OTS 20: From IFSP to IEP Featuring Sarah Putt of The OT 4 LYfe Podcast

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Welcome to the show notes for Episode 20 of the OT Schoolhouse Podcast.

In episode 20 of the OT Schoolhouse Podcast, Abby and guest, Sarah Putt, MA, OTR/L of the OT 4 LYfe Podcast, talk about the differences between school-based OT and Early Intervention OT. They also touch on what the transition from Early Intervention to school-based services may look like.

Sarah is based in the Los Angeles area and runs her own private practice where she sees kids primarily aged 0-3 in their own home. She works with both kids and their families to develop a plan of care that is geared toward catching the student up developmentally.

Sarah also hosts the OT 4 Lyfe Podcast (Apple Podcast App Link) where she interviews a wide variety of OT practitioners, students, and even prospective students about what Occupational Therapy means to them. In Fact, she even interviewed Jayson and Abby recently. Be sure to check out her podcast as well as ours!

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Episode Transcript

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Amazing Narrator   

Hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research. Now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session. 

Jayson Davies   

Hello and welcome to OT schoolhouse episode number 20, this is going to be well, first of all, thank you for listening. Definitely always say thank you for listening and thank you for listening to as many episodes as you have listened to this school year or this this year we've been doing this podcast now since March. Is that right? Abby?  

Abby Parana   

Yeah, just march, yeah. Not even full year.  

Jayson Davies   

Yeah. So not, not even in a full year. And we managed to get 20 full episodes, which is super cool. Basically, we've been doing an episode every other week and, well, let's just be honest. We are going to share with you that it is hard work that we are putting in to get these episodes out to you. Every episode is a hour and a half long Skype call and then another process to edit these episodes. So. 

Abby Parana   

because you got some mad editing skills, I do not have great editing. 

Jayson Davies   

It's all good. We work as a team. We get it done. And yes, so this is going to be the last episode of 2018 and we will be back with new episodes on January 8, and that is actually going to be a really cool call with a an occupational therapist who specializes in autism. And so I'm excited for you to all hear that episode. We will be back. 

Abby Parana   

I'm excited to listen to that episode. 

Jayson Davies   

Yeah, she's really cool. Her name is Meg, and she is actually she has an online course. And so we're going to talk a little bit about that online course that she has and dive into that. So again, I can't say thank you enough for listening to, you know, all these episodes, whether you've listened to five minutes of an episode, or all 20 episodes, which equates to something like 15 hours or something or more than that, I don't even know. Thank you. You helped us to reach 20,000 more than 20,000 downloads this year alone. Yeah, we never thought that we'd make it that far. I don't think.  

Abby Parana   

No, I remember thinking like, Oh, we've got reviews. And I was like, oh, but it was a lot of you know which friends and family members. Thank you so much. But it's just very exciting to see that it's the OT school house community is growing. So Happy Holidays to you guys. I don't know if you're going to be traveling home. I am traveling to Pennsylvania, my hometown and I often listen to podcasts while I sit in the airport. So if you care, to listen to some ot school house podcasts and pick up those PD use, I think we have six. 

Jayson Davies   

Yeah, yeah, six of the 20 episodes.  

Abby Parana   

Yeah, that you can go and take quizzes for over at ot schoolhouse.com and check that out. 

Jayson Davies   

Yeah. And real quick, back in episode number 18, just two episodes ago, we actually had Lauren on from the inspired tree house. And I just want to remind you all that she did offer to every listener of this show a 20% discount at the inspired treehouse.com and for any of you who don't know, the inspiredtreehouse.com has wonderful resources, everything from packets of work that you can print, printables that you can use with your children, up to webinars, even books and webinars that they offer. And so you can get 20% off any of those products that they have on their website using promo code ot schoolhouse 20 very simply, just go over, pick whichever ones you want to purchase and use that promo code in the checkout and you will get that discount. So that is good until the end of December. So if you want to take advantage of that, hurry on over to the inspiredreons.com Yeah, with that, why don't you go ahead and introduce Sarah Abby.  

Abby Parana   

Oh yeah. We have today on the podcast. We're going to be talking with Sarah from ot for life. That's the number 4, L, Y, F, E. She is a fellow podcaster, but also has a private practice doing early intervention. She started out working in school based therapy. So she made that transition to early intervention and now practices in that area. So we discuss a lot about transitioning from early intervention services to school based services, how that works, IFSP to IEP and she discussed a lot about what kind of strategies and the focus of early intervention. So if you are like me and have zero early intervention experience, or work in that population of zero to three, or have ever been intimidated by it, she really is great about breaking it down and kind of making you feel a little less worried about. Working with that age group, or, you know, really explaining what it is she does. She's a very busy occupational therapist. She does a lot in the field. So also, I would recommend just checking out ot for life podcast as well. She interviews OTs that are doing different things in the field, and she really has a nice style to it. 

Jayson Davies   

Yeah, and she actually just interviewed us, so Oh, that's true. If you want to hear us on her podcast, it's a little different. We're used to hosting, and so we got to kind of sit back and be the hosted and answer some questions for her. So that was really fun. And if you're fans of ours, you'll probably be fans of hers and have a listen. I don't think, I don't know when that episode will be out, if it's gonna be out when this episode comes out, but definitely check it out.  

Abby Parana   

Yeah, and she has some, a lot of interesting interviews. So two, if you're looking for the show notes for this episode, go to otschoolhouse.com, and check out show notes. Episode 20.  

