Episode 101: School-Based OT Within the OT Practice Framework
- May 23, 2022
- 46 min read
Updated: Aug 28, 2024
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Welcome to the show notes for Episode 101 of the OT Schoolhouse Podcast.
In OT school, most students are tasked with doing a deep dive into the OT Practice Framework, better known as the OTPF. But have you taken a second to reflect on the OTPF since you landed your school-based OT job?
It is important to periodically go back and review your practice as it relates to the OTPF, especially when it is updated (like it was in 2020).
In today's episode of the OT Schoolhouse Podcast, we are taking a look at the OTPF and how school-based OT fits within the OT Framework with two of AOTA's Commission on Practice members who helped to write the most recent iteration of the OT Practice Framework.
Joining us today, we have Susan M. Cahill Ph.D., OTR/L, FAOTA, and Julie Miller MOT, OTR/L, SWC. Susan and Julie are both lifelong OTPs who love our field and have volunteered with AOTA in a number of ways. Have a listen to learn more about Susan and Julie and hear how the OTPF-4 came to be and how school-based OT fits into the equation.
Additional Links to Show References:
Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. Am J Occup Ther August 2020, Vol. 74(Supplement_2), 7412410010p1–7412410010p87. doi: https://doi.org/10.5014/ajot.2020.74S2001
And a big shoutout to each of the Commission of Practice members who had a hand in the OTPF-4
Cheryl Boop, MS, OTR/L
Susan M. Cahill, PhD, OTR/L, FAOTA
Charlotte Davis, MS, OTR/L
Julie Dorsey, OTD, OTR/L, CEAS, FAOTA
Varleisha Gibbs, PhD, OTD, OTR/L
Brian Herr, MOT, OTR/L
Kimberly Kearney, COTA/L
Elizabeth “Liz” Griffin Lannigan, PhD, OTR/L, FAOTA
Lizabeth Metzger, MS, OTR/L
Julie Miller, MOT, OTR/L, SWC
Amy Owens, OTR
Krysta Rives, MBA, COTA/L, CKTP
Caitlin Synovec, OTD, OTR/L, BCMH
Wayne L. Winistorfer, MPA, OTR, FAOTA
And Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA Headquarters Liaison
THANK YOU!
Episode Transcript
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Amazing Narrator
Hello and welcome to the otschoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development now to get the conversation started, here is your host, Jayson Davies, class is officially in session.
Jayson Davies
Hello everyone. And welcome to Episode 101 of the otschoolhouse com podcast. You may be able to hear it in my voice, but I'm still reeling with energy from episode 100 where Sarah came on and actually interviewed me on the OT school house podcast. It was so much fun, I want to once again say thank you so much to Sarah for interviewing me on my own show. It was a very unique experience for both of us. It was the first time, I think, no, I don't think it was the first time she might have done it for someone else, but it was the first time being interviewed on my show, for sure, and it was the first time for her being the host of the otschoolhouse podcast, I really hope that you all enjoyed getting to know me a little bit better and hearing a little bit about Sarah as well. Today we are moving full steam ahead, and I have an episode for you that I think you're really going to appreciate. I had the opportunity to actually interview two of the members of the commission of practice from aota, or actually former members of that commission who helped develop the newest version of the OT practice framework, the fourth edition. So today, I am super excited to welcome to the otschoolhouse com podcast. Julie Miller, who is an occupational therapist, and Dr Susan Cahill, also an occupational therapist. Both of these guests have had a profound career within our profession of occupational therapy. They may live in different parts of the country, but together, along with the help from many other occupational therapy practitioners, they came together and wrote the otpf four, which has a major impact on everything that we do as occupational therapy practitioners. So I'm actually going to let them introduce themselves a bit. And yeah, you don't want to miss this episode. We are going to talk about the OT practice framework and how this all comes together for us as school based occupational therapy practitioners. So let's go ahead get into the meat of the episode. Here is Julie Miller and Dr Susan Cahill. Susan and Julie. Welcome to the otschoolhouse podcast, how are you both doing today?
Julie Miller
Doing well.
Susan Cahill
Great.
Jayson Davies
It's always interesting when I have more than two guests, because I have to remember that I can't just leave an open ended question like that. So let's go ahead and start. Susan, how are you doing today? What's going on?
Susan Cahill
Doing great. Thanks for having me here.
Jayson Davies
Absolutely. And it's a pleasure having you here. And Julie, we just realized that you are just on the freeway for me in Pasadena. How are things down in Pasadena?
Julie Miller
So far, things in Pasadena are probably similar, sunny,
Jayson Davies
looking good. So, Julie, you're in Pasadena. Why don't you go ahead and just start by sharing with us what you are doing as far as occupational therapy down here in Southern California?
Julie Miller
Absolutely. So my current position is, I'm the clinical director at pcda, which stands for professional Child Development associates for a non profit therapy clinic in Pasadena. Occupational therapy is just one service we are offering here, but it's really fun to be an occupational therapist, but also in a director role.
Jayson Davies
Awesome. And so in that director role, can you just kind of pull that apart a little bit? What does that entail?
Julie Miller
Oh, so many things I didn't ever realize that might entail. So I was actually the head of our Occupational Therapy Department here for about 12 years before I moved into this role and just a staff ot one of the department prior to that. And so had a really fantastic kind of upbringing in a multi multidisciplinary setting with other fields of practice to collaborate with all through my career, which was so fantastic. Then when you move into a leadership role, oh, you suddenly realize there's so many more details about what we do that we need to know. So now I'm far more involved in our funding streams, our contracts, communicating with our state funding systems and our insurance contracts, signing all the the financial behind the scenes paperwork for all of those school contracts, just all of all of that piece and then through covid, so much of my time really went to really breaking down what was going to keep our staff safe in those experiences and continue to deliver really high quality care throughout that experience. So that's the last two years has really been that's been top of what I've been doing.
Jayson Davies
Wow, yeah, you know, and at the otschoolhouse com, we often, I mean, we talk a lot to the people that are on the ground level, the actual clinicians, but yes, kudos. Appreciation to the people that are trying to keep us safe while trying to provide that effective therapy. So that's a lot. It sounds like you definitely have your hands full over there.
Julie Miller
Yeah. But I also do carry a caseload.
Jayson Davies
Oh, my goodness, what?
