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OTS 135: Empowering Teachers with Integrated OT Services


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Welcome to the show notes for Episode 135 of the OT Schoolhouse Podcast.


Would you like to have a better understanding of integrated OT services in schools?


In this episode of the OT Schoolhouse Podcast, Dr. Woolley shares many insights on integrated OT services, the importance of understanding individual student needs, collaborating with teachers, and adapting interventions.


She shares valuable insights and strategies for creating an inclusive learning environment. From understanding different service delivery models to integrating multimodal teaching approaches. Tune in now to learn more!



Listen now to learn the following objectives:


  • Learners will Identify how collaboration and effective communication between the OTPs and teachers is very important for successfully integrating OT services.

  • Learners will identify strategies to integrate services into the classroom through collaboration, modeling techniques for teachers, and providing coaching.

  • Learners will recognize the benefits of the co-teaching model and how it can help provide more effective services in the classroom.

  • Learners will recognize the importance to be flexible and adapt approaches to meet the specific needs and culture of each school or classroom


Guest Bio


Dr. Woolley is an experienced educator & occupational therapist with 25+ years of clinical and administrative experience in various clinical settings. She graduated with honors in 1994 with her Bachelor of Science in Special Education from BYU with certifications in mild/moderate and severe/profound disabilities.


She started her career teaching special education in a junior high school life skills classroom, which led to her interest in pursuing a career in occupational therapy. She earned her Master of Science in Occupational Therapy in 1998, as well as her post professional OTD in 2009 from the Sargent College of Health Sciences at Boston University.


Dr. Woolley’s primary area of clinical practice is outpatient pediatrics and school-based practice. During her work as a school based occupational therapy clinician and administrator she was instrumental in developing and implementing a co-teaching model for OTs and special education teachers in the classroom.


She is certified in Comprehensive Behavioral Intervention for Tics (CBIT) with the Tourette Association of America, and also has experience providing OT care and services across diverse settings and ages including acute care, out-patient rehabilitation and home health.


She has presented at local, state, and national conferences and continuing education programs on a variety of topics. In her free time, she enjoys reading, traveling, and spending time with her husband and five children.



Quotes


“Don't just share what you do, show what you do.”

Dr. Heidi Woolley


“The natural environment, that's when things are best learned, and that's where they're best generalized.”

Dr. Heidi Woolley


“Having the support of the district, of the department, of the principals, and then of the teachers, you have to get buy-in from those stakeholders to make these interprofessional interventions work."

— Dr. Heidi Woolley


"We can actually do a service to ourselves by instead of trying to get everyone to understand us, to flip that and to better understand the system that we are trying to provide services in."

— Jayson Davies, MA, OTR/L



Resources



Episode Transcript

Expand to view the full episode transcript.

Jayson Davies   

Hey there and welcome back to the OT schoolhouse podcast where we dive into all things related to occupational therapy in the school setting. I'm your host Jayson Davies. And today we have an incredible guest joining us. As always when we have a guest, Dr. Heidi Woolley has experience as both a middle school teacher and as an occupational therapist in the school setting. And today she is here to share how her experience in both arenas helped her to use an integrated service model as a school based OT and how you can too. Throughout this episode, we are going to discuss her experience as an OT practitioner, while also discussing a research study that she co authored on factors influencing school based occupational therapy service delivery models, which you can find and the Journal of Occupational therapy schools and early intervention will be sure to link to that in the show notes so that you can easily find it. Dr wooley will help us all to understand the different types of services that can be categorized as integrated services like co teaching, and also help us to get an understanding for how our caseload and our service models can impact one another. Our three key learning objectives for this episode are as follows. First to understand the integrated service models and how they can be used to implement occupational therapy services. Second, to explore the benefits of adapting interventions and the need for proper training to do so effectively. And finally, to discover strategies for collaborating with teachers and other stakeholders such as parents in order to provide the best possible OT services. There are so many quotable moments from this episode and I know the entire time you're going to be nodding along just like I was. So if you're ready to enhance your practice, gain valuable insights and make a real impact on the lives of your students. Stay tuned. Get ready to learn and be inspired by Dr. Heidi wooley and her experience and integrated OT services. 

 

Amazing Narrator   

Hello, and welcome to the OT schoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started. Here's your host, Jayson Davies, class is officially in session. 

 

Jayson Davies   

Dr. Woolley Welcome to the OTs schoolhouse podcast. How are you doing today? 

 

Heidi Woolley   

I'm great. How are you? Thanks for having me.  

 

Jayson Davies   

Yeah, wonderful. I'm doing great. I'm happy to have you here. And I'm excited because we're going to be talking about integrated services versus that pullout model today. I know that is something that is on the minds of just about every single school based occupational therapy practitioner out there. So I'm excited to talk to you about that one. But before we dive into that, I do want to give you an opportunity just just to kind of share kind of where you are at in your OT career at this point.  

 

Heidi Woolley   

Okay, so I have been an OT for just over 25 years. In my previous life, I call it I was actually a special education teacher in the junior high study. So I got interested, when I was teaching though he came into my classroom, I learned a lot more about it. And I was like, oh, that's something I really wanted to pursue. So I went ahead and got my master's. And then 10 years later went and did my doctoral. So was it was a natural kind of move to start working in pediatrics. And since I had been in the schools, I it was a natural setting. So I did start working. My first job was actually in the same school district that I taught in. And so it was a really easy blend. And I found out that my skills really overlapped. And it was a great commingling of careers. So I worked in the schools for a number of years. And then, as OTs do, I've worked in a lot of different settings, but always came back to peds and I progressed into working in a lot of different settings, outpatient and, you know, other pediatric settings except for the NICU and not that. And then I always taught adjunct a lot of times and gave guest lectures. And then I went full time into academia about 10 years ago, and so worked at a number of different settings. And now I'm a Assistant Program Director at the University of St. Augustine on the St. Augustine campus and continue to dip my hands in teaching because that's the bread and butter. That's what it's all about, you know, training new professionals to join us and to do evidence based practice and just make a difference in the lives of others.  

