oh, well, he had PE, yeah, but PE, maybe at the same time every day, rather than being, Oh, I see my class is like, all about to fall asleep, let's get up and do some movement. Yeah. And so I find that the general strategy, slash teaching them about how to kind of look for the signs of low and high arousal and and judge from themselves, judge for themselves on that and go from there.    Kelly Auld-Wright     Yeah. And it's also getting them comfortable with alternative seating options, which tend to, I think, sometimes have more impact in terms of if you can get the kids to go on a peanut ball instead of the floor during circle, or those things, and the rocking chairs that are that Virgo has and things, and the teachers knowing that, yes, they're going to move, you're giving them something to move. Their body needs to move, you know, but they're going to settle into it too. So like, you're going to see a couple weeks of just a lot of movement, exploring, exploring, and then hopefully you'll see them kind of settle in and just use it when they need to. So that's, you know, one, and you know the those. But again, it's also coming back to your assessment. So I'm not going to put a kid with vestibular postural issues on a ball. Because they have vestibular postural issues, you know, they have to be a little more creative in how we're giving them their movement information, you know. And eventually, maybe one day they can sit on a ball, but.    Jayson Davies     you're going to work with that kid individually on that task, so that one day they might be able to do it right, versus you're saying you're saying you're not just going to let them sit on it in the classroom. However, during therapy, that may be something that you're actively working on.     Kelly Auld-Wright     Yeah, and, you know, tying the you know, we're not, we're not good about taking the data related to our strategies that we put in. So how are we seeing differences with the pressure vests or that? And one strategy I found effective when I'm taking data is giving the teacher this option that more of a reflection for them. So if I have them on a different using a tool, for instance, during centers or circle time after circle time, what we do is kind of start with the baseline of in describing what the child's participation looks like at baseline, and then the data is more of a reflection on, You know, on Monday, did they perform better than baseline, you know, worse than baseline or the same, you know? And that's a way to start, you know, are we consistently seeing the child? Do have better participation? And that's something easier for the teacher to reflect on, you know. Like, oh, you know what? Today he during centers, wow, he did all his work. Like, yes, he did better, you know. And I think it's not overwhelming for them, and we you can actually get some some more meaningful data out of that. So I think, like, really being careful with that and tying it together. Um, helps, but it is hard. It's really a lot of work, and when you have a full caseload to have all that stuff in order and ready to go, I mean, I understand why things get the way they do, you know, because I've got a full caseload too, and you're just trying to help the kid that you don't have enough time To sit and have those discussions and provide the data and sit in the classroom with them as much as you would like. So you're really trying to do the best you can, you know, and so it's hard, and I think that's why a lot of us just take hearing the word sensory sometimes it's cool because it's a lot of work.     Jayson Davies     Yeah, yeah, that's true, yeah, yeah. So talking, we just kind of got into a little bit about the data. Of course, as school based OTs, we all have to come up with goals and take data on that. How do you go about developing a goal that is a measurable but also incorporates, like that sensory aspect, keeping it functional, but also clearly a sensory goal. Like, do you kind of have a formula or way that you do that?    Kelly Auld-Wright     I don't think something has to be clearly a sensory goal. So if you're talking about a child with somatodyspraxia Who doesn't feel their body right, yeah. Cutting is going to be hard. You can still have a cutting goal, but it's related to somatosta You can, you know, or it's related to how they form their letters and hold the pencil, you know. So your fine motor outcomes are the things we work on in school. Fine and visual motor or bilateral coordination, are all outcomes of proper sensory perception, integration and praxis. So you don't have to have this wild sensory bowl that he's going to do an obstacle course. It could still be cutting, you know, like your approach to it is different. You know, you're not doing us skills based, you know, tabletop work. You're doing full body work to get to the cutting and you know, sometimes therapists do do their obstacle course and then they go to the table. But I would challenge you, if you do that kind of model, to look at your child and decide, well, he has more vestibular based issues. So this obstacle course that I'm doing, or this sensory motor activity needs to heighten the movement vestibular pieces, or if this is so this child somatostaxic. So I'm going to have a lot more kind of tactile based heavy work kind of activities in our sensory motor warm up before we do the tabletop. So, you know, a lot of the research says sensory motor doesn't work, right? You know, the study. So again, that's another issue that they're not tying it to the underlying sensory issue. So, yeah, I don't write like I will in my present level, describe what's going on with their sensory system and how I think it impacts their fine motor skills, but it's still a fine motor goal?    Jayson Davies     Yeah, absolutely, yeah. That's great. How you describe that? Because, well, I won't go too much into detail, but I will sometimes, like write a student will display improved bilateral integration in order to do cut something or whatever. So that might be kind of how I put that sensory in there a little bit. But even then, it's not really, it doesn't say sensory. It just says that it's a skill that they need help with. And the sensory is more the treatment model that I may use.    Kelly Auld-Wright     Yeah, you know. And then so those are, like the perception, I think is easier to tie to one of those functional school things. I think the harder goals to write well are goals around those reactivity issues that impact their you know, attention. But I urge everybody to stay away from the word attention. Stay away from the word non preferred, because non preferred is not OTS. Nobody wants to do anything non preferred.     Jayson Davies     No.    Kelly Auld-Wright     That's, you know, what behavior say. That's not what OTS do. So what I try to my ideal with, with, with those kinds of things, is to find out what kind of goal the teacher already has, or is writing for attention and participation, and ask them if it's okay if I add using sensory strategies as needed to that goal. So that way, I am flexible in being able to support that student on that goal, but I haven't taken ownership of attention because attention is so dynamic. There's so many things that go into it, and sensory is a piece of it, and we do want to share our knowledge of how that impacts their attention. But what I found is year after year, you end up with this kid who has this attention goal, and it's never quite really being met, but then you can never really drop, you know, you know. And then the parent gets really stuck, because the OTS they were going to fix their intention, not fixing their attention. Yeah, right. So I try to always kind of veer that way. If I do have to write the goal. I might look at something about them, you know, it maintaining engagement in their classroom activity for, you know, five minutes without excessive sensory seeking, if they were the kid that was up and seeking input to their body by running around the classroom and that kind of stuff. That's the other reactivity piece. We didn't quite go over, but you have the tactile defensiveness that leads to attention issues. But then, besides vestibular perception issues, you do have reactivity issues where a child is over or under responsive to vestibular input, which also impacts their arousal and their attention. So.  Yeah, yeah, that's a whole.  Confusing for people in that regard. But that have a kid, you know, the over responsive kids with vestibular issues are your kids who are really sensitive to movement and avoid it, and they're always kind of because it's scary. Be in the world like that, and then your under responders are either running around the classroom because they need more of it, or they're just really sleepy. Yeah, turtles, though, that's another piece that you that you do look at, but yeah,     Jayson Davies     All right, well, we've been going on for a while, so I think I'm gonna stop us here. Well, I'll have to have you on another time, because I know there's so much information you have, but real quick, everything that we talked about today was obviously a very, very small snippet of sensory integration and treatment. And so where,what what was that?     Kelly Auld-Wright     Person in the schools.    Jayson Davies     In the schools, in the schools, particularly, yes. So where can people go to learn more about sensory integration, in the schools and or out of the schools, if that's what they care for?    Kelly Auld-Wright     Yeah. You know, I suggest, if you really want to learn more is to start with a good course that teaches you about the theory. And there's several different courses I am affiliated with, the collaboration for leadership in air sensory integration, the clasi. And they have a course series that you can find at CL dot, sorry, CL dash asi.org and so they have a nice, nice hybrid series of in person and online modules. But there are, of course, other courses. I think there was a article put out by Annie Baltes Mori describing the different courses available. So there's the clasi, there's also spiral foundation USC, as well as I'm blanking the sensory, sensory processing disorder in Colorado, Lucy Miller's courses, so I'm butchering that. So you know you have to find that, find what fits your learning style and your your structure. You know of how you want to learn. And we do hope that the clasi will soon have a school based course. Specifically, it'll probably be an add on after you learn the theory. So I would say, if you're interested in that, get started in the theory.     Jayson Davies     Yeah, and that's the course I'm currently taking right now. And very appreciative of that being able to go back and look at that. So yeah. Well, Kelly, thank you again. So much for coming on. It was great to have you. I'm so glad that I get to work with you and that we can, you know, have discussions like this for podcasts every now and then. So appreciate it. Thank you and have a great rest of your evening.    Kelly Auld-Wright     Bye, thanks. You're welcome.     Jayson Davies     Take care.     Kelly Auld-Wright     Bye.     Jayson Davies     All right. Well, that was Kelly, alt right, talking about sensory integration in the schools and what it is and how you can kind of treat it. So with that, my throat turning a little bit, I'm gonna go get some rest. I will see you all next time here on the otschoolhouse podcast, take care and be sure to stay healthy. Bye. Bye.     Amazing Narrator     Thank you for listening to the otschoolhouse com for more ways to help you and your students succeed right now, head on over to otschoolhouse com, until next time class is dismissed. You.  Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 174 of the OT Schoolhouse Podcast. In today’s episode, we’re talking all about MTSS—Multi-Tiered Systems of Support—and how occupational therapy fits into the bigger picture of supporting students in schools. Every school has its own challenges and strengths, and the way OT integrates into MTSS can look different depending on the setting. Joining us is Dr. Moira Bushell, a school-based OT whose systems-level work is both innovative and impactful. Moira was recently named a Fellow of the American Occupational Therapy Association and received the Recognition of Achievement Award at the 2025 Inspire conference. She brings deep insight into what it takes to implement collaborative, effective practices in schools—and how OTs can be a key part of that process. Whether you’ve ever wondered how to provide support within MTSS without a formal evaluation or you’re trying to better understand the differences between Tiers 1, 2, and 3, this episode is full of thoughtful conversation and practical ideas. Listen to learn more about how to enhance your understanding of MTSS and how OTs can drive student success. Listen now to learn the following objectives: -Learners will describe the core components of a Multi-Tiered System of Support (MTSS) and the unique contributions of occupational therapy within this framework. -Learners will differentiate between Tier 1, Tier 2, and Tier 3 supports and explain how OT strategies can be applied at each level. -Learners will identify collaborative practices that enhance OT integration into MTSS and promote systems-level change in school settings. Guest(s) Bio Dr. Moira P. Bushell, OTD, MEd, OTR/L has been a school-based occupational therapist for over 12 years. Her extensive experience in program facilitation and passion for education make her a strong advocate for children. Dr. Bushell has profoundly influenced school-based OT practice and volunteer leadership.  She excels in systems change, advocacy, and leadership development, transforming AOTA’s volunteer nomination processes to align with strategic goals and foster inclusive governance. Her expertise includes creating inclusive learning environments and supporting students of all abilities. She currently serves in multiple volunteer roles with the Illinois and American Occupational Therapy Associations. Her dedication to meaningful change continues to shape the profession and the communities she serves. Quotes “When you're doing MTSS correctly, you're looking at the whole child and a holistic perspective on everything that's impacting the student during their time in school and sometimes outside of school, and what factors are impacting them and their participation in the school environment.”  -Dr. Moira P. Bushell, OTD, MEd, OTR/L “Behavior should be a neutral word, not a negative word. And it's taken this negative connotation that behavior is bad, but behavior is communication.” -Dr. Moira P. Bushell, OTD, MEd, OTR/L “But we need to know that curriculum. That's the easiest way to start understanding how to support the kids, is to understand the curriculum.”  -Jayson Davies, M.A., OTR/L Resources 👉 Moira’s Email 👉 Moira’s Linkedin 👉 UDL 👉 Learning without Tears  👉 Zones of Regulation Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hello friend. Welcome to Episode 173 of the OT school house podcast. Thanks for being here. As you may know, I'm a huge advocate for ot practitioners having a route to leadership roles in the school setting is something that I once wanted to do even, and our ability to be leaders in a school department I believe is long overdue. Myself and many others have spent a ton of time and energy attempting to make this possible. Unfortunately, though, we have a lot of advocating still to do, and this often has to happen on a state by state basis, so there is still a lot of work that we have to do and make this possible. That's why, on the podcast today, I've invited three therapists who when challenged on the matter of OTs in leadership within their state, they stepped up and completed a research survey to help all of us demonstrate why we would make great leaders in our districts. I'm excited to welcome to the podcast Jamie Spencer Kim Wiggins and Serena Zeidler together. Kim Jamie and Serena conducted some much needed research into the perceptions of occupational therapy practitioners as leaders within the New York State Education System. Their findings and insights challenged the status quo and spark powerful conversations that we're going to have today about the roles that we can play and the impacts that we can have at an administrative level. Now I know you might be thinking to yourself, Jayson, I don't want to be an admin and sit in meetings all day. That is not why I got in to OT, and I get that, but I also know that there are some ot practitioners who would love to be administrators and have an impact on not just the OT department, but also maybe even your entire district as a whole. I mean, wouldn't it be awesome if we just could have an occupational therapy practitioner as the director of special education or pupil services, or maybe in some other amazing role that they could have a huge impact in. Well, to have this conversation and to better understand the research, let's go ahead and dive in with Jamie Serena and Kim to hear what they uncovered within their research and what the next steps are now that we have it.    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, Jason Davies class is officially in session.    Jayson Davies     Jamie Kim and Serena, welcome to the OT school house podcast. How are you all doing today?     Jamie Spencer     Great.    Kim Wiggins     Great.    Serena Zeidler     Great. Thanks. Yeah, thanks for your interest in our research.    Jayson Davies     Absolutely, I am excited. Your research actually just dropped about a year ago. We're right at the one year anniversary, I believe, from the published state. And the name of that article is perceptions of occupational therapy practitioners as leaders within the New York State education system. And yes, while it does have New York State education system in the title of the article, as well as I know you all know, and everyone else should know that this is about much more than just the state of New York. So let's go ahead and dive right into that discussion and to get things started right at the top here, let's just dive into the problem. Jamie, what do you see as the main reason, or the collection of reason that we are here, where we are today, where so many ot practitioners are not allowed to be leaders within a school system?    Jamie Spencer     Okay, well, there are a lot of answers, but first, we are not allowed to be leaders, because in most states, we're not considered educational or instructional. And the reason we're not considered educational or instructional is because when the education laws came about that required schools to provide occupational therapy for students who need it, for students with special needs. All of the OTs at that point were medical, and the schools were kind of tasked with hurry. We need to hire OTs to service these students right away, because the law says we do. And so where did they get those occupational therapists from the medical setting? So the OTs came over and they were using their medical know how, and they were widely considered to be medical professionals, and that's how they practice for a very long time. But since then, the education laws have updated dramatically, and our role has changed significantly. So we really are educational, but most states have not updated their legislation to categorize us as So.     Jayson Davies     Absolutely. and I think all of us here, and we talked about on the podcast before with ESSA, especially in 2015 that really kind of ingrained us into. To the educational world, as opposed to an outsider medical professional coming in and and I think we're going to talk more about that a little bit, but Kim Serena, or even Jamie again. Would you like to add on your thoughts as to, you know, why ot practitioners, you know, in today's day and age, aren't really looked as being, I guess, qualified for a leadership position?    Serena Zeidler     Yes. So when we did our research, John sauvignate Kirsch from Connecticut, her research indicated which states have educational credentialing for OTs. And then we our research was a few years later, and there were a few changes, and what we found was that the states of Colorado, New Jersey, Ohio, Washington and Massachusetts, which sort of has a back door way of educational credentialing, are now the five states that, To the best of our knowledge, OTs have the opportunity, if they choose, to take the coursework to obtain an educational administrative certificate. So in New York State, in order to take the coursework to become an administrator, you have to have be educationally credentialed, which we are not in New York. So I think there's and different states call this different things, like in New York, it's educational credentialing. I mean, in other states, they call it different things, but it all really comes down to not having that recognition    Jayson Davies     Absolutely. And that's similar to here in California. We've had this discussion before with Jamie and others on this podcast, that in California, we're having the same problem, and we're trying to overcome that hurdle, and we're having to be persistent about it. We're having to be creative about it, and I'm sure we'll dive more into that in a bit. One of the things that you really pointed out in your answer, though, Serena, was that there are states that do only a handful, but that also means that there are states that don't. This is not necessarily a country wide issue. It sounds like it's more of a state by state issue. Does that seem correct in what I'm saying based upon your findings, or do we feel like this is a larger or maybe it's not, but it should be a larger federal issue that needs to be kind of handled at a more broader issue? Does that make sense?     Jaime Spencer     Well, it's definitely a national issue, and there are a few states that allow occupational therapists to become leaders and really infuse their flavor and their holistic mindset into the school community. But it is also a state by state issue, because each state's legislation, and Serena said it perfectly, is a little bit different. So if I wanted to tell everybody, the big problem is that, for the most part, we're not considered educators. We're not considered instructional, but in each state, that might be worded differently, and the solution to the problem might be a different pathway, depending on the way the state has it set up.    Jayson Davies     Gotcha, okay, so, yeah, I mean, we're all gonna have to tackle this. It sounds like state by state. It's not like one mass legislation is gonna go through in Washington, DC, and make this problem all go away. It sounds like we're going to have to work at this state by state. Correct?     Jaime Spencer     Yes, but we're hoping that we can start an avalanche where one state will pass the law and the other one will also pass the law, and then little by little by little, and that we can all help each other to do that with, you know, educating each other on what we've tried and what key stakeholders we worked with, and what wording we used, and all of that.    Kim Wiggins     I think the other important piece too is that once that happens, then all of the OT schools need to start adding the coursework to their to their curriculum, and move towards that. Because I think that's something that we found in our research too, is that some of the states actually have that coursework included, so then they get kind of like a credential, like a certificate, just like the school counselors do and the psychologists. So it's, it's something that there's lots of steps to that we have to really consider,    Serena Zeidler     yes, that's, I think that's really a really important point to make in our research, we did interview an OT from the state of Washington who basically explained the process to us, and then she referred us to another ot who kindly let us interview her, who went through the process of becoming an administrator, she was eligible to take the coursework and so basically to just piggyback off what Kim said, there are two, she talked about, two schools in the state of Washington. One has that coursework. That Kim talked about, and the other one doesn't. So students graduate from the program that has that coursework, they're, I'm sorry, they're automatically considered educational staff associate, along with other related service providers, like school psychologists, school social workers. So any related service provider in the state of Washington needs to have that educational staff associate credential. Now let's say Jayson, you decide to move to the state of Washington and want to work in the schools, you would then have to take a coursework. And this administrator, it kind of indicated short course. She thought that you can do it online, but anybody that is a related service provider that wants to work in the schools needs to be in the state of Washington and educational staff associate, I hope I have this right, yeah, yes, so and this OT, who took the administrative coursework became a school director, director of special education and secondary program, so it worked out very well for her. But I think it is different in every state. In New York, we have, we're licensed through the office of the professions, but there is also the New York State Education Department, Office of the Teach of teaching initiatives, Office of Teaching initiatives. Ot i and they issue certificates in three categories, to administrators, to teachers and to pupil personnel services or service providers, school psychologists, school social workers, even I believe, master's level nurses, guidance counselors, but we're not in there. Neither is PT, and that's considered an educational credential. And you have to have an educational credential in order to be able to take the coursework to become a school administrator. So that's what we're looking to do. We kind of feel like we would like to follow the path of school social workers, you know, that are educationally credentialed and hold that certificate through the Office of Teaching initiatives. Does that make sense? Yeah,    Jayson Davies     absolutely. I mean, New York and California, sometimes we tend to be similar. And it sounds like it. In this case, it's relatively similar. You know, we're licensed by the state of California as an OT practitioner, but the whole educational side of things is kind of disconnected from the regular licensure, because they have certifications, right or credentials, sorry, not licenses. And same type of thing here. Speech Therapists, you know, they get their C's, and they can be administrators. School psychologists can be administrators, but PTs and OTs can't, because we are licensed on the other side of the government. If you want to kind of segment it that way, I sometimes tell people that if I was able to get a school administrative credential, the OT school house may not exist, because that was my initial long term strategy was to try to figure out how to become an administrator. And I found out that I would have had to go back to school for like five years, get a credential, work for five years, then, because you have to have an experience in order to apply to the admin credential. So it would have taken me like eight years or something like that, to go back and start from scratch, which is just insane, but yeah, here we are. So from what I've heard you all say exact same experience. Jayson, right? It's, it's very unfortunate. So it's great to hear that in five states, you know, they've got this figured out, but it sounds like, from what we've started with here today, there's a few primary problems, Jamie kind of started us off with. We weren't at the table at the right time, when all this was being discussed. We weren't at the table. Kim and Serena, you both brought up the education aspects that you know, we're not necessarily educated as educators. We're educated as medical professionals, and so there's a little bit of that. Then we also talked about the government side of things, where it's just education. Is often its own part of each state's education, right? Each state has a Department of Education, and OTs are not in that department really, like we're not ingrained into that department yet. I think I kind of summarize what we talked about so far in those three but are there any other key areas that we want to talk about as a problem before we move    Jamie Spencer     on. I think you can't not think of the effect. So that's a pro. Those are the main problems, but the trickle down effects of occupational therapists not being allowed to be leaders is just tremendous in terms of everything, in terms of who it affects, how it affects the school community, how it affects the profession, how it affects the stakeholders, the community. I mean you, you name it, and it's just limitless,    Jayson Davies     perfect. And that's exactly where I wanted to go to go next. Because obviously, when we think about this, ot practitioners, we are so unselfish. But at the same time here like it almost feels a little. Little selfish to be advocating for ourselves to be administrators, right? Like we want to be an administrator, that's like we need to be administrators. But it's not just about us. It is about the other stakeholders. So Jamie Kim, maybe one of you want to go a little bit deep into the stakeholders, who are the stakeholders that we might not always think about.    Kim Wiggins     Well, I think that so for I just wanted to also point out, like I actually don't have an interest in being an administrator, but I want, I want to have the opportunity for my colleagues to be administrators, right? And I think that that's super important. So the other stakeholders that are really impacted by all of this is the teachers, right, the NYSED or the education departments. We have all of our advocacy organizations for all of our states, you know, like so in New York, like nysoda, Nyssa, and then obviously the parents and the school community, like everybody involved really is impacted by the OTs not being having the leadership roles in the education system,    Jayson Davies     okay? And so to kind of go a little bit further deeper into that, in what way, like what way would as us being into the administration community, whether it's a assistant principal, a principal or a director or superintendent. What are some of those barriers that we're hoping to overcome so that we can have have an impact on all of those stakeholders?    Jaime Spencer     Well, I think you know when you work, when you work for a school and you're a member of the school community for a little while, you wish to establish a rapport with your colleagues, and you learn from each other, and you learn what a teacher does and how a teacher runs her room, and they learn what you bring to the table. The same would happen if OTs were at the administrative table. We have a unique skill set and a different holistic viewpoint, and we have a very, very creative mindset, and we think outside the box, and we come up with unique alternatives that I think a lot of school administrators would not think of because they don't have the background that we have, and because we're not at that table, we're not at the pro we're not A part of the problem solving teams. We can't show how great our profession is, and that, you know, because of that, administrators don't know exactly what we do, and it just goes on and on. So they don't include the OT and the flexible seating committee, or they don't include the OT in the social emotional learning curriculum development, because they don't think that they don't really know what we do.    Jayson Davies     And serene, if I come back to you, it sounds like you had the opportunity to kind of at least learn about someone who has been in this role and in that case, and this could be a for all of you as well. But from the people that have been in that role, what have they been able to accomplish as an administrator that maybe others weren't able to do like Jamie was talking about, because they aren't in that administrative position?    Serena Zeidler     Well, the administrator that we had interviewed had indicated that she wasn't so much interested in being a school principal, because she wasn't had that hadn't had the experience being a classroom teacher, but she was interested in being a director of special ed, which is, which is what she did. And I think if you know, for even us OTs like you know Kim, that maybe are not interested in securing a leadership position, you know, in the schools, we still may really value having a highly qualified ot in an administrative role, you know, because we want to be recognized and valued and utilized for our full scope of practice, including areas that we saw in our survey. You know, in the results that OTs are not fully, you know, utilizing like MTSS and mental health and health promotion, but if an OT was is there as an administrator, they would, they would be more likely, in our opinion, to recognize our value and utilize us for our full scope of practice.    Jamie Spencer     In Ohio, I actually presented last summer with Kim at the school based conference, and my presentation was about how in Ohio you have these opportunities, so you should take them, because in so many other you know, states, they don't have those opportunities. And I highlighted the success stories of a couple of wonderful occupational therapy leaders that did make a big difference as leaders. So one of them was Kareem Robbins, and she pitched the idea to her district that she should be the coordinator of all the related services. Services, and she wrote it out like a business plan, that we need this position, like, let's create this position. And she got it, and she moved up, and she said that one of the key benefits of her being a leader was that she was able to link the state licensure board to the educational law, and that this was a crucial point, because a teacher who became the special ed director could not do that as well as a related service provider. So it was very cool to hear the success stories of occupational therapy practitioners who did achieve wonderful things as a leader.    Jayson Davies     I think that's a really good point that I've never really thought about Jamie, because we often see school based ot practitioners that get a little conflicted by what the licensure of their state ot license says and what they're being asked upon within the schools. You know, schools might be asking them to document one way or not document because they're trying to save time and the licensing board says you need to document every service you need to do this and that for documentation. Same thing when it comes to evaluations, right? The schools might be trying to cut corners by decrease the expectation of an evaluation when the licensure board says a full evaluation looks like this and you need to do all those pieces. And I could go on and on, but I never really thought about it from that perspective. So that's a really    Jamie Spencer     good point. Yeah, I also interviewed Cheryl van hoose, and she's actually a PT, so shout out to the PTS who also don't have leadership opportunities. But in Ohio, she ended up advancing and advancing and became the liaison between the Ohio Physical Therapy Association and the Ohio Department of Education. So that's huge.    Jayson Davies     Yeah, yeah, a lot of.    Jamie Spencer     one of the key quotes that she said was that OTs and PTs have the foundational knowledge that can help kids learn. And I just loved that quote from her.    Jayson Davies     Yeah, and it opens up a lot of opportunities. And like I know, a lot of OTs would really appreciate ot practitioners. OTs included, of course, would love if their boss was just an OT and understood their job. And we don't have that fortunate aspect in most of our jobs. Whether or not we are a direct hire in the school district or if we're a contracted therapist. We might have someone, we might have someone who guides us from the contracting position agency, but they're not a direct employee of the school, and therefore they don't know our exact needs, our expectations, you know, our ambitions, and how we can support all the kids. So definitely having someone above us that actually knows what we do right would be really nice.     Kim Wiggins     I was just going to say that actually, I think in 25 years as an OT in various different positions and and schools, I've never had an administrator that was a related service provider. And you can and either have my colleagues and so when we have our our related service staff meetings that are being run and organized by whatever their backgrounds are, if they're teachers, typically, most of them have been teachers that have moved up to it being administrators. It's really hard. It's almost like we're educating them about what OT is first in order for them to be able to help us make decisions that we already have, you know, we think that we have really good answers to or solutions to, but we have to do all this educating and all this extra work before we can get any impact, you know. And so I think that that is a huge it would be a huge benefit to have related service providers as administrators, and I have been in situations where I know my speech pathologist friends have moved up to be administrators, and we're always like, cheering them on, and that's awesome, but it's really a matter of like, you're the people. Are people, and everybody has different qualities and strengths that they can use to be an administrator. So being an OT or a PT or a speech therapist or a teacher, becoming an administrator, I think it, I think it really just depends on the person you know, and why don't we have that chance? It just gives it. We need to have that chance and that option.    Jayson Davies     I'm gonna bring up one more thing that we've seen, at least here in California, in terms of why people are concerned about us looking toward an administrator credential. And I don't know if you can speak to this or not, but I'm going to throw it out there, because we've had people being very and I completely understand why, but we've had people very interested in what is going to happen to either a their status in or not inside of a union as part of an administrative credentialing being changed. That process being changed, and also their retirement. They're worried that they might be reclassified from non credential to credential or in other way, and that could impact the retirement. Right? Obviously, at least in California, I'll say it's not obviously, obvious everywhere, but in California, if you are in the school system, it's your pretty good retirement. Like, they're known for having good retirements in the public school system here, I don't know if that's everywhere, but people are worried about that, right? Like, don't mess with people's retirement, right? From your experience, have you heard anything about that? Is that come up with others or from yourself? Like, is that a perspective that you've looked at?     Kim Wiggins     I think that it's been I've noticed that it's pretty inconsistent. Like, I only can speak for New York, and even within New York, there are OTs that are in the teachers union, and have, they're obviously not in the Teacher's Retirement, but they're in the state retirement, which is very similar. And then there's OTs in New York that are not in the Union, and they, they're just, it just seems to be very, very inconsistent. And that just seems wrong, you know, like it just doesn't make sense to me. Like Jamie, you can speak to your personal experience too    Jamie Spencer     Well, to answer your question. Jayson, I do think that there are occupational therapists who are very concerned about that, and rightly so. But it wouldn't just be like a chop, chop. This is what we're doing. You know, there would have to be a whole transition plan and a process, and it's certainly, you know, we're looking to have equity. We're not looking to harm the profession or the professionals. We want to create opportunities for them so that they have equal opportunities to the rest of the educational staff. So the state or the United you know, the teachers associations, who have all the key stakeholders, would really need to put a smooth transition plan in place so that it wouldn't be harmful, but it's, you know, of course, everyone's going to have concerns. But what I always say, and like Kim said, in New York, things are very varied, from upstate to downstate to the city. We all have a different story, but we all have. A lot of us have similar problems, but different stories, but it doesn't really matter, because if this law changes, I can't tell you what's going to happen to Susie Jones in district two in Building C, with her principal, Mr. Smith, like I don't know, and I just hope that it works out, and there's going to be glitches and there's going to be bumps in the road, but for the profession as a whole, it's just not best practice the way things are right now, and we need to not be scared of change, because change can be a wonderful thing.    Jayson Davies     Yeah, yeah. And, and I've heard as well that a lot of those decisions on what union you're in and what retirement you're classified are really more done at the even local or area than just the state. And like Kim was saying, right, it's very different. Some people are in the teachers union. Some are not. That's the same thing here in California, and it sounds like that's more related to how the district, the individual district, has decided to classify OTs, as opposed to the state classified OTs in a way that would be impacted by an administrative credential or educational credential. So yeah, kind of kind of similar. I know we're talking about two states here, but I hope this resonates with with more than just the two states, and it sounds like it does.    Jamie Spencer     I think what we're talking about with the advocacy at the local level, it really charges occupational therapy practitioners that they need to be knowledgeable about what's happening, and they need to get involved. Because if you're not going to join the negotiating committee, or if you're not going to say anything to anyone, then you're not having a voice at the table. You need to take your seat, you know, like they say, if you don't have a seat at the table, bring your folding chair. But if you don't educate the decision makers about your role and the fact that you should be equal, that's going to limit the change even more. So we really need people to advocate for themselves and their profession.    Jayson Davies     Yeah, all right, I want to dive into your actual research a little bit here and ask you. A, who did you reach out to? What was the goal for reaching out to people, and what did that end up looking like? And B, what kind of questions did you ask them? What were you trying to trying to get out of these people?    Serena Zeidler     I can tell you a little bit about the the respondents. So we were looking to hear from school based OTs and OT occupational therapists and occupational therapy assistants in New York that have practiced, currently practicing or formally practicing in the schools, working in the in the New York State schools, and we were very fortunate that we had the support from nysoda, New York State Occupational Therapy Association. They posted our survey on their website. Jamie and Kim have a big social media presence, and we really able to get. The survey out there, and we're really fortunate. We had good numbers. We were used able to use the data from 714 occupational therapy practitioners. So of those, 714 600 were currently working in the New York State schools, and 114 were formally working. And we had 92% were occupational therapists, and 8% were occupational therapy assistants. And we had representation from throughout the state, although I think there was greater concentration in New York City and maybe Long Island, but there were respondents from from all the different districts. And, you know, Jamie and I had gone to Albany. Jamie, I don't know if you want to talk a little bit about that. You know, it was on the agenda of the nysoda of the OT board to discuss school based practice. And we were able to go to Albany and speak to the board about our concerns. This is, I think, in 2019 and they said, Well, you know, that's interesting, but with your data, does do occupational therapy practitioners? Are they aware what's there? Are they even aware that they're not eligible, and if they were eligible, would they even consider taking the coursework? Would they, you know, do they think they should advocate for these changes? So that's what you know prompted us to move forward with this research so that we would have the data to present to the OT board.    Jayson Davies     Okay, and so you were trying to figure out, a, do people know that they are not able to become administrators? B, do they want to become administrators if they had that opportunity? And then some other relevant information to kind of better understand the perceptions of the NY, New York ot practitioners.     