OTS 11: How To Be An Evidence-Based OT In Public Schools Ft. Dr. Amy Sadek
- Jayson Davies
- Aug 5, 2018
- 36 min read
Updated: Jan 26
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Welcome to the show notes for Episode 11 of the OT Schoolhouse Podcast.
In this episode, Jayson Interviews Dr. Amy Sadek about how every school-based OT should be using evidence-based practices and how to find the research to guide their interventions. Dr. Sadek's research has focused on linking nutrition with behavioral changes in children with Autism. While completing her research she quickly learned how difficult it can be to establish herself as an evidence-based practitioner, as well as how difficult it can be to conduct research in public schools.
Listen in as Dr. Amy Sadek shares how any school-based OT can take part in evidence-based practices & research opportunities.
Have a listen if you would like to freshen up on today's learning objectives, which are:
Understand the barriers to practicing EBP and conducting further research within Public schools.
Understand the steps to implement evidence-based practices (EBP) in a school setting.
Understand the levels of research and the steps to appraising a research article
Links to Show References:
Have a question for Dr. Sadek? You can contact her at ASadek22@gmail.com
"Antioxidants and Autism: Teachers' Perceptions of Behavioral Changes" - This is a link to Dr. Sadek's study in the Advances in Mind-Body Medicines Journal.
The American Journal of Occupational Therapy (AJOT) - Often referenced in the show as the AJOT, this is one of most attributed journals as it relates to occupational therapy.
Guidelines for Occupational Therapy and Physical Therapy In California Public Schools - Referred to in the show as the OTPT Guidelines, this document published by the California Department of Education is a useful resource to all School-based OTs, not just those in California. To access it, visit OTSchoolhouse.com/guidelines and click on the state of California.
ProQuest - ProQuest is a research search engine that is accessible to all National Board for Certification in Occupational Therapy (NBCOT) certificants. Just one more reason why each and every OT and OTA should maintain their NBCOT certification.
Autism spectrum disorder: interaction of air pollution with the MET receptor tyrosine kinase gene - This article referenced by Jayson is related to Autism and the effects of air pollution.
Google Scholar - This is another one of the many free Google tools that are so helpful. Dr. Sadek uses Google Scholar as a starting point to look up the research. While you may not be able to access every article you come across, it provides a great starting point.
FERPA - Briefly referenced in the show as the "HIPPA for schools," FERPA is indeed a privacy act that schools must abide by. All school-based personnel OTs should be familiar with the Family Educational Rights and Privacy Act, or FERPA
Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.
Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com
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Episode Transcript
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Amazing Narrator
Hello, and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy, tips, interviews and research. Now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session.
Jayson Davies
Hey, what's up everyone? Today is Tuesday, and it is officially August, and I'm sure many of you are probably already starting to get back into your routine, and we are here for episode number 11 of the OT school house podcast. And I am so glad that you are here with us today. Can't wait to get into today's content. Today we have a very special guest, and before I get into introducing her, I want to let you all know that this podcast is going to be a lot about evidence based practices and conducting research and school based settings. So with that, there are some objectives for today's professional development opportunity for those of you wishing to earn professional development after listening to this podcast. And those objectives for today are for you, the listeners, to learn the steps to conducting evidence based practices in a school setting. Number two, you will also be introduced to the steps needed to appraise a research article. And finally, we're also going to talk about the barriers to practicing evidence based practice in a school setting, as well as the barriers to conducting further research within a school setting. So stay tuned to hear a little bit more about all that. Like I said, today is going to be a professional development opportunity for those of you listening to the podcast, and you can earn your professional development by heading on over to OT schoolhouse.com forward slash, PD, as in professional development, or you can head over to the show notes at ot schoolhouse.com forward slash Episode 11. With that, I am excited to introduce to you, Dr Amy Sadek. Amy Sadek and I actually worked briefly in a school based setting when both of us were brand new OTs, and since then, we've both gone on to do much bigger and better things and understand school based occupational therapy much further than we did about six years ago. But you know, she's just an amazing person. She recently was featured in the newsletter by the Occupational Therapy Association of California, with an article that we will talk a little bit about later in the episode. But she's also awaiting publication of one of her articles in the advances in mind body journal, and that should be coming out any day now. It's supposed to come out in June, but as you know, journals are a little a little slow to get online and get to your mailbox. So we will put a link in the show notes about where to find her research article. So without further ado, I give to you all. Dr. Amy Sadek, hey Amy, welcome to the OT schoolhouse podcast. How are you today?
Amy Sadek
Hey, Jayson, I'm doing good. Thanks for having me.
Jayson Davies
Definitely. This is kind of the earliest I think I've ever recorded a podcast. So for anyone out there listening, hopefully we'll wake up and get going, but let's do this. So I just finished giving a quick intro into who you are, but I wanted to give you a chance to share a little bit, wow, I can't even talk, but a little bit about your education and where you are now today.
