OTS 151: Enhancing Collaboration and Flexibility Through the 3 to 1 Model
- Jayson Davies
- Jun 3, 2024
- 44 min read
Updated: Dec 18, 2024
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Welcome to the show notes for Episode 151 of the OT Schoolhouse Podcast.
Discover how the 3-to-1 service model can transform collaboration among OT, PT, and speech providers, streamline evaluations, and enhance communication with teachers and parents. In this episode, we'll dig into the scheduling and IEP logistical concerns that come with this model and explore strategies for successfully implementing it, including writing services onto the IEP.
Stay tuned as we uncover the impact of the 3-to-1 model on IEPs and highlight the importance of flexibility and creativity in delivering effective school-based OT services.
Listen now to learn the following objectives:
Learners will be able to identify the differences between the 3-to-1 model and the traditional one-time-a-week direct service model.
Learners will identify the key benefits of the 3-to-1 service model in enhancing collaboration among OT, PT, and speech providers.
Learners will identify strategies to manage their caseload effectively during flex weeks.
Guests Bio
Kristina Geraghty is an Occupational Therapist whom has been working in schools in New York and New Jersey for 14 years. She also does private work at a sensory gym after school. In 2018, Kristina started an online education business, Therapy Advance Courses, with her co-worker Lauren Catalier, who is a speech language pathologist.
They founded this company after trying to find graduate courses that enabled them to move on their salary guides at their full time school job and realizing there was a need for affordable courses that were relevant to school based therapists.
Quotes
“Bringing the IEP to life, you're able to really go in and implement those things that you suggest.”
— Kristina Geraghty, MS OTR/L
“I think going to the therapist first and getting them on board with this model is going to be key to keeping it going and giving it that ammunition that it needs to get implemented in more and more schools.”
— Kristina Geraghty,MS OTR/L
“The whole point of us doing this therapy is to get these skills to translate over into the classroom."
— Kristina Geraghty,MS OTR/L
“Just being a little less afraid to ask questions and say, how can we get creative? We get creative in our therapy sessions every day. So, why not get creative a little bit in how we are creating these IEPs."
— Jayson Davies, MA, OTR/L
“I do it 2 to 2. I really like this one, because it allows me to get into the classroom a little bit more, but still allows me to have that individual session."
— Jayson Davies, MA, OTR/L
Resources
Episode Transcript
Expand to view the full episode transcript.
Jayson Davies
Hello and welcome to another episode of the OT schoolhouse podcast. I'm your host Jayson Davies. And today we're discussing a common term in the world of school based OT. That often seems like a pie in the sky dream. You are likely familiar with the three to one model as a concept. But today we're talking to a therapist who works at a district actually implementing that three to one model. Kristina Geraghty is an experienced occupational therapist currently thriving in a collaborative district, where the entire OT and SLP team operate under the 321 model. That is exactly why I invited Kristina onto the podcast to share her insights on managing her caseload. While navigating the challenges and benefits of the three to one model. We'll explore how this unconventional service model can enhance collaboration among OT, PT, and speech providers, streamline evaluations, and even improved communication with teachers and parents. We'll also discuss the scheduling and IEP logistical concerns that sometimes arise with a three to one model, and how you might even write the services onto the IEP. So stay tuned as we uncover the strategies for successfully implementing the three to one model. Its impact on an IEP and the importance of flexibility and creativity in providing effective school based OT services. Let's jump right in. Here's Kristina.
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
Kristina, welcome to the OT, schoolhouse podcast. It's such a pleasure having you here today. How are you?
Kristina Geraghty
I'm good. Jayson, how are you?
Jayson Davies
Doing fantastic. You know, we're just talking about general location. You used to be here in Southern California like myself, but you are now in New York. How are things in in New York area? are
Kristina Geraghty
Are pretty good. You know, we have a summer like day today, which is great. I grew up here. So I only lived out in Cali for a couple years. But my whole family's back here. So things aren't good in New York.
Jayson Davies
Yeah. And have you worked as a as in like, the pediatric school base realm in both states or more one versus the other?
Kristina Geraghty
Yeah, I was not an OT. When I lived in California, I was very young. I was in my early 20s. So I was still finding my way at that time. And I became Yeah, I became an OT. When I when I moved back here to New York.
Jayson Davies
Yeah, I just really love talking to people that have practice in like multiple areas, because you really get to see like the differences and especially within school based OT, you know, it's very different from state to state, even county to county, heck, the same schools, and or two different schools in the same district even be so different. So it's always interesting just to talk to people from different areas. I love it.
Kristina Geraghty
Yeah, that is true. Well, I've worked in New York, and I've worked in New Jersey, and even though we're right next to each other, very different.
Jayson Davies
Yeah, yeah, I hear you know, I'm definitely on the other side of the country. But the whole contracting versus district employed, I know is very interesting in that realm. And I think that's going to tie into a little bit about the three to one model, as we're going to talk about today. So we won't go too far into that. But yeah, I would love to just learn a little bit more about you and your school based occupational therapy and just your occupational therapy background in general as we dive into this, so please, where are you in your, in your OT world today?
Kristina Geraghty
So I'm in my 13th year of practice, and I have always been in school based practice. So I when I graduated school, I was pregnant. And so I had my first child, and started my new career all within a few months. So it was a little bit crazy. But I definitely wanted to go into school based practice. You know, being a new mom, the hours definitely appealed to me more. I come from a family of paediatric practitioners. My My sister was a pediatric physical therapist. And my other sister was is is a special educator here in New York. She does early intervention and what's called CPSE here, which is preschool. And then my stepson is a speech therapist. So, we have a big a big crowd of pediatric therapists and my family so we're always talking about therapy and talking about our kids and, and things like that. So I began working in New York as an independent contractor for a school district in Westchester. And then I got a job in New Jersey, also as an independent contractor and then I ended up moving to New Jersey. And I landed a job as a school employee. And so I've been there for about seven years.
Jayson Davies
Awesome. Congrats. And how's that thing going from being a contractor to being a district employee?