Jayson Davies   

Perfect. So ready to dive into the interview? Oh yeah, let's get to it. Great. Here is Sarah put from the OT for life podcast.  

Abby Parana   

She does a podcast called ot for life, and we're happy to have you on the show. Sarah, welcome.  

Sarah Putt   

Thanks, Abby. I am so excited to be here. It is a pleasure. 

Abby Parana   

and we met at ot because Alexis set up our mastermind group, and we just met at Rubio at OTEC. That was fun.  

Sarah Putt   

Yeah, I kind of just, she posted it on Instagram, and I was like, perfect. I got nothing going on. I'm gonna be hungry. Yeah, let's go to lunch. And I, at that point, had no idea who was gonna show up, and so I sat down, and I was like, Oh my goodness. Like, this table rocks. I was so excited to be sitting there with you guys. 

Abby Parana   

I know we're It was fun. It was like, a very fun vibe. We had this opportunity to kind of bounce ideas of each other and what everybody's doing in the space to kind of promote occupational therapy in a different way. And we all had different settings and different areas that we were looking at. And I discovered you work in early intervention services and I work in school based and so there is oftentimes that connection between early intervention and school based services. That happens when a child transitions out of early intervention and into preschool, when we typically inherit them at school based OTs. So you're here on the podcast today to talk a little bit more about that. But also you are like a jack of all trades. It seems like in the OT world you are, you have so many different areas that you are contributing to the field in, and so we're probably going to have to touch on a lot of different areas. 

Sarah Putt   

That worked for me. I like to talk. So this will be good.  

Abby Parana   

It's just going to be a very chatty podcast. I love it, right? So let's start off with your background. Just give me a little bit of information about how or a lot of bit of information depends on what you want to share with us, but how you chose to become an occupational therapist and just what inspired you to do. OT? 

Sarah Putt   

All right, well, I guess I I'm definitely one of those people that I didn't always know that I wanted to be an OT. I didn't even know what ot was until after. It was like right after I had graduated from undergrad, and I had been working in schools, and I was a behavior therapist, and I had a couple kids that I was working with, and one day, one of my kiddos had occupational therapy, and it was during the time that I was working with him, and I was like, Cool, I'll go, like, I'll go see what this is all about. And I remember we he was a preschooler, so I remember we walked from his preschool classroom down to the little sensory gym opened at the door, and like his eyes lit up, my eyes lit up. And I was like, oh my goodness, like this. This is so cool. I saw like a ball pit, and I saw the scooter board ramp and the OT that was there was just fantastic. And so passionate about what she was doing. And I, like no joke, went home, researched what occupational therapy was, looked up schools, and started my prereqs, and started applying to programs right then. 

Abby Parana   

Wow, now that is gung ho. And you know what? It's funny, because I too volunteered and found an OT who was working with kids, and she was super passionate about it, too. So I could totally relate. It seems like, when you do meet an OT and they're passionate about it, it's contagious, and you caught the bug. 

Sarah Putt   

Yeah, exactly, yeah. It's like, it's just one of those things. I jumped into it and. Yeah, I feel like I'm so fortunate that I found it and just applied and got in and started, and I still really had no idea what it was, because I had such a limited view of it. But I look back and I'm like, I'm so thankful that I just somehow just fell into the profession it is. 

Abby Parana   

It's great profession. So what has your career path been up to this point? 

Sarah Putt   

So let's see, I have always been pediatric brain, like the entire way in school. I did three of my four field works in pediatrics, because back then we got to actually pick right right? And then I graduated, and I started working for a like a private clinic. They contracted with schools, and they also did in home therapy and clinic based therapy as well. So fresh out of school, I kind of got a really wide range of pediatric practice, I should say, pediatric outpatient practice. And really just got experience, kind of across the board, in that, in that entire realm. And I was there for about four to five ish years, something like that. And then I started independent, contracting with two different companies, and at that point, that's when I left the schools, and I was only focusing on clinic based and in home therapy. And did that for about a year or two, and then I kind of tired of the contractor role and decided to start my own practice and switched into only early intervention, only home based.  

Abby Parana   

Yeah, you had, like, quite the winding road, but always with peds, so you touched on multiple different areas. So that's that's pretty cool. That gives you, like, a good, well rounded perspective when it comes to following children through quite a big majority of their childhood. 

Sarah Putt   

Right? Yeah, I feel like when I when I was fresh out of school, I really just kind of had a wide range of experiences, and then slowly, every year, I just like niche down and niche down and just like honed in, and now it's like zero to three, and that is it. 

Abby Parana   

That's pretty cool, though. So I have minimal experience with zero to three population. I will admit that openly. I think I did some observation hours with a ot that was doing zero to three and home. And I mean, I liked it. I actually, actually, I'm work in school based, but I did not ever think that I would find myself in school based or working with kids. So working in peds was not my strong area at first, but once you're in it and you fall in love with it, I can't imagine doing anything else that I was doing before. So with early intervention services, though I am a newbie, a novice. I'm an OT that I've always been a little bit apprehensive about doing early intervention services, so I just want to know just generally what that is. So what, besides the couple hours like we talked about earlier, before it leaves recorded, we get just the hours we spend learning about early intervention in school based kind of vary so or how we learn about that. So would you share with us what OTs role is in early intervention services? 