Amy Sadek
Yeah, so I kind of have a somewhat of an eclectic background. I am. I have a bachelor's in nutrition and food science, and then, as you know, I'm an Occupational Therapist with my biggest emphasis being in the pediatric population. And then, more recently, I kind of merged those two backgrounds to get my PhD in Rehabilitation Science, so I kind of took a few turns, but have been able to utilize all degrees into one. So.
Jayson Davies
Wow. So how'd you go from you said your Bachelor's was in nutrition, or you had a background in nutrition. So how do you go from nutrition to OT?
Amy Sadek
I know it was kind of a random jump. So when I was getting my bachelor's degree, we had to do like, 100 hour internship observing a registered dietitian. And although it was really fun and I liked the information, it was kind of missing some of the creativity and more, like patient interaction that I was looking for. So I actually had a friend in PT school who was like, why don't you look into OT? Because I knew I wanted to stay in healthcare and have, you know, as much time as possible with patients and that kind of interaction. So I observed an OT in an acute rehab setting, and just kind of fell in love with it. From there.
Jayson Davies
Gotcha very cool a follow up to that, why the PhD in rehab sciences and not an OTD or a PHD in OT?
Amy Sadek
Yeah, good question. You know, I wasn't even planning to go back doctorate at all. I was like, I love OT. Like, this is awesome. I was on a school calendar. Like, didn't feel the need to really go back to school, but things just kind of aligned for me to. To get involved back in in school. And, you know, with the OTD, I think I just kind of heard different feedback from different mentors that I had had during my ot program. And the rehab science degree was kind of nice, because you have to have a clinical background to enter the program, and it was really research focused and kind of from an interdisciplinary perspective, and I could kind of take the reins with it a little bit more. So it just kind of allowed me to use some of my nutrition lifestyle interests coupled with with ot interests. So.
Jayson Davies
Oh, that's a great reason to do that. That's really cool. I'm glad you were able to find a program that kind of was able to put together everything that you wanted to do. That's cool, yeah. So you know what right there? I know we'll get into it a little bit later, but tell us a little bit about your study.
Amy Sadek
Yeah. So I looked at the effects of antioxidants on behaviors in children with autism spectrum disorder. So just to give you, like a cliff notes, version of it a clinical trial, and we gave the kids, actually, believe it or not, dark chocolate that was 70% cacao, 30% organic cane sugar, and had been measured by a scientific lab for total antioxidant activity. And it was really high. I mean, the highest food in the world and antioxidants is cloves. But we didn't think we'd get a good turnout if we gave kids cloves for four weeks. Clothes, kind of in the similar category is like ginger and, yeah, so it's not, not a very good flavor. And and actually, in the US, chocolate is the number one source of antioxidants, followed by fruits and vegetables. So it just kind of made sense to use a potent food and antioxidant that's also palatable, and, you know, one of the most desired foods in the world. So we actually did find significant results from both parent and teacher ratings and children in this study demonstrated reduced hyperactivity, reduced irritability, reduced unusual behaviors, improved self regulation, and some parents even reported that their child's anxiety reduced. So we could do a whole nother podcast on the effects of antioxidants on the brick.
Jayson Davies
But why everyone needs to eat chocolate? Yeah, basically, sounds good. All right, so I guess we should jump into the real content for today. The what we really wanted to talk about, and there are a few things, but the first thing that we wanted to talk about was how to appraise research articles. And so I know most people, most occupational therapists, you know, we'll skim through the Asia when we get it in the mail. I know the most recent one was all about older adults, so I barely looked at it. But honestly, when I do look at them, oftentimes I read the abstract after reading the title. Obviously, I might skip down to the results. If it's really catches my eye, I'll go into the methodology, but I know there is kind of a real process to appraising articles, and I know you're pretty good at explaining it. So what would be the first step that we should look for when we come across an article that might be worth our reading?
Amy Sadek
Right, so that's a great question, and that was something I kind of struggled with when I was a new OT and kind of after grad school, it really helped me refine that process. So there's kind of six key steps that usually you just kind of follow the titles of the categories in the article. So like you said, the title kind of orients us to the article. What is it about? You know, is it a topic related to our practice area? And the second part you need to look at is the abstract. So that's just kind of a brief synopsis of the study, and really tells us, is this worth me reading any further? Then we move on to the introduction, which is really a somewhat comprehensive literature review on that particular topic, and it also shows us the gap in the literature. So think about the introduction as the why, why are these researchers doing this study? What has been missing, and where are they bridging that gap? And then we move on to Section four, which is the methods. And the methods are really, honestly, I used to skip over them too, but now I realize they're kind of the most important section, because it tells us who was their population. Who were they studying? How did they recruit them? You know, what tools and assessments did they use? Were they standardized? Were they valid and reliable tools? How long was the intervention really the nitty gritty of the study? So think about the methods section as the how, how was the study conducted? And the fifth step is the results. So most of us know what that is. Those are the findings. So the part we all jump to, yeah, exactly. So was there statistical significance? But the results also gives us detail on, you know, what wasn't significant and maybe why it wasn't significant. In, and then the last section is the discussion section. So that's kind of a recap of the study, a little bit more of a literature review, kind of to tie everything together. But most importantly, it comes with sort of the author's interpretations of practical implications and recommendations for future studies. So we can think of the discussion as now, what? So, what do we do now that we have this information? And that's kind of the beauty of science, is it always leads us to more discovery and more questions.
