OTS 44: The OT - OTA Working Relationship Feat. Mary KleinHeksel & Cait Bowen
- Jayson Davies
- Mar 8, 2020
- 35 min read
Updated: May 29
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Welcome to the show notes for Episode 44 of the OT Schoolhouse Podcast.
In this episode, Jayson hosts an OT/OTA team from the state of Michigan to discuss the dynamics of the working relationship and how to maximize communication. Mary Kleinheksel and Cait Bowen talk about the systems they have put in place to maximize communications and facilitate trust among the practitioners. We also talk about aspects of billing, evaluations, treatment planning, and how many COTA's an OT can supervise.
This podcast does not qualify as a Professional Development Podcast. You can learn more about how to earn professional development credits through the OTSH Podcast for your OT/COTA renewal certification here!
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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
Hi everyone. And welcome to the OT school health Podcast, episode number 44 My name is Jayson Davies, your host. As always, it's been great getting back into the podcast, back into the swing of things. I'm enjoying working with my A to Z school based ot course cohort. That has been a lot of fun this past week or two. And yeah, we're gonna keep this introduction short. Today we are talking about the OT OTA occupational therapy occupational therapy assistant relationship with two very special guests. The first is the occupational therapist in the group. I will mention her first. Her name is Mary kleinhexel, and she is also joined by her occupational therapy assistant, and her name is Kate Bowen. You may know her as Kate the COTA on Instagram, she and the OT that she works with are joining us today, so we're gonna get into that. But first, I do need to say a special thank you to the pencil grip for sponsoring today's episode of the OT school house podcast. The pencil grip is the original ergonomic writing aid. Writing becomes easy and natural. The pencil grip improves handwriting, helps to give more control and reduces hand fatigue. Its unique patent design gently encourages the fingers and hand to rest in the proper position for gripping the tripod grip. Unlike other grips, the pencil grip feels natural because of its ergonomic design and soft, flexible, latex free material, Get yours at the pencil grip.com and use promo code ot school house to get 30% off your entire order. All right, like I said, we're going to keep today's introduction very short and sweet. So let's jump into our interview with Mary and Kate and talk about the OT OTA relationship. Hi Kate. Hi Mary. How are you both doing this evening?
Cait Bowen
Hi, good. How are you?
Mary KleinHeksel
Hi!
Jayson Davies
All right, so I'm going to so other people know I can see you, but they can't, Mary, why don't you go ahead and share with us a little bit about your background as an occupational therapist.
Mary KleinHeksel
Okay, I have been an occupational therapist for 29 years. 20 of those have been at Jayson public schools, where Kate and I currently work together. I've done a lot of things prior to that, outpatient, inpatient, home health care, hand therapy, you name it, but I've landed in school ot as my passion. Awesome,
Jayson Davies
fantastic. And then also joining us today is Kate. Kate, how about you go ahead and introduce yourself.
Cait Bowen
Sure. This is my fifth school year as a CODA, and this is actually the only ot job I've ever had. So I started off as a social worker, and that wasn't really my thing, so I went back to school for ot to become an OT assistant, and this is my first job out of college.
Jayson Davies
Wow, so already a life or school based OT,
Mary KleinHeksel
yes,
Jayson Davies
all right, great. Well, welcome to the show. I'm so happy to have you. This is the first time that we've had an OT, ot a team, joined the podcast, and I think this is something that people, all the listeners, listeners are really going to appreciate. So I'm excited. I hope you guys are excited to share your knowledge. Yes, great. All right. And before we get started, Mary, you kind of mentioned the district that you guys work for, but geographically, where about is that?
Mary KleinHeksel
So, Denison, Michigan is a public school. It is Western Michigan, about 2030, miles east of Lake Michigan. It's in the lower part of Michigan. There.
Jayson Davies
Great and again, the main reason that we're talking today is to discuss the relationship, the working relationship, between an OT and an OT. So we're going to dive into not only the actual work skills, but the interpersonal skills a little bit, because I'm sure that's an interesting dynamic. I know I've worked with a few CODAs or OTs, and you really have to have some teamwork. And it sounds like you guys have some good teamwork. So I know there's probably OTs and as well as COVID, out there that have never had that chance to work with the other before. And I think that there may also be some people that just don't understand that dynamic. So this is going to be awesome, and I hope you guys are excited about this. So to start things off, I wanted to kick into just a little bit again the background, are you guys, district employees? Are you county employees? What? How's that work?
Cait Bowen
We are district employees as of what was it? Mary, a couple years ago,
Mary KleinHeksel
fourth year. Yeah, that they hired us on.
Cait Bowen
Yeah. Yeah. So before that, we were independent contractors, yeah.
Jayson Davies
Oh, okay. And were you guys working for another contractor, or you yourself were the contractor.
Mary KleinHeksel
We were the contractor.
Jayson Davies
Gotcha. So each of you were independent then, Yep, yeah, interesting dynamic. So then they decided that after a few years, it was worth just bringing you on board, huh?
Cait Bowen
Yeah, it's been really nice. There's some added benefits to being a district employee. It's kind of nice to not have to worry about the self employment tax situation, right?
Jayson Davies
That's complicated.
Mary KleinHeksel
yes, so I definitely prefer it being in Yeah. I appreciate our district doing that for us. Oh, yeah.
Jayson Davies
So you've been with that district either as an employee or independent contractor for a little while. Then Mary, right, right?
Mary KleinHeksel
So 16 years independent, and then the four years now I'm a district employee.
