OTS 38: Creating a Referral Process & School-Based Occupational Therapy Manual
- Jayson Davies
- Sep 9, 2019
- 41 min read
Updated: May 13
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Welcome to the show notes for Episode 38 of the OT Schoolhouse Podcast.
In this episode, Jayson interviews Danielle Delorenzo OTR/L, My Bui OTR/L, and soon-to-be OTR/Ls Michelle Vuong, Mary Nguyen, & Rivka (Students in the Stanbridge University Master's of Science in Occupational Therapy Program at the time of the recording).
This fantastic group of OTs and OT students shares how they developed an evidence-based referral process and occupational therapy manual. This group has spent over a year together working on this manual for a school district in Southern California and recently presented their manual in a presentation at the Western Regional Occupational Therapy Symposium in San Diego. With any luck, they may also be presenting at #AOTA2019 in Boston, Ma.
This podcast qualifies as a Professional Development Podcast and you can earn 1 online contact hour when you listen and take the online quiz. Learn more here!
Interested in learning more about the special guests in this episode, simply scroll down (May not be visible on a mobile device).
Objectives for this Professional Development Podcast
Listeners will:
1. Identify and understand the need for an educational occupational therapy manual within a school setting and how to develop/ modify/ implement an educational occupational therapy manual within a school district
2. Demonstrate the ability to identify how an occupational therapist can assist teachers in general education through the use of RtI (Response to Intervention) via collaboration and consultation
3. Educate and empower all teachers and district staff on how an occupational therapist can provide strategies to support all student's foundational fine motor and sensory processing skills necessary for optimal engagement in academic tasks.
Links to Show References:
Download the 40+ slides that go along with this Podcast presentation including the references.
Follow along as you listen, or review at home afterward!
Also, Download the 3 referral processes discussed in the show here
Special Education Referral
General Education Referral
Parent Concerns/Referral
Follow Danielle and My Bui on Instagram at @Mornings.With.An.OT.Mom & @ElevatedStateOfPlay
Email Danielle and My at MorningswithanOTmom@gmail.com
Danielle Delorenzo, OTR/L is the creator of Mornings with an OT Mom, a multimedia experience about understanding the science behind play and everyday activities and their connection to overall development, emotional regularity, and academic achievement. Danielle is also the Co-Creator of Mindfulness in Motion. Together, with her work wife/business partner My Bui - Elevated State of Play, they are shifting the mindset of the masses by spreading the knowledge about how integrating movement and mindfulness can help to increase academic performance, life-productivity, and emotional regularity across a lifespan.
Danielle is currently enrolled at the University of St. Augustine’s pursuing her post-professional doctorate degree in Occupational Therapy. She has a Master's of Science in Occupational Therapy, and postgraduate studies in Infant Mental Health. She is a full-time lead educational occupational therapist and previously was an adjunct professor/thesis advisor for the MSOT program at Stanbridge University. She has 20 years of experience in Special Education. It is her dream to empower all individuals with the tools necessary to facilitate independence, maximize educational potential, foster positive overall development, and support optimal emotional regularity necessary to navigate through life and be as successful as they can!
My Bui, OTR/L received her Masters of Science in Occupational Therapy and has been a school-based practitioner for the past four years with an extensive background in neuro-rehabilitation. In addition to co-creating Mindfulness in Motion, she has also been the project manager of designing several therapy rooms and classrooms with a focus on prevention and remediation to increase independence and overall wellness through a multi-sensory approach.
My just completed her biggest and most recent project, in a collaborative effort with her coworkers, to develop the OT policies and procedures for the district. Her professional goal is to promote a holistic approach in expanding OT in schools district-wide through advocacy, education, and empowerment.
Michelle Vuong has a Bachelor of Science in Kinesiology from California State University, Fullerton, and is currently pursuing her Master’s of Science in Occupational Therapy at Stanbridge University. She is part of a school-based occupational therapy resource manual thesis project at Stanbridge University.
She has internship experience at an outpatient pediatric clinic as well as fieldwork experiences at an adult’s outpatient hand therapy clinic, senior living center, and development center for typically and atypically developing children.
After finishing the graduate program, she wants to work in inpatient care with ages across the lifespan and gain as much knowledge and skills as possible before specializing in one practice area. She also wants to receive specialty certifications in Physical Rehabilitation and Feeding, Eating and Swallowing. She is passionate about constantly learning the best practices to help clients with meaningful occupational engagement!
Mary Nguyen has a Bachelor of Science in Human Services from California State University, Fullerton, and is currently pursuing her Master’s of Science in Occupational Therapy at Stanbridge University.
She has experience working with people of all ages in a variety of roles such as youth ministry leader, after-school program instructor, student outreach university intern, private tutor, Karate For All volunteer, and ABA therapist. Her fieldwork experiences include a special education school, senior living facilities, and memory care centers.
She is passionate about working with kids and hopes to work in pediatrics in a school or outpatient setting after finishing graduate school. She is excited to start a career in such a dynamic and diverse field that promotes independence and engagement in meaningful occupations.
Rivka Negin Rahmani has completed a Bachelor’s of Science in Kinesiology from California State University, Northridge, and is currently pursuing her Master’s of Science in Occupational Therapy at Stanbridge University.
Rivka has had extensive experience working with children of all abilities. She has completed fieldwork experiences in an outpatient pediatric clinic, an acute rehab unit, and recuperative care facility for homeless patients.
Rivka’s favorite occupations are baking, dancing, and spending quality time with her family, friends, and pet cockatiel. She is eager to continue working in pediatrics after she finishes graduate school. She is passionate about Occupational Therapy, promoting occupational justice, and advancing the knowledge and awareness of our profession.
Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.
Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com
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Episode Transcript
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Amazing Narrator
Hello and welcome to the OT schoolhouse podcast, your source for 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 number 38 of the OT school house podcast. For those of you who this is your first episode ever listening to. My name is Jayson Davies and I am a school based occupational therapist here in Southern California, a little bit outside of Los Angeles. First of all, I just want to say thank you so much to everyone who came to Fresno. Actually, it's technically Clovis, but anyways, up in the Central Valley of California, you came to the OT Occupational Therapy Association of California, school based symposium for Friday and Saturday. I just got home fairly recently, but it was a blast. We had some wine. Some of you guys, I gave out some stickers too. I hope you're enjoying those. But we just had a great time learning more about school based OTs. So thank you for showing up. It was a pleasure meeting all of you. I'm just so glad that we were able to get 100 people and relatively short notice, and had a great time and learned a lot. So thank you so much. On today's episode, we actually have our first repeat guest, and that is Danielle de Lorenzo. She was on back in episode 28 I believe it was to talk a little bit about independent evaluations, also known as iees. But today she's back with some friends and some colleagues of hers to talk about how to develop a referral process and school based occupational therapy manual for a district. So she's here with her colleague from her district. She'll get into that in just a moment. But she's also here with three of her occupational therapy students that were actually doing this as a project. So I'm going to let them introduce themselves in just a moment for you. But I do want to let you all know that first, this is a professional development podcast, and I'm actually going to give this one out completely for free for the next two weeks, just so you all can get a taste of what it's like when you go to OT schoolhouse.com. Forward slash episode 38 you'll see a few places where you can say, get this podcast for free, or get this podcast professional development. Now, it only be up for free for the next two weeks. After that, there will be a price, but you can get it now. Check it out. See what it's like. You're going to get access to a few documents provided by Danielle and the crew, and that will be actually the slides for this show. Those you can get for free without purchasing, but just so you know, this is what you will get, the slides for the show, as well as some of the handouts that they reference to in the show. And you also get the professional development document that has a link to the quiz. And when you go ahead and click on that link, you'll take a short quiz. It's about 10 questions, and you will then earn a certificate of completion, which I will send to you in an email. So it's pretty simple. That's how it works. And you know, I just want to say, before we get started here, that Danielle and the crew, just like I am, were based in Southern California. So you're going to hear some California references, but that doesn't take away from the overall message. The last thing I want to point out before we get started is that this episode is going to be a little bit different. You're not going to hear my voice as much. It's almost going to be like they're presenting at a conference for the most part. I'll chime in a few times, but really, you're going to hear them as though they're presenting. In fact, they did present this not too long ago at the OTEC symposium a few months back. So without further ado, I'm gonna let them get into it. You'll hear me occasionally, but let me know what you think about this type of episode. I'd love to hear some feedback in an email or something, or even in the comments on Apple podcast or wherever you listen. That'd be great. So let's jump into it. Here is Danielle de Lorenzo and the thesis group that she's been working with for the past year or so. Hello, ladies, welcome to the show. How are you all doing today? I guess we'll start off with Mary. How are you doing today?
Mary Nguyen
Hi, I'm doing good. I'm Mary. I'm one of Danielle's graduate students from stanbridge University, and I'm really glad to be here.
Jayson Davies
Great. And then we also have joining us today is My. How are you today My?
My Bui
I'm doing great. It is E, S, Y, and much more chilled in the regular school year.
Jayson Davies
Yeah, extend to school year. Woo, woo. I got to go back to that on tomorrow. I think so. We also have Michelle joining us today. How are you Michelle?
Michelle Vuong
I'm doing well. Thank you for having us. Also another student from Stanford University and really excited for today's podcast.
Jayson Davies
Great. And the last student we have joining us today is Rivka.
Rivka Negin Rahmani
Hello. Thank you for having us. Jayson, we're really excited to be here.
Jayson Davies
Yes, thank you for joining us. And then I'm going to now pass it off to our final guest today, and that is Danielle Delorenzo, you might remember her from a few episodes ago. So how are you doing today Danielle?
Danielle Delorenzo
I am doing great now that tomorrow is my last day of work and I'm here with all you guys.
Jayson Davies
Yes. So what are we here to talk about today?
Danielle Delorenzo
So today we are going to talk about the educational occupational therapy manual, a district wide resource that we all created over the past year and presented that with OT. So what we're going to do is we're just going to kind of go into some brief introductions about ourselves and what the purpose of the project is, and we hope that all our fellow school based girls will really like our presentation, and it can help them within their setting.
Jayson Davies
Awesome. Sounds fun. Let's do it.
Danielle Delorenzo
Alright, so my name is Danielle Delorenzo. I've been in special education for about 20 years now, in a variety of roles. I've been in OT for about nine years, specifically in the school systems for the last five or so years. I'm currently a thesis advisor for stanbridge university within their MS ot program. I'm about halfway through my doctorate program at the University of St Augustine for my OTD with a focus on pediatrics, education movement and mindfulness. I'm the Lead ot at Rialto unified, and I'm the creator of mornings with an OT mom, which is an educational website focusing on the connection between fine, gross, motor, sensory play, mindfulness, and how it correlates to academic performance. I am going to introduce my fabulous work wife slash co worker, Mimi.
My Bui
Hi, guys. I am Mimi. I am working in Rialto unified, and I've been an OT for four years working primarily in special education. I've been focusing a lot of my current practice on flexible seating and building movement spaces, due to the current problem that as OTs see every day, which is the current lack of movement opportunities that our students are provided with when there is a lot of research correlating on how movement can promote academic success, I am in the process of building a platform that would integrate research and practical activities that can improve proficiency and effectiveness of learning for children.
Danielle Delorenzo
So we have our three fabulous graduate students that have worked so hard, and we are also proud of them, and I would like to give them a couple minutes to just introduce themselves again. So go ahead, ladies, introduce yourselves before we move on.
Jayson Davies
Go ahead. We'll start with Mary.
Mary Nguyen
Like I said before, my name is Mary. I am a student at stanbridge University. My interest is in pediatrics, and I had an opportunity to work with Danielle and Mimi at Rialto for my field work, and I just absolutely loved it. So I look forward to potentially working in the school base when I graduate.
Jayson Davies
And what about Michelle?
Michelle Vuong
Oh, hi. So as mentioned before, my name is Michelle, so I had originally started going into the OT program because my passion was in pediatrics, namely outpatient pediatrics, and so seeing the school based ot really changed my perspective. And I'm not too sure what I'm going to pursue in the future for specialty, but I know that whatever Danielle and Mimi have taught us throughout this term, it can translate very well into many settings, so it's been very valuable for me.