Jayson Davies
Yeah, and that's always the part where it says More research is needed on this topic. I feel like there's always more needed. So, okay, cool. So title, abstract, intro, methods, results and the discussion part. So what about limitations? Where do those fit in there? Because I know every study always has some section about limitations.
Amy Sadek
Right? Yeah, that's a good point. So we would find strengths and limitations of a study in the discussion section. So that's where they discuss, you know, did they have a small sample size, you know, was it only males or only females? You know, was there differences in gender? Things like that, recruitment usually is an issue, particularly with vulnerable populations. Maybe there was a low or a high attrition rate or dropout rate, so they lost a lot of subjects throughout the study. Other limitations could be maybe there was no follow up to see if the intervention kind of lasted beyond the experiment of the study. So things like that.
Jayson Davies
Gotcha, okay. And ethical considerations is also something I often kind of look for. What are some ethical considerations that must be or are often prevalent in a research article.
Amy Sadek
Right, so ethical considerations you might find at the beginning but sometimes at the end of the article. I've kind of seen them in different places, in manuscripts, but for that, we need to see that it was IRB approved or institutional review board approved. So the ethical statement should relate to whatever IRB institution approved the study. We also want to see if there was any conflict of interests, maybe, who funded the study, information like that. So it'll usually just be a few sentences on basically ethical approval for a human subjects research conflict and then funding.
Jayson Davies
Gotcha. And so if someone's going through, they're doing a research article through a college. Is it fair to say that the funding should be pretty typical, that the college is the one paying for it, or is it a, I mean, who can provide these grants and stuff?
Amy Sadek
Yeah. So if it was a student, you mean, yeah, okay, yeah. So in student cases, depending on the program, usually they'll have an allotted amount. Like for my program, for example, they gave us a certain dollar amount to complete our dissertation, for supplies, recruitment, all that stuff, but it really depends. Like even for my study, we ended up needing a little bit more. So you can always search grants through the state, through your professional associations, or, you know, I've even heard people using Go Fund Me. I don't know the rules are on that, but there are lots of resources out there. You just kind of have to dig for them.
Jayson Davies
Gotcha. And when reading an article, you know, we've kind of gone over, you know, the six steps or the six parts of an article, as well as limitations and ethical considerations. What should we really be looking out for? Are there any red flags or green lights that we really want to see in an article?
Amy Sadek
Yeah. So when you look at kind of the reputation of the article or the journal that it was found in, there's a couple of things to keep in mind. So I just learned this recently. So there are predatory journals. So those are journals that you might look on their website, and they have, or publishers that have, like 1000 journals that they publish, and it might be like somebody's home address in another country. So those are typically not reputable. So the green lights we want to look for are that it was a peer reviewed article, so experts in that field can sort of critique or critically appraise the work that we submit. So always being mindful of that, and then open access journals, I wouldn't say it falls under red or green. It's kind of in this middle gray area. Because on the one hand, you have one school of thought where open access journals are great, because if you're not a paying member or subscribed member to a journal, you can still access that information and read it and use it in your your research or your clinical skills. But on the other hand, people say, because you have to pay to publish, there's kind of this gray sort of, is it a conflict of interest, or are people more published because they're paying versus submitting a manuscript for free, kind of thing? So Gotcha. Just things to keep in mind.
Jayson Davies
Okay, and likely then in the Open Journal is not peer review. Right?
Amy Sadek
It depends. Some of them are. You just have to make sure you go to the journals homepage, and if it doesn't clearly say it, then look on the editorial board and contact one of the editors to make sure.
Jayson Davies
Gotcha. Okay. So in, for example, in the Asia are you familiar with how it's peer reviewed at all, or any articles or any journals. I mean.
Amy Sadek
Yeah. So typically it's going to be a blinded peer review, so the person that's receiving my manuscript submission, like when I submitted to a journal, I had to remove my name and all of my co authors, names, our address, any contact or identifying information. So that way there's no bias when they're reviewing it. Because, let's say, you know, you're on the editorial board of a jot, and you're like, Oh, this is Amy steady, awesome. I'm gonna publish this. But you know, to keep it ethical, it's typically peer reviewed. Should be blind review, so they shouldn't know who the author was. They're strictly critiquing it based on content and quality.
Jayson Davies
Okay. Very cool. All right, I faintly remember back in college learning about different levels of evidence. You know, there's some levels that are better, some that are worse. What is like that gold standard that we're looking for when it comes to an article and we're searching ProQuest or Google Scholar.
Amy Sadek
Right? So the gold standard and research really is a randomized control trial or RCT so we can kind of go over some of the levels. So level one is really evidence from a systematic review or a meta analysis of all RCTs on a given topic. So that's kind of the highest level of research, because it's collected all of these gold standard manuscripts or research articles and summarize them. So what can we take from, for example, all the research on handwriting, in handwriting instruction in, you know, the school system for OT? So that's really that's kind of the top tier. And then level two is, again from RCTs, but at least one well designed RCT, so it's not a comprehensive overview. It's like one really solid article.