Jayson Davies
And so you're liking being an actual employee.
Mary KleinHeksel
Yes, pension and yeah, they Yeah, definitely.
Cait Bowen
Call that good stuff.
Jayson Davies
I know that good feeling. Yep, it's nice to have that behind you, I guess, or just kind of being taken care of without you having to really worry about it cool. So, and then, are you the only OT and OT a in the district, or are there others within the district as well?
Cait Bowen
So, other part time coda,
Jayson Davies
okay? And so, Mary, you also supervised that Coda as well.
Mary KleinHeksel
Yep. So it was, I came on the scene and took over some hours for another one. So I'm the only ot of the district. And then Kate took over a previous coda, who was there, like, 20 years before her Yeah, and she recommended Kate, and we interviewed Kate immediately. We're like, that's the one we did. Director. And I were like, Yeah, we were Kate, so yeah. And then Kate and I got so busy that we were both like, we needed help. So we wrote a proposal, and yeah, the district then approved our proposal for another part time. OT assistant, who we love as well. Yay, Jody.
Jayson Davies
Shout out to Jody. Great. So how many schools are in your district then?
Mary KleinHeksel
So, yeah, so we, Kate and I both work at 10 different schools, okay? And Jody works at two, okay. And so, yeah.
Jayson Davies
Great. So you guys are busy and married, that means, well, Kate, too, if you have 10 schools, you're traveling around. But Mary, yeah, cool. So we're going to get into the dynamic about all of that. The first area that I kind of wanted to talk about was kind of communication. So I have some various questions that kind of I consider fall under the communication aspect. And I think many OTs and OT A's out there have the same types of questions. So the first one is a mentorship slash supervision. Question. You know, what does that actually look like? How do you guys work together?
Mary KleinHeksel
Go ahead, Cait, you wanna? Yeah, what do you think?
Cait Bowen
Hey, so Mary and I meet once a week to just kind of go over how the week has been, anything that may have come up looking ahead to the next week, but that's really the only time during the week that we have together. The rest of the time, we're so busy with our own caseloads that we communicate through text or through email, but we save the big stuff for our once a week meeting.
Jayson Davies
Okay, and so again, going a little bit further in that once a week meeting, do you guys take, like kind of formal notes or anything, or is it just very open?
Cait Bowen
I would say it's pretty open. I usually have a list for Mary, and she's got a list going for me, and we just kind of go back and forth and work our way through our list. I give her any paperwork that I need to and vice versa, I would say it's pretty informal, though.
Mary KleinHeksel
Over coffee, we have to have coffee.
Jayson Davies
Right? I know I used to meet up with my COTA sometimes at Starbucks, like the local burger joint or something, wherever we could find a table so I get that.
Mary KleinHeksel
No, I'd say definitely informal, but yeah, we still have lists, checklists and stuff that we need to get through. And yeah, and we do, but
Jayson Davies
so do you guys, and I'm not expecting this to be a yes, but do you go over the entire caseload every time you meet?
Cait Bowen
No, no, I we would be there for hours and hours, right? So we just go over, I would say, maybe kids that have upcoming IEPs, new students on the case load, any students that maybe had a tricky week, we focus on those ones for our meetings.
Jayson Davies
Okay? So. A handful of kids that are coming up with meetings, or were tricky. Okay? And then, so actually, this is great. I didn't realize that Mary, you've been or, sorry, Kate, you've been with Mary for about five years. So I actually want to ask Mary, then, how has the guidance been similar and changed over the five years working with a new occupational therapy assistant?
Mary KleinHeksel
So, yeah, so good question. I think at first I, when Kate first came on, I went through and I made a list of scenarios of, if this comes up, we probably will do this. So then Kate didn't have to feel like she had to ask me every single time, every single question. She was questioned, she could reference that. I think that was helpful to Kate. So yeah, because there was a lot of things that Kate wasn't even sure that would come up, and she's like, Oh, it was right in there. So yeah, and if there were any questions, then she could, I mean, I'm available on phone all day long. So we make sure that we do that, but yeah, and then I just kind of, as we went, things that I felt were helpful, like Kate would be like, Oh, this came up, and I'm like, Oh, I didn't, you know, you won't think of it in every single meeting, but oh, I have these reflex integration exercises. Well, what the heck? Here you go. Or, you know, I think Handwriting Without Tears would be a great continuing ed program for you and Jody, the other assistants I go to, because that really is a treatment changer, and it was for me. So just as things come up and that I think about them, and the question is asked that, yeah, then I'll just give some guidance and think things that helped me along the way.
Jayson Davies
So every state has different legislation. And the reason I ask this is I know, as in California, we just changed from being able to supervise two ot as to three. But just like that, every state also has different guidance or different requirements for how much support you have to provide to an OTA? Is that something you went and studied before taking on an OT a or do you, I mean, maybe in Michigan, are there very strict guidelines on how often you have to meet or how often you have to talk about a certain or the cases or whatnot? Do you know any of that?
Mary KleinHeksel
I think we go by Medicaid as well. I don't know if you bill Medicaid medical, same thing. Yeah, Medi Cal. So, yep. So our Medicaid here, that really needs to be done quarterly, but I feel for best practice that if we we at least need to touch base weekly. I think that's that's very important. So I think it's just my personal preference of best practice, and I think to keep connected with Kate as well, so Kate doesn't feel like she's just out there all alone. Absolutely support, because, you know, she gets, you know, tough kid OTs too. But, yeah, she's amazing.