Kristina Geraghty
I, you know, I really like it, they both had their positives and negatives. You know, as an independent contractor, I had a little more flexibility with my hours, I didn't work five days a week, which was, you know, a big, big bonus, especially when my kids were little. So I had, you know, when my kids were really little, it was nice, I worked like three or four days a week. But I always knew that I wanted to get to become, you know, a school full time employee at some point. And, you know, enjoy all the benefits of that. And I definitely feel that as an employee, I have a lot more opportunity for collaboration with my team. As an independent contractor, I felt like I was just coming in and out of the schools, they had me at, you know, three or four different schools. You know, and I was I was able to communicate with some people. But, you know, I hardly even went to meetings with parents and things like that. But now, as a school employee, I feel very immersed with with my team and with my students and their families. So there's much more of a connection there. Absolutely. And I think that's definitely going to come back up here in a little bit, as we talked about the three to one model, because that communication aspect is just so important. When it comes to the three to one module, to be honest, any model within the schools, there's a lot of communication within school based OTs. So. Yes;
Jayson Davies
Yeah, yeah, we'll get into that. So let's just kind of start by talking a little bit about what the three to one model is in relationship to school based occupational therapy. I think a lot of people have heard of this is something that has been around now for a few years, but for anyone who either just hasn't heard of it, or, you know, hasn't refreshed their brain with this one explained the three to one model.
Kristina Geraghty
So the three to one model is a workload model. And it basically takes into account the entire scope of the related service providers duties. So it goes beyond just, you know, the direct sessions that they provide to students individually and in groups, and takes into account all of the meetings and the evaluations, the consultations, all those extra things that we do you know, each day that that add up very fast. So it really goes, you know, above and beyond just the road service delivery that the standard model does.
Jayson Davies
Yeah, and when we're talking about the three and the one, what are we kind of referring to in those.
Kristina Geraghty
So every month, we have three weeks where we follow our traditional Monday through Friday schedule. And then we have the fourth week, which we we call our flex week, or you know, our indirect service week. And that is where we have some more flexibility. So we schedule some meetings with parents and teachers, we can schedule some observations we can get into, you know, different classes, different types of classes, different environments that we normally can't, because we're so bound by our schedule each day. So if I have a student that I want to go observe in gym or recess, or, you know, during writers workshop, I can make arrangements to do that.
Jayson Davies
I was just going to add a little bit, you know, I think when it comes to an IEP, a lot of us are used to seeing four times a month on an IEP for a student service or maybe 30 times a year or once a week even and I think that doesn't quite fit into the three to one model necessarily correct me if I'm wrong, but is that kind of a little bit different from what you might see on an IEP within the three to one model?
Kristina Geraghty
Um, well, we we put on our IEP as we go weekly, so most of our students are seeing either once or twice a week, or they may have you know, a monthly consult or maybe five consults a year or 10. You know, whatever that child that child needs. What we do is we have something written in our IEP s and that can be found on our on our handout that people can download. But we have something specific written in our IEPs about this indirect service week, and the students are still seen so we make a point we make sure that every student is seen at least once during that week. It's just may look a little bit different. They may get seen in a larger group they may get they may get seen alone. They may normally be in a group. me wait We may want to pull them out and you know, focus on something that's a little bit more difficult with a lot of kids around. So they will still get seen, it just may be in a different context than you know what stated in the IEP, they may get seen in their classroom.
Jayson Davies
Gotcha. Yeah. And I think it's important to see kids in multiple settings, you know, there's some things that you can do better as an OT practitioner in one setting, as opposed to another setting. And sometimes you really do need to see them in the various settings to address those different things for you, when you are deciding, you know, what the service is going to look like? I guess, do you ever consider not using a three to one model, or specifically using a three to one model for this student? Based upon what your evaluation is telling you?
Kristina Geraghty
Yes, yes, there's definitely some that you know, just do much better with one to one service, you know, but that flexibility is there. So if I do just want to stick to my regular schedule, and see a student the way I normally do, I can do that. But usually, like, during that week, like my wheels start turning, and I'll start thinking like, oh, maybe I need to bring the Aiden with him for this session. And I can, you know, review his sensory strategies with her or oh, you know, we talked about doing this a few weeks ago, we can do that during the flex week. So usually, more often than not, there's there's always something to do. But yeah, I mean, I think I think almost every student can benefit from their therapists pushing into their classroom. I mean, more often than not, I always learn something new about them, I always find something that they may be struggling with that I didn't know before. And usually, you know, it's a lot of times, it's something I can help with. So.
Jayson Davies
Yeah. And you talked a little bit about that blurb that you put into an IEP. But I know for us out here, we have to get really specific with our services on the service grid, like we got to put where the service is taking place, is there going to take place in a classroom? Is it going to take place in? In the students classroom or a separate classroom? We got to talk about if it's going to be one on one, or if it's going to be group and whatnot. So is it a little bit different in New Jersey, are you allowed to be a little bit more flexible? Or is that just what that extra blurb allows kind of a caveat to this to the very fixed schedule on the IEP?
Kristina Geraghty
both, so we have the blurb there. And then we also we do have those same parameters in, but we have a choice called natural learning environment for where the therapy takes place. And that kind of covers everything that would cover coming to the OT room, that would cover the classroom that would cover pushing into lunch, if we wanted to push into lunch, it basically covers us for everything. And we pretty much put all of our kids under natural learning environment.
Jayson Davies
That's great. We used to have an option. It wasn't called natural learning environment, but it was called service provider location. And so as it sounds, wherever the service provider was, that's where it could take place. Right. But you know, 12 years ago, when I started, that was common practice. And then slowly, it kind of disappeared, they wanted us to get more specific. And so they asked us to get more specific. But that only forced us to get a little bit more creative. And I'm saying this because I wonder if you've had to get more creative as well, because we had to start delineating that three to one when I would do the three to one. So I'd have to have two different services on the IEP, I would have to have three times a month in a pullout setting. And then one time a month in the classroom setting. That's how I would dictate a three to one service on an IEP. But it sounds like you're able to get in and get away with that natural context.