Jamie Spencer     I think we can add a C and say, how does it impact the profession and the children that we aren't leaders like, what's, what are the current trends? And Can we somehow link it back to the fact that we're not allowed to be leaders. All right. I also want to add that we did go to that board meeting in 2019 and they they did say, well, we need the data, and that was what prompted us, like, okay, I guess we're going to have to be researchers, and we'd better become adjunct faculty at a college and learn how to do like it was, however, Serena and I had been advocated. I personally went to nysoda and drove to Albany in 2006 to complain about this and to ask for help and to advocate, but it never occurred to me that we needed to like, what were the steps to get change? And this was something solid that was given to us. Well, give us numbers. Okay.    Jayson Davies     We'll get numbers right.     Serena Zeidler     And I think also, just to clarify that we were, we were interested in finding out about about pursuing educational, administrative coursework required for administrative positions, not necessarily becoming an administrator, but having the option to pursue the coursework. So we wanted to know the respondents level of agreement that they that we should be able to pursue the coursework. You know, do they strongly agree, somewhat agree? You know, do they feel neutral about it? You know, disagree this, you know, strongly disagree. And, oh, the overwhelming majority. I mean, the numbers were pretty high. Almost 95% agreed that we should be able to pursue educational, administrative coursework required for administrative positions. And also, the same thing with being a, should we, should the profession advocate for for policies, you know, so that, so that we would have the opportunity to pursue administrative coursework. And then we, you know, we, you also asked, Should, well, they would you consider, you know, how many would consider pursuing the coursework required for an administrative, educational, administrative position, if the opportunity was available to us, and we had pretty high numbers in that as well. And we we broke the data down for currently working and formally working. And you know of the respondents, of course, the choices were, would consider, would not consider and not sure the you know. So a good amount, almost 40% would consider of the currently working, and almost 46% of the formally working, you know, which led us to we also had questions about barriers to work satisfaction. And have you ever considered leaving? And for those that did consider leaving? The main reasons we presented like 20 different possible choices and the rack of opportunity for a leadership leadership position were within the top three reasons why respondents considered leaving. Yeah,    Jayson Davies     it's a lot. I totally believe it. I mean, that that's one of my top three reasons for for eventually leaving. I mean, it's hard again. This varies from district to district, obviously, state to state, but, you know, over here, you kind of max out. And it's not just maxing out on the pay scale, but you kind of see the end of a pay scale as also being kind of like the maxing out in your career. Like, where do you go from here? And for me, I think at one district there was five steps to maxing out. At another district there were seven steps to maxing out. I know some districts follow a teacher scale, which tends to be a little bit larger 2025 steps. So in that case, you're constantly moving up in air quotes. But yeah, yeah, and I don't know for me, I've had three jobs, three school based ot jobs that I primarily worked at. One was a contract position. I was there for very short term, but as soon as I got into a district like when you only see that there's five steps and no opportunity to really move outside of being an OT practitioner. And again, for nine I don't know for it sounds like 60% of people that's what they want. They want to go in. They want to be a practitioner. They're not really interested about the academic work, but for the 40% of school based ot practitioners, it sounds like you found like that's a barrier to them, and they might potentially go somewhere else, where they can.    Jamie Spencer     Which impact the children, because we're limiting carryover. We're limiting their relationship and rapport with the staff.    Jayson Davies     Yeah, and we, I don't know. I don't have the data on hand. I don't know if any of you do, but turnover in public schools is really high, not just for ot practitioners, but for especially in special education, but also general education.     Jamie Spencer     Yeah, was one of the questions that we asked. Like, you know, how long have you been at your current job? And the answers were scattered. But one of the key points that we found in this research was that 96% of the people we interviewed, or I should say, surveyed, they felt strongly that we should advocate for change in legislative policy. So that was an amazing number that we could then bring to our state association, as well as other key stakeholders in our state, like the New York State Education Department and, you know, legislators and people who we can speak to and say, everyone wants this. It was a strong percentage.     Kim Wiggins     I thought, actually, one of the things that I was actually surprised about, and I think is, is key, is a key factor is just the awareness of what people know about what they can and can't do. So, for example, we asked a question like they were asked their level of awareness that people that are considered under the people personnel services like school counselors and psychologists and social workers, are they eligible to pursue the coursework required for administrative positions, and only 34% of the people were completely aware that they were able to pursue it, where 34% were somewhat aware and 31% were not at all aware. So if you're not even aware of what you know you have to do to get to that spot, you know, it's going to be really difficult to move forward with that. So I think just bringing awareness to all OTs across the nation about what they have to do to advocate, or even knowing what they you know, what their particular state allows them to do or not allows them to do, I think is a key factor, too.    Jamie Spencer     And we also thought then, if the practitioners who are working in the field aren't aware we know that the students aren't being educated about it either.    Jayson Davies     Yeah, yeah. I was just looking at your your article, and something that really stood out to me was that people don't even fully understand how hiring practices, pay equity and healthcare benefits can all be impacted by the inability to earn a credential and become an administrator. So, yeah, the power of unknown is very powerful.    Kim Wiggins     What I really liked, I think one of I like a lot of things about our research. But one of the things that I little biased there, but one of the things that I really liked is that just completing or filling out our questionnaire, I think, actually brought awareness to people, because we were asking questions that actually, like, triggered thought, like, oh, I actually don't know about that. Or, of course, I want to advocate for this, or, you know, things, you know, they're just different questions that actually just brought more awareness in general. So I think, you know, doing the research, and I have, you know, in all 25 years, only in the last probably 15 years that I've been a presenter have I really had the time, or not even at the time, but looked into research and appreciated research because it is, it's a lot, but the more of us that are doing things like this really make a difference and bring advocacy to our to our profession.    Jaime Spencer      Absolutely, absolutely go ahead. Serena.     Serena Zeidler     I was just thinking about our statistician, and we were really fortunate that we had some funding for this research through the Torah University's Dean's Research Award, and we use some of that funding to consult with a research expert. But we also had access to a statistician because we we had students, the BSMS students, who are involved in our research, and we were really careful to reduce bias as much as we could by asking questions. You know, we wanted to know that, you know, the level of agreement that we should be able to pursue educational, administrative coursework, but we had to be careful how we sequenced the questions, so that it wasn't presented in a way that, you know, that somebody would want something once they learned they didn't have didn't have it, you know, so, but I think we did a pretty good job with that.     Kim Wiggins     Yeah, yes. We were very, very careful of that, because it's it is hard, you know, like not to infuse your opinions in there, right?    Jayson Davies     Yeah, yeah, absolutely. I mean, research is not easy, that is for sure. So kudos to you, to the three of you, for taking this on and getting published within a pretty prominent journal within the school based ot realm, for sure, the Journal of Occupational therapy schools and early intervention. I want to talk about what has happened in the year since you published, and maybe in the two years or so since you probably completed this study and before it was published. But the last question I want to ask before we do that is you made sure to include a, OT, a and Essa within this published article, you mentioned, I believe it was the vision 2025 from a OTA. And you talk a little bit about making sure that you kind of connect ot with ESSA. And I just want to give you the the opportunity to share the importance of that and why you did that.    Jamie Spencer     Well, one of the questions was regarding, did they feel that ot has in New York has met the centennial vision, and the centennial vision spoke about leadership. I don't know it off the top of my head, but we asked, you know, do you think that ot in New York has met this and there was mixed responses, but I feel that we have not met it. And so I wanted to put it out there that, you know, Vision 25 vision 2025 says that we are going to be leaders and that we are going to eliminate barriers in the community and like all these wonderful things. But how can we do that if we're not technically allowed to be real leaders. And I listen, I know maybe I could get promoted to like lead OT or something like that, but that doesn't require a certificate. That's not a formal leadership position within the education department. So it's different, and we need the same opportunities as everyone else. We also wanted to highlight the the disconnect between the federal law ESSA, which says that we are important members of the school community and that we are equal with other s, i, s, p, s, which are social workers, psychologists, speech language pathologists, librarians, and then the state law, which has us classified as non instructional, and when we look at who is classified non instructional, it's people who do not work directly with students on their education. It's people in the transportation department and the clerical department and the sanitation department. It's completely different, and we are instructional. The state just hasn't recognized it yet. So we really wanted to point that out, in addition to going to the key stakeholders and aligning the disconnect with their mission statements. So nice and mission statement is about equity, and, you know, advancing people to leadership opportunities and equal opportunities for women, you. At our profession, which is, you know, the majority women were all limited from these opportunities, so we wanted to highlight that as well.    Jayson Davies     Yeah, and I can't remember who it was, but one of you mentioned earlier that, in order to really have schools understand our ability to participate in school wide, district wide initiatives under MTSS, we really have to have OTs in place that understand our potential there and be in the administrative role to, you know, point out to an assistant supervisor that, hey, the OT might be the perfect person to help with this social curriculum or or whatnot like that. So, yeah, definitely. Well, let's go ahead, I want to talk a little bit about what's happened since you got this research out into the world published, and also the future implications from here on out. So what has happened in the last year plus, since this was published, and kind of you collected all this data?    Jamie Spencer     a lot. I'm so excited to say that, because if you would ask me a couple of months ago, I would be like, not much has happened, but just recently, a lot of things have actually come to fruition, which is so amazing and wonderful. We presented the information to our state association, and we also presented it to the New York State United Teachers, and they're huge stakeholders in New York State. They have a lot of power. We sent the information over social media. We've really spread the word as to what we found and why this is important. And just recently, nysoda put forth their priorities for the year for school based occupational therapy and getting us categorized under pupil personnel was on there, and they've always been supportive, but they just recently actually put forth legislation to categorize occupational therapy as pupil personnel, also to ask the commissioner of the education department To put forth a guidance document recognizing what occupational therapists in the schools can do, including early intervening, MTSS mental health, all those things, they kind of all tackle the problem. So we're very, very excited about that. And there was another bill that was introduced by Assemblyman Ari Brown, which actually asked for equal pay and career ladder opportunities for occupational physical therapists. So there's been some chatter on social media like, Is this because we're worried about Trump, you know, blowing up the Federal Department of Education, and then the states are going to be scrambling, and who knows why it's happening. We're just so grateful that it is happening. And then some things on the local level as well. There are districts around here in Long Island that have been hiring occupational therapists directly rather than contracting, and they're putting forth ra like putting forth proposals to their representative assemblies, asking for us to be included in the tenure laws and not even realizing, well, we can't be in the tenure law because we're not considered educators. So, you know, there's all this kind of the ripple effect of knowledge.    Jayson Davies     Yeah, that's why do you think that you're seeing districts start to hire directly, as opposed to contract positions?     Jamie Spencer     I think they're recognizing the value of occupational therapy more, and also recognizing the cons of contract therapists, how they don't have the time to collaborate as much with the staff, and, you know, really be a part of the school community, and there is high turnover, because a lot of contract therapists aren't they don't love that, or they are just put in a different building the following year, and they're just not included in everything, including professional development opportunities and districts who understand what we do are making changes.     Kim Wiggins     I actually think one of the biggest issues is MTSS, I think that when we have contracted therapists in the schools, they really can participate in MTSS as well, because it's not a billable service, and that's often how they're getting paid. And also, you know, you can't just, you know, a therapist like as a district, I was gonna say, district owned. That's not the right word. A district employee, you can just walk into a first grade classroom and provide tier one interventions or suggestions or ideas, and the same with tier two interventions, but as a contract therapist, you just can't. And so I think that, you know, administrators and school districts are noticing that, wow, maybe we could nip more things in the bud as far as, like, helping as many kids as possible. If these OTs or PTS are participating in MTSS tier one and tier two. But when they're a contract, they just can't do that. They're just not able to do it as much there. I'm sure there's cases where they They do, yeah, you know, whatever? Contract they've come up with, but it's, it's rare it's not, and I don't think that's just New York. I think that's across, I think that's across the United States. Yeah,    Jayson Davies     I mean, I think it's, I've seen in some districts where the contract at OT is almost, basically an in house OT, and that's just the way that the contract with the agency works. But I think in more cases than not, than not, it's more like what you talked about Kim, where you know they're they're getting paid by the half hour session, and that's got to be a billable session, otherwise no one's getting paid. And in that case, right? You want to, you're going to optimize your time toward billable sessions, right?    Kim Wiggins     And more, and there's more instances of pull out and less inclusion and and, you know, you don't have the chance to, like, talk to the teacher and figure out when is the best time for me to push into the classroom. I can come to, like, contract therapist. I can come to this school on Mondays and Wednesdays from 10 to 12, you know. And so you can't always push into the most, the best, particular spot in the school you can't push into art, you know, because art is, it might be changing every single day, or what's the time. So, yeah, I think, I think that's a huge piece of it, too. And I, I am and happy with the states and the districts that are starting to hire therapists, because it really does help with our professionals. Definitely.    Jayson Davies     So now that you did this research, what else would you like to know? Like, I don't know. Maybe you're already working on some further research. I don't know that yet, but what would you like to know? What did you not learn in this research that you're like, Darn, we should have asked this question. Or, I guess, what's that next step for you in terms of information that you wish you had, or maybe you're looking for already.     Jamie Spencer     So we actually did another we did this identical study. We had to change some of the questions a little bit regarding physical therapy. We didn't have as many respondents, but we had, I think, I think it was over 100 maybe 109 is sticking out my head. And we had similar results. We didn't write it up, and I did present the information at the A ot children and youth conference last year. But we're not finding that. We're not finding physical therapists like us who are passionately fighting about it. So I would love for PT to get on board with this fight. We also had thought about possibly surveying school administrators about their knowledge about occupational therapists and what we can do, but we actually did put that survey out there, and we had hardly any respondents. So it wasn't, it just wasn't Yeah, can I just anything you could grab on to?    Jayson Davies     Yeah, I that's one that I've been very interested in and in on. And I did find one article a while ago, but it was a little dated, and they also had trouble, you know, getting a hold of School Administrators. I think one that I saw, they actually did a focus group with school administrators, which was very eye opening, yes,    Jamie Spencer     and they interviewed them, right? Yeah, yes, I read that article,    Jayson Davies     but yeah, no, I think it's going to be key if we want to convince administrators and education, you know, experts, that we belong in the similar world as them in the educational world, we're going to need to have their input on it, because, you know, I could see you, all three of you, driving down to Albany and them saying, great, cool, you have ot data now. Where's the data that says teachers want you to be part of the team? Where's the data the school administrators want you to be part of the team. And I think that's going to be important for for us to have. And I know there's some are, there are some articles out there about it, and everyone that I've read it's been very positive in relationship to teachers wanting support from OTs and admin wanting support from OTs. It's just a matter of making it happen. Yes, agreed. So any other next steps that you're hoping for? Are you? Are you heading to helping you to share these results with them? Or have you shared it with the New York Education Board, or anything like that yet? Or is that the plan? Or, well,    Jamie Spencer     I'm on the New York State Education Department occupational therapy board, and I did share the information with them and bring it up as a as an issue in the profession. It's a difficult situation, because when you're on the board, you're not necessarily supposed to be promoting changes to legislation and all the things like that. You're supposed to be there to advise the board. But my my take on that was, well, I want to advise the board that there's a major issue in the profession, and it's, you know, we keep trying to talk to the Education Department, and nysoda has reached out and even had a meeting with ot a to meet with the education department about the state of the profession, and this was years ago, and they wouldn't even really entertain it. They wouldn't even take meetings with us or anything like that. So I. I do feel right now, New York State has a new executive director of the occupational therapy board of the Education Department of New York, and it's such a long term but yeah, it's not, it's not the professional association, it's the OT board of the State Education Department. We have a new executive director, and she's very knowledgeable about occupational therapy, she's been very open to listening, and I feel that we're being heard, and it's the whole board. We're all in agreement that this is a topic that's coming up again and again, and that it's impacting the children, and it's impacting the profession and our ability to influence our unique skill set to help the children.    Jayson Davies     Yeah, yeah. And I think my, my final wrap up question here is really going to be like related to everyone listening here, and they've got this research potentially in front of them. I know, I know not everyone has access to the Journal of Occupational therapy schools and early intervention, but if you have access to a school that does have access to it, be sure to get this, download it, save it to your computer, keep it or at least go get the abstract. But yeah, what? What is your hope that someone an occupational therapy practitioner you know, or maybe even an administrator or a teacher that's reading this article? What is your hope that they'll do with this information?    Serena Zeidler     Well, I think reading the article is going to open their eyes. They not may not even be aware that this is an issue, that this is a problem. And I think that's helpful in and of itself, you know, to understand that we're not eligible to pursue educational administrative coursework. We're not educationally credentialed. Of course, our research focused on New York, but to me, the first step is to become part of the Office of Teaching initiatives and the category pupil personnel, similar to school social workers and school psychologists. And you know, if somebody's reading this article, maybe would kind of open up their eyes to this issue. And in the article, we talk about how it impacts the students, it impacts the whole school community. And maybe if somebody's reading it, they'll realize, you know, what this is impacting my school as well. And, you know, talk to your state association. I think that's always a good start. I mean, we had, we had done this years ago, back in 2009 we had written Jamie and I and two other OTs wrote to the State Education Department, the Commissioner, we wanted to find out about, how do we become pupil personnel. And, you know, we basically were told we're not instructional, we're not pedagogical. And then we went to nysoda. Nysoda folks at that point in time were totally, you know, different professional, different OTs than they are now. And you know it, it's just been a really long process, but I think, you know, going to your state association, talking to OT other OTs, maybe getting involved with a university, and, you know, doing this, getting involved in doing a study, like we did. I mean, this, our study focused on New York State, but it could be generalized to any of the other states as as well.     Jamie Spencer     And I know I think people who are who are completely unaware, or who are not involved in the advocacy, like I've had a lot of OTs say to me like, oh, good for you, that you advocate. I'm not. I'm so out of the loop. And they're not. Those are not going to be the people that are then going to go contact their state association because they don't feel like they know it well enough to speak to it. But even just telling your ot bestie, did you read this article? Did you see what it says and the things that we're talking about, we've we've cited the research behind that. We've cited that OT is historically misunderstood. We've cited that the mission statement of the education department is A, B and C. So at least to give them talking points, you can't advocate without being knowledgeable. So at least this can provide a foundation of the problem and possible solutions.     Jayson Davies     Yeah. And you also never know when you'll be at a holiday party with the principal or superintendent or, yeah, or,    Jamie Spencer     you know, somebody even more important.     Jayson Davies     Yeah, yeah. I would love, by the way, you all shared a few stories about administrators that you know. I would love for those administrators to put out their stories OTs practitioners that have become an administrator. I would love for them to share their stories in the OT practice or in the Asia, somehow or anywhere that they can publish anything. I think that would be really powerful for others to see what that has looked like, what they've been able to do as a result of becoming an administrator. Sure,    Jamie Spencer     good point.     Kim Wiggins     That's a great that's a great idea.    Jamie Spencer     There. Actually, there is an article in OT practice a few years back, Jan Hollenback wrote it with a couple of other occupational therapy practitioners, and it did describe their pathway to become leaders. But each one was unique, and it was just a few people, but still, yeah,    Jayson Davies     yeah. I would love to see like one published every year. I don't know that's that may not be realistic, but it would be awesome. All right, Kim, we'll end off with you. What's one thing that you're hoping you know that an OT practitioner reads this article and takes away and maybe they take an action, maybe they don't, but what do you hope that they get from this?    Kim Wiggins     I think my biggest thing, and I've mentioned it a couple times today already, is just awareness. Like Serena said, like, I really believe that the more aware we are as therapists and in the school setting, the better it's going to be, the easier it's going to be for us to advocate. So if, like, I think that number that I shared earlier that people just weren't even aware that it wasn't that it was an issue. Is is a lot, because I think that if we are aware, we'll be able to advocate to our administrators, to our teacher friends, and, you know, OTs are typically very well loved people in the school like we, we really try to help as many people as possible in so many areas. And I really think that all of our colleagues would appreciate that, you know, for us, you know, and cheer us on and and want us to succeed and be able to move forward. I know that in all the schools that I've worked with, it's, you know, the OTs are often the glue, you know, to a lot of the other professions. And so I think that other people see it too. And so just having that awareness, I think, is a really important piece. And so I'm hoping, I'm hoping that that increases after they read it,    Jayson Davies     Kim, you just brought back some great memories of my profession, like just being at the IEP and kind of being that person that kind of hurt. The parent, heard the teacher, heard the administrator, and was kind of able to synthesize it a little bit and get everyone on that same page. Like I don't know that that is something that OTs practitioners, we do pretty well. I think we're good at listening. We're good at observing behavior and kind of keying into important things in each person's life and what they want for the child, and kind of bringing that together. I think that's a great point, and it's also why we might make, yeah, exactly, and it's why we might make great IEP team leaders as an assistant principal, special education provider, something like that. So, yep, superintendent, I have not sat in on an IEP with the superintendent at JP, Jamie and I hope I never will, but that said there's a lot of meetings that they do sit in on that are obviously very important, that an OT practitioner would be a welcome site. So absolutely, thank you all so much for being here. Serena, really appreciate you being here. Kim, appreciate you being here. And Jamie, as always, you're always welcome on the podcast, all three of you, but Jamie, been here before. Thank you all so much. We appreciate it, and we'll definitely keep in touch on your research. Thanks again.    Serena Zeidler     Thank you. Thank you for having us.     Kim Wiggins     Thank you.     Jaime Spencer     Thank you for helping us share the information.    Jayson Davies     All right, that is going to wrap up episode number 173 of the OT school house podcast, I want to extend a very heartfelt thank you to our incredible guest, Jamie Spencer, Kim Wiggins and Serena Zeiler. If you have any questions, well, first and foremost, go check out the research. I will link to it in the show notes. But if you do have questions beyond that, reach out to Jamie Kim and Serena on LinkedIn. Or if you know how to get in touch with them, they're pretty easy people to get in touch with, so give them an email if you have a question, or maybe you want to help out with research, I'm sure they would love to collaborate to make maybe a similar survey happen in your state, or maybe to use their research within your state to get things going. They would love to help you advocate for administrators or for OTs to become administrators in your state. All right. So with that, thank you so much for tuning in. Really appreciate it, and we'll see you next time on the OT squad 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 . 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 25 of the OT Schoolhouse Podcast. In this episode, Jayson interviews Dr. Zoe Mailloux, OTD, OTR/L, FAOTA on the importance of completing a comprehensive evaluation in sensory integration. Since being a research assistant for Dr. A. Jean Ayres, Dr. Mailloux has gone on to author more than 30 published journal articles and has taught courses on Ayres Sensory Integration(®) all around the world. She is also a professor in the doctoral program at Jefferson University in Philadelphia and has worked with many organizations on understanding the importance of sensory integration in all individuals. Listen in to learn more about Zoe and all of the incredible knowledge she has to share about sensory integration. Links to Show References: Quick reminder: Links below may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you The below references were mentioned throughout Episode 25 Websites www.zoemailloux.com ASI2020Vision.org Articles related to Ayres' Sensory Integration ​ More info on the EASI CL-ASI.org SIGlobalNetwork.com ICEASI.org [The International Council for Education in Ayres Sensory Integration (ICEASI) is currently not working as of 6/16/19] Articles and other Documents Guidelines for Occupational Therapy and Physical Therapy in California Public Schools Application of Data-Driven Decision Making Using Ayres Sensory Integration(®) With a Child With Autism Interrater Reliability and Discriminative Validity of the Structural Elements of the Ayres Sensory Integration® Fidelity Measure© Books By or Feat. Dr. Zoe Mailloux Clinician's Guide for Implementing Ayres Sensory Integration: Promoting Participation for Children With Autism Love, Jean Ayres Dyspraxia Monograph, 25th Anniversary Edition Sensory Integration and the Child: 25th Anniversary Edition Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript.   Jayson Davies     Celebrate good times. Come on. Doo doo doo doo doo doo doo doo Woo. More on that in just a second, but first Cue the intro.    Amazing Narrator     Hello and welcome to the OT school house podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.     Jayson Davies     Hey everyone, and welcome to episode number 25 of the OT school house podcast. I hope you enjoyed my little singing right there that is in honor of marking our one year anniversary of this podcast. So we made it one year. That was my goal when I started this was to make it one year, and we have made it and well, I'm just gonna say now I don't feel like we're ever gonna stop. So thank you to everyone who has been listening for that entire year. Thank you to everyone who has been listening for one or two episodes. Thank you to everyone where this is your very first episode. Listening. Very much. Appreciate it. And well, I couldn't be more excited for our special guest today, in fact, so excited that we're just gonna skip straight to it, and I'm gonna give a quick introduction to Zoe Mayu, and then I let her give a little bit more introduction and background to what she's been doing and what she's up to. So I first met Zoe back at a conference in Pasadena several years ago, and I've been kind of admiring her work since she has published over 30 journal articles in her nearly 40 years as an occupational therapist. And what makes Zoe a little bit unique is that she actually studied under Dr aging airs. And so today we're here to talk about sensory integration, and more specifically, ASI, or air sensory integration, and the evaluation of air sensory integration within a school based setting. So without further ado, I'm just going to let her give a little introduction about herself, and then we'll continue on with the interview. So here's Zoe Mailloux.    Zoe Mailloux     My name is Zoe Mailloux. I'm an occupational therapist, happily working as an OT for more than 35 maybe 40 years, quite a while. And I've been really fortunate to work in pediatric occupational therapy most of the time that I've been an OT.    Jayson Davies     Awesome. And so what are you up to these days then?    Zoe Mailloux     currently, I'm on the faculty at Thomas Jefferson University, which is in Philadelphia, by the wonder of technology. I live in Southern California and teach online in their OTD program, and I've I teach quite a bit of continuing education courses for occupational therapists, physical therapists, speech and language therapists who are interested in sensory integration. Worldwide, I get to travel around the world. I've been to many countries sharing information about sensory integration.    Jayson Davies     Yeah, in fact, weren't you just saying you just got back from was it India?    Zoe Mailloux     I just got back from Turkey and Dubai, Istanbul and Dubai?     Jayson Davies     Oh, man, that must be an amazing experience, just kind of getting to know the culture and and all that.    Zoe Mailloux     What's really great is having the chance to meet occupational therapists from all over the world and see how they live and how they work and how they shop and pick up their children from school. Yeah, it's a great way to get to know the world and to see our profession all over the world.    Jayson Davies     Is there one particular story that like comes to your mind when you think of teaching outside of the country?    Zoe Mailloux     Well, you know, since I just got back from Dubai, and that's fresh in my mind, what was really amazing there, I had a course of about 25 people, and 14 different countries were represented in that one course. And so Dubai is a place where most of the people who live there are from other countries. So that is really sticking with me, because they're quite proud, and I think they should be. They're quite proud of their ability to collaborate and work together in just an incredible multicultural place environment, yeah, yeah. And they're really, you know, they, they have a lot of pride in the fact that people get along. It's a very safe place. And so that was inspiring to see that and to see that melding of cultures. So,    Jayson Davies     so you're saying they're from 14 different countries, but they all live in Dubai now.    Zoe Mailloux     They all live in Dubai, and yes, and they were originally from 14 different countries. And actually in Dubai, I think only about less than 15% of the population is considered local or Emirati, and everyone else who lives there is from somewhere else in the world. That's crazy. Yeah, some for long. And some more short term but occupational therapy is quite strong there. There's a lot of OTs there, yeah,    Jayson Davies     actually, I mean, just doing the podcast and having our online, you know, expression through the blog and through Instagram and and especially Facebook. I have a lot of people on Facebook that seem to be from that culture. They that like us on Facebook and reach out, and it just seems to be a growing ot community over there.     Zoe Mailloux     There really is. And you know, just worldwide, ot has developed so much over the last few decades. And that's, I think that's the other, just general thing that I appreciate about traveling, is seeing our profession in so many different places in the world and how it works in so many different places.    Jayson Davies     Yeah, that's awesome. All right. Well, I only have you for a short time today, so I'm going to try and squeeze in as much as I can for everyone listening, but to kind of get started in what way have you worked with kids in schools?    Zoe Mailloux     Well, so I'll just, I'll back up a little bit and just say that very early in my career, I was really lucky to work with Dr Jean Ayres, and so I'm sure most OTs know that she was the pioneer who developed the theory of sensory integration. And when I first started working with Dr Ayers in California, ot was not very present in the school systems. It wasn't until about the 1990s in California that ot became a real central part of school services. So at that time, when this these changes were happening in California, I was really involved in some of the first ot services in our state. It was a pretty scary time, I think, for everyone, for parents, for therapists and for the school systems, because they were not at all familiar with what OTs did or why they might be in school systems. But I think the work in sensory integration, Dr Ayers was always focused on the ways in which sensory integration function supports learning and behavior and attention, and then the corollary is how sensory integration problems can interfere with learning. So it was always really clear for those of us who worked in this frame of reference that sensory integration was a very pertinent part of understanding how children succeed at school. So over, yeah, over my career, then I worked in many, many I was part of a nonprofit practice. For many years, we would send therapists to over 200 schools, many different school districts.    Jayson Davies     So in a way, si has kind of been in schools since ot has been in schools.    Zoe Mailloux     Well, at least in California, occupational therapy was part of the school systems going back to the 1970s when the legislation occurred that brought ot into the schools. But California was a little behind, because we had another system here. We had a system called California Children's Services that was focused on children with orthopedic problems, and there was kind of the view that that was those were really the only children who would need ot and then some changes have and so other children with other diagnoses were receiving occupational therapy, may be physical therapy through other venues, not through the school systems, until about the 90s. So really, in California, yes, that's true, but not for the rest of the country.    Jayson Davies     Gotcha. That's actually one of the podcasts that I want to do in the future is just kind of looking back at the history of OT and schools, because it's still relatively new, in a sense. And I mean, education has been around a lot longer than special education, and especially ot in education and and just that, you know, 15 year gap of what you're talking about between OTs being in schools in California. Well, that was, like you said, a good 10 to 15 years after idea originally passed. And so it's all crazy how it works, yeah.    Zoe Mailloux     And it created a lot of localized traditions or customs. You know, depending on where you were in the country. OT services really vary. But I think in California, the fact that we did have sensory integration pretty well developed, maybe affected a little bit more about the way ot services have occurred, great in this state.    Jayson Davies     Yeah, all right, well, it wouldn't be right to have you on and not talk a little bit about Dr Jean Ayres, as you know, you've worked directly under her so, but you also really can't talk just about Dr Ayers without giving a little background slash intro into sensory integration theory. So would you mind sharing with us a little bit about Dr Ayers and si Sure.    Zoe Mailloux     So Jean a jean Ayres was an occupational therapist. She was also a psychologist, and she was quite unique, I think, not only for our field, but just in general, in that. She was a researcher, an educator and a clinician throughout her career, and that's kind of unusual. A lot of times professionals focus in one realm or another, but she always ran a clinical practice and at the same time, conducted research studies, and did you know conducted education as well. She had some really unique ideas that were born out of her interest in how the brain functioned and what happens when things don't work well. She was especially interested in some of the lesser known functions of the nervous system, and so through that process of inquiry. She would have children who would be struggling in school in learning and behavior, and she sought, then to understand them through her study of the nervous system. What was really key in the development of sensory integration theory was the development of assessments. So she was always someone who really valued assessments and developed her own tests so that she could understand what was working well for the children what wasn't working well, and then she would know how to treat them. So I guess in a nutshell, and sensory integration is not the easiest thing to explain. Simply, no, but it's really about how we take in information through all of our sensory systems, and kind of process and coordinate and integrate that information so that we can interact successfully in the world. And so much of the theory of sensor integration is related to functions that we all take for granted, that it makes it sometimes especially challenging to explain, because when all of us have sensory integrative systems that are working, we don't have to think about them. Yeah, when we have especially developing children who are missing some of the foundational sensory functions. They are easily misunderstood. They're thought of as children who are not paying attention, who are not trying, maybe who are willfully misbehaving, but really we're expecting them to operate with functions that you know should be happening more automatically.    Jayson Davies     Yeah, and I'm glad you mentioned some of those expressive behaviors, or those behaviors that we see being expressed by students or kids with just sensory difficulties, and we'll get into that in a minute. But just while you're talking, something that popped up into my mind is obviously SI is known like OT, or SI belongs to OT quote, unquote. But who else is looking at Si? Obviously, it can't just be OTs that are doing all this research and stuff. Who else is out there, kind of looking into the brain, looking into the behaviors and stuff like that.    Zoe Mailloux     So that's a great question. I mean, I think it is important to recognize that sensory integration theory, and much that we know about this work is really core occupational therapy, because Dr Ayers, as an OT was interested in how we interact in the world, how we do things and how we participate. She really was that was her concern. How do children participate and engage in their occupations? And so that's why it's so strongly part of OT other therapists, other therapies, physical therapy, speech and language therapy, have also become quite interested in this approach. And I think since the advent of autism as autism, as the autism diagnosis, increased and sensory integration difficulties are so prominent in that diagnosis, then the interest in sensory integration become, became much wider. So autism experts, researchers, teachers, you know, psychologists, I think in recent years, especially because of that diagnosis, have been more interested in sensory integration?     Jayson Davies     Absolutely. Have you ever worked with, like a neuro, neurologist or neuroscientist to kind of look at the brain a little bit more while doing si or so?    