Jayson Davies
Great. And so Kate, then when over the past five years that you've been a CODA, how have you felt like guidance, supervision? How has it been for you? Did you feel like you needed more support at the beginning versus you do now? Do you still need the same amount of support? Or what's that feeling like?
Cait Bowen
I would say I definitely needed more in the beginning, especially as a new grad, I didn't have a whole lot of OT experience, so I relied a lot on Mary. Lots of questions. I wrote a lot of things down. I probably bothered her too much asking questions. But I feel like over the five years, I've become more confident in my job, more confident in the requirements, and so my questions are less frequent than they used to be, and I just feel more confident as a therapist.
Jayson Davies
Gotcha perfect. So then Mary, back to you. How do you keep up to date? I mean, it's kind of for both of you, I guess. But how do you guys keep up to date with who's seen what? Kids and just kind of those things that you kind of have to have a lot of trust in someone, right? But so how do you keep track of what each other are doing? Almost, does that make sense?
Mary KleinHeksel
Yeah. No, it does. So we each have our own case load. So the even the special ed Secretary will be like, this is Kate's caseload. This is Mary's caseload. This is Joy's case load. So those kids will be under Kate. Of course, they're all supervised by me, but I think it's important for everybody to have their own caseload, and I think that helps for, you know, just to feel ownership, and we believe in the relationship Kate has with her caseload, her students. It's better than I could just be coming swooping in and trying to do something. You know, I think that's important that Kate, that the OT assistant, has their own caseload as well, and of course, it's supervised by the OT. But yeah, so we when Kate first came on, she was, I. My love is all students, but I really love working with students with autism, so I kept, we have a categorical program, so I kept that. And a lot of times those are the trickier kids, and then Kate could decide when she was branching off, kind of where she wanted to go. So Kate, if you want to let him know, like.
Cait Bowen
My caseload is kind of a variety. I would say. I have students in the cognitively impaired program, emotionally impaired program. I've got some gen ed kids who just need a little extra help, some kids with developmental delays. It's kind of a variety, but it's fun.
Jayson Davies
Well, that's cool. So then you guys actually do, in a way, make up your own caseload. Obviously work together, but you guys kind of work to each other's strengths. Then.
Mary KleinHeksel
Yeah, I think so like, yeah. And if there's a tricky kid that I know is going to be tricky all around I will just keep that students, because that I just need to provide that level of Shall I save supervision or for that so Kate doesn't have to worry about getting involved in something tricky like that, so I'll make sure, I'll get a feeling at the initial IEP the evaluation, and then if that's the case, I will definitely keep that student So not to put Kate in any Jeopardy, especially. You are, though you You are amazing girl. So, yeah. So yeah, I just don't want Kate to be, have to be involved in the deposition or anything. So I will make sure that that stays in my court.
Jayson Davies
Absolutely I can hear the dog. That's fine. This is a dog. No, I always say it's a dog friendly podcast, so he's welcome to join us. I love it. No, totally fine. Oh man, it just makes me miss my dog a little bit. That's all right. So Kate, I want to ask you this. Then Mary was just talking about how she kind of, I mean, it's almost like screening, you know, and I've been in the same situation. There's certain kids that you have to be careful with, and there's certain kids you almost feel like you need to hold on to, right? Mary, you just kind of said that. But Kate, how do you go about if there's, like, one kid who you feel like you need more assistance, what is what do you do? Obviously, you would talk to Mary at that one to one meeting that you guys have. But have you ever had to go further and ask for more assistance?
Cait Bowen
I really haven't. Mary does such a good job at that initial screening and evaluation of taking any kids that might have something tricky coming up in their future. For any kids I've had that have been more challenging, Mary has always been so available to me that I've never felt like I've been alone or had to come up with a solution on my own. I know that I can just text or call Mary and she's right there to help me. And I've never had to go beyond that.
Jayson Davies
Perfect. That's great. I mean, that's nice when things work out that way. What about this? Have you ever had, because I've been in a similar situation to this? Have you ever had a parent request that their student be seen by the OT versus AOTA?
Mary KleinHeksel
You know what? In 20 years, I have not very fortunate. I am very fortunate. I know we, we have, not, we're I think we just are a team. And yeah, I just explained at the IEP that Mrs. Bellin is in this building weekly. She will be seeing your students. And yeah, and Kate does an amazing job. And I make sure the kudos goes to Kate, and the parents know that as well. So yeah, but no, I have, I have not, I think, I think it's screened out by me prior. I don't know. Yeah, I don't let it get there. No way.
Jayson Davies
That's good to hear. Similar to that. What about at IEPs? Does any? Of do, any of the parents request that the OTA be present because they're the because Kate's the one working with the child?
Mary KleinHeksel
Nope, again, that is, I know. But what will happen, though, is Kate's my, my backup. So a lot of times I'm double scheduled on, you know, on, fortunately, I can't beat the both. And I'll be, I'll ask Kate prior, and I'll be like, Kate, can you cover me on this one? And yeah, she's very willing to do that. But just for clarity, for staff, I think, for scheduling as well, that I'm the, I'm the paper pusher, and so that they need to, yeah, contact me and but Kate and I are a team, so yeah, a lot of the teachers make a comment like, Man, I want, I want Kate's job. I wanted to see the kids.
Jayson Davies
I've heard that a lot.