Julie Miller
Well, that's the fun part, I really enjoy all of it, but it's a part of the structure of this organization, is that we all also carry a caseload. It helps us really stay grounded in what we do. And so, you know, as we are making the adjustments between telehealth and in person care, I also was managing a caseload while I was doing a small fraction comparatively, but still really keeps me grounded in what is that we do as occupational therapists, and helps me better make decisions for my staff as well knowing what it's like for myself to go through those.
Jayson Davies
Yeah, absolutely. That's great that you actually do get some of that without just trying to make decisions without any know about what's going on at that level. Awesome, slightly Great. Well, Susan, why don't you go ahead and share with us a little bit about the world that you are in with occupational therapy right now?
Susan Cahill
Yeah. So I'm the director of evidence based practice at the American Occupational Therapy Association. I've been here since the summer of 2020, so that was an interesting time to transition. I do work from home. I'm based in Illinois, and so prior to joining aota, I was an MS ot program director and a faculty member at a couple of different universities. And then prior to that, I was a school based occupational therapist and also a school administrator in Illinois. So I oversaw the special education services for and related services for two school districts here in Illinois.
Jayson Davies
Sorry, I just had to pause because I'm like, I need to have you on for another podcast just to talk about that last part you said about being an administrator and overseeing a little bit of special education. That is, that's a whole nother topic in general, but that's really cool. Thank you for sharing that. So today we are here to talk about the otpf, the OT practice framework a little bit. We have the director of evidence for aota. We also have Julie Miller here, who was part of that. And I guess my first question is, how did this kind of come to be, where you guys came to work on it? I know a lot of people came to work on this together. It wasn't just you two. We just can't have 20 people on the OT podcast at the same time. So I don't know who wants to take this question, but kind of, what drove the otp for to come to be I know there's series of them. So what drove that to come, and how did you end up, kind of working together along with all the other people that came to work together with it?
Susan Cahill
So I can take this one. So the Commission on practice for aota is really the the body that works on updating the occupational therapy practice framework. And the first version of the otpf was actually published in 2002 and that replaced something that some listeners might know was called uniform terminology. So if you graduated otschool prior to 2021, or, you know, and before you probably were familiar with uniform terminology. And that document really just focused on sort of delineating and defining occupational performance and occupational performance components that were part of OT practice. But the framework really sort of fully articulates OTS distinct perspective and the contributions to promoting health and participation among persons, groups and populations through engagement and occupation. So that's sort of the difference, maybe, between the two documents. And then the OTPs is reviewed on a five year cycle by members of the Commission on practice, it undergoes, actually, an extensive review process by the members on the cop. And then we also seek input from outside members as well. And then the revision starts. So we're in the fourth version now, the current version of the otpf that was published in 2020,
Jayson Davies
awesome. So yes, as you kind of refer to there are just so many people that come together. You mentioned the term cop. Can you explain, though, in just a little bit further? Yeah,
Susan Cahill
Yeah, so the CLP, when we're going to be using it today, stands for the Commission on practice. We know that there are also communities of practice that use the initial co p, but when we're talking about it here, we'll mean the Commission on practice, and that's really the body that come together to develop all the official documents for the association, the otpf being one of them. But And Julie, you might even have more current topics related to those official documents that are being worked on right now.
Jayson Davies
Yes, so Julie, how do you play into this? Everything?
Julie Miller
Sure, yeah, I actually, I joined the Commission on practice in 2019 so that's how I came in into this discussion. I was encouraged by a colleague to join the Commission on practice. So I applied and joined right as the commission was really finalizing the otpf Four. And so it was really a fascinating experience to join in at a time that I will acknowledge most of the heavy work was done by the time I joined. They were really in the final revisions, clarifying some of the tables, working on the glossary. But the fascinating part that I continually impressed by is that every time that there was a review process and members, external folks were given opportunity to give feedback to the document, how much was really taken into consideration, time after time after time. You know, emails would come in, and there we would be at the Commission on practice meetings, going through them, really trying to decide, did this review? Did this comment fit to the section we were talking about? Did this comment actually further the document in some way was that information found somewhere else within the practice framework. So it was really, you know, amazing to see how much time and attention really goes into listening to member feedback and stakeholder feedback to make sure that the practice framework really models who we are as a profession. So that was how I joined. I'm currently still on the Commission on practice. We do have other documents currently underway that we're working on, and similarly, those are the other official documents on the same five year review cycle that we go through. And, you know, work with content experts. Some things are handled internally. Some most have external authors. And similarly, those documents go up for review. We fine tooth comb those review comments, go through them, see what we need to update or revise. So it's really a fascinating process. I'm really glad that I joined.
Jayson Davies
That's awesome. And, you know, I gotta hand it to OTA, because, you know, I have the otschoolhouse com and I am just dedicated to school based practitioners. Obviously, you both have some pediatric experience, but a OTA, when they make a document, you know, sometimes they focus in on one area, but the otpf is not that document. It is very broad. And I'm sure when you're getting feedback from people, you're getting school based OTs, you know, providing feedback private practice, people from hospitals, acute facilities, all of that. And so I can only imagine the amount of time and care that it takes to go through all of those and try and figure out, Okay, does this actually apply to what we what we're talking about here? So again, thank you both for being a part of that.
Julie Miller
Yeah, absolutely, I would. I would add to that. I think that's why it's so important that the Commission on practice has really good variety of types of clinicians and practitioners from the field, because we all come with our background and our experience. So when we're looking at a certain document, how does that topic resonate from different areas of practice, different funding systems, different, you know, the context of our everyday experiences, and how did those documents resonate with everyone? It's really quite interesting. Awesome. Yeah, I can only imagine being a part of that and just trying to comprehend all the information coming in. And I'm sure it takes a large team to figure that out. Speaking of that, was I in the ballpark when I said around 20 people came together to write this as I mean, I don't know if you have the exact number, but that, does that sound about right?
Susan Cahill
Well, I looked it up. I looked it up because I wanted to make sure. So when there was some overlap between different groups on the Commission on practice, so some people's terms ended as others people began. So Julie and I, our terms overlapped when we were on the commission, but there was around 14 authors practitioners, right? So that's a makeup of ot practitioners, ots, and occupational therapist, and then also one staff liaison, and that's Deborah Lieberman, and she's the aota staff liaison to the Commission on practice. So when I was on the commission, I was definitely working in higher ed and just a member volunteer as well.