Kristina Geraghty
Yeah, yeah, we just use that as like our umbrella term for pretty much every child. I mean, I don't think there's ever been a parent that had an issue with that, once we explain it to them. That, you know, yeah, most of his sessions are going to take place in the in the therapy room, but there are going to be some that take place in the classroom. You know, there are a few students where I, I will specifically, you know, delineate for me to be pushing in with them, you know, if I don't feel that they should be pulled out, you know, more than once or twice a week, or if they're getting pulled out for multiple services. And I specifically, you know, say I think it's best that I just push into the classroom during Writers Workshop, or whatever it is, and then I will put like, in class as my service location.
Jayson Davies
Yeah. It's very interesting. You know, there's a lot of, I want to say there's there's a lot of formalities that have been over time ingrained into IEPs. And some of them are just the way that services are inputted onto that service page and I think is OT practice. shinners mean, just as anyone working on an IEP, we kind of have to question why we're doing stuff, you know, why are we putting this specific option on that service page? And how what what changes if I decide to use the natural context setting instead of the separate classroom setting or whatnot, and right, you know, being being willing to go ask our manager and say, hey, if I do this, does that mean, I can do this? And, you know, the worst we're gonna get is usually a no. And so
Kristina Geraghty
Right,
Jayson Davies
just being a little less afraid to ask and question and say, How can we get creative, we get creative in our therapy sessions every day, so why not get creative a little bit and how we are creating these IEP. So that's awesome. They figured out a way to make it work.
Kristina Geraghty
Yeah, I'm very fortunate with the district I work in, it's a very small district, our supervisor gives us a lot of autonomy, you know, we can always go to her with things, but she, she does have a lot of faith in us that we're doing the right thing. And she's, she's really flexible with us. You know, it's always whatever whatever's best for the student.
Jayson Davies
Yeah.
Kristina Geraghty
You know, and as long as the parent is informed, I mean, we also have great parents at our district that, you know, are just super supportive and grateful for the services. And, you know, once we explain to them what we're doing in the in the classroom, I mean, we've had parents come in during the flex week, Lauren, our speech therapist, you know, had a parent come in and train her on AAC during the flex week. So you know, some of our parents really get to see the benefit of it.
Jayson Davies
That's awesome. So you just mentioned that the speech therapist is doing this, too. So it's not just the OT team.
Kristina Geraghty
No, it's the whole team, the whole team does it. So we were in a Regional District, with several schools, our physical therapist is employed by the region and not directly through our school districts. So she comes in maybe twice a week, some of our behaviorists are employed through the region. And the whole region follows the model set, or I think anybody that's in that is following the model in the region, there may be a few schools that aren't. But we all follow the same schedule. So we decided at the beginning of the year, what those flex weeks are going to be. And everybody follows the same schedule. So during that week, the PTE that's in twice a week, her and I are able to co treat we're able to, you know, have a console on a few students or, you know, if we have to do work on some seating together for a student, we're able to do that during that week, because we're all on the same schedule.
Jayson Davies
Wow. Yeah, that's really impressive. So have you been working with this district or the school since before they moved to the three to one? Or did you kind of come in and they were using this?
Kristina Geraghty
before, but only for maybe a year before? I think I was there for maybe a year or two, before we implemented it, our supervisor was actually the one that suggested it, she she had heard about it. And she, she came to us about it, and you know, we're all for it, obviously. And then, you know, we just had to sell it to the rest of the staff, you know, at first glance, it looks like, Oh, they're getting a week off, you don't get, we don't get a week off. But once we, you know, explain to them what it what it was going to look like, then, you know, we're able to get buy in. And then now like as we as we use it, and as we push into the classrooms, more of the teachers are able to see like, oh, wow, this is, this is super useful, you know, because you're able to the My favorite part about it is that you can take those, you know, all those accommodations and modifications that you check off, you know, when you're filling out an IEP, I call it like bringing the IEP to life, like you're able to really go in and implement those things that you suggest. And I think it's a lot less daunting for the teachers, if I you know, just rather than like giving them a list of suggestions, or you know, one of those like generic things by going in there and just showing them how it's done in real time. It's it's so much easier to implement that way. Yeah,
Jayson Davies
I think a lot of times people just assume that because something gets marked on an IEP that the teacher, the staff in the classroom, we're just gonna know how to implement that accommodation. And obviously, that is not true.
Kristina Geraghty
And it's a lot of work for them.
Jayson Davies
Yeah, yeah, absolutely. And they need support. So I have a question, though, because you said that you were there before they kind of started this program and you helped to transition them. What would you say the ultimate goal was during that transition year, like, what why did people why did the supervisor and the rest of the team decide, You know what, it's going to be a good idea for us to go from this. You know, just one child or every child is getting that same service every week, week after week to switching it up to a three to one model.
Kristina Geraghty
I think we just wanted to be more efficient in the way we delivered our services. And this, this really allowed us to, and also we have a lot of meetings. So because we are a small district, we do go above and beyond with a lot of our families. And, you know, we go beyond just having that once a year IEP meeting, and, you know, some families, we're gonna have multiple meetings a year with them.
Jayson Davies
Yeah.
Kristina Geraghty
If it's if it's a really high needs student, or if the if the parent requests it. So this kind of allowed us a little more flexibility for having the meetings during that week, also, so that we weren't having to cancel our regular sessions to attend meetings during the other weeks. You know, it's not possible to schedule all of our meetings during this week, but we do try to schedule a lot of them.
Jayson Davies
That's what I was going to ask next. All right, so so a good majority of your IEP meetings you're able to put during that flex week, but not all of them? Yes, darn. I have tried to get creative with that I have tried to, I've tried to get creative about how we can do this, because it is a problem for everyone, teachers, oh T OT A's to some degree, even SLPs PTS everyone, we are always complaining about the time that we spend in meetings and how that is limiting us from being able to actually serve the students and right there's only so much time in a day. And there's even less time in a day re or after school to fit those meetings. And so they end up leading into the rest of the day. So help us to share how do those meetings look for you during that flex week? Does everyone try to squeeze them into that week? Are they during the day? Are they after the day?
