Episode 103: Getting Student-Centered with the CO-OP Approach
- Jayson Davies
- Jun 17, 2022
- 58 min read
Updated: Nov 17, 2024
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Welcome to the show notes for Episode 103 of the OT Schoolhouse Podcast.
Are you constantly wondering how to be more evidence-based when working in a school setting?
In this episode of the OT Schoolhouse Podcast, we discuss how using client-centered top-down approaches will allow for more evidence-based practices and what top-down approaches look like with children in the schools. We are speaking with the creator of the CO-OP approach, Helene Polatajko, Ph.D., OT Reg. (Ont.), OT(C), FCAOT, FCAHS, OC, and the creator of “A Guide for Implementation: Using the Principles of CO-OP to Frame a Top-Down Approach with School-Aged Children,” Lara Collins Barros, OTD, OTR/L.
Guests' Bios
Helene Polatajko, PhD, OT Reg. (Ont.), OT(C), FCAOT, FCAHS, OC
Helene Polatajko is an international occupational therapy scholar whose work focuses on occupations and enablement. She has over 300 publications, is the co-author to the Canadian Occupational Performance Measure (COPM), and created and developed the Cognitive Orientation to daily Occupational performance approach (CO-OP). She has presented in over 20 countries and has received many awards and distinctions, such as being named a Fellow of the Canadian Academy of Health Sciences, the Muriel Driver Lectureship, and election to The American Occupational Therapy Foundation’s Academy of Research.
Lara Collins Barros, OTD, OTR/L
Lara has been a school-based OT in the Chicagoland area for over 25 years. When completing her OTD at NYU with the mentorship of Dr. Polatjko, she created and developed the CO-OP Principles for Participation which is an evidence-based guide for implementation that uses the principles of CO-OP for school-aged children with a top-down approach.
What you will Learn
Listeners will learn the principles and guidelines of the CO-OP approach and how they apply to school-based OT
Listeners will learn how the CO-OP was developed
Listeners will learn the difference between the behavioral approach and the cognitive approach
Listeners will learn more about top-down approaches
Listeners will learn about guided discovery and the role a supportive adult plays in the process.
Quotes
“I created these guidelines to show there is a way to be evidence-based in the schools” -Lara Barros
“We want to learn something to know what we can do. Not to know what won't work” -Jayson Davies
“Collecting your own evidence is so important”-Lara Barros
“CO-OP is problem-solving. You have a goal and have a kid get as specific as possible… and observe the actual performance”- Lara Barros
“In CO-OP, generalization is a major focus. Taking the skill, whatever that skill happens to be, into the place that it needs to be in the real world, and building on that skill so generalization transfers” - Dr. Polatajko
“The thing about guided discovery is being very careful about just the right challenge” - Dr. Polatajko
“By doing the task you will improve the component skills” -Dr. Polatajko
Resources
Episode Transcript
Expand to view the full episode transcript.
Amazing Narrator
Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host, Jayson Davies, class is officially in session.
Jayson Davies
Hello and welcome to another amazing episode of the OT school house podcast. So excited for you to be here today, and before we dive into the content for today and introducing our wonderful two guests that we have talking today about an amazing topic that if you've read the title of this episode, you are probably salivating, because you are ready to learn all about the co op model I know I'm ready to share with you. I This has been seriously, this was one of the best episodes I've recorded in a long time, and I'm really excited for you to hear about it. But before I do that, I want to give a special shout out. You know, you don't get to 100 episodes or 102 103 now without a little bit of help, and so I want to give actually, a special shout out to my brother in law. His name is James. We call him chemo, but he's my brother in law. He is my wife's brother, and he has been editing the OT school house podcast episodes for some time now. And I just thought you should know that. You know, I know some of you, some people reach out to me and they're like, hey, Jayson, I don't know how you do this all on your own. And the truth is, I don't do it all on my own. I have help. And so a special shout out to chemo for holding down the episodes, editing them, putting them all together, so that we can share them with you, and so that you can learn about school based occupational therapy every other week. And so I really appreciate it. Thank you so much chemo for putting this in. You're probably blushing as you edit this right now, you better not cut it out. But yeah, thank you so much. Kimo, all right, with that, I want to go ahead and actually introduce our two speakers. A lot of times I let them introduce themselves, but these two speakers deserve a little bit of an introduction, and so I'm going to start with Dr Helen Polatajko. I'm sorry, Helen, if I butcher that, I really tried. This is a hard name to pronounce, but you know, Dr Polatajko is a she's an occupational therapist from up north in Canada, and she has done amazing things. It wasn't till about five minutes before I jumped on the episode to record this that I also realize that she is actually the brilliant mind behind the Canadian occupational performance measure, the copm. Yeah, you know, it's not every day you get to hop on a call with the creator of the copm. And it's not just within the field of occupational therapy that she is known for her brilliant contributions. She was actually appointed as an Officer of the Order of Canada in 2021 and she is also a fellow of the Canadian Academy of Health Sciences. In addition to the copm Helen also developed the co op approach. The Co Op approach stands for cognitive orientation to daily occupational performance, and that's what we're here to talk about today, the co op approach, and how that applies to school based occupational therapy. So let me introduce our second guest on today, Dr Lara Barros. And Lara actually was an understudy, if you could call it that, of Helen. She completed her OTD with the support of Helen. Now, Helen lives in Canada and Laura lives in Chicago. We're going to talk a little bit about that and how they got connected. Got connected down the road, but now they have worked together, and Laura has actually put out a guide to using the principles from the co op approach within school based occupational therapy. So that's what we're going to talk about today, a little bit about the development of the co op approach and then how it applies to school based occupational therapy with both Helen and Laura. If you're listening to this and you've already registered for the back to school conference in 2022 you might have seen Lara's name on the list of speakers. Laura is going to be talking at the actual conference, going more in depth about the co op approach within schools, but we're going to talk a little bit about it today. If you're interested in the back to school conference and you're listening to this before August 26 2022 head on over to OT schoolhouse.com/conference to get registered now, or at least learn a little bit more about the conference. So without any further ado, I'm going to bring on Helen and bring on Lara, and we're going to talk all about the co op approach. So go ahead, get comfortable, or if you're driving, keep your eyes on the road and just listen. And while you do that, I'm going to transition us into our interview with Dr Barros and Dr Polatajko. Hello, Dr Polatajko and Dr Barros. How are you doing today? I will go ahead and let's start with Dr Barros. How are you doing today?
Lara Barros
Doing great. Thank you.
Jayson Davies
Anything special going on today?
Lara Barros
Not really, not here. Mardi Gras, I suppose, right.
Jayson Davies
Yep, yep. We are recording this on today is March 1. Right. March 1. Yeah. Happy March, everyone. I. And what about you, Dr, Polatajko, how are you doing?
Helene Polatajko
I'm doing fine. Thank you.
Jayson Davies
All right. Did I say it? Right? Polatajko.
Helene Polatajko
Almost, Pola, as in Paula, you know? And then Tyco.
Jayson Davies
Tyco, Oh, right. Thank you so much. Names are difficult, you know, we try our best, but names are difficult. So thank you both so much for being here today, and you know, rather than asking you how you all got started and found yourself in occupational therapy, I actually want to start with a different question, and that is, what is one of your most fondest memories of being an occupational therapist? And Lara, would you like to go ahead and start.
Lara Barros
Sure, Why not? I would have to say that one of my most favorite memory, or memories of being an OT was when I was doing my OTD. I had just taken finished a course where we had to kind of try to create, like our own kind of guideline, right? So we had, so I had created this with a partner, or this thing about, kind of a self monitoring thing for the classroom and all this stuff. And then the next semester, I took a course where we went back to the theories be, you know, the the models that are that, you know, are the foundations for OT. And I turned the page, and I found the cognitive orientation, daily occupational performance, the the co op approach. And I was like, I just, I just can remember, like, reading the description over and go over again thinking like, how, you know, anyway, just thinking I had found gold, right? So something that like I, I guess the, you know, younger people today say I was, I felt very seen when I started reading that so.
