OTS 35: Occupational Therapy and Trauma-Informed Care in Schools Feat. Colleen Cameron Whiting
- Jayson Davies
- Jul 21, 2019
- 42 min read
Updated: May 13
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Welcome to the show notes for Episode 35 of the OT Schoolhouse Podcast.
In this episode, Jayson interviews fellow school-based occupational therapist, Colleen Cameron Whiting. Colleen has recently had two articles published (cited below in the resources) on providing trauma-informed care (TIC) in the school and today she brings to the podcast a model about how school-based OTs can work with other educators to creating an environment in which students feel safe and welcomed. We also dive into what exactly trauma is, how some trauma can have adverse effects on the developing brain, and what occupational therapy using a TIC model looks like.
Colleen Cameron Whiting MS, OTR/L
Colleen is a school-based occupational therapist in Massachusetts. She is also the owner of The SPARK Sensory Clinic and the Faculty of the STAR Institute. Recently, Colleen has devoted her time and energy toward ensuring that other therapists recognize the importance of Trauma-Informed Care in public schools.
Listen in to this episode and earn 1-hour of professional development for doing so, as Jayson Interviews Colleen Cameron Whiting, MS, OTR/L, on Trauma, its effects, and what OTs can do about it.
Objectives for this Professional Development Podcast
Listeners will:
1. Be able to identify 3 levels of stress and how they may impact development.
2. Identify what Adverse Childhood Experiences (ACEs) are and how many ACEs are considered above the normal threshold.
3. Identify tiered strategies to help build a trauma-informed school.
Links to Show References:
Have a question for Colleen? Visit The SPARK Clinic website at SPARKsensoryclinic.weebly.com
Use this link to check out the STAR Institute and the various learning opportunities for occupational therapists working in the schools.
Every Moment Counts is a mental health promotion initiative that encourages OTs to go outside the normal pull-out sessions to create an inclusive school. They even provide free step-by-step guides to incorporating a few of their proven programs.
In the Podcast, Colleen mentions Interoception and Kelly's website, kelly-mahler.com. Be sure to check out her free webinars and paid course on "Improving Interoception"
Both Colleen and I agree that you need this book on your shelf if you are a school-based OT. The second edition is now available on Amazon and at AOTA.org. (Amazon links help to support the OT School House)
Learn more about the importance of supporting children with mental health concerns from Colleen, a parent, and an educator in this AOTA Podcast.
Articles Written By Colleen
Whiting, C. C. (2002). School performance of children who have experienced maltreatment. Physical & Occupational Therapy In Pediatrics, 21(2–3), 81–89. doi:10.1080/J006v21n02_07
12. Whiting, C. C. (2018) Trauma and the role of the school-based occupational therapist. Journal of Occupational Therapy, Schools, & Early Intervention, 11:3, 291-301, DOI: 10.1080/ 19411243.2018.1438327
Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.
Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com
Well,
Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts
Episode Transcript
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Amazing Narrator
hello and welcome to the otschoolhouse com, your source for school based occupational therapy, tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.
Jayson Davies
Hey everyone. And welcome to episode 35 of the otschoolhouse podcast, as usual, I am your host today. My name is Jayson Davies. I'm an occupational therapist Registered and Licensed here in Southern California, and I am glad to be joining you today. I really want to say thank you for listening in, making this a part of your day, whether you're at the gym, whether you're in the car, wherever you are just thank you for listening. And I know it's summer. A lot of you are on vacation right now. Actually, as I record this, I'm getting ready to head out on vacation, and the day that this episode actually goes live, I will be returning from Europe, so I just got back now that you're listening, and I guarantee I had a great time. I've been waiting a while to get this episode out to you. I really wanted to put it out for all of you to hear. It's fantastic. Today we have a very special guest for you, and her name is Colleen Cameron Whiting, and we're going to introduce her here in a hot minute. But first I have two things. I want to actually let you all in on a little thing that's going on here in California. We are having a school based symposium, actually, and it's going to be put on by the Occupational Therapy Association of California, also known as OTEC. And it's going to be kind of in central California. In this small city of Clovis, it's supposed to be central so that, you know, everyone from from San Diego and in LA can head up north, and people that are maybe in the bay area or further up in California can come down south a little bit. But it's going to be all about school based. And it's going to be September 6 and seventh. That is a Friday and a Saturday. Everyone is invited to join us. Of course, there is a registration and a fee and all that good stuff. You can find more about that on the OTEC website, at OTEC online.org, I will obviously have a link to that in the show notes for anyone who needs that. But just want to let you all know about that. I will be there. Hope to see you there. If you're there, come find me. I shouldn't be that hard to find, since I will be helping out a little bit with that. All right, diving into today's episode. It is a continuing education course today on the podcast, so you can earn one hour of professional development by taking the quiz, after listening, purchasing that taking the quiz, and then I will send you a certificate of completion. Today, our very special guest, like I said earlier, is Colleen Cameron Whiting. Colleen is a pediatric occupational therapist based out of Massachusetts, Hopedale, to be specific, and that's where she actually has a small clinic, along with providing school based occupational therapy services. Colleen has been an occupational therapist for over 18 years, and she is, in fact, sift and dir Floortime certified. She also teaches on the faculty for Dr Lucy Jane Miller star institute that's based out of Denver. We'll talk about that a little bit. But recently, she's published two articles related to programming treatment for children with trauma, and that's exactly what we are here to talk about today. Like, what is trauma? What does it look like when our students have experienced trauma, and then how to help those kids who may have experienced trauma to better integrate into the classroom and access their education? So I think it's time to jump right into that interview. Here is Colleen Cameron whiting here to talk a little bit about trauma informed care. Hope you enjoy. Hi, Colleen. Welcome to the podcast. How are you doing today?
Colleen Cameron
Very well. I'm excited to be here. Jason, thanks for having me.
Jayson Davies
Yeah, the pleasure is all mine. I'm really happy to have you on the show, and I am excited to see where we go today with this. But first, you know what? I want to let you kind of share about how you decided to get into occupational therapy. I love hearing these stories.