Kristina Geraghty
during the day, we don't have them, we don't have meetings after school or before school, they're all there all during the school day between, you know, eight and three o'clock. You know, as far as the service providers, we are given a lot of flexibility with the meetings like I'll go in, and I'll just say I have a student to see at one o'clock and the case manager lets me, you know, go first, and then I can be excused. So we do have that flexibility. Because I mean, to sit in every meeting for the full meeting time would be impossible.
Jayson Davies
Yeah,
Kristina Geraghty
Never.
Jayson Davies
I, I go back and forth with it all the time. Like I want to sit in every meeting, I see how valuable it can be to sit in every meeting for the entire time. But then, like you just said, you know, we'd we'd be in meetings all day, every day. Yes,
Kristina Geraghty
then same. Like there are definitely some meetings that, you know, I want to hear what the teacher has to say. And I want to hear you know what the parent has to say, and I want to get, like, the big picture for that student. And it would be great, you know, if we could do it for all of them. But you got to kind of pick and choose which ones are are the big ones that you you really need to stay on for. You know, some of them. I'm in touch with the parents a lot throughout the year. So you know, I can slip in and out with just a quick update for them.
Jayson Davies
Yeah, so so as you were kind of making this shift, what did that process look like? Was it just an overnight hate? This year, we're using the three to one model, these are flex weeks, let's go or kind of walk us through that. Yeah. And and as you were making that transition Did you feel like you had to convince people at all and if so, was there any research or any articles that had helped or was it pretty, pretty easy for you all to just kind of this is what we're gonna do.
Kristina Geraghty
So we brought it up at a staff meeting, we had our supervisor there. So you know, that was key was that we had, you know, our supervisor was really advocating for it. We had the buy in from our principal, we had already spoken to her ahead of time. So when we we have staff meetings twice monthly. So when we had our staff meeting, basically our supervisor stood up and she explained, you know, what we're going to do and what it was going to look like, you know, she explained the verbiage that we're going to use in the IEPs. And we created a calendar and everybody everybody got the weeks that we were going to be doing this indirect service. You know, like I said, I'm sure some people were skeptical. But like as you know, as time has gone on, they have seen it, you know, because they'll bring something up, you know, something will come up in a meeting about you know, something that students struggling with and it's like, oh, I can go in on the flex week and check that out. You know, so it's very the parents hear about it. You know, the staff definitely gets to see the benefit of just us having a little bit of flexibility to come in and out of the classroom at different times of the day. We did nothing I remember I think everyone was was pretty supportive. You know? And like I said, as time went on, we, you know, they just started to see the benefit of it, like we would communicate with them at the beginning of the week, or, you know, at the end of the week prior, and just, you know, give them a heads up and say, Hey, next week is the flex week, if there's any specific times that you feel would be useful for me to push in, let me know, if not, you know, I'd like to come in, during Writer's Workshop, you know, like, during the holidays, I would have, you know, a lot of teachers that had like, crafts planned out, and they would say, Oh, my God, we're doing we're doing his craft, and I just, I know, he's gonna need help. You know, can you come in at this time? Yep, sure, no problem. So, you know, once they see that kind of flexibility there, they're very grateful that we're able to come in there and help out. Yeah, the other thing they see, too, is, you know, a lot of times, like, I'll have multiple students in one class. So I'll plan like a whole class lesson. And I'll just come in, you know, for 4045 minutes, and I'll teach an entire lesson, you know, either on handwriting, or, you know, in second grade, I teach all the classes how to tie their shoes. So the teachers love that. So you know, that they see that benefit, too, that the the gen ed, population benefits from this too, from us pushing in? Sometimes they'll have, you know, a student like, oh, you know, what, since you're here, I wanted you to take a look, is there anything we can do to help him or like, I'll notice, you know, a child like, oh, you know, he could really use a seat cushion, you know, a wedge cushion to help with his posture. He's all over the place. So there's, you know, there's a lot of benefits that go beyond just servicing our students as well.
Jayson Davies
Yeah, yeah, definitely. And, and I know, there's been a lot of talking about the three to one model, we mentioned it up at the front, kind of, but when it comes to research, I, all the research that I've seen is more about like, this is a great idea. But it hasn't really been like compared to a direct pull out, you know, every week model, which would be great to see, I don't think that exists. If you know of anything, please let me know. But yeah, I, I love this idea of you calling it the flex week. And I'd love to kind of you've kind of teased a few things that you might do, you know, talking about accommodations, fitting in meetings, but what have you found to be the most beneficial part of that flex week, that's really allowed you to really just be more supportive for your students and your teachers.
Kristina Geraghty
I think it's just, it's it's creates, I think it creates that bridge for the student in that, you know, I pull him out, I pull him or her out of class, we work on these things in my room, and then they go back to class, and who knows, if they're actually using them or translating them. I mean, the whole point of us doing this therapy is to is to get these skills to translate over into the classroom. And I think sometimes with OT, they don't always see the connection. Right away. You know, when when you when you ask them, Why do you come to OT o because my handwriting sloppy, you know, but there's, there's so many other things that they're coming to OT for. And I think that when they see you in the classroom, and then you can say, oh, remember when we worked on this the other day, now's a good time to try this strategy. So like, a couple of weeks ago, you know, I was working with a student on on copying. And he you know, he was one of those kids that was looking at the spelling and like writing with it, looking at what he was writing and is writing was all over the place. And you know, I said oh, so let's let's do a little trick. You know, say it when you write it, say it when you read it. So I was teaching him to kind of chunk a few letters together, say it in his head, turn write it. And then literally, like two days later, I pushed into his classroom. And he he was working on a writing piece. And he had to copy and he was doing the same exact thing. And I was able to say, hey, remember when we were working on this in my room two days ago? And he was like, Oh, yeah. And you know, but then and then I was able to show it to the teacher and say, Hey, we were working on this and OTs a few days ago. Now I'm having him use it in the classroom. Now you know what to say to him? You know, say it when you write it, say it when you read it very simple. Now he's going to remember and I think like it just it creates that that bridge for the student, where, you know, they start to get like, why you're doing what you're doing in in OT.