Mary KleinHeksel
Yeah, the deal, I don't know. I don't know, Kate, you're, yeah, you're amazing. So yeah, she just makes it look easy and sound easy.
Jayson Davies
Kate or codas, do have the fun part? You know, totally get that I've met many OTs. Or I'm like, Well, do you ever think about going back and getting the masters and doing the OT like, Nope, I'm happy here. Don't want to go to IEPs. I'm good here, right? But So Kate, it does sound like you do attend a few IEPs, if Mary's double booked, what is that experience like for you?
Cait Bowen
Yeah, I've been to a few because I don't do them often. They are a little bit intimidating to me, just because I'm not used to that side of the job. I don't work a lot directly with parents, you know. I'm just not used to those types of meetings, but Mary always does a good job of, you know, kind of outlining what I need to talk about, and it's a student that I've been working with. So in that respect, I'm comfortable talking about their progress and what we've been working on and the goals that we're moving towards. So they're they go fine. I would say.
Jayson Davies
Great. And so I kind of want to go another way. But you mentioned goals. And so how do you guys work as a team to develop goals? Does Mary, do you just look at the progress and develop goals, or does Kate have input? Or how does that work?
Mary KleinHeksel
So at our meeting, or whatever, so we'll, we'll look at the goals and the progress, and I'll I'll be like, I think this is the next, next progression, but yet, I'll run it by Kate, and be like, Kate, what do you think? Does this look doable? Does this look like because Kate will be like, yeah, no. I'll be honestly, you're crazy, and I love that. I'm like, oh, good to know. Good to know. I think we need to obtain our goals, and they need to be, you know, realistic, so, but that's the feedback, or, yeah, we it's really good. It's just a great feedback with like, Cait needs to let me know that's too much or so, but I, I'm the one that, yeah, that is in charge of developing the goals with Kate's guidance on who she's seeing. Because, yeah, it's not fair. I don't think to just slap some goals down and expect you know someone I wouldn't want that if they're so lofty that I know I'm not going to get them achieved. So I think it's important for Kate to give me feedback, and she does a really good job.
Jayson Davies
Awesome. And then, so what about the kids? So obviously, there's kids on Cait's caseload. They're also on your caseload, but you're not seeing them right, or at least not as frequently as Kate. Do you have a certain system in place for when you're about to go to that IEP? I know for me, I hated walking into an IEP for a kid that I hadn't seen in a long time. And so do you kind of have a system in place when you're in that similar situation, for a kid that's maybe is doing great with Cait, but you just haven't seen them in a while.
Mary KleinHeksel
Yeah. So Kate will give me whether she'll text me something like a sample, a work sample, she'll attach a work sample for me, or a sample of what the goal was. She just recently did. There was a typing goal. So she's like, look at the typing. Look at she'll do a lot of the handwriting samples for me, which is great, and I can see it right there. Hand it to the parents, and then, like I said at prior to that weekly meeting, make sure that I touch base with her before the IP any concerns. Like there was one girl that glasses. We didn't she didn't have her eye glasses. Oh yeah. So Kate advocated for that, saying you really need to help me with that. So we did. We went in the IEP and the physical therapist, and I, yeah, advocated to get the end it's done. So yeah.
Jayson Davies
That's funny, because I've had at least three kids where I've had to do the same exact thing, whether the kid lost their glasses, whether they broke their glasses, whatever it might be, there's always seems to be a kid that's not wearing the glasses that they need, or just haven't got the prescription updated or whatever, but yeah, it's almost like you haven't been a school based ot until you've had to talk to parents about finding the kids glasses. So all right, well, we're about halfway through our podcast for today's episode, and so again, I want to thank the pencil grip for sponsoring this episode of the OT schoolhouse podcast. The pencil grip was designed by doctor and is widely used in classrooms at home and in therapeutic settings. The unique shape of the grip is designed to be a one size fits all to help the hands of kids and adults and work with both righties and lefties. The pencil grip can be used as a training tool and then permanently for added comfort. The pencil grip fits on pencils, primary pencils, pens, crowns, markers, paint brushes, etc, so its benefits can be widely enjoyed. A comfortable hand has more control and shows improved handwriting. The pencil grip guides the hand into an ergonomic position. It relieves hand pain, reduces fatigue and improves comfort. Consistent use teaches and reinforces the proper grip and stops common problems like fist grips, thumb wrapping and white knuckling. Parents, teachers and occupational therapists widely recommend using the pencil grip. Check it out for yourself at the pencil grip.com and use promo code ot schoolhouse for 30% off your entire order. Alright, well, let's just. Jump back into it with Kate and Mary. And this next question actually comes from an Instagram follower of the OT school house, and her question is, how important is it to rely on the OT a for progress on goals?
Mary KleinHeksel
I'll let Cait answer that one.
Cait Bowen
Yeah, I write my own progress notes for my students, and then how we do it as I write them all out, and then at the end of that week, when I'm done writing them, I sit down with Mary and we go through one by one, just so that she can get a visual too, of where each student is at, how goals are going, and just so that we're on the same page.
Jayson Davies
Perfect. Sounds great. It's It's nice when you have a team that knows how to work together and things just work well, it's very, very fortunate. I like it all right. So what about services? You're in an IEP, you've gone over those present levels that it sounds like Kate really helps with. You guys have collaborated to develop some goals. And what about services? Who brings those up, or how did those get determined, or whatnot.