Sarah Putt   

Yeah, I'll start by kind of explaining, like generally early intervention. And then I'll go more specifically into the OT realm. But, and I actually, I should start by saying that every state is different and true. Yeah, and I've only ever worked in California, and I've only ever worked in Southern California, so what I'm going to tell you is very specific to this region and other states could be slightly different. So going off my experience so far, but so early intervention is, at least in California, it's birth to three years of age. And there's really, like, kind of two different categories of kiddos that I would be working with, and those would be the kiddos that have some sort of like established delay. So those kiddos that are they have Down syndrome, cerebral palsy, maybe a genetic disorder, autism, even though that can be sometimes it can be a little bit more rare, because I am working with kids so young, so for them to have that diagnosis, sometimes they might be in the process of getting diagnosed, or a few kiddos actually have it, you know, around like 18 to 24 months of age. So there's those kiddos that that have a delay, and then they're the kiddos that are at risk of having a delay. So they might not have a delay, but they are considered at risk. And we're talking the kiddos that are born prematurely. They were exposed to drugs or alcohol in utero. Maybe they had a traumatic birth. They have a sibling or a parent that has some sort of disorder, disability, things like that, that would kind of put them at risk for having a delay, and so we are addressing the delays if they have them, or we are monitoring and making sure that no delays happen, or educating and kind of facilitating them throughout that kind of normal growth progression.  

Abby Parana   

Oh, okay, actually, that makes a ton of sense now. So yeah, how do parents, or, you know, how, how do parents find you, or how are children referred to you? I guess, would be a better question. 

Sarah Putt   

Yeah. So I work for a couple different regional centers, and they call it like vendored, basically like a contract. And so I have different teams within the regional centers, within the Early Start teams, I'm sorry back up here. So I have different Early Start teams that I'm kind of affiliated and plugged in with. And so the case workers will reach out to me because they know that I service a specific area or I have certain training in, say, feeding or sensory integration, that that, that their kiddo needs, okay, and they will send me the referral and say, Hey, can you, can you take this case, and if I can accommodate them into my schedule, then I Do, oh, cool, yeah. And I should mention that the this, the portion of early intervention that I do, is all in home based, okay? So kids can go to the clinic as part of their early start services if it's necessary. Most of the time they're seen within the home environment, okay? 

Abby Parana   

And so are they referred to these early start programs via, like, a doctor or?  

Sarah Putt   

Okay, yeah, it could. It could come from anywhere. So some come from doctors. Some come there. Could be, like, a parent referral, okay, they have a sibling that's older, and all of a sudden they realize that the younger one is not meeting the milestones, or there's a big difference in their development. It could also be coming from, like, other specialist nurses. Maybe they're already getting speech therapy through insurance or something like that, and then they're like, Hey, you should go get checked out by the Regional Center. So yeah, the referral really could come from anywhere, anywhere.  

Abby Parana   

Okay, and so it's, I guess I'm, how do clients pay for early intervention? Or do they or is it just through the regional center? How does that work?  

Sarah Putt   

So, okay, I'm back up here a little bit, but the regional center is a nonprofit organization, and they get as far as I believe, they get state and national funding for it, and then the early start program, or early intervention, is a portion of our a branch, a section of the regional center. So regional centers will actually span the lifespan, and they serve a client throughout. So I only work in a very small like fraction of the regional centers. 

Abby Parana   

Okay, yeah, at IEP meetings, too. A lot of times, people from the regional center will come to IEP meetings, and they'll sit in and they they seem to, yeah, update throughout a lifespan what the child's services are, and help get them what they need. Really advocate for them a lot.  

Sarah Putt   

Yeah, yeah. And kind of helping the parents go out, go throughout that process in terms of how the parents, how the parents will pay for it, or if they have to pay for it, the regional center is what we call the payer of last resort. And so the way that it works is that a family will come to the regional center and they'll get an intake evaluation. So basically an initial evaluation, where it will most likely be done by an OT or PT, sometimes it can be done by a speech therapist, and they will do a developmental assessment looking at all areas of development, so cognition, language, motor, adaptive behavior and social emotional skills. And if the kiddo qualifies for regional center services, which is a 33% delay or more, then, like, basically, the team will say, hey, we think it that, you know, the kid would most benefit from occupational therapy, physical therapy, whatever it is. And then if the families have insurance, like private insurance, they have to go to their insurance company first, or their insurance provider, okay, and say, hey, my kid qualified. Like I just had an assessment done at the regional center. They need occupational therapy. And then the insurance provider. Say, Great, we'll cover it. And then the kiddo gets their service through the insurance. If the insurance company doesn't cover it, then they come back to the regional center, they have to have a letter of denial, and then the regional center will kick in. Okay, gotcha. The other thing that can happen too is if the insurance covers it, but say there's a wait list. So a lot of these clinics and insurance places, they they're really impacted, and they don't they have a huge wait list. Three months, six months, wow, then what would happen is that they'd go back to the regional center and say, hey, it's approved, but we're not going to be able to start for six months. The Regional Center will cover the services until they get picked up through their provider.  

Abby Parana   

Okay, wow, yeah, I did not realize all those ins and outs of everything. I think it's kind of cool though that they assess for them to call it like they do the assessments up front, versus expecting it, expecting payment and then assessing, essentially, so like, the assessment sort of just because of the suspected delay of the parent or the doctor referral kind of thing.  

Sarah Putt   

Yeah, so typically, and I don't know, like, I know some of this just based on what I've been told. But I think if the kiddo receives services through the regional center, like treatment, therapy services, right, then the parents are expected to pay, and it's, it's like a yearly fee, and it's based on income, and I think it's up to like, $200 so.  

Abby Parana   

Oh, wow, that's, it's pretty reasonable for, I mean, therapy, yeah, yeah, okay.  