Jayson Davies
Yeah,
Kristina Geraghty
I mean, that's like my most simple example. But um, and I think that when you're pushing in and they're able to see other kids that may struggle with the same things that They do, but aren't getting pulled out for services, I think that really helps with just, you know, the being neurodiverse friendly, you know, I'm promoting that inclusion, especially with my with my shoe tying, when I push in, to teach the second graders how to tie their shoes, I usually am working on it with my second grade students in OT, in preparation, because I want them to feel confident when I'm teaching it to the whole class, like, I've had some of my students be the one to teach the kids in their class, how to tie their shoes, because we've already worked on it. And they've already mastered it. And I think that, you know, for the students that we serve us, there's so many that that struggle with so many things throughout the day. And, you know, they're they're just they're, they feel less than and I think it's important for them to see that, you know, the football Jack also struggles with tying his shoes or something like that, you know, I think it's just, it's just good for them.
Jayson Davies
Yeah, absolutely. And I think the more we can get into to the classroom, the better. You know, we already talked about some kids really need it more, more than than just the one time a month. And you can do that. And, and some kids, like you mentioned, you know, they still need that pull up session for that fourth time, the the month during the flex week, and that's okay, this is designed to be flexible, and flex week. Right? What are some of the things that maybe you struggled with completing in your job as a school based OT that now you have that opportunity to do during the flex week? Does that make sense as a question?
Kristina Geraghty
Yeah, I would say probably evaluations, because some, some years are better than others. But sometimes, like my preps are only 30 minutes, I may have like a few, you know, two different 30 minute preps during the day. And I feel like you know, you get started on typing up an evaluation, and then you got to cut it off and go take a kid and come back to it later. I feel like it ends up taking you longer that way. So sometimes if I have something you know, really heavy that like I really want to be able to focus on first typing up in a vowel, I'll use that time to do it. So at least you can kind of like, set aside bigger chunks of time than you would during your normal schedule where you're just going by every 30 minutes. Same thing with pushing, you know, when I pushed into the classroom, now I can push in for a 45 minute lesson, and not just a 30 minute lesson. So I think just having those extra big chunks of time to to do things is is good.
Jayson Davies
Yeah. Yeah. Whether it be evaluations, I'm sure, sometimes it helps to have some time to catch up on documentation prep for an IEP. So there's so many different ways that you can use that. So awesome. Yes. You mentioned prep. Do you? Are you on the teacher contract, potentially and get a prep period? Is that what that is?
Kristina Geraghty
Yes, we got I think right now we have 270 minutes of prep a week.
Jayson Davies
I'm jealous. Like, you know, how many OTs are listening to this right now?
Kristina Geraghty
A lot of people are still in town. But yeah, we get we get the same amount of prep time as the teachers.
Jayson Davies
Yeah, I'm sure that comes with its own set of difficulties as well, though, right? Like we all we all want prep time. But we also all want a lot of different things in the schools, higher salaries, people to understand our job, and it's hard to find a district that has it all. And so we're always, you know, weighing pros and cons everywhere. So, yes, that's nice that you at least have some time to kind of.
Kristina Geraghty
Yes, it is it, it makes a world of difference. When I was an independent contractor, I did not get prep time. So I just, I had like just, you know, squished all my kids into a three or four day work schedule. And I went in and just, you know, banged it out. And having that prep time now, it makes a huge difference in just, you know, not having to bring work home, and things like that.
Jayson Davies
Yeah, yeah, definitely. So when it came to kind of making that shift over here, to the three to one model, what were some of the challenges, we've talked a lot about the good, but what what were some of the challenges that, you know, you kind of had to overcome a little bit. I'm sure there was at least a few, especially with, like you, I think you alluded to earlier, right? Some people might have just thought you're getting a week off, but, you know, you kind of had to shift that around a little bit.
Kristina Geraghty
Yeah. I mean, I guess when we were initially explaining it to parents, you know, some parents had never heard of it. You know, some parents were, you know, just had a lot of questions. So, I mean, that was a challenge figuring out you know, what the wording was going to be in the IEP, to cover us to make sure that, you know, we dotted all your I's and cross our T's with that. That was a challenge too. But other than that, it went pretty smooth. I think, also the scheduling, getting used to, you know, you're so used to being just bound to that schedule that you create at the beginning of the year. And, you know, basically, I would start my week out with like, a blank schedule. And then I just fill it in with pencil, as I figure out what I'm doing. So, you know, the first couple of times having to do that, and making sure that, you know, every kid was getting seen at least once, you know, making sure I just had all my bases covered, was was a bit of a challenge. Especially if, you know, I had a really busy week before the flex week and like, didn't have a lot of time to plan. You know, all of a sudden, it would be Friday. And, you know, Lauren, the speech therapist would be like, Oh, it's flex week, next week? And I'd be like, oh, yeah, you know, and I'd have to kinda like scramble it all, to start to start planning things, because you do have to plan ahead, you know, you got to email your teachers, you can't email them last minute. And, you know, say, When can I push in, like, you know, they've got plans to So yeah, just kind of getting getting into that mindset of knowing that that week is coming, and you got to plan for it ahead of time. It's just, it's just a different, you know, a different way of thinking that you'd have to get used to. Yes.
Jayson Davies
Now, you gotta have that scheduling conundrum. Every month, you got to figure out what you're doing for that week. So. Yeah, yeah, I mean, we all complain right about having a build that schedule at the beginning of the year. But once you have adult at the beginning of the year, it's kind of nice, but you throw in this flex weeks, where everything is just now up in the air, and we have to reschedule everything and every, you know, fourth week or whatever, it is a little different.
Kristina Geraghty
Yes, and sometimes, you know, sometimes it works out that like, we don't have as much prep time, sometimes our flex weeks are busier than our regular weeks, just because, you know, there's meetings and, you know, every kid has to get seen or, you know, I plan to push into every second grade class to teach handwriting. So that's, you know, that takes up a big chunk of time where I'm pushing into every kindergarten class to do something. So, you know, there are some months where, you know, maybe I don't get that it's either 230, or I think it's 230, I can't remember, comes out to about like, 15 minutes a day of prep time. So yeah.