Colleen Cameron
Yeah, everyone kind of has their own path, right? So I was actually a psych grad in undergrad, major in undergrad, and I was working on a psych ward, child psych ward, and came across this woman that was an occupational therapist, and I'd never heard of the profession, and just fell in love with how she worked with the kids. She had such a focus on the children's strengths. She was really looking at the whole person, the whole child. And then I always knew I wanted to work with peds, and so getting into school based, it was like I had found my people, so.
Jayson Davies
Yeah, that's awesome. So actually, I wanted to ask you, because I kind of saw that you were a counselor in a psych ward, or I don't know, Psych unit, I guess you could call it, what did, what did that job look like? What were you doing in that role?
Colleen Cameron
Yeah, so it was something that you it was kind of an assistant role to helping kind of the psych ward works. You would help run groups. You could help, kind of keep tabs on where kids were going, doing check ins with them, helping navigate if they had to go to appointments. And it was just a really nice way to get a sense of the kids themselves, and kind of just hanging out with them, as opposed to, like this targeted piece, because I would be with them for, you know, an eight hour shift so that Is really cool.
Jayson Davies
Awesome. All right. Well, let's move kind of into the here and now then, and in what capacities are you working as an occupational therapist now?
Colleen Cameron
Well, I wear many hats and very busy. First and foremost, I've been a school based ot for almost 19 years now, in the public schools. I also have a very small private practice on the side that I see kiddos, Spark sensory clinic. And my other other role is I'm really honored to be on the faculty for the star Institute for SPD, which is where Dr Lucy, Jane Miller and Dr Schoen are. I'm able to do some teaching there some course development. I've actually helped them develop their most recent course, which is a school based intensive and what that looks like is a kind of a hybrid intensive training model. It looks at theory, the star frame of reference, adapted for the schools, and then intervention at all across the tiers. And then, of course, my experience with the trauma realm is I've actually published two journal articles around school based role of the occupational therapist and trauma, and had the pleasure of presenting at lots of conferences around the country. So.
Jayson Davies
Well, that's awesome. We are definitely very honored to have you here on the podcast. So I wanted to ask you real quick, the star Institute, you're not, they're in Denver, correct? Or near Denver, and you're not in Denver, so you're doing all that online. And when you say hybrid, does that mean partially online, partially in person classes?
Colleen Cameron
Yeah. So for the school based course that I'm currently teaching for them, it's hybrid. So it's one day that's actually of taped lectures, which we tried to make it manageable for school based therapists to be able to not, you know, they can't take off a week of school, and so one one day of the lecture, online modules are taped, and then there's two days live. And I so I travel around, not just to Denver, but all over the country, kind of doing those two day live experiences. But I always also get to go out to Denver sometime and play, so.
Jayson Davies
Awesome, yeah, I love going out there with all the snow they have out there, fun to get up on the slopes. Yeah? All right. Well, the other thing you kind of mentioned was your journal articles about trauma, and that's kind of where we're going in this podcast today. So we won't tap into that yet, but, you know, we'll get into that in a minute. With that. We're here to talk about trauma. All right, yeah, today, we're here to talk about trauma. You know, how these experiences may affect students or kids and how we can support them. So my first question for you today is, why is this such a topic, a hot topic, especially in education right now?
Colleen Cameron
Yeah, it's a good question. It really is a hot topic. Everyone's talking about it, bringing up a lot of initiatives. I guess the bigger piece is trauma informed care has really become a federal initiative for service providers across settings. So that's the first piece, but the research around trauma right now, the neuroscience, really the knowledge about the long term changes that can happen as a result of trauma is exploding in the research, and so that's led those in the education setting to realize the importance of becoming more informed. And what I really try to when I'm out presenting, is talking to people about really the beauty of the sensitive school or sense trauma informed model, is that it's really helpful for all students, not just the ones that have experienced trauma. So.
Jayson Davies
Yeah, that's perfect, especially when we get into kind of talking about RTI and the the three tiers. Because, of course, you know that tier one we're trying to hit, you know, 95% of the kids, or 80% of the kids, whatever you want to say. But we are trying to help every kid, not just those kids who may have experienced trauma or may have fine motor difficulties or whatever. We're trying to help all kids. So exactly, that's fantastic. So when we talk about trauma, I just want to make sure we're all on the same page here. So I want to come up with a working definition of of that. And so from your standpoint, how is trauma defined in a child's life?
Colleen Cameron
So yeah, people do different definitions of trauma, and depends kind of their how wide a lens, but in most general terms, they look at it including loss, loss of a consistent caregiver, household challenges, domestic violence, substance abuse, that can be different kinds of abuse, neglect, traumatic loss, are all included under that category. And was really, I think was around 1997 that the adverse childhood experiences study came out. And that was really what kind of moved this movement forward. It was the largest investigation at the time of childhood abuse and neglect and household challenges, and they made an incredible connection to later life health and well being. And what they found is those that have experienced four or more ACEs, which is what they consider the adverse childhood experiences, they were more likely in later life to engage in high risk behaviors and experience really quite significant health issues.
Jayson Davies
Okay, so. You use the word average, four being like the average is that or
Colleen Cameron
So they if they experience four or more ACEs, that's where they really sought found those significant results.
Jayson Davies
Gotcha. Okay, so if a child you know had one experience, would be like a divorce or something like that, correct? So if they just went through that. Maybe we wouldn't call them high risk, but if they had a divorce, then they also went into an orphan, or they became an orphan, or something like that, and a few other things happen. Now we're being concerned.
Colleen Cameron
Yeah, and I think it has to do a lot with as far as what kind of resources they have available, because for each kid, it's really an individualized experience. So it might be that one piece might be really traumatic for that child, so I like to think about different levels of stress, kind of thinking about what this trauma and this might be helpful to think about in this framework. So we think about positive stress being when there's just that mild increase in stress. Psychologists call this zone of proximal development. We, as OTs, like to use the just right challenge. The positive stress is what really is motivating you is more short term, increasing improving performance, then we move into tolerable stress that's more significant. It can cause anxiety or concern. It's activating the body's alert system as a result of more severe, longer lasting difficulties. It could be a single piece, like a loss of a loved one. It's more time limited, but often buffered by supportive relationships. When it becomes more impactful for the child, is really toxic stress or trauma. We're talking about strong, frequent or prolonged adversity. So that's really kind of the difference, that activation of the stress response and the child doesn't have sufficient resources to combat it, and it takes that cumulative toll on them, their physical and mental health, which was found in the ACE study and actually shown to be toxic to the developing brain architecture of these little guys. So.
