OTSH 84 - Journal Club: OT in High School & Post-Secondary Transition Planning




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"Help! I was just assigned to a high school & I have no idea what to do!!"


Ever had that thought before? It is not uncommon for me to receive an email with something like that in my inbox.


Now, I am no specialist in providing OT in high schools, but just like you, I can read some articles and listen to others who have done it before to learn from them.


In this episode, I am sharing my experiences from working at the high school level and also what I learned from two recent articles about OTs providing Post Secondary Transitional (PSTP) Services.


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Links to Show References:

  • Doris Pierce, Amy Spence, Lisa Sakemiller & Celeste Roberts (2021) School-based Transition Readiness Services for Adolescents with Disabilities, Journal of Occupational Therapy, Schools, & Early Intervention, 14:2, 207-224, DOI: 10.1080/19411243.2020.1835601


  • Pierce D, Sakemiller L, Spence A, LoBianco T. Effectiveness of Transition Readiness Interventions by School-Based Occupational Therapy Personnel. OTJR: Occupation, Participation, and Health. 2020;40(1):27-35. doi:10.1177/1539449219850129

Episode Transcript

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Jayson Davies

Hello, and welcome back to the OT School House podcast for Episode 84 today, so happy to have you here. My name is Jayson Davies and I am a school-based occupational therapist in Southern California. One of the most common questions that I get on social media refers to high school. So today we are going to do just that. We're going to talk about high school. And I'm not talking about, you know, my terrifying and also glorious days in high school, with marching band and animation class and Spanish, all those things that man I just couldn't do today, I couldn't remember half of that stuff. But we're gonna talk about occupational therapy in high schools, also in middle schools because that's kind of that transition period into high school.


Traditionally, most occupational therapists work in elementary schools. But one day, we often get the call and say, Hey, you know what, we have services that need to be provided at the high school, and I need you to provide those services. And we look like a deer in the headlights we don't know what to do. And I do get questions on Instagram and in my email box about Hey, what do you do with high school students? What do I do with high school students? How do I support these students? What is educational for high school students, and maybe what about transition or planning, we did have an episode earlier about transition planning with a special guest? But I do want to go a little bit deeper than that. Because, well, I'm not a specialist in high school services, I have provided services at a high school for a total of about two years at two different high schools. That is my total experience within the 10 years that I've been a school-based occupational therapist.


So I am by far not a specialist in that area. But just like you, I do have the ability to look up research to find articles to support what I can do. And so that's what we are going to do in today's episode, we are going to dive into a little bit of research. I actually have two articles today that we're going to be discussing. They're both from the same core researchers, but they have different not opinions, but differing visions. I should even say that they do have similar visions. It's the same research, but it's pulled two different ways. And so I want to share this with you because they not only looked at the quantitative data as to whether or not the students made progress and what they did. But they also looked at the other side, the qualitative side of the occupational therapist who provided that service, what their perceptions were, how they experience the services that they provided to students. So let's go ahead and cue the intro. And when we come back, we're going to talk about high school and even those older middle school kids as they transition from high school and out into the real world. So enjoy the music. Stay tuned, and I will be right back.


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 is your host, Jayson Davies. Class is officially in session.


Jayson Davies

All right. All right. All right. We are back like a Lincoln commercial from Matthew McConaughey. And we are ready to discuss High School and occupational therapy within the high school. I cannot believe I just use All right. All right, all right, in a podcast. Anyways, let's go ahead and get started. We have two articles that we are discussing today. The first is titled "School-based Transition Readiness Services for Adolescents with Disabilities", and the second is actually a very similar title, but it is the "Effectiveness of Transition Readiness Interventions by School-based Occupational Therapy Personnel". Both of these articles have the same primary researcher and the name of that researcher is Doris Pierce. And there are a few other researchers that collaborated with Doris on these articles. The first article is Doris Pierce, Amy Spence, Lisa Sakemiller, and Celeste Roberts. The second article is again, Doris Pierce, Lisa Sakemiller, and Amy Spence. But instead of one of the other therapists, we have Tony LoBianco that also helped out with that second article.


These articles are relatively recent, they come from 2019 and 2021 of them come from the Journal of Occupational Therapy, Schools and Early Intervention and the other comes from the OTJ or Occupation, Participation and Health Journal. As I mentioned earlier, one of these is more of a quantitative article and the other is a qualitative article. The quantitative article looks to see if transitional services provided by an occupational therapist would be effective for students in high school, aged 14 to 16. The other article looked at that same exact that's same exact research, but from a different lens, they looked at a qualitative idea. And they actually spoke with the occupational therapist to see what their impact was and what their thoughts were about providing these services to transitional age students. And so we're going to talk a little bit about both, I am really hoping that I can eventually have doors or one of the other researchers on here to go more in-depth with these two articles. I think that'd be awesome. But for now, I really want to share with you what I learned from these articles, as well as some of my experiences from working in high school and how I participated as an OT within a high school setting.


So I'm going to go ahead and actually start with sharing some of my experiences in high school. In fact, I don't think I've ever really had experiences in middle school, I've always done either elementary or high school. But with that said, my very first year as a school-based occupational therapist, and actually, as a contracted school-based occupational therapist, a high school was one of my assignments. And my goodness, I had no idea what to expect, and I had no idea what I was doing. Now looking back on that. I really did approach working with those students in high school. Well, actually, all my students at that time, from a very clinical based model, I had had volunteer experience in a clinic, I had also completed a level two build work at a CCS, which is a California Children's Services, which is very much a clinical model as well. And so when I got this job, I knew the thing to say, because people had coached me and what an IEP is. But, when it came to the treatment side of things, all I knew, was very much a clinical model. And I was very much working on performance skills as opposed to functional output for the students. In that sense, I would potentially go into the classroom and work on things like range of motion with students with severe disabilities and, and motor disorders. And I would work on simply pushing a button, but there was really no functional aspect to it. And I had no idea what I was doing.