Jayson Davies
Well, that's awesome. I'm hoping that when we, as we go through our conversations today, I'm hoping that there's many people that are listening that will feel the same way, because we are here to talk about the co op approach, and so that is awesome. Now I have to share a little story before Helen, I asked, What's your most fondest memory is, because I was, you know, we were scheduling this podcast, and I had no idea that I was about to jump on a call with the creator of the copm, the co op model, and you have just done so much for our profession. So first I want to say thank you, and also, like I said, give you that opportunity. If you had to pick one thing, what's kind of your most fondest memory as an occupational therapist?
Helene Polatajko
Yeah, I don't know if it's a memory. I guess it's a memory. I guess it's a memory, but it's certainly a moment. My most favorite moment, and it has to do with the words that Lara just used, which is about being seen. Is when I was a young therapist, my first job ever, I worked on what was then called a back ward where the children that nobody has any hope for are placed and basically forgotten about. And one of the children on that Ward was this little boy named since she his real name was Jesus. But I guess, because it's a very Christian environment, people decided not to call him Jesus. So they called him since she and since he was a little boy. I had cognitive delay, of course, slight, slight, very slight. CP, very few words, the most amazing smile. And every morning, when I came to work, as I opened the door to come on to the unit, he would run across the corridor, jump into my arms and kiss me, hello. Oh, that is my ot moment of all time.
Jayson Davies
That is awesome. You know, it's amazing that you know, no matter how much you create in this world, no matter what books you write, journals, you write, podcasts, you create. It's those memories that stick with us a lot of times, the ones that that that kid that we we touch their life in some way. So thank you for sharing that. I really appreciate that. So I just mentioned before you answer that question, that you're the creator of the copm, however, Dr. Barros Lara over here, she is not in Canada. So how did you two come to work together?
Helene Polatajko
Well, if you want me, I'll go first.
Jayson Davies
Sorry. It's open ended.
Helene Polatajko
From my perspective, how we got together was Laura sent me an email saying, Can I talk to you? And I said, sure.
Jayson Davies
yeah. And Lara, you want to add to that?
Lara Barros
Yeah, I mean, that's basically it. I had taken the introduction course, and I reached out to my, one of my instructors, and was like, you know, I'm trying to use this in the school. I want to make sure I'm doing it with fidelity, right? I want to make sure I'm doing it well. And then, um, probably within what, like, an hour, we were connected. So it was, it was amazing.
Jayson Davies
Wow, you know. And I'm in, yeah, go ahead.
Lara Barros
I'm in Chicago. Helen was in Toronto at the time, right? And I was, I'm in school at NYU online. So.
Helene Polatajko
Who knew? And it was in the depths of of COVID. So everybody was on Zoom. Anyways, really matter who was where?
Jayson Davies
Yeah, absolutely. And that's what I love about podcasting, YouTube, the internet has made the world just much smaller these days, and it's quite amazing. And you know that that story also just shows that, you know, never be worried about sending an email, a cold email, out to someone. You never know what that person is going to. Respond. I mean, yeah, some emails get lost, but no one looks at an email and, like, purposefully says, No, forget that person. I'm not going to respond or anything. At least not very often. For the most part, OTs are very kind, and we're open to receiving emails and and and getting back and especially when it comes to working on an OT project about something that you've created, I would imagine that you're very eager to help people when it comes to the co op approach. How many other I'm sure you've had other OTD students and whatnot that you've worked with, anything stick out as far as a specific program that you helped develop that was really great?
Helene Polatajko
So not a lot of OT students, because there are no OTs in Canada, doesn't exist. That's right, but lots of PhD students who've done various pieces of work around Co Op, you know, one that comes to mind was a woman by the name of Sarah McEwen, who was a physio with 15 years experience in stroke, and she was working as my research assistant, and she kept looking at this stuff, and she's saying, you know, this should work with with stroke. This should work with stroke. I think this should work with stroke. So we ended up doing a stroke study and looked at Co Op and stroke, and she and we've done a number of other since. And then one time I got an email. I had done a co op workshop in London, England, and I got an email from one of the participants who said, you know, I work with kids, young adults, sort of teenagers, young young people with severe dystonia. And, you know, Co Op seems to work with all kinds of kids, and there's nobody knows what to do with people with severe dystonia. Could we please try Co Op? And that's generally how it happens. Somebody sends me an email or asks me a question, or I go to, I do a workshop, and somebody in the audience says, What about and because my dedication is always to research, if I my answer to What about as always, well, we either have data, or if we don't have data, are you interested in doing the research?
Jayson Davies
That's a good way to look at it. That's a great way to look at it. Let's, let's get some data. Awesome. Well, yeah, yeah. We are here to talk about the Co Op, the cognitive orientation to daily occupational performance approach. So I want to dive right into that. For many people listening, this might be the first time they've ever heard those six or so words put together. They might have heard Co Op, but not necessarily know what it exactly means. So Helen, I want to give you the chance to actually just share kind of your elevator pitch for Co Op. When someone asks you, what is Co Op, how do you respond?
Helene Polatajko
Well, first, I want to talk about the word daily in there, because it's cognitive orientation to occupational performance. Was the original name. And we, and I work a lot with colleagues who are not OTs, and they know I work in pediatrics, and they say, Well, really, you're doing occupation with children, that seems a bit odd, like, aren't there laws against that? And so I said, Well, I'm talking about the stuff they do every day, and how does the word daily in front of the word occupation work? And everybody was happy. So that's why it's daily occupational performance and and it is daily occupation performance, but because it's all about figuring out what we can do to help people do the occupations that are important to them to do. And it's using it's a top down approach, and it uses their own cognitive strengths, their own abilities, to identify strategies that help them be able to accomplish the tasks, the goals that they want to accomplish.
Jayson Davies
Gotcha. And it sounds very occupational therapy, so I love that. And going a little bit further, and you can answer this question as well as, how did the co op really come to be into existence? What What drew you to creating this model?
Helene Polatajko
So I'm a researcher, and I'm a clinician and I'm a researcher, and I had my PhD was in the area of sensor integration. Very excited about it, because it was such a hot, exciting topic at the time. And my research, my early research after my PhD, was all on interventions that therapists were using, because mostly people do them, and there's not a lot of data. And I'm very, very married or dedicated to getting data. So I started doing a whole bunch of research studies, and the joke in my lab kept being that my P value was larger than my T or my F, and if you're not a stats person, it means that there is no result like basically it makes no difference. So after doing research for several years where everything I did made no difference, clinicians were starting to not want to work with me, because it just kept showing that what they're doing doesn't work. And so out of frustration, I decided that, you know what, we're going to stop looking at helping and I was, I was always in pediatrics, we're going to stop looking at helping children do better by using these sort of various sensory, motor, neurosensory, motor, neurodevelopmental approaches. And we're going to do what I used to do with since she, you know, the little boy, when I worked with sin, she, we were a behavioral unit. We use behavioral principles. And I was frustrated, because I know I can take a child. An IQ of about 20 and teach him skills. I can do that using a behavioral approach very simply. It's hard work and it's long work, but it's not hard to do, not as intellectually hard to do. And now I can't take a kid with a DCD or clumsiness who's got an IQ of 120 and I can't teach him how to write his name. That just doesn't make sense to me. So I decided to abandon all of those things and go to a behavioral approach. But because we were talking about kids with, you know, normal or better IQs, I didn't want a straight behavioral approach. I wanted a cognitive behavioral approach. So that's how we got to co op.
Jayson Davies
I want to ask you to ask you to actually go a little bit further on that cognitive approach versus behavioral approach. How do you kind of delineate the two?
Helene Polatajko
So a cognitive approach, a behavioral approaching, was all about observable behavior, stimulus and response. So you do something, you do a response. I reinforce it. It increases the likelihood of occurrence and and if you do, if you don't do it, I don't reinforce you, and it decreases the likelihood of reoccurrence. COVID behaviorism arose some years ago, many years ago now, because what they started to notice is that when you were doing these studies, if you told the subject, and these are intellectually normal people, if you told the subject what the reinforcement schedule was. And, you know, the research on what reinforcement schedules do and what kind of behavior they create, and how that behavior works, whether it's a scallop effect or a step effect or what have you that clear, that research is well established. It's very clear. So what they did was they would tell people what the reinforcement schedule was, and then they would actually implement a different reinforcement schedule than the one they told them, but the behaviors that emerged were consistent with the reinforcement schedule they were told, not the actual reinforcement schedule, which made it seem and that's the case is that The cognition, the thoughts, the thinking was actually controlling behavior much more so than the actual reinforcement schedule. Oh, interesting. And basically, that's kind of the birth of cognitive behaviorism. So now what we do is we use ideas to help you through your through whatever you have to do. And that's what Co Op is all about. It's all about cognitive strategies used to help you perform.