Sarah Putt   

Like the evaluations and all of that that doesn't play into it. So that's only if they are eligible and they start receiving, say, occupational therapy, okay, through the regional center. 

Abby Parana   

Ah, okay, got it. Wow, now I have a thorough understanding of how the regional center works and how these referrals are made and how they get to you to get assessed. So what kinds of assessments do OTs perform in early intervention? What tools do you use? Sort of what I mean. I guess maybe the Peabody is one that I'm familiar with as far as standardized assessments go. But I know there's multiple other ones, I'm sure. So what kind of assessment tools do you utilize?  

Sarah Putt   

So the two regional centers that I contract with, they both utilize the Bailey, okay, I've heard they do the Bailey and portions of the Daisy, okay, that's it. And then if I do like a specific sensory evaluation, then I would be doing, like, the sensory profile, but, okay, yeah, there's just, just a couple of them, kind of nice. 

Abby Parana   

Would you describe the Bailey just maybe, like a brief overview of it, for any OTs that maybe haven't heard of it, or OTs like myself that probably haven't brushed up on those types of things, being that I work in school, so just but I think it's important for school based OTs to know those assessments, because those kids eventually transition to school where we may end up assessing them for school based services. 

Sarah Putt   

So kind of what I mentioned before, typically when we're doing evaluations, either intakes or reevaluations. We are doing full developmental evaluations. And so not just ot specific, I am looking at development across all areas. And so the Bailey specifically, and the sections that we use of the Bayley is cognition and then language, which is broken up into receptive language and expressive language, and then motor, which is fine motor and gross motor. So we only do those five sections of the Bailey, and most of them are like either hands on, where they're stacking blocks or walking on a path, or putting pegs in a pegboard, pointing at pictures in a book for some of the language portions of it. And so it's very it's based on the child's skill and what they can do during that evaluation, and what scene.  

Abby Parana   

Oh, okay, so is it. And you do all of those sections, or I do it all that's very functional. Like, I think sometimes, as OTs, we tend to pigeon hole, like we do fine motor, like we fit in this box. And really functions about cognition. It's about, like, it's about all those pieces. So, right? That makes a lot of sense, yeah. And then the second assessment is not one that I'm as familiar with, either. So.  

Sarah Putt   

Oh, the day see the data, developmental assessment in young children of or of young children, something like that. And that one is basically just a it's more of like an interview. Do. So I just asked the questions, and it's kind of a yes or no, and so we only do adaptive behavior and social emotional and so we're asking questions about, can they feed themselves? Can they drink liquid from a straw and they wash their hands? Can they interact with peers. Do they help put their toys away? Do they engage in play that type of stuff? So some of it will actually see during the assessment, but some of it is like sleep, and so we're not going to be able to see that. So we that's when we ask the parents. 

Abby Parana   

Oh, okay. Oh, that makes, well, that makes a lot of sense too, because then you're looking at, again, it's grow like, grossly looking at developmental skills, but it's very functional. It sounds like, like you're looking at actual functional skills for the child at their age level, or, yeah, mental level, I guess would be a more appropriate way of putting it. 

Sarah Putt   

Exactly, exactly. And I think too, it's even though I'm looking at all of development, and I'm looking at it kind of from this grand scope. I'm always utilizing my ot brain, so I'm coming at it from the lens of occupational therapy, but I'm looking at everything that's going on with the child and really trying to get a clear picture as to what the needs are. If there are any needs, I get a lot of kiddos that come for an initial evaluation, and they're doing beautifully. They don't need anything. So it's really kind of just integrating everything and getting that well rounded, holistic view of the child and what they need at that moment. 

Abby Parana   

That's occupational therapy, that's for sure. So what main areas of occupation do you address for your clients? So for a child in one of those eight or from, I guess, zero to three, what are the, I guess, the areas of occupational occupation that you're looking at? I mean, I think I have an idea, but I want you to tell me, because you're the one who works in that field or that area of practice. 

Sarah Putt   

I feel like it's such a broad question. I do so much. So what do I do? Of course, I do a lot of fine motor, gross motor type stuff, I'll do sensory and event interventions, a lot of like milestone attainment, so always trying to hit the next milestone, whatever it is, yeah? So of course, with my with my little guys, we're working on head and neck strength. We are working on rolling, we're working on tummy time, then moving into sitting, crawling, pulling to stand, like that whole kind of develop, developmental progress, and then with when they get a little bit older, then we really start to hone in on the fine motor skills and The pincer grasp and the bilateral motor coordination. Yeah, I do quite a bit of feeding interventions. And I kind of have the two different categories. I have the picky eaters and the ones that are more like sensory, they just don't like the textures, or they don't like the color or whatever it is. And then I also do some like non oral. So a kid that has a feeding tube and they're making a transition from non oral to oral feeds, okay? And then I know I'm gonna keep going. 

Abby Parana   

Super broad. That's it. That's Oh yeah.  

Sarah Putt   

And then we also are, I also work with the family routines. So sleep would be a big one, and how they how they function within the community, being able to go out and go to restaurants or go shopping or whatever it is that they need. So pretty much any anything like the sky is the limit of what I can be, can be addressing with the family. And, you know, a lot of times I'm doing caregiver education and just teaching them what they should be expecting with their kid, or how they can be interacting with their kid, or also how to help the if their siblings involved, how to help the siblings understand, how to engage with these kiddos, and try to get the carry over. So when I'm not there, we have the siblings working on it. We have the family working on it.  