 

Jayson Davies   

Absolutely knowledge translation to all those who will be helping us in the future and eventually taking over for us in the future as occupational therapy practitioners so wonderful. I actually want to kind of go off but one of the things you mentioned, I didn't know that you were an education teacher before you got into the world of OT and I don't know I've heard of that a few times. And every time I ask As someone who's gone through that path, they really attribute their understanding of school based occupational therapy, to first understanding that education model, what it what it's like to be a teacher in the schools. And so, I'd love for you if you could just share a little bit of insight of how being a teacher first. I mean, did that help you? And if so, like, what, what types of things do you think it helps with?  

 

Heidi Woolley   

Yeah, it really gave me that thorough understanding of what a classroom can be like the stresses that teachers are under, and what their daily routine can look like. And the different ways everybody has their different style. As OTs, we all have our own different style. And as educators, we add our own different style. And over the years, I mean, I've been in education for over 25 years, it has changed, a lot has changed, and how we provide services, the number of students that we're seeing the challenges, and actually what they're accomplishing, and what we can do. And there's been a variety of, you know, legislation, what we're, what our support role is. So I think having that classroom opportunity really gave me the experience to know that when I come in as an OT, one of the things I tell students all the time, remember, you are a support services, it's their classroom, it's the students classroom in that teacher's classroom. So you really need to do what OTs are great at, analyze the environment, analyze the tasks that they need to do, and see where maybe you can step in and help and fit into what is already in place. Because the last thing I wanted was for somebody to come in my classroom work with the students, that's great. But then as they go, it's like you need to do A, B, C, and D, good luck with that you didn't have time to really consult that was one of the barriers. And so finding that blend, and every teacher is so different, and what their classroom is set up. And you really have to analyze that and their openness to working with you. Because if they're not open, and if they don't think that you understand what they need, and that you're not going to make their life easier, and make the students help the students learn better. They're not going to be open to having those services or having you in their classroom.  

 

Jayson Davies   

I love that I absolutely love that, you know, at school based occupational therapy practitioners, especially in those schools. And I'm guilty of this too, we sometimes complain like, oh, the teacher doesn't know what I do. The principal doesn't know what I do. But I like to think that we almost need to flip this because we don't understand the teachers role. We don't understand the principal's role. And as you mentioned, we are there to support the teacher and the students. And I think that we can actually do a service to ourselves by instead of trying to get everyone to understand us to flip that and to better understand the system that we are trying to provide services and, and so I love that you kind of shared about that and how being a teacher helped you to understand that side of the road before you became an occupational therapy in the same educational route. So thank you.  

 

Heidi Woolley   

Yeah, and as I got out there, too, I realized not just my classroom, every school district work is different, every state is different. And every classroom is different, you know? So you have to be that, really that therapeutic use of self come in, learn what's going on and understand, like you say that system, but what is the culture that you're working with that? And, you know, we need to be the flexible ones to say, what do they really need? Maybe not what I think they can do, because that's always not you need to find that just right blend of what they need and what you can help them with and what they're capable of integrating. I mean, sometimes we have great, you know, things that we could do that we can suggest, and they want to do it all. But I know as a special education teacher, I think I worked it out the first couple years that I was teaching, it was like, you put so much work and I think I was making like $2 an hour. Just so overwhelmed and what you need is that support to make your teaching more effective. Not just more to do.  

 

Jayson Davies   

Yeah, absolutely. All right, well, five minutes in and we've already got a ton of value and we haven't even gotten into our main topic. So let's go ahead today we are here we're gonna be talking about the co teach model as we discuss an article that you are an author of, and the title of that article is integrated services or pull out factors influencing school based occupational therapy service delivery model. So I think I already kind of know the answer to this, but what got you interested in this topic of understanding integrated or pull out type of services? 

 