Jayson Davies
Wow. Thank you. That was a really good explanation. I appreciate you taking that and just going with it. That was great. Now, you mentioned how you kind of started with children and developing the co op approach. Was that simply because, at the time you were working with children, or was there a specific reason that you decided to go that route?
Helene Polatajko
Well, as I said, my PhD had been on sensor integration, and I had been working with kids with learning disabilities. And so the kids we were working with were all kids with learning disabilities, and as I said, I was getting very frustrated because we weren't having any effects on their outcomes. So we tried to identify an approach that would work with kids. So we used cognitive behaviorism. Drew a lot of work from Mike and bound. Donald, Mike and bound. I don't know if you're familiar with it, but gentlemen stuff, but he does a lot of cognitive behaviorism using problem solving techniques. So we thought, we decided, You know what? These are bright kids. They know how to problem solve. Who can use their skills as Problem Solver to help them solve these problems, their performance problems. So if you can't write your name, what is that about? And let's solve that performance problem. So that's how we started, and that was my population. All of my research had been in the area of DCD, so that's how we ended up working it with kids.
Jayson Davies
Great. Well, thank you. Now I want to kind of switch gears just a little bit and go back to Laura here, because, like you both mentioned earlier. It started with an email, a simple email to Helen about wanting to do an OT project, about Co Op. How did that turn into this project that you have where you created guidelines for school based OT? Lara?
Lara Barros
Well, Helen would probably say it was hours and hours of trying to figure out what I could do and what, what I could actually do, because the research was there, right? Because I originally wanted, I originally clicked with Co Op, because of, I see so many children with kind of regulation, emotional and regulation issues, and they can do everything, but they couldn't do anything, right? You know, you, you they have everything, but they can't perform. So, um, after a very, you know, a lot of a lot of thinking, I really thought that, you know, I created this guideline because I wanted to be able to, I want to be clear, too. It's not the co op approach that this, that this guideline is, it's that using the principles of Co Op, right? So if in order to learn the co op approach, you need to take a course. There are books. It's more in depth than my thing. It's more about using these principles to become evidence based in the schools. And I, you know, I'm a school based therapist. I've been at school based therapist for 20 some years. And you know, always, you know, therapists are always hearing, oh, like you need to push in, you need to do this, or you need to be evidence based. And I, what I found is that, you know, really great therapist I work with. Didn't were resisted pushing in because they felt like they felt like an assistant, right? They felt like they were being a paraprofessional, and they didn't know how to push in right, how to be in the classroom and feel like a therapist. And I also saw so many people still and still tied to these performance component, you know, like, not a bottom up approach versus a top down approach. So I wrote this kind of as a way for therapists to hopefully have at least one way to see that they can be evidence based in the school, right? You know, because I think there's in and one way to try to do it, right? I mean, yeah, I would like to say the best way, but, but there, you know that there is a way to be evidence evidence based in the school, great, and you have to completely change how you're thinking, right?
Jayson Davies
You gotta completely change how you're thinking to be evidence based.
Lara Barros
Yes, yes. Because, well, not to be evidence based, you have to, like, turn you should change what you're doing, right? Because most there, did you want to say something? Oh, you finished, and I was going to add something to, okay, yeah, because I think what you'll see, and I, like, I, and I did read, read research from this, like, therapist would say, oh, I want to push in. I want to do this, but it interferes with my ability to do these performance component like, you know, using playing games with, like, fine motor games, or doing these visual motor or visual perceptual task. I can't. How do I do that in the classroom? So they're kind of this disconnect of, like, of, you know, of what it means to be evidence based. Does that make sense?
Jayson Davies
Yeah, I think so. And Helen, I think Helen wanted to add on.
Helene Polatajko
Yeah, yeah. I think the in terms of being evidence based, this is sort of back to, you know, why do we even start with Co Op at all? Why did we created, being evidence based the evidence right now, and it's been there for some years, the evidence right now, in terms of Pediatrics, is that a top down, task specific, task oriented approach. That's what the evidence supports. The other approaches that have been around forever more, that are very bottom up. So, you know, improving your visual perception, improving your midline crossing, and proving your grip, improving your bilateral coordination, all of those approaches that do that one way or another, they don't have the results. They just don't have them the evidence doesn't support their use. So if you want to be evidence based, you have to go to top down approaches, because the other approaches just don't have the evidence behind them. Now, once you go to top down approaches, then how do you actually do that? And that's, I think, where, you know people like Lara are, because I think so, how do you do that? And that's where, if you don't know what you're doing with that, it does feel like you're just, you know, sitting beside the student, like the way a teaching assistant would, because you don't know what you're doing, but if you do know what you're doing, then a top down approach makes a lot of sense. And in particularly if you do a co op approach from a top down perspective, it makes a lot of sense. And I just want to add it to that, like, because Larry didn't say, but I thought he might, actually so how do we get from where Larry wanted to be, which was looking at self regulation, and how could we use co op for self for for self regulation the school system to using the principles of co op to help create guidelines for school based practice was through a process called Guided Discovery. Like, I don't know if Larry realized that that's what I was doing with her.
Lara Barros
Not, not obviously, in the moment, but yes, afterwards, I'm like, Oh, perfect. It was perfect. Yes, yes.
Helene Polatajko
So regarding her discovery, she says, I want to do self regulations. I want to do this. And then we start asking questions about it before, before you know it, it's, oh, I guess we should do these guidelines. Wasn't my idea? Was her idea?
Jayson Davies
That's perfect, yeah, because, you know, I'm a master's thesis advisor, so I have four students at a local university that I work with, and yeah, it's kind of the same thing. You know, they come to me wanting to know what I want them to do. And that's not exactly how research works. We have to look at the literature that's already out there and find those gaps, and then kind of move from there. We can't just kind of say, hey, I want to go after this. We need to figure out what's actually out there, right?
Helene Polatajko
I have to say, you're lucky if you students come to you saying, What do you want me to do? That'd be great. Most students come to me and say, I want to do this. Can you help me? That's usually how it works. That's how it worked with Laura too.
Jayson Davies
Yeah, I, I think that's, you know, they do kind of come and say, I want to do this, but I have to re guide them, kind of what you're talking about a little bit, I think, to to look at what's already out there, because they might want to be doing something, and then they realize, oh, that's already out there. Or, you know, they can't find any research on it. Well, why do you think that might be one thing that I am a little not judgmental about but you know, if you read an article, the conclusions are typically going to be, this works. We don't often read articles that say this or, okay, maybe not, this works, but we think this is going to work. We need to continue doing evidence, but we don't read articles probably because they're not really published that say. Eight this didn't work, and that's because they're not getting published, necessarily. And so, you know, there's a lot to look at an article, read and take away from it, and also what you don't get.
Helene Polatajko
My PhD dissertation was that this did not work result. And it was, it was initially very hard. It was, it had to do with ot stuff. And it was initially very hard, in fact, impossible, to get it published in OT but I did get it published in developmental medicine and child neurology, which is, you know, better journal anyway. But it's hard to get negative data republished for sure.
Jayson Davies
Yeah, I bet. I mean, no one again we want to read something to learn what we can do, not necessarily to learn what isn't going to work. So, yeah, all right, so we've kind of already dipped into this. But Laura, if you had to say you had one two main goals for your capstone project putting these guidelines together, what would you say? Those were.