Abby Parana   

Yeah, yeah. I mean, that is, there are so many areas. I mean, it sounds but you, I mean, I'm thinking about it from a standpoint, when I'm thinking of like school based OT, I can totally see where early intervention services are super key to a child's success in school and later on down the road, being able to sit in a classroom and learn or for. Perform those tasks like I think getting those services early Are you because there's research that shows when kids don't meet their developmental milestones, or they skip them, or things like that, that their learning abilities can be impacted later on. And so I just think early intervention is super key, and obviously covers so many areas. So how do you develop your service, I guess, your service delivery model, or how you would start your service dosage, or how do you determine that kind of thing? 

Sarah Putt   

Yeah, so pretty much, I'd say, generally, I'm seeing kiddos either once or twice a week, depending on the level of need, or once or twice a month, okay, and that that's kind of kind of what it looks like. So I'd say more often than not, it's once a week if there is a significant need. So once they once they have that 33% delay we're looking at once a week. If there's a really significant delay, then there might be that twice a week. A lot of the kiddos that tend to be on the like the monitoring, so those the at risk, the prematurity, the drug exposed, those kiddos most likely, when they come to us, they, they usually start, especially because, like, a lot of them will get referred from the NICU, so they're really young, and at that point they tend to be developmentally like, age appropriate, right? So we just have, we're just monitoring them. So those are the kiddos that get that once or twice a month type monitoring service.  

Abby Parana   

Yeah, no, that I this all makes sense in my brain right now. I'm like, having so many light bomb moments. It's like, Oh, right. Isn't as intimidating as I thought. And you were right.  

Sarah Putt   

Yeah, no. I mean, it's not too bad. And it's pretty much, it's up to the the team at the regional center, as well as that evaluating therapist, or if you are the treating therapist, to figure out whether to set the frequency or to increase, decrease, anything like that, if it's in the middle of therapy. Oh, okay, got it, yeah, I, I wanted to backtrack, because you said something, and I had so I have something really good to say about it, because I Yeah, but I want to answer your question first. But so what I always try to do, especially because I have the experience in the schools and a lot of times, a lot of the parents have a harder time understanding what's going on with the kid when they're so young, so I always try to put it in perspective of, like, what are we looking forward to? They're going to be starting school, you know, they're going to go to college? Like, I always try to give them that big picture kind of thing. And so I'm telling the parents that a lot of the stuff that we're working on with these kiddos is kind of that pre learning we are preparing them to be able to learn, to be able to attend, to learn to be able to sit, to be able to access any type of learning. So it's, it's those kind of beginning level things, those building blocks, those foundational skills that we're working on so they can go to school and learn and be a contributing so, yeah, to be a contributing member of society and like, the other thing that I was going to mention, because you kind of said that the research that's coming out about kiddos that are either skipping or Maybe doing their milestones, but they're not doing it appropriately, right? A big one that I talk about, and I'm kind of going to get on a soapbox here for a second, so. 

Abby Parana   

Get the soapbox out. You can. I'll help you step onto it, like I get it. 

Sarah Putt   

Yeah, crawling. 

Abby Parana   

I knew it. I was gonna be like, crawling. I know which one she's gonna say crawling absolutely like. 

Sarah Putt   

It's such an under, undervalued, underestimated skill. So typically, like, when we get a referral, it's because a kiddo is not walking or not talking. Very rarely do we get a family that comes in and they're like, my kid's not crawling yet? Like they're they don't even worry about that. Or I get the parent that's like, oh yeah, like, the kid just learned to roll over. And they're like, Nah, they're just gonna skip crawling. They're just gonna go straight to walking. And I'm like, wait a second. Hold on. We're gonna backtrack. And I'm gonna tell you every reason that a kid should crawl because it's so important, and I do the same thing where I make this connection, because there's research that's saying that kiddos that do not crawl and do not crawl appropriately, like on their hands and knees with open hands, they have a tendency to have poor handwriting or weak hand. Weak grasp and all of that kind of stuff. Yeah, and so I'm always trying to tie it like you might not think that crawling is so important, but it is later on in life, there it puts them at risk that something might be harder for them because they're not getting all those foundational skills from crawling. 

Abby Parana   

Right, right? Absolutely. And I agree 100% what do you think about the walkers I've heard recently? Walkers aren't as great mentally either? Maybe not recently. I mean, I've always kind of felt that way about walkers. But what do you think of those types of things? 

Sarah Putt   

So I'll start by saying there are certain kiddos that walkers are necessary for, and walkers are 

Abby Parana   

the ones, like developmentally appropriate I should refer to that I'm talking about right with the tray around them, not walkers that are like, 

Sarah Putt   

used to medically need, but like PlayStation. 

Abby Parana   

Where the kid just sits upright in it and Like, uses their feet to propel them when they haven't developed walking skills yet. That's what I'm referring to.  

Sarah Putt   

There's actually a name for it, and it's called container syndrome. And it's not just the walkers, but it's bouncers. It's extra saucers, gotcha. It's bumbo. Boce seats. Oh, yeah, any sort of contraction that babies 

Abby Parana   

look comfortable in bumbo seats? No, I just don't think that they do. I don't have a baby, or I don't have kids, but to me, when I look a baby, I'm always like, I don't think that's that doesn't look comfy 

Sarah Putt   

again, like this is totally like another soapbox for me, because I deal with it all the time. And in moderation, any of these devices can be used functionally and appropriately, and I don't have a problem with that. But in moderation, and we're talking five or 10 minutes once or twice a day, maybe like Max, right? But the problem happens when the use of the devices is to be a babysitter or a pacifier, and so that nobody has to be watching the kid, it just keeps them contained. And then these kiddos are spending hours and hours, or a majority of their day in these containers, and they are not allowed to move functionally. They're not allowed to develop the muscles that they need in order to hit those milestones, and maybe they still will, but they'll start walking, but they'll have no sense of body awareness. They'll have no protective responses, because they're always expecting somebody else or something to be holding them or catching them. And it's it's definitely gotten worse. I've seen more and more over the years, and constantly educating my families. Just get rid of them. Put a floor on a mat, get down on the floor with them, engage with them. That's going to be the thing that you can do. 