Heidi Woolley   

Well, obviously I was interested in this topic and actually Dr. Heather, what she was doing her pulse professional OTD work. And this was a topic that interested her. So we were hooked up as I was one of the faculty mentors that helped her with that study. So she was the brainchild behind the study. But what I was really interested in as I was like this needed to be done, we need to know what's going on. Because my personal experience was I was going around, you know, doing the traditional pullout, because a lot of therapists say, This is what I learned it was kind of that medical model, let's pull them out, see what we can do. Put them back in the classroom, say try this, this and this. And so you know, you're doing that you get overwhelmed, one of the biggest challenges was finding time to collaborate with those teachers. And that's what this study found as well, that finding the time to collaborate, an even understanding of this is what I actually need. It was a real big barrier. And the results of our study showed that as well. And but it really came to a head when I was working in a classroom, and it was the same kind of classroom that I had taught in it was a junior high classroom. It was self contained. So they had students with more difficulties, challenging difficulties in there. And then they had peer tutors. And the teacher of the classroom came to me over the summer and just said, this is not working Heidi, and I just got devastated. It's like what did I do? Don't you want me in your classroom anymore? And she was like, here's what we're gonna do, you have so many great ideas. And I think I know what you're saying, but I just I don't, I don't have time. And I don't really know how to carry it out. So I breathed on my students schedules, all my students are going to be in my first chart period class, you're going to come in every other week, and you're going to teach with me that first period, and I was like, great. Okay, so we did it. And it was a huge experience, a huge experiment, I should say. But we were both gung ho. And so I took her take her lesson plans, I was like, What are we doing, and it happened to be English. So great. We weren't just going to work on handwriting, which is what a lot of you know, people think that we do, but we can work on all the skills that were on all of her students IEP during that time, so I took her her lesson plan, and I integrated aspects of OTs into it, now she was willing to do anything and everything, which is very rare. So I had the unique opportunity of being able to just do it 100%, but we actually co taught so it was like you're gonna present this, I'm gonna present this. And I took that lesson plan and integrated, that multimodal teaching that was in there. And I helped her adapt, because we had all ability levels, levels from cognitive levels of maybe, you know, kindergarten up to almost like ninth grade. And then, but we also had a lot of different physical ability levels, as well. So we had to adapt each of her activities to accommodate that. So we did it, we did a number of groups, we came up with different things that she could adjust. I went in and did it with her taught her how to grade it up and down, which is an OT term, to meet the needs of those students. And then this was the code, I call it the co teaching therapy model. It was born and then we moved on from that to finding general activities and teaching her how you can use this activity to teach this topic. And you can make it easier and harder. But then you can also use this activity to teach a different topic, how would we adapt that to teach them maybe math. And so I really worked with her on teaching her and our classroom staff and myself different ways to take those activities and get that multimodal teaching in. And one of the biggest benefits was that when I was in the classroom, we would both go around and I would help somebody out. Like if there was a there was a child that has cerebral palsy. And they were sitting in their kind of their stander and so we wanted to get them out and get a movie. And so I showed her how to position them and I just really simply rotated the hips of that child and it fixed there. It didn't, you know, permanently fix their posture but it improved their posture that she was sitting up straight and all of a sudden she could you know access what was on the table in front of her and not have to focus on a give her support and I just pointed it out to her. I'm like, see what I did. And she was like, Oh my gosh, a light went on. And she was like that's what you meant. In and I was able to do that as I could go around and work one on one, get a lot more direct service in because I struggled as an OT to get that direct service time it was so much assessment and going to their IPs. So it gave me that opportunity. But then the unforeseen consequences that were great was the I was also able to help other students that were more at that at risk, that maybe didn't qualify for one on one services, we could do really simple things that made a huge difference to them as well. So it benefited all of the classroom. And then the magic moment, sorry, I'm going on and on with when I walked in unexpected into the classroom, just to drop something off, I walked into the classroom, and it was probably sadly to say, one of the first times that I saw her using a hopscotch activity to teach math that we had used for English and she was integrating it and we had done it for one kid. And she was using it with a different kid and, and one of her classroom staff was there helping her and they were just taking it and running with it. It was just like this is it. This is the magic moment.  

 

Jayson Davies   

Absolutely, absolutely. You are a wonderful stellar storyteller. By the way. I couldn't stop if I wanted to. I was just so intrigued by everything you're saying. But all of that was actually prior to this research. Right? That was when you were more practicing in the schools. 

 

Heidi Woolley   

In the schools. Yeah. So when Heather when Dr. Watt came to me, and this was her topic that she wanted to do her capstone on, I was like, Oh, thank you, thank you, we so need this, because it's just not happening in we, we really don't know what everybody else is doing. Because you're so busy meeting with other therapists from other districts, let alone other states. If there's so many different models and variations, we didn't even know what is happening. I knew it was not happening in our district very much, and how to do that. So I introduced it there. And there were a lot of pros and cons. And I had great colleagues, that gave me a lot of feedback. But when she wanted to see we just had to start out with what are you doing? Yeah, you know, what are you able to do? And what are those barriers and the results of the study, that you no time knowing how to do it, I did not realize and I had one of my colleagues bless her, she was so blatantly honest, she's like, Heidi, this is great idea. But you've been a teacher, I don't know how to do this, I'm just I'm an OT, I'm like, You're not just an OT, you're a great OT. But she's like, I don't know how to adapt these. So they need more training. And that was one of the biggest barriers of how to do that. Having the support of the district, the Department of the principals, and then of the teachers, you have to get buy in from those stakeholders to make these interprofessional interventions work, which is one big thing that we tell our students here at the University of St. Augustine, we have, you know, we have PTS we have speech? How can we work together as a team, that interprofessional team and break the silos so that we take advantage of your expertise as a teacher, your expertise, or speech, my expertise as an OT to give that those best services to those students? And it really depends on learning that environment, what is what do they need to do? What is possible to do and how to break those barriers? So yeah, the study really reinforced what I thought I already got, there still needs to be a lot more research to done because we know I think in the OT world, we know that works. We know what we're doing as well, good. But one of the things that we're emphasizing with all of these new graduates that's emphasized a lot more than when I was in school is you can take these results and you can publish you are all researchers, even though you come out of school, I just want to be a clinician, I just want to work. It is so important for us to get that knowledge out there and get that those statistics get those numbers out there to say this really works. Or this doesn't, maybe we thought it did. But there's a better model maybe that we can produce and our students are coming out more and more able to do that and translate those results into evidence based practice.  

 

Jayson Davies   

Awesome. That is definitely a good future for OT to have researchers out there. You know, everyone be a researcher. Know when you talked about the project or the program that you put in, you called it the co teach model. And then in the research, they use the term integrated services. I've heard other types of services that are fairly similar but people are using different terms is what I'm trying to get to right you have integrated services you have co teach services, you have push in services, to some extent, they're all going into the classroom. So when the article they're using the term integrated services, what does that actually entail? does that entail that co teaching? Does that just mean getting into the classroom? What does that refer to?  