Jayson Davies
Great. And lastly, we have Rivka.
Rivka Negin Rahmani
Hi there. I'm Rivka. I'm also a Stanford student. I'm really excited to have worked on this project with these fabulous ladies. We put a lot of heart and soul into it. I love pediatrics, and Danielle and Mimi have shown me that school based is a lot of fun, and it has its ups and downs, but a lot more ups and downs, and I'm really excited to see where I go next.
Jayson Davies
Great.
Danielle Delorenzo
So you know, this presentation represents the journey we have been on the past year, trying to ensure best evidence based practice was being implemented via ot within an educational setting. Please be mindful that this presentation is about our journey with our school district on creating policies, procedures and resources that would be the just right fit for Rialto. This is meant to be a guide in how you can begin to develop your own policies and procedures or advocate for all things ot at your own setting.
Jayson Davies
Great and real quick. Actually, we are going to have the slides up for this presentation, and that will be at ot schoolhouse.com, forward slash episode 38 so be sure to head on over there if you would like to see the slides. And you'll be able to get those completely free, so check that out, and let's go over some of the learning objectives.
My Bui
So at the end of this presentation, we want our listeners to be able to identify and understand the need for an educational occupational therapy manual within a school setting and how to develop, modify and implement it. We want to be. Able to demonstrate the ability to identify how an OT can assist teachers in the general education through the use of RTI, via collaboration and consultation. We also want to educate and empower all teachers and district staff through trainings, collaboration and consultation on how an OT can provide strategies to support students foundational skills necessary for engagement and academic tasks. We have found that the best way that OTs can make a bigger impact is through the power of collaboration and education. And through this approach, we can empower our teachers and district staff to incorporate ot components in their vocab and, more importantly, their classrooms. We want to give you an idea of how large Rialto is. Our district has over 2700 district employees and is considered the largest employer in the city of Rialto. And within our district there is 25,000 students. And our district consists of five high schools, five middle schools, 19 elementary schools and 20 preschools in the cities encompassing the Inland Empire. So within all of this number, only 20.1% of our students are proficient in math, and only 33.1% is proficient in reading, which ultimately affects handwriting. So looking at these numbers and considering that there are only three OTs in our district, which is Danielle me and our other co worker, Robbie, our goal was to make an impact that is bigger than just our assessment and our treatment caseload. So of those numbers, 3000 students are in special education, and only one to 2% are exited from special education. We have to remember that special education is not a place, but it's a service. So we ask ourselves, How can we OTs make a bigger impact to fit the needs of our student and our culture?
Mary Nguyen
So I'll be going over some of the things that we found in our literature review, we mainly wanted to focus our literature review on two themes, handwriting within the Common Core standards, and RTI, as we initially wanted to focus on handwriting, since OTs get such high referral rates specific to handwriting, we have since narrowed our focus of the manual to be about RTI, although parts of the manual address handwriting concerns, the next couple slides contain our compiled literature review on both of these themes and how to incorporate the Common Core writing standards into the manual. So an average caseload for a school based occupational therapist can be between 40 to 45 students at times, an occupational therapist caseload can reach over 100 students annually. Additionally, occupational therapists have to complete initial and triennial assessments, which can take anywhere from five to 15 hours per assessment to complete. We have a study from Holt singer and height in 2005 where they conducted a survey on over 500 school based OTs, the results showed that one out of 13 therapists were affected by excessively high caseloads. There are no specific guidelines as to how many students will be assigned to one therapist caseload, and it may increase assessment and referral rates when there's such a high referral rate and not a high recommendation of occupational therapy services, this significantly takes up time that could have been utilized to provide teachers with RTI supports and strategies. The majority of teacher referrals are being made for handwriting remediation, but teachers are referring for initial occupational therapy assessments without providing RTI strategies. First, some examples of RTI interventions for handwriting challenges could be changing up the type of pencil the student is starting with providing adaptive paper to guide the student when writing and supplemental handwriting programs like Handwriting Without Tears, part of the role of OTs in a school setting includes teacher education on RTI interventions. Most teachers are not trained on the scope of occupational therapy practice or how an occupational therapist can provide support in an educational setting. Teachers have little collaboration with the occupational therapist on tools and tricks to help students gain access in their handwriting skills or any other problem areas, this may be due, all in part, to pull out method of OT services, rather than the push and model where the OT works with the student in their own classroom in 2006 bionna et al stated that teachers were dissatisfied with respect to frequency of contact with The therapist, stating that there was insufficient time for collaboration and inadequate follow up by the therapist. This presents a need for increased time for the therapist and teacher to meet and consult on the students progress and exchange information. Lastly, we see that handwriting legibility is an expected skill for students to develop by the second grade. As stated in California's Common Core however, when we were looking over the common core standards, there's absolutely nothing to guide instructors to achieve these skills. Teachers have no guidelines placing a specific set of time in the curriculum for handwriting practice, and instead, students are expected to produce their own handwriting skills through other courses.