Fast forward about eight years, and I had another round of opportunities to work in high school, and man were things so different. Rather than working with them on the performance skills that they had probably been working on for 12, maybe as little as eight years with their occupational therapist, in K through eight, or even early intervention through eighth grade, I went a different route. I started to have conversations with the students with who I could have conversations, and ask them what was meaningful to them. What did they want to do after high school? How can I facilitate their ability to make that happen? The kids who were in RSP resource, and mostly in general education, for the most part of their day, really were able to tell me what their plans were after high school. And I was able to support that and support them in that opportunity. We talked about jobs, we talked about college, we talked about what might be needed in order to make those things happen. I had the opportunity to work with students that were both in that ninth grade through 12th grade, traditional high school age, but also students who were in post-high school classrooms from that 18 to 21-year-old range.


And you know what, I found that they were so similar, especially those classrooms with students who had moderate to severe disabilities, they were no longer focusing on math skills, and history and science, they were now focusing on daily life skills and being able to eventually leave high school and be as independent as possible. And so you know what, that's what myself and my speech therapist that I worked with, there, really tried to do, rather than pulling students out to just working on some simple, meaningless handwriting that they might need to learn. We embedded ourselves into the classroom, where we could teach the aides, the teachers how to actually implement that in the classroom. Not only do we help the teachers and the aides, but we developed a rapport with every single student in that classroom. And they knew who we were. And as many of you know, especially if you have dealt with teenagers, maybe even teenagers of your own, that rapport is so important. They know when to call BS on you, right? And so you have to have that rapport with them. And you start to see where they are not functioning within their community, their community, is their classroom, the school, and the larger community, the city, the county, whatever it might be. And so that was how we saw our role was by helping them be a part of the community.


So we got away from those performance tasks that they had been working on for so long with occupational therapy. And we really started to focus on how they can be independent at school and in the community. In regards to the term and idea of post-secondary transition planning or PSDP think I said that right? I had never even heard of this term when I had my first stint in high schools with students with disabilities and as an occupational therapist. I didn't know what a transition plan and I don't even remember hearing the word transition plan. When I was in that first, that first job, that was back in 2012-2013. Fast forward to 2000 and about 18-2019. At a new school asked to work at a high school, I definitely became more familiar with the transition plan. But never did anyone ever asked me to help out with it, I'd be in an IEP, and the teacher would kind of review what was on the transition plan what they had created for the transition plan. But it wasn't really something that I was included in. I guess I knew it existed. But I was not part of the transition plan is how I would best describe my role within the PSDP. So now I have done the research I have learned, and there is so much more that I believe we can do and that we should be doing. And it's really funny that we often are not included in a transition plan because ADL is is like one of the key points to a transition plan, making sure that students can actually live independently in their life skills. And if that's not OT, then I don't know what OT is, right. So I think it's almost comical that we are not embedded in that we should be. And that's going to bring us now back to our research articles that really share how we can and what we can do in order to be a part of that transition plan, and why OT being a part of the transition plan is truly effective. So let's go ahead and dive into a little bit about the articles.


So Doris Pierce knew that IDEA mandated post-secondary transitional planning and services. But what they could not find was a lot of research, at least on the occupational therapy side, showing how OT is provided for these PSDP services and planning. And also whether or not that was effective, you know, if you have been in the high schools, you might know about the basics program or other programs that that teachers use in order to facilitate life skills and whatnot. But there isn't really anything out there for occupational therapists. And so they knew that IDEA use language similar to the language that we might use in our OTP at the board. You know, words and phrases like life skills, work skills, self-determination, are all words that are used within IDEA are phrases used within IDEA that we as occupational therapists know, that are meaningful in a patient's life or a student's life because that's what's in our occupational profile. We have research that shows that OT does help with life skills, work skills, and self-determination. And I know a lot of us to get frustrated by those who just think that we help people get jobs. But for these students who are in high school, looking to the future, that's exactly what we do for them.


We use both occupations as a means and as an answer to help them to develop the skills that they need to be successful and whatever is meaningful to them, right? I get that we feel slighted when people think we just help people get jobs. But in a roundabout way, that is exactly what we do. And so Doris Pierce and the other researchers that were a part of this wanted to look into what a program might look like in the high school for Post Secondary Transition. And they also wanted to determine whether or not occupational therapy can be effective in helping students in their post-secondary transition planning. So what did they do then? Well, they found some OTs and they found some students and they got busy. They actually found 42 students to participate in this research study, along with 10, occupational therapists and four occupational therapy assistants. So a total of four Occupational Therapy - Occupational Therapy Assistant teams. Now, the students who were a part of this research study were adolescents with IEPs and disabilities who spent at least part of their day in general education. Surprisingly, the funding that they received required that the students did have some form of general education which was mandated by the state who helped to fund the study. They also required that the students had an IQ of 60 or greater. This led to them having a pretty diverse set of students.


Some of the identified criteria on an IEP included Asperger's, autism, and learning disabilities. But no matter their identified disability on the IEP, they all spend at least part of their day within a general education classroom. So this is where thin