Zoe Mailloux     Absolutely, in fact, right now, I'm part of a study, an intervention study to compare occupational therapy using sensor integration for children with autism, to compare this approach to applied behavior analysis. And we're about midway through this study right now, and part of the study does involve imaging, brain imaging, to look at if we can see any changes in the brain that correspond with some of the changes that we see in function. So there's been quite a few neuroscientists and neurologists who've been interested in this approach.    Jayson Davies     Awesome. So the whole point of today's podcast, we wanted to get into evaluation and sensory integration. But. So real quick, I do kind of want to, I'm pretty sure I've heard you speak, and I feel like anyone who worked under Dr Ayers always has a good story about Dr Ayers. And so before we jump into the evaluation, do you have a story about Dr Ayers that you'd like to hold in your memory?    Zoe Mailloux     I probably have a lot of stories about her. You know, she was a very, very down to earth person, very humble person, extremely scholarly and dedicated to her work. So the stories we have about her not exactly kind of like funny, you know, flipping stories. I think what really stands out in my mind is what an gifted clinician. She was, I mean, her research is well known. Anyone who ever heard her lecture knows that she was a gifted educator, but not that. Many people got to see her with the children and with the children, she was extremely playful. They loved her as soon as she came into the room, they just knew that she was someone they could trust, and she was not at all afraid to get down on the floor, to get on a scooter board, to jump on a swing, to jump off of something. So that's really what stands out to me, is when I think about what I learned from her. I learned obviously, so much, but the way that she could observe children and completely relate to them is what I remember most about her.     Jayson Davies     Yeah, I can't remember if this is I've seen the picture several times. I don't know if it's on the cover of one of the books, but it's her on the scooter board, like kind of slightly behind one of the kids, and she just has the biggest smile on her face. The kid has a huge smile on his face. And, yeah, that's kind of what I think of when I think of Doctor of Dr Ayers.     Zoe Mailloux     So yeah, and she, you know, she knew from her own body how important the sensory integrative processes were, like she knew how, and she engaged in the therapy activities so that she could understand what the children were experiencing and what they needed. Yeah, all    Jayson Davies     right, so earlier you did mention you know that the DR Ayers really understood the importance of the assessments. And now I know you very much appreciate and understand the importance of assessment. So when it comes to schools, why is assessing sensory integration so important?    Zoe Mailloux     Yeah, so, I mean, this has really become my passion, especially in more recent years. I mean, I think my early training with Dr Ayers taught me this at a really core level, but I'm not really sure what happened to occupational therapists, but we seem to have moved away from careful, comprehensive assessment. And maybe it's the pressures of funding or just other administrative pressures, and as a field, I wonder sometimes if we're not quite assertive enough, because when I travel around the world, maybe even more so in the US, I hear things like, Well, I'm only allowed 20 minutes for an assessment, or I'm not allowed to use that test. And I never quite understand those kinds of comments, because I feel like, well, we are trained professionals. It should be up to us before we treat a patient. It should be up to us before you know, before we start intervention, to decide what we need to know. So I think it seems to me that OTs have been a little bit too willing to jump into treatment without fully knowing what they need to treat so and then again, back to Dr Ayers. I mean, she was so clear that you would never try to treat a child if you didn't fully understand what their problem was. I mean, a young, developing child is a fragile thing in a way, you know, they're developing. We have to be so careful. So the idea that we might just take a checklist or make some observations and then treat a child, sometimes for weeks, months, years, and that, I think, has always been sort of the confusion to me, that if a therapist, for whatever reason, feels that they cannot take an hour or two or even three to complete a full assessment. How can they justify treating a child for weeks or months or years? I mean, we're guessing. We're spending a lot of that time and effort and somebody's money on trial and error, and we would never accept that for ourselves. We would never accept that if we were injured or ill, we wouldn't allow our health professionals to do a trial and error approach to help us. Yeah,    Jayson Davies     I totally agree, and I think sometimes in the schools, it almost feels like we're doing an assessment. Judgment as a formality, I think, sometimes, and that's totally how it should not be. And you're right. We need to put that time in to focus on really figuring out what the student really has difficulties are, or what the student has difficulties in. We need to know what the strengths are too obviously. But how can we treat a student if we don't fully understand the difficulties they're having.    Zoe Mailloux     And a comprehensive assessment should illuminate the strengths as well. I've worked in the schools a lot, as I mentioned, and I've taken full case loads. I've spent time in school systems where I have a full caseload, and I just can't imagine trying to provide any kind of therapeutic intervention program to those children. So I would, when I had that role, I would conduct the assessments I thought were needed if they took longer than the traditional time. So be it, you know, and I would make a case for it. I found that in a school system, if I had a strong rationale, and I talked to the administrators, and I talked to them about cost. Think that's another thing that sometimes, as OTs, we're not so accustomed to thinking about the financial aspect of things. So I would always talk about cost effectiveness, you know, talking to the parents and administrators, you do not want me to take this child's time and this system's funding unless I know what I'm doing. And the same thing with our outcomes, I don't think we've been strong enough about demonstrating what our outcomes are and how they relate to cost. Occupational therapy has a very, very close relationship to long term cost. If we help a child in early intervention, the cost of the school system go way down. If we help a child in the school years, long term support costs go way down, you know? And I think there's actually quite a bit of research about investment in years zero to five and how much that saves from years five to 85 but we don't, as a profession, I think we could do a better job of communicating about that.    Jayson Davies     Yeah. And I would love if you have those potentially on file somewhere. If you can dig them up, I'd love to have those to put onto the website for everyone, just to kind of be able to have access to that'd be great. Because you're right. I've heard from a lot of OTs that, you know, either they don't want to or they just don't like that's not the real their realm. The business world is not their realm. The money they just kind of wanted. We want to assess and we want to treat we want to treat we want to have fun with the kids, and we want to help them. But you're right kind of thinking about the business side of it is not something that we're that we're very good at.     Zoe Mailloux     So go ahead, but even just back to the assessment, you know, I'm not sure how this happened. That OTs just, you know, thought it was okay to do a very cursory assessment and then move into intervention and even, or even consultation, I mean, maybe even at least as much, if not more, so that if you are going to try to help a teacher or someone else help the child, you really need to understand what The underlying issues are. And I think it there's been, you know, some Criticism and controversy around sensory integration as a whole. I think a lot of that comes from this problem that OTs have often thought or said that they were using sensory integration without a full understanding of what was going on with the child, and then picking techniques that were maybe just the same techniques over and over, but not carefully chosen in an individualized way. And really, that's why, you know, that's why the term Ayers sensory integration started being used. Dr Ayers would never have put her name on her work. She was not that kind of person, but those of us who work in the field recognized that we had a problem, that a lot of stuff was being called sensory integration, all kinds of sensory whatever things. And so in order to be more clear about her work, her family was able to trademark the term airs sensory integration. It's not for financial purposes. It's not for anyone's financial benefit. It's only for the purpose to be clear about what do we mean when we're talking about sensory integration as developed by Gene airs versus sensory stimulation approaches, or just the use of sensation in some way, yes, and as part of air sensory integration, it is required that a comprehensive assessment take place. I mean, one of the examples, I mean, a common example, is that occupational therapist in school systems work a lot on. Handwriting, you know, I think we wonder how we became handwriting teachers sometimes. But okay, so it's a common referral. And how do we assess there are so many different reasons why a child might struggle with writing. Some of them maybe are visual perception or visual motor difficulties. But there are many, many other reasons why a child might struggle with writing, and if we don't know why, and we just continue to practice and practice writing and use techniques to teach handwriting. You know, anyone can teach handwriting. Yeah, we don't need an OT for that. What we need an OT for is to understand fully the underlying difficulty that's contributing to that problem at school, and then being able to offer specific, individually tailored intervention that addresses what that child needs. I have a story I commonly tell about a little girl in a school system who had the same goals year after year after year. When I came in to see her, she'd been in occupational therapy, I think, for about five years, and her goals were very similar. She was about an eight or nine year old girl. She'd never had. The only assessment she had was a VMI, a visual modern integration test and maybe some checklists.     Jayson Davies     And let me guess, she had a goal to space her letters out, to put them on the line appropriately.    Zoe Mailloux     something about her grip. And this little girl had actually almost absent tactile perception. Her ability to use her tactile system was so dysfunctional that it was it would be impossible for her to have an adequate grip on a pencil or do some of the other things that were in her goals, like buttoning. You know, our use of the Touch system is so critical to everything we're concerned about an OT and I think if you went to the school systems today and surveyed to find out how often in the school system, OTs are truly assessing tactile perception, I bet it would be less than 10% of the time. You're probably right. And you know, I know that many, many children who have learning disabilities, attention problems, some kind of coordination difficulties, autism, speech and language problems, a huge majority of those children have poor tactile perception. And so if the OT doesn't even know the child has poor tactile perception, how would they know to work on it? And how will that child's function in these occupations that require good tactile perception? How are they going to improve? And there's just so many different examples of that that's just one little piece of sensor integration. We could pick many different functions that are not assessed. And then, you know, just really create obstacles for children to be successful at school. Yeah,    Jayson Davies     so I know. Again, sensor integration, very complex. We don't have time to go over everything in this podcast, like all this, all the tests and the sift. Obviously, we're not going to do that. You have a whole nother course for all of that good stuff. But what should a good sensory integration assessment look like?    Zoe Mailloux     Well, kind of in a nutshell, the main areas of sensory perception that contribute to so for OT, we're concerned about doing, you know, being able to participate and engage in activities. That means tactile perception, proprioception, vestibular perception and visual perception, at least. So those four areas of sensory perception need to be assessed, Praxis or motor planning. Postural ocular, bilateral integration and sensory reactivity, sensory reactivity separately, or at least understood as differentiated from sensory perception. Those are the four main umbrella areas that contribute to a comprehensive sensory integration, assessment, sensory perception in those sensory systems, praxis, postural, ocular, bilateral integration and sensory reactivity.    Jayson Davies     Okay, so if you were in a school today and you got a referral, kind of, what would your How would you kind of go about through that step? I mean, obviously, I know there's a much larger, complex. But what tools would you use? What observations would you do? What would you be looking at?    Zoe Mailloux     Well as an OT who has worked in the school system, I would if I felt there was some chance that the child's difficulties might be explained by sensor integrative functions. I. Would give the sensory integration and Praxis tests, because those are the only tests we have right now that are standardized for children that mirror that measure all of those areas they don't include sensory reactivity. So I would use the sipped plus observations and standardized questionnaires to teachers and caregivers, something like the sensory processing measure. Okay, the in combination something like the sensory processing measure and the SIFT would cover all areas. And unfortunately, there has not been an alternative. It's not like we can say, well, you know, instead of the SIFT, will use such and such, there is currently no alternative that's a standardized test for children. In in most of those areas, there's some visual perception tests. Yes, that's it. Yeah, there's no there's no other test of praxis. There's no other test of tactile perception or proprioception or vestibular function.    Jayson Davies     Correct and sorry, I want to ask you real quick, because this morning, I went on my Instagram, and I just, I actually did ask for feedback for questions like, hey, sensory integration podcast, who has any questions that they want me to ask or kind of, you know, try to try to put into the podcast. And one was, one of the questions was SPM versus the sensory profile, and you mentioned the SPM, is that your preferred?    Zoe Mailloux     I personally, I prefer the SPM. I don't think there's anything wrong with the sensory profile. Both instruments rely on someone else's perception of the child. So, you know, I always have that in mind, and I recognize that what the parent sees at home might be different, and it might truly be different than what the teacher sees at school, and might be different than what I would see in a direct assessment. I you know, I think we'll probably talk about in a few minutes, but we do have a new set of tests that are under development that are meant to address some of the challenges that seem to have kept OTs from using the sip. And in that new set of tests, we will have some direct measures for sensory reactivity. I can't really, you know, the reason I use the sensory processing measure is that it's easier for me to interpret the results in relation to the sensory integration framework. But I think both of those questionnaires that are caregiver reports require a lot of additional thought, like any test does, but even more so when you realize that you are going through someone else's lens.     Jayson Davies     Yeah. And I often will get questions, either via email or Instagram or whatever, and people want to know, well, what? How do you interpret when, like, everything across the board on the SPM is way up in the definite dysfunction, and I think what you just said kind of explains it. You have to take into consideration that this isn't your trained, skilled observation that is that scaling this or that scoring this kid in the definite dysfunction this, this is the behaviors that the parent is seeing or the teacher is seeing. And does that kind of make sense?    Zoe Mailloux     It does, and in the manual for the SPM, the questions are categorized by what they're actually getting at. So it's also important to look at which questions were answered in sort of the extreme ways. So you can't only look at the score. You really have to dig deeper. Absolutely, it's not enough, even if you have definite dysfunction in every area, most of the questions on the SPM or the sensory profile are about over or under sensory reactivity. That's a really important thing to know about. It's an important area, but it's only one of, as I mentioned, the core areas that need to be assessed. So what I see most often is that therapists might use a questionnaire like the sensory profile, sensory processing measure, and then maybe they use the VMI, maybe they use a little bit of the brunix, but that means they have not considered praxis. Praxis is not assessed by those instruments. They haven't considered tactile perception, proprioception or vestibular functions, and they haven't considered a lot of other aspects of some of the core si areas, like bilateral integration. I mean, OTs, we have to look broader than only sensory integration, but these are some really basic core building blocks for learning, behavior and attention. And if we're not looking at these, no one else is, yeah, you know the OTs using a VMI, that's great. But usually a psychologist, a school psychologist, is doing some kind of visual perceptual testing. Absolutely, if I had to give up any area as an OT, I would give up visual perception because. I think I could get that information from someone else on the team. If I don't test these other areas, no one else is going to look at them. So I feel like I'm really responsible for that.     Jayson Davies     Yeah, and you're absolutely right. I don't even use the VMI anymore because, I mean, I use the ravma, which is very similar to the VMI, and portions of the bot, again, similar to the VMI, but I can't use the VMI because my psychologist uses it, and we can't use the same assessment at the same time. So    Zoe Mailloux     that's right, but who's testing tactile perception? Who's looking at proprioception? You know, when the child has too much pressure on the writing, or too light of pressure, or they're, you know, bumping into their friends, who's assessing their proprioceptive functions to understand why those things are happening. Yeah, if we're not, no one else is. And then if you don't know there's a problem, it's more likely that it's thought of as a behavioral issue or something purposeful.     Jayson Davies     Absolutely, you brought up the new assessment. The Easy correct is that.    Zoe Mailloux     yes. So we have a new assessment well under development. It's called the evaluation in airs, sensory integration, the EASI, the easy named, hopefully, so that therapists will not be quite as afraid of it as they have been of the sipped. And it's going to be a free, open access test. So I believe my view, my little view of on the SIFT, is that I think it's a fantastic test. It's a fantastic set of tests that doctor has developed. They're difficult to learn, but they are not difficult to give once you know, once you're familiar with them, just like driving a car. I mean, learning to drive a car is not simple, but once you know how to drive a car, you don't give it a second thought. Yeah, pretty much. And I think that's the case with the sift. So the double edged sword with the SIFT is that it's difficult to learn and it's expensive to give because it has a high price tag on scoring. Yes, I don't think the kit itself is exorbitant. You know, test, test kits cost money, but the fact that there is an ongoing scoring cost, in my view, has made it a special occasion. Test, I think OTs are a little bit of a hoarder have a little bit of a hoarder mentality, and they like to save things that cost money. And so what I've seen a lot of therapists do is they might learn how they might learn the SIP, but then they don't give it frequently, because it costs money, and because they don't give it frequently, it never becomes easy to give, and so it always feels overwhelming for me. I give the sip. It takes me an hour, maybe an hour 15 minutes. Yeah, I get so much information that would take me hours and hours to try to put together by other tools and observations and guessing, and I know what to work on immediately. I know exactly what to work on in my therapy. I'm not playing trial and error. And the kids get a lot better. They get better their goals. And we're effective, and we can be effective. So the easy is meant to tackle some of these challenges. It's it's a grassroots effort. It will be a test standardized on children aged three to 12. Currently, we have 105 countries participating, so it will be normed around the world. That was another issue related to the SIFT is that it was only standardized on children in the US that worked for us here in the US, but there was an interest around the world. So this is meant to alleviate that problem, and we hope that with a free test, that then therapists will actually get over that hump, that it won't feel it's not going to be any easier to learn. It's going to still be it's motor planning for the therapist. A therapist has to motor plan these skills until they become automatic. Once they're automatic, we hope that no one will think it's that big of a deal. It's just an assessment. You use, you score, and you get your results, and then you know what the children need. That's what we hope.    Jayson Davies     Yeah, and if I can share real quick. I I was fortunate. My district that I used to work for sent me to all four courses of the SIP by WPS and USC. And you kind of explained exactly my whole quote, unquote fear, yeah, yeah. I went to it. I went to all four classes within a year's time frame. I completed, you know, the sipped in order to get the certification, you have to assess a kid or two, you know, a typical developing kid and and a non typical, I think it was, but I still have the little flash drive, the little purple flash drive with a few assessments left. I still have all the protocols sitting in my somewhere, and I was so. Scared to use it in a way. I mean, it's for me. I never learned it well enough for it to be, I don't want to say effective for me, but it practical. Yeah, probably wasn't practical, correct. But at the same time, how many kids did I not test that I should have tested? I probably could have helped a lot better or a lot more.    Zoe Mailloux     I mean, what we you know, I've probably taught 1000s of people by now over all these decades, and what I see is that a very small percentage move ahead and get over that hump. The therapist who get over the hump and who know the SIP routinely tell me they can't imagine practicing without using it once, once you get over that hump and you use it, and you see how much information you get and how facilitated your treatment is, and how you probably missed so many problems and other kids you can't imagine not using it. But the problem is that the percentage of people who get over that hump and you yeah is small, yeah, so we felt like we needed an alternative to that, and we're just hopeful that by making a test that's more accessible and feasible, we're also hoping that we can use something called Computer adapted testing that would be in real time as you're testing, that you would get some guidance. You know, if you're entering scores as you go, that you might be able to get messages that say, Okay, this with this child, you can jump ahead to this item. With this child, you can stop now, so that rather than having just predetermined basal and ceilings, they could be more in real time related to how that child's doing, to tell you what items you absolutely have to give. So we're hoping that's a way that we can shorten the testing. But honestly, I think in OT we have to somehow, across the board, get away from this obsession with having the shortest possible assessment. When I worked in the schools, sometimes school psychologists would test children for 13 hours days. And I just always thought, how did this happen? That OTs are told they get 1520 minutes, and they say, okay, the school psychologist would never think that was okay, because they need that much time to understand the child. Yeah, so I've never been an advocate for Well, we have to find a test that takes, you know, that's a screener that takes 15 minutes. I think if we're going to take a child's time and someone's money to apply our professional skills, that it's our ethical responsibility to know what we're doing, and the only way we can know what we're doing is to first start with a comprehensive assessment.    Jayson Davies     Yeah, I think you're right. It's true, though, and I think some of us don't want to see it. I think some of us don't want to realize it, and we get comfortable.    Zoe Mailloux     I and I understand the pressure. I mean, therapists in schools have heavy case loads. Yes, I have them too. I don't know, I had 60 some children on my caseload, but, you know, it doesn't really make our jobs easier to not know what we're doing absolutely. You know, we're spinning our wheels, and these are precious children's time we're taking, and especially if we, you know, whatever we do in OT it's fun, you know, the kids are having fun. We make it playful, which is what it should be. So the negative side of that is that it's a little bit easy to skate, you know, it we can make it all look like everything's okay. The children are happy to come to us. They're not complaining. We probably hit and miss somehow, make some changes, but I know where. I know we are missing important functions we could make a lot better if we understood them.    Jayson Davies     Yeah, and I'm gonna throw it out there right now. We're lucky to have both you, and then we actually have Kelly coming on for a part two, kind of to the sensory integration, which you're very familiar with. So we're not I know I would love, and I'm sure everyone else listening would love for us to dive into the treatment aspect, but we're going to kind of take it back to the evaluation aspect. We'll get into treatment a little later. So the easy I'm currently enrolled in, I believe it's Module One of the CLASI, the CL asi.org , website, the module one, course. So is that kind of the new, the new modules of courses to go through, to learn kind of about, still the SIFT as well as the easy.    Zoe Mailloux     Well, actually, fortunately, there's a big international effort. I'll just say briefly that in 2014 a group of occupation mostly occupational therapists and physical therapists who were meeting internationally recognized that in the year 2020 Dr Ayers would have been 100 years old. So we launched an initiative called the airs sensory integration 2020 vision that that will culminate next year in July. By 2020, what would have been Dr Ayers 100th birthday? That initiative involved three goals. We got together. We said, What would Dr Ayers want for her 100th birthday? And we set three goals to meet. One of them was to develop a comprehensive set of tasks that would be accessible and feasible. That was the easy another goal was to recognize scholarship in this field and the evolution of sensory integration theory. So for any listeners who want access to more current literature, the goal number one is on the ASI 2020 vision website. It's ASI 2020, vision.org and we have been having people around the world review articles, research papers related to sensory integration, and then once we decide if the paper does or does not contribute, it's posted. We're a little behind in posting the papers, but I think we have about 40. Our goal is to have 100 and we've reviewed quite a few, but we only have 40 of them posted so far. So it's a good resource. Yeah. And then the third goal was to establish standards for training. So there's an international a new international organization that's called the International Council for Education in ASI, it's ice ASI, and that organization has established a definition of what is required in training related to air sensor integration. What are the standards? What are the components that must be included? Organizations around the world that meet those criteria will get kind of a stamp from this international organization, ice ASI, so in the United States, CLASI, which is a non profit organization, the collaborative for leadership in ASI, has applied for and has been granted, you Know, approval that that that program meets those standards, occupational therapists or therapists around the world will be able to look for that stamp to know if a program that they are if they want to learn about air sensor integration, they'll want to go to a program that has that stamp. So it doesn't mean that it's the only training in the you know, available related to sensory functions, but it will be the standard for learning about Ayers sensory integration. And so, I mean, that was a long way around to answer your question, but the collaborative for leadership in Ayers sensory integration has a certificate program in Ayers si that has six modules. The first module is on theory. This. There's a strong emphasis on assessment, and right now, the assessment is both the SIFT and an introduction to the easy those that happens in modules two and three, the we're still training on the SIFT, because we can score the sift. We have children who are coming next week who need help, and we can't wait a few years until we know what the scores on the easy will mean. So that program includes both the SIFT as the tool to use today, and information about the easy so that you know people are aware of it. The easy is as similar to the SIP as as is feasible when making a new test. So we do believe that anyone who knows the sip and has practiced the SIP will have a much smoother transition to the easy, and we don't think it's a waste of anyone's time to learn the SIP now and use it now. It will provide a strong foundation for any new test in the future. Awesome.    Jayson Davies     So then classes one is theory. Two and Three is the assessment. Four, five and six are treatment.    Zoe Mailloux     Two is online training in in the details of assessment. And three is an on site practice course where once you've been on your own trying to learn the assessments, you come together and get some feedback and mentorship. Four is the interpretation of the scores online. Five is the is an introduction to intervention and learning about something called the heirs si fidelity measure. One of the important developments in sensory integration over the last 10 years has been the development of a fidelity measure. Fidelity measures are common in intervention work, and they verify that an approach you think you're using is actually that approach. So in research, it's really not possible now to do intervention research, if there's not a fidelity measure that kind of proves that you're actually providing the intervention you're studying. And we are encouraging OTs to use this fidelity measure in their own practices. If you think you're doing or using air sensor integration as a framework, then check it. By using this tool to see if you really are and then module six is a hands on application of the interpretation and intervention principles.     Jayson Davies     So where can people find that tool? Is that a tool on sale? Or is it published in a no.    Zoe Mailloux     It's not. We don't sell anything. We try to give everything. We don't want anybody to be held up by funds. Now the Arizona fidelity measure, we have three articles in a ot going back to 2007 on this tool, it's available during the CLASI module five. You know, the publications that are out in the journals would be the place to get information about it.    Jayson Davies     and we'll be sure to we always have a show notes page, and we'll be sure to link to those different articles. It's going to be at ot  schoolhouse.com , forward slash episode 25 so we'll be sure to link to all those articles at the show notes.     Zoe Mailloux     Just one other thing we do use an approach called data driven decision making in Ayers si that was developed mostly by Dr Roseanne Shaw as part of her intervention studies. And it you know, sensor integration is very complex. It's not a protocol, it's not a recipe approach, but data driven decision making is a step wise approach that encompasses the complexity of sensory integration to help therapists be methodical and systematic. And one of the things that we use in this approach is to make your decisions based on data, just like it's called rather than, hmm, I think today we'll try this and we'll see what happens. And so we in our programs, we try to link, you know, step one, step two, step three. Start with theory. What are your ideas? But then do an assessment, take that assessment data and specifically plan your intervention based on your assessment data. It seems like a lot of times in OT, in all aspects of OT, we kind of jump into treatment. We might even do an assessment, but then we jump into treatment, and we're not often carefully going back to the assessment data to make our day by day, moment by moment decisions in in our treatment sessions.    Jayson Davies     Yeah, so I wanted to jump back just slightly. I am part of the ASI 2020, Vision goal for the academia to look at some of those papers.    Zoe Mailloux     And great. Thank you. Thank you for reviewing papers definitely.    Jayson Davies     And, so I did look at as a recent one. I have it right here. It was the efficacy of sensory integration on school participation of children with sensory disorders. And one of the things that that it points out is how different sensory strategies are from sensory integration. And I think, I think you kind of referenced it a little bit earlier, is that sensory is just everywhere now, like the word sensory is, teachers are using it. Every item in a classroom that's not an academic item is a sensory item. And so how do you explain to people when someone might be referencing to sensory as though it's sensory integration, but it's not really sensory integration?    Zoe Mailloux     Well, I mean, I usually with that conversation. You know this the just to recognize that air sensory integration is a specific theory and intervention framework that includes components that must be there to actually meet the definition of air sensor integration, and that there might be other approaches that, in one way or another, use a sensation, use a sensory component that by itself, in no way means it's the same thing. And so in evaluating whether or not an approach, an intervention, you know, a tool, is going to be effective or not, we need to know what we're talking about. And I can feel very confident about using air sensor integration, because I understand all the steps that are needed. I know that there's strong evidence for this approach. We have good, strong evidence that this approach is effective, and I don't know that about a lot of the protocols or strategies that are out there. I'm not even to me. I'm not even really sure why they got names and why we started using them. I mean, we use a lot of therapeutic activities. Yes, we don't name every one of them, you know? We don't put a name on them and a protocol. So I don't know. I think for OTs, we have caused a lot of our own problems by jumping in and using techniques without really understanding why we're using them, by trying to treat children without a full assessment, we've probably caused a lot of the criticism that has occurred, and it's our responsibility to be more professional and. Scholarly about our work.    Jayson Davies     Yeah, and I think that's why evidence based practice is obviously so important. So keep researching and keep looking up articles. Yeah, okay, so I think I have one more question for you before I let you go. And this is a popular one, and it may also be a little loaded.     Zoe Mailloux     Okay, I'm Sicilian. I can take it right.    Jayson Davies     When assessing, how do you determine what behaviors may be due to sensory factors versus what behaviors may be due to more strictly behavioral factors?    Zoe Mailloux     Okay, well, that's actually a great question, and I don't really think it's out loaded. It's just a perfect question. I mean, really when we assess, I mean, when you're assessing with a child I have, I can't even tell you how many countless children I've assessed who were labeled as having an attention problem or labeled as having a behavior problem. When I am giving them an assessment, I get data, and I can tell if they're I rarely have children who cannot attend to these kinds of tests, and so when I know that they have been paying attention and they have been doing their best and they still have a low score, then I have data that tells me Now occasionally there is a child who is not able to take tests. But what I find is that OTs seem to think many more children are not testable than those children who are when you understand what you're assessing and you're fluent at the at the you know, administration, many, many children can take these assessments, and some of them don't even require that much cooperation. Like one of the tests we give is a post rotary nystagmus test. We're measuring a reflex. It's easy to give that test. Many, most children enjoy the test, and there's no behavior or attention involved. We give that test, we see the reflex. There's no question about, did the child try? Try or not try? They don't have that. And there's a lot of the test scores are like that. So when we have that data, and especially, you know, you mentioned strengths, when we give a comprehensive set of assessments, we can see which tests the child does better on and which ones are having more trouble with. Now, if they're if it was just purely attention, they would have trouble on everything, you know, they would just not be able to score. So I think it comes back to the same answer. You know, a good, strong assessment will will go a long way to telling us if there's a true attention problem, if there's a true behavior problem, but most of the time, you're going to get information that really helps to differentiate and most children, I mean, you know, I just think most children want to participate when they Can't. There's a reason for it, and when no one has recognized why they're having trouble, it must be so frustrating they have every reason in the world to be angry or to withdraw. Sometimes withdrawing is adaptive. You know, if something's really difficult, it's adaptive to get yourself out of that situation, yeah? So, I mean, we're the professionals, we're the adults. It's our job to try to understand and by, you know, just skimming over things, quick checklist, a little observation, that's not doing our job.    Jayson Davies     Yeah, I kind of agree with that. But when you're talking right there. Sorry, I want to share one more story. You kind of well, just the story came up, and I remember this was a student right after I just taken the sift all four courses. And I was, I actually did use the sipped with this student. I can't remember if this was right before or right after I did the SIP, but this student, she was doing, she was writing, and all of a sudden, she just pushed all her paper off the table, through her pencil, so frustrated because she was having a tough time, and then within like, two seconds, was like, I'm so sorry. I'm so sorry. Picked it all up, and you could just see the frustration on her, just it was so difficult for her to write. And I truly believed, I mean, through my assessment, that, yeah, there was some sensory stuff going on that was making that difficult. And no matter how much we continue to work with this student to learn how to write her name, unless we work on some of those underlining factors, some of that vestibular integration and stuff like that, it just wasn't going to come together for her and so.    Zoe Mailloux     Exactly. And you know, I mean, and it's not to say that there aren't other elements. I mean, we are OTs, we have to consider the whole person. There could be emotional, psycho, emotional things going on, psychosocial things going on. There could be medical issues. I mean, I had, when I worked in this one school where I was the only ot for a while, and I had a full caseload. So. So there was one child that the teacher suddenly said this, this kid has to come see you. And we happened to be at a school where there was a little Therapy Clinic at the school, and she wanted this child to come and see me every single day. And this child was really unhappy. He was crying. He was uncomfortable. I said, there is more going on here. This is not just an OT issue. This is not a sensory integration issue. Well, this little guy had abscessed cavities in his mouth, and he had autism, and he'd been kind of written off that it was just the autism, and it wasn't just the autism. He had a raging infection in his mouth, so we can't just assume that everything can be explained, you know, by and we have to keep our our wide brimmed ot hat on that considers all the possibilities. But that That being said, at least if we do our job and consider the areas that no one else is considering, yeah, we can really be an important member of the team to illuminate. And I found in the schools that when I came with data, and I could show test scores and I could explain the relationship of these functions to what was happening in the classroom, I didn't have any pushback. I had psychologists and principals explaining sensory integration to parents. You know, my job got a lot easier. I didn't feel like this was a struggle. It was. We were all working together to understand the children and to help them and more of the time, it was a relief to the team that somebody at the table had information that was making sense. So I think we'll do better as a profession if we step up.     Jayson Davies     Yeah, got to do those good assessments. So all right. Well, I want to say thank you so much for coming on. It was a pleasure having you. Yeah, I've seen you speak a few times, and I was just like, when this podcast first got started, you were like, one of the first names that popped up into my mind. I was like, I want to have Zoe on this podcast.     Zoe Mailloux     And so happy to be here, and I hope that the listeners stop guessing and start assessing.     Jayson Davies     There you go, real quick before I let you go. Is there anywhere other than the CL, asi.org website where people can learn more about you or?    Zoe Mailloux     I have a website, I do have a website that's just my name, Zoe Mailloux.    Jayson Davies     I can put a link to that, of course.    Zoe Mailloux     .com, and I mean, one of the things on my website that I do have are some free information pages for parents that explain things like tactile perception and proprioception in everyday language, and they're translated into four or five languages, so those are available. Might be helpful to the therapist and might also be helpful to their consumers.    Jayson Davies     Perfect. Well, thank you so much, and I'll let you enjoy the rest of your President's Day. Have a great day.    Zoe Mailloux     Thanks. Thanks for doing this podcast. Yeah, great. Thank you.     Jayson Davies     Bye. Bye, all right. Well, that concludes today's episode with Zoe Mayu, and I just want to give out a very special thank you once again to Zoe for coming onto the podcast. I couldn't have asked for any better way to really celebrate one year of the OT school house podcast. So really do appreciate that to all of you out there listening. Thank you for listening again, whether this is your first episode of the 25th episode you're listening to just a big thank you to everyone, and we'll see you in episode number 26 when we start year number two. Take care. Bye, bye.     Amazing Narrator     Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otsoolhouse.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 23 of the OT Schoolhouse Podcast. In this episode, Jayson interviews occupational therapist and creator of the Zones of Regulation self-regulation program, Leah Kuypers. Leah has spent nearly all of her career working with children as both a private practice pediatric OT as well as a school-based therapist. But, it was during her Master's in Education program that she had an idea to develop a program simple enough for any school-aged child to understand. Based on 4 primary colors, the Zones of Regulation helps students to identify and express their feelings and how to react to these feelings. Listen in to learn more about Leah and the fantastic program she has developed! Links to Show References: Have a question about the Zones Or Regulations? Shoot an email to info@zonesofregulation.com The Zones Of Regulation Program on Amazon (Using this link helps us earn a small commission at no additional cost to you) - This is the book that started it all. If you want to learn how to incorporate the Zones into your practice, this is where to start. ZonesOfRegulation.com Interested in learning even more about the Zones? Visit the website and sign up for a full day training. Leah offers both live and virtual training. There are also other items and games that can be purchased to go along with the book. The Zones Of Regulation App Get the Zones of Regulation app for your iPhone or iPad Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.    