Lara Barros
Um, I would say something that was, like action oriented, not just like thinking like thinking like something that was actually, I feel like I'm in the point where I'm like, I don't want to hear about what I'm supposed to do. But like, how do I do it, right? And, like, and also seeing people around me struggle with that, like, how do I do this? That would be the first one. And then obviously, I mean, like, I I said this before, when I found Co Op, it was just connected to where my brain was, you know, I have, we can go when we go into some of the principles we can talk more about, you know, just wanting to have the child's voice in it, so much more, but also having it be more than an instinct, but have it be like real that, you know, this really does happen. I think that was it, um, that child center in this, you know, just a way to collect evidence as well. You know, to collect your own evidence. Like, I think as a OTs, we're always asked to collect data, and you're taking data on stuff, and you're like, you know, I don't know that what this data I'm taking is not particularly useful to anything or anybody. So I think the other thing was, is that using Co Op and using the P, Q, R, S, which is part of the process is you can collect your own evidence, like you said about reading articles. You know, even if you find an article that's like, oh my gosh, it's so close to what I want to do, it's this, there's always something that makes it not be completely applicable to your population or and no matter what, you have a kid in front of you who's not like that person in that study. So you, you know, collecting your own evidence is is so important.
Jayson Davies
Absolutely, and I want to move on, but I also want to stay on that with collecting your own evidence. What do you do within your practice to collect that evidence? Are you writing in your daily notes, a little you know, two out of three attempts were complete, or whatever it might be. Are you using some sort of computer programmer? What does collecting data for your own evidence look like for you?
Lara Barros
Well, I think that's probably jumping a little bit just because we I think we should talk about the co op approach being like, starting from the goal right leave. Does that make sense?
Jayson Davies
Perfect. Yeah. I like. I tend to get ahead of myself sometimes. Yes, we will get there.
Lara Barros
So I don't know if we're at the point where I can just go ahead and say like, like, so it's a top down approach, right? Co Op, and so you start with the goal you don't like, rather than going and like testing, Oh, you don't do like, the VMI. You don't do like, Oh, let me check out the classroom. You don't, you don't do all those things ahead of time, you said you have a conversation, it can be the copm, right, and you could say, Hey, what are you know, what do you want to do right with a kid and and sometimes in the school as well, we don't the goals don't always come from a student, right? A lot of times the goals come from a teacher, something that the kid has to do right, or is expected to do, and so, but always finding the time to kind to translate into something that the child has decided doesn't, you know. So, so maybe the teachers like, oh, they need to write like this much. Well, then you talk, you know, there's this conversation that goes on. What do you if you had to write this much, like, how? You know, what would you want to write about? You know, whatever. However you get to the child's goal, you have to start with a with a goal from a child.
Jayson Davies
Awesome. Yeah, I completely love that. It's, I always tell people that the first thing we really need to do is develop that occupational profile, right? We always have to start with the occupational profile, and part of that is realizing or understanding why the child's even being referred to us. You know, there needs to be kind of that overarching what, what are we looking for? You shouldn't just get, at least, in my opinion, the teacher shouldn't just say, hey, I need an OT referral for Johnny, and then we just go look at Johnny, like, what are we looking for? We need to know what the concern is, what the goal is, like you just mentioned. So absolutely, we're going to continue that, but I want to go one thing backwards, one step, because in the guidelines that you have, you pointed out three very particular participants, and two of those, I think, makes complete sense. You have the occupational therapist ourselves. You have the student, obviously we were. With the student. But then you also mentioned a support adult. What do you mean by the support adult?
Lara Barros
Okay, and that is part of the co op approach, right? So it's not something unique, and I didn't, I didn't make that up, but the supportive adult is really the person who I mean. First of all, they're your go to person, right? Like in general, right? This is somebody who needs, who has to be able to see the kid do what their goal is, right? And so this person is going to be your ally. They will, they will be the person who helps with the generalization and transfer, and also kind of actually report what it looks like when you're not there, right? And so they can help. You can actually teach the adult, this supportive adult, how to do Guided Discovery. Because I think what we see in schools, from OTs teachers, everybody, everybody wants to see a kid be successful, right? And so we go in there and we sharpen their pencil, just right. We like, you know, tilt their paper, so teaching this person what Guided Discovery is all about, and what you're doing, leaving a plan. I mean, I think it'll all make sense later that they'll they'll be the person that is the one who can report back to you. Does that make sense? And it could be that teacher, it could be the in the schools. It should be someone in the school, and you can also have the adult, the parent or the Guardian at home. Yeah.
Helene Polatajko
If I can add some Co Op has four basic goals for any intervention, those the same goals for all people, for all our clients, the first goal is the person's goal. So whatever that person wants to do in Co Op, we usually ask for three goals for lots of reasons. We can talk about theoretically, if you like, but we usually ask for three goals, but it's got so the first thing is goal achievement, goal attainment. So whatever that goal is, you know, riding your bike, riding your name, playing Nintendo, catching a soccer ball, kicking a soccer ball, whatever your goal happens to be. So that's always. The first goal that we have within Co Op is that we achieve the goal that the client wants. The second goal we have in Co Op is that the client learns strategies. They learn to use a problem solving strategy, which is a meta cognitive strategy, and they also learn to use domain, domain specific strategies. We can talk about all of those things, if you like. The third goal is generalization, and the fourth goal is transfer, generalization, and transfer is about the child or the client being able to do the thing that they're learning with you and OT out there. And then transfer is about the client learning how to do the thing they learned with you in OT and then related skills or different skills. So I know when I was a therapist, when I was a practicing clinician, and the teacher would tell me, you know, that kid has real trouble focusing, or real trouble, you know, using a pencil or stuff. And I used to be really, really proud, because when I worked with the kid in my sessions, he was fine in my sessions. He paid attention the whole time, like I had an hour session, he was with me for the full hour. I don't know what's wrong with that teacher, because he can't keep his attention right. So that's about generalization. That's about if I can manage your attention for an hour, what can I do so that you can take that ability to attend into the classroom? And mostly we don't worry about generalization. But in Co Op, it's a major, major focus, taking the skill, whatever that skill happens to be, into the place it needs to be in the real world, and then building on that skill. So generalization transfer,
Jayson Davies
that's great. I really like that, because kids don't go to school to get therapy. They go to school to be in education. And so if what we're doing is only helping them in the OT room, then we are not necessarily meeting the goal for that student when it needs to be done in the educational setting, right? So perfect. You mentioned some problem solving. And I know, Laura, you've had some several different pieces of the puzzle when it comes to your guidelines, and a few of those guidelines really revolved around problem solving. So I just want to let you elaborate on those principles a little bit more.
Lara Barros
Yeah. So really, Co Op is problem solving, right? So you have this goal, you you try to get the kid as specific as possible, right? So recently, let's say I have a, I have a girl who wants to cut paper. She has to cut every you know, her spelling words out, right? She wants to cut it, but the the she's really bothered by the sound of the paper, right? So, for cutting for some reason, right? So this is something that she's identified. So she wants to be able to cut neatly, whatever. So get it as close as possible, right? The goal is, is as specific as possible, and then to actually observe the the actual performance, right? So sometimes in the school, you might have to have someone record it, because you're not there exactly when it's happening, right? So if possible, you can to do that and then, or, you know, in any way, so you want to observe the actual performance. So that's part of that's the first thing. That's the dynamic performance analysis, right? So you're watching it, and you're kind of, you're recording, and this is where the p q r, the first p q, r s, comes into right? This the performance quality rating scale. So. Then, based on what their goal is, you watch their performance, and then you determine, on a scale from one to 10 how close they are. You know, where, where is their performance at on this, on this self identified goal, right? And then, and then what you do is, then you you identify the breakdowns, right? So you're not saying like, Oh, they're too weak. They can't do this. You're saying, Oh, she cuts off the line, right? You just, you, just, you do whatever. Just an observe, an observable, observable behavior that you can see, versus trying to think back and like, try to sound like technical, which I think is OTs. I think sometimes when, when we don't know what to do, we try to sound more technical, right? And so I think it was kind of a relief, too. So you say, you might say, Oh, she drops the scissors, right? She she stops, and she shakes her hands a lot, like something, what are you seeing that's interfering with her? Be able to her being able to do this. And so that's the first thing, right? You watch this performance, and then, like Helen just talked about guide discovery, which she so cleverly did on me before I was very good. Is that and then is the process of helping the child? First you want the child to i to kind of identify their own you discover their own breakdowns, right? So helping them kind of see whether or not see what's happening. Do you know? You know, kind of was, did it work or not? And, you know, let's see why, you know, why? What do you think might have gotten in the way, kind of a thing? And then helping them, helping guide them to their own strategies, right? So let's say, if someone's I think, um, Helen always gives that example, which is a pretty good example for kids, right? Is the like, you know, so many kids try to write and their papers moving right? Like, they're not holding the their hands, not down their papers, moving their writing, so just doing things super like helping guide them. And then, like, I guess I'm jumping ahead. That's a bit of an enabling principle, right? So you're kind of showing them. You're showing them however they need to see, so that they can they can be one. Oh, wait a second, my hand needs to, you know. So you're trying to doing what you do best as an OT that you typically would have done on your own, guiding them to figure out on them by themselves. I love that. I know Helen can probably say it a lot clearer than that, but.