Jayson Davies
Wow. And so it seems like the positive types of trauma, you know, we have a little bit of control over, um, tolerable. It sounds like, you know, that's the death in the family. We, we obviously have no control over that. But in a way, it can be understood as a natural life event. However, the toxic it sounds like the kid might have absolutely zero control over it, and it is completely something that is unexpected, and you should not expect that a child would have to go through these things.
Colleen Cameron
Yeah, I think you know, it's different. Kids have different capacity to cope, different resources available to them. Their surrounding circumstances and social context might be different. So I like to think about, when you change it to thinking about toxic stress and trauma is really they don't have the internal resources to the coping skills or that positive, you know, view of their personal future and their external resources, such as a safe and supportive family or access to consistent nutrition or safe housing, they don't have the internal and external resources sufficient enough to buffer the effects of that trauma.
Jayson Davies
Gotcha. Okay. And so then moving forward, you know, we kind of see these kids at school. When should we start to worry about a student when it comes to experiencing trauma, like, are there things that we can look for as far as trying to see if there's a student that we should, not target, but, you know, try to be more mindful with?
Colleen Cameron
Well, you know, the fact of the matter is, we don't, we can't identify, you know, all the kids that have had trauma. So that's what's really nice, thinking about the trauma informed care, is that we're really providing this for all students, if we as OTs, can be consistent external resources for them trying to build their internal resources. That's really where we come into play, as being available. We've done some outreach as far as identifying through, you know, whether kids have had specific trauma, I've worked really closely with, you know, my BCBA, if a lot we have a lot of behaviors come up, we'll be really trying to look into the why of what's going on, as opposed to just making assumptions. So it's something definitely in the back of your mind that considering that this child might have experienced on some trauma in their life?
Jayson Davies
Gotcha. And I mean, I don't know the answer to this, but are there people that are screening children for trauma like I've never seen that in my school based capacity, but have you ever seen a certain, I don't know, in psychological, psycho educational testing, do they screen for trauma, or is this something that's happening?
Colleen Cameron
They don't screen for trauma. I mean, Nadine Burke Harris, who's a pediatrician, has really put together some really nice, quick screening tools that she's trying to advocate for pediatricians to use in their office, and some of the schools have adapted those models to do, you know, say, on kindergarten intake. Screenings, asking some of those questions, but it's very sensitive information on those. It's kind of just more marking, whether some things have happened, not giving a lot of specifics. And then it's really important then for the school psychologist to be the one to kind of reach out and have a supportive conversation around it. So this is something because it's, you know, can be difficult to to talk about and to disclose to the school.
Jayson Davies
Of course. And, you know, we all go through training as mandated reporters and stuff like that, and, and all of that is so, I mean, it's borderline stuff, you know, when to make the call or when not to make the call, and, and the ramifications of that too. You know, a lot of I've seen teachers make that call to whatever the state's program is for some sort of abuse or neglect, or whatever it is, and that can have, very much, can have adverse effects on the parent, teacher relationship, student, parent, student, teacher relationship, all that good stuff. So yeah, definitely, that can be a tough topic to talk about,
Colleen Cameron
Very hard to navigate, yeah.
Jayson Davies
Yeah. So now we have a little bit of an understanding of trauma and what is defined as, what it might look like, a little bit. Let's move into how these experiences are affecting our students. So what does the research say in regards to how trauma is affecting the brain and the body?
Colleen Cameron
Yeah, So it's really exciting. All the research that has come out about this on a very fundamental level, these kids often their physiological stability is impacted their ability to have appropriate adaptive responses to what's happening in their environment. Scientists have found that the their neurobiology is influenced even their epigenetics, that these pieces can be passed down across generations, the children oftentimes can have difficulty with an appropriate arousal regulation. So you know, their stress responses I mentioned before has been triggered, and this can lead kids to operate on in this like hyper aroused state, and that's their baseline. So when that's happening, you can't really access all those great functions of your prefrontal cortex. You know your executive functions becomes offline. You're having trouble monitoring and modulating your own behavior, and you've left with this really overreactive limbic system that often can take over, and that's what controls your arousal, your emotion on that fight, flight or freeze response. I really like the way that Dan Siegel talks about this because he talks about kids flipping their lids. So just being really matter of fact with kids like, you know, your lid has been flipped, your prefrontal cortex has gone offline, your emotional system. And then how can we, you know, that feeling, that downstairs part of your brain? How can we get them to be able to flip back up to that thinking part of their brain? Because that really provides them with the capacity to be thinking and reasoning, maintaining all of that flexibility. And then, I don't want to forget to mention also, we're seeing a lot of these kids with sensory modulation difficulties. In particular, we're seeing over responsivity for a lot of these kids, for some of the children that have experienced neglect, we're seeing some under responsivity, in particular to auditory and tactile and vestibular. And we're also recognized in the classroom. These kids have a large amount of hyper vigilance to visual input. They're constantly scanning their surroundings. So you know, we're talking about really some significant body based pieces these kind of kids are coming to school with. So.
Jayson Davies
Yeah, and of course, in the schools, you know, we're not giving a diagnosis, we're saying that a student has characteristics of autism or characteristics of ADHD or something like that when we bring them into special education. But you kind of started down this route a little bit. What? What else might we see in school when it comes to behavior for kids who have experienced trauma?
Colleen Cameron
well, yeah, along that diagnosis line, you see a lot of these kids coming with other diagnosis. They're diagnosed with ADHD. They're diagnosed with conduct disorder, Oppositional Defiant Disorder, reactive attachment anxiety, pieces and you see in the school from an OT lens, a really strong impact on their occupational areas of play, of their social participation and their education. So we're seeing them more likely to have been suspended or failing a grade. They're often, at times, achieving a lower academic achievement, more impaired intellectual capacity. I mentioned about the difficulties with the executive function, memory, concentration, seeing language delays and then challenges in their relationships with peers and teachers. They're demonstrating delayed play skills. So it's really quite comprehensive the impact.
