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OTSH 83: Evaluations vs. Screenings

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Welcome to the show notes for Episode 83 of the OT School House Podcast.

In this episode, Jayson shares the difference between screenings and evaluations. Using AOTA documents, IDEA references, and court cases, we will discuss when it is and is not appropriate to use screenings in a school-based setting. We will also briefly discuss how to ensure that your using a top-down approach when completing evaluations.

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Episode Transcript

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Amazing Narrator

Hello and welcome to the OT School House podcast, your source for school-based occupational therapy tips, interviews, and professional development. Now to get the conversation started, here's your host, Jayson Davies. Class is officially in session.

Jayson Davies

Hey there and welcome to Episode 83 of the OT School House podcast. Thank you so much for being here. For anyone who has never listened to an episode of the OT School House podcast, maybe you just saw something on Facebook about evaluations and screenings, and you hit play. I just want to thank you so much for being here and also introduce myself. My name is Jayson Davies, and I am an Occupational Therapist in Southern California. I'm the host of this podcast, the OT School House podcast, and I've been practicing as a school-based OT for about nine years now. And well in this episode, I am just super excited to get into the three keys to school-based occupational therapy screenings and evaluations.

That's what we are going to talk about today. How screenings are similar, how they are different from evaluations, and also when to use a screening versus an evaluation. So we're going to talk about what IDEA says we're going to talk a little bit about what AOTA says about screenings and evaluations. And then we're going to kind of bring it all together and talk about when to use which one and how they can impact your practice as an occupational therapist working in the schools. All right. So real quickly, usually, this is the moment in the podcast where I get to introduce our guests. But I'm going to take this opportunity since it's just me and you today to share a little bit about myself. I am a school-based occupational therapist as I mentioned in Southern California. And I do have experience as both a contracted occupational therapist and in-house or district employee occupational therapist. In fact, recently, I also had an opportunity to work as an online contracted therapist for a teletherapy company, which was very interesting, I must say, personally, my preference is to work within a school district. I just feel like you have a better connection with all the people involved. The kids, the teachers, the administrators, people up above you, the speech therapist, the other occupational therapist in the district, I just really appreciate that setting.

I'm also the creator and owner of and School House education LLC, which is kind of the overarching company that runs OT School House. So at OT School House, we provide professional development opportunities through this podcast their conferences, through recorded CEU or professional development opportunities. And you can learn all about that at and by listening to this podcast, really, this is really a place for school-based OTs to come to learn to be heard, I really like to interact with you. And with every single person that listens to this podcast. If you've ever sent me an email, if you've ever sent me a direct message on Instagram or Facebook, you know that I get back to you. It may be a week or two. But I will get back to you. It's something that I just believe in that we all need to communicate and get in touch. So feel free to hop on Instagram, if you're not driving, and send me a quick message saying “hello, let me know you're listening to Episode 83”. And just that, you're enjoying this, that you appreciate this, and that you want to learn more, you can even drop a message in there and say, Hey, Jayson, I'm really trying to do this at work. I'd really love a podcast about whatever that is that you're working on, I will definitely try to get something in here for you.

So if you're here today, listening to this podcast, you saw the title, maybe you just listened to every podcast no matter what the title is. But this particular title, maybe you saw it and it said evaluations and screenings. Well, you're probably just like me, your school-based OT practitioner who wants to do right by the children and the students you serve. And by that I mean, you want to know when should I do an evaluation? Or when should I do a screening? What's the difference between the two? You're right on, you're in the right place. You might also be wondering, you know, how can I make my life as a school-based occupational therapist easier? I've heard of people using screenings. I've heard of people using the evaluations. But sometimes it seems like a screening can be an evaluation or an evaluation is a screening. How does that make my life easier if I screen? Or how does it make my life more difficult if I screen? Well, we're going to talk about that in a little bit.