Jayson Davies     Hey everyone, and welcome to the OT school house podcast episode number 23 so happy to have you, whether you're in the car at the gym or just relaxing at home after work or maybe on the weekend, who knows. Just want to say thank you for joining us today. We have a special guest, but first, I want to just kind of give an invite to everyone out there to follow the OT school house, not just the podcast, but also on social media and our email list. We are on Instagram and we are on Facebook, and if you're on Instagram Facebook, sometimes we do some giveaways for some of our podcast. We have other giveaways that we've done in the past that we're looking forward to doing here in the future. But just joining us over there, we have a lot of kind of treatment ideas that we post regularly and some other cool stuff. So also on our website, if you are not already an email subscriber, you can become a subscriber to our website, and we have a nine page freebie. It's called gray space paper, and it helps you. It's helped mostly your students actually out with learning how to space and size their letters and words when it comes to handwriting. So please join us over there@otschoolhouse.com so we can get you signed up and get you some some really cool freebies that you can use tomorrow. With that, I'm going to keep this short and go ahead and introduce today's guest we have on Leah Kuypers. You may be familiar with that name, but you're likely definitely familiar with her program, the zones of regulation. It's kind of become a phenomenon. Psychologists use it. OTs, use it. Special education teachers use it. It's really awesome. I'm actually about to start up a program tomorrow as I'm recording this. It's something you can do in the classroom. And so we're going to dive into that. I'm so excited that Leah was able to come on, and she just kind of was so enthusiastic once I told her what we're doing here at the at the OT school house, and with the podcast, she was super excited to come on, and she wanted to share this. So kick back. Relax. If you're driving, keep your hands on the wheel. But here's Leah to talk a little bit about how she developed the zones of regulation program. Welcome Leah to the show. This is going to be a fantastic show. I've told a few people that you are going to be on, but I'm excited mostly to talk to you. So how are you doing today?    Leah Kuypers     I'm wonderful, and I appreciate you hosting me. Thank you for the invitation.     Jayson Davies     Definitely. So for those of you who are listening to this, this isn't going to be released until like February, but this is like the morning. What are we like, three or four days before Christmas? Yeah, something like that    Leah Kuypers     approach here.     Jayson Davies     Yeah. So how are the holiday season shaping up for you? Anything special going on?    Leah Kuypers     We are just looking forward to spending lots of time with family and friends and still have some last minute shopping to do. So absolutely, there's a lot on the plate, but.    Jayson Davies     Right, we always do. So, yeah, so, well, welcome again to the show. It's so glad to have have you. I've used your program for the last Oh, I mean, I've been an OT for six years now, and I learned about it probably in that first year being an OT at the school district I was at and starting to learn a little bit about it. So I've kind of used it on and off. And so I'm excited to get more information from you about it, but I want to start off first by, you know, just learning a little bit about you. I know as OTs, we tend to like to know about people, so tell us a little bit about like, what made you decide to be an occupational therapist?    Leah Kuypers     That's kind of a funny question, because I was in high school trying to figure out what I wanted to go on to college for and I was thinking healthcare. I took some of those aptitude tests, and OT came back as my number one recommendation on two different tests. However, I went to different pathway at the persuasion of my calculus and physics teacher, he encouraged me to go into engineering. Oh, wow. So I went on to the University of Wisconsin, Madison in their engineering program, and by the first winter break after the first semester, I was in tears. I just didn't see this as my career path. I was not enjoying my coursework, and I had declared a major as engineering, and at Wisconsin, you couldn't go undecided again. So in order to switch paths, I had to declare a new major, and they had an occupational therapy. Program, so I started up courses for the next semester with the OT pathway. That's kind of the way I came to be    Jayson Davies     Wow, that's an interesting pathway. When you switched over pathways, were there any other professions that you were kind of looking at, or was it just kind of, let's go OT?     Leah Kuypers     Yeah, I was looking education, occupational therapy. I was looking at design.     Jayson Davies     Design, yeah, as well, like art design, or what kind of design? Oh, okay.     Leah Kuypers     And in hindsight, what I realized I wanted to be was an industrial designer, not an engineer, but.    Jayson Davies     What is, what do you mean by an industrial designer?    Leah Kuypers     Like, who would construct and design? Say, a couch, oh, or Whoa, that would be fun. Along that line, right?    Jayson Davies     So do you think is it fair to say if you were not an occupational therapist, you'd be an instruction How do you say it again, Instructional Designer, industrial. Industrial Designer, sorry,    Leah Kuypers     I you know, I don't know if that's the case. I didn't figure out what it was until I met some people after college, and I was like, that's what I wanted to go to college for how the world works out that point, I was really bought into the path I chose, and I feel fortunate to have my ot degree perfect.    Jayson Davies     That's super cool. Well, I'm glad you're an occupational therapist. I'm glad everyone's an occupational therapist. So, so you went to Wisconsin, Madison, right? Yeah, that's badger. A badger. Yeah, very cool. And so you graduated with occupational therapy degree. And then what came next? What was your first job out of out of college?     Leah Kuypers     Yeah, so I was young. I just have my bachelor's in occupational therapy. I went on to sensory integration clinic in Chicago area. Worked there for a few years. Got burnt out, and that was a really kind of grueling position. I loved the families I worked with. I liked what I was doing, but the intensity, kind of the grind of it, was challenging, and it was hard to see the impact I felt with just seeing a client one day a week and sending them on their way. So I then opted to move into Chicago public schools and work in a school based setting, which I found a lot more meaningful and like that was my a better fit for me.    Jayson Davies     Oh, okay, so you started an SI clinic. Did you have any type of mentorship when you were at the SI clinic?    Leah Kuypers     Sure. I there was. It was a very heavily staffed OT department, so there was people there with a lot more experience who certainly pointed me in the right direction, gave feedback, but it was kind of also a throwing into the wolves situation, like show up for their first day of work. Yeah, I was what, 22 maybe, and there's a student there or a client there who's on my case load that day, and you just jumped right in, and I just was like, Ah, I just didn't feel totally prepared either.     Jayson Davies     Yeah, that sounds tough, especially being a brand new graduate. So did you in school? Did you get a lot of sensory integration type of just knowledge from, you know, maybe your pediatric class, or?     Leah Kuypers     You know, some it's a whole nother thing when you're trying to talk to the child's adult parents, and, you know, sound like you're coming across confident and knowledgeable. So that was really intimidating for me. My field work experiences, I had a school experience, and then my level two pediatrics was in pediatric mental health state facility, so that did not have as much of the sensory integration piece to it, more the mental health, which I think probably steered me in the direction that I have woven today for my health. Path, but that was a population I found really fascinating and intrigued by. So the in college, while I was doing my ot coursework, I was a line therapist doing ABA work with a child with autism. And it was really that autism experience that got me that job at the clinic, as well as ot degree, obviously, but and they were really looking at me to create some more autism programming for that population and some groups for the clinic.     Jayson Davies     So it sounds like they wanted you to take kind of full plate, and you weren't quite ready for that yet. Being a new grade.    Leah Kuypers     I wanted me to bring the what was the Wisconsin autism project to the Chicago based area. Just, you know, wasn't quite prepared for launching something of that scale. I'm like, I was the bottom of the totem pole, as in the hierarchy of this organization, the one doing the, you know, the work with the kid. But there was lots of people directing me.     Jayson Davies     Exactly, giving you the mentorship that you actually needed, and they wanted you to, all sudden, kind of just be the lead and just not ready for that yet?     Leah Kuypers     Yeah. So then we we moved on, and that was a good choice. And I ended up in the Twin Cities area, Minneapolis, where is close to where I grew up, and I again moved into the school setting when my husband and I got married and we moved here, and that was then also just a really enriching experience. And I had some amazing mentors in that site who just were fantastic, and have really still are cheerleaders for me today. So.     Jayson Davies     Sorry, is that a school based? Or is that? Yeah, it was a school based.    Leah Kuypers     It was an all special ed district. So it was itinerant position, moving between lots of different sites where we might have a classroom in regular ed Elementary, but we would bus the students who were severe and profound into a classroom from around the county so that they could be educated together in a school with non disabled peers, but have the intense programming that they needed. So we had autism classrooms, severe and profound classrooms, and then we did have one school that was an all special ed school for the kids who had a federal setting for as their least restrictive environment to be educated in. And so these kids had a lot of the behavior challenges, the mental health challenges, the social emotional work was needed. So that was where that site I really gravitated to, and I ended up finding myself full time there the fourth year I was in that district, because the needs were just so intense and kept pulling me there.     Jayson Davies     So, when you were at that district, you said earlier that, you know, seeing a kid once a week in a clinic just kind of wasn't there for you. Did you have more flexibility to see the kids? Kind of, yeah, to the extent that you needed to.    Leah Kuypers     Right? And that was at that point where lobbying, that, you know, these kids are so intense, their needs are so profound, that they did have to have that consistency. It wasn't a one time a week consult with the teacher, but there some kids I saw, you know, daily, even where maybe they weren't getting minutes daily from me as the OT provider, but I was consulting with the teacher. I was in the classroom helping a different kid, so I could still keep my eyes on them and be supporting them.     Jayson Davies     Yeah, and I, I've been fortunate in the position that I have now to kind of do the same type of thing. You know, maybe I'm not seeing the kid directly multiple times a week, but on the same time I am in the classroom a few times, you know, twice a week or so. And can do the same thing where you have your, you know, you're just watching and you're seeing them, and a lot of times, you know, if we're only seeing them once a week, we only get to see them for that 30 minutes, and then we don't get to see what they really do in the classroom when they're getting ready to get on the bus or as they're getting off the bus in the morning. And so I think it's a blessing that for those who do have the ability to kind of take some time to be in the classroom. Them and kind of see what's going on, because you really get to see so much more, for sure.    Leah Kuypers     Yeah, pulling a student ot only gives you it gives you that opportunity to build that rapport and really focus in on some skills that you might be addressing, but you're missing so much of that big picture and how they're applying those skills and that support they might need to generalize, and how you can be coaching the staff in the classroom to carry over. I think building those relationships with the teachers the staff is just as important as the students, so that that work where we are doing has further extension beyond a therapy room.    Jayson Davies     No, you're absolutely right. I try, especially in the severe, profound classes, I try to do a lot of in the classroom, work with the kids, just because, I mean, you don't get that generalization. Sometimes you can work on a skill outside and then go back into the classroom and it's just not there. It's not happening. So, but before we get too far along, because you did kind of mention a little bit of your first few years out of college as part of the podcast, we do have a lot of new grads that often listen, and they often email and they ask me questions. Oh, what do you recommend for a new grad? You know, this is my first time in schools, or sometime it's someone that's switching over from a clinic setting into schools or from another setting into schools, and they often are just looking for a little piece of tidbit of information to help them get through their first year. What would you kind of say for that new school based occupational therapist, just a little piece of advice to help them get through the their first school year?    Leah Kuypers     Oh sure. I spend time building relationships with staff, with admin. I think that helped then me feel connected to the school, a bigger part of that community of the school, and I think that benefited my students greatly. Another thing I did was I just took a lot of continuing ed courses too, and I was just hungry for I hear about this or that, and I wanted to learn. I saw that my skills were helping, but there was so much more out there that I felt could be expanding upon that base that I had, and so I took a lot of courses beyond that, and I think that really helped me become more confident, better able to fine tune my therapy with each individual student, and, you know, customize it based upon what their needs were.    Jayson Davies     Yeah, do you remember any, any one course, or any few courses that just kind of stand out in your mind? We're like, you know, you probably don't remember the entirety of what they were about, but any that just kind of stand out.    Leah Kuypers     Sure, well, you know, let's see, I've been an OT now for o1 so a lot of them probably are not quite there. Executive functioning wasn't a term anyone was talking about, you know, yeah, eight years ago, autism was barely, you know, it was such a small population then. So I took a lot of courses and autism thinking of, you know, I oh gosh, I did the, I did a whole graduate certificate in autism spectrum disorder. Okay, so that was, you know, really profound. And, you know, I did Stanley Greenspan's floor time and learning about, I did therapeutic listening.     Jayson Davies     Yeah, I don't, I've, Wow, it sounds like you were very busy.    Leah Kuypers     Well, now I've had a lot of years, add them all up, right? But so.     Jayson Davies     But that's great that you continue to learn, because that's part of the reason that we did the podcast was one because we wanted to learn for ourselves. Abby piranha, the other host, as well as myself, like we just kind of were in a rural district, and we didn't have a lot of opportunities to work with other occupational therapists the county would sometimes have, like, an OT meeting. You know, hey, school based OTs come here. But it was like at 1230 on a Tuesday, like, who can afford to leave work to drive a half an hour or an hour across the county? And I. And so, yeah, it just didn't work. So part of the reason was because we wanted to learn more, and we knew if we kind of started something, we would have to learn because we're putting information out there. But the other side of this, which is I'm already learning just in, you know, the 15 minutes that we've been talking is like how different things are from one school district to another school district, especially when you start crossing state lines and you're talking about stuff going on in in the Midwest and from California, I mean, some of the terms you're using, I mean, I can generalize and figure out what they are, but they're just different from California and hearing about like all special education schools, and it's just some things occur differently in different places, and so.    Leah Kuypers     Well, I I moved to California for a while too, and it was, yeah, just a very different looking for jobs. I, at that point, had my autism certificate, and I got my master's in education, which was a really nice compliment to the OT bachelors. And being that, I really saw my career path as a school based therapist, I felt like I could talk the language a little bit more with educators. But yeah, so my husband moved to California and were in Oakland for three years. And it's certainly a very different approach to therapy, the kind of therapy world. And I found there wasn't very many school based ot jobs. Rather, they were contracted in from outside agencies. So I ended up working for a private practice rather than a school at that point, for those years, and did a lot of group work as well after school groups.    Jayson Davies     Oh, really cool, because you were working with a private practice, so they wanted to do that.    Leah Kuypers     Yeah, but then I also had the school clients.     Jayson Davies     So I know there's a few people that do a similar type of thing. So was this a clinic that you would work in for a few hours a day, and then you would also travel to the schools? Or were the kids coming to the clinic? Or what did it look like?     Leah Kuypers     It was both. Yeah, it was communication works in Oakland. And we had, I had, I was on several students IEPs, so I had some of those daytime hours, some days where I would be itinerant and going to different sites. But then at about three kids would be off school, and then they would be coming into the center, and I was running self regulation, social emotional groups, as well as I would see some students, some clients, just individually, but most of it was group work. So it was a combination of both, in that position.    Jayson Davies     And so like you said, you moved from, you know, one part of the country to another part of the country, and you said it was different. Can you expand on that a little bit more? Like, how did you see it as being different?    Leah Kuypers     Well, like, you hit on, like the language, just the jargon. You know, I was like, Wait, what are you saying? Like, different acronyms, different ways we're talking about different populations, kind of what's trending in the schools in California versus back home. Like, for example, the certs model was something I learned about when I moved out to California, and the Hannon approach. And these weren't things that anyone was talking about back in the Midwest, and so that was kind of cool to say to my friends back home, you know, hey, check into these things. I think they're, you know, really nice compliments to what we're doing and and also, then just bringing things out to California that was in my tool belt that.    Jayson Davies     Yeah, that you were    Leah Kuypers     working with that I could mentor around and support them.     Jayson Davies     Very cool. Okay, so a second ago, you mentioned that you got your masters in education. Was that general education or special education, or was there an emphasis or something general education. Okay, so did that come with also a credential Then?     Leah Kuypers     No, no. So, because I'm licensed through the state, at the state's health department, so I, you know, have a professional license, I didn't want to be a licensed teacher. Rather, I thought it was so helpful to have that background now, because in occupational therapy school, we get trained with a very medical model, yet our number one employer are schools, and they work on an educational model. So do. I found this just really helped me understand more of that education theory and how to teach. You know, what we're doing as therapists is teaching skills. And it really made me think about my approach, how I'm setting things up, how I'm delivering that. How do we make it, you know, and certainly we are always talking about our meaningful occupations. But how do we turn these desires into that knowledge and demonstrate that performance and demonstrate that knowledge, and with the OT school fit, I just found that it helped me just see things in a different light, and like come at things from another angle to really, I think better deliver the services I was providing.    Jayson Davies     Yeah, I mean, I often have contemplated going back to school and either getting another Master's or doctorate, and one of the areas that I've looked at is education, because, for the same exact reason, we're in schools, and I feel like, just like you said, we don't get that educational piece when we're in OT school. We don't learn a lot about what the public school system looks like. And unless you do a field work in schools, which I never did, you really don't get a whole lot. You get more that clinic based, if anything, with pediatrics. So I've contemplated that a little bit. One of the I don't know if you want to call it a buzz it's not really a buzz word, but it's a hot topic right now, is occupational therapy, or occupational therapists practitioners potentially being administrators in schools. I don't know if you've heard about this yet.    Leah Kuypers     Well, I considered this. Yeah, so when trying to figure out what to do, my master's, and I had all those graduate coursework credits for the autism certificate, and my district was reimbursing for doing partial credit reimbursement, so I was just, I was finding it so motivating to go back to school as now an adult, versus being in my teens and early 20s. And I was just like I said, I loved learning. I was hungry for knowledge and how this could help my caseload. And one of the roles I was really finding myself in in my district was not administration, but I was being pulled into a lot of planning meetings, organizational meetings at a district level to think about our students and how we're serving them and what kind of Programming we're offering. And I found myself a very powerful advocate for many of my students, and having those tough conversations with admin that I really contemplated doing that licensing. My hiccup was that in Minnesota, I was licensed through the Department of Health, and I would have needed to first get my teaching license and go through the student teaching process in order to get my admin license. And that was one barrier I saw to that. The other being, I think, you know, it's there's so many hard decisions I feel admin have to make, and I just want the students to have it all, and I have a hard time living with, you know, anything less than what I feel like they deserve. And I think there's just so many pull things, pulling on an admin that I don't know, that I quite have the stomach for it.    Jayson Davies     To say No, a little bit more often, maybe as the occupational therapist does. Yeah, I understand that,    Leah Kuypers     but I will say this out of my master's in education, I wrote the zones so that was a result of that path I chose, and it really served as a vessel for me to take all these ideas that I was using with my caseload. And I had that idea of the four zones and that we're working on self regulation, and my colleagues kept telling me, like, you need to write a book. You need to, you know, create a curriculum about this. This is good stuff. And I just thought, There's no way I'm going to do that. I was so overwhelmed by that thought of, you know, trying to create a book curriculum. Um, you know, we wrote treatment plans. I never had written a lesson plan. So the masters in education required a capstone and like a thesis, but on steroids. So we had the choice to do research or create a curriculum. So that was my moment of really like conceptualizing the bigger picture of this and that I'm going to be able to put this together. I'm going to be able to create this more user friendly medium now that I can share with my colleagues. I had no concept that it would grow to what it is today. But, you know, I just thought, if I can put together a binder for my, you know, the teachers who are using it for the other therapists, that would be awesome. And,    Jayson Davies     yeah, so now that we're kind of on the zones, what was the first time that you like, kind of came up with four different zones. Like, were you in a therapy session? Were you sitting in one of those masters of education classes?    Leah Kuypers     Yeah, I was in continuing ed course on visual strategies for the autism learner. And there was, I think, just like, something that they were talking about. I don't remember if it was the four colors or they used the word zones, but all of a sudden, something clicked in my brain, and I was like, four colors, zones of regulation. We're putting emotions into these four categories, and I know this is going to work for my caseload, yeah. And so I then, you know, I told you, I have this kind of design, yeah, creative side of me. So I really loved making visual supports and creating work for my not work, but I just really enjoyed that problem solving for each student. And so I would create a lot of visual supports that were customized for each student, because that's what they needed. I had a really tough case load, and so it was kind of then went back to my computer with board maker programming, I started putting together some simple visuals and brought it to this one teacher that I had all the students in her class. And it was a really tough, tough class. And she was like, Yeah, let's give it a go. And so we started there, and pretty soon the whole school nearly was adopting it. And my other OTs I had, there was three of us in the OT department in this district, and the other two were kind of like my second moms. They were veterans, and they, as I said, continue to be just these big cheerleaders for me. And they were saying, Leah, you need to, like, they were using it. They're like, this is working. This is brilliant. Like, you need to get this out there. So it was kind of that, was that being planted in my head enough times that I thought, Okay, I'll give this a shot and see what I can put together for my capstone.    Jayson Davies     So the first classroom that you implemented it into was that a special education classroom or a general education special ed, okay, yeah, specifically for kids.    Leah Kuypers     Sorry, yeah, I had, I was Oracle room, but all kids had really significant behavior. I had a couple autism rooms around the district, or few autism rooms. And so those sites quickly adapted it too. And yeah, it was cool just to see the students respond, and it made sense to them with the zones I took something I integrated in the systemizing theory by Simon Baron Cohen, and tried to create a simple system for their brains to make sense of all these more abstract ways we feel like color coding them and sorting them And then create these simple pathways for them to follow, like when I'm in the blue zone, I can take a rest, or whatnot like that, so that it was a very kind of linear approach to regulation. And create this simple language and this vision. Will way to communicate it as well, so that we could not have as much need on the auditory which students with autism, many of my students on my caseload, were not necessarily able to process auditory very well, or had limited verbal abilities with the visuals, easier way to communicate.     Jayson Davies     Yeah, so one of the things that I heard you say was like, how you're using the word curriculum. And As occupational therapists, we don't use the word curriculum, we use maybe program or a treatment strategy or a treatment plan, we don't use curriculum. So when I hear using the word curriculum, I automatically think a large classroom or a classroom setting one, and I also think full group. And is that how zones of regulation was intended to be used as more of a full group versus an individual treatment.    Leah Kuypers     Yeah, the lessons are all written for group format, so small group, but that was the thinking behind that, because many of the classrooms, when I would go in, I would with a special ed room, take a group of the class of maybe four to eight kids were in the classroom, and we would be working together on this. So I was delivering it in often that in a more social setting. And then I also was working in small or by the time it really got released. I was in California by that point, and again, working with small groups after school, really kind of, then just fine tuning a lot of the lessons and kind of working out some of the kinks and whatnot. And that was, I thought, a powerful way to deliver it. I liked that the kids were creating this community of understanding each other, and we had this common language to talk about it, and it just became the norm. And then there was that CO regulation piece between the students, where they were helping each other. And it also, I found, provided a lot of those just really in the moment, stressors that then served as an opportunity to practice what we were working on and have those real time teachable moments that often when you're working with self regulation, aren't there when you're working in a one to one setting, a lot of These kids struggle more when there's more dynamic, yes, settings other people, other moving parts to them. So.     Jayson Davies     Yeah. So I just realized that we've been talking, you know, well, the first few minutes we weren't talking about the zones, but the last 10 minutes or so, we've been talking about the zones, but we haven't really gone over what what it is. We've been talking about the development of it. But for people who, for May, whatever reason, not know what the zones of regulation is, can you just give a brief what it is, and maybe the four colors and what those mean?     Leah Kuypers     Sure. So the zones of regulation is just a cognitive way to think about all the ways we feel. The zones are defined by our feelings on the inside, our energy, our levels of arousal, our emotions. So there's four colors. There's the blue zone. When we are having those down emotions, our energy is low. They might be sad, sick, tired, bored. In the blue zone, the Green Zone is when we are in a calm, organized state. I put more neutral emotions there, as well as happy content, focused, calm, ready to learn. The yellow zone is when we have an increased level of arousal, a little more intense emotions. Our energy might be elevated, but I think about it as we still have some of that cognitive control, that executive functioning is still a little able or easier to be tapped into. So these emotions and states I put in there are the anxious, worried, we can be frustrated, silly, excited, so positive emotions too, giddy, overwhelmed, stressed, and then the red zone is those really. Big, intense emotions, those heightened states of arousal. We might even be in fight, flight or fright, freeze mode. There so things like panic, devastation, feeling furious, irate. We can be elated, ecstatic. You know you win the championship and your sporting event, you know, maybe in that red zone, cheering and celebrating. So and you know, tear as well, that really intense fear. So with that, the zones, all the zones are okay, it's natural that we're going to experience all these zones, and the zones aren't about telling you how you should feel there. It's about helping you understand what you're feeling and then giving you strategies to manage those feelings. So once the individual is able to recognize what zone they're in and what feeling they're experiencing, we start putting tools into place to help them then manage that zone so they developed their Blue Zone tools and their green zone, their yellow on their red zone tools.    Jayson Davies     Yeah, and so, and I think it's very important, like you said, there isn't a bad zone per se. You know, it's not like we're always trying to get to that green zone. And it's not imperative that we are in the green zone 99% of our day. Like that is not the purpose unless, I mean, correct me if I'm wrong, but.    Leah Kuypers     You're absolutely right. I mean, I would say I kind of live in the yellow zone, but maybe from the outside, and my behavior appears like I might be in the green, but inside, you know, that's why the zones are about what you feel on the inside. Because inside, you know, gosh, Christmas is in four days, or three days or something. And, you know, I still have this Christmas list to do. We have these projects we're trying to get done by the end of the year. We have family coming and hope, you know, and all organizing that. And so there's a million things running through my head, and I've kind of got a little bit of that scatterbrained, loose sense that I need to tie up, but hopefully I'm coming across sounds pretty good to me. Yeah. So absolutely, it's, you know, helping kids recognize and not just kids, the zones, I think about the zones in my own life that is applicable for adults, too. And what's helping you just have that awareness of where you're at and if you need to manage it so you can get your job done, you know, think about what's the task demands, what's your goals, and then what's the setting you're in, the situation, who's around you. And so those are the factors that come into play as we think about, how do we need to manage our zone, what's going to support us, and sometimes maybe we don't need to manage it. And you know, it's okay to you know, I think my kids went off to school today. They're both wearing Santa pajamas. This school is just like we've given up. We expect pretty much all the kids are going to be in the yellow zone. So do we have movies on deck today? We have popcorn parties, you know? And so it's kind of like, sometimes we don't need to manage it. It's okay, like all these kids are really excited and giddy and maybe a little anxious too, about Christmas and the holiday break. And.    Jayson Davies     Yeah, yesterday, yesterday was our last day. And I thought the school was actually pretty smart. They made it a minimum day, so they knew that the kids were gonna be partying all day. So they're just like, all right, you can party all day, but you only get a half day to do it. Like, that's smart. And of course, all of them were in their their pajamas and all that good stuff. So yeah, of course, I had two IEPs so I could not dress in my pajamas. But, but yeah, so while you're talking, one of the questions that popped up into my head was just like anything out there, I'm sure that there are some misconceptions with your program. Whether, have you heard some people talking about your program out there, maybe as someone that asked you a question or and they just had a misconception, and it was just something that needed to be clarified?     Leah Kuypers     Sure. Well, I think one of the most common ones is that, you know, we need to be in the green zone. And it's really not about needing to be in the green zone. Certainly feeling in that calm, organized state is where we're probably going to get our best work done. In the classroom, our social relationships will probably flourish when we're are more likely to flourish. When we're in that calm, organized state, but that's when we go out for recess and everyone's playing a game of tag and we're competitive and around you know, it would be common for many of those kids to be in the yellow zone in that moment or I think there's this kind of almost contingency, this threat, that gets put upon students, you know, you need to get back to the green. And I think about it more as we're not going to take a kid who is sad and just wipe away the sadness and say like, No, you need to be happy in the green rather, it's about, you know, how can we support him managing his blue zone? It might be interfering right now, because he's crying, he's upset, he can't work. But can we give him some tools or strategies to support that place where he's at, help him manage that sadness so that he can still get through his work, participate in class, partner with other kids, and recognize that he still might be sad, but sometimes trying to find those healthy coping mechanisms for him so that he can still perform.    Jayson Davies     Yeah, definitely, and like the same thing. So I have this kid, O who is a fifth, sixth grade student, and I'm new to the school, so I'm new to him at the beginning of the school year, and one of the programs that he is very familiar with is the zones of regulation. In fact, when I first started working with him, he would come in, he had autism, and he would come in, and he would just be like, OT, zones of regulation, and me being a new ot he or me being the new person on campus, he just kind of assumed that I knew zones of regulation. And, you know, I kind of played it off a little bit because I wanted to see what he knew. And so I was like, what's the zones of regulation? And this, this kiddo just went berserk on Drew he drew me an entire diagram on the whiteboard. But one of the things that I easily was able to see is that for him, and I've continued to see this over the course of the last six months, is for him, he's obsessed with being in the green zone. And he will always answer that he's in the green zone, and he's, you know, the green zone is the best zone. I need to be in the green zone. And so this entire year, we've been kind of working on more expression of the other zones, or, yeah, his ability to express himself in the other zones and to understand that it's okay to be in the other zones.    Leah Kuypers     For sure.     Jayson Davies     It's something that takes a lot, because especially the kids with autism, they want to if you tell them that the green zone is like the zone to be in, then I mean, any kid wants to please an adult. And if they feel that, if I say I'm in the green zone, that's going to please the adult, then we kind of lose the the importance, or we lose the entire reasoning for the zones of regulation.     Leah Kuypers     Yeah. And I talk about, you know, using our tools to get back to the green when I recognize, you know, this seems really uncomfortable where they're at. And so helping them see that they're not going to always feel this way, you know, like it's finding you know that say that kid who is just kind of washed over with anxiety, and let's try to find some tools to help us take care of our yellow zone, and maybe we'll move back to the green. But it's not like this threat that we have to or, you know, sometimes, some days, yeah, I'm just kind of stuck in the blue zone, and I'm like, I want to get back to the green, right? But, um, but yeah, I think so much of that kind of the intonation and just kind of context in what you're saying, it can create so much meaning around that, so that, if it you know, we can talk about, let's find a tool and get back to the green, which sounds supportive, versus like you need to use a tool and get back to the green sounds very much more like a threat or something or that there's something wrong. So yeah, I thank you for helping him gain comfort and explore that this is.    Jayson Davies     All right, so we know what the zones are, I want to ask you, going forward, what I'm sure that you have ventured out into the evidence realm, or people have used your program to kind of figure out who it works for, what it works for. Off the top of your head, are there some evidence? Some. Articles or things going on with the zones of regulation that you can speak to?    Leah Kuypers     There is a lot of people who have done their graduate work and research around the zones, and rarely does it go on to the point of getting published in a peer reviewed journal. So there's been some posters presented on the zones at a OTA. There is a group that I've worked with who did a study with using the zones and with the fetal alcohol syndrome population that produced some evidence. There is the biggest study that I've been in communication with, and they've yet to release any of the findings, but it was this group in Brevard County, Florida, and they had a huge, multiple million dollar grant from the government the I know, I'm not going to say the right name, what brand, or What department, but they they received it for improving school climate and safety. Okay, and so the zones was a piece of this study, and they used the zones in elementary and middle schools as in their intervention for at risk students, and they were having a lot of success, and they decided they wanted to extend the grant another or this research another year. And so it officially ended spring the term last year. And there's not been a release yet of the findings.    Jayson Davies     So they're still putting all the data together.    Leah Kuypers     Yeah, so it was nice because I needed to get two years of data then, and I know several of the schools moved to using zones as a school wide approach versus just with their at risk students. But I don't have the hard numbers, and I just keep holding my breath, waiting for but, yeah, I think one of my weaknesses is definitely a more research based mind. I'm much more on the creative side of things. I really kind of struggle when we start thinking about.     Jayson Davies     Putting the numbers and all that good stuff together, right?    Leah Kuypers     So I always say I will do everything I can do to help support anyone who wants to take a lead in that. And we actually just got, there's a new study with Clemson University that's going to be unrolling now, I believe in this new year. So that person I've been in contact with as well as they work to set up the study and the parameters and stuff around that, but yes, so email me if that's your if you want to know some research, my publisher and I are happy to help facilitate in any way.     Jayson Davies     But yeah, all right, well, I think we should probably start wrapping up. But I want to ask you, and on a good note. What's, what's a story that you can share with us that the zones of regulation worked with a kiddo or a group of kids or something like that. Can you share with us just a specific instance that you recall that just made you smile, because it worked so well?    Leah Kuypers     Yeah, if you come to my full day trainings, or really any training I do. I talk about the student Nate. I He was a third grader when I started working with him, and I worked for with him his third and fourth grade year, and he was in a group, but we also started doing some individual work with him. I, he had a very inflexible brain. I He wasn't had didn't have any diagnoses. He didn't qualify for any services through the school. So his parents were bringing him to me privately and but he really struggled with self regulation, and he was bright, articulate, but he just really struggled to manage those stressors, and it often showed in. His quick temper. He had sharp tongue. He easily just kind of would shut down when the stress compiled or there was conflict. So he he was a kid, he walked into the my office the first day I met him, and he said nothing to me. He stared at the zones visual on the wall, and he turns to me, and he had, kind of like a young professor, like voice he had, he said to me, Well, I guess I'm in the yellow zone. I'm feeling anxious. I've never met you before. He was very matter of fact, and it clicked instantly for him, and it he told me after the end of the second year, he said something to the effect of, I've always known this was hard for me to deal with my emotions, and you put together something so easy to understand and for me to follow. And you know, he just has this really kind of this brain that, you know, if you can just map it out, he's going to follow that. And so once it just got organized for him in this way, he started using tools. Within a few weeks of he had that awareness of his feelings, and it just now we had these tools categorized into these zones, and he had a lot of that grit and determination, but he just needed some, some way to kind of help him make sense of this and give him some of that structure to really perform it and or put in a place. And so he was just a kid who made really amazing gains and was so fun to work with because he challenged me, and he would make me think about things that I'm like, Oh, I didn't, I didn't pull that apart to that degree. And he would, you know, pull it apart and make me think. And I think he challenged me as much as I challenged him, but in the end, it was a win win, and I usually end with this, my talks with the slide of his report card, because his parents sent me his report card, and they said, for the first time ever, Nate got a perfect string at ease in that self control and social responsibility category, and these are he's always had all the academic grades, but he's always struggled in this area. So.    