Michelle Vuong
So thank you, Mary for giving us an explanation of the overview of the problem. I'm going to now dive into the first theme, which is handwriting within the Common Core. So what we found is that decreased handwriting instruction time and lack of specifications under the common core curriculum were huge flaws that ultimately impacted writing, handwriting skills, the more technical side of handwriting problems were mostly related to students having illegible handwriting, inappropriate spacing, inappropriate sizing and placement and also having an awkward pencil grip. Teachers reported that due to emphasis placed on other academic areas, such as math and language arts, there was a lack of instruction time to develop these handwriting skills. Teachers also defined that the common core curriculum was seen as cookie cutter and it failed to acknowledge each child's different individual developmental needs. When doing our literature review on RTI strategies that address handwriting problem areas, several studies have reported that supplemental handwriting practice in addition to regular curriculum, have significantly improved the different areas of handwriting. So one specific study, Hoya et al, looked at the different interventions that targeted handwriting difficulties, and what they found was that handwriting practice, remediation and homework were key to improving handwriting skills. They also emphasized that handwriting practice should occur about twice a week, anywhere from 20 to 30 minutes in order to be effective. Furthermore, another study by Peterson and Nelson looked at first graders who received additional handwriting interventions twice a week for 30 minutes, and it showed a huge improvement in spacing, sizing and placement of letters. There also needs to be a strategy in place for a carryover effect in the students handwriting skills. Since students are not receiving handwriting practice through the common core curriculum, the need for additional handwriting practice can help to generalize this skill for students to apply to other subject areas in their curriculum. It is important to note that many teachers and other district staff may think that occupational therapists teach handwriting, and we know that we do not teach handwriting, therefore it is important to educate our teachers with the knowledge that occupational therapists support the foundational skills necessary to support efficient handwriting skills, and that is where RTI comes in. So moving along according to the OT and PPT guidelines, RTI is where OTs make suggestions to the teacher regarding the handwriting curriculum and strategies for fine motor and visual motor development, ideally, what we want is for all students have access to tier one, Universal Supports, and we do this by providing high quality research based intervention strategies. We want to prevent the need for any additional or restrictive services.
Jayson Davies
Real quick, Michelle, you actually referenced the OT PT guidelines. Is that? Where do you find the OT PT guidelines? Is that state specific, or is that a national ot PT guidelines? Or Where were those from?
Michelle Vuong
We can actually pull that off of, like, if you look it up on Google Online, you could totally pull up, like, a PDF version of it.
Jayson Davies
And it is the California ones that you guys reference to correct, yes, yes, that's what I thought. All right, go ahead. Continue.
Michelle Vuong
Okay. So ideally we want to have all of our students, like I said, have access to tier one universal supports. And I was just going to mention Colette et al in 2017 which is a study that identified a gap in RTI strategies being available, and teachers education on when and how to implement them. So another study, Cahill et al, found that teachers would benefit more specific from specific guidelines outlining RTI strategies as they are able to provide their students with the consultation of OT so our manual will give teachers intervention tools and strategies to implement on their own and in the hopes that these strategies are effective before referring their students to OT services. This follows the model of RTI, as I mentioned previously, for children who are possibly at risk for falling behind in their performance in the classroom. In giving teachers a manual that contains a process for making appropriate referrals, we hope that teachers will increase their use of RTI strategies, and I will now pass it off to Rivka, who will discuss our second theme.
Rivka Negin Rahmani
Thank you, Michelle. So as we know, fine motor and handwriting skills are the most common. On reasons for school based ot referrals and visual motor integration is a strong predictor of handwriting legibility and related academic performance. We found a study that discusses the effectiveness of RTI to improve those areas which may help reduce these referrals. A study by ot al showed that OTs led 30 minute lessons in collaboration with teachers for 10 consecutive weeks in the 30 minute lesson collaborations, the OTs provided the teachers with ways to model gross and fine motor skills to students, and gave the teachers visual aids to use. The teachers worked on skills such as how to hold a pencil, cut with scissors, draw a person and put on a coat with the students. The students were given time to practice what they learned, which then helped with the carry over of learning. There were two main things that we found to be extremely relevant to our project. First, the intervention group demonstrated significant improvements on the VMI and bought two average scores. Second, the therapist teacher at logs indicated that an OT provided an average of six to 33 minutes per week of consultation with the teachers. These implied that we realized that OTs play a huge role in tier one RTI strategies, and we can help consult with teachers these short term interventions can have a significant effect on fine motor and visual motor integrations or handwriting readiness. The study also validates the efficacy of collaboration between the OTs and teachers by providing the teachers with the right skills and tools they can use it with or without an OT present in the future. Another study by zultra and Pfeiffer in 2016 looked at the use of a handwriting intervention called Size Matters handwriting program, and found that 30 sessions completed twice a week over 16 week period demonstrated an increase in handwriting legibility. There's been this constant discussion between push in and pull out services. Ideally, OTs want to push in because we want to create the least restrictive environment and increase transfer of learning skills. Also decreased disruption to the child so they can remain their classroom and maximize their academic performance. This study ultimately showed that with push in services, the OT works with the child in their gen ed or special ed classroom, and is effective in improving their handwriting legibility. After conducting our literature review, we believe that taking the time to implement a handwriting practice program within the classroom through collaboration within ot can then increase handwriting skills and increase a transfer of learning to support students at all academic needs. And now I'm going to pass it on to Danielle.