Okay. So, today, we have three overarching key points that we're going to go over. And those three, I'm going to lay them out right here so you know what to expect are, why screening is not an evaluation, how to use screenings as a means to reduce unnecessary evaluations and actually help more students. So how you can help more students even though you're actually going to be evaluating fewer students. And also how to how to produce effective evaluations to support individual students, we're going to go over that just a little bit as well. So we're gonna start with what I think most of you are very familiar with. And that's OT evaluation, not everyone's screens. But I think everyone does occupational therapy evaluations in the schools. I'd like to share with you a direct quote from the Individuals with Disabilities Education Act, also known as IDEA. And well, this is talking about evaluation. So listen really quickly, each public agency must conduct a full and individual initial evaluation in accordance with other parts of IDEA before the initial provision of special education and related services to a child with a disability under this part. So basically, it's saying that we must conduct an evaluation, not screening and evaluation before the initial provision of special education and related services are provided.

As an occupational therapist, we are a related service provider under IDEA. And so in order to provide a student with services, under an IEP as a related service, we must have an evaluation. If we are going to provide that service to the student, whether it be an individual or even a small group service, or even consultation on behalf of that specific student, we need to have an evaluation. The fourth and most recent edition of the occupational therapy practice framework published in Asia by AOTA, notes that the evaluation process is focused on finding out what the client wants and needs to do, determining what the client can do or has done, and identifying supports and barriers to health, well being and participation. Participation is the key word there because as school-based OTs, we are really focused on the student's ability to participate and access their curriculum. Within the Individuals with Disabilities Education Act, they don't break down different evaluations like what an OT evaluation should look like, versus a speech evaluation, versus a psychoeducational evaluation. But they do list out in Section 300.304, that we must use a variety of assessment tools and strategies to gather relevant functional, developmental and academic information about the child, including information provided by the parent, that is a key one information provided by the parent, I recently went through a due process. And well, I'm not gonna lie with you, I'm not perfect, I omitted getting parent information. I might have called the parent and left a voicemail, but I never actually got the information that I should have gotten.

Usually, I sent home a questionnaire at the very minimum or a Google form in this case, to be honest, I can't remember if I sent it out, but I did not get that information back. And that was something that, fortunately for me, and never went to due process. But that would have been something that I would have had to potentially explain in that due process. So be sure that you do get some parent information. It also requires within IDEA that we use more than one tool to determine the need for services. So we can't just use observations, we can't just use that parent information, we need to use multiple tools, that could be an observation in addition to a standardized assessment tool, but you still need to be sure to get that parent information. And then also laid out in Section 300.304 is actually that we just need to be at the goal that is actually laid out in IDEA. I thought that was almost a little silly that it had to be mentioned there. But it is there that we have to be ethical.

While AOTA and the OTPS occupational therapy practice framework don't necessarily mention using a top-down evaluation procedure. I think that's something that we all learned in OT school is kind of starting with that very general top theme that concerns overarching concern, and working our way down. And so that is the evaluation process that I use as well. And what that kind of looks like is starting with that student's occupational profile, getting a good picture of them, their strengths, and their concerns. And then from there branching down to the embedded observations to actually get into the classroom and see or translate almost, if what you were told or what you found out by doing a review of historical records and talking to the parent, if what they told you, you can actually see within the classroom happening from there, going down a little bit further then we can pull out this year. And do some structured observations and our standardized assessments in a controlled environment. You can also within that controlled environment, and actually in the classroom, if you want it to is try some relevant trials, if you have the opportunity, you can say, Hey, we still have a few weeks before the IEP or before that assessments do, let's see what happens if I give that student a pencil grip. Or if I put some Thera band around the chair, or if I try one of those other strategies that can be implemented, right within the classroom, that's okay. And that can go into your evaluation. And maybe at the end of your evaluation, you find that those trials that you completed are actually enough for the student as possible.

After you do all of that the profile, the observations, the assessments, any trials that you want to do, then you have to be sure to include two more things, your interpretations. What does everything that you did actually mean? This is really where some reports, I see fall apart, and I've been guilty of that, too. You know, we can't just summarize our findings, we need to actually interpret our findings. What did it mean that the students scored below average on this assessment, but average on this assessment? How does that impact the student's ability to complete classroom activities, that is all part of the evaluation, and then at the end is when we can summarize that up. And even if your district wants you to provide a very specific or general recommendation, some districts even want you to add goals into your evaluation. Again, that's up to the district, it is not required. So I do actually have a tool and I want to offer this to you, you can head over to And you will get the checklist that I use during my evaluations. And this is something that just helps you control or not control, I guess it helps you ensure that you are using that top-down approach. If you go down the list in order, you will be completing a top-down evaluation. So that's going to wrap up our discussion on evaluations. But now I would like to take a moment to talk about screening.