Jayson Davies
Yeah, and so you mentioned a little bit from the OT perspective. But what about from the teacher to or the administrators? What do they say when you tend to if they're talking about a student that might have some trauma, what do you tend to hear the teachers and administrators saying about the student?
Colleen Cameron
Yeah, these kids get discussed a lot, because there's often, you know, the kids that are kind of in. That more of that fight response, we're getting some aggression, loss of emotional control. We can see a lot of these kids having really self deprivating, deprivating comments. Oh, that's, yeah, it's early, self injurious behaviors. You can also see these kids like really socially withdraw. We can see these kids fleeing classrooms when they're upset, or you can have them really digging their heels in and wanting that sense of control. These are kids historically have had that lack of sense of agency or ability to kind of control their environments they might be trying to exert more control, and which often impacts their ability to function in the classroom.
Jayson Davies
Absolutely. I mean, I know I'm not the only one who says this, but one of our first roles as educators, whether we're a teacher, an OT, or any role as an educator, we have to ensure that the child actually wants to be at the school. And so many times I see a kid, you know, the walk out of OT and like, you can just see, I mean, it doesn't happen often, but you just see that they don't want to go into the classroom, like they're almost scared to go back into the classroom, or something like that. So I can just imagine how this toll could potentially affect a kid's ability to learn.
Colleen Cameron
Yeah, and I think that, you know, we provide, we're really, you know, co regulating them and meeting kids where they are, and they're feeling really safe in these ot environments, and so that's what's really important about spreading it out across the tiers, that we're developing that sense of community and safety across the school. So.
Jayson Davies
Yeah, all right, well, let's jump into us As occupational therapists. Why are we the right fit to help these students, and what unique contribution can we make for these students?
Colleen Cameron
Well, I It's like my personal mission out there. I really feel school based OTS need to be recognizing their distinct value and providing supports for students that have experienced trauma. It's a important seat for us to have at the table. I know I recently presented at a conference down in DC, the trauma sensitive schools conference. And there were 1000 people there, and there were four otschoolhouse com, we have to rally our troops to understand our distinct worth in this starting off really looking at there's a great new chapter in the new best practices for occupational therapists in the school book that just came out a couple months ago, actually by some very talented and passionate OTS that I would encourage people to read. That's a great place to start. But OTS are such an untapped resource in this model, if you think about we're really trained to analyze tasks, modify environments, and identify participation barriers, and we've already recognized that. So a lot of what these kids are presenting with, we have this great, extensive knowledge about sensory and motor arousal regulation. We're trained in mental health. A lot of us don't recognize that capacity that we have, that that's a really important role for us in the schools, and we are trained to work bottom up with body based relational supports for these children, and so we have such a knowledge base and a skill set to come forward to really help these kids feel safe, help them build resilience, and they talk a lot about post traumatic growth, that's a real area that we can impact.
Jayson Davies
Definitely and real quick. I want to say two comments from what you said is that the book will definitely have the new school based ot book, or best practices in school based ot I'll put a link to that in the show notes at otschoolhouse com, forward slash episode 35 and then the other thing is that about mental health, I know. I mean, here in California, I recently went to the otschoolhouse com health, not necessarily in schools, but just in general. OTs being a mental health you know, that's kind of almost where we have our roots. And now only, I think, 3% of OTS work in mental health. And I also know that's been a big focus of concern for aota as well. I know Amy Lam, the outgoing president of aota, has talked several times in her just or in her keynote speeches about mental health. So that is an area that I think OT is really moving forward into. And I think we also need to continue that trend, not only into mental health for adults, but also mental health for students as well, since we are prominent in the schools.
Colleen Cameron
Definitely. I mean, Sue basic, I don't know if you're familiar with her work, but she's a huge advocate for this area. So anyone that's interested in really feeling empowered to work in this area, in the school, she's a great resource. Her she has a website every moment counts, where she has all these really great tier one, tier two strategies for supporting kids, and she's a huge advocate for that. It's very, very important.
Jayson Davies
Absolutely, actually, you know, it's funny you say that I was just watching a video of her on YouTube. She has like, an hour long lecture. I think she had won an award, and so she was kind of giving a lecture that went along with that award, and she was talking about this program that she helped facilitate in a cafeteria. Yeah, and it was about teaching social skills in the cafeteria. And what I loved about it was that it wasn't just the students she was working with, it was the cafeteria employees she was also working with. I mean, I don't know about you, but I've been in toxic cafeterias where, for sure, where the aides or the whatever you want to call them paraprofessionals, are downright mean, and I've had discussions with principals about it. I mean, I know principals don't always make it in the cafeteria, but I've gone and been like, Excuse me, Mrs. Principal, but have you been in the cafeteria recently? Because, I mean, they were isolating students at one point in a way, and I was like, What's going on here? So that's really cool that Susan Sue Susan right. Sue basic, yeah, Sue basic. She's doing so much for our kids, so that's awesome.
Colleen Cameron
Yeah, definitely.
Jayson Davies
All right, so back on track. When you think about intervention and support, what frame of reference do you utilize?
Colleen Cameron
So I'm very eclectic. I feel like every you know, everything needs to be really individualized for kids. So I pull from a lot of different places. I've think the the biggest advocate in this area has been Tina champagne. She's really been a champion of the cause. So that was originally, what really got me started on defining ot role in the school, was her work, sensory modulation and trauma informed care is She's a real leader in the field the sense, of course, sensory processing and integration. I have strong background in the work of Dr Ayers, but also Dr Kumar did really was a champion in getting OTS involved from a sensory realm as well. Of course, my working at the star Institute for SPD, their frame of reference actually kind of highlights three pieces, sensory regulation and relationships. So that's really what informs my thought process and intervention. I'm also dir floor time certified, and so that whole connection and Intune and CO regulation for these kids, and recognizing that has been a strong influence for me. I've done some coursework, if anyone's interested, the neuro sequential model by Dr Bruce Perry. He's actually come out with an education track, and it's specific for clinicians and school based providers, and that's something you can to do online. That's a really great reference. I've done some of his work, and then Dr Steven Porges, his work with polyvagal theory has really influenced me, and that's thinking about the influence of their physiological state and how that's expressed through some of their behaviors.