Gotcha,
Jayson Davies
Gotcha, wow. Well, I will, you know what I'm going to do at the end of this episode. I'm going to name all 14 people at the end of that document, because they deserve recognition for putting this together. So I will do that near the end. All right, so let's dive into the otpf a little bit. You know, when I like to look at articles, I think, you know, kind of like what they teach you in school, you know, do a little scan first. And the first thing that I noticed was how long this otpf document was. And I remember, I think we were in the second version when I was in school, although the third version is what I really remember the most, because that's kind of when I started to dive into research a little bit. And I feel like it's a lot longer than the third Bridget Hey, am I wrong about that? And is there just more charts? Or why do you think it's more extensive?
Julie Miller
Sure, I knew that this is my question to answer, and when I first read it, I chuckled with like, it's long, it is it's long, I think, like, like we just said a minute ago, how do we capture all of what ot practitioners do in our field, in all of our different types of settings that we work in? You know? How do we, how do we gather all that and stay true to what our professional identity is? So that that takes some time, and that takes some attention, I reached out similarly. I reached out to our AOT liaison, Deborah Lieberman, to say, how would you answer why this is longer? And you know, there are some pieces of that. This was a more significant revision than past times and particularly but the two major things I wanted to highlight first is this idea we added in this section of cornerstones of OT practice? So there's a section really about the cornerstones of practice, particularly with how an OT practitioner does the work between domain and process. So the thought that we have distinct knowledge skills, qualities that contribute to the success of our occupational therapy process, and then the corners specifically were identified as our core values and beliefs that are rooted in occupation, our knowledge and expertise in the therapeutic use of occupation, our professional behaviors and dispositions and our therapeutic use of self. So those were some cornerstones that, regardless of what context we were working in really consistent to really identifying who we were as occupational therapy practitioners. That's one area that took up some space. The other area that took up just length was that we really wanted to really make sure we were clearly identifying what do we mean by client. So in the document, every time we say client. What do we mean by that? And so a piece of that is really thinking about who is our client, in understanding that it could be a one on one client, it could be a group or it could be a population level client. And so if we really think about how that's different, of how we might articulate what we're doing between a one on one clinical session versus a group of individuals. So every time we needed to give examples, and we wanted to give examples of those three client pieces that those tables then got a little bit longer. So that's another piece that made just kind of the length get a little bit more notable, also the feedback that we got from members and the feedback that they got from students, that information in tables helped people apply the material Absolutely So rather than just a text heavy document as many places as they could, they were trying to add in the information in table format and with examples. And I think that's the part, when that part was done by the time I joined the commission, but when I read through, I just keep thinking about all of the members of the Commission who are trying to come up with examples for each one of those things. Then I think it really helps make the document more hands on and interactive, particularly for new practitioners to the field and students trying to understand that content.
Jayson Davies
I absolutely agree, and I didn't know that about the cornerstone. So thank you for interjecting that part, because we weren't even going to talk about that today. So I'm glad you talked about that. The one thing that I always go back to as well is, you know, our client, and from a pediatric perspective, whether you're in the schools or outside of the schools, we never have one client. You know, we have this kid, but the entire family, the teacher, the administrator, they are all part of the client. So I think that is very important for occupational therapists, especially you do have to delineate who your client is a little bit and now as school based, OTs, we're getting into more some of us are dipping our toe or going all in on RTI Response to Intervention. MTSS, and that is really getting into the larger picture of the entire school, potentially, and working with that. So, yeah, absolutely, we have multiple clients. And then the last thing that you touched on, I was just looking at it the last 50 pages. It's a 87 page document. Sorry, the last 60 pages of an 87 page document are almost all charts. And so as soon as you said that, I realized, yeah, every time I look at this document, I typically bypass the text and I go straight to the charts, because they help so much. So again, to the 14 people that all worked on this, thank you for the charts. Susan, I don't know would you like to add any, any additional comments on that?
I was just going
Susan Cahill
I was just going to mention the charts that Julie did it, but she definitely already did it. And I would just say that that really came up in some of the feedback that the Commission got when we were having people to look back at the OTS three about what were the pieces of that document that had been the most helpful. And again, those tables and charts were the things that were brought up and and we really felt like, instead of again having that text heavy narrative in the beginning, that it would be just so beneficial to put the information where people are looking and definitely be found when it came to defining and describing how the OT process worked with groups and populations, that people needed examples. So there, you'll see that there are a lot of the tables and charts that have separate columns for individual clients, groups and population.
Jayson Davies
Yeah, great. All right, so Julie talked a little bit about the cornerstones, but that's kind of one of the three big pieces within otpf. We also have the domain and the process. And so let's dive into the domain. Would one of you like to describe the domain and define that domain a little bit as it relates to the otpf and just our practice as occupational therapists.
Julie Miller
Sure, I can keep jumping on this one other piece that made it a little bit, not this, not markedly longer, but another piece that we were really talking about is, how do we visually represent domain and process and there's actually an infographic image within the OT practice framework that really was trying to get at, how do you visually represent how these pieces fit together? That was another piece that I joined into when I when I was on the commission, and there was lots of meetings of, how do we put this in a picture? Ultimately, the pictures end up being kind of concurrent rings so there's a Central Middle about achieving health, well being, participation through engagement and occupation being like this the central core. And then around that you would have the process or the evaluation and intervention outcomes. But all that circle all the way around the outside of that would be the domain, if that is context, performance patterns, performance skills, client factors, or the occupations themselves. I think it's really important to think about how they all fit together and how the domain really wraps itself around the process of what we're doing is that we're understanding what the domains of our profession are. So in domain, we have five pieces of that. So that would be occupation, context, performance patterns, performance skills and client factors. Do you want me to go in and describe those a little bit?
Jayson Davies
Yeah, I was gonna ask how they're kind of, are they fluid, interconnecting, or are they individual? And yeah, go for it. Sure.