Jayson Davies     We can't get a much better testimonial than from a fourth grader on this program.    Leah Kuypers     I wish it was like, one of those moments where I'm like, oh, I need to write this down, and I didn't, but he's just a kid who won over my heart and just will always be a memory inspiration for me to keep working and thinking about.    Jayson Davies     keeping on. Yeah. Well, thank you so much for coming on and sharing that story with us that that's meaningful. And I think that as occupational therapists, I think we all strive for for that same exact conversation with our students. You know, after working with our students for a little bit, we like, I mean, come on. We like to hear from the students that they're making progress, and we like them to feel proud of themselves. And so for this kid ot to really feel that, you know, I'm kind of under control for the first time in my life, and I understand what's going on in myself, basically, is what I'm hearing that's really cool. And, yeah, yeah. So, all right, great. Well, before I let you go, is there anything else you would like to share with people out there. I'm thinking, well, anything you want to add, but also, if anyone would like to contact you or learn more about the zones.    Leah Kuypers     Um, I have a lot of information on my website, zones of regulation.com and contact is info at zones of regulation.com so there's our training schedule. We offer webinar, web based training as well, and it's kind of what I've been working on, and different our products and creations. And there is some more on the research and those bits I was talking about finding, you can find some links for more information, and, yeah, some free share stuff too that you can use to accompany the curriculum in the book. So    Jayson Davies     definitely, and we will link to that in the show notes, as well as to the. Directly the actual program, we'll link directly to that as well. So thank you so much for coming on. We appreciate having you, and hope you have a great rest of your holiday season.    Leah Kuypers     Thank you so much.     Jayson Davies     Take care. Leah.     Leah Kuypers     Okay, bye.     Jayson Davies     All right. Well, that does it for episode 23 of the OT school house podcast featuring Leah Kuypers the zones of regulation. And I hope you guys will check out the show notes at ot  schoolhouse.com . Forward slash 23 for everything that we talked about today. Hope to see you there. Take care. Bye, bye.     Amazing Narrator     Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to OT schoolhouse.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 22 of the OT Schoolhouse Podcast. In this episode, Jayson interviews occupational therapist Tracey Davis, a pioneer in the world of telehealth occupational therapy services. With technology advancing every day and becoming cheaper to access in all forms, it is no longer a matter of if virtual OT services will become prominent. Rather, virtual OT services are already here and are only going to become more prevalent in school-based settings, as well as in other traditional medical roles. In this training, you will understand the necessary tools required and guidelines to follow in order to provide telehealth OT services in a school-based setting. You can earn 1.25 units of professional development by listening to this podcast and purchasing the episode 22 podcast PD opportunity here . Objectives for this Professional Development Podcast. Listeners will: 1. Understand the guidelines placed on service providers looking to provide telehealth OT services. 2. Know what tools, software, and hardware are needed to provide virtual services. 3. Understand the difficulties and limitations associated with provided virtual OT Services. Links to Show References: Have a question for Tracey? You can contact her at TDavis@talkpathlive.com ​ American Occupational Therapy Association (AOTA) - AOTA has a plethora of telehealth-related documents on its page. Use this link to access them . Some are only available to AOTA members. American Telemedicine Association - The ATA has several resources and puts on an annual conference for telemedicine provides similar to AOTA's conference. Click here to visit The International Journal of Telerehabilitation, published by the University of Pittsburg Teletherapy for OTs and SLPs Facebook Group - Join over 700 other service providers that are interested in the same thing you are, TELEHEALTH! FERPA - Briefly referenced in the show as the "HIPPA for schools," FERPA is indeed a privacy act that schools must abide by. All school-based personnel/OTs should be familiar with the Family Educational Rights and Privacy Act, or FERPA 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 the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.    Jayson Davies     Welcome everyone. My name is Jayson Davies, and this is episode number 22 of the OT schoolhouse podcast today. I am, well, genuinely excited about this one, because we're talking all about telehealth, and this is actually going to be one of our first professional development podcasts in a while. So you will have the chance to earn professional development by listening to this podcast and heading over to OT schoolhouse.com forward slash episode 22 or OT schoolhouse.com forward slash PD and purchasing the opportunity to take a short quiz and earn a certificate of completion for listening to this podcast. It's actually going to be an hour and 15 minutes worth of professional development, which is really cool. And all you have to do is sit back, listen, and then go take a short quiz of about 10 questions, and you'll be on your way with an extra 75 minutes of professional development that you can use for NBC, ot recertification. With that said, let's jump into the objectives for today. Today, you will be able to or at least by the end of listening to this episode, you'll understand the guidelines placed on service providers looking to provide telehealth ot services, you'll know what tools, both software and hardware, that are needed to provide virtual services, and you'll also understand the difficulties and limitations associated with providing virtual ot services. And with us today is Tracy Davies of talk path, live. She's an occupational therapist herself, and she's really been at the forefront of telehealth. In fact, I think she's been doing this. We'll get into it in a minute, but she's been doing this since 2012 I'm not even sure I was using Skype in 2012 so she's really come a long way, and she's helped telehealth come a long way as far as occupational therapy services. Tracy is based in Ohio, but because she does telehealth, she provides services all over the country, that's pretty awesome. She could be providing services in New Mexico a half hour ago, and now she's providing services in New York City, perhaps. So it's a real treat to have her on and share her wisdom about telehealth. Like I said, Tracy is well versed in telehealth, and she regularly provides trainings in telehealth, not only for employees of talk path live, but also for other occupational therapists who are thinking about getting into tele rehabilitation. So now, if you've ever thought about working from a computer in the area of telehealth, this is the podcast. This is the place for you to be right now, obviously you know how to get to access podcasts. So you must be somewhat technologically savvy, and well, we're going to step up the game a little bit and figure out how we can do well therapy over a computer is basically what it is. So sit back, relax. And here is Tracy Davies, hey, Tracy, welcome to the OT school house podcast. How are you doing this evening? Just fine. Thanks, Jayson, great. And remind me again where you're actually located. I am in Ohio. That's awesome because we're doing telehealth, and we're going to jump into I know you don't just, quote, unquote, work in Ohio. No, not at all. You're all over the place, right? Yeah. So I'm super excited specifically for this podcast only because I've kind of looked into telehealth a little bit. It is, in a sense, my dream to work from home, whether it be seeing kids in my backyard, or doing telehealth or or even doing this podcast and blog full time, something like that. It's kind of my dream, mostly because I want to be able to be there for my kids when I had them, but I am excited about telehealth, and I can't wait to get into this. So before we jump into that, why don't you give us a little bit of information about you, where you went to school, maybe, and how you got to where you are now.    Tracey Davis     Sure, Sure. So I went to school in Wisconsin, a small school just north of Milwaukee. I got both my bachelor's in psychology and master of OT there. I've been in OT for long time now. I'm not even sure that luck now, maybe 19 years, something like that. And I've been working with children pretty much that whole time. So pretty much very versed in pediatrics. I've been working in telehealth for a while now as well, about six years maybe or so, and I was one of two OTs when I first started working in telehealth at the company that I worked for, and so we kind of muddled through everything. You know, together. I've worked with kids of all ages and all different settings, but my family moves around a lot, and so telehealth was the answer for me to continue my career, even though we move around a lot. And it i i. Have just really enjoyed it. So now I I'm now the Clinical Director for a telehealth company. Talk path live, and I teach continuing ed courses as well, and talk with people like you about the versatility and all the things that can be done in this with this service delivery model.  That's awesome. I mean, you kind of jumped on really quickly into the telehealth role. If you've been doing it for six years, we're 2018 2012 I mean, yeah, as far as you know, when was like the first real telehealth like, hey, someone's doing telehealth, yeah. So it started with speech therapy. They were doing it before us, but not too much longer. Before us, there were, there were a few people who were really doing some research in the, you know, early 2000s but really it wasn't. It wasn't until about, well, a ot a identified it as an emerging niche in 2011 Okay, so you're right, Devon, I was pretty close, and their their first position paper came out in 2013 Okay, so, so, you know, people were doing it before then, for research and things like that, but it really has only been in the last five, six years that it's gotten to be sort of mainstream for occupational therapy. Okay,    Jayson Davies     and I might edit this part out. But have you been in contact with a ot a as all when it comes to telehealth? Are you one of their go to Resources In a way?    Tracey Davis     I don't speak with a ot a as a, as an organization, but I have, I have spoken with some of the, some of the people who wrote those documents. You know, Janna cayson is, is a big one. She and Ellen Cohen, they co edit the International, International Journal of tele rehabilitation. And Ellen Cohen is a speech therapist, and Jan is an OT and so, you know, they were kind of very much pioneers, and I, I run in those circles a little bit.     Jayson Davies     So good. Hey, I mean, if you've been doing it, I mean, like you said, it's emerging, you were, I mean, you had to be one of the first few 100 people maybe doing it, and if not even sooner than that. So.    Tracey Davis     People to ask.    Jayson Davies     Exactly, right? Well, now it's a little bit more. So, all right, well, I want to hear from you Exactly. How do you define tele health? When someone asks you, like, what do you do for a living? How do you define it?    Tracey Davis     So I tell I mean, if I'm talking to a lay person, I tell them that I provide therapy services to children over a secure internet connection, that I meet with them via video chat, basically, and that we do therapy together, which is kind of exactly what it is, because it's it's considered a service delivery model, so it's one of the tools in our tool chest, essentially. It's not a specialty or anything like that. It's just one of the ways that we can provide services to individuals. Anyone.    Jayson Davies     Yeah, very cool. And so what do you say if an occupational therapist asks you, obviously they know what OT is, and you're telling them it's telehealth. Now, is it a little bit more? What? What questions do you get and what answers are you giving?     Tracey Davis     You know, it's interesting. I have to say that the biggest skeptics are other therapists. And you know, it's just OT is a hands on profession, and it's hard to picture how you can provide those services when you're not in the same room as the person that you're working with, and so I I go into a little bit more detail, of course, but if I were talking to a therapist, I would just tell them that I do exactly the same things that you might do, but I use instead of my hands, I use my Voice to effectively communicate, and we often compare it to a coaching model, which we've found to be highly effective, especially in areas such as early intervention and home health services. We're working with the an entire team of people, caregivers included, and so we utilize coaching techniques in order to communicate what we need, what we need to happen.     Jayson Davies     Yeah, and if anyone wasn't sure what this specific podcast episode was about, that just kind of summarized it all up, and I can't wait to dive more into it. So we talked a little bit about a OTA, kind of the people that kind of do some some telehealth in that community does a ot a specifically define telehealth? Do they have an official definition for you?     Tracey Davis     They do within their within the position paper that they created, they they defined it as the application of evaluative, consultative, preventative and therapeutic services delivered through. Telecommunication and information technologies.     Jayson Davies     Okay and that's in the AOTA position paper you said on telehealth. Yep, perfect. We'll be sure to link to that in the show notes. But so that's a OTs definition. What about other definitions? I know that doctors are doing telehealth. Obviously you said speech therapists are doing telehealth. I mean, is it all pretty similar. And who else even is out there doing telehealth?    Tracey Davis     Yeah, so telehealth has really gotten so much bigger than it than it was. It's still growing, but, but physicians are doing it. A lot of specialty physicians especially are doing it. So let's say that you live in a community that doesn't have a particular specialist, then you might access a specialist through it, via telemedicine and physical therapy. We physical therapists are doing it as well. And so they actually, APTA created a position paper in 2012 so around the same time as a OTA, then we there's also a group called the American Telemedicine Association, and they have a lot of different resources, things like that, but they have a telerehab special interest group, and so they've created a it's an interdisciplinary document for all rehab professions, where they also kind of their original document was called the blueprint for tele rehabilitation guidelines. It's been updated since that time, and it might even have a different title now, but it's, it's just an update of the original position paper. But all of them have very similar definitions, and all of them identify telehealth as a viable service delivery model, meaning that, number one, you don't really need any sort of specialty certification to conduct telehealth services. And number two, research you know, has shown it to be an effective means of delivering services.    Jayson Davies     Perfect. I mean, that's kind of the two things that really you need to know. Obviously, there's a few more, and we'll get into those here in a few minutes. So, so let's dive a little bit deeper into telehealth. What are some examples of telehealth that's being used more specifically to OT and maybe, you know, this is a school based platform that we're talking on here. What are some different ways that telehealth occurs in school based therapy?    Tracey Davis     Yeah, so it actually is a little easier to picture telehealth when you go when you use examples, so specifically in school, in schools, all, all school sites do make use of telehealth. So brick, some brick and mortar schools use telehealth therapists. Virtual Schools use telehealth therapists. The charter school system like in California. So basically, homeschooling families who are accessing Special Education make use of telehealth. So, so all, all different types of schools. There are schools that are using telehealth. And an example could be, you could be doing a direct one on one session with a child using, you know, a pull out sort of scenario, where they come and they sign into your virtual room and they meet with you. We also conduct small groups using telehealth, where there might be two kids sitting at one computer, or there might be two kids from two different school buildings within the same district that are both signing in together for a group session. Okay, so, and they basically just sign into a video, you know, a compliant video software. We use it for, maybe for consultative sessions with teachers. We we use telehealth in order for our therapist to attend IEP meetings. So there's, there are all different, all different areas where it's being utilized, within the schools.     Jayson Davies     I remember one person telling me that there's a difference between, I think it's called synchronous and asynchronous telehealth. What's, what is that? Or what are those? And what's the difference?    Tracey Davis     Yeah. So synchronous technology is basically just real time. So that just means that you're providing a live therapy session or a live any type of session. So you and whoever you are working with are meeting in the in the at the same time in the same place. Asynchronous is store and forward technology, so we don't use it so much in the schools, although there are some scenarios where we use it, but but basically you would make use of some sort of software where the therapist is putting, maybe a home exercise program with into this software, the client then signs into that software, completes the home. Size program, including maybe even recording, you know, video recording themselves doing it, and then the therapist, then signs back in, sees that they've done it. Maybe watches the recording, makes adjustments that would be asynchronous.    Jayson Davies     Okay, so kind of think of it like an email. You know, you send the email now, but maybe the person opens the email later and takes action on it later. Okay, correct. Gotcha perfect. In fact. I mean, does anyone use email as a way to perform telehealth?    Tracey Davis     You know, you can, you can do that. But some states have laws that you know, say that phone calls are not telehealth. Email is not telehealth. In fact, some states go so far as to say that you must be using the synchronous in order for it to be considered telehealth, although there are lots of states that consider asynchronous but, but they do. But a lot of places do require you to use some sort of software or something where you're each logging into the same website, maybe not at the same time, but you're logging into the same place, if that makes sense.    Jayson Davies     Okay? And you kind of touched on that. You know, different states have different things going on. So at what level is telehealth really regulated? In the sense, is it a OTA regulating it. Is it California Board of OT regulating it, or who regulates it? And how are they different from maybe state to state?    Tracey Davis     Yeah, so it's not federally regulated by a OTA or NBC OT or anyone like that. Rather, a OTA provides guidelines for its use, its ethical use, and, you know, its effective use, and things like that. But state boards are who tend to regulate it. There is some there are some possibilities for there to be a little bit broader regulation. Because the problem with each state regulating is that each state's laws are different, of course. So one of the great things about telehealth is that you can, you know, you can work anywhere, yeah? But because different state laws are different, it's sometimes difficult if you took to be crossing state lines? Yeah. So there are, you know, there are some possibilities in the future for that to become a little bit more level across the board, but, but the first place, if you had any questions at all about the regulatory laws within your state, would be to contact the state licensure board, because it makes sense. There's, they're the ones who, if there are any specific regulations for telehealth, they will know, and they will be able to tell you.    Jayson Davies     Gotcha so the board of occupational therapy in that state, right? Yep, exactly. I think everyone should know how to they should know that website for your state, and you should maybe have them on speed dial every now and then. But you mentioned some platforms. What do you mean by a platform?     Tracey Davis     So by a platform, I mean just basically whatever it is that you're using to to as a virtual meeting space. So if it's an asynchronous platform, then it'd be, you know, one of those software programs I mentioned, or something, or if it's synchronous, then, then some sort of video, video based meeting space. But it needs to be HIPAA or FERPA compliant, so they're, you know, not just anything.     Jayson Davies     Yes, and HIPAA and FERPA complaint, that's a whole nother. We won't dive too much into that. But yes, yes, and for anyone, just really quickly, for anyone who doesn't know, fairpa is kind of like the school based version of HIPAA and it regards, it talks about educational documents that need to be secure, as well as any sort of telehealth documents or telehealth videos that would need to be secure. Correct, correct. Okay. So, for instance, right now, we're recording this on Skype that would be considered a platform, but not necessarily a platform that would be okay for telehealth. Is that right?     Tracey Davis     That is correct. So the short answer here is that whatever you're using, you need to, you need to be able to get what's called a BAA certificate from them, meaning a business associate agreement. And if, if what you're using can supply you with that basically, that is the software that you're using, the platform that you're using basically says we're encrypted and we follow, we follow these rules. So that's what your BAA certificate does for you. And if you aren't using if you. Don't have one of those, then it's not you. It's not HIPAA or for compliant. Now, I will say we're on Skype right now, yes, and there are free versions of Skype and there are paid versions of Skype, just like there are free versions of zoom and paid versions of zoom. Yeah, yes. It's a lot of times the same thing. It's the same connection, yes, but you need you know, using the free version doesn't necessarily mean that you're being HIPAA or FERPA compliant. Does that make sense?     Jayson Davies     Yeah. And from my experience, too, and I think at my previous district, we were looking into even using Google Docs within a school district, and we had the same type of conversation about the BAA, because Google Docs is not technically HIPAA, fairpa compliant. However, you can get that Baa, but in order to get the BAA, you have to basically upgrade to Google suite, and you have to do all this application process. The school district has to talk to Google. They have to set up their entire IT department has to reorganize everything to make it set up. And so I know just from that small experience how difficult it can be for a school district to get set up with a BAA with a company, it might be a little simpler if it's just you and you know, I'm sure Google has an entire team that you can contact, and it's probably not too difficult. But when you're looking at, you know, a school district that has 1000s of computers and an IT department and all that good stuff can be a little crazy. I'm sure.    Tracey Davis     It can get that way. But what some places do, and the company that I work for does, is we use, we use a FERPA compliant platform for our video sessions, but then we have proprietary software for all of our documentation and everything like that. So it doesn't have to be an all in one solution. And if there are some reasonable video, video platforms that you can that are not very expensive, and that you can, that you can get, that are HIPAA FERPA compliant, so I typically use Zoom, that's just what I use, because I have found it to be pretty user friendly for new clients who are signing in and things like that. It's just pretty easy to use. And I have, I have a paid version of zoom, and it is, it's pretty reasonable and wasn't very hard. So, so there are options out there, but, yeah, that's just kind of a whole, I feel like that's a whole nother discussion. You know, with all of that, it's important for the listener to know that, you know, just signing on to FaceTime or something with someone doesn't necessarily mean that you're following the guidelines that you should be following.    Jayson Davies     Exactly. I mean, and it's hard because technology, I mean, it's so accessible now. I mean, I want to say even, like, three years ago, it was harder to do what we're doing right now, talking with video over Skype. I mean, it's amazing how fast technology is going. And, I mean, we've already talked about laws and regulation a little bit, but you know, it's trying to keep up with, with with telehealth. I mean, so and all the technology.    Tracey Davis     And it's in the hands of a lot more people now too. So you know, when I start a session with someone, I mean everybody, like, it's not that difficult for people to, you know, to click a link to sign into my therapy room anymore, because everyone has access. Most people have access to something, and a lot of the platforms these days have, like, app versions, smartphones or tablets. And, you know, we don't really recommend telehealth on smartphones just because the screen so small. But, you know, the access doesn't necessarily have to be from a computer. So. Yeah, it's, it's amazing what we can do. It just, it just really is. It is. So I think that's a good segue. Now, like, what do you see? You've been doing it for a while. What do you see as the benefits of telehealth that maybe even more so than regular occupational therapy in a school? Yeah. So, you know, it's interesting. Our out, like research wise, our outcomes measures are showing outcomes equal to and in some cases, greater than, in person services, which is very interesting to me. I have my own theories about that, but I think one of the biggest benefits is I work with a lot of very remote school districts that literally can. Not find a therapist. Yeah, and these kids who hadn't had therapy all school year long now are making progress on their IEP goals, you know, on their ot goals, on their IEP because, because we're able to meet with them, you know, over an internet connection. And it's not only remote areas. But we have found, even in some very urban areas where maybe it's hard to retain a therapist, maybe it's an area of town that isn't quite as safe, or maybe, you know, there's just, they're just other barriers to getting into those environments that make it very difficult. We you know, I can give you an example too, of we are working with a school district that has a lot of children who have ASL needs, and they don't have any therapists on staff who know ASL, but we are able to provide them with an ASL fluent therapist. Oh, okay, believe it or not, you know, she doesn't, she doesn't live anywhere close to them, but we're able to hook them up via telehealth, yeah, so, so those kids are accessing service too. So it's not just geographic barriers that we're talking about, but it could be language barriers or cultural barriers that you know, or even even just travel restrictions, you know, we we do some work with kids. We do work with kids who are in, like a home, hospital based school kind of thing, and so, you know, they don't have to miss out on any therapy there, either. So I think that's probably the biggest benefit that I see, is just getting kids access therapy,    Jayson Davies     yeah. What about for the the team, the other players on the IEP team, you know, maybe the speech therapist, the teacher, the administrator. Do you see a benefit for them as far as you being part of the team?    Tracey Davis     Yeah? So, you know, sometimes it's a little bit of a learning curve for people, you know, trying to get used to the idea of a therapist not actually being in the building, but ultimately, we have had some very great relationships with the team. You know, I don't know what kind of district you work in, but when I worked in this in a brick and mortar school, I did a lot of traveling, and I had to supervise some CODAs, and we hardly ever crossed paths, because we were all traveling everywhere, all week long. And this way, you know, we we are able to connect via email and phone, and even sometimes, you know, in in our virtual meeting spaces, and it doesn't, we don't have to worry about the travel pieces and things like that. So that's been really beneficial to to team members, for you know that we don't have to all get into the same place at the same time.    Jayson Davies     Yeah, and you mentioned two big things there. I'll ask you one at a time. CODAs are there? CODAs working as telehealth.    Tracey Davis     There are some CODAs working as telehealth. You have to check with your specific state, because some states allow it and some states don't. So when    Jayson Davies     you say allow it, do you mean the billing of it, or just even the practice of it,    Tracey Davis     the practice of it only because of the supervision piece. Um, so, but honestly, I have found supervision to be almost easier, because if, if we're providing telehealth services, I can just literally sign into the session as supervisor. So, and just, I usually just don't turn on my video or my audio, yeah, and just watch. And if I need to, I will, but you have    Jayson Davies     no idea. I would have loved that when I was supervising a Cody, you know, just to be able to kind of pop in and be a fly on the wall and just check in. And then you don't even have to do anything at that moment, like you said. You can leave everything off. But then after that session is over, after School's out, and you have time you can, you know, give your Coda a quick call. Or the coda can call you and say, Hey, I had difficulty with this dude in and boom, they Yeah. I mean, that way sounds even better. I could imagine my COTA saying, Hey, I'm having difficulty with so and so. Can you attach into my phone call this time, at this day when I'm working with them, exactly right, versus me having to travel across the district, yeah,    Tracey Davis     exactly. I mean, it really, it really, truly is easier. And I think, in fact, I know that speech therapy tends to be using it a little bit more in that way. I think we have some catching up to do there. But I just see that as just another great, great benefit of telehealth, yeah, is being able to use CODAs and provide that kind of that level, the level of supervision that we need.    Jayson Davies     Wow, yeah, all right. The other thing that I wanted to ask again, kind of looking at the benefits, is the benefit for the clinician. And one thing that I wrote down real quick, as you mentioned, class. Collaboration. What about collaboration with other OTs? Do you get that as a telehealth provider,    Tracey Davis     you need to be very intentional about it, because we're all working from home, and so it's easy to kind of get isolated, but there are a lot of really easy things you can do to connect with other people. There's some great Facebook groups that are specifically for telehealth therapists. So I would encourage you to to just, you know, even just do a search, because everybody has has Facebook. But it's funny, because    Jayson Davies     I think that's actually how I found you, right? It was, I think it was the telehealth group, yeah. So,    Tracey Davis     so there are some great groups there. There are some that are interdisciplinary and some that are, you know, just for OTs. But there are always people. I mean, I get, I get emails every single week from people who are saying, you know, I want to add telehealth. You know, what can you tell me? Can you, can we collaborate a little? Can you tell me what you know, basically, so, but you do have to be a little intentional about it. Just be, about it, just because it's easy to get isolated.    Jayson Davies     Yeah, I believe you got to make time, you know, for listening to podcasts like this one, going to conferences and stuff like that. You know, just like any other ot does exactly all right. One more last, I guess person or entity that I feel might have been a benefit from is the payer in school based that's obviously different than what it would be like in a hospital. But how does billing work when it comes to Medicaid and providing telehealth? Yes,    Tracey Davis     so there are some states that do reimburse as Medicaid for telehealth services. Not every state does currently, but each time I check it's more states have been added as as allowing telehealth for Medicaid. So, you know, basically within the schools, I mean, it just, it's kind of the same thing. You just when I provide, when I provide Bill, you know, I when I work privately and I provide, like, a super bill or something like that, then I usually put there is a location code of OT to is for telehealth. So, you know, there's a specific location code that you put in there when you're billing, but it works the same as everything else, if you're in a state that Medicaid reimburses for telehealth. Now, if you're not in a state that that reimburses for telehealth, Medicaid, I mean, then telehealth is being used a lot less by schools, but there are still a lot of schools that use it anyway, because ultimately it is a cost savings. We were talking about traveling between locations and with without. The Traveling therapists are more productive. You know, when you don't have to, you can see more kids in a day and things like that. So there are some cost savings. So there are schools that, you know, even schools that can't bill for Medicaid for telehealth services, are still utilizing it, just, you know, with their special ed funding, gotcha,    Jayson Davies     that's very cool. What do you see now, the opposite side of all this, what do you see as some of the challenges, some of the things that I'm thinking of is, like you said, working in a completely different state, if you will. You just kind of mentioned scheduling a little bit and traveling, that's kind of a benefit, but also, I'm sure it's also a challenge, yeah, so, so what are some of the challenges? So    Tracey Davis     personally, you have to be very organized. You have to you have to keep track of your schedule, and so you don't have random kids popping into your virtual therapy space, you know, on not right times and things like that, and you have to be a very good communicator via email and phone, and even just during the therapy sessions, you have to be able to communicate what you want to see happen. You have to be able to show it right and so. So personally, those are kind of some of the challenges that I found when I started doing telehealth. And I found that to be a pretty steep learning curve at first. So that was, that was a little hard, nothing that you can't overcome, but, you know, it's, it's definitely a challenge. The Medicaid piece, where not every state is, is, reimbursing, is, is definitely a challenge. Licensure is also a challenge, because currently you need to be licensed in your state of residence and whatever state you practice in. So PT is a little bit ahead of us on this. They've actually joined physicians and nurses to sign a telehealth compact. I don't know if you're familiar with that, but they it went active recently. I'm not exactly sure when, a couple months ago, maybe, but basically, several states have signed this compact. I think current. Currently, maybe eight of them are live and but there are a whole lot more that are going to be live. So what this compact means for PTS is that if you are a resident in one of the states that has signed the compact, and you are licensed there, you may practice telehealth in any of the other states that have signed the compact. So I hope that ot follows that trend because it will make the licensure piece easier, because you can get Christ cross license, you can get licensed in a state where you're not living, but it gets a little expensive, complicated. Yes, it's expensive for all those licenses, and it's complicated because each state might have different regulations as far as continuing ed go and when your license expires. I mean, when I had, when I was holding six state licenses, I just had to make a spreadsheet of the state and what it expired, any special continuing ed classes that needed to happen and things like that. And it just, it was, it was hard to keep track of    Jayson Davies     I can imagine. I mean, yeah, I know I get a lot of continuing, continuing education units in every year, but still, even just remembering where I put the certificates or making Excel spreadsheets so that when it's time to turn them in, just for one state and NBC, OT is enough. I mean, I can only imagine doing it for 346, states,    Tracey Davis     and this state needs, once, an ethics course, and this state wants an HIV course, and this state wants a, you know, I don't know, some sort of, like, safe handling course, so you have to keep track all of that. So that's, that's kind of a challenge as well. Gotcha    Jayson Davies     All right. Well, I think this is where we're going to kind of transition a little bit into, what does a day look like for you when you, you know, you get in front of your computer, what does that kind of look like for you at a school based model, um,    Tracey Davis     so, you know, in a school based model, you you have some    Jayson Davies     Hold on one second. Tracy, give me one second. Say, you you there? Can you hear me? Let's start that over a you. Internet went bad. So, so, okay, no, I'll just ask you the question again. So that way it's a natural transition. So, so transitioning a little bit now to kind of what the day to day looks like. You know, I think a lot of therapists are a little scared about what it would look like for them. What does that look like for you and your work day when you're working in a school based model through telehealth?    Tracey Davis     Yeah, so if I were working in the schools and I had several students to see. I will have already prepared a little bit beforehand, because, let's say I need to work on cutting with some of my kids, and I want to do a cutting worksheet, I will have probably emailed that to whoever is bringing the student to therapy, which I need to make this point is that in the schools, when we're working with kids in the schools, we there is, there's always an adult who is bringing the child to therapy, and usually it's up to you as therapist to decide what role they will play. You know, are they just available if needed? You know, is this a middle schooler you're working with and they're fairly self sufficient, or is this a kindergartner and you need that adult to provide assistance throughout the entire session. So, but regardless, there will be someone, so I will have probably, you know, sent a little bit of preparation to the to that person, you know, and if it's some sort of worksheet or something, they will have printed it out, or something like that. So you have to kind of plan ahead of time a little bit, yeah,    Jayson Davies     and I'll speak to that just a second. In a district that I used to work at, they did go ahead. We couldn't find enough speech therapists in our area, and so they did do speech for telehealth, and even just setting up that, trying to manipulate the AIDS within the district, because obviously they didn't want to hire one aide at every school just for telehealth, and so they really had to be, I mean, they had to be efficient with the way that they worked with the aid, so that someone was always in that room, and also just to find a computer even At some at some of the schools,    Tracey Davis     then that has been a challenge at some schools. And we try and be very creative with, you know, the fact that we need an adult present, you know, because we don't, obviously we don't need the school doesn't want to be having to hire a person just to bring the kids to therapy plus pay the therapist, right? So we try and be very creative there, but it a lot of times it's someone like, maybe a pair of professional or someone like that, and sometimes it's, you know, we've even set the computer up in the back of a classroom, you know, not necessarily in a separate space, yeah, all right, so. Sorry, go ahead and continue. No, that's fine. So then I would, I would sit down, and I usually don't bother with creating, you know, all of these schedule and meeting invites and things like that. It gets very complicated. And I like to, I like to have one link for all the time so, so I have it set. You know, some of the some of the platforms have this quote, unquote waiting room feature. So basically, when someone tries to come into my virtual meeting space, they're put in this other space, and then I'm alerted that they're there, and I have to let them in, if that makes sense. So, um, so I sit down and I wait for my student to come. And what you need to know about telehealth is that it looks very, very similar to what you're already doing. You know, it's not a bunch of just high tech games and this and that. I'm an OT so I still do a lot with Play Doh. I still do yoga. I still, I still do dance to YouTube videos and things like that. So I might sit down and they might come in, but I'm not necessarily going to stay seated. You know, we're gonna we're gonna get up and we're gonna move around, which, which brings me to another point, is that you really need an external webcam if you're going to provide telehealth services, because your built in laptop camera, if you want to point it at the table, then you're closing your laptop. So, so you need to, you need to not only have one which they're very inexpensive, I mean, like 20 bucks, you know, nothing, nothing huge, but you need to have that, and you need to make use of it. So if you're doing something fine motor wise, then you want to point the camera not at your face, but at your hands. If you want to, if you're doing something gross motor wise, then you need to point the camera at your body. You need to stand up, and you need to move and so, so you need to be very aware of what your camera is pointed at, what is it that the student is seeing? And so they're going to come in and I'm going to, we're going to do some warm up movements, and then we're going to maybe do some tabletop, you know, origami, or play doh or something like that. And maybe we'll do some handwriting or cutting or something, but all the same activities,    Jayson Davies     and how much so when I think of it, this is, as occupational therapists, we're allowed to use CODAs as a either aid in our own treatment or as an aid to do their own treatment, but under our supervision. But that person that's in there, if it is a paraprofessional, how much can they help you?    Tracey Davis     So it'd be, it'd be a little better if you thought of that person more in that early intervention or home health kind of scenario, where it might be a caregiver, but not necessarily a skilled therapy assistant, if that makes sense. So you're still going to make use of them. You're still going to instruct them to, you know, help you with, maybe making sure that the student is has nice posture, or their chair is facing the table, or something like that. But I wouldn't ever ask them to do something that you know would be considered skilled therapy, gotcha. But we use people like that all the time. We instruct caregivers in home exercises, and we get their feedback when they come back to therapy. And so we can use, we can use the the aid who comes with the student in much the same way. So they might help me get out materials. They might toss the ball back and forth with the with the student, or maybe even, I mean, even, you know, I have, I have given input to, you know, oh, I'm noticing that their shoulder, the one side of their shoulders up just a little bit. Can you just put your hand just gently on their shoulder? You know, nothing, nothing that's outside of what their scopes might be, but just providing that little bit of cues? Great.    