Abby Parana   

Because I think sometimes when you position a baby, and you might and correct me if I'm wrong, but maybe before they're ready to be positioned in that way, their muscles haven't developed enough, and so they can do like, kind of, could they learn? I guess I'm asking, it's more of a question. Could they end up learning compensatory movements that probably you don't want them to learn. You want them to learn. The correct developmental approach in those situations. Is that the right way to phrase it? 

Sarah Putt   

You are spot on with that. Yeah, they learn. Kind of, yeah. 

Abby Parana   

They'll learn to cheat, and then those muscles weren't designed to work that way. And so if they're doing it before they're ready, that's not good either, because if you learn to develop those muscles before they're trained appropriately, I could see where you're com, compensating, well, compensating. And that could lead to poor habits, or, yeah.  

Sarah Putt   

Skills later. The big one that I see too, especially like when we're talking about like walkers or bouncers or something where they're like upright, is that they develop really strong extensor muscles, so the muscles of the back. 

Abby Parana   

But not the abs. 

Sarah Putt   

And so their core strength is horrible. And so then because of that, they lack that CO contraction between the flexors and the sensors of the trunk. And so they have difficulties with postural stability, postural control, being able to sit up, being able to walk, being able to catch themselves when they are shifted off balance, all of those types of things. So. 

Abby Parana   

This all makes a lot of sense. 

Sarah Putt   

Like the light bulb going on. I'm like, 

Abby Parana   

I'm having so many light bulb moments right now. I'm just like, whoa, hi. Oh. That's why like that. That makes a ton of sense. Why you wouldn't, you know why you'd want to promote those developmental milestones and the progression appropriately with those children. So when a child becomes school aged, essentially, what happens with early intervention? I mean, how do they transition out of early intervention into the next, I guess, phase after three.  

Sarah Putt   

Yeah, so typically the transition will start like, generally it's right around two and a half, but sometimes even within the meetings and the evaluations, if the kiddo is, like, two years or older, we already start talking about it that at three they are going to be eligible to transition to the school district and at least start to prep the parents. And so specifically, when say it's a kiddo that I've been working with, and generally, I'd say there's kind of two different types of kiddos, like, there are kiddos that I'm working with that. I'm pretty sure that they're going to continue to they're going to be eligible for therapy in school and continue to receive it, and then they're, they're kiddos that I'm like, You know what they are doing great. You guys probably will go through the transition period, but there's a good chance that they might not qualify, because they're doing that well. And so I really just try to educate my parents, on both sides, whether or not they're going to continue or not, what that process looks like, because it's a lot.  

Abby Parana   

Yeah, no, it must be a lot, I mean, and they go from having kind of this face to face therapist in their home with them, kind of developing programs with them, and then it's kind of, when it comes to school based, we're a little bit more developing programs with the teachers and the staff, and we do, I mean, touch base with the parents as well. That I think that that's very important. But it's almost like the parents are kind of being told what we're doing at school versus, you know, they're always a part of the team. I don't want to say that they're not, but when it comes to therapy, they're not sitting in on our therapy sessions. There's a lot of trust that has to take place. So I can imagine being a parent making that kind of transition would be difficult.  

Sarah Putt   

Yeah, it's, it's just, it's just a lot for them to go through and the service, the services and the service delivery, kind of what you were talking about that looks different. But even just the the initial IEP, so going from the if the IFSP, the Individual Family Service Plan, right? Say that, right? IFSP, what? Yeah. Family 

Abby Parana   

IFSP. You know, I wrote IFSP on here, not really knowing what the acronym actually stood. 

Sarah Putt   

For so many times, and then it came out. 

Abby Parana   

That's not right. And I used to like my previous experience was, I did. I was a part of that transition team, but that was when I very first graduated. I was working in Hawaii, and I was a part of that whole process of transitioning from early intervention to school based, and I would do the assessment for school based for those kiddos. And so I knew it. I knew IFSP, but I had forgotten what the actual acronym was, because I haven't done that for about nine years now. So I'm like, I know there's an IFSP, and that turns into the IEP, and we have a meeting about it, and I cannot remember what all that entails. So, yeah, allow you to elaborate on it. So what is the if? 

Sarah Putt   

The Individualized Family Service Plan is that's basically the IEP for the kiddos in early intervention. And the the big main difference is that the family is a part of that team, so we can actually write goals that are for the family, or for the routines of the family, or something like that, whereas I know in the schools, you guys aren't going to be writing a goal, that they are going to do this strategy, or whatever it is. 

Abby Parana   

As a matter of fact, we can't even really write like parent, as somebody responsible for the goals or or anything like that. In the IEP, they are, at least the districts I've worked for strongly discourage that, like saying, like, the parent will work on this for the kid, because everything is supposed to be focused in the school. 

Sarah Putt   

Is that new? Because I've definitely seen that written on.  