Mary KleinHeksel
So the frequency of service, frequency? Yeah. So we write a range. We're lucky here that we are able to write a range of time. So we can write it monthly, and then I make sure that Kate will be able to meet that whether it's no days that have one coming up in a couple days here, that kind of thing, monthly, we're not expected to backtrack and see those students. So by that we do write arrange. Kate sees students in groups, so there's Yeah. So we usually write a range monthly in there to cover that.
Jayson Davies
That's really nice to have that leniency. We don't have that here and in the district I work for. But anyways, I don't want to tear any ot OTA relationships up. But is there ever, or has there ever been a time when you guys have been in a little bit of a disagreement about goals or the frequency of services?
Cait Bowen
Have we ever had a disagreement Mary?
Mary KleinHeksel
I don't think so. Maybe over, who's gonna buy coffee? Right? My turn? No, I think no, because discharge for us is based on standardized testing. So a child.
Cait Bowen
a child, has reached a student, yeah.
Mary KleinHeksel
Yeah. So it's picking it up as soon as so it's not like, yeah, so it's based on data. I think that helps. So, yeah, I can't, I can't think of anything that we've, we've both are like.
Jayson Davies
So do you guys only, obviously, you need the data to discharge, exit, graduate, whatever your term you want to use. But what about at the annuals in between? Do you do do you keep most of the kids at a pretty consistent rate? Or do you ever decrease kids based upon you know, they're meeting all their goals? Or does that remain pretty steady?
Mary KleinHeksel
We actually do testing each year, yearly. We do. We test yearly for standardized testing. We do test yearly. So.
Jayson Davies
Is that a Michigan thing, or is that just something your district and you have decided to
Mary KleinHeksel
do? That's our district, yep. Why keep a student on for two more years if they're average, fine motor, visual motor, that type of thing. So yep, and as long as the IEP team is in agreement. So now, if it's if they're eligible under, let's say otherwise, health impairment under an OT eligibility, then we need to do a re eval if that's the case, like if that makes sense on an official form, to then make it official for a re eval. But yes.
Jayson Davies
Wait. Okay, so Reval, you like making it sound like they're different. So in my school or my district, we like one eval. Is an eval like we do it every three years for the triennial, but you're saying you'll actually do some standardized testing every year for some kids Correct. Okay? And so what does that look like?
Mary KleinHeksel
So that looks like maybe a Beery visual motor or beary motor, maybe a Peabody developmental motor. Scales for yes, so yep. So we will get standardized data and test on them yearly to show that's a good way to show growth as well. Yeah, and yeah, and you can give a test if you've given it a year the same time.
Jayson Davies
So, so do you do a full write up for that, or are you just kind of doing the standardized just to show that actual assessment in the meeting?
Mary KleinHeksel
So then I'll put that in, like, the present level, okay, of the IEP.
Jayson Davies
Okay, so not a complete write up. And that's what you're talking about for the other students, where you might do a complete report, write up.
Mary KleinHeksel
Correct which we call a re evaluation.
Jayson Davies
Okay, yeah, okay. And so how, what does that look like then the reevaluation?
Mary KleinHeksel
That has to be done at least every three years. It could be done prior, but usually it's a full team reevaluation. Do. Very few instances that OT is the only one on an IEP, yeah. So, yeah, and eligibility, we only have like 13 eligibilities in Michigan, yeah. So, yeah, I don't know if that's the case with you, but yeah, yeah.
Jayson Davies
I think that's pretty standard. I could be wrong, but I think that's pretty standard. Okay, so there are some kids that is new to me, though, is that you made it sound like there are some kids that receive only ot on an IEP that is not something in California that we do. And I an idea. I don't it must be a state thing. And so how many kids I mean, estimate, do you have that are ot only?
Mary KleinHeksel
At this point we don't have any very rare, very rare, okay, under an otherwise health impairment, such as, has to have an outside medical diagnosis, yeah, yeah. So perhaps then, yeah, they didn't test out, or they have more goals that they need for.
Cait Bowen
I think we had one Mary, and we graduated him in the fall.
Mary KleinHeksel
Yep, I think there. That was our last one prior to that, maybe one other one that I can think of, very rare, but occasionally does happen where, like, speech was on and PT, but then they both discharged, and our, our standardized testing showed that he still required or could benefit from ot service. Gotcha.
Jayson Davies
Okay, see, that's the thing in our district right now, is that there's the speech only kids, and the argument is that at least coming down from admin, is that they shouldn't have ot unless they have that specialized academic instruction, the sai, because we're supposed to be helping the student in their education, right? And if they don't have specialized academic instruction, then what is ot supporting? But I understand how every district is a little bit different, but yeah, so that's interesting to hear. What other states how things happen. So cool. All right. Well, we started down the evaluation route, so I want to go that way, and that is, how do you as a team handle evaluations, or Mary, do you do all the evaluations?
Mary KleinHeksel
So I, so I do all the initial evaluations, okay? And then Kate helps with then, if there's a student of hers, she will gather data for me for any re evaluations. I feel that's helpful, because she does have that relationship. I've had it before where I've come in, even if Kate's there, I'll sit down and the kids like, no working for you. And then Kate will be like, Come on, let's do it. And then, yeah, yeah.
Jayson Davies
That's when you got to bring the goldfish. Be like, goldfish Skittles. There you go. Does Kate ever do any actual formal assessments? I know some states allow it, as my under I know in California we can have ot as actually do some formal evaluations they are not capable of, or they're not allowed not to say that they're not capable of it. Many OTs are capable of it, but they're not allowed to interpret the results. So does Kate actually provide like, will she give the Peabody or the berry?