 

Heidi Woolley   

Yeah, so when we refer to that it's a spectrum, it's along a spectrum, it can mean anything from going into the classroom and running a group, with just a few kids to going in a classroom and working with a child, one on one within their classroom routine, it can mean that it can up to this co teaching idea that you're fully integrated, you're teaching along with the teacher, you adjusted the curriculum and everything. So it's along that spectrum, which is really important, because I think when we have a new idea of what we want to do, I look at that I'm like, Oh, this big program, we can do this, and this and this. And you can't, if you start out with little steps, and that's what the teachers are ready for, for the most part, I had a very unique that she would take everything, but the majority of 95% of the other teachers that I worked with, that wouldn't work in their classroom, I had to choose where it would work best, or what child if I could go in, and then they would see me working with one child. And they would generalize that to working with others. Oh, that's similar. Could I use this. And that, I think, is one of the roles that I enjoyed the most I know, when students go out and tea and they get in the school services, they think, Oh, I'm gonna see kids all day long, kind of like a clinic. And not that's not necessarily the truth, a lot of districts, you're evaluating a lot. And then you have OTAs, at the teachers that are teaching. And I often say, no matter how magic, my want is me going in half hour a week, and going both of them, you know, it's not going to fix the kids. What's going to help them is being a teacher to the teachers, being a teacher to the parent, who is spending all of that time with that kid, because we know that kids learn through repetition. They don't learn overnight, it's all it takes a long time and kids with disabilities or challenges need even more repetition, we're not there to do it. So it takes that ability to step back and go, Oh, my role might be a little bit different. And I can teach them. It's not just me that can do this. I mean, some things we are certified to do, but I can teach others how to implement this and make it a part of their daily routine, which is the most key important thing.  

 

Jayson Davies   

Yeah, yeah, absolutely.  

 

Heidi Woolley   

answered your question probably went off on all tangents.  

 

Jayson Davies   

No, but it's absolutely right. In fact, there's a resource that I've recently rail, it's not so recent anymore, but it's something that, honestly, I should know who the authors are, by by how many times they've actually, you know, put this out into the road. But it's not an OT study. It's actually an educational teachers study. And the teachers basically, were sharing what they found most helpful from not only OTs, but other related service providers. And what they found most helpful was when a related service provider not only shared what the teacher can do, but actually demonstrated what the teacher can do in their classroom. And I think that kind of just goes right in line with the integrated service model, right? Like not just doing a teacher training after school on the minimum day or whatever to share with them what they could do sensory wise and implement a plan to actually go into the classroom and show the teachers how they can implement those sensory programs, those fine motor skills and whatnot. So it all lines up from both sides,  

 

Heidi Woolley   

I always say, don't just share what you do show what you do. Because that was the aha moment. It was like, oh, that's what you meant. And I'm like, Did I not explain myself? I just to actually see it and actually see at work. And we do have those skills of adapting on the spot of grading it up and down and adjusting it to what that student or that environment needs. And we don't realize that I think is OTs because it just comes natural with our training. But seeing that ability and actually seeing emotion. It's like, oh, I can do that. It's like, yes, you can. But it does take that modeling. We're just like kids learning something new. We're different. Most of us, you know, auditory learners. We're usually kinesthetic or visual or combination multimodal learners. So it makes sense not to just give it to them. auditorially but to show them and actually have them do it with.  

 

Jayson Davies   

Yeah, yeah, absolutely. So I want to dive into the article a little bit. I have a few different things that I pulled out and I just kind of want to get your take on maybe why you feel this is and maybe where you see it going. And one of those is that it seems like it's about a 4060 split with 40%, using a more of a pullout model seen a student in an occupational therapy area, and 50 to 60% seen students in their special and general education settings. So I just want to get your take on a what that means and maybe where you see that going in the future and why.  

 

Heidi Woolley   

Yeah, so I think there since it came out, and we have the least restrictive environment that's really helped, I think, promote what we as though Tinos, we talk about an all around that are models of practice, that natural context, the gym, you know, the natural environment, that's where things are best learned. And that's where they're best generalize. But when we looked at this, that 40% pull out, that sounds really great. Oh, you, you know, do half and half. And it is but it was broken down the other 60% was, were you in the special ed classroom? Yes. Or were you in a, you know, general ed classroom? Yes. But that can look anything from consultation, to observing, not maybe not directly and purposefully and intentionally doing an intervention within the classroom. So I think that's where there might be a little bit misconception with the numbers that they are in the classroom. But how much are we actually and this is what we need to do more studies on? Are you working with a kid one on one? Are you doing groups? What kind of integrated or pushin model therapy are you doing? How interactive Are you? And how effective is that? So? Yeah, so it was encouraging that at least we're breaking out of the mode of you know, I just pull them up into this little room or under the stairs, it would all ot school otp . No, you know, you'll you're stuck in a corner under the stairs was the most popular, you know, even got the club.  

 

Jayson Davies   

On the stage is my favorite.  