Abby Parana   

I know I've seen it written as well. I'm not saying it's everywhere. I just know, personally and my past couple years experience, they've really discouraged saying that the parent is responsible for something because everything was supposed to take place at the school. Yeah, okay, yeah, yeah. So I think that's just 

Sarah Putt   

a big difference. And when parents are exposed to the early intervention side and. They're used to like what you said, the in home therapies, the direct therapy, they are working on anything developmentally that's within that therapist scope of practice to then transitioning to the school district, where it looks different. I always just want to make sure that my parents understand, or at least have heard it before. Maybe they don't understand it quite yet, but I've talked to them about it, and I've talked to them numerous times about it's going to look different. The school therapists are going to be working on accessing their education, right? Everything is going to be education based, and education skill based, and a little bit less on that kind of developmental family based side that we focus on. And so I feel like I try to just prepare my families to go through that with this understanding of it's going to be different, and it's going to be a lot. Definitely, you're going to you're going to sit there, you're going to go through it and you're going to come back and you're going to talk to me and ask me questions, and I will explain it. I'll have families. They'll go to their IEP, and then I tell them, bring it back to me. We will walk through it. I will explain what this page is and what this is, and what these goals mean, and everything like that. So they really like try to get a better understanding. Yeah, that's gonna look like.  

Abby Parana   

And I think it's intimidating well, and I do want to clarify, it's not that we don't I mean, parent input is always super valuable, important. I guess what I'm saying is we don't write in there that they're responsible for a goal right on the IEP. That's what I mean. To clarify, they're always involved that parent input is super important to their child's education and involvement. And they are a member of the IEP team that, you know, invaluable member. Yes, so I just want to clarify that I was just thinking to myself, I hope that didn't come out like, Oh no, they're not. We don't make them responsible for anything. But what did it? I just mean they're not responsible for, like monitoring the progress of the goal, or noting on the goal, or anything like that. So what do you think? But I was just thinking to myself, we go through the IEP documents in an hour, and sometimes there's 22 to 30. I mean, plus pages in this document. And each page is full of information, and then we go through it with them. And at the end we're just like, sign here, here and here, initially, these areas, and you kind of briefly describe what each thing is. You go through their rights. You go through all of those things in the beginning, but I can only imagine how stressed out these parents must be transitioning from having all these services in their home and being a part of their lives and their, you know, developing trust and all of that, to coming into a meeting that feels very cold in a way. And then also, we need your signature on all of this. We need it today, kind of a situation. So what has been your experience with that? I guess, helping transition them out, like you already touched on it a lot, but like, just kind of, would you Yeah, or do they get stressed out? I would think that they do.  

Sarah Putt   

Yeah, yes. And I always just try to give them examples of, like, when I was in the schools, like, what it would look like, because not only is it this kind of unfamiliar, kind of foreign document, they're like, IEP what I don't I don't even know what this is, and there's all this language on it that they're like, I can't even comprehend. And then they have 510, 15 specialists that come into a room and they're telling the parent that their kid can do this and can't do this, and they're delayed and this, and, like, all these issues, and it can be a lot, and the families will kind of can have a tendency to, like, shut down and like, whoa, whoa. Like they feel like they're getting attacked. And this is not against the schools, but we're like, you guys are used to it. You guys go to IEPs all the time. You deal with difficult situations all the time. But every family is unique. And so like, what, what I try to do is prepare them with, hey, there might be a lot of people, there's going to be a lot of paperwork, but you guys have rights. You guys have rights as parents, and do not feel pressured to do anything that you do not feel comfortable doing. Because even if the schools don't mean to do that, I think sometimes it happens because they want to get things in place, they want services to start, and they want this and they want that, and the parents are just kind of still dealing with just accepting what's going on. So it's just a lot to process 

Abby Parana   

give their child over that they've been taking care of to a group of adults that they don't know. Yes and hope for the best, I think, like for. A large portion of the Kids Day, and then, and I, and I think, and I think it's tough too, because we have to always come from it, from a justifying why we're giving support kind of way. And we have to do that through strengths and concerns, or, like strengths and needs of the child, and so you're trying to justify why they need services. So you're trying to list the deficits. And you're right, though it can come out very like, these are the things they can't do. These are the things they can do. And that can I would imagine, that would be a very I'm not a parent again, but I could imagine we need to be a little bit more empathetic of or describe, just take our time a little bit giving that information to parents, right? 

Sarah Putt   

But you guys don't have that time. Like, 

I wish we had that time. 

Sarah Putt   

Yeah, it's like, it's catch 22 because it's like, yes, you need to take the time. But if you guys took all that time, like your three hour IEPs, or whatever the going rate is now, it's about would turn into six, 810, and, oh, gosh, 

Abby Parana   

I know. But, and you get that look from like, somebody who's taken like you better hurry it up. Get through your report a little quicker here, because we all have to do another meeting, and like, at this time it's scheduled, you know? So, yeah, and 

Sarah Putt   

so that's why I feel like because, especially if they're already getting serviced, and I've been with the family for a while, I know that the kids turning three, and so I try to start bringing those conversations in as I'm there. I'm trying, I'm trying my best. And so I can try to tackle some of these things before they even get to the schools. And then they know the parents know that they can come back to me and ask me questions afterwards. So if they've already been in the meeting for four hours and they need some time to process, they can come talk to me and I at least attempt to try to explain things and help them understand a little bit better, 

Abby Parana   

yeah, and they get time to digest and kind of maybe like, okay, is this normal? Is this not normal? Because I would imagine I would have that question. So I'm gonna just, I think we've covered a lot, and so you're also doing a podcast. What? And what's the name of the podcast? And how did you get inspired to do podcasting next? 