Jayson Davies
Okay, an RCT may be something like a project that someone did, and it was a control study with a control group as well as a experimental group and blinded and all that. Right? Exactly, yeah. All right, perfect. So, and then the you said, level one, the meta analysis is kind of like a bunch of those put together and studied, right, right? All right. So level three.
Amy Sadek
So level three is evidence from well designed control trials that might not have randomization. So we call these quasi experimental studies because there was an intervention, but either there was no control or no randomization. But if you don't have a control group, typically you're not going to have randomization, because there's only one group anyway. So those are typically seem like my study kind of fell under this category because it was a pilot study. So maybe you don't want to have a control group until the intervention shows some sort of efficacy, and then you can do a follow up study with a control group to see if the difference, if the true difference, was related to the intervention. So I would say quasi experimental studies are either for small studies, maybe small sample size or pilot studies kind of thing.
Jayson Davies
Gotcha, okay, and we move on to we won't go through all seven, because by time you get to level five or so, you should really be looking for something above that, but level four is evidence from a well designed case control or cohort study. So what's a case control study?
Amy Sadek
So a case control study is often used in epidemiological studies, and it's typically retrospective in nature. So we have the cases, which are the people that have developed the disease or disorder that we're studying, and the control group are people who don't develop that disease. So they look back to see, you know, who had exposure to what, and that's how they kind of determine, you know, correlation to the cases versus the controls.
Jayson Davies
Gotcha, okay, this kind of reminds me of a study. I've never actually read this study, but I've heard about it several times. Is the autism study, where they found that kids that lived within so many miles of a freeway had developed autism. I know this is an older study, but they kind of looked at it and they found that if you lived within so many feet, or whatever they want to whatever measurement of distance they use, but that was used to go back in time to say, oh, you know what? For some reason there's a large population of kids with autism that live within so much distance from a freeway, so that might have been something like a case control.
Amy Sadek
Yeah, exactly. So the people already have the disease or disorder of interest, and we're kind of looking back to see, what were they exposed to that made them develop the case versus controls and not develop the case.
Jayson Davies
Gotcha. Okay, cool. So I want to move on to our next topic, but first, I've been getting some questions lately, just in conversation with other OTs about IRB. I'm a master's thesis advisor, and so right now, we're going through the IRB process. But I didn't realize how few people really understand an IRB could you in a short way, I guess, kind of explain what an IRB is, and who needs to work with an IRB?
Amy Sadek
Right? So IRB stands for Institutional Review Board, and really it's essentially a human subjects research ethics committee. So their primary goal is to make sure that you are not causing, you know, unnecessary harm to the subjects you want to recruit in your study. That's really the Cliff Notes version of, you know, the purpose of an IRB, and really it's related to any human subjects research. And there are kind of different levels of IRB, like, if you do need to do full board review, that's when you're collecting, like, biomarkers, maybe urine or blood serum samples from your subjects in your study, or you can do more of an expedited review, if it's just maybe a survey or a questionnaire type of thing. So there are different levels depending on how quote, unquote invasive your intervention is.
Jayson Davies
Yeah, it's just that they're out there to protect the community. They're there to make sure that we don't harm anyone. Right? Exactly, perfect. Yeah, I don't know how we have to fill out our IRB in the next two weeks, and I'm a little nervous because I've never done one before, so I'm gonna have to contact you for a little help on that, but we'll see. So, all right, so now, in school based OT. Usually we're looking at the age OT, just because that's what most OTs kind of default to. But once we decide, You know what, hey, we've got this kid, we don't know exactly what to do with this kid. How do we go about in practicing evidence based practice?
Amy Sadek
Yeah, so that was something that's to answer one of your questions from earlier. That's another reason why I went back to school. It, you know, being a school based ot myself, I realized kind of the limited skill set I had in appraising literature and implementing ebp for some of those more challenging cases, and just to make sure we have credibility among our our peers and administrators in the schools. So the there's a really awesome resource that we have in California. It's the OT PT guidelines, which I know you guys have on your ot School House website, right?
Jayson Davies
Yeah, we have a clickable map that you can just click on whatever state and you'll find the OT PT guidelines. It's actually ot schoolhouse.com forward slash guidelines. And if you want to find a little more detail into what Amy is about to talk about, you can just click on the state of California, and that will guide you to the OT PT guidelines for California.