Cait Bowen
Yes, I give the berries, but I don't score them, so I will administer them to my students, and then I give them to Mary to score.
Jayson Davies
Okay, and so, how does that work for you guys? Do you feel like you're able to get all the data you need from the interpretations that are not the interpretations, but from the actual protocol, as well as all the information, you know, maybe the handwriting samples and stuff like that that she provides you.
Mary KleinHeksel
Yes, for sure. And then she takes notes for me. I, you know, show her what to look for. I need please comment on this, like any fidgeting or that kind of thing, you know, some clinical observations during it as well. So she definitely contributes to it as well. And that is allowed. I know. I believe our national association allows that as well.
Jayson Davies
Yeah. So then Cait, how do you feel about doing the standardized evaluations? Is it just the berry that you're doing, or are there others?
Cait Bowen
Yep, that's those are the only ones that I do. I usually do the Beery visual motor and I do the Beery motor coordination.
Jayson Davies
And those are pretty once you learn them, they're pretty simple to administer them in my sleep. I think most of us can. Personally, I don't do the berry because our psychologist likes to do the berry, and so oftentimes she'll do it, but I don't get the information until, like, we're at the IEP, and so I do, like the ravma, or, you know, the bot or something to help kind of get some of the things that I would get from the berry, but everyone does it a little bit different, right? That's right, yep. All right. So you go through the evaluation, whether or not it's a one year evaluation or three year evaluation, reevaluation, what are the steps Mary that you take after. That to make sure that Kate knows the new information based upon the evaluation.
Mary KleinHeksel
So, yeah, so I will, I'll score it, and then based on Yeah, when the IEP is or sometimes, I'll text her right away, woohoo. You know, he did it. There's been a few big celebrations. Yeah, you were on a roll. There it was live. So yeah, and it's really good that for Kate, whether her treatments working is, you know what? I mean, that's good data to drive the treatment as well. Or, oh shoot, you know, you're We're close, but we got to hang on there. So yeah, so I will definitely share that with with Kate before the IEP,
Jayson Davies
okay, and then what are so, I guess the question is like, once you have the completed IEP, how do you relay that information to Kate on the new goals, any new information based upon whether it be things that the parent told you or insight that the teacher had during the IEP or something like that. Yep,
Mary KleinHeksel
so I take notes on that IEP form. I'll copy it. We have a it's called Power School, our IEP system. Okay, so copy that document. I'll put Kate's copy at the top. I'll take notes on the back what parents said, because, yeah, we have so many we can't, can't remember those details. And then, and then we'll meet over coffee, and yeah, and right then. And then I give that document that it's Kate's document for her to keep, because I have a I have a copy in Power School electronically. And as well as I could put a copy in my my files. So.
Jayson Davies
Great. That works out. Well, then cool.
Mary KleinHeksel
It does work out. And there's that weekly meeting, I think is important a key, right? It is to keep up on everything.
Jayson Davies
And so I have a question, you have a part time Coda too? Do you meet with the part time Coda individually, or is this a group team meeting?
Mary KleinHeksel
Nope, I meet with her on a different day as well, individually. So because she's at a different school so, but fun. Side note, we're all gonna meet, three of us, actually, Thursday for Professional Development Day. Yay. We never get to meet.
Jayson Davies
Awesome. We're gonna get into that in a minute though professional development. So hold on tight for that. Earlier, Kate, you touched upon a little bit of the documentation. And correct me if I'm wrong. But Mary, you have to co sign all the notes, right, the daily progress notes. Or is that not necessarily a thing?
Mary KleinHeksel
That is not a thing in Michigan. We do not have to. We keep our own notes in our charts. But yep, there's nothing for me to sign daily here, which is, which is helpful, I think why it works so well. I do have to sign quarterly Medicaid that's Medicaid notes, yeah, but yeah, that's the only thing that I have to sign quarterly.
Jayson Davies
And so are your quarterly Medicaid notes are those also the same notes that would potentially go home on like a report card or progress report for the kids? Or do you guys not have to do that?
Mary KleinHeksel
Yeah, no, totally different. So Kate does the progress notes. I look at those progress notes, but I don't have to sign them,
Jayson Davies
okay, but those progress notes do go home to the parents versus your progress or your progress or your note that you're doing for Medicaid is separate, correct?
Mary KleinHeksel
It's just for, for Medicaid, yeah, and for, like, an audited one time. So definitely was good. We were,
Jayson Davies
yeah, they're doing a lot of stuff with Medicaid, medi, Cal, all that stuff right now. It feels like they're trying to reorganize it a little bit, and it's crazy. I mean, we use a system called paradigm, and yeah, I mean, we have to input our note every day after at the end of the day, and it takes time. And I'm not the fastest. Diaper takes a little bit extra time, but.
Mary KleinHeksel
We do as well weekly. We do our weekly Medicaid students after our session and weekly, and then I have to approve that monthly. So Kate inputs it daily, or whatever. After she sees it, she does a monthly summary, and then I approve Kate's monthly summary. If that makes sense, yeah, yeah,
Jayson Davies
that does make sense. It's amazing how things are so different from, I mean, obviously from one state to another, but I'm sure you guys have probably, well, Kate, you've been in this district forever, or since you've been in OT a but I mean, even when you go from just one district to another district, things can be so different. And of course, state to state, county to county, all that. It's crazy how different things can be. So it's kind of cool being able to talk to people from different regions. Yeah. All right. The last area I kind of wanted to touch upon is RTI and RTI again, response to intervention for anyone who doesn't know. It yet. Check out episode 42 broke it down. All there for you. It has three different tiers. We have that level one tier, level two, level three. I identify level one as being very general, very like trainings and stuff like that. Do you guys participate in trainings, both where you're the trained, being the person being trained, as well as the OT or the OT a providing trainings.