Helene Polatajko
the example of the paper moving thing is, is, is one of the first kids we worked with, and we're working with the child, and we're working on handwriting and the kids writing. And of course, he's not stabilizing his paper, because they don't. Many PCD kids don't. He's not stabilizing the paper. And so from a Guided Discovery perspective as a therapist, I realized that he needs to stabilize his paper so, but from a Guided Discovery paper, sorry, perspective, I say, Huh, that's really interesting. And the kid kind of goes, what's interesting? And you go, Well, I don't know. Like, I don't does this. I wonder if that happens when I write. And the kids like, What are you talking about? What are you talking about? We go, Well, when you write, the paper moves and the kicker? Oh, really, yeah, does the does my paper move when I write and the kick? So then you write, and, of course, you very, very blatantly, slap your hand down on top of the piece of paper so that it doesn't move. And the kid says, No, your paper doesn't move. And then the next question is, does that matter? Like, does it matter if your paper moves or doesn't move when you're rent right? And then eventually, the child discovers that he needs to stabilize his paper, and that he has a helper hand to do that with. And then homework, the homework becomes so this helper hand, and this is a true all the all my stories are always true, by the way, I don't make them up. And so this kid, his his homework was to go home and find five other things that you can use your helper hand for and come back and tell me next time. This is the generalization transfer piece that we're talking about, right? And so it seems like opening up a bag of popcorn or a bag of potato chips or, you know, buttoning my dress, my shirt, whatever. So five things, and then the next piece of homework was and the other thing I want you to find out is, does everybody in your family have a helper hand? And you know what happened? He came back and his brother didn't have one. And you know what? He wasn't going to tell him.
Jayson Davies
He wasn't going to tell his brother that he didn't have a helper hand.
Helene Polatajko
No, and he wasn't going to tell his brother that there is a helper hand.
Lara Barros
about his brother.
Helene Polatajko
He was going to let his brother struggle.
Jayson Davies
Figure it out on his own, huh?
Helene Polatajko
Yeah, BCG tends to run in families, right? There's a genetic component. To DCD. And so if he, if he's got DCD, somebody is likely to have DCD in that family. So when you send him home with the homework, it's likely that somebody's going to come back and not have a helper hand.
Jayson Davies
Interesting.
Lara Barros
Yeah, and I was going to say, like, with my example, with the scissors, she noticed that she really holds onto her scissors really hard. She really grips them really hard. So and like, one of the things about the school is we don't have 45 minutes right to work with a student, so we had to kind of leave it at there. We we talked about, okay, that you hold your I wonder if that's what's making cutting so hard, right? And not not the exact words, but then also saying, Okay, well, why don't you, why don't you go over the next week and play around with like, what happens when you hold your scissors different ways? Or are there other things that you hold really hard that you that if you if you held them lighter, you could still actually hold them and it would work better. So that was this girl we didn't get to, like the final thing, right? But we're able to use what she discovered about her performance and have her work on it through the week. And actually, I was supposed to see her today, but she was today, but she was absent, so I don't know how that worked out.
Jayson Davies
That's all right next time next week. You know, I really like the conversation we're having right now, because I feel like there's a lot of occupational therapists out there, not just in the schools, but in general, that feel like, if we're not hands on, then we're not doing occupational therapy. And I'm sure you you could both speak about this, and I'll give you that chance in a moment. But, you know, I'm thinking about a girl that I've worked with who she got so frustrated. She was trying to, I think we were cutting. She got so frustrated, she just threw the paper and the scissors down on the table. You know, me trying to do hand over hand in that moment would have been pointless. But doing something like what you're talking about, you know, helping her to guide through what's going on and see where the trouble points are, I think, would have done wonders. So, yeah, do you want to talk about that idea that if we're not doing, you know, hands on therapy, that's still occupational therapy. Helen.
Helene Polatajko
Sure can. I want to say two things about that one, in terms of the frustration piece, right? So from a Guided Discovery purpose, and this is why Lara said, before you know what we're going to we can talk about Co Op, but it's not going to help you figure out how to actually do it. Because one of the things about Guided Discovery is being very careful about just the right challenge, right? Because you don't ever want to get the kid or the whatever client, because we keep saying kids, and I know this is about ot school, but co ops, not just for kids. You don't want to ever get the client to the point of frustration, because from a behavioral perspective, then they're not going to want to do this ever again, right? So you want to be able to change the way you guide your discovery sufficiently that we never get to that point of frustration. And you want to be able to predict how that's going to happen. You also don't want to do the opposite. You also don't want to make it so simple that the child gets the sense of, Well, this is like, you just made it so easy for me. Like, it's not doesn't really matter, because, like, you're really the one who's doing it. I'm not really doing it. So you want the child to have ownership of the solution. You want to have the child ownership of figuring out what's going wrong. And you want the child to have ownership of figuring out that this is working well. So that's one thing, the hands on thing. And you know, I have to stabilize you, or I have to hand over hand, or whatever. My comment about that, and therapists ask about that often in workshop, my comment about that, I give if you're if it requires you sort of stabilizing the child's hips, let's say to do whatever. Are you prepared to like be with that child, 24 hours a day, seven days a week. And if you are great, then let's use stabilization. But if you're not, then you have to think of different way to do it.
Jayson Davies
So real quick, I want to just push back, just for the sake of conversation and talking it out. What about using some sort of an adapted chair or something just going along with that? What would you say about that?
Helene Polatajko
I would say, and how many pieces of adaptive equipment sit in the back of people's cupboards, right? So an example we have is, and this was an older Well, compared to kids, but young, 45 year ish, older, 45 year old gentleman post stroke, about three, four years post stroke, who had been riding, who used to ride his bike all the time, and then during Co Op, he decided that he'd like to learn how to ride his bike again. And one of the problem from a dynamic performance analysis perspective, one of the problems with his bike riding is that, due to the stroke, he had lost all sensation in his right foot. So when he's riding his bike, when he tries to ride his bike, he has to stare down on his foot to guide the foot into onto the pedal and to keep it on the pedal, because he needs to use visual guidance. He can't do it from the sensation of the foot. So if you suggested to him, and somebody had that, you know, we could give you a bike, and we could give you an adaptive bike, and he's, no, I don't want that. I don't want anything like that. But that gentleman, because he was into bike ride. He happened to watch the Tour de France on the weekend, and all the professional bikers use toe clips. So no, he did not want an adapted bike, but he absolutely wanted those professional toe clips. So off he goes to the store, buys the best possible toe clips, gets the man on his bike. And now all we need is some visual guides to get his foot into the toe clip, and after that, he's home free.
Jayson Davies
Don't forget, you also need to get your foot out of the toe clips. Otherwise, it's not good.
Helene Polatajko
Getting out. He was fine, but getting into this, yeah, yeah.
Jayson Davies
Perfect. All right, that's great.
Helene Polatajko
Adaptive equipment is only as good as if the person wants it. If the person wants the adaptive equipment, by all means, but if the person doesn't want it, what's the point?
Jayson Davies
Yeah, and I think we often, I mean, just as a whole, as OTs, or if you're in schools, the IEP team, we often forget about that, that piece, you know, the kid is not sitting there, often in our IEP with us, and we have to take into account how they might feel with whatever we're doing, because especially when you get up into middle school and high school, those kids care so much about the perception that they receive from others. And you know, we had a 1617, year old with visual difficulties, and the last thing he wanted to do for his social image was sit in the front of the classroom. And so we had to come up with another way. Otherwise, you know, he would have sat in the front of the classroom and then totally disengaged. And so.