Jayson Davies     Yeah, I think that makes sense. Because originally going to school and doing a level one or level two field work. I remember being in more an acute rehab setting, or something like that, where they had therapy aids, and we were kind of taught that this therapy aid is not to have any sort of contact, or at least in like California, this is what we were learned, or we're taught, you know. But when we come to thinking of a special education classroom at a school district. It's so so often you see either an aide or teacher providing that hand over hand assistant. You don't have to be you don't have to be a ot to provide hand over hand instruction. So I think that that fits in from what I see. Okay, so    Tracey Davis     yeah, and if they're working at the school, then they're already authorized to be working with the children. So exactly,    Jayson Davies     perfect. All right, so I think this is going to be a big question that everyone has those that is listening evaluations, yeah, how do you do an evaluation? Are you limited in your assessment tools that you can use? Or how does that work? Yeah.    Tracey Davis     So we do an evaluation in much the same way I meet together with the students. I do think that there are some things that are harder to see. Number one, it's, I think it's very hard to really, truly assess ocular motor movements over the over the computer, even with a great internet connection, if you're looking at some subtle jerkiness, you know, the smooth pursuits and things like that, it's kind of hard to see. So, you know, I'll just lay that out there. And I'm the first to say, you know, sometimes there are things that we have to problem solve around. But I will also say that, when we're working in the schools, what are we doing? We're determining if the student is eligible for services, yeah. And so, you know, you might not need that level of detail in order to determine their eligibility. So for an evaluation, a lot of times, if I'm doing maybe standardized testing, it might involve a paper booklet, like, you know, the beer VMI or TVMs or something. Yes, exactly. So we physically mail those booklets to the school, and then the adult who's helping. Some people call them e helpers. Some people call them learning coaches, whatever. Then, you know, we instruct them in how to place that booklet in front of the student. Don't tilt it, you know, please place it right in front of them. Give them a pencil. Don't, please, don't, you know, prompt them in any way, that kind of thing. And then they either mail them back or they scan in the in the the booklet, and email them back exactly. So, you know, there are several assessments, and there are even some companies, some publishers of some assessments, that have been working to make them more accessible for us by digitizing the manual, the examiner's manuals, or are the test plates, you know, if it's a visual perception test or something like that.    Jayson Davies     Honestly, I'm surprised that there's not already, like Pearson or something working on a lot of iPad based assessment tools. I'm sure there might be in the work by now, but I    Tracey Davis     mean, it kind of is, it kind of is, but I'm surprised that it's going a little slower than than it is now, sensory sensory testing, very easy to do because both the sensory processing measure and the sensory profile are online, so they can be done easily. We can do visual motor testing, there's some and visual perceptual testing, we can do those, and we can do most things of the bot. The hard part is, anything that has specialized equipment is a challenge. You know what I mean. So any testing material, like, you know, the blocks, the string of the Yeah, okay, you know that kind of thing. So do you ever send    Jayson Davies     those materials, or do you kind of just try to use alternative methods to get the information that you need?    Tracey Davis     Yeah, we usually just try and use alternative methods, just because it gets really difficult. Now, if you're only working with one district, or, you know, yeah, like you're working independently, then that wouldn't be so difficult. But I work with a company that provides services to so many districts that that it's just, we can't, we can't send those materials to everyone. Gotcha?    Jayson Davies     No, that makes sense. All right. Well, I kind of, oh, we're talking about evaluation still. So moving forward now, do you do a classroom observation sometimes or Uh huh, yeah. So they just set you up in the back of the classroom somewhere, something with the computer, and boom, you're in,    Tracey Davis     yeah, making sure that, making sure that I, as therapist, can see the person I'm evaluating, and, you know, some other peers, to see how some of that interaction goes. And then we're just, we talk in great detail with the teacher, either via email or phone or or whatever. And if we need to take something like a handwriting sample, then typically, I'll just have them, you know, scan it and send it back to me so that I can take a look at that. And, you know, I'm going to also prompt them to be moving their camera down to the table top if I'm looking if I'm looking at fine motor movements or whatever that is, yeah. So some states do require something like informed consent, we call it, and so I just as best practice, always include a statement in my evaluation that you know this was conducted via telehealth. And that, you know, the school was informed and are in agreement with this service delivery model.    Jayson Davies     Okay? And speaking to that real quick, is there any sort of extra paperwork, I guess you have to say, I mean, we have to get an assessment plan, you know, for any student who's going to be assessed. But is there any sort of form that has to go home to the parents saying that you're being your child is going to be assessed and or treated via telehealth, or is that state to state? Yeah,    Tracey Davis     it's state to state. But as best practice, we just try and we, we make sure that that parents are informed of that before we start services. That makes sense. So they and if, if we're, you know, doing an evaluation, we send home a consent to evaluate, and they sign it and and give it back to us. Just, it's just for our records. It's just kind of what we what I think is good practice to do, definitely.    Jayson Davies     All right, you've mentioned a lot of things that people already need, or already start that over. All right, so you've mentioned a lot of things throughout this, you know, 45 minutes or so that we've been on about what someone might need, a platform, the hardware that they need. They need a external camera. They obviously need to have a computer that works. And we're already having some technical difficulties tonight, so people need to make sure they have some some fast internet, you know. But what else might they need if someone wanted to do telehealth,    Tracey Davis     you know, that's kind of those are kind of the big ones that and what I consider to be necessary pieces of equipment, a couple just luxury items that you don't necessarily think about. It's really nice to have a second monitor, because you can put the student on one screen, and you can pull up their goals on the other screen, and then you can keep them nice and big. I    Jayson Davies     wish I had that just like every day, like for all my treatments, my    Tracey Davis     second monitor wasn't working the other day, and I just felt lost without it, because I'm so used to it now. It makes me so much more productive. And I actually, I did telehealth for probably a year before I invested in a second monitor, and it cost me, I think, $100 and I don't know, like, as soon as I got it, I had no idea why I just didn't do it from the beginning, because for the for the level, the improvement in my efficiency and my productivity, it was just so worth the investment. Um, so and then you just need to have a secure way to be sending documents. You know, at the bare minimum, you need to be password protecting. You know, if you've written a report and you have to send it to the school,    Jayson Davies     speaking of that, okay, so report, we kind of skipped that part of the evaluation. What does that look like when you are doing a report, you're presenting a report. I mean,    Tracey Davis     it looks pretty much the same as any other, as any other piece, though, the one thing that I also include is when I the standardized tests aren't necessarily standardized for telehealth use, and so I usually put a statement in there, just saying that, saying that, but then I say, but with clinical observation, these skills are thought to be representative of current of the level of function. Yeah, just to make sure, to cover all my bases, but it's, it's pretty much just the same report that everybody else does. And I    Jayson Davies     know with the company that we were using, the speech therapist would call in. Is that pretty typical a call, versus having to screen time or whatever you want to call it in video. Or do you do video? We    Tracey Davis     usually do video, okay, but it just depends if you know, if it's a brick and mortar school, it's just a little easier with video, because typically everyone's sitting around the table, and then for you to be there too, like being seen is nice, but if we're talking about a virtual school scenario, then probably everybody's calling in, yeah, that's true, so it just depends on the setting.    Jayson Davies     Gotcha, yeah? Because, I mean, and that's the same thing, whether or not you're on telehealth or in just an everyday brick and mortar. IEP, I mean, for instance, yesterday we actually had a face to face in the school IEP, and it was a part two to a meeting that had been over the phone. And because the meeting that had been over the phone, because it was over the phone, everyone just so much communication was lost. And that has nothing to do with telehealth. I was a high school that I work at, brick and mortar, and just the communication just wasn't there over the phone. And, you know, as OTs, you know, we know, we understand, as most people do, facial expressions matter, body language matters. All that good stuff is, you know, 90% communication is not what is spoken, as they like to say. So it's important to be present.    Tracey Davis     I mean, I. Go to a lot of meetings, because I'm a clinical director for this company, and I, I go to a lot of meetings that you know, where schools are coming on board and things like that. And I really prefer this format, I mean, you and I are looking at each other right now. And I really prefer this format as opposed to just a phone call, because I think, I think it just sets everything off on the right foot. And one thing is that, you know, sometimes we get, I don't want to say resistance, but just questions about how it's all going to work, and things like that. And so maybe I'll go into a school and I'll do a meet and greet, where my I'll leave my therapy room open, and parents can, you know, classroom 101, has my is logged into my therapy room. And when they go to pick up their kids, they can stop and say hi and ask any questions. And it, it tends to diffuse a lot of that anxiety surrounding what telehealth is. When you guys, you can actually see it in person, and you can understand, you know, I had a teacher say, once she she actually said to me, I just don't know how I'm going to get my my students to interact with a computer. And my answer was, you don't have to. I'm a person. They're interacting with me. It just happens to be over the computer, yeah. But the interaction is with me, a person, the same as if I were in the room. And you can tell she never even considered that. So you know, just actually having this format and being able to see what it looks like really tends to dispel a lot of that, those fears absolutely    Jayson Davies     and I know when we again, we had the speech therapist coming in for our it was about half of our district because we couldn't find enough speech therapist. And yeah, there was, I mean, that five to 10, maybe 15% of parents that were skeptical about it, and they didn't want their child being seen by a computer, quote, unquote, you know, yeah. And so, yeah, they were resistant. And so I can imagine, you know, you do get that 10% or so that are like, whoa, what's going on? But for the most part, I heard good things about it for speech, and it sounds like you're doing great with OT and you love it. Yeah, we do. You know, I never got to I didn't ask you this at the beginning, what drew you into telehealth? Well,    Tracey Davis     you know, I had read some research on it. I had read some interesting articles on it, but ultimately I decided to give it a try, just because my family moved around so much, and I was tired of starting over every time. But I stuck with it, just because of, number one, the flexibility. I just love the flexibility. I make my own schedule. I you know, I decide I took my daughter to the Nutcracker today, and so, you know, and then I came home and I worked. So that is really nice. I love the collaboration aspect, because, because I'm not physically present, I'm kind of relying on the adult who's with the student. And so it's more than just me saying, Oh, we worked on this today in therapy. You know, the that adult helper is is kind of an active participant in a lot of what I'm doing, which I think aids that collaboration, I think, is what's helping our outcomes measures. Because I think people are getting a greater understanding of what we're doing and why we're doing it, and I think that is leading to better carryover throughout the week. Yeah. So I love that collaboration piece, and I like the problem solving as well. We tend to, we tend to attract a lot of therapists who are maybe secure in their therapy skills. They've been doing therapy for a while, but they want kind of a little bit of a different challenge and and this is it, because it's a lot of problem solving. How can I accomplish this goal when I'm not in the room?    Jayson Davies     Yeah, that's super cool. I again, I'm already thinking about how I would probably do this at some point. And I think a lot of OTs don't even realize, but I think a lot of OTs are going to be doing this in the future at    Tracey Davis     some point, because it's only going to grow. Yeah. I mean, really, I'm    Jayson Davies     right there with you. I think so. But at the same time, I kind of want to, I want to push you a little bit on that where, where, what's the next step in telehealth? Or where do you see telehealth going? I    Tracey Davis     think, I think number one, we need to kind of rally and really push for clear guidelines, not guidelines from you know, a OTA has really done some good guidelines. The World Federation of occupational therapists has some great guidelines. But as far as just like different state regulations, there's just so much out there that has actually hindered the progress. At one point Texas required, and they've since rescinded this. But it's only recently that this happened, that they rescinded. But they, they were requiring an in person evaluation followed by an in person therapist signing off on the telehealth sessions and the whole, it just defeats the purpose of telehealth, because you can find an in person therapist. Why would you, I mean, like, then just use the in person therapist, you know? So, so I think there, there is some regulation going on in states that is kind of hindering our progress. And so I think we need to get, we need to rally, and we also need to, as therapists, not hinder each other either. Yeah, we need to, we need to be more supportive, yes, and open to it, yep.    Jayson Davies     I mean, I just think about, you know, nowadays I have a, well, I shouldn't say A, I have three Google homes in my house. I don't have, you know, like the Facebook portal one now, or anything yet. But we are all just getting so much more used to technology in our house, in our daily lives, listening to us, watching us doing I mean, I did make fun of my speech therapist yesterday because she had us she had a piece of tape over her camera on her computer, like, are you scared of people watching you? And she's like, Yeah, but, but for the most part, you know, people are becoming more familiar and more understanding of technology. I really do think of the portal as the new thing, and I could see eventually pieces of technology like that being used for telehealth, especially more of the medical model and nurses checking in on patients and stuff like that. Yeah, absolutely. I think the portal, the Facebook portal, now, is the first one that can actually follow you when you move. So the camera actually looks at you as you move across the room, which is correct. I mean, only amazing for telehealth reasons, you know, right,    Tracey Davis     right? And so the potential is, is huge, exactly.    Jayson Davies     So I want to ask you two more questions before you go, can you share a time where telehealth, just like was the perfect opportunity to be used in a school based setting?    Tracey Davis     Yes, I do have a great, fantastic story I had. I had a child with autism who transferred to a virtual school and so from a brick and mortar school. So he came to me for virtual therapy. And his dad was his learning coach, so to speak. He when he first came to me, he just his attention was all over the place, you know. So I knew that we and his IEP that came with him from the brick and mortar school, said, 245, minute sessions a week, and his attention was not great. And I thought, oh, so we just developed this plan. We had this I had this YouTube video that I used every single time to mark the start of therapy and another one to mark the end of therapy. I mean, I could sing those songs in my sleep crazy. And then I used the whiteboard feature of the virtual space to make just basically a schedule of what we were doing, and I would let him mark it off each time. And we were doing a lot of sensory breaks and things like that. And in Ohio, when they come in on transfer IEPs, and we have 30 days to kind of assess how things are, and then we have an IEP to create a new IEP so by the fifth session. So he has therapy twice a week. So that'd be by the beginning of his third week, he was going through his 45 minute sessions. No problem. His attention was appropriate. He was doing everything. He was loving it. You know, great. So when we got to the time to recommend, make our recommendations. I He didn't even need 245 minute sessions anymore, but he had two highly educated parents, and you know how parents can get kind of attached to therapy? So I thought, I don't know. So I called them to tell them, I'm not, I'm going to recommend a decrease in services. And immediately his parents said, absolutely fine. And so we actually ended up cutting it in half to 145 minute session. And so I asked, I said, out of curiosity, you know, why were you so quick to agree? And they said, Well, he loves therapy, and we love therapy too. Ot also, but because dad was his learning coach and he was participating in therapy every day, they said, for the first time ever, we know what he does an OT. We know why he does it. We know what it's working on. And so he gets ot every day. We do that. We do the activities that you know, the things that you do during therapy. We do it every single day. We follow through. So that was just a huge success story for what we could accomplish, and that, that collaboration piece, yeah. So that was one of my, one of my brighter moments. It was, it was great.     Jayson Davies     Yeah. And on the other end of that, I mean, even if the kid wasn't a homeschool kid, if you want to call that, but if the kid was in brick or mortar and you were providing this treatment in the back of the. Classroom or with potentially an aide that spends half of their time in the classroom and half of their or one day a week helping those kids with you well now that aid is seeing what you're doing and getting that all that is going right back into the classroom.    Tracey Davis     That's exactly right. And we see that at brick and mortar schools as well. We see that same thing going on? Yep, cool.    Jayson Davies     All right, this is the opposite side of that question. What? I'm sure there has been a time where you kind of felt that maybe you can't help this kid potentially, or if there's just another challenge. But what has been one instance when you had a big challenge with a case? Sure,    Tracey Davis     you know, there haven't been a whole lot of times where I've recommended in person services, but there, there have been a few, and I'm happy to recommend in person services if needed, because I, you know, ultimately I want, I don't want telehealth to succeed. I do, but only because I want the child to succeed.    Jayson Davies     Can I stop there real quick? What do you mean when you recommend? You just said I will recommend, or I will do in person therapy.     Tracey Davis     No, I will recommend a transfer from telehealth to in person if needed. You know, I'm happy to do that, if that, if that needs to happen, and it hasn't, hasn't happened a whole lot, where I felt like, you know, they really, you know, the child I'm working with doesn't really needs an in person therapist as opposed to telehealth, but it has happened a few times, and you know, I want the child to succeed. And there was one, there was one case in particular where the boy had had more profound autism, and he honestly didn't even know I was there. He was constantly being prompted to to look at the screen, to look at me, but he just really didn't have that awareness. And we tried everything. I mean, I went all the way down to I had the aide make boxes, you know, yeah, and we're just going through box number one, there's the activity, box number two, box number three, but it's still, it was just such a challenge, because he just had no awareness that there was a therapist even in the space. And so that was just a huge challenge for me, and we made it work for a while, but ultimately, ultimately, we found him, we found a therapist to come in and see him. Gotcha okay? So we had to turn it off, because if, if you, you have to be able to connect with absolutely on some level, and I just, I couldn't, I couldn't make that connection without being in the world, yeah, physically, okay, yeah, I lied.    Jayson Davies     I have one more question only, because what you said kind of makes me wonder some of those more like you said, mod, severe type of kids, maybe, or even the kids who have low, maybe an intellectual disability, and maybe they're in high school and they're functioning at that really, much Lower mentality. Does that get a little difficult with over over the web?    Tracey Davis     It can but ultimately, if, if you can make a connection with them, if you can connect, you know your person, with that person, then you can probably do therapy. Okay? I see that as a bigger challenge. But there are definitely, there are definitely challenges with that. Like, some of the life skills are hard. Not not life skills, but like, like, ADL type, yeah, things you know, if they're in a life skills program or something, it's hard to work on, on, you know, bathroom stuff or something like that, or or kitchen stuff. But we, we sometimes do what we need to do. We create simulations as best we can, especially if it's a case of them not getting services.    Jayson Davies     Definitely, you know, and I it's hard, I think, for any occupational therapist sometimes, to be in those life skills classes. I'm in a high school life skills class, and it takes a lot of energy. It takes a ton of collaboration, communication, all that good stuff I do.    Tracey Davis     Then you're already well suited for telling, oh, man, you're collaborating, you're communicating,    Jayson Davies     but, but here's one thing that I do with them, and maybe I mean I could again, being, as you said, in order to be a telehealth you have to be a problem solver. One of the things I love doing with that classroom is every now and then I attend the community outing. But again, now. I can see it already, you know, kind of working through it. Those teachers have iPhones. Those teachers have stuff that they take with them. And I heck, most of the kids have iPhones or tablets or whatever, you know, and it could happen with the right collaboration potentially, so they could so, yeah, that's super cool, alrighty. Well, that was like the quickest hour I've ever had in my life. Thank you so much for all that information. I love it. Oh, good. Is there anything you felt like we forgot to say?     Tracey Davis     I don't think so. I think we covered I think we covered pretty much everything that I wanted to make sure that we covered. So well done.    Jayson Davies     Awesome. Well done us. Thank you so much for coming on. I appreciate it. It's awesome that we're able to do this on the podcast. Yeah, where can people reach out to you if they have questions? Or is that okay?     Tracey Davis     Yeah, no problem at all. I can be reached. And you might want to, you might want to, you know, put this in print too, but I can definitely be reached at t, as in Tracy Davies T Davies at talk path, live.com .    Jayson Davies     Awesome. And yes, that will be on the episode show notes, which will probably, I might have to edit this, but ot  schoolhouse.com , forward slash, episode 22 and so that will be the show notes where you will be able to not only listen to this episode, well, you've already got that far. You're already listening right now, so you've already got that part, but also any of the resources that Tracy has sent me that we can put up onto that site, so that maybe some links to, like the A OTA document she was referencing earlier. We'll have a link to that on there, as well as a link.   Tracey Davis     And also the international I'm sorry, I don't know.   Jayson Davies     You're fine. Go ahead.   Tracey Davis     but I was just gonna say that the the International Journal of tele rehabilitation is actually a free publication. So so that's a really great resource. Has a lot of research in it. So great.    Jayson Davies     Well, yes, thank you, Tracey. I appreciate you so much for coming on here. All your information was fantastic, and you made me like, I know you can't see me all you out there, but like, I'm putting my fingers together, like you made me that much closer to doing telehealth in the near future. So um, right. So anyone out there, if you have any questions about telehealth, be sure to reach out to Tracy, she's also active in, like she said, some of those Facebook groups. So there is telehealth Facebook groups out there. Be sure to join those. And if you have any other questions and you're not sure, feel free to reach out to me or her, and we will point you in the right direction. So thank you so much for listening. Thank you, Tracy, and we'll see you all next time. All right. Well, that wraps up. Today's episode number 22 all about telehealth. Be sure to head over to OT schoolhouse.com . Forward slash episode 22 for all the different links that we talked about in the show on our website, you'll also have the opportunity to earn professional development for listening to this podcast. All you have to do is purchase episode 22 professional development opportunity, and you'll take a short quiz, and once you pass that quiz, we will send you a certificate of completion that you can use for NBC OT and some state professional development requirements. And with that, I just want to say thank you for listening, and we'll see you next time on the OT school house podcast. Take care.     Amazing Narrator     Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otsoolhouse.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 21 of the OT Schoolhouse Podcast. In episode 21 of the OT Schoolhouse Podcast, guest Meg Proctor of LearnPlayThrive.com joins Jayson to share five essential strategies for occupational therapists who work with students who have Autism. Meg is an experienced pediatric occupational therapist who specializes in the provision of services with children diagnosed with Autism Spectrum Disorder. She currently sees clients privately and provides both live and self-paced online trainings through Learn Play Thrive, LLC. To learn more about Meg and Learn Play Thrive, visit LearnPlayThrive.com and click on "For Therapist" at the top to grab a free ebook on how to help kids with Autism who do not have many occupations. If you enjoyed this podcast and would like to dive in further with Meg on her full 6 Module course, Click here and use promo code schoolhouse25 for a special discount for OT School House Podcast Listeners only! Be sure to also visit Meg's Facebook group, "OT & Autism" for occasional live videos and extra content for Meg. Also mentioned in this podcast is a survey we are currently conducting. We would appreciate your help in directing our next step in helping you succeed. As a thank you, you will receive a discount code for a Podcast Professional Development Opportunity. Click here to take the survey now!​ Check out the episode below if viewing on a computer. Or use the links below to listen to Apple Podcast or Spotify on your phone. Do you use another podcast player? Just search for the OT Schoolhouse Podcast on your player! Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.     Jayson Davies     Hello and Happy New Year. Welcome to 2019 and episode 21 of the OT school house podcast. Hope you all are enjoying your winter break and well, by now, I'm back, and I bet some of you are back. Some of you may be going back next Monday, but all in all, welcome back to the podcast. Welcome to 2019 and welcome back to work in your school or pediatric setting, or wherever else you may be. I know we have actually some some educators that listen to this. So welcome back. So last year, before we had the podcast, we kicked off the year with a blog post that kind of outlined what Abby and I wanted to do here at the OT school house, and part of that was actually beginning the podcast, and, well, now we have the podcast. So instead of doing a blog post this time, we're going to just kind of do it on the podcast, concerning most of you listening now on the podcast, versus, uh, seeing the blog post that we have. So we're going to kind of focus on the podcast more this year. I know right now we're doing an episode once every two weeks, and I think our goal is to get it to be weekly for you all, and so we can bring on more guests. Have on more discussions between Abby and I about what's going on in our school based life and and what may be going on in your school based life. And so we want to talk about IEPs, talk about services, talk about even deeper into goals, maybe have some of our favorite guests back to talk about vision and talk about autism and and that's actually where we're headed today, is is autism. But first I want to talk about two more things that are on our radar for the for the rest of 2019 and one is that we want to become a OTA approved as a provider of continuing education through this podcast. Right now, you can earn continuing education through the podcast, and it is completely viable for you to use for your NBC ot renewal. However, we're not a OTA approved yet. Not that it's a huge deal, but we would like to be officially recognized by a OTA as a professional development provider. And with that, I also want to acknowledge the glass half full podcast. They actually recently just got acknowledgement from a OTA as a CEU provider for several of their episodes. So they're doing similar concept that we are, where you listen to the professional development podcast and then you can take that short quiz afterwards. And so it's really cool to know that a OTA is backing them up and saying, Hey, yes, this is a viable way to earn professional development. And so that's kind of really lifting for Abby and I, because it's like, whoa. You know, we had this idea, and we didn't know someone else was working on it with a ot eight. So now we know that, and you guys can be be also confident. You know what, that this is something that will be able to be used as professional development for your state. And hopefully, well, it's already available for NBC, OT, but hopefully even more so for your state licensure, it's going forward. So we're excited about that, I guess we could say so hopefully that will come in 2019 and then the last thing that we are hoping to get out sooner than later is a larger course for you all. Actually, this will be a course that you would take online through our website, the otschoolhouse.com and I don't want to release quite yet what it will be about, but some of you have taken a survey for us, and we thank you so much. If you're still wanting to take that survey, I'll put the link in the show notes at ot  schoolhouse.com , forward slash episode 21 we'll appreciate that if you do. But we're kind of headed in that direction. We're working on it. We got an outline, and we're putting it together for you all. So hopefully that'll come sooner than later. But with that, you know what? Let's jump into our very special guest today, as I hinted earlier, it is about autism and our guests. Her name is Meg Proctor, and she is an occupational therapist. She's actually currently on the East Coast, and we'll get into that a little bit, but super happy to have her on. She is a autism specialist in her own right, and she taught me a lot of valuable information through not only the podcast that you're about to hear, but also she allowed me to jump in on her course that she has, and that course is actually open right now and again, we'll talk about that a little bit more if you want to dive in deeper with Meg. But she's fantastic. Her course is amazing. She gives a lot of information about autism, and today we're going to talk about the five essential strategies that any ot should know when working with a student with autism. All right, I know this has been a really long intro, but I wanted to share all those really cool things we got going on with you. So without further hesitation, let's jump into our interview with Meg. Doctor of learn playthrive.com . Hey, Meg, welcome to the OT school health podcast. How are you doing today?    Meg Proctor     I'm great. Thanks. Jayson, I'm happy to be here.     Jayson Davies     Thank you so much. We appreciate you being here and looking forward to talking a little bit about kids with autism and some ways to help them out. So before we get into that, though, would you like to give a quick background information about who you are and what you're up to these days.    Meg Proctor     Yeah, absolutely. So I've had a little bit of a winding journey in my ot career to get to where I am now. So when I started as an OT right out of OT school, I jumped right into early intervention, and I was really excited, and then quickly I was like, What on earth am I doing? I wanted to do all these best practices like parent coaching and come to families, homes without a bag of toys, things that I had never seen anybody do and didn't know how to do. And I felt all this pressure like, Oh, these families really need me, and I don't know what I'm doing. And I was working mostly with young kids with autism, so I made a little bit of a shift into school based practice where I felt a lot more supported, and I had a team, and I could really get my feet under me as a new therapist, but I still felt in my very autism heavy caseload, that I was missing some really sort of important intervention knowledge about how to best support my kids with autism. So eventually I moved back to Asheville, where home is from Chapel Hill, where grad school had been, and I got this amazing job at UNC Chapel Hill's teach autism program as a clinical faculty member there, and I got trained and trained and trained and mentored and trained some more in autism. And that whole time, I was thinking, oh my gosh, I just wish I'd known all of this all those years, working in early intervention and working in the schools. And I got trained to be a trainer for their program, and I was training teachers and speech therapists and psychologists from all over the world. I was like, Where are the OTs? We need this so badly. So I eventually launched into my own private practice. I don't work for teach anymore, and I have a business called learn, play, thrive, where I work with families of kids with autism, and one of my favorite parts of what I do is I train therapists in how to work more effectively with their clients with autism.    Jayson Davies     Great. That sounds really cool and really fulfilling at the very beginning, you kind of mentioned about going into into the kids house without a bag of toys. Is that like a common thing, or is that something that you're kind of just doing? Or I've never heard of an OT walking around without a bag of toys behind them?     Meg Proctor     Yeah, in early intervention, that's considered best practice now, to use the materials that are actually available in the natural environment so that families can learn the strategies and keep using them after you leave. But what OTs have done for forever is come in with the Mary Poppins bag, do lots of fun stuff, and then leave, and it's kind of like, yeah, who cares? That was one hour of the week. And it doesn't matter when we're making it impossible for families to have carryover, because we're bringing these special things.     Jayson Davies     That's very true. We kind of come in with our special toys, and then we're like, all right, your kid made progress. Now, time to take the special toys away. That's true. So I like your idea of using the toys that that they already have. And I think that goes for school based therapists. You know? I think there's a little bit more of a push to be collaborative with the teacher, and kind of use tools that the teacher has and or provide tools to the teacher, rather than, you know, kind of similar to what you're saying, you know, pulling the kid out, working with them on a special pencil or something, and then sending them back to their regular pencil in the classroom or something like that. That's kind of the equivalent to that. So I like that, that collaborative method, working with the parents, the kids, everyone involved, and so that they can continue to work on it even when you're gone. So, right? Absolutely, I like it. So, learn, learn play thrive is learn, play thrive.com . Right, yeah, that's it all, right. Well, Meg has a course over there that she kind of just referenced to. She is trying to train other occupational therapists out there and working with kids with autism. And she was very generous, and she actually allowed me to take the course. And it was fantastic. It's about six videos about does it total? Was it a total of six hours? It was all right. And it was very detailed. It was a lot of information. We'll get into it a little bit more, but first, Meg is actually here to give you some free information, and it's fantastic information. I can't wait for her to give this to you, and it's going to be all about how to, well, help, help children with autism. That's what she's doing with her. With her larger course, but today she's kind of here to do a little bit of a mini course. So Meg, I'm kind of kind of let you jump right into this. You know, what are some of the essential ways that we can the essential strategies, I guess I should say that we can help kids with autism.    Meg Proctor     Yeah. So one of the things that most of us sort of know about how kids with autism think and learn is we say they're visual learners, and what that looks like is we say, oh, I should probably put some visuals on the things I'm making, since this child is a visual learner, and a couple of things on that. One, yes, visual learning is a relative strength for kids with autism. There's some research, there's a lot of strong research that receptive language is a relative weakness, so our kids aren't able to make sense of what they hear as well as they're typically developing peers, and that's even true for kids with autism who can use a lot of language. There's some newer research that shows that visual learning isn't always a strength compared to their typically developing peers. It's just a relative strength, since receptive language is so difficult for kids with autism, and that's not true for everybody. You may have heard Temple Grandin say, I think in pictures, I think some of our folks with autism are profoundly visual learners, and have an incredible strength in that area, but for some it's really just a relative strength to their receptive language. So one of the things that I used to do when I worked in a lot of self contained, very young children classrooms in the schools of kids with autism and I had, like, the off brand program of board maker, I can't remember what it was called, and I, yeah, I put those, like, symbolic pictures on everything, and I felt like I was doing a good job, right? Because I was using visuals, and my young kids, you know, ripped them up or ignored them completely. And it really didn't help. And I just kept doing it because I didn't know what else to do. And one of the things that I learned that sort of made me rewind through everything I've done, was that it's really important to figure out what specific type of visual is meaningful for an individual child with autism. Just because visual learning is a relative strength really doesn't mean that those symbolic board maker pictures or clip art ever is going to mean anything at all to them. So I think it's really important to evaluate what type of visuals are going to be meaningful, and that might be objects. That's the thing that a lot of us miss.     Jayson Davies     I think you're I think you're right. And that was one of my, like, first aha moments in taking your courses, like you're right. An actual object of a ball is, like, the first visual cue that you're going to give to a child. You're not going to go to this to a photo. The first thing you're going to see, the first thing that child is going to be able to match is a red ball to a red ball, not a picture of a soccer ball. That means a red ball or something like that. So having that actual object right there with you is really, you know, that's the first go to.     Meg Proctor     Yeah, absolutely. And, and the reason is that doesn't require symbolic thinking. We're not teaching them that the ball represents something. The ball is just the ball. So I learned lots of ways to use object level instructions in my learning activities, to use objects for a schedule rather than pictures or words, to use objects for a to do list. But you know, stuff really isn't intuitive. I had to learn it, and I like teaching it to others. And then some kids can understand pictures, but more like photographs, rather than the clip, Arty kind of pictures. And then there are kids, there are kids that understand board maker, great. And you can usually tell that they can make sense of it because they use it. A child who understands symbolic pictures would be able to match the object to the symbolic picture, and in whatever context, would be able to show you that they're making meaning from the visual you're providing. I learned a lot from having a child you know my my kid at like 15 months, could look at a cartoon of a balloon and point to the balloon in the room, but that doesn't mean I could give him a schedule of cartoon pictures and he would know what it meant. You know.    Jayson Davies     Yeah, and that kind of comes to a little bit of mastery, because oftentimes in the school district, we're writing goals, and we'll write a goal for a kid to have 80% mastery and something I don't know, but we kind of this 80% ever since I started growing or since I started in schools, has kind of been like this magic number that if a kid can do something with 80% consistency that's considered mastered, how do you decide kind of where the child's master. Is and being able to identify object to object or object to symbolic image?    Meg Proctor     Yeah, that's a great question, and I think it's a really important one, because, you know, we often want to use an emerging skill for something. Let's say, like a schedule. We're like, well, they could sort of read, let's just write a written schedule. But if you imagine if I were to use an emerging skill for you, let's say you're learning Spanish, and I'm like, that's cool. I'm gonna write you're in case of emergency instructions in Spanish, and then you're on the side of the road in a rainstorm, in the middle of the you know, something very stressful is happening, and you're looking at these that you could maybe sort of understand on your best day, but now that you're stressed, it's gone right? I did not choose a mastered skill to give you your instructions. So it's so important that we don't try to pick an emerging skill just because it's easier for us, or because we have some sense that the goal is to move up and up and up. The goal is not to move up to move a kid from objects to pictures. The goal is to use whatever makes sense to that kid. So honestly, I decide what type of visuals to use through a process of assessment. Can they match objects to pictures? Can they match pictures to symbolic pictures? But then through a lot of trial and error of seeing what works for a specific activity or for a specific type of intervention, and then going back to the drawing board and changing it if it doesn't.    