Jayson Davies
Do you ever feel like you still either Miss sessions, even when, because of the prep time? Does it actually make it sometimes more difficult to actually see every student? Or do you feel like it? I don't know, more difficult, easier, or just kind of the same?
Kristina Geraghty
Well, I guess it depends on my caseload that year, but my caseload basically stays around 40 Kids, which is pretty manageable in a five day week, with those prep periods, every, every so often, I'll get, you know, it kind of goes up up up, like towards the spring, and then you know, the meetings come and you start, you know, reducing some kids and your schedule comes back down. So yeah, there are some times that, you know, maybe I don't get all my prep time, and that's okay. I think, you know, we can get compensated for it if we if we don't take our prep. But I feel like sometimes I have an absence and I can't find another kid to poll or sometimes there's an assembly and none of my kids are available. So I feel like it all evens out in the end. So I never really looked to get compensated if I missed that, that prep time.
Jayson Davies
Yeah, do you? Do you build time into your prep for Miss sessions with absences? Is that kind of when you might make up some miss sessions? Or do you have time set aside during the rest of the week? Or does it all just kind of work out?
Kristina Geraghty
No, I would use my prep or I would call, maybe pull out like a bigger group and maybe kind of combine groups to get that makeup in. We are not required to make up every session that we missed, that would be impossible. You know, just because I mean, you know, if we take a personal day or a sick day, you know, we don't we don't have a sub. So it's just this but yeah, usually if you know if I have a student that you know, has been out a lot or if I've been out a lot, you know, if I if I was out sick or earlier this year, my dad passed away. So I was I was out for a couple of weeks. And then when I came back, I was kind of loading up my groups and skipping a lot of prep periods just to get a couple more sessions in. But you know, it ebbs and flows. So ya know, Oh, thank you. It's I know Overall, it's a good schedule. So,
Jayson Davies
Yeah, yeah, that's it's nice that it allows you to have some of that flexibility both within work. And then also a little personally, you have some flexibility as well to, to take on some of those things. Because I know that's why that in general, there's a lot of high burnout in education, not just OT, but just an education world. In general, there's a lot of burnout and a lot of people quitting within the first few years, just because of the time commitment and how much you have to do with such little resources. So that flexibility the flex week, and almost counteract that rigidness of every Monday at 9am. I know I'm gonna be seeing Johnny for the entire school year. Yeah, the 930 is gonna be this kid and this kid and,
Kristina Geraghty
Right, right, right. And we have like, right, now we have a substitute shortage by us. So we are always short on subs. So a lot of the teachers get called to sub in classes, during their prep periods. And you know, that that did create a bit of a challenge, because because we are IEP driven, we can't miss a session to sob. So we we were unable to really contribute to that. So, you know, they did ask us if, like, during the flex week, if if we would be available to sub so, you know, we said yes, but under the caveat that, you know, put us with our students, so, you know, as best we can. So if there if one of our students AIDS is out, you know, let us let us be with him.
Jayson Davies
Yeah.
Kristina Geraghty
And like, you know, we'll do a session with him, and then maybe go in the classroom and do a couple of things with him. So we make it into into a session. So that's how we we work our way around that is that, you know, usually if one of our special ed teachers are out or for the aides or someone like that, they'll just give it to our team. And we will rotate with that students. So the speech therapist will do a period with him, I'll do a period the behaviorist will do a period. So we work it out that way.
Jayson Davies
Oh, my goodness, that's like even going beyond the three to one model to be extra flexible. That's right.
Kristina Geraghty
Yeah. Yeah. It but it works for us. It works for us. And, and again, you know, sometimes it's it's going into a classroom at a time where I'm normally not in there. But I have students in there and you know, you just kind of get to look at them with a much wider lens. That way.
Jayson Davies
Yeah, I want to get into the topic of whether or not you monitor this program, or the district somehow monitors this program. But before I do, I want to kind of go back to a topic that we that we alluded to way up front, and I knew we'd come back to just the communication aspect and how important it is that not only the OT team is on the three to one flex model, but you know, the the PT kind of supporting in a way the speech therapists are on the three to one flex model as well, like, how has that really benefited the IEP teams?
Kristina Geraghty
Well, it definitely gives us some more time to communicate with one another. You know, like I said, especially with me in the PTE she's, you know, she's in and out of the building, I think maybe like two afternoons a week. So even just giving us like a 15 minute block of time to kind of just catch up on some students and, you know, collaborate a little has been amazing. Sometimes, you know, we'll just arrange like a co treatment session where we'll both work with the same student for you know, half an hour and you know, she RPT is really great. She she comes up with all sorts of great like behavioral and like motivational strategies. So I love you know, stealing her for keeping some of our more challenging kids motivated to complete their, their their therapy with me. So yeah, it's gives us gives us a really nice opportunity to to work together.
Jayson Davies
And so does your district allow you then to if you meet with a PT or you meet with the SLP, and the child is not present, under that IEP in the way that it's all written? Does that still count as a quote unquote, session for that student?
Kristina Geraghty
I would say yes, we, you're probably going to hate me again. But like, we don't have official like documentation that we have to do. We basically, in New Jersey, they do not require you to do any, like, session logging. Like there's no blanket.
Jayson Davies
Okay.
Kristina Geraghty
Yeah. So we do log our sessions through real time, which is our, you know, our IEP system. And but you're not, you're not required. So I guess it's kind of like a gray area. But, you know, like I said, what I do is I just have that blank schedule. And I fill it out in pencil everything that I did. And then I type it into a Google Doc, and then send it out to my supervisor and my principals. So, yeah, so they know everything I'm doing. And you know who I'm seeing. But I don't think like, I think if we did like a code treatment session, yes. But I think if it's just like a 15 minute console on a student, I would still be seeing that student that we would still be giving them some kind of direct service.