Mary KleinHeksel
So yeah, we do so our RTI, we give training to the teachers, just general classroom teachers. They say, We have students that need help with their handwriting. At that point, then we're like, try these techniques, and then we do, we are requested to do some trainings for teachers as well, just, let's say, on fine motor as a whole. So we've done that. And I don't know, Kate, have you? I don't know if you've done that with me. No, I haven't think that was at the early childhood center. So I think Jody did that. So we'll do like a parent child day, where the parents come in and we'll Devon in service on that as well, and the teachers are there. So various, yeah, so various in services for them and then for us. I think it's more of like Kate and Jody just went to that Handwriting Without Tears, conference, that type of thing.
Jayson Davies
Yeah, going to seminars and stuff like that. So what are you guys doing this Thursday for your PD day?
Mary KleinHeksel
So we are working on that special, telling Jayson earlier, our special, we have a special sensory equipment coming out. We can't quite say everything yet, but a big reveal soon. So we're going to work a little bit on that. And then that's actually in some of our schools right now, that as a program so and then, so we're going to work on tweaking that. And then preschool, actually RTI Kate came up with this fantastic idea for RtI home, home activity boxes. If you want to elaborate on that,
Cait Bowen
I can't claim the credit for the original idea, but I did adapt it to fit our needs. So we call them fancy fingers fine motor boxes. And basically they're just a box of fine motor tools that can be sent home with a student, but we rolled them out. Two years ago. I got some funding through Donors Choose, and we rolled out 35 boxes so we really focus on the younger grades. We gave one to every kindergarten teacher and every preschool teacher. Is that right? Yeah. And so the boxes were a little bit different for preschool and for kindergarten, but we included instructions inside, and it was activities like pop beads or a tennis ball mouth or putty with beads, just things that we picked out to really work on those fine motor skills, and that's been a huge help. We got a great response from teachers. For those we've actually had to make, I just made six more in the fall, and we need to make some more for the preschool. So they've been very popular.
Jayson Davies
Awesome. So do these stay in the classroom or do they go home?
Cait Bowen
We kind of leave it up to the teacher. They can use them at their discretion. So some teachers like to use them as like part of a center as kids are going around the classroom, and that's helpful if a kid is really struggling and the teacher feels like there will be follow through at home, we've left it up to them whether or not they want to send that home for a couple weeks and then send it back to school so that another kid can have it. We just kind of leave it up to them.
Jayson Davies
Okay? And then, since I just asked you about sending things home, do you guys as an OT, ot a team, send home anything like homework? Do you give the child ot homework? Do you give them things to do at home or home exercise program or anything like that.
Cait Bowen
Yeah, I actually created monthly home exercise programs or activity lists, and we send those home every month to all of our students. And I just started sending home just some extra worksheets for students, things that we've been working on in our sessions that have been kind of challenging, just some extra practice at home, cool. So we're really building up on that follow through outside of the therapy session.
Jayson Davies
That's awesome. And so you have an Instagram account? I do, yeah, are pictures of these items on your Instagram account?
Cait Bowen
You bet I have pictures of our fine motor boxes. I have pictures of some of the things that I send home, and they're also available in my Teachers Pay teacher store. So people are welcome to check those out. It's just some great i. Extra worksheets that they can send home or use in therapy or give to teachers.
Jayson Davies
Okay, so I know the easiest way to find your TPT, teachers, pay teachers account is probably through your Instagram. So what's your handle? Kate, the coda. Is it all? I can't remember. Is it just Cait the cota, or does it have underscores in it?
Cait Bowen
Kate, underscore, the underscore. COTA.
Jayson Davies
that's what I thought. Okay, yeah, be sure to follow her. I follow her on Instagram, so be sure to follow her. And if you didn't catch that, there will be a link to her Instagram on the show notes@ots.com forward slash episode 44 so yeah, be sure to follow her, and then I want to continue on the RTI route. So you talked about Mary, how you do some some trainings for teachers. We talked about how Kate will go, and the other COVID You probably do yourself, because you have to have continuing education, going to seminars, going to things like that. What about the next step, level two, kind of getting into potentially individual classrooms, doing groups of some sort. Are you guys able to do any of that?
Cait Bowen
So our level two, we do a lot of the classroom adaptive equipment at that point. So we'll push in. We'll say, try a slanted writing board. We've typed up handwriting legibility rules from Handwriting Without Tears. That work, amazing. We'll give pencil grips. We'll try different pencil weights, yeah. So at that point, we'll push in, give ideas, and then have them try that as well, before moving forward with with a pull out. Tier three for us is then the teacher is like, it's not working. Then I'll, I'll get parent written, parent permission for an OT evaluation, for a pull out
Jayson Davies
Gotcha. Yeah, cool. So I think I meant to ask you this earlier, but do you guys do a lot of treatments in the classroom, or is most of it a pull out session?