Jayson Davies
Great, yeah. And we'll definitely make sure that we get as many references to those on the show notes as well. So be sure to check that up, there's going to be great show notes this episode. So
Colleen Cameron
I love giving people more resources.
Jayson Davies
right? You can never learn enough, and that's why I love doing the podcast, because every time I do a podcast, I get to interview someone, and I learn new stuff. So it's awesome, as do the listeners. So now I know you are keen on tiered tiered interventions, such as like RTI response intervention, and we talked about it a little bit a few minutes ago. So what are some of the tier one strategies that every school based ot can partake in to make a difference for these students?
Colleen Cameron
Yeah, it's really imperative that OTS are supporting students across the tiers with a continuum of service delivery. So with tier one, we're referring to the whole school support, and that's when you can really team with administrators in the school to making sure that they're defining a trauma informed vision for the whole school, having some attention centered on things like self regulation and relationships, social support, helping to promote some of those positive Mental health initiatives, having a focus on all the classrooms, on social, emotional learning, thinking of ways that they can minimize unnecessary triggers in the environment, some of those prevention pieces, but I guess the biggest piece is really collaborating with administrators to help build that feeling like I mentioned, the feeling of cohesion and community for the whole School is essential and really great again for all kids.
Jayson Davies
Absolutely. I mean, sometimes I feel like I can do it all on my own, but I know I can't. And you're right. You absolutely have to collaborate with every single person at the school. I mean, like we even talked about in the cafeteria, even those noon aids or those people need to be involved in this. So yeah, you're spot on collaboration.
Colleen Cameron
Yeah.
Jayson Davies
So are there any specific activities you would recommend to therapists or classroom teachers?
Colleen Cameron
Well, if we're talking about wanting to increase that feeling of safety in the classroom for these kids, consistency and predictability is very important setting aside time for developing relationships or increasing some of their external resources. So I like to give teachers ideas for whole class pieces, some of Dr Bruce Perry pulls out a lot of things that are rhythmic pattern activities that reinforce really repetitive opportunities for self regulation. So. Examples could be like drumming or chanting songs, humming, clapping, hand patterns. So I have some teachers use that for transitions from, you know, snack time to rug time, or how they're getting kids attention and thoughtfully working that into their classroom day. I also like the idea of adding in mindful minutes throughout the day. And if that's something you can do across the board, where administrators are on board like everyone has a mindful minute when they make that really difficult transition right from recess to like a quiet activity, we know it's hard for all kids. Is that something that we can make consistent and predictable for them to be able to develop opportunities, to develop social, emotional competency and some of that positive self concept and increasing some of those internal resources as well.
Jayson Davies
Absolutely. And we actually had an episode about mindfulness. I believe it was episode seven, if anyone hasn't listened to that, but that was a great one on mindfulness, and we did talk about those little things in the classroom that you can do just to keep the kids in the moment. So another area that we often have to look into is when we talk to parents. And obviously, as otschoolhouse combat OTS in particular, we spend a lot of time in IEPs with the parents. And so what are some suggestions or topics or key points that you sometimes have or you find yourself having conversations with with the parents.
Colleen Cameron
Yeah, for so for these kiddos, it's really important to team with the parents about developing healthy life habits and routines at home. Sometimes that can include just education about for these kids, it's really important for them to be having access to consistent nutrition and hydration. So like a protein and water every two hours, or they might not be aware of if these kids are having, you know, meltdowns and they're using up all of their energy and glucose pieces, you can see they might need to be thoughtful about having a snack afterwards. So some of it can be elements like that. Some of the sleep routines for these kids can be really, really challenging. So working with them to develop a healthy sleep routine. Can they think about setting aside time to just, you know, play and develop that feeling of safety and connection at home, getting them some ideas for that. And then, if you're really adventuresome and a go getter, thinking about, can you bring in some family parent nights where the kids are kind of doing an opportunity for shared family activities. So.
Jayson Davies
Yeah, so it sounds like you're a little involved. I know some therapists are. They waver on you know, how much do I talk to the parents? How much do I send home and stuff like that. Are you the type of therapist that would print out a sheet and give it to the parents. Do you have different handouts or something like that that you provide to parents sometimes?
Colleen Cameron
I don't do a lot of handouts. I'm not a handout because I really feel like it needs to be individualized, and so important to be relationally connecting with the parents, because they might have different concerns. I wouldn't say that I'm spending hours upon hours doing this piece, but I am very thoughtful about having parents be part of this, being feeling educated and empowered for these kids, it helps me be more successful. The teachers be more successful with the school. If the kids come with, you know, appropriate nutrition and hydration in the morning and a good night's sleep, it's, it's helpful for all. And so it doesn't have to be something that's super time labor intensive, but a thoughtful, quick phone call or email touch base is really helpful for these families.
Jayson Davies
Yeah, and again, I think that's also very important that we're there for the IEPs too, so we can have that connection with the parents. So all right, so that was tier one. Now let's move on to tier two. What are some different ideas you have for tier two?
Colleen Cameron
So for again, the relationship piece being really critical at that classroom level. We're going back to our mental health training here. How can we give the teachers ideas to build some of those strong relational foundations, welcoming invitations to the kids. As far as, how can they present consistent, proactive pieces. Can they build in a morning meeting in the morning, or a cool, welcoming thing that they do when the kids come in that they're giving them some individualized check in time? I think it's really important to consider teachers own their own stress response and their own sensory profile and making these pieces, because the teachers are coming with their own elements, but really helping to educate the teachers. As far as the relationship being so critical for these kids, and that's how we're kind of rewiring these brain patterns, that feeling of safety, and having them understand that when they feel safe and connected and regulated, that's when they can be open to challenges in the classroom of academics. But really they have to feel that first before they can be open to those academic challenges. So understanding kind of that first then piece is essential.