Amy Sadek
Right? So they have a really, really nice process that I wish I would have read like years ago, but it's okay, better late than never. So they have kind of five steps, and the first step is really with any research process is asking ourselves a question, a research question. So why am I using this particular intervention? Is there evidence supporting it? Is it as effective, more or less effective than maybe another intervention? Step two is essentially a literature review. So going into our, you know, search engines like ProQuest or Google Scholar, or if you're a student through your university library, and typing in, you know, keywords related to whatever topic it is you're trying to find information on for a specific intervention, and then step three, I'm really glad they talk about this is appraising articles. So those were those six key steps we kind of went over earlier. So remember going over the introduction, methods, discussion, results, all that good stuff. So once you have those skills, then number four is really critical for OTs, because that's where we use our professional expertise coupled with our knowledge of the child's needs or clients needs, to best integrate the research evidence we found into our service delivery model. And then step five is really evaluating the use of our intervention in our practice, and we can measure outcomes through a variety of ways, maybe it's through observation of the clients performing the occupation or activity. It can be through formal data collection, maybe interviews with parent, caregiver or teacher, again, using standardized or criterion reference tools, and analyzing that data work samples is another great way rating skills, goal, attainment, scaling, and even our treatment notes. So there's a variety of ways to assess whether an intervention that we've chosen is in fact, you know, working for our client.
Jayson Davies
Definitely. And I know a lot of people have difficulty with coming up with an initial question, or what should what's the intervention? Attention. And what I will sometimes find myself doing is it's during the IEP that I often come up with those questions. You know, you're sitting there, you're listening to the family, you're listening to the to the teacher, maybe the administrator that knows the kid really well, and that's where the questions start to pop up in my mind. And so sometimes I kind of start this process right there in the IEP, like I jot down a few of those questions that I have for myself during the IEP, and that way, when I get back home or to that little office that I actually kind of have, I can go back and and open up Pro Quest, open up Google Scholar, so getting into that lit review process. What do you have any recommendations for how to find something like, Are there keywords that you should try and use? Or do you have any, even just different resources that might help?
Amy Sadek
Yeah, so keywords was always something I struggled with myself. But you know, if maybe you start with the keyword, that's exactly the intervention you're looking for, let's say, for example, handwriting. Maybe you just type in handwriting intervention or handwriting, and then the word and, and then, you know, school based, and then and, and then OT or something. But you kind of have to play around with key words. But I would say, once I find a solid article that starts my literature review, I look at not only their references on the reference page. But also, one of my favorite search engines is actually Google Scholar, because once you find that article, there's an icon that says cited by so you can see not only their work, but everyone after them that cited their work. So again, along the lines of that same topic. So that was kind of a nice trick, too. Instead of going down a rabbit hole with keywords, you can kind of, once you find a solid article, check their references and check everyone that cited them.
Jayson Davies
Had to tell my thesis group to do that over the past few months, because they found a lot of meta reviews or meta analysis. And while they're great, they provide so much information, we wanted to get into the nitty gritty of stuff. And so they were actually a little worried about having too many meta analysis in their references. And so I told them, I was like, yeah, just go down into those reviews or into the references from that meta analysis and pick out, you know, find five that seem interesting, and look up those, and that way it kind of helps you get to the real bottom of something.
Amy Sadek
Right? That's a good point, because the although the meta analysis of an RCT is kind of the gold standard, sometimes we do, like you said, have to get into the nitty gritty and figure out because the meta analysis isn't giving us detailed description of each study's methods and how, what intervention they used, how they used it, and all that stuff. So, I mean, it is detailed, but sometimes you have to go through each RCT with a kind of fine tooth comb to get out, you know, specific mechanisms for using an intervention.
Jayson Davies
Yeah, because with meta analysis, too, you just never know what they really used. And, you know, you know, you can read the article, and you look at the limitations, and you look at their what they use to qualify an article as being part of their meta analysis. But in the end, I really think you want to look at those individual articles, in my opinion. So definitely, for those of you out there, I do want to give a quick mention to NBC OT. If you are a member of NBC OT, you have access to ProQuest through NBC OT. Amy was just talking. She likes to use, what was it? Google Scholar. Okay, and Google Scholar, do they limit you at all, or can you access just about everything that you find there?
Amy Sadek
You there are some limitations that I had to then find the article on my university's library website, but for the most part, it's a great place to start, I would say, because again, maybe that original article you found on Google Scholar. You can't download the PDF, but you might find people that cited them, and then those manuscripts might be available. So it just, it kind of just depends where the journal was published, and that's kind of related to the open access stuff. So if you have to be a member of that journal, then typically you wouldn't be able to download it. So.
Jayson Davies
All right, good to know before you went back and got your PhD, what would you say was like the most difficult part of practicing evidence based practices within a school based setting.
Amy Sadek
Yeah, I think, honestly, time was an issue. You know, when you're, you know, running between schools, travel time, IEP time, report writing time and kind of getting support from the district and seeing what resources we can use there. And prior to, you know, my recent endeavors was being able to critically appraise research on given interventions that I could present at an IEP or discuss in a report, or, you know, go over with a teacher or whatnot. So I think it was kind of a culmination of things, because it's not just. Just reading an article and spewing the results out to somebody. I think it's really being able to see why it was used, how it was used, who it's appropriate for.
Jayson Davies
Definitely. Did you ever take articles with you to IEPs? I know some people do.
Amy Sadek
I didn't. I would usually do that reading kind of on my own, but in some of the places I worked, we would cite stuff occasionally, either in our reports or whatnot, just to, you know, show reputability, and.