Mary KleinHeksel
So I do a handful of treatments in the classroom. We've done it both ways. We've done small group pull out, we've done push ins, we've Yeah. So I think it depends on the students. Definitely depends on the student needs. But for us, I think a quick, quickest remediation is that, is that pull out at this point, that we're able to still do that. We're pretty lucky about that. So.
Jayson Davies
Gotcha, okay, but it sounds like at the same time you're giving the teachers the material they need, at least, especially in the preschool, kindergarten level, with those boxes that you're talking about.
Mary KleinHeksel
Yes, they have, they that's, that's part of those systems that we talked about, they have to try these things first, and they find that, wow, it really did help. Wow, yeah, miraculously. So, yeah, the it's all things that we're telling them that we're doing in therapy sessions, and too, I like when they send it home, then the parents alerted that it's an issue, and they can, they can buy in before you send home a scary ot form. What I didn't know anything was a problem. Well, they'll know before then they're looped in to the process that we found that really helps too.
Jayson Davies
Cool, yeah, that's good. So I think we're getting down to the end. I want to ask each of you one more question. Don't kill me if it turns into three more questions. But for each of you, I'll start with Mary as an experienced OT. What would be your piece of advice to an OT who is starting to supervise a coda for the first time?
Mary KleinHeksel
I would say the most important thing is have open communication. That's that's huge, like just, just be open and allow communication to flow both ways. You got to be able to take things you know, have mutual respect as well. You know, Kate is not my assistant. Kate is an assistant of Jayson public schools. Just like, Yeah, I'm not necessarily my special ed directors. OT, it's, I'm Jayson. So yeah, just have mutual respect for each other. And yeah, I think that will go a long way, but that communication is key for sure.
Jayson Davies
That's fantastic. But you did mention that whole supervision weird thing. I know in the past, it's been a little complicated, because you're the supervisor, but you're not their work supervisor. You supervise the actual therapy, not the actual person. I mean, you are not Kate's boss, right? You she works for, like you said, she works for the district. It's probably like the director of special education is officially her boss, or something like that. True. That is 100% true. Yeah, yeah. And so I think that's just what I want to make. I want to just clarify, because I don't think a lot of people understand that necessarily. And it is a very unique dynamic.
Mary KleinHeksel
It is unique dynamic. I think just the name. Of our occupations. Yeah, it makes it confusing to others. And yes, I think that's perfect clarification.
Jayson Davies
Yeah. I mean, I think it even took me a while to realize that CODIS stood for certified occupational therapy assistant versus therapist assistant. I mean, right out of school, it's like, Wait, yeah, is it therapy? Therapist? What does that even mean? Like, what's the difference? And then you come to realize, then you come to realize, oh, that's why it's therapy assistant.
Cait Bowen
Yes, and I feel so lucky that Mary, from day one, has always made me feel like an equal. I have never felt like her assistant or just someone lower on the totem pole. It's always been an equal feeling, and I'm so thankful for that.
Jayson Davies
Great that's good. Kudos to you, Mary,
Mary KleinHeksel
Cait is amazing. You should see that you can own her Instagram. She is very, just talented.
Jayson Davies
All right, so Kate, a similar to question to you. You can't talk about communication because Mary just stole that one. But what piece of advice would you give to a new to an OT a new maybe they're new, maybe they're experienced, but they're kind of being supervised for the first time.
Cait Bowen
And I can't say communication. Come on.
Jayson Davies
I'll let it slide.
Cait Bowen
I just think it's so important to have that good relationship with the OT, just a place of trust, a place like Mary said, of mutual respect, someone that you feel comfortable talking to about the good, about the bad, about the struggles. I think that's why Mary and I have been such a good team. Is it's been so easy to talk to each other. And I honestly, I think that's the biggest part.
Mary KleinHeksel
Yeah, each other, anything and just be, for sure, totally brutally honest.
Jayson Davies
Scary. Sometimes. Well, that's great. It sounds like you guys have a wonderful relationship, both in work and the actual therapy itself, as well as outside of work. It sounds like you guys are doing things together, which is super cool, but yeah, thank you so much for coming on and sharing all that information. I'm sure many OTs and OTs out there listening, we'll find it comforting to kind of hear how things work, and maybe we didn't talk about too many struggles. It sounds like you guys are doing really well, but it's nice to know what a good working relationship can look like, and I think people will be able to take away a lot from hearing what you guys have had to say. So thank you so much. I appreciate it for all of you listening out there. Definitely do. Go check out Kate's Instagram. Kate underscore, the underscore coda. She has a lot of great information there, and on her home page, I believe right now, she has a link to her Teachers Pay Teachers account too. So go check that out. If you don't know what TPT is, then, I don't know what you've been doing in life. TPT is amazing. They have so many free and paid resources and yeah, so thank you so much for coming on the show. I appreciate it and
Cait Bowen
Thank you so much.
Jayson Davies
And we'll have to have you guys back on sometime when you guys have a little bit more info on the super secret sensory tool. All right. All right. Well, take care. Have a great evening, and I'll talk to you next time. Thank you. All right. And that wraps up episode number 44 of the OT school house podcast. A very special thank you to Mary and Kate for coming on the show and explaining their ot OTA relationship. They obviously have a great thing going on there. Thank you also to the pencil grip for sponsoring today's episode of the OT school house podcast. I really appreciate all of you listening through this podcast, and we'll see you next time for episode 45 of the OT school house podcast. Take care and have a fantastic week. Bye, bye.
Amazing Narrator
Thank you for listening to the OT school house podcast for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed.
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