Sarah Putt   

So the name of my podcast is ot for life. And I well, I guess, being that I do in home therapy. I drive alone, and I drive all day, every day, pretty much every 15 minutes or so I'm in my car for at least 10 to 15 to maybe 30 minutes, driving from one house to the next right. And a couple years ago, I actually, I got big into podcasting, like I used to listen to music all the time, and then somehow, and I don't even know how I started, but I got into listening to podcast and fell in love with it because it was just all this great information, and I loved hearing all the stories that The different shows that I was listening to, right? And when I started, or when I started listening to podcasts, I was not listening to OT podcasts. I was listening to the like, finance related ones, like real estate and, like company entrepreneur type stuff, right? And then somehow I stumbled upon a couple physical therapy podcasts. And they were brilliant. They were amazing. And I was like, Wait a second, if there are PT podcasts, there have to be ot podcasts out there. And this was, this was a couple years ago when this, when this first started, and I did my research, and there were only a couple, and like, a few that were out there. I They started in like 2013 and their last episode was, like 2014 and I'm like, okay, oh, this one's not still going. And I like that. That was kind of happening on one end, and then on the other end, I was going to all these conferences, and I was meeting all of these amazing occupational therapists that are doing such cool things. They just have these fantastic stories. And I'm like, I want to share this with people, because I'm getting value out of it, and I want other people to be able to get that same value. And so fortunately, since that, like initial research that I did a couple years ago, there have been more ot podcasts that have popped up like you guys, which is great, but I still felt like there, there's room for more. Are there are, there's 

Abby Parana   

always room for more ot related anything, just Yeah, in the blank. But I, I agree with you. So what is kind of the theme of your podcast? Because I know here for ot school house, we do things related mainly to school based OT, some pediatric practice type things, but it's mainly related to school based education and occupational therapy. So what is it that your pot, your podcast, is quite a bit different from that? I 

Sarah Putt   

yeah, I am pretty much sharing anything that is ot related. So yeah, like, even though I am pediatric and I am early intervention. That is not all I'm talking about. I am talking with people that are in all walks of OT life, because I really just want to highlight the stories of practitioners in the field. I want to give a voice to the students, because I am also a field work educator, and I love having students, and they have such a unique voice and such an amazing passion for the field, and I love like when they're telling me things. And so I want to give a voice to the students and the next generation of occupational therapists. Yes, I want to shed light on entrepreneurship and try to promote more OTs, kind of paving their own way and really getting out there and doing kind of just shifting up the medical model and really just making a change, yeah, yeah. It's, it's kind of anything and everything. OT Well, I 

Abby Parana   

highly recommend it. Listen to thank you episodes. I think it's fantastic. I also feel that, you know, I would agree with you. I don't think that we do enough to promote occupational therapy as a profession. I don't think we're our faces or OTs role is so unique and and it really does make a difference to the kids we work with, but also when I work with adult populations as well, it's a very important profession and service, and I don't think that we do a good enough job expressing that, because it seems that we're just misunderstood a lot of the time. So I feel that what your podcast is bringing to the table is something that is greatly needed in our field. For sure. 

Sarah Putt   

Yeah, I feel like a lot of times, if somebody is familiar with OT, like, not not a therapist, but somebody outside of the OT realm, and they're familiar with OT, they they think of it in like one category. So it's like, Oh, um, oh, you know, my grandmother got it in a skilled nursing facility. That's what OT is. Or my cousin has autism, and he got it in school. So, right, that's what OT is. And it's almost like very compartmentalized in one or, like, just a very small aspect of what we really do. Yeah, and yeah. So like, really through my podcast, I am just kind of use utilizing the platform of audio to be able to share with the rest of the community, the rest of the world, about who we are and what we do and what we can bring to the table, because there's so much just utterly amazing things that OTs are doing out out there, and I want other OTs to know that. But then I also want people that want to learn more about ot to understand that we have such a unique skill set, and we have so much to bring to the table. 

Abby Parana   

We are a diverse group, that's for sure. 

Sarah Putt   

Right? Exactly, definitely. 

Abby Parana   

Well, Sarah, it has been a pleasure chatting with you this evening. I apologize for any interruptions from my dog, but I think that we've covered a lot of ground in this interview, and I really appreciate you coming on ot School House to talk about early intervention, your life as an entrepreneur and podcaster, and it sounds like you're doing a huge amount of things related to OT. So I appreciate you taking the time out of your busy life to chat with me tonight. 

Sarah Putt   

I appreciate it so much. This has been so much fun, and it's really cool to connect, because I feel like a lot of times, like in the EI realm, like we just kind of do our thing, and then the school therapist, they do their thing, and it's cool to get that collaboration and kind of hear what your viewpoint is, and then for you to kind of understand what's going on on our end. And I think it's just, it's great, just across the board. So I appreciate the opportunity, and this has been a lot of fun. 

Abby Parana   

Yeah, I've had a great time. I've had so many light bulb moments.  

Sarah Putt   

So thank you very much.  

Abby Parana   

You're welcome. All right guys, well, thanks for listening to Sarah put and I talk. Talk about early intervention services, a little bit of podcasting and a couple other little roads. We took detours in that interview. You can go ahead over to OT schoolhouse.com/episode 24 Well, the show notes, Happy Holidays to you guys from ot school house and stay safe and we'll see you in the new year.  

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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