Jayson Davies
Gotcha. And you know, as tier two, sometimes I will actually kind of go into the classroom, whether it be to do like a handwriting group or something like that. Do you collaborate at the teachers inside the classroom at all?
Colleen Cameron
I do. So I'll go in and we'll kind of model things together about how to implement and add things into the classroom. A lot of times I'll go in and they'll say, this is a difficult time of the day. So I can go in with my ot lens and think like, Okay, well maybe could we modify the task or the environment or the structure of how the classroom is set up in that moment, so giving our specific lens of how to problem solve things with the teachers,
Jayson Davies
great. All right, this is going to be a little bit of a throwback, because I know this is something we talk about in otschool, but it's something that I think might fly over a lot of heads, and that's the therapeutic use of self. And so I wanted to ask if you could explain that one just a little bit more, because I think that therapeutic use of self is important when it comes to mental health. Because yes, there's some things that can be tangible, but there's also some things that are intangible, that are more relationship based versus activity based, and that's where I think the therapeutic use of self comes into place. So would you mind unpacking that a little bit?
Colleen Cameron
sure. So if we're looking for the kids to be able to feel at ease and motivated therapeutic use of self, is really the therapist having a conscious effort to optimize their interactions with the child. So that's being aware of yourself, what you're saying verbally, what were some of your nonverbal experiences, your body language, how you're using your own judgment. So communicating as you respect even by body position. So I've even gone into classrooms and working with assistance saying that they're really not there. The kids are really responding to their interactions with them in a very you know, they're feeling very hostile or defensive pieces. So we've kind of talked about, instead of looming over behind them, could you pull up a chair next to them and kind of be on their level like so sometimes just that simple shift in body position, and then it really then brings it into a collaborative piece, so that we're not having kids, we're not doing things for the kids, we're connecting together, so that we're empowering kids to be able to do for the things for themselves, and they're on the kids are co producer, producers of the support, and not just passive consumers of that support.
Jayson Davies
Yeah, definitely. And I think that kind of leads into the next question I wanted to ask, and that is about the environment. What can we do about the environment that has such a huge effect on our kids?
Colleen Cameron
Yeah, it's funny, because one of my pieces I always talk about it is lighting in the classroom having such a big impact and being the end of the school year, a lot of worked, a lot of my teachers that's going around my school, there's a lot of teachers with lights off around this time of stressful year, and it's and you go in and say, the kids off the wall, they're like, yes, but I also need it. So these are all things that can be helpful for everyone's arousal and regulation. So thinking about other dimmable lights, or, you know, pole lighting. A lot of these classes have been put you know, that big fluorescent lighting in the classroom can be really, really abrasive. So thinking about, can you offer dimmable lights, Altena alternative seating options. Can there be a spot that you can to dedicate in your classroom? A lot of teachers like to do this with, like a reading nook corner, a spot that's kind of dedicated for kids to be able to have a safe place that they can go to to regulate so it's not like a time out spot. It's a really a time in where they're kind of recognizing of themselves. They need a moment to re regulate, and having that being a connected experience that someone's potentially going over with them. So offering things like a bean bag, some scented pieces, some fidgets, some oral motor pieces, I like to use pinwheels in the corners. A lot of times you have kids trying to take deep breaths, and when they're really having a hard time. They're taking really shallow breaths, but it's really the exhale is what activates your parasympathetic nervous system, not the inhale. So you have kids taking deep breaths, and they're doing a lot on the inhale. So building things like a pinwheel or bubbles are things that are focusing on that exhale allows kids to kind of bring their arousal level back down. It's regulating for them.
Jayson Davies
Wow. Okay, so I want to follow up on that. Then I see the same thing with, you know, people developing these different types of nooks or little corners or whatever. How much do you want to have a role in your teachers developing this nook? Are you giving them specific suggestions, or are you just saying, Hey, you should look into having a nook. How involved in that process are you? Or do you like to be?
Colleen Cameron
Yeah, so I've collaborated a lot with my principal on this, as far as having it be an expectation of classroom teachers developing these nooks. But for me, for kind of the generic having a beanbag or a place to be regulate. It's not as much about me having a specific opinion about, you know, this fidget versus that fidget, but the kids being involved and having it be really individualized. Because even, you know, if they have, like, a scented, you know, lotion, per se, some kids could smell that and be really alerted by it. Only come after a thorough assessment in which it was found that sensory processing challenges were specifically evaluated and found to be affecting their participation in the schools.
Jayson Davies
Gotcha. Okay, so you kind of started down this route, but I want to even ask you to go a little bit further with the sensory processing I like what you're saying today, because a lot of it has to do with large group, tier one interventions, but when it really comes down to that, sensory processing, a lot of times, we need to make sure we're doing a very thorough evaluation and that people are trained completely on sensory integration and sensory processing before they really try to do some treatments, because it's not necessarily effective unless you're really doing it the right way and are looking at the right things. And so can you dive a little bit deeper into what you're talking about when you say an evaluation and treatment and sensory processing for these kiddos?
Colleen Cameron
So for an evaluation, you know, here, okay, here comes my big pet. A sensory evaluation is not giving a parent and teacher survey and calling it a day. You know that that's a really important lens that you can have into what their perspectives are, but it really needs to come from your own clinical judgment, seeing them in the classroom setting, as well as having them going and doing a clinical evaluation where you're doing formal and infernal, informal clinical observations, doing some standardized testing pieces, and really making an informed decision. Because some of times, you know, if I'm really talking about a direct model, I take that very seriously and a pull out piece, because we are in that educational setting. So, you know, I get the question like, Oh, these kids have trauma, you know. Now you're going to be doing some pull out models. You know, I'm really very clear as far as not only if I'm finding sensory processing pieces, but it needs to be affecting their participation in the school setting as well,
Jayson Davies
Definitely. So now we are working with these students. What are some potential outcomes of an OT using a trauma informed approach, when working with these students, what are we hoping to have as far as our student participation outcomes?