Danielle Delorenzo
Okay, so now that we've talked a little bit about the literature and how originally, we wanted to start out with a handwriting program, and then we realized that, you know, in addition to handwriting, sensory processing, fine motor skills. So many other things can go into supporting a student's academic success through the use of RTI, and empowering our teachers to be able to have these strategies at hand to help really educate who we are, what we do, and what our role is within an educational setting. So hence the development of the educational occupational therapy manual, our district wide resource. We wanted to create a document that was esthetically pleasing and user friendly. We did not just want to hand a teacher another document and say, read this and never come back again. There are so many individuals that can sit in on IEPs when ot questions come up. Therefore, it was imperative to develop a district wide resource that was accessible to all to ensure accurate information be expressed district wide. Knowledge is power in an IEP, you must know the laws about all the related services, and you must have a foundational understanding of special education, the IEP process and how ot fits into it all. Moreover, through RTI, we can empower teachers and district staff with ot tools to add to their teaching tool bag to help not just students on ot caseload, but all students district wide. And through this process, we hypothesized that there would be an increase in appropriateness of OT referrals more teacher utilizing RTI within the classroom, and less students needing related special education services across a lifespan, specifically in the area of occupational therapy. You know, from July 1, 2018 which seems so long ago, that was the day that Rialto took back their ot services as a district so now district would be providing service up until around November, we were working so hard, collaborating with local districts, therapists, psychologists, SLPs, orthopedic impairment specialists, literally anyone that we can think of to try and incorporate strategies and suggestions that would be beneficial for. All students. We then presented to 30 speech pathologists, two psychologists and autism specialists, and all our graduate students were present. And it was amazing. Our presentation was very well received, and it was very empowering to the speech pathologists, which led to their own questioning as to what they can do as a profession in regards to also implementing RTI intervention within a school setting. Already, the empowering began, you know, and then after we presented to speech pathologists, we met with our director, and we had to make some revisions. Like everything is all about revisions. Don't ever think the first thing you created will ever be the thing that you end up with, trust me, ours project has evolved so greatly from the beginning, it's amazing. So through this journey, we then collaborated with ASHA Asher. And if you guys do not know who she is, she is brilliant. She is a school based guru with over 40 years of experience. You should look her up. You should read her articles. They are amazing, and so is she. We asked our director to have coffee with us one night after school, and She sure did. So it was myself and Mimi Asha and our director shout out to Olive market and Redlands for staying open late that night so we can all talk, all things. OT Asha was amazed that our director had came out to really listen and hear what we had to say. And you know, our director truly is a visionary that believes in inclusive practices and a push in model for services. And most importantly, she believes in us and tries to let us execute our vision as best as we can. So after we all collaborated, you know, we went back to revise and make our final edits before presenting at ot in March. And what we realized is that sometimes when a district is transitioning into a different type of support system and other policies and procedures, the transition can be a little rocky. It is imperative to maintain a collaborative relationship with teachers and other district staff to ensure smoothness during the transition period. In order to support staff and student needs, we are learning that when trying to implement change at a district level, you have to be like the tortoise and not the hare, because there are so many contributing factors that are outside of our control that can have impact on our own policies and procedures within our educational therapy program, such as funding, staffing, support, etc. So the components of the manual consist of the contributions, everybody who helped along the way, our purpose, mission statement, goals, what ot looks like in California, the big educational versus medical ot that I know all of you can relate to, the guidelines to determine the need for an OT referral, policies and procedures, The OT educational relevant concerns document, our referral form and our teacher resource. So much love to these amazing people. The collaboration for this project was amazing and such a great learning experience. It truly takes a village of innovative individuals to see the bigger picture, and most importantly, how each piece fits in the grand scheme of the whole child's education. Rivka, during our research, stumbled upon a copy of the 2015 Fresno ot handbook, and it reflected the policies and procedures that we were trying to implement here at Rialto. So I reached out to Michael Fletch, who was Fletcher, who was the program manager for Fresno, and he was more than thrilled to collaborate with us share his documents that he had. And then we got excited, because we just sent him our final edits to our manual. So we have been doing this back and forth, ongoing collaboration with so many people all across the country with one common goal and in mind, to collaborate, empower and educate. So it's really been quite a beautiful experience to see how many people really came into making this document and how it's evolved since then.
Jayson Davies
Yeah, real quick. So everyone can can know, obviously not, not everyone can see the slideshow right now, but she has people on here from Rialto. She also has all the names of the stanbridge students here, everyone that you're hearing from, as well as other occupational therapists from Fresno. And just Danielle reached out to so many people and the students did to make this project happen. And so if you'd like to see a full list of everyone that contributed to this project, be sure to get the show notes or the slides from the show notes, and we'll have those up for you.
Danielle Delorenzo
Yeah, like I said, we never would have been able to do this without collaborating with everybody to make this document happen. You know. So I think the purpose for us was to create a district wide resource on all things occupational therapy. You see a reoccurring theme with this. It's to educate, empower and communicate. Our mission statement is to provide and implement policies and procedures that will meet the occupational therapy needs of students in a uniform and consistent manner through the Rialto Unified School District in compliance with federal regulations, state laws and professional standards of practice. You know, we have very specific goals in mind that we wanted to execute through this document. We wanted to adopt the ecological model of student performance in the person environment, occupational model as a philosophy for therapy services. We wanted to provide a safe space for all students to engage in organized movement through fine and gross motor activities, sensory experiences and practice mindfulness to support emotional regularity and academic success. We wanted to provide RTI via tier one, two and three support in order to reduce referrals for special education services across a lifespan, while ensuring at risk children receive immediate support and intervention in the area of need. We wanted to improve transition of students between programs with appropriate delivery of therapy services as well as support with inter district transition, such as pre K to K, elementary to middle, middle to high and adult transition. We want to adhere to timelines for assessment and comply with laws for the delivery of therapy services, to educate and empower staff district wide on all things educational. Ot to collaborate and promote occupational therapists as part of the transdisciplinary teams servicing the special needs students, and to expand the range of occupational therapy service delivery options that were available. You know, the one beautiful thing about California is that they have their own specific ot PT guidelines. Unfortunately, they are just a guideline that you have to use in conjunction with federal laws in addition to what your district governs as their own policies and procedures. So you can't just take this document, walk right in and say, you have to do this. They don't. It's just a guideline. It's not the law. So remember, you have to take the law, the guidelines, and then your setting and how you fit into there.
Jayson Davies
Yeah. And Danielle, I don't know if I've shared the story with you, but one time I went into like a lead psychologist office when I was up at my previous school district, and I said, Hey, look, I found this really cool document, and it's all about, you know what ot should look like in California? And the response I got was, is it ed code, is it educational code? And I had to answer, Well, no, I mean, it's not law, it's not in the California Educational code, but it was that version of this, which was a, was it the first or second edition? I think it's all one and only isn't it?
Danielle Delorenzo
Yeah, they're working on the second edition. But I feel like Lisa test and I were talking about this at OTEC, where I feel like they're working on the revisions right now, or something that they're trying to get out there, but something that has to do outside of my area as to why they haven't been able to revise it, because some of the terminology in there has become a little outdated and needs to be replaced with What's going on right now?
Jayson Davies
Yeah, and so it is being updated, like you said. However, from my understanding right now, is that California Education Code, or the Department of Education, is actually not doing it with them, and they are basically doing this independent. So the next one that comes out, although it'll be fantastic, and it'll have so much good information, it will not be sponsored, if you want to say by the Department of Education, and not being sponsored by the the can't speak, not being sponsored by the Department of Education. Well, that doesn't, it's like, I mean, a bridge to nowhere. You know, there's nothing, really, no one can say it has any water, you know, or any substance to it, because it's not I wouldn't be able to say, Oh, hey, Director of Special Education, this is important, because California sees it as important. No, I'm only saying ot see it as important. So, yeah, yeah,
My Bui
Jayson, I think we encountered the same problem too. We had a meeting with our supervisor, and we're saying this is best practice, it follows our guidelines. And they're like, Well, is it a code approved? And we're like, well, we have to go back to the drawing board and kind of make it fit into ed code.