 

Heidi Woolley   

Oh, yeah. On the stage, during lunch time on the stage when the curtain there that everybody, there's so much noise, like you don't know how it's gonna happen? Yeah. So. So I think that was one of the big aha moments. It's like, okay, great. But I think one of the things that could really be studied is how was that time exactly being used, and what is, is coaching more better? Or is maybe, you know, the consultation model where or where you're teaching the, you know, the teacher and or you're just working with the student and you're not collaborating within the classroom. I think that needs to be, you know, ot's Avila because, as OT school OT's we know, the case loads are enormous. I don't care where you work, and what state work is, and what model if you're using consultation or direct service model, you're busy. And I think that time that it takes to really find a way to teach or to share and show the teachers in the classroom staff? What can be done and what may be helpful and how to do it, kind of how intentional are we in that, or we're just so busy, you run in, you see the classroom, and then you run out? And I know, a lot of times I didn't have time, it was like, Oh, I'll email you, oh, I'll call you. And that never happened while I was in the classroom again. And you're just running because you're trying I mean, logistics, you're trying to get those minutes in that you need to see the kid which is, I mean, I hate to say it, but it's true, you know, it's like, Oh, I've got to see. And then it's off to the next kid. So how intentional Are we being and to really have an effective model, you have to do that training portion. And that collaboration, and that interprofessional talking, teaming and planning, which in our study, it showed, I think it was an average of planning and collaborating was like 4% of their time, 5% of their time. And that's just not enough until you come up with a, you know, a system, it will take less, but to really break down those silos to really take advantage of everybody's expertise. You do need time and, you know, a way to facilitate that. So,  

 

Jayson Davies   

Yeah, yeah, you know, there's when you look at things like other professions, a lot of times and you know, I don't know every profession, but an education and health care. There is so little preparatory time given for each individual or for all the cumulative service that we provide. And when you think about other jobs, right, like, I'm just gonna use a lawyer because everyone knows it, right? Like a lawyer, like they might spend maybe a three weeks in trial, I'm just gonna throw that out there. Maybe they it's a three week trial per se. But how much time do they spend actually preparing for that one trial. And as occupational therapy providers as speech therapist is everyone in the healthcare and even teachers, like we're not given that preparatory time, like, it's 7am to 3pm is the time that the kids are there, and, uh, maybe you have a half hour before and an hour after maybe, 

 

Heidi Woolley   

like maybe one period prep, which if, depending on how much they're teaching, that's not enough. I mean, it's finally time to breathe without half an hour lunch, and then collaborating the teachers time with the time that you're available. That was the hard time thing. It was like, How can we so we use those minimal days or the early out days, that was one of the things that we did as a district that we tried to pull the teams together? It's like, okay, who goes to these schools? You take this early out day and go, and we would collaborate with the principals and say, Can we come in and have some time with your teachers, like, or at least your special education team? And, and then even then it's not enough. But yeah, you have to be really creative. And even in healthcare with all the productivity models, it's, you just have to jump in and do it. I know, when I was teaching some of the students where I had them come up with a treatment plan or a lesson plan for their, for their clients. And one of the one of my colleagues called me and she was like, What are you teaching them? And I said, What do you mean, she's like? So the student asked me where my lesson plan. We teach them that so that we understand they need to know that they do what they're doing is based on a frame of reference, a practice model, that evidence base. But I need to make it more clear that yeah, when you get out into the field, that you have it in your head, and you can verbalize it. But actually sitting down to making a, you know, this big, long, gorgeous lesson plan. That's probably, 

 

Jayson Davies   

yeah, yeah. Oh, man. All right. Well, there was one other point that I really wanted to pull off in the article and talk to you about, and that was this, that during some of the interviews that were conducted, participants were positively inclined toward providing those pushing services. However, they did not believe the services were always best for meeting the child's needs. And so why do you think that is that there's this like, I think that we should be providing push in. But I don't know if that's best for the student? Do you think there's a disconnect there? Do you think it's that it's an individualized feeling? Do you think it's a system problem? What are your thoughts?  

 

Heidi Woolley   

I think it's a little bit of all. So I think, from my perspective, and I, you know, I could be wrong, it comes from that remediation model, I need to get in this, there are certain kids that do need probably that one on one time, and that one on one teaching teachers find it too, you know, but they have a whole classroom. So it's that mixture of being able to work on a specific skill, maybe being able to pull them out and just working intensely, one on one with that student, to maybe help work on that, and that skill. And I think and then take it back into the natural environment. I think there's, there's a fear with parents, when you say, Oh, I'm going to be in the classroom. It's like, No, you need to be with my kid, my kid needs this one on one time. Whereas that's not always the best. And so you have to educate them and yourself to well, this is what I need. I am working one on one with your kid. But it's not always the best that it's an isolation here on their own. Yeah, they may need that at a certain part. But they're not going to learn they're there to function in school, and then hardly ever one on one, they're not going to they need to learn to function. Learn from different people learn with other students, because they're not in that one on one environment. And so I think that's one of the it's fear. It's like, No, Mike, they need to get this they need to, you know, and you was like, Well, I can't help them with this skill to really learn the skill and master the skill unless we just do it over and over repetitive with me right there. And there are ways not that there are times that you do need to pull them out. But within the integrative model, what I found is I can take a student and take them aside to the corner of the room or even outside for a little bit to get some calming and it's like okay, when it gets overwhelming, here's what we do, we can step out in the hall, have the teacher work with us and say, this is a way that you can get that one on one. But it's still within the natural environment. So I think there's there's that dichotomy have individualized, how can you deliver that effectively or purposefully? And it takes a skill, you know, you have to kind of learn how to do it. You're not I wasn't great at it, and I still have a lot to learn.  

 

Jayson Davies   

Yeah, yeah, absolutely. And you know, a lot of people talk about that imposter syndrome and overcoming that imposter syndrome. And I think there is that little piece. In fact, I often hear from from therapists, and they asked me, well, you know, I push in, but then I feel like I'm just a teacher's aide. And I always know, like, I've discussed this in the podcast before, but I feel like you are the perfect person to get an opinion on this as well. You know, like, how is it different from a teacher's aide, sitting right there, right there with a student in class, versus an occupational therapy practitioner sitting there with a student, I love your your take on that?  