Jayson Davies
Okay. Yeah, I think that's where, for me, you know, being in California where I think we're a little bit more litigious, and everything's got to be like ran on IEP, that's where for me, I would write onto the IEP to separate service lines. And that first service line would be whatever the three weeks is out of the month, right that one time a week in the classroom, I'd probably write it a three times a month or around 30 times a year. And then I would add an additional service line that said, like 15 minute consults with IEP team members or something like that. And that would be my quote, unquote, flex. Okay, yeah. So just trying to think of creative ideas for someone out there who might be in a state where they got to, you know, figure out a way to put it on their IEP to make the three to one system work. So yeah,
Kristina Geraghty
right, like, maybe just putting that in for every student, but then, you know, it's, it's so hard, because like, not every student needs that 15 minute console per month, sometimes, you know, the PT and I are talking about the same student every month. Sometimes, you know, it's the same two or three students. But yeah, you know, once once you put it into that IEP, then you know, you're obligated to provide that service every single month.
Jayson Davies
Yeah, yeah. And I think that's, most of the districts out here have kind of gone to a 30 times a year on the IEP model, or three times a month. And even though we say 30 times a year, when there's really about 36 weeks, I believe of school, maybe 38, depending on how many holidays or whatnot. Or, or obviously, there's at least four weeks and every month, right? We still use that three times a month, or 30 times a year, because that kind of gives us that flexibility. We still put the student on our calendar every single week. But we have that flexibility, because we said 30 times a month. So it's you know, give yourself a little bit of buffer.
Kristina Geraghty
Yes.
Jayson Davies
And you're doing it on the right way, right? Like you're not saying I'm going to see four times a week and then only putting them on or sorry, four times a month, and then only putting on three times a month, right? You're going to Officer way, right? But that does give you a little buffer as long as you as long as you get your three times a month, then that fourth week can be a flex per se or something like that.
Kristina Geraghty
Yes, yes.
Jayson Davies
Anyways, all right. It is that I want to talk to you a little bit about progress monitoring at this program. And I don't know if you do or not, but I did just kind of want to open this door up to you and asked, you know, are your supervisors in some way trying to figure out if this model is working better than the previous model did? Or even from your perspective, are you seeing differences?
Kristina Geraghty
My supervisor now I don't, it's not really being monitored, per se. You know, we do seek out feedback from from the teachers and the other staff. And I think now it's just become such a natural part of our yearly schedule, that people don't really question it anymore. I feel like, you know, the actual effectiveness would would be really difficult to monitor as compared to, you know, four weeks of direct service. I think there definitely needs to be more research. Our download does include links to a few articles that have been put out recently some preliminary research, but you know, like everything else, there's always challenges in the in the research realm. And you know, finding really solid research behind it, but there definitely is some I know that I can't think of her name right now. She she does the Size Matters handwriting. Beverly, yeah, I know that she really pushes for this workload model. And she also has like a wealth of information about, you know, the research behind it and things like that. But as far as monitoring it now, I mean, I would suppose that, you know, you could send out surveys to the teachers, you know, a few times a year or something like that just to get to get feedback to get, you know, satisfaction levels. How satisfied are they with with This mode of service, they feel like it's helped they feel like it's kept things the same. You know, are they seeing the the direct benefits of using this model? So I would think something like that for a start would just be getting just be getting feedback from everybody.
Jayson Davies
Yeah, yeah, I'm just gonna throw this out there. There's anyone interested in a PhD, I would love to see like a program that potentially uses even you know, Christina's district and kind of compares it to a district that the OT team is using more of a, you know, traditional one time a week for every student, direct service. And I don't know you got, you'd have to get creative with the outcome measures and how you figure that out, maybe you're looking at the outcome measures of the teachers, the OTs or just the students, you have to get creative with it. But it would definitely be interesting to see just how things are different. I think that'd be great. So yeah,
Kristina Geraghty
Yeah, no, I think that would be a great idea.
Jayson Davies
Yeah,
Kristina Geraghty
To start looking into
Jayson Davies
One day, all right, we'll kind of get to the wrap up here. But I wanted to talk to you about one more other model that kind of falls in line with the 3 to 1 model, and something that I've used quite a bit in my past as a as an OT in the schools. And that's actually changing it from a three to one to a two to two model. And I do it two to two, I really liked this one, because it allows me to get into the classroom a little bit more, but still allows me to have that individual session. And so the way that I would often write this on an IEP would be either two times a month, or 15 times a year, pull out, and then same thing two times a month, or 15 times a year in the classroom. And that would allow me to either alternate every other week, right? In class, every class in class out of class, or I could make two pull outs, and then two portions, whatever. But yeah, have you ever used any model like that? And if so, your thoughts?
Kristina Geraghty
we haven't, but my first thought would just be how tricky that might be with scheduling. So being able to, you know, work your regular pullout schedule, and then schedule the right time to push into the classroom, I find that so challenging. And, you know, I've heard a lot of therapists say, like, you know, I tried to push into the classroom, but they're not doing anything relative to what we're working on. And I'm just standing there, and I feel like an aide. So, you know, I think that is really tricky, scheduling wise, just figuring out when you're going to be able to do that question and how it's going to work with all of your other sessions every month?
Jayson Davies
Yeah. And I'll take a little stab at that. Like, I think for me, it was just that not every student was on that two to two model versus I think what you're talking about with most kids are on the three to one models, not like half of your kids are on the three to one or 25%. Everyone is on that three to one. And so for me, those two to two, the kids that I had on a two to two model, were the ones that would go on my calendar first. And so I would, I would schedule their in class sessions. And then no matter what week it was, I always had them at the same time on my calendar. I just went in during that that in class session, I already figured out that that was a good time in the classroom. I hope that makes sense. Yeah. But again, that was because you know, maybe I had 10 kids on that, as opposed to every kid. And so I was able to find times where it made sense to go into the classroom for those 10 kids, but totally understand what you're saying. Right? If everyone on your on your caseload. Yeah, you got to figure out how to see everyone in a good time in their classroom, which is very hard to do.
Kristina Geraghty
Right right.
Jayson Davies
That makes me anxious just thinking about it. But yeah, so. So we talked a little bit about the or a lot about the three to one model. We talked about that two to two model idea, potentially. But looking ahead, do you see any potential developments or adaptations to the three to one model in response to the changing educational landscape and what has and has not been working for you?