Colleen Cameron
For really highlighting that person centered, strengths based approach, I'm looking for change across their occupational performance areas in the school environment, but that can look like different things. It can be an increase in their ability to self regulate, in their strategies, an improved ability to problem solve and communicate, that they're better able to advocate for their needs, like they're able to independently recognize that they're having a hard time and choose a calming sensory strategy when they're needing that change for an arousal change overall that we're really looking to bring help bring success for these kids, like you were saying like that, you know that looming feeling of going back to the classroom or looking for them to feel successful in their occupational performance areas and empowered to really build some of that resilience and be engaged in in their school job?
Jayson Davies
Yeah, definitely. And so in preparation for you know, this interview, I definitely went back and looked at your 2018 article on trauma and the role of school based OT. And one of the things that really struck out to me, and of course, you've already talked about it today a little bit, is your emphasis on collaboration. And so I really want to dig into that. And as far as collaboration with other IEP team members, what are different ways that we can we can collaborate? I mean, obviously there's that person to person collaboration, but within the IEP, there's so many different areas that we can collaborate, whether it be goals, treatments. How do you collaborate? I guess I should ask.
Colleen Cameron
So I do it lots of different ways, because individualization is the game for me. So I've done well. First of all, for your question about IEP goals, I will oftentimes do a collaborative goal for these kids. So sometimes that might be with my BCBA around adaptive behavior, or sometimes with my school psychologist around emotional regulation, or the classroom teacher as far as accessing some of their academics. So for me, it needs to be back in in the classroom as far as participation, and it's it's not just one person working in isolation. We need a full team on this. And So collaboration is so key for these kids, because we're all bringing different skill sets to support them in direct service pieces that can sometimes be a co treat with the school psychologist, as we know as OTS. If we have kids coming out that some of these emotional pieces, you get a breadth of them, kind of sharing what they're nervous about or how they're feeling, and it's a really exciting piece of connection, of CO regulation and opportunity to really help kids recognize and name their own emotions and be able to feel empowered to make a plan.
Jayson Davies
Gotcha. Okay, one question that I sometimes get, whether it be on Instagram or an email, is that OTS are coming, are having struggles, I guess you could say, with those collaborative goals, creating collaborative goals with teachers, you know, they're getting a little pushback for. A teacher, a counselor or something. How have you found the way to break down those walls into help teachers understand that collaborative goals can be not only appropriate, but sustained and high quality?
Colleen Cameron
So I actually do use goal attainment scaling for all of my goals across the board, and so that I am going, you know, was before with the IEP meeting, I sit down with the teacher and we talk about what their concerns are in the classroom again, bringing it back to participation challenges. And that's what we highlight, really in on our objectives of whatever we're working on, is, how does it? Bring it back to the classroom so they feel a part of what the goal says. First of all, we're not implementing that. And then the other piece is really data collection. It comes down to them, you know, because a lot of my data collection is about how they're participating in the classroom, so you need to be thoughtfully making it obtainable for the teacher to be collecting data on that goal. And that's something that's weighing them down with a lot of time pieces.
Jayson Davies
Okay, I want to, I don't want to go too far into this, because I do plan on having a whole other podcast on goal attainment scales. But would you mind explaining it just a little bit for people who may not be familiar with it?
Colleen Cameron
Sure, So goal attainment scaling was originally in the mental health world when they were trying to find a way to make things that were a little bit harder to make measurable measurable. And so it's built along a zero a negative two, rather to positive two scale. Different people kind of define it different ways. But so negative two is really what the kid is presenting, whether their performance, their baseline, at baseline, yep. And then your zero mark is going to be what your objective says in your IEP, and what you're filling in for those other pieces is negative. One is slightly less than expected. Plus one and plus two, obviously are more than expected, but we're really only changing one factor across the board, so that could be their number of times that they're doing an amount of support that they're needing for it, but we're only changing one thing, and it's really very helpful for as far as progress reports, to make things measurable that are a little tricky to measure.
Jayson Davies
Gotcha, absolutely, I can't. I really want to learn more about the goal attainment scaling, because I think it's something that helps us, not only help the kids, but also to really understand if what we're doing is actually effective or not, because you do have those different levels of attain, of attainment. So, yeah, all right. Another question that's very popular is the sensory versus behavior question, you know, is it sensory? Is it behavior? But no one's ever asked, as far as I know, you know, is it trauma? And that's something a little bit from a different lens. And so what do you make of different behaviors exhibited by children dealing with trauma.
Colleen Cameron
So the big question that the trauma sensitive community looks toward is moving from what's wrong with you to what's happened to you. So it's like you were saying, kind of digging a little bit deeper into the reasons behind what's going on, trying to find a way to better understand the motive behind the behavior. So the behaviors, oftentimes that we're seeing with this population is really their attempt at Adaptive coping responses. They're physiologically based. Their nervous system has been triggered to protect them. They could be shifting into fight or flight. And what we want to think about, and I work a lot with my BCBA on this, is understanding the individual differences, so we're not looking at just the what has happened is what has happened the antecedent piece and the behavior, but we're considering the individual difference of what that child is bringing to the table, how that when it flows through the child before the behavior, what are some things that are different? So that could include sensory but include so much more that we need to consider. So then, when we're talking about like a behavior plan, we're offering redos, we're communicating the child's worthiness and not shame, and we're not focusing on decreasing behaviors, but increasing their capacity and competence. And polyvagal theory has a real focus on this, as far as we're using that social engagement system and the relationships really, to get there. Gotcha. Okay, you've mentioned BCBA or ABA a few times now, and I know that that is a topic. It's not a bad topic or anything, but it's something that OTS sometimes struggle to really work together with an ABA in schools. I've heard of it. I have had good experiences, but I know other OTS have have struggled to incorporate that collaboration. So could you dive into a little bit what that might look like when you're collaborating with the BCBA? Absolutely. I just actually submitted an article with my BCB and interprofessional collaboration perfect, and it's a really important topic for me, because I think that there's a lot of misunderstanding. I happen to work with a phenomenal BCBA, so that really helps, that she's really open, but we've learned each other's language, and we've learned to kind of recognize that a lot of the things that she might be working on, I might be seeing when just kind of calling it a different piece, but part of that can be for these kids. In particular, recognizing, you know, a big thing in the community of of trauma is that they don't like those clip up charts, right? That are really powerful, you know, popular as far as kids getting clipped up or clipped down. So the concept with this would be a kid, you know, you could have them being clipped up for proactive, pro, social, rather, behaviors in the classroom, but there's no, you know, kind of clipping down pieces. So for me, that collaboration is really centered around proactive strategies that we can put in place for these kids, as opposed to being reactive. And that's very much what from a behavioral lens, what they're looking for. And if you're working with a really skilled BCBA, they're not just looking to decrease the behaviors. They're also looking at, you know, those the skill piece, as far as increasing their competency as well.