Jayson Davies
Yeah, I know in our assessments, sometimes I have the OT pf the or not, sorry, not the OT pf the OT California state guidelines. Sometimes I quote a little bit from there and then, yes, if there is an article that I looked up during my evaluation, for some reason, I might cite that or at least give mention to it. So I don't think I have a folder of different articles, you know, at work that I keep in my binder just to refer to. But, yeah, I don't think I would take an article and just be like, Hi parent. This is an article I found, and that's why I want to do this. I would just summarize that in the evaluation. I think.
Amy Sadek
Right, right. Yeah, the parent is just going to want the Cliff Notes version. And I think with that, you know, you just kind of, I mean, it's a good idea to have a binder of articles, but I think just giving them the kind of cream of the crop of, hey, like this, you know, there's a lot of research on this particular intervention, and I think it would be, you know, applicable to your child, but just for the listeners out there, really like evidence based practice is mostly based on literature within the last five years. And typically, if you go beyond that, it's only for kind of foundational or theory based knowledge. So try and keep your searches within the last five to maybe seven years for the most relevant.
Jayson Davies
Good to know. So Amy, why don't you go ahead and tell us a little bit about the challenges you had with getting into a school district to do some research.
Amy Sadek
Yeah, so I was in for a big surprise because I thought, Oh, I'm an OT it'll be so easy to get all these special ed departments on board with my study like I've got, you know, a common denominator I've worked in special ed, but I was quickly surprised that that was not the case. So there were a few challenges I ran into, and one of them was honestly just making sense to them, so being able to clearly and quickly articulate kind of the purpose of my study, or anyone out there, if you're trying to conduct a study in the schools and make sure they understand, I mean, I had people that I called at different school districts that didn't know what an IRB was, or didn't know what evidence based practice was. So not only was I trying to get their buy in for my study, I was also having to educate them on, you know, the process of researching what's involved. And I think for some school districts, it was intimidating, because when there was that lack of awareness, it kind of shut people down to the interest or being open to participating in this study. Other things that came up were, you know, each school district I contacted, I think I contacted 33 in Southern California for my clinical trial, and some of them had really strict policies, like you had to fill out an application for them to review in terms of why they should participate in your research, what's involved, and others had no policy. People just gave me kind of a hard No. So being clear, because sometimes you only get that one phone call and then kind of investigating what's the priority of research in schools. So I've worked in a few different school districts, and there's always kind of talk of doing research or, you know, checking student outcomes and things like that, but knowing the history of that school or that district and what they've done with research, maybe it's a novel concept to them. So kind of gathering that stuff ahead of time would have been really helpful for the purposes of my study, and knowing who to speak to. So I would get tossed around from secretaries to special ed directors, even superintendents. So there wasn't really a go to person at each district in terms of who do I talk to, to kind of pitch my research to and propose it to. So usually it's best. Particularly, I was working with kids with autism, so I think the best person in my case was the director of special ed, and then they could kind of take it from there, gotcha. But knowing who to speak to was really important, and connecting with parents. So in terms of recruitment, like, you know, oftentimes parents of kids with special needs, know other parents of kids with special needs, so they really honestly helped with recruitment. And then the length of the study. So school districts, you know, teachers, as we know, have limited time, and maybe they're, you know, even struggling to carry over some of our interventions. So the length of the study is something to keep in mind. Mine was four weeks, and we felt like That was just enough time to see if there was going to be behavior change, but not too much. Where you. Know It interrupted the teacher's prep time or curriculum time or anything like that. So I think those are kind of key things, and make sure to be clear on how much time you're spending in the classroom, if any, and how much time you're taking from the teacher and the child. So in my study, I was never in the classroom. I only met the teacher at the beginning of the study and at the end of the study for 15 minutes at each time slot. So making it as least intrusive as possible really helped.
Jayson Davies
Yeah, we all know how busy teachers are. I mean, we're running around, and we try to catch teachers in between passing period or on their way to lunch, because we don't want to take away their lunch. But how did you I'm sure you took in time, obviously into account. When you were asking these teachers, how did you try and limit the amount of time that you needed from the teachers, like you said you met with them 15 minutes pre and post of the four weeks? Did they have any other obligations to help you out with?
Amy Sadek
No, so. Well, other than their informed consent process, but typically, I would give them the pre questionnaires after they agreed to participate in the study. But we couldn't really get teacher involvement until, of course, we got parents to agree to allow their child to participate in the study. So other things we did was we offered an incentive, just a small thank you gift card to the teachers, because, you know, we know their time is limited, so I specifically chose behavioral questionnaires that were quick and easy to administer, that wouldn't take up, honestly, more than 15 minutes of their time. So.