Julie Miller
Sure. Well, if we think about each of these areas, we really as ot practitioners, we really dive in deep in understanding and defining each of these sections. And again, that's another piece. If you're looking at the practice framework and reading the text, it really goes through each of these just keeps lining them out. As we all know, as occupational therapists, that the idea that occupation is really central to our to a client's health, identity, sense of competence, and have some level of particular meaning or value to that individual. And then in that, and I know as a practitioner, sometimes we're asked to do one of these occupations, because the occupations could be ADLs, idls, health management, which was something that was added this time around, rest and sleep, education being one, work, play, leisure, social participation. And I know as a practitioner that sometimes I'm asked to work on like one of those. And that's the value of having this this document to keep reminding us, no, we work on all of these as occupational therapy practitioners, right? But there's sometimes funding or payment systems might pick out pieces. The next would be context. These are both environmental and personal factors which are specific to each client. Again, reminding us that client could be person, group or population, and they influence engagement and participation and occupation. How much do you want me to go into those? I can keep listing them up. There's so much
Jayson Davies
No, that's all right. That's all right. When I look at this, I'm looking at the image right now, and everyone you could find this image on page five of the otpf. And I see occupations, context, performance patterns, performance skills, client factors. And when I look at that, I see an evaluation. I see those are the pieces that I'm really looking at, when I do a school based, especially ot evaluation, I have to look at, you know, the environment and now virtual environment. I have to look at what the student they if they have a disability, what is impacting based upon that disability, their performance patterns, but then also what they actually care about. What does the student want to work on? What does the family want to work on? And a lot of that is just, I just listed terms that we might use every day, but those are terms that are part of this domain. And so I really think that it's just quite, it's quite an encapsulating image that you put here in this diagram. So I think that's awesome. Let's actually dive in. I wanted to get a little specific here related to school based occupational therapy. You know, I had a little a little exercise, if you might go along with me. And you know, you mentioned education as being the primary occupation per se for school. But obviously they also students being also engaged in social participation, play and even ADLs and so would you say that a child is constantly shifting from one occupation to another throughout the day, or does the occupation of education encompass these other aspects within school?
Susan Cahill
Well, I would say that definitely, students are shifting all across different occupations throughout the day. When I start to think about school based ot services, I like to start with the outcomes, right? And one of the outcomes that we're working on is role competence. And so I like to really think about all of this is in the context of student role performance. And so students in their roles, you know, children in their role as students, are engaging in education, for sure, but depending on the needs of the student, they're also definitely doing things in their day related to ADL, toileting, toilet hygiene, dressing for PE feeding and eating. Functional mobility. They're engaging in iadl, like communication, management, maybe they're taking care of a classroom, pet, maybe they're working on driver's ed, depending on the age of the student and sort of the setting, the school setting, also potentially meal prep, home management, task shopping, health management for any student with a chronic condition that has to manage the performance patterns to support their health, rest and sleep, for kids that are in early childhood who need to take naps. And then, of course, plan leisure, you know, on recess, in other types of school environments, and then social participation that's happening everywhere, in the classroom, on the bus, in recess, in the bathroom. You know, it's really happening everywhere. So to say that we're only focusing on education, I think, is sometimes limiting. And you know, idea really gives us the opportunity for providing occupational therapy as a related service, to address things that are educationally, developmentally and functionally relevant. And so that really gives us the opportunity, I think, to write goals and to address all different areas of occupation within the umbrella of education, really for the to support competence in that student role.
Jayson Davies
That's not fair. Susan, every time you started to speak, I was going to ask a question, and then you answered that question, that's perfectly fine. That's exactly how this should be. I love it, because you're right. We might feel like we get a little pigeonholed if all we focus is on the academics, the education within school based OT. And there is so much more to school based ot than just focusing on the academics. I mean, there's students and families that are in school and there, let's be honest, there are some families that could care less about the academics, because their student needs more functional output once they move on from school. And so if we were just focused on the academics, then would we be supporting these students? I don't know. But like you said, you have that functional aspect to it, which is, which is so important that we can be a part of. All right, Now we cover domain, and then we go into three processes, or three pieces to process within ot in the otpf, we have evaluation, intervention and outcomes. So starting with evaluation, what does the otpf really say about what we need for an evaluation?
Susan Cahill
So for evaluation, we know it's best practice, and we always want to start with an occupational profile, and then also do an analysis of occupational performance. And just want to plug one aota ebp resource, which are the choosing wisely recommendations, and one of them is very well aligned with otpf, which is, don't initiate occupational therapy interventions without the completion of the client's occupational profile and setting collaborative goals within the framework. And it's part of our choosing wisely recommendations. And I mean, we're really thinking about getting a great understanding of who the student is in that educational context, but also understanding how the family and the community influence, you know, how that student performs and engages in those occupations that take place at school. And then I think the collaborative goal setting part is really important too. So we oftentimes, I think, in the schools, that goals with the teacher and with the parents, but we can't forget that the child or the student is there, and that that child or student has goals too, and we have to really be thinking about how we can engage that child in that process. And I think occupational therapy practitioners are great at doing this, because we have the profile as a tool, and can really be a way that we can help to sort of ascertain what the child sees as priorities, if they're even identifying some of these things that all the adults are identifying as areas that they want to work on, or do they feel like they have bigger fish to fry, right? Maybe social participation is the thing that they want to address, you know? Or maybe it's math facts like we don't know until we really do that profile to find out what's making that kid tick? The other big part is the analysis of occupational performance, and this is really involved using assessment tools and strategies to measure the child's quality of performance and occupations at school. And so again, tools and strategies that can mean multiple things, depending on what it is you're specifically trying to assess, and that's going to come from the occupational profile, and, of course, also the conversation with the educational team in terms of those priority areas for the evaluation.
Jayson Davies
Awesome. Yeah, it's evaluations are multi pronged, but I love how you talk about starting with that occupation profile. That's exactly what I tell people. What I tell people when we're talking about evaluations, because we don't know where to go until we have that occupational profile. We don't know what we need to look for. A lot of times in the schools we might see on an IEP referral for OT and like, that's it. And we're like, Okay, well, why? What do you want us to look at? What is the team actually asking us to do? And so, until you develop that occupational profile, then you don't know where to go with the actual analysis to determine what skills are necessary, what occupations are we actually even even looking at? So awesome. Now I kind of want to put two pieces together. Earlier. We talked about client now we just talked about evaluation, and we kind of mentioned, I mentioned earlier that RTI piece a little bit. What might it look like for an occupational therapist to be going in and doing more of a larger evaluation when we're talking more of that community as a whole? Is that still very similar to, I mean, in process? Is it still similar to an evaluation of a single person, or does it look different?