 

Heidi Woolley   

Well, and that's what I think you need to go back to your learning. It's like, no, what am I doing this skilled? Am I just sitting there doing kind of common sense things? Yeah, in a way, but I think we devalue what we're trained to do, how we really break down an activity, how we are looking at all the aspects, we're looking at the tools that we're using, we're looking at what's going on in the environment, we're taking all of these into account. And to the outside onlooker, it might look like, while you're doing the same thing as that over there, but what I always tell my students and my fellow practitioners, that's worked for me, if I am explaining to the teacher to the child, I we're doing this because if we repeat this, if we adapt this, if we do it this way, it's going to help you do this, and that makes you stay. Why am I doing this? Oh, I'm learning the amusing the motor learning, or I'm using social participation, I'm using those types of things, if you can verbalize that, and use that language, which I don't care If you went back to the school in my day, we had one or two models, you know, we had Mulholl and developmental. Now there's a ton we teach them all these practice frameworks and stuff. And I'm like, even though you might be more experienced OT you might not know that language of what it's called, but they do know why they're doing it. I'm doing this specifically because of this, I took into account this. So if you verbalize that to somebody, because you're teaching them even if the kid that state makes you stay skilled, that makes sure that you're not just doing what a classroom aide could do. And as the same in a hospital setting, or what you're not just doing what a CNA does, you're actually using all of that expertise in that analysis part and bringing it all together, and you're adapting as you go. So we need to give ourselves a lot more credit for what we're doing. And I think if you verbalize that, then my documentation was a lot easier. It's like, what did I say? What was I doing? What was explaining to them? Then I can use that skill, vocabulary as well, to show that I was providing a skilled service.  

 

Jayson Davies   

Yeah, absolutely. And, you know, I like to also tell people that are I mean, I think we all do, right, the task analysis, that's something that we do, that other people are not doing, and we are doing it in the moment, as you described a little bit earlier. And for other for occupational therapy practitioners who, you know, maybe you want to document that, then you can document it in the way that in one session you went in, and you provided this type of service where you were sitting there with a child. And then maybe a week later, two weeks later, your next session you go in, and you can document whether or not you're seeing that transition over right like is the teacher able to then incorporate what you taught them to do like that is still part of a therapy treatment service like that is not, there is data collection there. But that can be part of your service,  

 

Heidi Woolley   

I think we have to keep in mind, the OT is not just there's a lot of different service delivery models. And we're taught that now. Collaboration, coaching, you know, consultation, these are all parent teacher, caregiver education. These are all occupational therapy services, because you can't pull somebody off the street, and they can say the same thing. So this is all part of the service. Direct service is not just you putting your hands on somebody and helping them to facilitate doing something. We have a much larger scope of how we can deliver these services. And I think especially in the school system, we need to take advantage of that and say, because that one on one pull out medical model can work for a few skills, but they have to learn to integrate them and like I said, no matter how magic your wand is, you can't go in and just fix them with one thing. They have to be taught to be, we'll have to repeat that all the way adjusted. And if I come into the classroom again, like you said, and it's like, Oh, I did this and this and this, and then I see that it's not being done. I need that's part of my assessment. Okay, what did I do? Did I not teach them? Did I think they were watching me and that didn't get across? Or maybe that just wasn't effective. And so they stopped doing it. You need to investigate that and see, you know, where that disjoint is. And we're always doing that. And I think one of the things too, we do get that impostor syndrome. And I know people get nervous, oh, don't ask me a question. Because I know, I know why I'm doing it. You know, especially if you're younger therapists, I just embrace it. You don't know everything. I don't know, everything I have learned the most from classroom aides. I mean, they have, they're in there all the time. And they have these great ideas. And I'm like, Oh, my gosh, that is so fabulous. And then I can bring it into the context of our profession and go, Well, this and if you look at it this way, and just embrace that learning. And it's okay to say, you know, I don't really know, let me think about that. Let me talk to some other people, I think you get a lot more respect. If you acknowledge that, I don't know everything and my profession. And that goes back to that interprofessional breaking down the silos. What, uh, you know, what were you trying to do? This is what I prayed to do. And it's like that mixture, that eclectic mixture of using all these different techniques to find out what will really work. And just, you know, it's hard. But yeah. You know, a lot more you think you do.  

 

Jayson Davies   

Very true. Very true. You usually know more than you think you do. And a lot. Wait,  

 

Heidi Woolley   

Well, 

 

Jayson Davies   

How do I do? You know, it's kind of like, if you think you're, the more you know, the less you know, and the less you know, the more you think, you know, right? Like, you know, a lot. So just be confident and go in there. And if you don't know something that's gonna lead into my next question for Heidi, which is, you know, if there is someone listening right now, they're like, hey, I want to push more into the classroom. Totally understand, but I don't feel that confidence. Like what might you recommend to an OT practitioner that's out there? There's like, I want to, you know, maybe maybe there's some people on board with it in the school. So what should they what should they do? What should they try? 