So let's go ahead and jump into that. Now I want to start off this section of the podcast with a very clear statement. screenings are not evaluations. This is another quote that comes from IDEA section 300.302. The screening of a student by a teacher or specialist to determine appropriate instructional strategies for curriculum implementation shall not be considered to be an evaluation for eligibility for special education or, and related services. So it's saying that screening is not appropriate in order to qualify a student for eligibility for special education and or related services. So it's not exactly identifying what screening is here. But it's saying that screening is not enough. It does say that screening is really for determining appropriate instructional strategies for curriculum and implementation and around about way, again, this is section 300.302. If you'd like to listen, or sorry, not listen, look it up for yourself in IDEA.

So this is kind of how I break down evaluations versus screenings, and evaluation is individualized, right, you're going to only look at one student, when you do an evaluation, you're not going to see three students and give them all the bot at the same time. That's not what we do. An evaluation is always individualized. The evaluation also will have implications for an IEP team right? After you complete your evaluation, you're going to go in and you're going to give a report to that IEP team, you're going to let them know what the strengths for the student are, what the weaknesses for the student are. And also you're going to present goals and whether or not you recommend services. It's also 100% required before the provision of related services. And occupational therapy, as it relates to IDEA is a related service. Now there are ways to provide services as an occupational therapist without going through IDEA. And that's where the education or sorry, Every Student Succeeds Act of 2015 comes into play. And that's kind of where we're going to go with the screenings. But for this, if you're going to provide services to a specific student, you're going to need that evaluation.

Now, on the flip side, screenings do not have to be individualized. You can maybe not the bot but you can use some tool and provide that screening to an entire classroom or an entire group of kids. It is not necessarily individualized. Screenings are also used to determine appropriate instructional strategies. Whereas the evaluation is used to determine related services and goals. Screenings are used to determine appropriate instructional strategies. Those instructional strategies could be put in place by yourself alongside the teacher, or you can provide the teacher with recommended instructional strategies. And that teacher can then carry out those strategies, you are not providing an individualized strategy, you're providing strategies for the entire instruction. And finally, you can probably already assume this, but screenings do not result in the provision of related services. So now, if screenings don't lead to services, then why would we screen right?

As an occupational therapist, you were hired by special education to evaluate and treat students and to go to their IEP is to write goals to write progress on the report. That's what you were hired to do, right. But if you can't do screenings, I shouldn't say if you can't do screenings, because everyone can do screenings. But that's what you're hired for. And so what does it mean to make that shift over to screening and why would we want to do that? Well, that brings us to the second part of this podcast, where screenings as a means to reduce unnecessary evaluations. And to help more students, you may have heard the term RTI, RTI, or MTSS, these are all multi-tiered levels of systems that we put in place to support students before they need special education, and occupational therapy, as specialized instructional support personnel under the Every Student Succeeds Act of 2015. We can absolutely 100% partake in that RTI, which stands for response to instruction and intervention, RTI, or MTSS, which is multi sorry, got to make sure I get that right, multi-tiered support systems. We can participate in those different systems, whether they call it RTI, MTSS, or just multi tiered system. So just to break down RTI, a little bit, there are three tiers, you have tier one, which is strategies for all, a tier-one strategy would be something like, using appropriate posture, we know that's going to help every single person in the classroom, including the teacher, so if we can train teachers about posture, then they're going to translate that into their students, everyone's going to have better posture, therefore, they're going to have more success, or at least that's in theory, right?

Well, maybe you provide those postural strategies, and I'm just using an example that doesn't have to be about posture. But maybe you do share these postural strategies with the teachers, the teachers, in turn, do share that with all of their students. Well, you just helped an entire school at that point. Maybe the more if you presented this at a district level? Well, now, say there's a group of students that don't quite or maybe the entire classroom, one of those three classrooms that you presented to, they still need a little bit more support. Well, that's when you get into a tier-two strategy, where you are really providing that it's not individualized, but it's more specific to that entire community of the classroom, the classroom as a community. So now maybe teacher number two comes back to you and says, you know, what, my students are still kind of fidgety. And, you know, it's just I need a little bit more, would you mind coming into my classroom, just observing the student as a whole, not one particular student, but just looking at the student as well, or looking at the community that is the classroom and providing some potential strategies that I could use. So that would be more of tier two, a tier two strategy under RTI or MTSS.