Helene Polatajko
From a guided perspective, Guided Discovery perspective, you shouldn't you shouldn't be saying we had to come up with a totally different way. You should be saying we had to help her or him come up with a totally different way. The way that they felt that child's health was important.
Jayson Davies
And that's what was key for me. And because we're sitting in this IEP, and he's not there, and so that's what I'm talking about. We're trying to come up with an idea, and I had to bring that idea to the table. You know that because I had had those types of conversations with him, and he's that's how I knew to let the team know, you know he's not going to want to sit up there. We need to include him on this. So absolutely, this leads perfectly into, I think, the next question, which also Laura, it's going to feed back into where you left off with the copm with that student with the scissors, using the scissors and cutting. Where do you go from there? What type of service models fit best? I kind of think I already know the answer, but I want to let you establish a little bit more.
Lara Barros
Well, this girl is actually just an RTI kid, so like a response to intervention, just somebody, she happened to the teacher reached out because she had tried giving her she's a fourth grader. She had, the girl had, actually, it's kind of kind of funny, because it fit perfectly into this. She had the girl identified three goals on her own right. She had, she her, she has a y in her name, right? And she would reverse it. And then she also was having a hard time writing when she would write a times like from a math problem, like four times three, it would turn out to be a plus, and so she was having a hard time writing that, so that, and then the cutting piece. So really, she, this wasn't, this is an RTI kid. She came with her three goals. We didn't even really have to do much of an occupational performance or a profile, right? She she had them, and the teacher had already tried, like the basic like, giving her handwriting, she'd already done what the teacher could do, right? She'd really tried. And so, I mean, RTI, it's perfect for RTI, which, of course, that means that it's, it's perfect for a direct service, perfect for pretty much everything. The only thing it's would be hard for, unless you're recorded for, is, you know, just a pure consultation, where you're only talking to the teacher. It just requires more, more talking, right? Like in more more work on the back end, where, if you actually, the best way is to actually be able to physically see that the student that.
Jayson Davies
Yeah, yeah. So then collaboration is what often comes to mind, you know, getting into the classroom, potentially sitting close to the student. And I want to be careful, because collaboration is there's a difference between collaboration in the classroom versus, in my opinion, a push in one on one, where you're almost, I don't know when I think of push in one on one, I think more of that. It's pulled out. It's just in the classroom I'm going to be there as a support person, like you talked about earlier, versus a collaboration model, getting in there, making sure that we have all three people involved yourself, the student and the support person, likely the teacher or even a potentially an aide, helping with the with the process. Does that make sense?
Lara Barros
Yeah. So, like, what comes out of this dynamic performance analysis, obviously, with the Guided Discovery and just helping the student come up with their breakdowns, is a plan, right? So this student creates a plan, and how are they, you know, okay, this is, this is the, you know, like, I guess, with Helen with her paper, right? It would be like, Okay, I when I you she might not have had to do this, but, like, when I'm writing, I will put my hand down on the paper, right? It doesn't have, I mean, so there's a plan that goes back to the teacher, right? So, in. Sometimes it's or the support person. So that's like another piece of the collaboration. So even if you were to pull the kid out and work on this, you come back to the class with a plan. No matter where you stop, you come back. Well, this is what, this is where we're at, and this is what we're going to to focus on. Like, just Monday, I think I have a I have a little, I have a little kindergartner who he holds, you know, he holds his pencil very high on the on the pencil. And so we did some, you know, Guided Discovery, like, you know, way, where does it feel best, like, have his hand all over. And then I took a picture of where he said it felt best, right? Again, we're still in the middle of this right now, and the problem I'm having now is he's having a hard time understanding, like, how he would even get his pencil to look like the picture, right? He's, he's, he's not there yet, right? But he's, but we're in the process where we're, we're starting this. It's not always, like a 20 minute thing where they're like, Oh, I do this and look, it's magically done sometimes, especially with a this is a kindergartner, and he's also a kid with some language challenges, like both English as a second language, as well as just me having a hard he's he's got some articulation challenges where so it's hard, like the communication is can be a little bit challenging. So I guess I can't remember the question. Now, go ahead.
Jayson Davies
We were going on and talking about the process you were going through. So you know you had identified the concern, and now you were going through the, sorry, you're going through the Guided Discovery, and then trying to figure out problem solutions and helping him to.
Lara Barros
Helping him figure, yeah. So basically, what we're noticing is that, you know, he was having a heart. This kid was having a hard time writing in between the lines, right? And knowing that when you when you know, when you hold the pencil the very end, at the one side, that it's really hard to control, like, we just played around with, like, is there? Is it? Could this help if you held it somewhere else? Could it help? And then? So, that's what. So he's still in the process. So this is that was still his. His homework was to, kind of, to see, you know, to play around with that if it mattered where it was, hand was on the pencil.
Jayson Davies
Okay. Gotcha, now, let's go kind of full circle, because I started too soon with the data part, but now we've kind of watched through that process a little bit so and maybe a different example. It sounds like you're not quite there with this kiddo yet, but with another kid, OT, what does it look like down the road, a little bit when you get to that part to see if what you did actually worked?
Lara Barros
Okay, So then that's, well, it's the DPA is a continual, like iterative process, right? So you keep, you keep doing it, you keep doing it, and then you come up with a plan, and then you have the kid try it like in their real environment, right? And then kind of report back, Hey, is your plan working? Yes or no. And then at that point, I would either, I mean, it depends on the kid and depends on when you can do it, either get a teacher report back, right that yes, this is, this is working, or go in and observe, or have somebody record it to see, and then, then you would score it based on that. And if, of course, if it wasn't working, that'd be another time to go in and watch and say, what's what's going on? Maybe there's something that we didn't notice the first time that's happening. Or maybe, you know, a lot of times, if you fix, like, one thing, other things will resolve, but not all the time, right? So, um, so just always going in and looking and seeing the actual performance as much as possible, right? So that you can, because otherwise you can't pull in that environment piece, right? So maybe, maybe the kid next to him is, you know, is irritating him, or, like, like you said, you know, any, anything that might, that might impact performance, really?
Jayson Davies
Yeah, and I want to ask you a question. There's no right or wrong answer the to this, I don't think. But when you take data, do you like to take data every single session? Do you like to do it once a month? Do you like to really, maybe quarterly? What does that look like for you?
Lara Barros
I think that depends on the student. I would say, like I would like to take, you know, I'd like to take the data when I'm when we feel like, when the kid feels like they have, they're trying out a new perform, you know, they're ready to show me. Then I'll do it with a p, q, r, s, yeah, that Gotcha. But I think it depends on the kid. It depends, and it also depends on the actual task they're doing, right? Something like, like the girl who's making the x's and pluses, right? Like, mixing them up. Like her, I did it, like we did it the first day. I mean, she once we fixed her. Why? Or we, yeah, once she figured out how to fix her. Why? She, then she, it was like, Oh, I we were like, Oh, I wonder if that plan that you had to fix your Y, I wonder if that will work, that strategy will work to fix your x right, like that, right? And so then, so then I just took data afterwards to double check and make sure it was sticking. Because otherwise, you know, I mean, like we said, just because they can do it in your room, right, it does not mean that they can do it in math class. So, yeah.