Jayson Davies
Gotcha, yeah. I mean, that's kind of what you really have to think about when it comes to teachers. I know my wife's a fourth grade teacher, and she is consistently busy. And I know running around all the OTs that are listening to this that work in schools, they know how hard it can be to just get a few minutes of a teacher's time. So completely understand that. So you gave us, what was it about six different challenges that were difficult, needing to make sense to the people that you're going to talk to, knowing what the policies are and the prior priority of research are in schools who to speak to, connecting with parents, which I thought was a great you have to connect with parents for two reasons. One, because parents tend to get things done in school districts, and two, because obviously, when you're doing a study, you have to have that parent consent. So and then, of course, length of study. So those were some of the challenges. What were there solutions that you had to kind of combat these? Or what did you learn from this?
Amy Sadek
Yeah, so I learned a lot along the way. I think when I talked about preparing to make sense, I think even in OT we talk about having our elevator speech on, you know, what is OT? So having an elevator speech on, you know, the purpose and sort of premise of your study. Why are you doing it? How's it going to help them? How's it going to benefit them, and what do you need from them? So being really, really short and sweet and quick and to the point about that, was something that I learned after calling a few districts asking about research processes. Was another thing. So there isn't really a formal process in the state of California that I have come across, but my study was approved by my university's IRB, and some districts wanted to do their own IRB, even though mine had already gone through IRB. So I don't know if any of the listeners have feedback on that, but from my understanding, they definitely are allowed to review my IRB approved documents and protocol and assessments. But what I understood is that they don't actually have to. I don't I shouldn't have to, or researchers shouldn't have to go through a second IRB process with the district. They're welcome to review it, of course, to determine if they want to participate. But my understanding is that one IRB process should be enough. So that was just one thing. But if anyone knows differently, I would love to hear that.
Jayson Davies
Definitely. I didn't even realize that school districts had RRBs?
Amy Sadek
Yeah, some of them do. A lot of them didn't. It. Just it really all varies. But the other thing I would say is really just to ask questions to anyone you can get on the phone in the school district to contact, because sometimes you'll get that one person that you know knows how to lead you in the right direction. So building that relationship ahead of time would have been really valuable. So I just thought, because I was an OT I'd be able to get all these schools involved, particularly the districts I'd already worked in. But it wasn't that simple. So I think what I learned, probably the most valuable lesson is kind of building the relationship almost before you need it, um, and then communicating details and being transparent, be be open about these are the tools I'm using. You can look at the questionnaires. You can look at the intervention. I won't be in the classroom, or I will be in the classroom, so they're going to want to know, really, all the details, because they also. I have to consider FERPA, which is kind of like the HIPAA for the school system. So how much information are you getting from the teachers? How sort of intrusive is it is the parent on board? So details and transparency are key. And then recruitment was another thing. So broadening recruitment was important. Initially, I was only recruiting five to 12 year olds, and then I realized that other people that were younger and older wanted to participate, and we were kind of low on numbers in the beginning, so it helped to get a larger in order to get a larger, larger sample, we had to kind of broaden our recruitment criteria without compromising the integrity of the study. And I would say lastly was timing. So like I said, ours was four weeks. But as you know, kids get, you know, week two, week three, week long break. So making sure that there wasn't an interruption to the study with some of those holiday breaks was important as well. So getting the school calendars ahead of time, I would say, is critical, because I was working with several different districts, so all of their calendars were very different. So prior to your study, contact the district, build those relationships, get their calendars and and make sure you have someone on your team from the district that will kind of support you through the process.
Jayson Davies
I can't imagine with the timing, because I know so many districts have different schedules. Some of us have like, fall breaks in the middle of October. Most of us don't some of us have week long breaks for Thanksgiving. So that must have been tricky. Did they all end up like? Did you have to select a specific time that every single kid was in school for four straight weeks?
Amy Sadek
So, you know, basically I had to consider all of the breaks. So because I wasn't interrupting instructional time, we would give the chocolate to and mine is unique, right? It's not like directly OT, but we would give the chocolate to the parents and have them give it to the child. We legally and ethically couldn't give it to the teacher to administer to the child. So I was lucky in that sense, that we didn't really have to consider instructional time or what class period they were in. But I did have to consider breaks, because if there was an interruption to the study, not only could there be dietary or time confounds with the children, the teacher would have missed a week of observations for behavior change. So depending on what your study is looking at, those components will vary.
Jayson Davies
Gotcha. Cool. All right. So you mentioned that you talked to several different people throughout the districts. I can only imagine, I can just imagine calling, getting the receptionist, and then saying, hey, I want to talk about research. Can you point me in the right direction. You must have talked to so many different people. What was Was there a time that you were just completely shocked by a response that you got from a district?
Amy Sadek
I was hung up on once? That's funny. That was kind of a bummer, but you just move on and go to the next district.
Jayson Davies
Yeah. So how many total districts did you end up working with?
Amy Sadek
I think we had a total of I'd have to go back to my sheet. Actually, that's a good question. I want to say it was somewhere from 10 to 15 districts and but we contacted 33 Oh,
Jayson Davies
wow. So less than 50% of them actually were able to help you out in some way. Right, right, right. Wow. So to follow up with that, I have a few questions. Are you familiar with whether or not CODAs can help out with researching and taking data?