Now, tier three is where we get a little bit closer to that line of what is individual services and what is still under that RTI, what's special education versus what is RTI? And some districts will even identify tier three as being a referral to special education. I don't think that's quite right. In my opinion, tier three is for students that are kind of on a student support team sometimes called an SST. It's almost like a mini IEP, except it's really just a consultation between the administrator, the teacher, the principal, and maybe yourself if you're involved. There's not going to be special education teachers involved at this point, but you can still come in and provide general strategies, not student-specific strategies, General strategies. Think about a teacher who's googling for students. is kicking legs on under the desk? sure that student is or that teacher is thinking about a particular student. But you don't need to know all the information in order to answer that Google question, right? You have some general strategies that may support that student without knowing any more about that student. Maybe the teacher tried the strategies that you gave to the entire district, that just the strategies that you gave to her as a classroom. But there are still, maybe two or three kids in her classroom that are still fidgeting without doing any evaluation. Again, you can provide some very general strategies.

RTI, two, aims to prevent students from requiring special education through this tiered prevention. So by providing those tier-one strategies, we're helping the entire school, maybe even the entire district. at tier two, I like to think of it as helping either a specific grade level, maybe three teachers that are all third-grade teachers, or at the individual classroom level. When you get to tier three, you may be talking about an individual student, but you're still providing general strategies as opposed to student-specific strategies. So now, where do screenings fall into the whole RTI or MTSS process? Well, I kind of alluded to it a little bit earlier when I talked about tier two. And that's where I feel screenings can have the most impact when it comes to supporting classrooms and supporting students conducting a screening for an entire classroom. Remember, tier two would be an entire classroom, or maybe a group within a classroom, you can then lead to that collaborative intervention with that teacher. So let me lay out what that might look like. We'll get away from the postural example. And we're actually going to move now to a handwriting example, mostly because I feel like this is the area that it's easiest to transition to, to start screening and start that RTI process. It is something that all the teachers recognize us for, and therefore we can use that to start the process.

So let's say you just provided some general handwriting strategies through an in-service for all of the kindergarteners and first-grade teachers. Well, now, teacher number two in the first grade comes to you and says, Hey, Mr. or Mrs. so and so I loved those strategies that you gave me, some of them are working. But there's still this going on, maybe it has to do with students writing, like literally on the line versus on top of the line, maybe she has several students that are writing letters. And they don't understand the big small talk, where you place letters either on the line to the top of the line, and so forth, right ground, grass, sky, and dirt letters type of thing. Well, now you can then work with that teacher and maybe set up a time for three weeks in a row where you can go in and co-teach that. And you can bring in your materials, you can bring in your sky grass, dirt, paper, 30 copies of it, and do it with all the students, as opposed to pulling out just that one student that might have a little bit of trouble with it. You also don't have to take the time to evaluate that one, maybe three students that are having trouble, you can go in and support the entire classroom. So odds are that first-grade teacher, especially if it's a kindergarten, kindergarten teacher, they are going to be working on some sort of handwriting. And maybe it's not directly handwriting, if it's in first grade, maybe they're working on sentences. But that doesn't mean that you still can't be a part of that lesson, and kind of focus on the actual act of handwriting while they're working on the act of the grammar of putting a sentence together per se. So that screening can then lead to some intervention within the classroom.

Now that I've discussed a little bit about how that screening can help you, let's talk about the steps to a screening. There are three steps that I'm going to lay out here first, and the first one is to determine the need through teacher feedback. So obviously, in the example that I use about handwriting, the teacher came to you and she said or he said, Hey, I have some difficulties with my students writing on the line. Their kind of their G's are on top of the lines, their Q's are hanging down below the line, whatever it might be, that she's giving you or he's giving you some general feedback. Based upon that feedback, you're now going to go into the classroom and either observe the classroom from afar, you're not looking at any one child in specific but you are there to just observe the general setting. However, if you're going to be screening for handwriting concerns, it may actually be more beneficial for you to use a screening tool such as maybe the print tool or the etch, which is the evaluation tool for children's handwriting if I got that, right, etc, ah, and you can go in and it's not an evaluation, because you're going to give it to the entire class at once. The print tool is a pretty simple tool. However, if you want to go even more simple than that, you can have all the students copy a sentence and write a sentence on a piece of paper, they don't need to put their name on it, and they can turn it into you. Now you can look at those 30 papers or 25 papers, whatever it might be. And based upon those, you can develop an idea of what supports those students need, then that can lead to your intervention, which leads to number three, which is collaborating with the teacher to determine potential solutions.