Susan Cahill
Yeah, definitely. So in process, I think it really does look quite the same. So the occupational therapist is still really using the occupational profile and then doing that analysis of occupational performance, but you know who the client is, then is the thing that changes, right? So if you're looking, for example, let's say, like at the whole school community for more of like, a tier one style intervention, and you do your occupational profile, and you're collecting data from the teachers and the administrators to really understand sort of what is going on in terms of needs. And let's say they determine that it's like bullying in the lunchroom, for example, is something that they would like help to address. So the occupational therapy practitioner would look at all the different contextual factors that are going on, occupational therapists would make some decisions about what sort of data to collect, and maybe they're going to be looking at things like how the lunchroom is configured in terms of space, how long people are waiting in line, what they're doing after they're done eating, till the time that the bell rings for dismissal. And so it's trying to collect all the different information that's then to come up with a plan and to really determine, you know, sort of where the mismatch is between what's going on with the people at the environment. And then, you know, that bigger, larger occupation, so understanding what the school community values, again, thinking about what aspects of the context are supporting or limiting. And so maybe then the occupational therapy practitioner, you know, determines, or the occupational therapist determines that kids are aren't really talking to each other, they're not engaging in social participation in real life. They're only doing it, maybe virtually on screen. I mean, so maybe they want to start to work with the school community on some recommendations related to use of phones during lunchtime and and how they could potentially engage people during some calming cafeteria activities, or some games, things like that. So a lot of different ways to really address that. In addition to who's sitting with who, how the traffic flow is, getting kids to do something other than wait in line, could all be some some possibilities, but it would really be dependent on what's going on at that particular school. So when you do the occupational profile and this analysis, you sort of move away from these cookie cutter, sort of suggestions, and you really find the targeted response that's going to matter for that school, right in that community, or if you're going back to the individual level, that child in that classroom with that teacher this year, not sort of in general. And I think that that's really something that that we bring to the table, maybe that other practitioners or providers, perhaps don't.
Jayson Davies
Yeah, I mean that occupational analysis and the profile combined, really, that's what we specialize and we have that eye to really combine those two pieces, see them both individually, and then combine them, put them together to create a plan. Love that. Now, before we move on from evaluations, I have one more question, and this has been a I don't know that I've ever not heard this question every year that I've been an occupational therapist, and it has to do with standardized assessments being used in well, this in particular school based OT and we have some people who, you know, swear by standardized assessments. We need a standardized assessment. We can't do anything without a standardized assessment. Then we have other people who say that they're not functional and that what's the purpose of them? Because, you know, they're just giving me numbers, but they're not really telling me whether or not a student can actually succeed in the school, and so I just kind of want to ask for your opinion on standardized assessment tools. And I know I do not want anyone to speak for aota or anything like this. I don't think that would be appropriate, but yeah, what about what's your thoughts on standardized assessment tools within school Based?
Susan Cahill
I think standardized assessment tools are really one ways that OTS can collect information for the analysis of occupational performance, and we know the benefits of using those tools right? We get some standard scores. Sometimes we're able to compare with other assessment tools that have been done by other team members. Sometimes you get to compare the child performance to specific criteria, and in some cases, a standardized assessment tool, I think is the way to go. We definitely it also probably depends on what it is that you're assessing right? So I can maybe cut back to that in a second, but I think there's also a difference, and we can maybe educate team members on what's the difference between a standardized assessment tool and what's a formal assessment tool. We have many formal assessment tools that are not standardized in administration, because they allow flexibility to be used with with clients, and then the practitioner can grade them accordingly, so that the individual can be successful completing them and the right amount of information can be gained. And so that's one option I Think too. And OTS might also decide to do some structured observation, and that would involve having the student perform an activity or an occupation, and really doing that analysis to determine where the breakdown is in terms of, you know, performance, skills and components and things like that. So that's something to think about. I think too you mentioned RTI earlier, and when we start to think about multi tiered systems of support, the other thing that's really encouraged is progress monitoring. And so oftentimes we'll see some people favor progress monitoring data, if it's collected Well, favor that over the standardized assessment tools, because they're really actually then able to compare, you know, if they've got a lot of tier one data, that student against all the students in their local district, their local classroom, right and then, and really sugar. So a difference between how that child is progressing compared to the rest of the pack, and sometimes that information is very valuable. So that would be maybe another thing to consider in terms of assessment tool. The thing that I wanted to mention was that we have one more Choosing Wisely recommendation. I have to get my plugs in for that and just and I know many ot practitioners really provide sensory based interventions to students, but we do have a Choosing Wisely recommendation that states don't provide sensory based interventions to individual children or youth without documented assessment results of difficulty processing or integrating sensory information. And so this is so important. We know that many children and youth are affected by challenges and processing and integrating sensations, and that affects their ability to participate in school. But we also know that this is complex, and it has to really result in individualized patterns of dysfunction that have to be addressed in personalized ways. So we've got to have that stuff documented before we can move into intervention. And that when we think about RTI and MTSS is tricky too, because every teacher in the world would love a couple strategies that they could just sort of put into place. And we have to really be careful about thinking about, you know, sort of what's good in terms of, like, human development and, you know, child development in general. And then when we started to get really like movements good for everybody, right? Yeah. So when we start to get super specific about what these breaks might look like and what these options are, it gets a little bit dicey. We definitely want to have some documented evidence about what the needs are before we make recommendations.
Jayson Davies
That's a very good point.
Susan Cahill
Thanks for letting me get that plug in.
Jayson Davies
No, I have been really appreciating the choosing wisely campaigned. They don't come out as frequently as I wish they did, because I know a lot of work goes into them, but when they do come out, they are very impactful. And I think they get a lot of claps, you know, like, if they just, I'm thinking of the emoji, you know, the clapping emoji, just like when something like that goes on Instagram, it gets a lot of claps. And so I think that that's great. What I also appreciate, as far as sensory integration, is that we are getting more standardized tools coming out. We are getting the soci, I believe it's called from Dr Erna Blanche, and the easiest coming out, which hopefully will make things a little bit easier, rather than using the sift. And I think there's other tools. I mean, a lot of things are coming out. The SPM just got revised, and so it should be a little bit easier for people to get some of that data that you're talking about. So that's pretty cool. All right, so moving on from evaluation, whether it be sensory or whatever it might be intervention that is the next step and so, or at least within the process and in general, I guess. So, what does the otpf when it comes to intervention? What are some of the key points?