Helene Polatajko
some therapy, some therapists like to, so this is what Laura is describing. Is the pkrs performance rating scale. So we you know, how well is child performing this now on a 10 point scale and then at the end of your sessions, or whatever, again. But some therapists like, or for some kids, they like to do that PQRS with the child every day, right? So, so how good was that x yesterday? Or you could do something like So count how many times, how many x's did we make, and how many of them were the way we were perfect, the way you want them, and how many of them were not so perfect. So let's count how many perfect X's you did. I remember this one child we were working with handwriting, and the therapist, child was was doing really badly, and the therapist was getting frustrated. The child was getting frustrated because there were just so many mistakes, like so many mistakes, right? So I went back and I said, Well, how many were good letters? And then what we did was we kept track of, how many good letters do we do today? And what we kept track of was how many, not me, the therapist and the child. And then what we kept track of, we even graphed it, because that kid like that idea. So we've been graphed how many good letters? So what percentage of all the letters you wrote are good letters, right? It just changes everything. And we and what makes this and sometimes this A is a good a and this A is not a good a. So what's the difference between this two? What makes this a good a well, because it goes up higher, or it goes up lower, or the circles rounder or and once you start talking with kids about these things, they know it. They can tell you it's not like they have sensory perceptual deficits, and they don't even know the difference between a good circle and a bad circle. They know the difference between a good circle and a bad circle. But you can get them to do their own data recording, and then you've got for your charts.
Jayson Davies
Yeah, I just keep thinking to myself that I love how it's there's that client centered self assessment piece to it, and that seems to be a really key point, valuable point, to using the co op approach. Go ahead, Lara.
Lara Barros
Yeah, I was just gonna say, and I know that just a kid today I have who was looking at his handwriting, right? And he was just give, you know, you find out a lot about their self efficacy, right? Their self esteem. Allow this with it, because this kid was being terribly hard on himself, like, like Helen just said, but, and he hasn't been hard on himself in the past, right? So just kind of, I think it gives you when they're self assessing, it gives you a feel for where they're at and and something else to maybe, that maybe is a breakdown, right? Like, something they need to work on with this. So, like, how do we help him feel better about what he's doing? Because, I mean, I would just say handwriting. The main purpose of handwriting is so someone else can read it, right? Well, if I can read it, then that's pretty good, you know? So, anyway, so just kind of changing. I always try to, too, like with the kids, help them understand the goal of what it is like. Yes, you want to write neatly and everything. But why is it important to write neatly, right? So someone else can read it, right?
Jayson Davies
Yeah, you know, handwriting is not in the AO or, sorry, the OT practice framework as an occupation. It is not a occupation on its own. Yes, it is very meaningful to many of the occupations of, you know, learning, education, work, everything like that. But it is not an occupation itself. The the whole point, like you just said, we need to be able it's communication is what it really is. And so if you can communicate, then, then we're doing okay.
Lara Barros
I'm sorry. You can tell that's like, a like, something that sticks with me, because I do have this conversation with OTs all the time. It's like, who cares if they can hand write, right? It doesn't. It's like, the purpose is the written expression, right? It's really so that they can do this assignment. They can do this, you know, they can. I mean, I do love for a kid to be able to write their name, right? I think everybody, every parent, wants their kid to write their name. But beyond, you know, beyond that, other than, like, finding out what is important to the parents and family, like, you know, if they're supposed to, if handwriting is super laborious for them and they don't know what they're saying, like, why not see if the kid, maybe the kid might be interested, you know, in trying out, like, technology to see, especially since it's so available to so many students. So.
Jayson Davies
Yeah, and you know, we are getting a little far along in the podcast, but I had a question that I really wanted to bring up. And I know, I know Helen was really interested in this topic, because this is something that comes straight from the A O T, a community commune, OT, I should say, and it's about handwriting, where we were just talking about and someone anonymously posted and, well, I'm just gonna read it here. You know, they wrote that they found an A OTA document that stated, don't provide isolated training on the components of handwriting. And so their question was, is the research telling us not to use the interventions that address isolated component skills for handwriting at all. And what they cited here was actually a document that does come from a OTA that I don't know if it was the evidence practice type of stuff that they put out every occasionally, but there was a document and it said this. And so Helen, what would you what's your comments on this?
Helene Polatajko
Well, we've already talked a little bit about the evidence for top for. Top Down versus bottom up. Approaches and teaching the components of hand money is definitely bottom up. So I guess the question I would have for anybody who's listening is, let's imagine for a minute that you need hand strengthening, right? Because your hand fatigues when you write and and you need hand strengthening. So we do lots of lovely little exercises on hand strengthening, and now you've got your hands really nice and strong, and you've got great independent digit movement, and you've got great grip, even a lovely pincer grip. You've got it all. Everything's really good. Go ahead and play the piano. For me.
Jayson Davies
I can barely keyboard. I mean, like type, so yeah, that probably won't help me at all with keyboarding.
Helene Polatajko
So the point being, those component skills might give you difficulty doing a task, but if you don't know how to do the task, doesn't matter how good your component skills are, you'll never be able to do the task, and by doing the task, you'll improve the component skills. So if you need to learn how to write, then let's work on handwriting. And by working on handwriting, you're also going to get better grip and better pencil grip and better strength and all of those kinds of things. The difference between Co Op and other sort of handwriting programs, for example, or any direct skill training programs, is that the direct skill training, direct skill training works. We know that, right? The trouble with direct skill training is, after the training is over, it often fades down, like from an if you imagine the graph, so we didn't know how to do it. We're now doing it, and I know this is audio, and nobody's watching my visual, and.
Jayson Davies
We have a downward, a downward, right trend on a graph.
Helene Polatajko
Yeah, you have a doubt. So usually, you know you're you, the graph is going up because you're teaching the skill, and now we have the skill, and then therapy is over, and it plummets again. The reason it plummets again is because the skill, the task specific training, doesn't maintain, and it doesn't generalize, and it doesn't transfer. The thing that helps it maintain, the things that helps it generalize and things that helps it transfer are one motivation, right? If the child really wanted to learn how to ride a spike or learn how to write his name, he's once he's got it, he's going to do it some more, versus you decide that he's got to do strengthening of his hand. And then secondly, the activity, in and of itself, does that right? Like we talk about therapeutic use of activity, well, if y'all want to get a better grip, handwriting is a therapeutic use of activity, if you want to think about it that way. But the therapeutic use of activity does not become the skill, right? So it's kind of it's not that it's a two way street. It literally is a one way street. And then, so now we have the skill. If the child wanted that skill in first place, which is why we're client centered, then he's going to use that skill outside of the therapy room. And if you're going to start using that skill, then it will increase the ability to, you know, use his fingers or whatever. I think you said Jayson, that you had watched the TED talk with the girl on her bike riding. So one of the things, one of the side effects of her improving her bike riding is she actually had to start using she actually could get away with using her wheelchair a lot less, because one of the things that bike riding does for you is it increases the strength in your legs. So now she didn't need to lose her wheelchair Hardy at all anymore.
Jayson Davies
Wow, that's awesome. And yeah, for anyone out there, I will be sure to link in the show notes to the TED Talk that Helen gave. When was that? How long ago was that TED talk?
Helene Polatajko
Oh, I know, maybe three years ago now.
Jayson Davies
Okay, so still pretty recent. Seems like forever ago, but that's that's not too long ago. All right, yeah, I will link to that so you can all watch Helen share the story about a teenager who used the Co Op, who they collaborated. The team collaborated, using the co op approach to to support this teenager in riding a bike in super happy.
Helene Polatajko
The teenager who had wanted to learn how to ride her bike since she was five years old, because her whole family was bikers. She lives in Ireland, actually, and she had, you know, in fact, you can. She's given speeches on this stuff. She'd done chord strengthening, she done all of those kinds of things, and still couldn't ride her bike. And even though her family, as I said, her bikers, and she's trying to learn how to ride a bike since she was five, she's with 15 at this time. And she learned how to ride a bike in 180 minutes, she became an independent bike rider in 180 minutes.
Jayson Davies
That is very fast, very fast. Wow. Yeah, I was just watching, hoping that she knew how to use the brakes at some point, she's got this. Yeah, she's got the pedaling.
Helene Polatajko
Yeah. This is a young woman with just with severe dystonia, such severe dystonia that she had actually had to have a brain implant to try and control the dystonia.
Jayson Davies
Wow, wow. Okay, so yeah, we will be sure to link to that so anyone can watch it. And you know, TED talks are nice and short, and they're always fun to watch. So yes, we will be sure to link to that. All right, I want to wrap up, but I have one more question, because I think this is important in the guidelines, Laura, you kind of mentioned the importance of being in a supportive environment. And I just want to ask you a little. Bit about that, what should OTs kind of look for? But also, how can they support a supportive environment? How can they create a supportive environment within their schools?