Jayson Davies
Yeah, yeah. And that's a that's hard work, because Ed code is so substantive, you know, there's so much there, and but at the same point, very little related to occupational therapy. So you really have to, it provides guidelines in itself, but there are very little set rules for occupational therapy in the educational code. And so you kind of have to, like you said, kind of make it fit.
Danielle Delorenzo
Yeah. Yeah, and I think that just stems from a lot of people's frustration, and at least from an educational occupational therapy perspective, because here we all are trying to do best practice, trying to do what we know the evidence is saying we should do, but there are so many disconnections between the law also having very outdated laws that should probably be updated in terms of, just like, you know, parts in the idea that really could help support us and working closely together. And if all of us just had, like, this generic policy and procedures for educational ot that can then fit into each district district, we'd have a little bit more room to stand on. But unfortunately, it's like we're all alone, and we just have these guidelines that it is literally up to the districts that we work for whether or not they want to enforce all, none or some of these guidelines. Yeah, and, you know, ot in California when we you know, so we have this guidelines. And I think what, well, a lot of people don't understand is we are a related service. Not many people know that. And what a related service means is that a student has to be receiving special education services in order for an occupational therapist to even come out and look at them in an educational setting. So a student may have an educational need as well as a medical need. However, some motor difficulties may not directly impact educational progress and may not constitute educational need. That's why I think it's important that parents and district staff understand what educational OT is, what it means as a related service, and how we can provide support for students that are not on ot caseload, but are still demonstration foundational concerns with the areas that fall when you know, under educational occupational therapy, another big issue is educational versus medical OT. Now you guys will see there's a chart up here. That's where we're at in our slide, and we attach this to our assessment reports, especially when we're not recommending services, so parents can understand why sometimes their kids are getting medical OT and not educational, and why from an educational perspective, you know, OTs are only going to Pick up students where they have difficulties accessing their areas you know related to OT concern within their education. I also think that you know one of the biggest misconceptions is where the information is coming from. Before they even get to the school district. You have parents are receiving their information about educational ot from practitioners IRC, the doctors in family based and medical models, and it begins before they even get to school. So the more that we could empower and educate within our community, to the local doctors, to IRC facilities, which we actually are in the process, we're going to be presenting at IRC. They are very excited for us to come and work on that, to share what we're have going on here. You know, parents, district staff, then if the community can be educated as a whole with accuracy and research based information relating to educational OTs, such as, please don't put ot on a prescription pad and hand it to me at an IEP. That's not how this works. So we have to kind of look at all of the factors that are contributing to the misconception, and work really hard on trying to really again, educate and empower all all people everywhere, on what we do and how it is very different from the medical model.
My Bui
Yeah, we even started signing in our emails and introducing ourselves as educational occupational therapist. To really emphasize that ot support has to be related back to access to education, I feel like being a school based OT, we're like, on our little island, and everybody else is, you know, the medical model. So we really wanted to change the lingo to really emphasize the difference between the medical and the educational occupational therapy.
Danielle Delorenzo
Yeah. So now we're talking about the guide to determine the need for ot referrals. So you know, as we talked about, a student might benefit from ot if he or she is having significant difficulties in the classroom, performance as impacted by curriculum, educational environments and abilities. Simply having deficits in the areas of praxis, fine motor skills, visual perception skills, sensory needs and self help skills, does not mean that a child needs occupational therapy. Special education teachers can assess and assist students who have special needs in sensory or motor skills. And most special education teachers with needs, most special education students with needs in these areas can and should be served by their teacher and other district staff. So again, you know, as stated earlier, we have a lot of teachers that are referring for occupational therapy services. Without taking a period of time to implement RTI interventions that what we've seen the research about 80% of the time. When these RTI interventions are implemented, it decreases these at risk kid OTs, and it also decreases the need for initial occupational therapy referral. And so by increasing the appropriate net of referrals where, when a kiddo is not responding to RTI interventions within that period of time, then we need to assess, to determine what else is going on, whether it is ot that is needed or another service to help. You know, in order, you know, we talked about, in order to receive OT, they have to be eligible for special education first, I think that within this framework, both the American Occupational Therapy Association and federal legislation focus on improvement of functioning and not servicing goals beyond the capacity of the individual. The objective of occupational therapy within you know, a school setting is to have a student participate and function as independently as possible. In the classroom setting, we have a lot of kids that stay on caseload for long periods of time, year after year. And I think it's important to remember we are not striving for perfection and pushing beyond the student's capability. We are looking for functionality and access to the education, and if they are able to do that with their supports and modifications set in place, then that's when we would start to be discharging those sit kiddos off of OT caseload, since all of their educational needs are met. So one thing that we decided to do was we decided to create a document that would help psychologists or case carriers or other individuals that are sitting in on initial IEPs. It's called the educational relevant concerns document. So the purpose of this form was to help facilitate a conversation when OT is identified as an area of concern, these questions are meant to help guide the conversation to determine if the identified area of need is related to educational occupational therapy, the goal is to shift the mindset to the identified area of concern to begin the process of providing immediate support. By focusing on the area of concern, discussions can then be facilitated to determine who is the best person to help provide support to meet the students needs in the area of concern that has been identified. This can help shift the mindset that it is not one identified member of the IEP team. Hence, my kid needs ot it's more my child is demonstrating a concern with handwriting legibility. But then when you talk more about it, maybe they don't like to write, and they're not motivated, and they actively say that they don't care what their writing looks like. Now, is it really a motoric or processing issue, or is it an issue of motivation? So there are many factors as to why individuals can be showing or demonstrating concerns in the area of OT but you need to really ask further questions so we can really decide who is the best person to provide that support. This is how we can begin to implement a multi disciplinary and multi tiered level of support that can help the students immediately and ultimately be able to help them access their education as best as they can. So some of the questions you know, do the students have difficulty accessing their environment? Do parents and teachers share similar concerns? Is this concern related to the home or school? What are the areas that these kiddos are having difficulty access? Are they making any progress? What led up to the request for additional support? What has the teacher tried if they have difficulty sitting still? Is it impacting their education? Because sometimes I have teachers tell me it's annoying that they bounce so much. I'm like, Well, are they paying attention? And they're like, Well, yeah. And I'm like, Well, let them bounce. It's more problem about the teacher rather than the student. So it really helps to put it on the student and what the student needs to be successful. You know, especially this one is the concern sensory related, and then ask for a specific task. What academic task is the sensory related concern impacting? Because sensory and behavior, they are very closely interrelated, but we're really trying to figure out what drives what and where the interventions need to take place, which is why we're so lucky to have amazing autism specialist and Behavior Support team that we can collaborate with to really help bring that multi disciplinary, you know, approach when We're looking at the whole child. I'm going to now pass it over to Mimi, who is going to review our policies and procedures that we have incorporated into our manual.