 

Heidi Woolley   

I think they should collaborate, use your lunchtime, use your and services, find in all podcasts like this one, I think that's great. But don't be afraid to have book groups. And now we have the internet. And we have webinars and everything. So you can collaborate on a much larger level. And also reach out and do. There's so many places that have continuing ed, especially online, that's not expensive. And one of the things that we teach the students is to do a journal club. I know I think that I don't know how common that is, the EO TA has their journal club, but it's taking an article taking an idea, use it during your lunchtime talk about it, you can get continuing ed credit for it with NBC OT, but then talk about it and say, how could we integrate just maybe one idea per minute, what am I see what have I done, go on the blogs, you know, educate yourself, and then take it down. There's no conferences. And even if you have a little bit of a success, put into do a small poster or to do a short for your national, your state conference you put in to do a presentation with one of your co workers, hey, we did this. It doesn't have to be big. I think we get so afraid that we have to have this big research thing. And I don't have enough to show I'm like case studies when sometimes the some of the best learning examples. And that's why you go to conferences, we encourage our students, they have to go to days of conferences, which I love, because I didn't do that when I was a student and it shows them that networking. And that collaboration can be it's your biggest learning tool.  

 

Jayson Davies   

Yeah, absolutely. As we kind of tail end here, I want to ask you based upon this research, right, so we found out you know, what, what therapists are using and some are using direct, some are using that more traditional pullout. And we found some facilitators, we found some barriers. What would you like to see in the future? someone's listening today? And they're like, hey, I want to continue on this study. What would you like to see come out a future research around this topic?  

 

Heidi Woolley   

I really would like It's on my bucket list for me to really flesh out this co teaching model. I mean, I call it that and I've done it, but not you know, I need to write it out. Stimulating to me, you know, and I'm like, okay, but I still just need to jump in and do it. So I don't think it just getting people on board with the idea and taking one or two things and then really getting that research out there. Even if it's just a small survey, the students are coming out with the skills now from their scholarly classes to be able to translate that into some sort of presentation, disseminate that information. So I think if we can do it little by little, I would like, you know, even in the AOTA the school, you know, portion this, I can't remember what it's called the SAS.  

 

Jayson Davies   

SAS, yeah.  

 

Heidi Woolley   

Yeah. Or one of the school based the smaller publications or OT practice, just examples, don't be intimidated, I still get so intimidated about publishing research at all, which is, I get my own way. But just even trying out different aspects of this look into different there's a lot of different co teaching models that's in the educational realm that we can really adapt to the OT and the therapy, build, borrow from them, learn from them, and go, How can we adapt that to work? Better to maybe, you know, do a couple of these ideas and see if they work?  

 

Jayson Davies   

Yeah, yeah, absolutely. So if there's anyone interested in co teaching, Heidi will Lea St. Augustine University, get in touch and maybe you'll end up with a with a doctorate? 

 

Heidi Woolley   

Love it? Yes, I totally love it. We have a lot of doctoral students. And I'm like, anyone who's interested, I would love to work with them. And you make the time when you get more than one person involved. That's the key you can do, you can get a few people that are really passionate about it, you'll keep each other on. And I think just not knowing that you don't have to have this big, major thing. Even these little successes, they're worth knowing I want to hear about it. Everybody else wants to hear about them. So find a way to share.  

 

Jayson Davies   

Yeah, absolutely. All right. And the article, there's one point, it didn't really tie directly into your article. But it's something that's very common that we talked about in school based OT workloads and case loads. And it was noted the participants in Utah, you looked at before I say that we haven't talked about participants, the participants came from Utah and Colorado in the study. And they found that Utah OTPs, in Utah work longer hours with nearly double the case loads consisting of more children and higher grades than those in Colorado. Now, I don't want to get into a debate or discussion like why Utah versus Colorado, but just in general, what does it mean to you when you see such differing case loads and workloads amongst states? Like how does that hit you? And what would you like to see potentially in the future?  

 

Heidi Woolley   

I think it just depends on the model that they're using. So I saw like, in Vegas, that one of the one of the one of the school districts there, and they did really the one on one models, so the therapists would have, you know, 30 kids that they saw, and they thought directly one on one are with the school district that I worked on, we worked on a consultation model, or that we were teaching the classrooms and our direct services were with the kids, but it was more focused on teaching. The classroom staff in the classroom teacher do this, that and the other. So it really depends. And now I'm out in Florida, it's very different. And so I think we have to look at the model that we're using embrace it, because I know there's some people that are like, No, I got into OT to see kids. So I'm only going to work in this. And I came to embrace the fact that I wasn't necessarily working one on one with the kids a lot. But I took on the education role of and I did a lot of in services, I would meet with the preschool teachers once a month. And then I would meet with, you know, maybe the self contained in the emotional classrooms, the kids with emotional issues, I could work with them and do some sensory stuff or things like that. I really embrace the role of being a teacher to the teachers to the parents. And I found that rather than me just seeing, like, if I was working in a preschool, and I saw 30 or 40 Little preschoolers on my own, and then talk to them. That was great. But if I had an I did I would have these in services and trainings. If I met with 15 teachers, and they integrated just one or two things, how many more kids Am I touching? So I think that mindset Yeah, of where those ripples of effect can happen. And it's just, I think a lot. How many therapists can you have? It's a matter of survival, you know, and how many, you know, school districts are known for not paying a lot. So looking, I think thinking outside the box and giving that best practice and maybe not as always just using directly that one on one and maybe sometimes you can refer that out to community service and they could get those. I mean, there's a lot of different ways. So I think it's yeah, it's just hard to answer because there's such great variability, which is why we need a lot more research to say what is really going on?  

 

Jayson Davies   

Yeah. And that's a good point that you talked about the different type of model. Because when you think about a caseload model, typically you think about a 30 minute direct service for a student once a week like that is kind of if you tell someone your caseload that's kind of their go to ice I, like you said, 30 kids, right? Immediately, I say, okay, divide that by two, that's 15 hours of therapy per week that that that caseload is right. But that's not the case for everyone, right? Like some people do groups, some people push into the classroom and almost treat the entire classroom such as like the co teach model, where maybe your caseload is it could be much lower, because you're not having students directly on your caseload per se, or it could be much higher, because every student in that classroom is on your caseload technically. But you're seeing them all within that one hour time. So you're right, it definitely varies greatly with the caseload needs to match or the workload needs to match the model. And vice versa, the model should probably match the caseload and whatnot. So that's something new to think about. I've never thought about that topic, so. 