So, meet with the teacher after school that same day or that same week, at some point, and say, Hey, this is what I saw based upon your students turning in those papers to me. And you know, I don't know which student had these difficulties. But I saw about five students that had this going on, I saw a few students that had this going on, here's how I can support you, do you have any lessons coming up, where you're going to work on writing, is there a time that I can push in and work with you a little bit, I would love to teach you so that you can, in turn, continue to support them throughout the rest of the school year. So that is one of the potential outcomes of screening, maybe you do end up collaborating with the teacher. But there are also two other potential outcomes from a screening. One is very simple and is literally just providing strategies. Maybe you went in, you observe some postural instability, and you said, Hey, a few things that might work, I can provide you with these tools, and you can easily use them within your classroom. Or maybe I can provide you with some handouts that you can post up and explain to your kids once a week and remind them about postural stability and being able to touch the floor, or the ability to stand while doing work.

Instead of sitting if they don't feel comfortable, whatever it might be, there are so many different options to there are so many different solutions to a number of difficulties, and you can work to provide that for your teacher. And then your teacher can implement that. The other potential outcome of screening is a referral. And I know some people will use a screening. And when I say people, some occupational therapists will use screening to determine if an evaluation is necessary. That is not what I'm saying here. By all means, and I will make this as clear as I can, you should not be screening an individual student. As soon as that student is told to you that there is a concern by name and you know that student by name, that is essentially them saying an evaluation is needed, the bar is very low when it comes to when a new evaluation is needed. The reason that I am so persistent on this about screening and not being an evaluation on vice versa. And not using screening as a way to determine whether or not you should complete an evaluation is because there have been lawsuits where that has turned out poorly, where someone completed a screening, but then did not do the evaluation based upon that screening. And so I'm going to share that lawsuit with you in just a few minutes.

But I want to continue on first and kind of go through. It'll make more sense if we go through everything first and then go for that lawsuit. So bear with me. However, in the sense that I was talking about a screening where you are determining instructional strategies, there is the possibility that while you are screening the entire classroom, that you do see a student that you really believe needs a referral. And when that happens, you need to work within your school's guidelines for referring a student, you probably need to work with that general education teacher in order to refer that student. After all, it is really the general education teacher that has that concern. Or even if you're in a special education classroom, that special education teacher that has that concern, whether they have an IEP or not, you can still be a part of that referral process. Maybe you're in the classroom and you see a student that has no services at all, no IEP at all. But you see something that is concerning, you probably want to start with a psychoeducational evaluation, or perhaps a speech evaluation. Because those services are kind of the kickoff to special education. Speech can be a standalone service. Occupational Therapy, in most states, cannot be a standalone service. If you can be a standalone service, then maybe you could refer the student to yourself. However, you probably want to start with whatever your district has outlined. When it comes to referrals.

The second example is if the student already does have an IEP, maybe the student already is identified as having an IEP and needing additional supports. Well, in that case, maybe you could go to the case carrier, and let them know what you saw and why you think the student may need a referral to yourself or to another special education provider. So to kind of summarize those three outcomes of a screening or the potential outcomes of screening, it could be as simple as providing strategies to a teacher, you may provide strategies and then also help in the implementation of those strategies through a collaboration or co-teaching model. Or you may also decide to submit a referral for a formal evaluation of a student. And again, work with the teacher to do that, it should not just come from you, you should have that discussion with the teacher to make that referral. Just like any occupational therapist, when there is research about something that we're discussing, I want to share it with you. And there are two sides to the research here because RTI MTSS tiered supports are relatively new as his screening when it comes to an occupational therapist, the SSA Every Student Succeeds Act that describes us as specialized instructional support personnel was only passed in 2015. There just isn't a lot of research. In fact, I couldn't find any research related to occupational therapists providing screenings within the school system and the effectiveness of doing that.