Amy Sadek
Oh my gosh. I'm so happy you asked this question, because I just learned that this year. So CODAs can actually act as research assistants, or RAs in research studies, so they can collect data, they can input data. Obviously, they they're not always specifically trained to analyze and, you know, put data together, but they can definitely be used as RAs, which would be really awesome in the school setting, because they can, you know, maybe our form of data collection is work samples. CODAs can help with that, but they definitely have a place in the research process. And I was really happy to learn that because research, it oftentimes takes a village to get it done. So definitely, CODIS can definitely be RAs.
Jayson Davies
Great. And then one really last follow up question, I think, to this is, what advice would you give to an OT who's in a district right now and kind of has an idea about a research study?
Amy Sadek
Yeah, um, so they have an idea, you're saying
Jayson Davies
they have an idea. They want to do some sort of research. They kind of think they've got something on their mind that they kind of want to prove maybe, and they're working at the school district right now. Is there one piece of advice that you can think that might help them out?
Amy Sadek
Yeah, there's a couple of things I would, you know, get your, you know, OT department kind of on board with that, because I think to. Together, you can brainstorm ways to navigate, how to get it implemented in the district. And two, I would say, talk to your special ed director. And really the biggest, I know, I'm giving three pieces of advice.
Jayson Davies
No problem, the more the merrier.
Amy Sadek
Yeah, the biggest piece is getting that district buy in. And how do we get that? We get that by showing them the value of this research to their students and their teachers. And maybe we offer them, you know, program development at the end, or maybe we offer them an in service at the end, showing, like full circle, how their participation contributed to, you know, research and special education. And you know what district or administrator wouldn't want their district to be, you know, up to speed with appropriate evidence based practice, not just in their curriculum, but in their special education related services. So I think getting their support and buy in is probably number one.
Jayson Davies
There you go. That also led me to ask one more thing. Sorry, I lied. I have one more question. Does someone need to be in a master's or a doctoral program in order to attempt a research study like going back to this ot who, you know, they've got their buy in from the OT department, their sped director and maybe even the superintendent, do they need to be part of a doctoral program like you were when you did this research, or can someone kind of do research on their own?
Amy Sadek
Yeah, great question. So you do not, you definitely don't need to have a doctorate to do research. I mean, even at our master's levels in OT we did research going through the IRB process and everything. So I would say if you're at the bachelor's level, it might be helpful to have a mentor, or some somebody who's already done research to kind of help you through that process, because typically BS or ba programs don't go as in depth through the research process, but a master's OT is plenty to get a research project done. I think as long as you know they kind of go through the stuff we went through today on critically appraising literature, knowing the IRB process. And, like I said, you know, research takes a village to get done, so I think anybody with a master's degree could easily conduct a research study.
Jayson Davies
Gotcha, I guess, what begs the question for me there is, if they're School District, if they're there. You know, I'm in a school district. I don't think my school district has an IRB. Can I apply to an IRB at a college, or do I have to be enrolled at that college? Do you know?
Amy Sadek
that's a good question. So I was just an adjunct faculty at a local university, and being adjunct somewhere, you have access to their IRB. So you can propose an IRB project that you want to use in the school district through a university's IRB. But I'd have to dig a little further to determine, and I think that's another barrier, honestly, to school based EBP, is how do we then, you know, because it is a human subjects research, and it's a vulnerable population. How do we navigate the IRB process if a district doesn't already have an IRB or access to one? So I think you and I have more research to do.
Jayson Davies
Yeah, I agree. We'll have to look into it. So great. Well, thank you. That was so much, a handful, if not, like, three handfuls of information. So I hope everyone enjoys that out there, and that's going to wrap it up for today. Congratulations on getting your your PhD, and I just wish you all the best. Is there anywhere if someone wants to get a hold of you, is there a way that people can get a hold of you to ask you questions? Maybe they have about an IRB or how to do research?
Amy Sadek
Yeah, definitely. People can reach me at my personal Gmail address, which is a for Amy, and then my last name, Sadiq, S, A, D, E, K, and the number 20 two@gmail.com so I'd love to hear from anybody. And thanks so much for having me. This was a lot of fun.
Jayson Davies
Perfect, definitely. And we will link to that on the show notes, which will be ot schoolhouse.com, forward slash Episode 11 now, so be sure to visit the show notes so that you can click on the link to contact Amy. So great. Well, thank you again, so much Amy, and wish you all the luck in the world.
Amy Sadek
Awesome. Thanks. Jayson, you too.
Jayson Davies
Take care. Bye, bye. All right. Well, that's going to do it for today's episode of the OT school house podcast. I hope you all enjoyed listening to Dr Amy today on how to conduct evidence based practice in your school based setting. If you're interested in receiving a certificate of completion for this professional development of the podcast, you can head on over to OT schoolhouse.com forward, slash P, D, as in professional development, and click on Episode 11. There, you'll take a short quiz and we will send you a certificate of completion. So thank you again, everyone for hanging around and we'll see you next time. Bye, bye.
Amazing Narrator
Thank you for listening to the OT school house podcast for more ways to help you and your students. And succeed right now. Head on over to otschoolhouse.com. Until next time class is dismissed.
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