Jayson Davies     Yeah. And you know, as far as Spanish goes, Donde esta el banyo is, like, the only thing I got down, but I can read a visual schedule in Spanish, yeah.    Meg Proctor     I think one place this comes up a lot is with our emerging readers. And it can be tempting for teachers to use the schedule or the instructions as an opportunity to teach more reading. And I always say that giving instructions of any kind is not an opportunity to teach a new skill.     Jayson Davies     And what happens if you do it the other way around. If you're using, maybe you're using a picture of something of a physical object, and the kid can do something more, like actually reading. Does it do you ever see kind of the kid back away because you're like, you're giving me this simplistic, this too easy of a picture to see, or is it better to go safer than sorry, I guess? Or.    Meg Proctor     Yeah, that's a good question. I think that going more concrete is usually safer than going more symbolic. But I do have kids who eventually are like, I'm done with this, and then I go back to the drawing board and try something different. I'm, you know, I consider myself an autism specialist, and that doesn't mean that I make a plan and it works, you know? It means I go back to the drawing board based on the information that that child gives me from what happened. So it's a constant process of trying something, learning from the kids response, and going back to the drawing board and trying something different.    Jayson Davies     I love your definition of specialist. That's great, because it does not mean that we know everything that is for sure. All right, well, you kind of already started leading into this, I think. But the next step that I think you wanted to go over with, with what we're going over today, is teaching to the visuals. And so what does that look like?    Meg Proctor     Yeah. So one thing that that I learned, that I used to do, and that so many of us do, is we create these awesome visuals and then we teach our students not to use them. So I'll give you an example. Let's say you're in the schools, and you I'll use a schedule again. You make a schedule, and you're like, this is totally gonna help. And you put it on the kid's desk, and then you go off, and you're like, Okay, Jayson, I go up. I'll be the teacher. Okay, Jayson, time For Math. Look at your schedule. It's math time. You need to get up and go to math, right? What I'm teaching that child is that I I am going to come and tell you what to do. I am not teaching them that they need to look for the instructions. They need to look for their schedule. They need to follow the instructions from their schedule. And this has so much to do with how we prompt. We like to be very interesting and part of the activity and to get the kids attention. But our kids with autism, part of the autism learning style is that they learn routines quickly, and if we're making ourselves part of that activity, well that's part of the routine. I sit here until Miss med comes in with her big, bubbly voice and tells me where to go next and points at the schedule, and then I go. So we have to be really careful with our prompting, to make sure we're teaching kids to use the visuals, not teaching them to use us.     Jayson Davies     That's funny that you say that actually, because right as you were saying that I this kid popped into my head, and he's this type of student who he knows. He's very aware. Here he has autism, but he's very aware, and he when he does something bad, he will then prompt his teacher to say, Don't do that. Like he wants that that routine from the teacher to tell him that you're not supposed to do that. And he will literally prompt his teacher. He'll say, teacher, tell me, don't do that. And then the teacher will have to say, yes, yes, student, don't do that. It's like he knows that he's not supposed to do it, but he has developed that routine. And like you said, she she's a very animated character, and so he gets a kick out of her responding and telling him not to do something. And so if, maybe if she kind of toned it back a little bit, became a little bit less animated and relied on the visuals that she does have for that student, it could go a different route.    Meg Proctor     Absolutely, I remember a student that I had my second year in the schools who was a middle schooler with autism, and he had had a lot of behavioral therapy with a lot of reinforcers, and he was very bright, but if he answered a problem like on a Math Worksheet and you didn't say, good job, he would erase it and look for a new answer. And that's kind of what I always pictured as prompt dependence, because that's the extreme, but, but we all do this in our own way, even if we're not, you know, handing out candy for right answers. We're doing it with our faces and with the way we're prompting. We're teaching kids to look to us. Still.    Jayson Davies     Definitely All right. So we went into kind of some gestures versus verbal prompts. One of the notes I took during the course was air free learning. What do you mean by air free learning when it comes to visuals?     Meg Proctor     Yeah, so when I say that we want to prompt differently, I don't mean we want to just kind of throw our kids out to the wolves, right? Like, you know, you just said gestures versus verbal prompts. I'm going to use a lot more pointing and helping them look to the visuals, and a lot less trying to get their attention to me. And let me be clear, I'm talking about when the goal is for them to access their visual instructions independently. I do a ton of work on social engagement, and those are the times I want them looking at me. I want that engagement. When I'm teaching a child to follow instructions, it's not about them engaging with me. It's about them engaging with the instructions. But I don't want to just like point and hope it works right. So there's a lot of good research showing that our kids learn, our kids with autism, learn best by getting something right the first time, rather than by making a mistake and having us go that's wrong, and that probably relates to the routines and to the receptive language piece. So I will jump in before a child makes a mistake and give them as much support as they need to get an answer correct or to do a process correctly the first time. And then I'll be really intentional about fading out how much I'm supporting them and how much I'm prompting so that that isn't the routine. The routine is they're learning how to do the activity and how to do it correctly.     Jayson Davies     Gotcha. Yeah. And so do you have a hierarchy of prompts a little bit? I don't know if you so obviously verbal. I well, I don't know what's the highest level of prompts that you would use or that you consider the most restrictive or the most needy prompt for a student?    Meg Proctor     Yeah, I think doing part of the activity for or with them, so physical assistance I don't do hand over hand. It's not it's not philosophically comfortable for me to move somebody's body, but I will hold a material with a child. I work with a lot of young kids, so if we're doing like a shape sorter, I might hold the block with them and help them get the block in. So I think that that type of physical assistance with permission from the child is the highest level.     Jayson Davies     Yeah, I agree with that. I I can't stand hand over hand, either. And especially working in the schools, there's so many things that can go wrong. And you know, I think all OTs have to deal with this, but even more so male OTs, it's just being in the schools. We have to be very careful of you know, what prompting is going on. And so, yeah, I just kind of stay away from the hand over hand prompting as much as possible. Of course, there are times that it is needed, but it's kind of that very much only as needed. You know, we want, like you said, we want to set up our kids to be successful and and be engaged, and how engaged are they really when we're doing hand over hand prompting? So absolutely, yeah, all right, well, I think the next step that you have listed here was the informal assessments. And so we all of course, do you know in the schools, we often use the bot to. The M fun, the rabma, things like that. But a lot more OTs, I think, are using informal assessments, because we can, we need to be able to see the actual routine that the kid is doing. Is that similar for you? You're trying to see the actual routines that the kid might need to do in the home.    Meg Proctor     Yeah. Yeah. So I think that our kids are our best teachers. So we can know all kinds of things about autism learning styles and about whatever the occupation is, but if we're not actually watching that particular child do that particular activity, we're really missing an opportunity to learn from them about what they need from us to be successful. So you know, if I think about again, one of the things I used to do in the schools as I'd get some sort of goal for a kid to like color in the lines, and in my first session, I would start teaching. And what I should have done is start with an informal assessment. Same thing in the home. I don't know if, if you guys have these uncomfortable conversations with teachers that I've had with parents, where you're like, making suggestion after suggestion after suggestion, and they're going, yeah, we've tried that. It didn't work. Yeah, we've tried that. It's embarrassing, it's a waste of time. And you know what we're really missing? Well, there's several things missing in that example, but one of them is that process of informal assessment. Show me what's happening now. Show me what you've tried. What would you like this to look like? That's if you're working with a caregiver or consulting with a teacher, but really just sitting down and putting the materials out and seeing what the child does without you teaching here, I'll use my least to most prompting. So if I put those crayons and the paper down and they don't do anything, I'm not going to end my informal assessment, because I've learned something, but I haven't learned enough. Yes, I might then give a prompt color the picture, and if they still don't do anything, I might hand them a crayon. And if they still don't do anything, I might start coloring and then hand them a crayon. But now I'm really learning, okay, what does it actually take for this kid to get started and understand the instructions, and then what do they do? But if I just started by giving a demonstration and handing the crayon, I have no idea what their baseline is.     Jayson Davies     That's true. That's very true. I like that, yeah. Because, again, going back to the different types of prompts, you know, we sometimes will jump jump ahead, just for the sake of time, or for the sake of just getting an assessment done to get it done versus getting it done to really understand what the child can and can't do. And so like you said, we will skip ahead and we'll just give the kid the crown, or we will just or even go further. And like you said, We'll color for them and then have them color, versus just seeing what will they do with the crown, or what will they do. And so we need to take that step back.    Meg Proctor     Yeah, and this isn't just something that we should do during the actual evaluation. It's something we have to come back to time and time again to see where we're at. For me when I work with field work students, or even in my own practice, when I feel stuck, when I'm like, I have this goal and I don't have any idea where to start, it almost always means I haven't actually done an informal assessment, because we can't come up with interventions in the abstract or not really. I mean, if you're working on the same thing over and over, you might sort of be able to, but when we feel stuck and then watch something, it's like, oh, that's where you're stuck. It's not just I'm supposed to teach you to brush your teeth or cut on the line. It's I'm supposed to teach you to sequence the stop Sure. I'm supposed to teach you how to turn the paper right. The other opportunity we miss when we don't do informal assessment is sometimes we miss the opportunity to see that we're being successful. I do some one on one consultation with therapists, and I had a therapist who was working really hard on teaching play, and she finally sat down and did this very structured play session, and it went awesome. And she was like, did I maybe he could already play? Maybe, maybe that was unnecessary and, and I don't think that was the case. I think that she hadn't started with an informal assessment, so she couldn't see that her intervention was what created the success.    Jayson Davies     Yes, no. And, you know, I just started a new school district this year, and so, you know, my caseload of 55 kids, or whatever I was brand new to, and I didn't do their initial evaluation, or their recent triennial evaluation or whatever. And so that's kind of the first thing I really had to do is, you know, meet the kids and then kind of do that little informal evaluation, because I'm walking into these, into these IEPs. Or looking at their documents, and, you know, they have two or three goals that I'm supposed to be working on. And of course, I've never met the kid. And so, yeah, that's kind of where I started, too, is with a little bit of an informal play, slash, I mean, yes, it was play for the kid, but for me, it was an informal evaluation to see where they're at and kind of what that next step is. So one of the things I think OTs sometimes get flack for is not taking data. And I think through that informal, occasional informal assessment, you can kind of get a little bit of data that helps you, helps you, not only reason, but also helps you, show the parents or show the teachers or show the parent advocate or whatever, what progress has been made come time for progress reports and the annual IEP? So, yeah, I think we all need to be doing more informal assessments throughout the course of the treatment, because we do need to kind of see that progress, like you said. So All right, so what's next?    Meg Proctor     Well, I sort of mentioned this when you were asking me about how to figure out what type of visual to use for a kid. And this is the idea of when something's not working, going back to the drawing board and restructuring our intervention. And I think this is important enough that it's worth, you know, tackling as its own strategy, because what we often do as therapists is we develop an intervention and then we teach it, and if it doesn't work, we teach it and we teach it, and we teach it and we teach it more. And that is especially true if we spend a lot of time making it and we laminate it. I'm going to use this intervention, and this really ties in with the informal assessment. If I were teaching a child to, I know an activity I've seen a lot in the schools is the one where you teach a kid to, like, organize the letters of their name into order. I would make that really quick and dirty and do an informal assessment with how they do with it, because I might learn, oh, this child wants to Velcro on top rather than underneath. Or this doesn't make sense at all to this child, but I know he likes activities where he can put something in. So maybe if I make it into a put in activity where it says j, A, y, s, O, N, and there's a little slit, and he's going to stick the letter in the box, I can do or, you know, I could learn any myriad of things from trying this activity, seeing what the child tells me. They throw it on the ground. It doesn't make any sense to them. They do it incorrectly and then restructuring it to make it more appropriate for that child's learning style, rather than insisting that they learn the way I have created the activity which is frustrating for everybody.    Jayson Davies     Yeah, I like how you I mean, we're constantly restructuring. That's kind of why we have this job as an occupational therapist and as an OT the different ways that we can restructure include not only what we've been talking a lot about today, the visual instructions, but also changing the environment. And so how are some ways that you've changed the environment?    Meg Proctor     Oh, absolutely, yeah. You know, if you find that you're in a session with a kid and your whole job is just trying to get them back to the table. I know I have lots of those. I try to see from the perspective of the child, that that the environment speaks to them. So are they staring at the wall of toys where they're sitting? Are they sort of in an open space in the middle of a room? I've worked with a lot of more concrete younger kids who when they're kind of in a little nook, not trapped at all, but like there's some furniture on either side of them, and they're sort of nestled at their little table space. That space says to them, Hey, stay here. Like there's nothing else calling to them. And one time, just as an experiment, I took a kid where that was going great, and I put the table in the middle of the room, and she literally ran in circles around the table the whole session, because that's what the space was saying to her. So, you know, this is again, somewhere that we want to think about. What makes sense to a child, the like blue tape on the ground to say, like, here's where you're supposed to be, maybe. But that's super symbolic. You know, the mat to stand on, maybe for some of my kids, actually just rearrange the furniture so that the space is like, hey, rest of the room is boring. This is where you're supposed to be.     Jayson Davies     There you go, Cool, all right. And then I think this was my favorite part that you wanted to talk about now was actually expanding the occupation. And I work in a high school, and so we've been doing community outings and stuff, which this is kind of my focus point right now, is expanding their occupations that they're learning in the classroom out to different environments. So what does expanding the occupation mean to you?     Meg Proctor     That is so awesome that you get the chance to. Do that that's so important. Well, you know, we always give this like token reference to our you know, kids with autism have trouble generalizing, so we have to help them generalize. But what I find is that more often than not, we kind of forget or don't get around to actually doing it. And that can mean a lot of things. One, it can just mean teaching a skill with different materials. So okay, you can sort by color with the little bears. Can you sort by color with chips? Or, let's see, I know so many of my examples are for young kids. You can solve these math problems in in this room, you do it in this other space with this other teacher. You know, because our kids are are forming routines around what they do and where they do it. So we want to make sure that they can use their skill with different materials, in different places and with different people, and I don't I don't usually start there. I don't usually start if you're teaching a child or cycling. I don't usually start by going out to the community where it happens. Because what I know about the executive function piece of autism learning styles is it's hard to figure out what to pay attention to when there's a lot going on. So I'll teach with learning activities at the table, where I know I can help the child see the main point versus the details, learn the activity, and then I know I need to explicitly work on generalizing and helping them get out to where they're going and use that activity there, and then make sure they can do it with their teacher, not just with me make sure that they can do cans versus cardboard, not just cans versus bottles. So making sure whatever skill I'm teaching they're able to do it in different places, with different people and with different materials.     Jayson Davies     Yeah, definitely. I think that's one of the biggest things that when I get pushed back in an IEP, especially a more high profile IEP, where there's an advocate, or something like that. That's often the first question that, one of the first educated questions that I will get is, you know, okay, you said this child met their goal in? What environment did they meet their goal? And so well, if I say they met their goal in a one on one setting, in the therapy room, and, you know, this kid's occupation is to be functioning in the classroom. Then, did they really meet this goal? Well, not really, because they're only with me, you know, 30 minutes once a week versus we need to make sure that they're meeting all these goals in the classroom, where they're supposed to be accessing their education, or on the playground, if that's where the social difficulties are, or wherever the actual occupation is taking place. And so, yeah, I completely agree that we need to be expanding that outward. We need to be helping these kids in their natural environment, not just in that therapy setting. So yeah, so any other tips and tricks that you want to give a quick shout out to? I don't know there something on your mind?    Meg Proctor     No, I have so many I could, I could ramble on and on, but those are the I have, those five, sort of laid out in the little free eBook on my website and in a bunch of Facebook Live videos as well in my Facebook group, OT and autism. So I'll, I'll stick with that for today.    Jayson Davies     Sounds good, and we'll be sure to put all all the links to those various sites on on our show notes. So that was at learn, play, thrive.com . You also mentioned your Facebook group, which I know I'm a part of, and so we can put a link to that. And was there one other thing? Oh, well, you mentioned the Facebook videos that you have that are on your Facebook, yeah. So, yeah, no problem. We will definitely put some links up to those. So again, thank you for learning, for allowing me to learn all of those tips, plus many more in your course. That was super, super helpful. All the activities that you have kind of fit right into the course. I love some of the little the little animated videos that you had for your case studies. Those are all fantastic. I enjoyed those. So one thing that I wanted to ask you is I learned so much in that course. What do you feel that these strategies can be geared toward kids who don't necessarily have autism? Or do you feel like these are pretty autism specific?    Meg Proctor     That's a great question. So I think that when we are working with a child, we need to think about that child's learning style and the strategies that I lay out in the course have to do with how kids with autism think and learn. So if you are working with a child with a different strength and a different set of differences and. You might want to use, you might want to tweak what you're doing. That being said, there's a lot of similarities between learning styles with ADHD and learning styles with autism, especially the executive function piece, and also often some of the rigidity. And I know in the schools, you see a lot of kids with autism and with ADHD, and these strategies are very effective for students with ADHD, as well as students with autism. I think some of the principles are important no matter who your student is, but I think it could be sort of a sticky trap to think that you know visuals are going to enhance every child's learning when you might have a child who's really a poor visual learner who doesn't have autism, so just really individualizing and thinking about, okay, what is this child's strength and what is their learning style, and how can I tailor what I'm doing to them?     Jayson Davies     Yeah, I want to ask you one question is kind of a specific question, but, and if it doesn't work, it doesn't work. But, so I made a visual schedule for this kid's morning routine. And so you know, it's Get out your backpack, put your lunch wherever it belongs, turn in your or get out your homework, turn your homework, and then he actually goes to the RSP classroom at the end of his the end of the schedule. And so we made it so that he can completely just cross everything out. And this is a little older, I want to say, like third grade kid. And so he can read. He can do stuff like that. So it's a little symbolic picture with with some language or with some words on it. My problem, though, is that he won't often initiate it until, like, if he sees me, like, sometimes it got to the point where I would kind of just stop into his classroom real quick, just so he could see me, because that gave him that prompt to start that cue. So just based on that limited information we do, you have a recommendation that I could potentially try?    Meg Proctor     Yeah, yeah, that's interesting. Initiating is hard, so one thing that you could try is to have a pencil that he always uses, maybe that has like a little flag on it that says check schedule, or has a little picture that represents the schedule, and have that maybe velcro to his Cubby, where he puts his backpack, whatever routine he has. So you'd want to teach him the routine of like hanging his backpack and then grabbing the pencil, and then it's the pencil that's going to tell him you're supposed to go to your schedule. And that's not going to be meaningful to him right away. You have to teach it. But again, you're going to be teaching in a way that you're boring, you're pointing, you're silent, if you can be and you're fading yourself out so that he's learning to come in he's backpack, look for the pencil. For that pencil to tell him to go to his schedule and to get started from there. Sometimes having something physical to carry and do can be more compelling than just like a routine.     Jayson Davies     I do like that idea because that's already part of his natural routine. Is to put his is to put his backpack down, and so if that that object, or whatever it was, was right there, he would see it as he's doing it, and it would just be a continuation of already a current routine that would just kind of lead into the next thing. So I like that idea. Good job. I put you on the spot, and you succeeded. Good job.    Meg Proctor     Well, you know, do your informal assessment, you might have to restructure that very true,    Jayson Davies     but it gives me a place to place to kind of start with. So yeah, I appreciate it. All right. Well, Meg, I definitely want to say thank you for coming on the podcast. It was, it was great having you talk about so many different areas that can help our kids in the schools, or for any ot that might be working in, like you, early intervention or in the in the other areas pediatrics. But before I let you go, I want to ask you, you know, I took your course, I learned a lot from it, but I want to hear from you, what do you feel like, what are people going to get out of your course? What do you hope that every therapist that will take your course will will learn?    Meg Proctor     Yeah, so there's a whole lot of content. It's things that I probably learned five or six times before I stopped getting something new every time I learned it. So I think no matter what your level is, you're going to get something different. But I really want therapists to have a framework that lets them consider autism learning styles really in depth. Consider autism learning styles, not their visual learners, but have a really deep understanding and appreciation of the complexity of how a person with autism thinks and learns, and actually use that to help us shape our interventions. You took the training. It's not there's not much theory, it's a lot of practical applications. So I want people to have these frameworks that they can use and then individualize for their particular learner.     Jayson Davies     And today we talked a lot about a lot about visuals, but what else is in the course that you enjoy talking about?    Meg Proctor     Yeah. So I go deep on autism learning styles. I teach a behavior problem solving process, and I have sort of a work book that folks can go through on their own or together with teachers. And that's the process I use in my own practice. It gets me better, more relevant hypotheses and interventions every time to make a behavior plan that's not like, oh, the child obviously wants attention. Like, that's not usually a super relevant hypothesis. Teach them how to think about what is causing a behavior. From the perspective of autism, we do schedules, we do visual to do lists, which is, you know, everything can't go on your schedule, and when we try to put everything on a schedule, it gets kind of complicated. I think the longest module is actually about play and leisure, which is so, so important to all of our kids. Talk about self care, and then at the end, we tie it all together with how we can take these skills and help our kids be successful moving out into the community. So each of those modules has a whole lot of content, a lot of specific examples, a case study, and then an opportunity for the therapist to apply the knowledge to their own practice and come up with a plan they can use right away.     Jayson Davies     Absolutely. And the last case study really made me think you kind of, in a way, forced us to give you multiple hypothesis as to why this behavior was occurring. And like you kind of said, you know, the first thing that came to me, the first hypothesis, was attention seeking. But you know, you kind of, and typically, I would stop there. I mean, I might see a kid doing in my informal observation, I might see a kid do something. I might think, okay, that's attention seeking. But because we had it on paper and the way that you structured that that worksheet, it made us come up with another and another hypothesis. And I think my third hypothesis might have been just amazing compared to he just wants attention. And so by forcing us to kind of go through all the different hypothesis that may be possible our hypothesis, it just kind of makes you think a little bit deeper, a little bit more outside the box, and you kind of come up with conclusions that you wouldn't have come up with without going through all the steps that you lay out in that mostly that last course, the the community based learning or generalizing, I should say, and so. So yeah, I want to say thank you so much for coming on the show. Thank you for allowing me to take the course. For anyone out there who who wants to take the course, I highly recommend it. And I actually, I'm going to let me tell you where, where you can learn more about the course.    Meg Proctor     Yeah. So if people go to learn, play thrive.com , and click on the the four therapists part, they'll see a link to the course. It opens for specific enrollment periods, I like to kind of work with my therapist through the course and be there to support them. So I do have it open right now at the beginning of January, and I am enrolling new students in the course, and the enrollment period will close, but it'll open again in a couple of months. So I'd love to give your listeners a little bit of a discount just for being awesome and listening to the podcast, so they can use schoolhouse 25 schoolhouse all one word and then the number 25 to get $25 off their enrollment in the online training or the live training if they happen to be in the North Carolina area.     Jayson Davies     That's where you're going to be. North Carolina. Very cool. Yeah, awesome. Well, thank you for that so much. That was unexpected. I appreciate that it's kind of fun when you're able to come on and help our listeners. So I appreciate that so much. So yeah, definitely be sure to check out Meg's website, at learn playthrive.com and also she has a Facebook group, right? You have a Facebook group?     Meg Proctor     Yes, absolutely. Please join the Facebook group on this is where people come to ask questions. We problem solve together. I'm always coming on and doing little mini trainings via Facebook Live that aren't also on my website. I make announcements in the Facebook group when I open new training. So that group is called OT and autism, so if you search for it, you'll find it. And we'd love to have you there.    Jayson Davies     Perfect, yes, and definitely join us there, because I'm in there too. And so it's a fun group to be active in. And and Meg is awesome, because she does just come on like, I feel like I see your face coming on a live video once a week, or at least once every other week or so I see a video up there, it seems like, and so it's very nice that you do that for everyone in the in the group. So, yeah, well, thank you so much for coming on. I appreciate it. And I hope everything's going well for you. I think, thank you. Yeah, thank you also, again, for allowing me to take the course. It was so much fun and so much information that I learned, and I'm already using it. I mean, even the visual schedule that I created was like, smack dab after watching whatever module it was in your video. And I'm like, You know what? I don't need to be perfect. I can just kind of make a simple visual and try it out and see what happens.    Meg Proctor     Oh, I love that. That's like, one of my favorite takeaways is, everything doesn't have to be perfect. It doesn't have to be beautiful. Let's just try something exactly that's awesome.    Jayson Davies     You made an influence on me. So thank you so much. But yeah, so All right, well, we will say goodbye, and I hope you have a good 2019.    Meg Proctor     Alright. Thanks. Jayson, bye, bye.    Jayson Davies     Alright. Well, that was Meg Proctor of learn play thrive.com and of the OT and autism Facebook group, be sure to check out learn play thrive.com the course is currently open here at the beginning of January, and like she said, she opens it and closes it periodically, because she likes to be very intimate with the few amount of therapists that she really allows into the course. So be sure to check her out at learn, play, thrive, or it sounds like she's also doing some live sessions now of her training. So if you're on the East Coast in North Carolina, be sure to check those out too. She's very much a animated character, and she's great to learn from, so be sure to check it out. Also be sure to check out ot  schoolhouse.com , forward slash episode 21 for any of the show notes and links and a copy of that discount code so you can get over and get $25 off of her course. All right, everyone. Well, take care, and we'll see you next time on the OT school house podcast.    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 20 of the OT Schoolhouse Podcast. In episode 20 of the OT Schoolhouse Podcast, Abby and guest, Sarah Putt, MA, OTR/L of the OT 4 LYfe Podcast, talk about the differences between school-based OT and Early Intervention OT. They also touch on what the transition from Early Intervention to school-based services may look like. Sarah is based in the Los Angeles area and runs her own private practice where she sees kids primarily aged 0-3 in their own home. She works with both kids and their families to develop a plan of care that is geared toward catching the student up developmentally. Sarah also hosts the OT 4 Lyfe Podcast ( Apple Podcast App Link ) where she interviews a wide variety of OT practitioners, students, and even prospective students about what Occupational Therapy means to them. In Fact, she even interviewed Jayson and Abby recently. Be sure to check out her podcast as well as ours! Check out the episode below if viewing on a computer. Or use the links below to listen to Apple Podcast or Spotify on your phone. Do you use another podcast player? Just search for the OT Schoolhouse Podcast on your player! Freebies! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts Episode Transcript Expand to view the full episode transcript. Amazing Narrator     Hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research. Now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.    Jayson Davies     Hello and welcome to OT schoolhouse episode number 20, this is going to be well, first of all, thank you for listening. Definitely always say thank you for listening and thank you for listening to as many episodes as you have listened to this school year or this this year we've been doing this podcast now since March. Is that right? Abby?     Abby Parana     Yeah, just march, yeah. Not even full year.     Jayson Davies     Yeah. So not, not even in a full year. And we managed to get 20 full episodes, which is super cool. Basically, we've been doing an episode every other week and, well, let's just be honest. We are going to share with you that it is hard work that we are putting in to get these episodes out to you. Every episode is a hour and a half long Skype call and then another process to edit these episodes. So.    Abby Parana     because you got some mad editing skills, I do not have great editing.    Jayson Davies     It's all good. We work as a team. We get it done. And yes, so this is going to be the last episode of 2018 and we will be back with new episodes on January 8, and that is actually going to be a really cool call with a an occupational therapist who specializes in autism. And so I'm excited for you to all hear that episode. We will be back.    Abby Parana     I'm excited to listen to that episode.    Jayson Davies     Yeah, she's really cool. Her name is Meg, and she is actually she has an online course. And so we're going to talk a little bit about that online course that she has and dive into that. So again, I can't say thank you enough for listening to, you know, all these episodes, whether you've listened to five minutes of an episode, or all 20 episodes, which equates to something like 15 hours or something or more than that, I don't even know. Thank you. You helped us to reach 20,000 more than 20,000 downloads this year alone. Yeah, we never thought that we'd make it that far. I don't think.     Abby Parana     No, I remember thinking like, Oh, we've got reviews. And I was like, oh, but it was a lot of you know which friends and family members. Thank you so much. But it's just very exciting to see that it's the OT school house community is growing. So Happy Holidays to you guys. I don't know if you're going to be traveling home. I am traveling to Pennsylvania, my hometown and I often listen to podcasts while I sit in the airport. So if you care, to listen to some ot school house podcasts and pick up those PD use, I think we have six.    Jayson Davies     Yeah, yeah, six of the 20 episodes.     Abby Parana     Yeah, that you can go and take quizzes for over at ot  schoolhouse.com and check that out.    Jayson Davies     Yeah. And real quick, back in episode number 18, just two episodes ago, we actually had Lauren on from the inspired tree house. And I just want to remind you all that she did offer to every listener of this show a 20% discount at the inspired treehouse.com and for any of you who don't know, the inspiredtreehouse.com has wonderful resources, everything from packets of work that you can print, printables that you can use with your children, up to webinars, even books and webinars that they offer. And so you can get 20% off any of those products that they have on their website using promo code ot schoolhouse 20 very simply, just go over, pick whichever ones you want to purchase and use that promo code in the checkout and you will get that discount. So that is good until the end of December. So if you want to take advantage of that, hurry on over to the inspiredreons.com Yeah, with that, why don't you go ahead and introduce Sarah Abby.     Abby Parana     Oh yeah. We have today on the podcast. We're going to be talking with Sarah from ot for life. That's the number 4, L, Y, F, E. She is a fellow podcaster, but also has a private practice doing early intervention. She started out working in school based therapy. So she made that transition to early intervention and now practices in that area. So we discuss a lot about transitioning from early intervention services to school based services, how that works, IFSP to IEP and she discussed a lot about what kind of strategies and the focus of early intervention. So if you are like me and have zero early intervention experience, or work in that population of zero to three, or have ever been intimidated by it, she really is great about breaking it down and kind of making you feel a little less worried about. Working with that age group, or, you know, really explaining what it is she does. She's a very busy occupational therapist. She does a lot in the field. So also, I would recommend just checking out ot for life podcast as well. She interviews OTs that are doing different things in the field, and she really has a nice style to it.    Jayson Davies     Yeah, and she actually just interviewed us, so Oh, that's true. If you want to hear us on her podcast, it's a little different. We're used to hosting, and so we got to kind of sit back and be the hosted and answer some questions for her. So that was really fun. And if you're fans of ours, you'll probably be fans of hers and have a listen. I don't think, I don't know when that episode will be out, if it's gonna be out when this episode comes out, but definitely check it out.     Abby Parana     Yeah, and she has some, a lot of interesting interviews. So two, if you're looking for the show notes for this episode, go to otschoolhouse.com , and check out show notes. Episode 20.     Jayson Davies     Perfect. So ready to dive into the interview? Oh yeah, let's get to it. Great. Here is Sarah put from the OT for life podcast.     Abby Parana     She does a podcast called ot for life, and we're happy to have you on the show. Sarah, welcome.     Sarah Putt     Thanks, Abby. I am so excited to be here. It is a pleasure.    Abby Parana     and we met at ot because Alexis set up our mastermind group, and we just met at Rubio at OTEC. That was fun.     Sarah Putt     Yeah, I kind of just, she posted it on Instagram, and I was like, perfect. I got nothing going on. I'm gonna be hungry. Yeah, let's go to lunch. And I, at that point, had no idea who was gonna show up, and so I sat down, and I was like, Oh my goodness. Like, this table rocks. I was so excited to be sitting there with you guys.    Abby Parana     I know we're It was fun. It was like, a very fun vibe. We had this opportunity to kind of bounce ideas of each other and what everybody's doing in the space to kind of promote occupational therapy in a different way. And we all had different settings and different areas that we were looking at. And I discovered you work in early intervention services and I work in school based and so there is oftentimes that connection between early intervention and school based services. That happens when a child transitions out of early intervention and into preschool, when we typically inherit them at school based OTs. So you're here on the podcast today to talk a little bit more about that. But also you are like a jack of all trades. It seems like in the OT world you are, you have so many different areas that you are contributing to the field in, and so we're probably going to have to touch on a lot of different areas.    Sarah Putt     That worked for me. I like to talk. So this will be good.     Abby Parana     It's just going to be a very chatty podcast. I love it, right? So let's start off with your background. Just give me a little bit of information about how or a lot of bit of information depends on what you want to share with us, but how you chose to become an occupational therapist and just what inspired you to do. OT?    Sarah Putt     All right, well, I guess I I'm definitely one of those people that I didn't always know that I wanted to be an OT. I didn't even know what ot was until after. It was like right after I had graduated from undergrad, and I had been working in schools, and I was a behavior therapist, and I had a couple kids that I was working with, and one day, one of my kiddos had occupational therapy, and it was during the time that I was working with him, and I was like, Cool, I'll go, like, I'll go see what this is all about. And I remember we he was a preschooler, so I remember we walked from his preschool classroom down to the little sensory gym opened at the door, and like his eyes lit up, my eyes lit up. And I was like, oh my goodness, like this. This is so cool. I saw like a ball pit, and I saw the scooter board ramp and the OT that was there was just fantastic. And so passionate about what she was doing. And I, like no joke, went home, researched what occupational therapy was, looked up schools, and started my prereqs, and started applying to programs right then.    Abby Parana     Wow, now that is gung ho. And you know what? It's funny, because I too volunteered and found an OT who was working with kids, and she was super passionate about it, too. So I could totally relate. It seems like, when you do meet an OT and they're passionate about it, it's contagious, and you caught the bug.    Sarah Putt     Yeah, exactly, yeah. It's like, it's just one of those things. I jumped into it and. Yeah, I feel like I'm so fortunate that I found it and just applied and got in and started, and I still really had no idea what it was, because I had such a limited view of it. But I look back and I'm like, I'm so thankful that I just somehow just fell into the profession it is.    