Lara Barros
I'm trying to think, like, the best way to say this, well, I think one, one thing is, is to really become a part of the environment, right? To become a part of the school. I know it can be hard if you're like, in, I mean, I right now I'm in five different schools, right? I've had the luxury of being able to be with some of them for years. But it, I mean, it is tricky. I would say the best way is to talk to people, right? Is to talk to people is, I think the first thing is, is to, once you start collaborating, once you start asking the teachers, like, what their goal is and what that's going to what does that really need to look need to look like? You start to build these relationships with them, and then they start to understand more what you do. Because I think for many teachers, and Jayson, you might agree, and I'm sure you do Helen, that, like, what ot does is a mystery. They're not sure what they do, what you would do. And I think administrators, people who are administrators right now, we're mostly teachers in the heyday of working on performance component skills, right? The OT is the one who brings in these fabulous activities. They're so cute and they're so fun, but like, so just getting in there and kind of trying to change the perception of it. So I've, you know, what do I do? Like, I, you know, I joined book clubs, right? We, I, you know, I go in there half an hour early a week, and I join book clubs. And what I find as an OT is that these teachers that I work with are a lot more similar to me than I would have ever thought their their wishes and their hopes for these kids are the same. And then just take, I think, really, once you take the time to listen, right, and you take the time to show them, I guess the biggest thing I've noticed is when, as soon as you show a teacher that, if you ask a student, hey, what do you think, how do you think you should you should do this, right? Even if you don't go through the whole Co Op thing, right? If you just say, like, hey, how do you think this works? And then they, like, you teach them how just to even ask the kid. Because I think teachers feel this huge weight, and I think in OTs as well, feel this huge way to be a problem solver, like, I have got to fix this for this kid. But sometimes it's like a five minute conversation with a kid, and they, they know what, they know what they want to do, right? Like, what if I do this? Okay, well, let's try it, right? Like, so I think, I mean, I think it's just, it's about relationships as always, as far as in, in being present as much as possible, right? Is, I know it's hard, but.
Jayson Davies
Yeah, no, I completely agree. And one thing that I like to say is the the power of a quick win. And I think something like so many of the examples you've given today, that could be an easy, quick win that you do in front of the teacher, and the teacher sees it, and that teacher is now knows what to do the next time she sees a student not holding the paper, holding the pencil incorrectly, they know what question to ask, or they know what little accommodation to use. And teachers love that so much. I sometimes joke that us as occupational therapists, we go and we sit in hour and a half, two, hour three, hour long training sometimes. And when I go to conferences with my wife, their trainings are like, their sessions are like 30 minutes long. I'm like, Wait, how are you doing anything in 30 minutes long? But teachers are used to that. They're used to getting just what they need, not necessarily all the research behind it. And if we can give them exactly what they need. It helps us to develop a relationship with them, which, again, that supports a supportive environment. So.
Lara Barros
Yeah, yeah, I can say one quick, more quick thing, really, that is also tying it into something they're already doing, right? Like, so when I'm working with you know, I mean, most of what we get handwriting and regulation, right? Those are our two biggest things. Like, Oh, I can't get this it. So in my district I'm in, they use the ruler program, which is out of Yale, they use this mood meter. So if I can, the more I can get them to understand that sensory in quotation marks, right? Is no different than this mood meter here, right? Like, it's, you know, like, and bringing that cognitive piece into it, I think, like Helen said earlier, like the nothing magical is going to happen. So like, I know a lot of teachers are doing gold noodles. They're taking, you know, movement breaks, but hey, the reason why we're doing this is to bring the energy down in here, so that the kids actually are they start to understand why we're doing this stuff, not just like, magically thinking it's going to happen. So that's another thing, is tying it into something that they're already doing.
Jayson Davies
Absolutely. Teachers don't want more work. They want less work, and if you can make it easier on them, they work exactly, exactly. All right? Well, we have been talking for a long time. I don't know. Maybe this will even be split up into two episodes. I don't know. Once we edit it, we'll figure that out. But it's it's obviously not long enough for someone who really wants to understand Co Op we talked about a lot, but as I think, Laura, you said earlier, you know you really need to actually go through the training if you really want to understand this. And so with that, where should people who are interested in taking that next step? Where should they go? Where can they learn more?
Helene Polatajko
The thing about the co op. Approaches. We're researchers and clinicians, and we care about people doing better. We're not marketers, and we're not great business people. So if you want to, if you want to learn about the co op approach, there is a free half hour video that through the University of Toronto that you can go look at any time. It's free for anybody who wants to go look at it through the University of Toronto, the occupation, Toronto, the Occupational Therapy Continuing Education tab, I think, other than that, you can take a co op course. There are, there is an online course, again, through the University of Toronto, that you can take. But mostly what happens is people organize training courses, and we don't organize them or anything, but people invite us to come and set up training courses. We have, you know, over 50 instructors, Co Op instructors around the world, and we do training courses in the various languages. So, you know, in in Hebrew and in French and in Italian and Dutch and Swedish and whatever. So basically, you can go to the website, you can find out you know who are the OTs in your neighborhood, or you can invite me and Laura, I'm sure, or be happy to come and set up a course, and we'll teach you how to do Co Op.
Jayson Davies
Awesome. And I'm looking at the website. It's, I believe it's the I Can Co op.com.org, sorry.org, so that's an area to at least get started with learning a lot more about what Helen just said. And who knows, maybe we'll organize specifically something for the OT school house that would be fun, too. So maybe we can even work something on under the next step. Laura, would you like to say anything else about what to do, what would be the next step for a school based OT?
Lara Barros
Um, I would say what I've told my friends, right, is just um, is start by just starting, you know, asking a kid what they want to work on, what is their goal. So, starting, starting there and then, and just, you know, just wait for what happens after that. Once you, once you start, including the kids more than, I mean, you'll be hooked, to be honest. So, so, yeah, do that. And to obviously, top down, right, like to start let go, like, let go of your bags, let go of your hours of treatment planning and and just go in and and be with the kids where they're at.
Jayson Davies
That sounds like the perfect sentence to end this podcast on. Thank you so much for sharing. I really appreciate you both being here. Helen, I see your finger up. Go for it.
Helene Polatajko
Yeah, yeah. I just wanted to end the COVID the podcast with a slightly different end, and that is Co Op, we said, is a problem solving approach, the meta cognitive strategy that's used in Co Op is goal. Plan. Do check, What's my goal? Your goal today was to have a podcast. What was your plan?
Jayson Davies
I put questions together, and I was going to ask you questions.
Helene Polatajko
You put questions together. You invited us. And did we do it?
Jayson Davies
We did.
Helene Polatajko
And check, are you done? Are you happy?
Jayson Davies
I am not done. I've got to edit it. I've got, I actually got a lot to do, but I am happy with how this conversation turned out. So excellent.
Helene Polatajko
Right? So your plan is multi step, and we've only done a few of the stuff. Absolutely we've got a way to go. So goal plan, do check away to go. Oh my god, is the check.
Lara Barros
That is, that is absolutely amazing that we went for like, an hour and a half without saying. Goal plan, do check. I have I don't even know how it happened. Yeah.
Jayson Davies
Goal plan, do check. Alright, we got you check. Sounds good. Laura, Helen, thank you so much for being here today. I really appreciate it, and I look forward to staying in touch with you all and watching the co op approach continue to move forward. It's been a pleasure, all right, and that is going to wrap up this episode of the OT school house podcast. I really hope you enjoyed learning a little bit more about the co op approach. Thank you so much to Helen and to Laura for taking the time out of their day to spend about an hour, maybe even more, with me talking about the co op approach. It's quite an amazing approach. It's very client centered, and it really does help. As you heard from Helen and Laura, they are using it throughout their careers, and yeah, it's it's just something worth learning more about. You can learn more about the co op approach for yourself at I can Co op.org or if you're also interested, check out the OT school house. Back to School conference at ot schoolhouse.com/conference where Laura is actually going to be presenting about the principles of the co op approach and school based ot until next time, take care. Have a great rest of your day, your week and your month, and yeah, I hope to see you in the next episode of the OT school house podcast. Take care. Bye.
Amazing Narrator
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