Julie Miller
Sure I'll take this one, and I think this is the part that I think is really amazing about what we do as occupational therapy practitioners, is each section flows into the next, so to try really hard not to be redundant, right? Think about all the work that we've done in the evaluation section. You have done. We've found some tools to measure what some of those performance skills look like. We've done the full occupational profile. I love that the two of you spent so much time talking about the occupational profile of how important that is to what we do and how we really understand that client or group's needs in the moment, so that we can make sure we're creating an intervention plan. Then that is meeting specifically the needs of that individual or that group specifically. And it's not just, oh, everyone who has this need, this is what we do for it, period, right? I think that this piece that makes us really different in the quality of intervention that we're doing. We're really thinking very specifically of what is needed for this person and how is this person's plan going to be established. So similarly, with the evaluation like we might really want to be including the teacher or other adults who interact with that student in throughout their day, there's also the piece about making sure we understand the family's needs, the family's interests, and that's true also for the intervention plan, so that they under so everyone understands what is it that we're doing together to help support the progress, like Susan said before, about how the students able to fulfill their roles in that setting, right? And so that the work that we're doing individually. Actually in the therapy process, is supporting that success in those roles. It's not just doing other things in that time, right? It's always going back to that itself. So, you know, sometimes it's looking at specific needs for performance. It might be looking at elements of the different context or activity demands, really looking at more of those client factors and making sure that we're using evidence to support those plans too. And that goes back again to everything that Susanne was just saying, is making sure that the the strategies that we're thinking we might use really are rooted in the research that our field has been trying to support and further as well. Similarly, we're not just randomly picking things on a whim and applying them, but we're really making sure that what we're doing is supportive to that client's needs and basic and science in our profession.
Jayson Davies
Yeah, and you mentioned the intervention plan, and personally in the schools, I see that as sometimes being a missing piece. We have the evaluation, and we have an IEP, we have goals, obviously, but there's nothing connecting those goals to the intervention, or at least nothing formal. And so I encourage all school based OTs, you know, you should have a separate document. Don't just rely on the IEP as your treatment intervention. You know, the IEP has goals, it has present levels and it has services, but it doesn't have the in between stuff, you know, the actual different things that you're you want to work on with the student in order to meet those goals. Sometimes I have, you know, well, I shouldn't say sometimes, all the time, I have my iPad up and I'm taking notes during the IEP and that's kind of what I'm jotting down. Also, what do I need to look up? What research do I need to go home or later, try and find based upon what we talked about in the IEP meeting? So that intervention plan is definitely a piece that we need to have, but I feel like, personally, I feel like, sometimes goes missing. We just kind of imply that if we have goals, then we have an intervention plan. So yeah,
Julie Miller
I think I would agree. I think that's a really important comment as well, to make that it's not just looking at the goal as written and repetitively, doing that thing over and over and over again, right? Is that we're using that goal as a measurement of the skills and roles that that we want, that students succeed in, right? And we do other, we do other intervention around supporting progress towards that goal as well.
Jayson Davies
Absolutely. Because, I mean, if we I'm just going to use it a handwriting goal, there's nothing that says paraprofessional can't ask the student to write letters, A through Z over and over and over again in the classroom. We have to do something different. We're not just doing repetitive practice. We are doing something that is skilled intervention, and that doesn't necessarily mean coming into the OT room writing A to Z over and over and over again. No, we're going to break that down, break it down into the components, potentially look at the context and build up. So yeah, absolutely need that plan before we move on from intervention. There's one key term that I really appreciate, and to this day, I feel like I understand it, but I would love more and and I know probably neither of you give you know trainings on this, but at least discuss a little bit the term therapeutic use of self. I'd love to just a little more information from you, potentially why this was such a key term within the practice framework.
Julie Miller
Sure, it's such an interesting piece to think of a value which is literally a cornerstone of our profession, and yet still sometimes, as an experienced clinician, we think, How do I explain that. How do I explain how I use who I am to help support these goals? And maybe also I'm going to embed in that how we recognize, how we might make assumptions based on our own life experience, which makes assumptions about other people, about their experiences. And I think that that's a piece to consider in therapeutic use of self, but it's how we can use ourselves and recognize about the exchange that we're working on. Really, what we're not doing is handing out. Here's your list of exercise do this. Really, rather, we're connecting, recognizing the emotional interaction that happens as we help facilitate change for that individual and for that client. And in that, recognizing the power shift that can happen between practitioners and clients, and really trying our best to minimize the power differential. In that, we're really trying to align side by side, we're doing this work together. So I was thinking about this, and I was trying to think of a really great example for you of you know what we might do. And something that comes up for me so often is, I think, when we're working directly with children, and the young children, so many of us as pediatric clinicians naturally get very playful and connect, and we try to make our work very meaningful to that, to that little one, maybe, right? I find myself really using therapeutic use of self more so when I'm connecting with that client's parent, particularly if that parent doesn't have a lot of interaction or get does an opportunity to see what's happening in the intervention or in the in the process of making sure I'm also using myself to help understand, help that parent understand. What is it? What occupational therapy is? What happens in our sessions? Why is this meaningful to them? How trying to gather more information from that family also so I can understand what's really meaningful to them that, you know, how that also helps us understand, how can I present this content in ways that maybe is more meaningful to this parent? You know, am I making my descriptions about occupational therapy as accessible to the parent and using that in part of that exchange? I don't know if that helped, or if Susan has any comments on that as well.
Jayson Davies
Yeah. I think Susan is, I think she's got something for us.