Abby Parana     It's great profession. So what has your career path been up to this point?    Sarah Putt     So let's see, I have always been pediatric brain, like the entire way in school. I did three of my four field works in pediatrics, because back then we got to actually pick right right? And then I graduated, and I started working for a like a private clinic. They contracted with schools, and they also did in home therapy and clinic based therapy as well. So fresh out of school, I kind of got a really wide range of pediatric practice, I should say, pediatric outpatient practice. And really just got experience, kind of across the board, in that, in that entire realm. And I was there for about four to five ish years, something like that. And then I started independent, contracting with two different companies, and at that point, that's when I left the schools, and I was only focusing on clinic based and in home therapy. And did that for about a year or two, and then I kind of tired of the contractor role and decided to start my own practice and switched into only early intervention, only home based.     Abby Parana     Yeah, you had, like, quite the winding road, but always with peds, so you touched on multiple different areas. So that's that's pretty cool. That gives you, like, a good, well rounded perspective when it comes to following children through quite a big majority of their childhood.    Sarah Putt     Right? Yeah, I feel like when I when I was fresh out of school, I really just kind of had a wide range of experiences, and then slowly, every year, I just like niche down and niche down and just like honed in, and now it's like zero to three, and that is it.    Abby Parana     That's pretty cool, though. So I have minimal experience with zero to three population. I will admit that openly. I think I did some observation hours with a ot that was doing zero to three and home. And I mean, I liked it. I actually, actually, I'm work in school based, but I did not ever think that I would find myself in school based or working with kids. So working in peds was not my strong area at first, but once you're in it and you fall in love with it, I can't imagine doing anything else that I was doing before. So with early intervention services, though I am a newbie, a novice. I'm an OT that I've always been a little bit apprehensive about doing early intervention services, so I just want to know just generally what that is. So what, besides the couple hours like we talked about earlier, before it leaves recorded, we get just the hours we spend learning about early intervention in school based kind of vary so or how we learn about that. So would you share with us what OTs role is in early intervention services?    Sarah Putt     Yeah, I'll start by kind of explaining, like generally early intervention. And then I'll go more specifically into the OT realm. But, and I actually, I should start by saying that every state is different and true. Yeah, and I've only ever worked in California, and I've only ever worked in Southern California, so what I'm going to tell you is very specific to this region and other states could be slightly different. So going off my experience so far, but so early intervention is, at least in California, it's birth to three years of age. And there's really, like, kind of two different categories of kiddos that I would be working with, and those would be the kiddos that have some sort of like established delay. So those kiddos that are they have Down syndrome, cerebral palsy, maybe a genetic disorder, autism, even though that can be sometimes it can be a little bit more rare, because I am working with kids so young, so for them to have that diagnosis, sometimes they might be in the process of getting diagnosed, or a few kiddos actually have it, you know, around like 18 to 24 months of age. So there's those kiddos that that have a delay, and then they're the kiddos that are at risk of having a delay. So they might not have a delay, but they are considered at risk. And we're talking the kiddos that are born prematurely. They were exposed to drugs or alcohol in utero. Maybe they had a traumatic birth. They have a sibling or a parent that has some sort of disorder, disability, things like that, that would kind of put them at risk for having a delay, and so we are addressing the delays if they have them, or we are monitoring and making sure that no delays happen, or educating and kind of facilitating them throughout that kind of normal growth progression.     Abby Parana     Oh, okay, actually, that makes a ton of sense now. So yeah, how do parents, or, you know, how, how do parents find you, or how are children referred to you? I guess, would be a better question.    Sarah Putt     Yeah. So I work for a couple different regional centers, and they call it like vendored, basically like a contract. And so I have different teams within the regional centers, within the Early Start teams, I'm sorry back up here. So I have different Early Start teams that I'm kind of affiliated and plugged in with. And so the case workers will reach out to me because they know that I service a specific area or I have certain training in, say, feeding or sensory integration, that that, that their kiddo needs, okay, and they will send me the referral and say, Hey, can you, can you take this case, and if I can accommodate them into my schedule, then I Do, oh, cool, yeah. And I should mention that the this, the portion of early intervention that I do, is all in home based, okay? So kids can go to the clinic as part of their early start services if it's necessary. Most of the time they're seen within the home environment, okay?    Abby Parana     And so are they referred to these early start programs via, like, a doctor or?     Sarah Putt     Okay, yeah, it could. It could come from anywhere. So some come from doctors. Some come there. Could be, like, a parent referral, okay, they have a sibling that's older, and all of a sudden they realize that the younger one is not meeting the milestones, or there's a big difference in their development. It could also be coming from, like, other specialist nurses. Maybe they're already getting speech therapy through insurance or something like that, and then they're like, Hey, you should go get checked out by the Regional Center. So yeah, the referral really could come from anywhere, anywhere.     Abby Parana     Okay, and so it's, I guess I'm, how do clients pay for early intervention? Or do they or is it just through the regional center? How does that work?     Sarah Putt     So, okay, I'm back up here a little bit, but the regional center is a nonprofit organization, and they get as far as I believe, they get state and national funding for it, and then the early start program, or early intervention, is a portion of our a branch, a section of the regional center. So regional centers will actually span the lifespan, and they serve a client throughout. So I only work in a very small like fraction of the regional centers.    Abby Parana     Okay, yeah, at IEP meetings, too. A lot of times, people from the regional center will come to IEP meetings, and they'll sit in and they they seem to, yeah, update throughout a lifespan what the child's services are, and help get them what they need. Really advocate for them a lot.     Sarah Putt     Yeah, yeah. And kind of helping the parents go out, go throughout that process in terms of how the parents, how the parents will pay for it, or if they have to pay for it, the regional center is what we call the payer of last resort. And so the way that it works is that a family will come to the regional center and they'll get an intake evaluation. So basically an initial evaluation, where it will most likely be done by an OT or PT, sometimes it can be done by a speech therapist, and they will do a developmental assessment looking at all areas of development, so cognition, language, motor, adaptive behavior and social emotional skills. And if the kiddo qualifies for regional center services, which is a 33% delay or more, then, like, basically, the team will say, hey, we think it that, you know, the kid would most benefit from occupational therapy, physical therapy, whatever it is. And then if the families have insurance, like private insurance, they have to go to their insurance company first, or their insurance provider, okay, and say, hey, my kid qualified. Like I just had an assessment done at the regional center. They need occupational therapy. And then the insurance provider. Say, Great, we'll cover it. And then the kiddo gets their service through the insurance. If the insurance company doesn't cover it, then they come back to the regional center, they have to have a letter of denial, and then the regional center will kick in. Okay, gotcha. The other thing that can happen too is if the insurance covers it, but say there's a wait list. So a lot of these clinics and insurance places, they they're really impacted, and they don't they have a huge wait list. Three months, six months, wow, then what would happen is that they'd go back to the regional center and say, hey, it's approved, but we're not going to be able to start for six months. The Regional Center will cover the services until they get picked up through their provider.     Abby Parana     Okay, wow, yeah, I did not realize all those ins and outs of everything. I think it's kind of cool though that they assess for them to call it like they do the assessments up front, versus expecting it, expecting payment and then assessing, essentially, so like, the assessment sort of just because of the suspected delay of the parent or the doctor referral kind of thing.     Sarah Putt     Yeah, so typically, and I don't know, like, I know some of this just based on what I've been told. But I think if the kiddo receives services through the regional center, like treatment, therapy services, right, then the parents are expected to pay, and it's, it's like a yearly fee, and it's based on income, and I think it's up to like, $200 so.     Abby Parana     Oh, wow, that's, it's pretty reasonable for, I mean, therapy, yeah, yeah, okay.     Sarah Putt     Like the evaluations and all of that that doesn't play into it. So that's only if they are eligible and they start receiving, say, occupational therapy, okay, through the regional center.    Abby Parana     Ah, okay, got it. Wow, now I have a thorough understanding of how the regional center works and how these referrals are made and how they get to you to get assessed. So what kinds of assessments do OTs perform in early intervention? What tools do you use? Sort of what I mean. I guess maybe the Peabody is one that I'm familiar with as far as standardized assessments go. But I know there's multiple other ones, I'm sure. So what kind of assessment tools do you utilize?     Sarah Putt     So the two regional centers that I contract with, they both utilize the Bailey, okay, I've heard they do the Bailey and portions of the Daisy, okay, that's it. And then if I do like a specific sensory evaluation, then I would be doing, like, the sensory profile, but, okay, yeah, there's just, just a couple of them, kind of nice.    Abby Parana     Would you describe the Bailey just maybe, like a brief overview of it, for any OTs that maybe haven't heard of it, or OTs like myself that probably haven't brushed up on those types of things, being that I work in school, so just but I think it's important for school based OTs to know those assessments, because those kids eventually transition to school where we may end up assessing them for school based services.    Sarah Putt     So kind of what I mentioned before, typically when we're doing evaluations, either intakes or reevaluations. We are doing full developmental evaluations. And so not just ot specific, I am looking at development across all areas. And so the Bailey specifically, and the sections that we use of the Bayley is cognition and then language, which is broken up into receptive language and expressive language, and then motor, which is fine motor and gross motor. So we only do those five sections of the Bailey, and most of them are like either hands on, where they're stacking blocks or walking on a path, or putting pegs in a pegboard, pointing at pictures in a book for some of the language portions of it. And so it's very it's based on the child's skill and what they can do during that evaluation, and what scene.     Abby Parana     Oh, okay, so is it. And you do all of those sections, or I do it all that's very functional. Like, I think sometimes, as OTs, we tend to pigeon hole, like we do fine motor, like we fit in this box. And really functions about cognition. It's about, like, it's about all those pieces. So, right? That makes a lot of sense, yeah. And then the second assessment is not one that I'm as familiar with, either. So.     Sarah Putt     Oh, the day see the data, developmental assessment in young children of or of young children, something like that. And that one is basically just a it's more of like an interview. Do. So I just asked the questions, and it's kind of a yes or no, and so we only do adaptive behavior and social emotional and so we're asking questions about, can they feed themselves? Can they drink liquid from a straw and they wash their hands? Can they interact with peers. Do they help put their toys away? Do they engage in play that type of stuff? So some of it will actually see during the assessment, but some of it is like sleep, and so we're not going to be able to see that. So we that's when we ask the parents.    Abby Parana     Oh, okay. Oh, that makes, well, that makes a lot of sense too, because then you're looking at, again, it's grow like, grossly looking at developmental skills, but it's very functional. It sounds like, like you're looking at actual functional skills for the child at their age level, or, yeah, mental level, I guess would be a more appropriate way of putting it.    Sarah Putt     Exactly, exactly. And I think too, it's even though I'm looking at all of development, and I'm looking at it kind of from this grand scope. I'm always utilizing my ot brain, so I'm coming at it from the lens of occupational therapy, but I'm looking at everything that's going on with the child and really trying to get a clear picture as to what the needs are. If there are any needs, I get a lot of kiddos that come for an initial evaluation, and they're doing beautifully. They don't need anything. So it's really kind of just integrating everything and getting that well rounded, holistic view of the child and what they need at that moment.    Abby Parana     That's occupational therapy, that's for sure. So what main areas of occupation do you address for your clients? So for a child in one of those eight or from, I guess, zero to three, what are the, I guess, the areas of occupational occupation that you're looking at? I mean, I think I have an idea, but I want you to tell me, because you're the one who works in that field or that area of practice.    Sarah Putt     I feel like it's such a broad question. I do so much. So what do I do? Of course, I do a lot of fine motor, gross motor type stuff, I'll do sensory and event interventions, a lot of like milestone attainment, so always trying to hit the next milestone, whatever it is, yeah? So of course, with my with my little guys, we're working on head and neck strength. We are working on rolling, we're working on tummy time, then moving into sitting, crawling, pulling to stand, like that whole kind of develop, developmental progress, and then with when they get a little bit older, then we really start to hone in on the fine motor skills and The pincer grasp and the bilateral motor coordination. Yeah, I do quite a bit of feeding interventions. And I kind of have the two different categories. I have the picky eaters and the ones that are more like sensory, they just don't like the textures, or they don't like the color or whatever it is. And then I also do some like non oral. So a kid that has a feeding tube and they're making a transition from non oral to oral feeds, okay? And then I know I'm gonna keep going.    Abby Parana     Super broad. That's it. That's Oh yeah.     Sarah Putt     And then we also are, I also work with the family routines. So sleep would be a big one, and how they how they function within the community, being able to go out and go to restaurants or go shopping or whatever it is that they need. So pretty much any anything like the sky is the limit of what I can be, can be addressing with the family. And, you know, a lot of times I'm doing caregiver education and just teaching them what they should be expecting with their kid, or how they can be interacting with their kid, or also how to help the if their siblings involved, how to help the siblings understand, how to engage with these kiddos, and try to get the carry over. So when I'm not there, we have the siblings working on it. We have the family working on it.     Abby Parana     Yeah, yeah. I mean, that is, there are so many areas. I mean, it sounds but you, I mean, I'm thinking about it from a standpoint, when I'm thinking of like school based OT, I can totally see where early intervention services are super key to a child's success in school and later on down the road, being able to sit in a classroom and learn or for. Perform those tasks like I think getting those services early Are you because there's research that shows when kids don't meet their developmental milestones, or they skip them, or things like that, that their learning abilities can be impacted later on. And so I just think early intervention is super key, and obviously covers so many areas. So how do you develop your service, I guess, your service delivery model, or how you would start your service dosage, or how do you determine that kind of thing?    Sarah Putt     Yeah, so pretty much, I'd say, generally, I'm seeing kiddos either once or twice a week, depending on the level of need, or once or twice a month, okay, and that that's kind of kind of what it looks like. So I'd say more often than not, it's once a week if there is a significant need. So once they once they have that 33% delay we're looking at once a week. If there's a really significant delay, then there might be that twice a week. A lot of the kiddos that tend to be on the like the monitoring, so those the at risk, the prematurity, the drug exposed, those kiddos most likely, when they come to us, they, they usually start, especially because, like, a lot of them will get referred from the NICU, so they're really young, and at that point they tend to be developmentally like, age appropriate, right? So we just have, we're just monitoring them. So those are the kiddos that get that once or twice a month type monitoring service.     Abby Parana     Yeah, no, that I this all makes sense in my brain right now. I'm like, having so many light bomb moments. It's like, Oh, right. Isn't as intimidating as I thought. And you were right.     Sarah Putt     Yeah, no. I mean, it's not too bad. And it's pretty much, it's up to the the team at the regional center, as well as that evaluating therapist, or if you are the treating therapist, to figure out whether to set the frequency or to increase, decrease, anything like that, if it's in the middle of therapy. Oh, okay, got it, yeah, I, I wanted to backtrack, because you said something, and I had so I have something really good to say about it, because I Yeah, but I want to answer your question first. But so what I always try to do, especially because I have the experience in the schools and a lot of times, a lot of the parents have a harder time understanding what's going on with the kid when they're so young, so I always try to put it in perspective of, like, what are we looking forward to? They're going to be starting school, you know, they're going to go to college? Like, I always try to give them that big picture kind of thing. And so I'm telling the parents that a lot of the stuff that we're working on with these kiddos is kind of that pre learning we are preparing them to be able to learn, to be able to attend, to learn to be able to sit, to be able to access any type of learning. So it's, it's those kind of beginning level things, those building blocks, those foundational skills that we're working on so they can go to school and learn and be a contributing so, yeah, to be a contributing member of society and like, the other thing that I was going to mention, because you kind of said that the research that's coming out about kiddos that are either skipping or Maybe doing their milestones, but they're not doing it appropriately, right? A big one that I talk about, and I'm kind of going to get on a soapbox here for a second, so.    Abby Parana     Get the soapbox out. You can. I'll help you step onto it, like I get it.    Sarah Putt     Yeah, crawling.    Abby Parana     I knew it. I was gonna be like, crawling. I know which one she's gonna say crawling absolutely like.    Sarah Putt     It's such an under, undervalued, underestimated skill. So typically, like, when we get a referral, it's because a kiddo is not walking or not talking. Very rarely do we get a family that comes in and they're like, my kid's not crawling yet? Like they're they don't even worry about that. Or I get the parent that's like, oh yeah, like, the kid just learned to roll over. And they're like, Nah, they're just gonna skip crawling. They're just gonna go straight to walking. And I'm like, wait a second. Hold on. We're gonna backtrack. And I'm gonna tell you every reason that a kid should crawl because it's so important, and I do the same thing where I make this connection, because there's research that's saying that kiddos that do not crawl and do not crawl appropriately, like on their hands and knees with open hands, they have a tendency to have poor handwriting or weak hand. Weak grasp and all of that kind of stuff. Yeah, and so I'm always trying to tie it like you might not think that crawling is so important, but it is later on in life, there it puts them at risk that something might be harder for them because they're not getting all those foundational skills from crawling.    Abby Parana     Right, right? Absolutely. And I agree 100% what do you think about the walkers I've heard recently? Walkers aren't as great mentally either? Maybe not recently. I mean, I've always kind of felt that way about walkers. But what do you think of those types of things?    Sarah Putt     So I'll start by saying there are certain kiddos that walkers are necessary for, and walkers are    Abby Parana     the ones, like developmentally appropriate I should refer to that I'm talking about right with the tray around them, not walkers that are like,    Sarah Putt     used to medically need, but like PlayStation.    Abby Parana     Where the kid just sits upright in it and Like, uses their feet to propel them when they haven't developed walking skills yet. That's what I'm referring to.     Sarah Putt     There's actually a name for it, and it's called container syndrome. And it's not just the walkers, but it's bouncers. It's extra saucers, gotcha. It's bumbo. Boce seats. Oh, yeah, any sort of contraction that babies    Abby Parana     look comfortable in bumbo seats? No, I just don't think that they do. I don't have a baby, or I don't have kids, but to me, when I look a baby, I'm always like, I don't think that's that doesn't look comfy    Sarah Putt     again, like this is totally like another soapbox for me, because I deal with it all the time. And in moderation, any of these devices can be used functionally and appropriately, and I don't have a problem with that. But in moderation, and we're talking five or 10 minutes once or twice a day, maybe like Max, right? But the problem happens when the use of the devices is to be a babysitter or a pacifier, and so that nobody has to be watching the kid, it just keeps them contained. And then these kiddos are spending hours and hours, or a majority of their day in these containers, and they are not allowed to move functionally. They're not allowed to develop the muscles that they need in order to hit those milestones, and maybe they still will, but they'll start walking, but they'll have no sense of body awareness. They'll have no protective responses, because they're always expecting somebody else or something to be holding them or catching them. And it's it's definitely gotten worse. I've seen more and more over the years, and constantly educating my families. Just get rid of them. Put a floor on a mat, get down on the floor with them, engage with them. That's going to be the thing that you can do.    Abby Parana     Because I think sometimes when you position a baby, and you might and correct me if I'm wrong, but maybe before they're ready to be positioned in that way, their muscles haven't developed enough, and so they can do like, kind of, could they learn? I guess I'm asking, it's more of a question. Could they end up learning compensatory movements that probably you don't want them to learn. You want them to learn. The correct developmental approach in those situations. Is that the right way to phrase it?    Sarah Putt     You are spot on with that. Yeah, they learn. Kind of, yeah.    Abby Parana     They'll learn to cheat, and then those muscles weren't designed to work that way. And so if they're doing it before they're ready, that's not good either, because if you learn to develop those muscles before they're trained appropriately, I could see where you're com, compensating, well, compensating. And that could lead to poor habits, or, yeah.     Sarah Putt     Skills later. The big one that I see too, especially like when we're talking about like walkers or bouncers or something where they're like upright, is that they develop really strong extensor muscles, so the muscles of the back.    Abby Parana     But not the abs.    Sarah Putt     And so their core strength is horrible. And so then because of that, they lack that CO contraction between the flexors and the sensors of the trunk. And so they have difficulties with postural stability, postural control, being able to sit up, being able to walk, being able to catch themselves when they are shifted off balance, all of those types of things. So.    Abby Parana     This all makes a lot of sense.    Sarah Putt     Like the light bulb going on. I'm like,    Abby Parana     I'm having so many light bulb moments right now. I'm just like, whoa, hi. Oh. That's why like that. That makes a ton of sense. Why you wouldn't, you know why you'd want to promote those developmental milestones and the progression appropriately with those children. So when a child becomes school aged, essentially, what happens with early intervention? I mean, how do they transition out of early intervention into the next, I guess, phase after three.     Sarah Putt     Yeah, so typically the transition will start like, generally it's right around two and a half, but sometimes even within the meetings and the evaluations, if the kiddo is, like, two years or older, we already start talking about it that at three they are going to be eligible to transition to the school district and at least start to prep the parents. And so specifically, when say it's a kiddo that I've been working with, and generally, I'd say there's kind of two different types of kiddos, like, there are kiddos that I'm working with that. I'm pretty sure that they're going to continue to they're going to be eligible for therapy in school and continue to receive it, and then they're, they're kiddos that I'm like, You know what they are doing great. You guys probably will go through the transition period, but there's a good chance that they might not qualify, because they're doing that well. And so I really just try to educate my parents, on both sides, whether or not they're going to continue or not, what that process looks like, because it's a lot.     Abby Parana     Yeah, no, it must be a lot, I mean, and they go from having kind of this face to face therapist in their home with them, kind of developing programs with them, and then it's kind of, when it comes to school based, we're a little bit more developing programs with the teachers and the staff, and we do, I mean, touch base with the parents as well. That I think that that's very important. But it's almost like the parents are kind of being told what we're doing at school versus, you know, they're always a part of the team. I don't want to say that they're not, but when it comes to therapy, they're not sitting in on our therapy sessions. There's a lot of trust that has to take place. So I can imagine being a parent making that kind of transition would be difficult.     Sarah Putt     Yeah, it's, it's just, it's just a lot for them to go through and the service, the services and the service delivery, kind of what you were talking about that looks different. But even just the the initial IEP, so going from the if the IFSP, the Individual Family Service Plan, right? Say that, right? IFSP, what? Yeah. Family    Abby Parana     IFSP. You know, I wrote IFSP on here, not really knowing what the acronym actually stood.    Sarah Putt     For so many times, and then it came out.    Abby Parana     That's not right. And I used to like my previous experience was, I did. I was a part of that transition team, but that was when I very first graduated. I was working in Hawaii, and I was a part of that whole process of transitioning from early intervention to school based, and I would do the assessment for school based for those kiddos. And so I knew it. I knew IFSP, but I had forgotten what the actual acronym was, because I haven't done that for about nine years now. So I'm like, I know there's an IFSP, and that turns into the IEP, and we have a meeting about it, and I cannot remember what all that entails. So, yeah, allow you to elaborate on it. So what is the if?    Sarah Putt     The Individualized Family Service Plan is that's basically the IEP for the kiddos in early intervention. And the the big main difference is that the family is a part of that team, so we can actually write goals that are for the family, or for the routines of the family, or something like that, whereas I know in the schools, you guys aren't going to be writing a goal, that they are going to do this strategy, or whatever it is.    Abby Parana     As a matter of fact, we can't even really write like parent, as somebody responsible for the goals or or anything like that. In the IEP, they are, at least the districts I've worked for strongly discourage that, like saying, like, the parent will work on this for the kid, because everything is supposed to be focused in the school.    Sarah Putt     Is that new? Because I've definitely seen that written on.     Abby Parana     I know I've seen it written as well. I'm not saying it's everywhere. I just know, personally and my past couple years experience, they've really discouraged saying that the parent is responsible for something because everything was supposed to take place at the school. Yeah, okay, yeah, yeah. So I think that's just    Sarah Putt     a big difference. And when parents are exposed to the early intervention side and. They're used to like what you said, the in home therapies, the direct therapy, they are working on anything developmentally that's within that therapist scope of practice to then transitioning to the school district, where it looks different. I always just want to make sure that my parents understand, or at least have heard it before. Maybe they don't understand it quite yet, but I've talked to them about it, and I've talked to them numerous times about it's going to look different. The school therapists are going to be working on accessing their education, right? Everything is going to be education based, and education skill based, and a little bit less on that kind of developmental family based side that we focus on. And so I feel like I try to just prepare my families to go through that with this understanding of it's going to be different, and it's going to be a lot. Definitely, you're going to you're going to sit there, you're going to go through it and you're going to come back and you're going to talk to me and ask me questions, and I will explain it. I'll have families. They'll go to their IEP, and then I tell them, bring it back to me. We will walk through it. I will explain what this page is and what this is, and what these goals mean, and everything like that. So they really like try to get a better understanding. Yeah, that's gonna look like.     Abby Parana     And I think it's intimidating well, and I do want to clarify, it's not that we don't I mean, parent input is always super valuable, important. I guess what I'm saying is we don't write in there that they're responsible for a goal right on the IEP. That's what I mean. To clarify, they're always involved that parent input is super important to their child's education and involvement. And they are a member of the IEP team that, you know, invaluable member. Yes, so I just want to clarify that I was just thinking to myself, I hope that didn't come out like, Oh no, they're not. We don't make them responsible for anything. But what did it? I just mean they're not responsible for, like monitoring the progress of the goal, or noting on the goal, or anything like that. So what do you think? But I was just thinking to myself, we go through the IEP documents in an hour, and sometimes there's 22 to 30. I mean, plus pages in this document. And each page is full of information, and then we go through it with them. And at the end we're just like, sign here, here and here, initially, these areas, and you kind of briefly describe what each thing is. You go through their rights. You go through all of those things in the beginning, but I can only imagine how stressed out these parents must be transitioning from having all these services in their home and being a part of their lives and their, you know, developing trust and all of that, to coming into a meeting that feels very cold in a way. And then also, we need your signature on all of this. We need it today, kind of a situation. So what has been your experience with that? I guess, helping transition them out, like you already touched on it a lot, but like, just kind of, would you Yeah, or do they get stressed out? I would think that they do.     Sarah Putt     Yeah, yes. And I always just try to give them examples of, like, when I was in the schools, like, what it would look like, because not only is it this kind of unfamiliar, kind of foreign document, they're like, IEP what I don't I don't even know what this is, and there's all this language on it that they're like, I can't even comprehend. And then they have 510, 15 specialists that come into a room and they're telling the parent that their kid can do this and can't do this, and they're delayed and this, and, like, all these issues, and it can be a lot, and the families will kind of can have a tendency to, like, shut down and like, whoa, whoa. Like they feel like they're getting attacked. And this is not against the schools, but we're like, you guys are used to it. You guys go to IEPs all the time. You deal with difficult situations all the time. But every family is unique. And so like, what, what I try to do is prepare them with, hey, there might be a lot of people, there's going to be a lot of paperwork, but you guys have rights. You guys have rights as parents, and do not feel pressured to do anything that you do not feel comfortable doing. Because even if the schools don't mean to do that, I think sometimes it happens because they want to get things in place, they want services to start, and they want this and they want that, and the parents are just kind of still dealing with just accepting what's going on. So it's just a lot to process    Abby Parana     give their child over that they've been taking care of to a group of adults that they don't know. Yes and hope for the best, I think, like for. A large portion of the Kids Day, and then, and I, and I think, and I think it's tough too, because we have to always come from it, from a justifying why we're giving support kind of way. And we have to do that through strengths and concerns, or, like strengths and needs of the child, and so you're trying to justify why they need services. So you're trying to list the deficits. And you're right, though it can come out very like, these are the things they can't do. These are the things they can do. And that can I would imagine, that would be a very I'm not a parent again, but I could imagine we need to be a little bit more empathetic of or describe, just take our time a little bit giving that information to parents, right?    Sarah Putt     But you guys don't have that time. Like,      I wish we had that time.    Sarah Putt     Yeah, it's like, it's catch 22 because it's like, yes, you need to take the time. But if you guys took all that time, like your three hour IEPs, or whatever the going rate is now, it's about would turn into six, 810, and, oh, gosh,    Abby Parana     I know. But, and you get that look from like, somebody who's taken like you better hurry it up. Get through your report a little quicker here, because we all have to do another meeting, and like, at this time it's scheduled, you know? So, yeah, and    Sarah Putt     so that's why I feel like because, especially if they're already getting serviced, and I've been with the family for a while, I know that the kids turning three, and so I try to start bringing those conversations in as I'm there. I'm trying, I'm trying my best. And so I can try to tackle some of these things before they even get to the schools. And then they know the parents know that they can come back to me and ask me questions afterwards. So if they've already been in the meeting for four hours and they need some time to process, they can come talk to me and I at least attempt to try to explain things and help them understand a little bit better,    Abby Parana     yeah, and they get time to digest and kind of maybe like, okay, is this normal? Is this not normal? Because I would imagine I would have that question. So I'm gonna just, I think we've covered a lot, and so you're also doing a podcast. What? And what's the name of the podcast? And how did you get inspired to do podcasting next?    Sarah Putt     So the name of my podcast is ot for life. And I well, I guess, being that I do in home therapy. I drive alone, and I drive all day, every day, pretty much every 15 minutes or so I'm in my car for at least 10 to 15 to maybe 30 minutes, driving from one house to the next right. And a couple years ago, I actually, I got big into podcasting, like I used to listen to music all the time, and then somehow, and I don't even know how I started, but I got into listening to podcast and fell in love with it because it was just all this great information, and I loved hearing all the stories that The different shows that I was listening to, right? And when I started, or when I started listening to podcasts, I was not listening to OT podcasts. I was listening to the like, finance related ones, like real estate and, like company entrepreneur type stuff, right? And then somehow I stumbled upon a couple physical therapy podcasts. And they were brilliant. They were amazing. And I was like, Wait a second, if there are PT podcasts, there have to be ot podcasts out there. And this was, this was a couple years ago when this, when this first started, and I did my research, and there were only a couple, and like, a few that were out there. I They started in like 2013 and their last episode was, like 2014 and I'm like, okay, oh, this one's not still going. And I like that. That was kind of happening on one end, and then on the other end, I was going to all these conferences, and I was meeting all of these amazing occupational therapists that are doing such cool things. They just have these fantastic stories. And I'm like, I want to share this with people, because I'm getting value out of it, and I want other people to be able to get that same value. And so fortunately, since that, like initial research that I did a couple years ago, there have been more ot podcasts that have popped up like you guys, which is great, but I still felt like there, there's room for more. Are there are, there's    Abby Parana     always room for more ot related anything, just Yeah, in the blank. But I, I agree with you. So what is kind of the theme of your podcast? Because I know here for ot school house, we do things related mainly to school based OT, some pediatric practice type things, but it's mainly related to school based education and occupational therapy. So what is it that your pot, your podcast, is quite a bit different from that? I    Sarah Putt     yeah, I am pretty much sharing anything that is ot related. So yeah, like, even though I am pediatric and I am early intervention. That is not all I'm talking about. I am talking with people that are in all walks of OT life, because I really just want to highlight the stories of practitioners in the field. I want to give a voice to the students, because I am also a field work educator, and I love having students, and they have such a unique voice and such an amazing passion for the field, and I love like when they're telling me things. And so I want to give a voice to the students and the next generation of occupational therapists. Yes, I want to shed light on entrepreneurship and try to promote more OTs, kind of paving their own way and really getting out there and doing kind of just shifting up the medical model and really just making a change, yeah, yeah. It's, it's kind of anything and everything. OT Well, I    Abby Parana     highly recommend it. Listen to thank you episodes. I think it's fantastic. I also feel that, you know, I would agree with you. I don't think that we do enough to promote occupational therapy as a profession. I don't think we're our faces or OTs role is so unique and and it really does make a difference to the kids we work with, but also when I work with adult populations as well, it's a very important profession and service, and I don't think that we do a good enough job expressing that, because it seems that we're just misunderstood a lot of the time. So I feel that what your podcast is bringing to the table is something that is greatly needed in our field. For sure.    Sarah Putt     Yeah, I feel like a lot of times, if somebody is familiar with OT, like, not not a therapist, but somebody outside of the OT realm, and they're familiar with OT, they they think of it in like one category. So it's like, Oh, um, oh, you know, my grandmother got it in a skilled nursing facility. That's what OT is. Or my cousin has autism, and he got it in school. So, right, that's what OT is. And it's almost like very compartmentalized in one or, like, just a very small aspect of what we really do. Yeah, and yeah. So like, really through my podcast, I am just kind of use utilizing the platform of audio to be able to share with the rest of the community, the rest of the world, about who we are and what we do and what we can bring to the table, because there's so much just utterly amazing things that OTs are doing out out there, and I want other OTs to know that. But then I also want people that want to learn more about ot to understand that we have such a unique skill set, and we have so much to bring to the table.    Abby Parana     We are a diverse group, that's for sure.    Sarah Putt     Right? Exactly, definitely.    Abby Parana     Well, Sarah, it has been a pleasure chatting with you this evening. I apologize for any interruptions from my dog, but I think that we've covered a lot of ground in this interview, and I really appreciate you coming on ot School House to talk about early intervention, your life as an entrepreneur and podcaster, and it sounds like you're doing a huge amount of things related to OT. So I appreciate you taking the time out of your busy life to chat with me tonight.    Sarah Putt     I appreciate it so much. This has been so much fun, and it's really cool to connect, because I feel like a lot of times, like in the EI realm, like we just kind of do our thing, and then the school therapist, they do their thing, and it's cool to get that collaboration and kind of hear what your viewpoint is, and then for you to kind of understand what's going on on our end. And I think it's just, it's great, just across the board. So I appreciate the opportunity, and this has been a lot of fun.    Abby Parana     Yeah, I've had a great time. I've had so many light bulb moments.     Sarah Putt     So thank you very much.     Abby Parana     You're welcome. All right guys, well, thanks for listening to Sarah put and I talk. Talk about early intervention services, a little bit of podcasting and a couple other little roads. We took detours in that interview. You can go ahead over to OT schoolhouse.com/episode 24 Well, the show notes, Happy Holidays to you guys from ot school house and stay safe and we'll see you in the new year.     Amazing Narrator     Thank you for listening to the OT schoolhouse podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com . Until next time class is dismissed. Click on the file below to download the transcript to your device. Click here to view more episodes of the OT Schoolhouse Podcast