However, there are many research studies out there about the effectiveness of handwriting programs for an entire classroom or for many at-risk kindergarteners, for instance, the journal club that we had just on episode 82 of the podcast, where Dr. Beth and Dr. Sheryl came on and described how they use the size matters handwriting program to assist several students, not just a single student who had an IEP, they saw all students or not all but a large group of students of kindergarteners that were at risk. At risk, not necessarily meaning that they had an IEP. In that case, it could be called a tier two intervention that the occupational therapists were seeing students not with an IEP, but in a group because of their concerns based upon a teacher screening. Beyond the research, I also have an actual court case that I'd like to share with you. And this is actually the court case titled Terrence Dee versus School District of Philadelphia, and it comes to us from 2008. So it is 12, almost 13 years ago, probably. But it does kind of explain why we need to be sure that we are using screening and an evaluation appropriately. Because if you use one when maybe you should have used the other than, well, it might come back to haunt you, like it did in this case. The lawyers for Terrence Dee argued and correctly I might add, they argued that Terrence actually was not fully evaluated by the occupational therapist, when the district said that they were completing an evaluation. Instead, they quoted that the Occupational Therapist performed only a cursory OT screen and failed entirely to assess tolerances need in the sensory area.

Now I know everyone has their own opinion on sensory in the schools or whatnot. But if you say you're going to assess something, then you need to assess it. Or if there's an area of concern within that area of sensory, you need to assess it. Right. So what happened then, based upon those findings that the occupational therapists never fully evaluated, Terrance, well, turns out turns did eventually qualify for Occupational Therapy through a full evaluation at a later time, the court ruled that if any evaluation would have been conducted earlier, a full comprehensive evaluation rather than an "OT screening", then Terrance would have had occupational therapy services potentially for a much longer time and at an earlier period. So the Occupational Therapist did that cursory screen, it went to court at some point and well, the school district did actually lose that argument. And compensatory strategies were required to be provided. The lawsuit doesn't actually state that OT services were part of those compensatory services. But it also doesn't say what services were required. So I'm going to assume that OT was part of that based upon the outcome, however, I could potentially be wrong, so take that with a grain of salt.

The court also found that the district actually violated the Americans with Disabilities Act by withholding public services because of this whole debacle for lack of a better term, I guess I can say. So with that, I think I gave you some evidence that shows Yes, we can be efficient within the RTI setting. I think I also shared with you some decent points as to why screening is not an evaluation. And I laid out a little bit about what an evaluation should look like and what screening should look like. Remember, you can get that checklist that I use at I'll also make sure I put a link to that in the show notes for this episode. But I just wanted to make sure that you have this overview of screenings versus evaluation and know the difference between the two. I think sometimes those words, those actions of screening versus an evaluation can get misused and confused. And a speech therapist might use one and you might use another and some people might kind of say, well, the speech therapist said screening, you said evaluation, but they sound the same.

Well, now this can help you to identify maybe some common language to be used within your school, or even at your district. And you can also use this to share with your administrator the next time they ask you to do a screening and ask them to really define what they mean by screening. Are they really asking you for any evaluation? Or are they asking you to complete screening, all very important things that need to be identified within your role as an occupational therapist in the schools? Alright, well, that is going to wrap up our discussion on evaluations and screenings, when to use them when not to use them and how they can support you.

Before I let you go, I do actually want to let you all in on. A lot of this information actually comes directly from my course, the A to Z school-based OT course, the A to Z school-based OT course really is the perfect course for anyone that is either currently or transitioning to a school-based occupational therapy job in the course we really start from scratch and work our way all the way up within the school-based OT realm. We start with understanding what school-based OT the role of school-based OT is in schools, we then move on to the referral process and RTI strategies that you can put in place. I even provide an entire slideshow for you to complete as an in-service for your teachers. I mean, I have a lot of resources in there, so be sure to check it out. From there, we actually talk about evaluations, I give you templates for evaluations. And then we go into actually dealing with IEPs, treatment planning, and even how to exit a student from occupational therapy. That is all included in the A to Z school-based OT course, which you can learn more about at I will definitely put a link to that in the show notes as well. Until next time, take care, and yeah, just enjoy your week. 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 until next time, class is dismissed.

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