Kristina Geraghty
I think that, you know, it's really still in its beginning stages. And I think that we are going to keep hearing more and more about it and the more schools that try it, hopefully the more research we will have to back it up. I think that, you know, as therapists and as you know, workshop presenters and educators, I think we can start by, you know, providing some more continuing ed, for therapists on you know, what they can do in the classroom or you know, how they can implement this model at school, what it looks like, what kind of activities can you do, and kind of giving them that toolkit to get started, I think is going to be really useful. I know that you know, the inspired Tree House has had a workshop for they've had it up for a couple of years. I took it a long time ago called pushing into the classroom, and they have some great ideas in there for, you know, lessons that you can do in like whole class lessons. And, you know, I just think that you know, the more workshops and courses we can offer, the more the word gets out, the more the therapist start to become open to this and start talking and seeing the benefit, and then start talking to their administrators. So, you know, I think, going going to the therapist first and getting getting them on board with this model is going to be key to keeping it going and, you know, giving it that ammunition that it needs to get implemented in more and more schools. I think also, you know, schools, a lot of schooling has become so academic heavy, and it's getting more and more difficult to pull students out of class, especially in middle school. I know, I don't see a lot of kids in my middle school, but I know, the speech therapist that we have at our middle school, she, she goes through it with her schedule, man. You know, just because they have such small windows through the day that they that they can afford to get pulled out of class. So I think you know, that, as far as like changing landscapes, you know, we're just we're becoming so much more academic heavy during the day. And you know, there's just less and less time to be pulling out for these services. And I think, you know, as the kids get older, they are more cognizant of getting pulled out of class, they don't want to get pulled out of class as much. So you know, we do have to start rethinking around, you know, pulling kids out of the class throughout the day.
Jayson Davies
Absolutely. And in heck, now, there's also schools that are going four days a week, which is going to make it even more interesting, and who knows where that'll go. But, yeah, Yeah, yeah. I mean, even at the elementary schools, there's been some schools that I had been at where they're like, this is your block to get in, it's either got to be after lunch, or like, a certain block in the morning. And I'm like, I have six schools. I will try my best, like, we'll see how we do here. But yeah, you're right, scheduling is getting harder and harder every year. So yes, well, Christina, I want to say thank you so much for being here. Before I let you go, where can anyone go to learn more about yourself and the three to one model.
Kristina Geraghty
So the speech therapist that I work with, we actually own a business together called therapy advanced courses. And we have a website where we have links to a number of free downloads. So we have a link to a three to one download. And it basically explains, you know, how we implemented the model, it has a copy of the letter that we sent to our administrators, when we wanted to implement the model. It has links to different research articles, few different activity ideas, you know, and just how we how we go about organizing and implementing it. You know, as far as our business, we provide postgraduate courses for related service providers, so that they can move on their salary guide. So as you know, a lot of districts have a salary guide, where if you get if you take extra graduate courses, you get a bump and pay you move into that, you know, plus 15 lane or plus 30. So we create courses, specifically for OTs, PTs, speech therapists, social workers, school psychologists, guidance counselors, we are starting to branch out. We do have some teachers that are taking our courses, we have some special ed teachers that are taking our courses. So we are starting to branch out and create more generalized courses that you know, anybody any school employee can take. So most of our courses are three graduate credits. And they are all self paced and self study. So you complete the courses in your own time through our online learning platform. So,
Jayson Davies
Yeah, that could be a very helpful and actual useful way to move over on the PCL, because I know a lot of us look at the PayScale and we're like, I need 15 units, but I'm not gonna go get my doctorate. So what the heck am I going to? Like? Yeah, 10 units, So.
Kristina Geraghty
Yeah, well, that's that's really where it came from, was when I came to this district, I wanted to move up on my salary guide, and I had the hardest time finding courses that were really relevant to what I did. You know, I was able to take some like general courses on some of the teacher education websites, but they really weren't specialized. And as Lauren and I started talking, we thought, You know what, I wonder if we could just create our own I mean, unfortunately, I can't take my own course. But it turned into a real educational experience. And, you know, I learned so much now from creating these courses. And I, you know, I'm inspired every day in school because, you know, what do I what do I want to learn more about, you know, and how is it going to help me be a better school based practitioner? And that's really what the core of our courses are about is just, what do we need to know? What do we need to learn more about for our specific skill base position?
Jayson Davies
Awesome. Well, Kristina, thank you, again, so much for being here. It's been a pleasure. And we'll definitely keep in touch and see you next time.
Kristina Geraghty
All right. Thank you, Jayson.
Jayson Davies
Once again, thank you so much. So Kristina, for coming on and sharing her experiences with the three to one model. I hope after this episode, you're feeling like it's maybe a little bit more attainable to reach out to your administrators and your OT, or maybe even the SLP team as well, and say, hey, you know what, we can potentially implement this three to one model and just kind of start to paint a picture of what that can look like. And maybe what the transition might start to look like, it's really hard to make a shift overnight. But if you put that plan in place to start saying, hey, on our IEPs, we're going to start shifting our language just a little bit in this way on our services. And we're going to explain it in this way. And you know, that can really make that shift just, again, not overnight. But week by week, month, by month, you'll start to see it happening. And the next thing you know, two years later, yeah, I know it can take two years later, or take two years to get there. But all of a sudden, you will now be on a three to one model, you'll have time to complete those evaluations, you'll have more time to collaborate, you'll have more time to do all the things that you know that you should be doing, but just don't have the time to do right now. And all that while your services are likely just as efficient as they were when you were seeing a student every single week, not having time for anything else. So thank you again to Christina for sharing so much on the three to one model. Thank you for tuning in today. We really appreciate it. And again, don't forget that you can earn a certificate of completion for listening to this podcast as a member of the OT schoolhouse collaborative. If you'd like more information on the OT schoolhouse collaborative and how to join, you can do that over at OTSchoolHouse.com slash collab. I hope to see you in that community very soon. Thanks again for tuning in. We'll see you next time. Take care.
Amazing Narrator
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