Susan Cahill
Yeah. So I was gonna say, you know, I think that when I think about therapeutic use of self, I'm really thinking about the sort of the client centered approach that occupational therapy practitioners take that is collaborative and really like sort of grounded in empathy, that promotes really that open exchange of information, and it is really honoring the client as a partner and the whole thing. And so I think even in the school, you know, we work with very young children. We work with students with with very significant disabilities, but but no matter who the student is like, they are our partner in this and so, creating a really inclusive, supportive environment where it's safe to take risks and make mistakes is super important also, I mean, to allow opportunities for choice and for kids to show agency, I think, is really important. But it does also extend, I think, to the adults that we work with too, and so, you know, those are the teachers and the administrators and and well, as well as the families and parents that are involved. I think I've really seen examples of it come to play when, you know, I've helped a student to sort of advocate to his teacher about what he wants in terms of an accommodation, particularly as they sometimes relate to classroom behavior management and for students to be able to really feel empowered to say, I want to do the job and I want to meet your expectations. But when you use proximity control, coming up to my desk and standing over me because you think that's going to make me stop talking, it really makes me angry, and then this is what happens next, right? And it's helping, I think, kids to have those words and to be able to know that you're supporting them to do something like that. But it's also then, you know, to support the teacher, because I think we come in with our all of our super great ideas and our bag of tricks to say that we're looking at what you're doing and the environment and what the students are doing, and we've got a million ideas as soon as we walk in, but you're still the captain of the ship, because this is your classroom, and ultimately you're responsible for the instruction of all these students here. And I am specialized instructional support personnel here to support or I'm a related service provider here to provide related services. And you know, however you're framing it, but I'm not always the captain of, you know, fourth grade. And so I think that that therapeutic use of self is also, I think, you know, having that same empathy and holding that space for the teacher to be able to say, I need help, or that's never going to work what you're suggesting in my classroom, because I cannot implement this or this. I need two people to help me implement this, and where will you be right? So I think it's, it's really being collaborative, and it always wanting to collaborate more, I think, which is sometimes hard because of our busy schedules, but I think when done, well, that's the sort of trust that we can build with other educators. And then they will look for for occupational therapy more for their students, because they'll see the value of it.
Jayson Davies
100% agree. I always, always tell therapists like that is collaborating, providing those quick wins, even if you can, for teachers, that is kind of the best thing that you can do to develop a rapport with them, and once you have that rapport with the sky is limitless. I mean, once you have that rapport, you can do so much more with a teacher, and so by getting in there, collaborating with them, collaborating with the students, yeah, you can do just about anything. So that's awesome. All right, the last step of the process we had evaluation, intervention. We come to outcomes. When I think of the word outcomes, I also think of a term out there is data driven decision making, dddm, and we also, I can't remember if it was Susan or Julie, mentioned creating our own evidence within like tier one, right? We almost are comparing a student to the rest of the kids. And I think of that with outcomes as well. Can we just kind of really briefly, we're getting close to our end time, but talk about how outcomes, kind of, in a way, start the whole cycle over again a little bit.
Susan Cahill
Yeah, the framework defines outcomes a little bit differently. So just want to sort of talk about that. So it's not always the individual child outcome, but it's more of the outcome of OT intervention, sort of like in a big picture way. So this might be something like increased occupational performance in a big way, or role competence in a big way, or participation, I think quality of life, right? These big outcomes, and we are definitely going to have IEP goals or. And performance goals that are going to be, you know, more manageable and definitely measurable, right? But when we're beginning occupational therapy evaluation in the schools, I mean, we always need to be thinking with the end in mind and and when I'm thinking about students, you know, if I'm working or I was working with an early childhood student or a second grader, middle schooler or high schooler, I'm always have to think about what's going to happen after this kid's done with high school, right? We always have to be thinking about that post secondary life, whether the student is in, you know, full time in general ed, or they're in a more restricted environment, but really thinking about, you know, what are the child's goals for that post secondary life? What are the family's goals, and what can we do to get them as close to that as possible, knowing those things could potentially change. But I think it's definitely important to be thinking about that. I think that when we do that, we really we focus on those larger scale outcomes, or we hold them close. When we're doing all that intervention planning, it helps us to not continue to do the same thing, maybe year after year, which is sometimes a challenge in the school systems, right? If a child's not making a goal, you brought up handwriting earlier, so I'll just stick with that. But if a child's not making progress, and handwriting is difficult, we have to start thinking at some point, is this the way? Is this what we want to spend our time on? We've got 30 minutes or 45 minutes or 60 minutes a week with this student, and that's that's the time that we can cause some big change or and with consultation with the teacher. But is that how we're going to get the biggest thing for a buck for that child for the course of their academic career? Right, leading to these, these outcomes? So we have to always keep them, I think, close when we're thinking about that data, I think, and sort of doing that intervention review can really help us to know when we should start to change course. And so again, that intervention review is that continuous process of really looking at and reevaluating and reviewing our intervention plan, and when we're seeing that students aren't making progress by the data that we're collecting. I mean, I think that's our opportunity to go back to the drawing board to say, Can we do something else? Is it time to shift gears? What other supports need to be provided? And is this still worth it? Is this the target that we should be going for, or is there something that's going to have a bigger impact in the student's life now and also down the road?
Yeah, absolutely. And thinking of that larger picture. You know, there's sometimes when I think a year is a really long time for a goal, and then there's other times when I look at the bigger picture, that I'm like a year is nothing. I mean, a kid is only in school for 12 years. And if you don't have that longer term goal, especially as you get into the middle school, high school realm, your time is ever so short with those students. I mean, not just us, the teachers, the administrators. We don't have a long time to make an impact. And if we sometimes focus on the little, tiny increments, we lose track of the bigger picture. Where's this student going to be once they are no longer within the school system and and thinking about that bigger picture? So Thanks, Julie. Would you like to add anything about outcomes?
Julie Miller
I really would agree with Susan. It's interesting because I work both in we do a little bit of school support, but mostly pediatrics, more of an outpatient setting, and so I have opportunities then to also see kids move into more young adult or community placements too, and to really think about, I think that's such an important piece of you know, over time, what are we hoping to see and how what's, what does success look like in those different places and ages and stages? And like you said before, Susan, not sticking to one goal year after year after year, but really re envisioning every year. What does success look like? What does independence in the setting look like? What does functional dependence look like, ongoing and when do we want to start looking at other areas to support that student succeed?
Jayson Davies
Yeah, and there's just one comment. We don't need to have a big discussion about this, but there's one comment that I did want to or quote, I guess, from the otpf, that I just was surprised to see it there, but was very happy to see it there. And it states that planning for discontinuation of occupational therapy services begins at the initial evaluation. And I don't think many of us think that way. We don't think about graduation of services until we don't see the student progressing anymore, or we don't think about discontinuation until they met all their goals. And you know, just like we are taught sometimes in elementary school, starting from the end and working backwards, it's the same thing when it comes to our practice, where do we want that student, that client, whoever it is, to be at the end? Because how will we know when they're ready to move on from occupational therapy services or anything, if we don't have that end goal in mind. So I don't know if either of you want to speak just a little bit more. Have anything to add about that?