My Bui
So the referral process we. Wanted to make this as user friendly as possible, and so we decided to categorize it into three different categories. The first one is, if your student is in general education, what would the referral process look like? So we have, we made a beautiful flow chart. Mary made it really pretty. So the first top tier would say this kid is in general education. So specific classroom concerns. The teacher would fill out our educational occupational therapy teacher training form. And so what that would look like is they tell us specific, or, I'm sorry, General, classroom concerns, and then we would find a specific time and date that works best for the teacher to do a consultation with them to help the entire classroom. And then we also have a bracket on the other side that it's if it's student specific concerns, but they have no IEPs, and what that would look like. So the next one would be special education. So if the student is in special education, that's a whole different referral system. So if it's again, if it's a classroom concern, they do the same process. They fill out that form. We would provide general strategies. They would then take data for four to six weeks, and then we would visit those status and see if our strategies, our strategies were working, or if they weren't working, and then where we would go from there. So So again, we would provide general strategies and training in areas of concern. And then we would provide them with an RTI approach by providing them the OT teacher strategies handbook, which we will cover a little bit later. And then again, they would take data, because we are very data driven to support the need. And then we would also be available to them if they have any additional questions, and so say if the strategies are not working and they need additional ot support, that is when we would go ahead and proceed to an evaluation. We created the form called an educationally relevant occupational therapy assessment referral form and that would begin the process for an OT assessment. So this kind of puts sit back on the teacher to try RTI strategies before they seek out specific, skilled support from an OT because again, I think Mary discussed earlier, it takes us anywhere from the shortest, probably like 10 hours to the most, like 20 hours to do an assessment. So this would really help us cut back on on assessment referrals, or relevant assessment referrals. Okay? And then the last one is if there are parent concerns. So we the teacher would discuss the related area of concern, and then what would be the outcome of discussion? So if the team determined the area of concern is related to educational OT, and they would fill out that questionnaire we that Danielle previously discussed, and again, it would follow the steps of, you know, we would provide the teacher with the handbook, and then they would take data on it and do the RTI strategies, and again, we would be available for consult. Now, if the parent request and an OT assessment, then we would go ahead and fill out the Rota, which is an educationally relevant ot assessment form, and we would go ahead and assess them, because per parent request, we would have to honor their request for the the assessment.
Danielle Delorenzo
I just want to jump in and say that we've also had a lot of success with explaining our referral process to our parents, and we have actually had a couple of parents that who have requested an assessment. And after we said, hey, can we just come in there? Can we try some RTI first and just kind of see what we're doing, and then in a couple weeks, can we re me? And sometimes the problem, you know, took care of itself with RTI strategies, but then we were learning more information, and they were like, oh, you know what? This is a more appropriate referral. And then we were able to incorporate these RTI strategies with into our assessments, which just made it even more meaningful and more individualized to be able to really hone in on those students specific needs and really helping to increase the appropriateness of those referrals.
My Bui
So going back to the OT teacher handbook that we just discussed about in the in the referral process. So the purpose of this document is to provide teachers with a resource manual that outlines educationally appropriate ot strategies and interventions for students progress while complying with federal regulations, state laws and professionals. Agendas to practice going back to Ed code. So the OT guidelines mentioned are meant to assist and guide teachers and members of the educational team and administrative staff in implementation of school based ot strategies for all students in general and special education. Our objectives for this resource manual is to provide teacher education and protocol for specific common issues seen in students academic performance. So as you're listening to this, you probably already like came up with a bunch of common issues that your teachers might come to you for, whether it's pencil grip or student can't attend or student can't sit still. So our content. We pretty much broke it up like this. We gave our mission statement, our educational, I'm sorry, the purpose of the document, the mission statement, the frame of reference, contributions. And then we broke down educational, occupational therapy, Classroom Strategies, into sensory and then listing all of the areas that might be affected. And then we broke it down to handwriting and visual motor. And then we broke it down to a fine motor and self help. And within this resource, it's very user friendly, where they would basically have is your if you see this in your child, try this strategy. And these are very cost friendly, user friendly strategies. And we also want to use this form as a data collection tool where, let's see what you've tried out in the classroom. So they would just check it. Very simple, if you want to open it up, we will attach this also just a few sample pages. And so, you know, we go back and we're like, well, you tried this, you tried this, you tried this, it isn't working, okay. Maybe you do need our skilled expertise to address these concerns, okay? And then our future plans, everything we have done this year was just a few check offs on our large to do list, we want to continue doing what is best for our district and most importantly, our students. And here are our future plans to accomplish in the next few years, we want to provide trainings to all teacher district wide, all teachers district wide, on how to use the manual and implement RTI strategies with fidelity, that is the key word. And we want to share case loads and provide whole group interventions to support all student outcomes. We want to train and implement organized movement activities. Emphasis on the organized part. We want to create ot movement space at all 19 elementary schools, we want to incorporate ot in every classroom, district wide. And we also want to, most importantly, empower and educate teachers and district staff with all things educational. OT.