Jayson Davies
And in your previous response, you mentioned ABC data, antecedent, behavior, consequence, but then you also kind of tied in something that I never heard before. Was individual personalities or individual Sorry, what was the difference? Differences?
Colleen Cameron
Differences, yeah.
Jayson Davies
So it's almost like aibc or something, if you want to call it that. But I want you to dive into a little bit deeper. How you in that BCBA, then, how does that collaboration work? Or how do you help to identify those individual differences for the student?
Colleen Cameron
Yeah. So I think that when they're doing their functional behavior analysis, oftentimes they're the first ones on on the ground that's been called in, right? Because these kids are having behavior challenges, and so we have a really close collaboration. So she's seeing pieces where she's, you know, this isn't just that they're trying to, you know, avoid this task because it's too hard. But I am seeing them have big responses to things that I wouldn't necessarily consider, or I'm feeling like they're when they do their FBA, there is that sensory category, which is that internally motivated category, and she's seeing a lot of facets like that. We've talked about that if she's seeing kind of some of those highlighted pieces, that that's an important piece for her to come to me, and we're looking to dig a little bit deeper on so a lot of times, even for these kids, if we're doing an initial evaluation, it's the BCBA looking from a behavior lens me looking for my ot lens. And the school psychologist is really delving into what some mental health contributions to this. So you're really getting, you know, looking at differential diagnosis very systematically.
Jayson Davies
Wow. And that really sounds like you guys have a good team that works together and stuff, because that's hard to find a really good team that everyone's kind of using this lens and can Yeah, knows each other's roles well enough to know, hey, I see this area, I need to go to the psychologist. I see this area, I need to go to the OT or the BCBA. So that's fantastic,
Colleen Cameron
yeah, and being comfortable with that overlap and not getting defensive to really have to, you know, put up your walls, because we, you know, if you really have a great understanding of that distinct value and role and being able to articulate that piece, but you're also being open and respectful to other people's lenses that helps to kind of bridge that gap. Yeah, you did mention on the FBA that the BCA, the BCBA, you kind of mentioned how they said they'll see something sensory, but it's called something else. So it's actually called sensory in their categories. But really what it means is not that they're seeing a sensory processing deficit or integration deficit. What they're seeing is that it's internally motivated versus an avoidance or escapement, so that there it's something internal that's motivating the behavior. And so that's when you really need to be thinking about digging deeper. Because they're not making a determination of what that is. They're just kind of like, oh, well, it's not avoidance of the task. It's not, you know, that they're trying to get someone's attention. And so that's where we can really collaborate to give them some more in depth knowledge as far as what's going on internally for that child, those individual differences?
Jayson Davies
Wow, that's the first time I've heard that explained. So thank you. I appreciate that. All right, well, we're coming up on our on our hour, so let's wrap this up. But first I want to give you the opportunity to kind of share with people, if they're interested in learning more about your work, about trauma, informed care, what are some you've said so many resources, but are there any other ones? Or if you wanted to kind of wrap it up and summarize everything, where are some different resources?
Colleen Cameron
So I think that I've tried to make it available for people to be able to read my article that don't necessarily have a subscription piece, but I am allowed to put it on a personal website. It's kind of the pre published version. So that would be my first thing is on my personal web page, which is spark sensoryclinic.weebly.com, if you go into the Resources tab, I actually have the PDF for my article, so that's a really great way to delve a little bit deeper into some of this tier three intervention. I'm also traveling around the country and actually doing some international teaching for that school based intensive for Star Institute. And I've really incorporated my trauma informed approach into that training. So that's another great place to delve more into. That's www dot SPD, star.org and if you go under education, you can see those courseworks. And I also have some new publications in the works. So keep up. Keep an eye out for those. Definitely and is the best place to reach you through your personal Weebly spark Clinic website? Yes.
Jayson Davies
Perfect.
Colleen Cameron
There's a connection to my my email, and I'd be happy to hear from people
Jayson Davies
Great. Sounds good, Well, Colleen, thank you so much for joining us on the on the podcast today. I feel like this was very informative, and I can't wait to share this with everyone. So I appreciate having you on and best of luck in all your new publications going forward.
Colleen Cameron
Great. Thanks so much.
Jayson Davies
Thank you. Take care.
Colleen Cameron
You too.
Jayson Davies
All right, everyone. Well, I hope you enjoyed that very thorough interview with Colleen Cameron Whiting. I know we got a little bit off topic there at the end, but I think it was just so fascinating. So I left it in. And I hope you did enjoy hearing a little bit about how she collaborates with a B CBA or ABA therapist. It's very cool that they're working together to get some stuff done. If you did enjoy this episode and would like to earn your professional development for doing so, be sure to head on over to the show notes at otschoolhouse com, forward slash episode 35 or to otschoolhouse com, forward slash PD, as in professional development there, you'll be able to purchase the professional development course that goes along with this, and basically you already listened to the podcast, so all you'll have to do is complete the 10 question quiz, and I will then send you a certificate of completion for one hour of continuing education for your NBC OT and or state license. Be sure to make sure that your state recognizes online, independent based learning before submitting it to them. Most states do, but there are a few that don't so check into that. Otherwise. I hope you enjoyed this podcast. Can't wait to see you guys next time in Episode 36 until then, take care.
Amazing Narrator
Thank you for listening to the otschoolhouse com podcast. Now that you've listened to this episode, head on over to otschoolhouse com, forward slash PV, as in professional development to earn your continuing education certificate, until next time, class is dismissed.
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