Susan Cahill
Yeah, when I was listening to you say that quote, I was also just thinking about how we do sometimes think that the end of OT services is when the child leaves our building, or when the. Graduate, and, you know, really thinking of maybe a little bit provocatively about different phases of the students education, and you know, do they need to be on a caseload from kindergarten all the way through eighth grade, you know? Or Is there flexibility within a district for for students who receive services just in time, services when they need them for as long as they need them, and then to pull back, and then for it not to be such a big deal to get back onto the OT caseload. And is that a possibility, a more sort of flexible model? And I think, I think that would, that would feel so great to be able to have the opportunity to intervene at different points, and to really realize that, like, you know, we're talking about 30 minutes, 45 minutes of our time. But, I mean, you're right 12 years and like, six hours a day, or six and a half hours a day, and every one of those minutes is precious, and we can't if we could pull away so that the child could get more bang for their buck someplace else, then that might be the thing to do. So that sort of fluidy. And if you began with that end in mind too. I think, like it would like revolutionize the system, right? It would be really exciting to see how that would go. So that's what I thought about when I thought about that quote, the end of school, for sure, post secondary, but also, like, a more flexible model. And I think that that's where multi tier system support can really work in our favor.
Absolutely, totally agree. All right, so I have one more question for each of you before I let you enjoy the rest of your Monday evening here. And Susan, you just got done talking, so I'll move over to Julie. Julie, where do you see occupational therapy potentially moving forward, whether it be the occupational therapy profile or, sorry, not the profile, the practice framework, or just in general, what do you see as the next step for occupational therapy?
Julie Miller
What a great question. I am really excited that I think occupational therapy practitioners are really doing some of the work to really look at, who are we? What do we do? Who are the clients we serve, and all of the barriers that might be in the way for them, which goes beyond, I think, some of the more traditional skills based work that practitioners did in the past, and moves far more into how are structures or policies limiting to people's access to occupation? And I think that is the thing that I am most motivated by. You know, seeing students coming out of OT programs already asking those questions is really exciting. So I'm really excited for that.
Jayson Davies
That's awesome. Yeah, I never thought about that. I mean, you're right, though, I talked to newer grads, and they already have very, very big mindset, some very big ideas. So that's awesome. And Susan, what about you? Do you have any big picture things for occupational therapy? I
Susan Cahill
think when I think about occupational therapy in the school systems, I think we're starting to gain some really good traction as having other educators recognize us as specialized instructional support personnel. And so I think that that's really, there's a lot of momentum in our community right now to sort of focus and promote our role as this and I think that that would be something that I think, I hope, would continue. I think that once the building realizes how invaluable an occupational therapy practitioner is from providing, obviously, supports to the students that are receiving, you know, IEP services, but also the general student body, and then also their teaching staff, right their faculty and the other educational personnel, and how they can create environments that are supportive. I just I don't see why a building, a building level administrator, wouldn't say I want one of those in my building, maybe two or three. So I really think that I'm hoping that more ot providers, or current practitioners, rather, embrace that role as a sis and are not afraid of it, because it does mean doing things a little bit differently. But I think that ot practitioners are very adaptable, and really can think about how they can again, provide services to that whole building, not just the kids that are in their traditional caseload.
Jayson Davies
Absolutely. And yeah. Well said, If anyone has any other questions about Sisp, s, i, s, p, specialized instructional support personnel. We actually did an episode with Abe Saffer, which is a colleague over there at aota, all about Sisp and what he's doing in in Washington, DC, to kind of try and get the ball rolling, and what we can do to get the ball rolling at our district level. So be sure to tune into Episode 91 for that well, that is going to bring us to the end. Thank you so much for your big ideas about ot as well as walking us through the otpf a little bit quick question is LinkedIn the best place to find you both, if anyone might want to connect that sound like a good place.
Julie Miller
Okay, that's the way to find me.
Jayson Davies
Awesome. Well, I will link to both episode 91 I will link to to just your LinkedIn profiles. People can find you there if they like, in the show knows, and also make sure that we. Link to the otpf. I think you have to be an aota member to get otpf, or is that? I can't remember what is and what isn't necessary, but either way, we should all have that on file. We need that on our desktop to reference to at any point, so be sure to get the otpf. And yeah, with that, Susan, Julie, thank you so much for joining me on this episode of the otschoolhouse podcast.
Julie Miller
You're welcome.
Susan Cahill
Thank you.
Thank you. Take care. All right, and that's going to wrap up episode number 101 of the otschoolhouse podcast. Wow. It feels so strange putting three digits together to actually say where we are in the otschoolhouse com podcast. I want to give a huge shout out to Julie Miller and Dr Susan Cahill for coming on the show and just sharing with us not only how the OT practice framework comes together for school based OT, but also a little bit about the history behind the practice framework and the commission that put this together. And as I mentioned earlier in this episode, I want to thank every single person that had a hand in this, the OT practice framework document and the Commission on practice chairperson was Julie Dorsey. So thank you so much, Julie. But there were so many authors, as we mentioned earlier, and I'm just going to list them very quickly by name, because I want to thank them for everything that they have done for the field of occupational therapy. So in addition to Dr Julie Dorsey, we also have Cheryl boop. Dr Susan Cahill, who we spoke with today, Charlotte Davis, Dr ver Alicia Gibbs, Brian hare Kimberly Kearney, Dr Elizabeth Griffin, Lanigan, Elizabeth Metzger, we talked to Julie Miller today. We also had Amy Owens, Krista rivers, Dr Caitlin sinovic, I hope I pronounced that right, Caitlin, if you're listening to this, as well as Wayne winnistofer. And finally, we also had Deborah Lieberman. So to all of those, every single person who helped to develop the OT practice framework. And to be honest, I'm sure there were so many more that were not listed as authors on this document. Thank you so much for putting together a place for us as occupational therapists, particularly us the school based OTS who listen to this podcast, for having a guide to look to, something to help us guide where we are going. As occupational therapy providers, you know we all need a little help, and you have done that for us with ot practice framework. So thank you so much, and thank you for listening today. I really appreciate you listening all the way through if you have done that, I know you are a super fan, and I really appreciate it. Until next time I will, I'm gonna go enjoy myself, and I hope you do too. I hope you have a great rest of your week, a great rest of your May, and even a great rest of your day. So I'll see you in episode 102. Take care everyone. Bye.
Amazing Narrator
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