Danielle Delorenzo
You know, it is so important to remember that as occupational therapists within a school setting. We are just a small piece of many components that make up special education, that are within the entire educational system. This is the first time we have examined a very large organizational flow chart, and it is amazing how many individuals are responsible for so many different factors that can impact impact and occupational therapy program, we have learned that even when the research is showing what is best evidence based practice, there are constraints that limit what we can and cannot do. That does not mean it's a no, it just means it's a no for right now. The other lesson is that if you really want to do something make true change, you have to work very, very hard. You cannot give up. You will feel defeated. You will get knocked down, and you have to get up each time, because change doesn't happen overnight, and you have to always see the bigger picture. Focus on what you can change. Make small, attainable goals and do what is best for kids, and let that guide your practice. Working in a school based setting is super stressful, with pressing deadlines on a continuous timeline. Try as best as you can to separate the emotions from when frustrations arise, knowing that this too shall pass, be mindful of your role and strategize how you want to fit into the bigger picture, channel your energy and intentions on utilizing your caseload and assessment lists as opportunities to provide RTI through educating and empowering teachers on all things. OT, this project has evolved into something so much bigger, and we are so excited to see and watch it grow and continue to modify it as it goes, to continue to meet all of the needs of Rialto, you know, and what is best for our kiddos in all things occupational therapy.
Jayson Davies
Awesome. Well, thank you, ladies for for sharing all that. I want to ask you real quick. Danielle. What exactly would you like to make available for our listeners? So
Danielle Delorenzo
today, what we're going to make available for our listeners is going to be the PowerPoint presentation. I am going to pass along the policies and procedures those three documents we were reviewing, and I will be able we until, if people want to reach out to us for some further info, we would love to share what we have via a collaborative model. So it's kind of like we had this big vision at OT and forgive me, if there are any listeners from OTEC, I've already ran into a couple of them that have been like, where's the drive? Where's this collaboration drive? It's coming. It's just been a crazy school year. So our future plans is to have this nationwide collaborative resource drive where everybody can contribute to, you know, all things OT and to share, because that's we don't need to reinvent the wheel, you know. So at least from out of here, we want to be able to provide those so people could see how we formulated our policies and procedures, and kind of just like a guideline for everybody else. Because I know we've heard a lot of feedback, especially at ot that a lot of people are kind of stuck on, how do you approach change? How do you make this work? So this was how we did it, and we're hoping, by sharing all of this information, that anyone can take that and tweak it to bring it back to their setting, to help make the changes that they want to see.
Jayson Davies
Absolutely and just like the PEO, you know, person, environment occupation model, I think you also have to almost call it like a DEO district, environment occupation model, like every district is slightly different, and so no one, no one manual therapy manual, or whatever you want to call it, will work for every district, and I'm sure you guys have figured that out. And so even if you were to share your manual the way it is with another district, it wouldn't be applicable. I mean, yeah, maybe 90% of it will be but there's going to be those small things that need to be changed because the different policies that that district has, the different vision that district has, the mission, the type of students, everything and so yeah, but that's very awesome that you're gonna provide some resources, that collaborative document that you got going on. What's the best email to reach out to people.
Danielle Delorenzo
The best email would be mornings with an OT mom@gmail.com
Jayson Davies
All right, cool and mornings with an OT mom, she's also, that's Danielle. That's also her Instagram handle, and so you follow her over on Instagram, and then, yeah, that's pretty cool. I know you have one other project kind of going on right now, something about mindfulness and movement. What's that going what's that about?
My Bui
Yes, so we are working on a project with all of this being said, this was our foundation that guided our journey to start this mindfulness in Motion project. We realized that our there are so many hurdles to jump over when you're trying to make change, we felt like it was necessary to shift the mindset towards a new culture of how OTs can help on a larger scale by integrating movement and mindfulness to increase academic performance, life productivity and emotional regularity throughout a lifespan. So, yeah, Danielle's personal Instagram is mornings with an OT mom, and mine is elevated state of play. And you can find more about this project by following us@mindfulness.in dot motion on Instagram also.
Danielle Delorenzo
Yeah, we're really excited about this project. I think what we want to really show everybody, especially our graduate students, that when you start out with this little, little itty bitty idea, you never know what it's going to grow into or what's going to blossom from this idea. And this project came out of pure motivation to do what's best for kids and to provide a service. That's all we want to do. So we hope you'll check us out, and you can contact us at either Instagrams, and we hope you all enjoy what we're going to be doing.
Jayson Davies
Well, I just followed you on Instagram, so you have one additional follower. I hope everyone else out there will do the same. Go check them out. They got a lot going on. Danielle and mine, the rest of the team over there, sorry, me, not mine. And yeah, really appreciate all that you guys have have done over the last year and a half or two years or so, and putting this all together, it's really, it's really awesome to see OTs kind of stepping up the game and putting such an emphasis on RTI and access, or allowing kids to access education before needing that. That referral potentially. So very cool guys. And yeah, I think that's all we have for today. We will see you next. Some on the podcast.
Danielle Delorenzo
Thank you so much. Jayson,
Jayson Davies
definitely. Bye. Everyone. Take care. All right. Well, that concludes today's episode number 38 and I want to give a special thank you to Danielle, My, Mary, Michelle and Rivka for coming on the show. That was something that they did not need to do, but they were excited when I asked them about it, and they wanted to come on here and share everything that they've done. They put a lot of really hard work into this project, and it's gonna go so far to help Rialto school district. And you know several other people, you know people that are listening right now, as well as people that hear it at ot a potentially, and yeah, I'm just looking forward to seeing what these ladies do. They are all really ambitious and really amazing. So it's going to be awesome again. Be sure to head on over to OT schoolhouse.com. Forward slash episode 38 there you will be able to either get it for free, if you're quick enough, or purchase the professional development. It's one hour of PD, and you can purchase that or get it for free and take the short quiz to earn your professional development certificate for NBC ot renewal. So check that out, and we will see you next time on the OT school house podcast. Take care and have a great week.
Amazing Narrator
Thank you for listening to the OT school house podcast. Now that you've listened to this episode, head on over to OT schoolhouse.com, forward slash PB, as in professional development to earn your continuing education certificate until next time class is dismissed.
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