 

Heidi Woolley   

I think when we think about it is integral, you know, integrated pushing models, like I said, there's a spectrum. What is that exactly? You know, because you can integrate some of those one on one principles, but still do it within the classroom. And that way, you can maybe get more bang for your buck. It's like, okay, I can see this one and this one, and then decide where that one on one is needed. But I think it's just letting go of that traditional model, I think that we all have, and it's easy to do, you just get I just have to do this, and I have to do this, and then I go home and go to bed. You know, so I think taking a pause and thinking about well, maybe we could try something else. It's out of the box. It are the results is good. And being open to that, because I think it's really hard to give up some of those things that you've been doing forever, and, you know, words, but to be open to maybe this might work just as well. I don't know. And so being open to try it.  

 

Jayson Davies   

Yeah, definitely. And and you're right, it's, it's going out of the norm, right, if we're used to working nine to five, eight to four, whatever it might be seeing kids one on one individual 30 minute services and moving to something new. It takes some planning, you know, figuring out a what, what type of program you're actually going to do. And then the other thing that if someone out there is listening, you probably want to somehow track data on this to actually determine if it's working to determine, Okay, well, instead of doing a one to 130 minute session, if I'm going into each classroom for 30 minutes, does that make a difference in the goal attainment by the students that I see? So, yeah.  

 

Heidi Woolley   

That's all about and being open and then getting the buyer to say, well, we've always done it this way. Let's see, this might be mil a little bit more fiscally responsible, as well as just as effective, it may not. But that data collection is so key, and to show that, hey, this does work. And that's where change and progress comes from is trying something new. And sometimes it's because you have to. But if you want to, I'm looking for those, open those new ways. That's hopefully what we're instilling in our students to understand. You don't have to do everything. Traditionally, there's, I mean, before the pandemic, we didn't think telehealth would work and we found some great things that have come out of telehealth. That's not the answer to everything but didn't answer a lot. And I think I was personally surprised with what could be done via telehealth. I was like, Whoa, I really did not anticipate that would be as successful. I was like, No, we I have to be in person to do that. And I've been pleasantly surprised.  

 

Jayson Davies   

Yeah. So yeah. Telehealth, I've, I love it and hate it at the same time. It's hard. It's hard. And I respect anyone who can do it. It's it's a tough cookie to crack.  

 

Heidi Woolley   

It have to be trained. And there's certain techniques there too. That's where it gets back to being intentional about how you do it. You don't go out and say, Oh, I did it. I think you need to be very evidence based. What are the procedures that I'm using? What are the techniques and strategies and be very purposeful and intentional and then collect the data? Because otherwise, you're not really, you know, it's not really a ballot measure if you're not, if you haven't planned out?  

 

Jayson Davies   

Yeah, yeah, absolutely. All right, Heidi. Well, thank you so much for joining us. Before I let you go though, I do want to give you the opportunity to share where anyone who might be interested in asking you maybe a question about co teaching or getting in touch with you about maybe future doctoral work about co teaching and at St. Augustine. Where can they learn more about you or get in touch?  So you can email me it's hwoolley, H W O L L EY two O's, two L's E Y @usa.edu. If they want to find out more about OT at the University of St. Augustine, we have a variety of programs. And we have different modes of programming, as well as we have different locations. So, and we have different programs, we have mot, we have OTD, we have post professionals. So there's a lot of variety if they go to usa.edu, uh, go under Events. There's webinars there that talks about all the programs as well. But I would love to hear just send, send me an email, my email is my to do list so it stays flagged. And if I don't get back to you, you just email me again. Yep, that's how emails tend to work these days, right? Or terminal to do lists. So no, Heidi, thank you so much for coming on. Thank you so much for sharing the story, your co teaching story about how you went from educator to OT, and then almost back again, with a co teaching model. I really appreciate it. And I'm sure that that's going to help inspire some OT practitioners listening today to do something similar. So I can't wait to hear what hear what comes of it.  

 

Heidi Woolley   

Well, thanks for having this platform. Very popular. I love them.  

 

Jayson Davies   

Thank you. We'll take care and have a great rest of your day. You too. I want to give one more big thank you, of course to Dr. roley. for coming on and sharing all of her experience and some of that research about integrated services within school based occupational therapy. I hope that if nothing else, you were inspired, but honestly, I really hope that you have a better understanding of a few different types of integrated services within the schools after this chat that we had. And I do hope that you are inspired a little bit to try one. Right as Dr. Rowley said, you know, you don't need to do everything. You can just try one, find one that maybe fits within your caseload that you can do and try it with that one teacher start using an integrated service model. Not every student will need an integrated service model. Some students benefit much more from that more traditional pullout model, but there are several students on your caseload that likely would and it would be a wonderful thing for you to do to try and implement that type of service. So once again, thank you so much for tuning in to the OT schoolhouse podcast. This was episode 135 And you can find all the show notes at OTSchoolHouse.com slash episode 135. Thanks for tuning in and I will see you next time. Take care. 

 

Amazing Narrator   

Thank you for listening to the OT schoolhouse podcast. For more ways to help you and your students succeed right now. Head on over to OTSchoolHouse.com Until next time, class is dismissed. 


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