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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 things get a little interesting now because you know, when you're reading a journal article, you really want to know what the therapist actually did in order to see the progress that was made right? Well, that's not exactly what they did here. The researchers actually pointed out that they wanted this to be as realistic to occupational therapy in the schools as possible. So they actually didn't give the school-based occupational therapist a specific program, because they know that that's just not realistic for most school-based OTs, which I thought was absolutely amazing that they did that. And that they actually included that, because we all want to have this cookie-cutter program to implement. But that is not always the case. And so they actually specifically put it in the article that they didn't do that cookie-cutter program because they knew that therapists wouldn't be able to follow a cookie-cutter program.

So instead, what they did was something more like what we might actually do. They had an annual meeting where the therapist got trained in some different ideas in different theories. And then they also had monthly meetings, like many of us also have with our OT team, if you have an OT team, or maybe you go into Facebook once a month to ask a question or whatever that might be. But they use monthly meetings, to then give more ideas, and to also collaborate and see what other therapists were doing, and get ideas and bounce those ideas off of each other, so that they could then use those ideas at their school. I found this very unique and really intriguing because that's what school-based OT actually looks like. It is not a perfect program. And even when we are given a program, we know that those programs don't typically go exactly as they say in the book, right, they have to be accommodated for and adapted in order to meet the needs of our students. So I really appreciated how they use this intervention.

Now, because this was a post-secondary transitional planning and research project, they didn't use assessment tools that we might typically use, they weren't going to use the BOT, they weren't going to use the sensory processing measure, they weren't going to use the sipped, obviously, because the students are too old. But just because that was not what they were focusing on. So they ended up using two assessment tools that honestly I had never heard of. The first is the Scales of Independent Behavior Revised. And this was a self-report from the student. In most cases, they were able to get that self-report, although they did mention that in some instances, they had to get help from a teacher or a parent to fill that out. And the SIBR includes four scales, I guess you could call them the motor scale, the social interaction and communication scale, personal living skill, and community living skills. So that was the SIBR and actually, the SIBR had been used in the national longitudinal transition study, which is the largest national study for students going into the workforce from school, and that they use to track whether or not students with special needs are getting jobs at the same rates, which they're not, it's much lower as their typically developing peers.

So they did use that same tool that was used in a very large study, which kind of shows that, you know, they, they're using something that is valid and reliable. The second tool that they use with the arcs, the ARCS self-determination scale, and was to assess self-determination, as it implies in the name of the assessment tool. So this was used, it wasn't something that had been used in the national longitudinal transition study, I don't believe, but it is something that gave them some information. Now, in the findings, they ended up finding that the arcs self-determination scale showed some improvement, but nothing that was significantly relevant during the course of the time. Now, something that I forgot to mention earlier is that students participated in this program for two full school years. So from August to June, and then August to June, again, the second year, they started right before they turned 15 for the most part right at 14. And they ended a little bit before they turned 16 because it was about an 18 month-long program.

So now that you have that 18-month timeline from 14 to 15 and a half years in your head, let's talk a little bit about the SIBR results. On average students scored in a range that showed that they were at about a nine almost 10-year-old range at the onset of this research. So when they were about 14-14 and a half, they were scoring at the range of a nine to 10-year-old. By the end of the 18 months, almost two years of the study. They were now scoring at what a 14 and a quarter-year-old student would score. So they jumped up almost for almost five years, actually, in this time span of about a year and a half, almost two years. So while they were physically aged about 18 months, their scores on average on the SIBR increased so much that it was like they had gained more than four years of experience related to life skills. That's pretty awesome. That is showing that you know, these students who were on average behind, were able to make up ground by going through this program with occupational therapists. How cool is that? I think that deserves another Matthew McConaughey. All right, all right, all right. All right, for reals though I'm done with that. Anyways, that is really cool though.

Doris Pierce and her team showed that therapy can make a huge difference. Over a course of about 18 months, they made almost four actually closer to five years worth of progress in the areas of motor skills, social interaction and communication, personal living, and community living, as shown on the scales of independent behavior revised, or the SIBR. Now, you may not be able to access the qualitative article, the school-based transitional readiness services for adolescents with disabilities article, because that is in the Journal of Occupational Therapy Schools and Early Intervention, which you don't get with your AOTA or NBCOT monthly or yearly dues. But you all should be able to get the other article, the more quantitative article which is titled, "Effectiveness of Transition Readiness Interventions by School-based Occupational Therapy Personnel", because that does come to us from the OTJR, Occupation Participation and Health Journal, which you do get access to if you are an AOTA member, so be sure to check that one out. And I do want to go just a little bit further because you're probably asking, you know, what did those OTs actually work on?

From the qualitative article, we actually see that OTs spent a lot of time working on self-determination, groups and group projects, pre-vocational exploration, like what type of jobs are out there, and what jobs they might want. They also heavily relied on life skills, cooking was a big activity, because it was more easily graded than some of the other life skills. Social and communication skills were also a big area as studied organizational, and time management skills. Among those a few things that really stood out to me was the group projects, they really saw students as a group, not individually, they didn't meet with them individually for the actual assessment, and then also to kind of start to build that rapport. But they quickly turn those into groups. And they did long-term projects, these weren't just like, come to OT, we're going to do something for today. And the next week will be totally unrelated. Nothings were long-term. They had to plan this week, they had to plan next week. And then the week after that, they actually had to implement something. And then they had to go further. And further and further until they actually achieved whatever goals that they had actually set out for.

The therapists were not the ones that were creating the long-term outcome goals for the students, the students were creating goals themselves. That's that self-determination, part, right? Teaching students that they can have their own ideas and their own goals that they are not just living to please the adults in their life, the therapist really wanted the students to have a sense of autonomy, and to understand their disability, and be aware of their strengths and their concerns and what they have access to as far as accommodations about the internet, how to use the internet to find things. But even going further than that, the students work together in some cases to create their own jobs. They actually created stores and collected money within the high school community, and then donated that money to a foundation, which they were actually then able to attend the foundation award ceremony and be recognized for their contribution. How awesome is that, that they had so much personal, personal investment into this and then also got to be rewarded for it. That is so much learning that can only be done through real occupations.

We can't just work with a student one on one on an off-shoot day, I guess, you know, working on one skill, and then working on a new skill a week later and expecting that to make a change. These are real things real activities that the students are engaged in. And that I believe is what's leading to that such large impact that the research shows. So what can we do with this information? First and foremost, I would highly encourage you to go get access to at least one of these articles and read it for yourself. After that, you're going to take a time, take a moment to reflect on what your practice as a high school or even a middle school occupational therapist looks like and how you could potentially change things up over the next year or even two years. It does take time to change. But by reading this article and getting a piece of what is there, you can change the way that you are providing services to be more occupation-based to think about not just tomorrow with a student needs but think about what they need in four years, five years, six years, when they're no longer in school, perhaps. What is meaningful to that student trying to actually have conversations with students to determine what they want to do.

Even high schoolers who give the most simple one-word basic answers when given a simple question, even they want to talk about themselves in a positive light, and they want to envision themselves outside of high school, they want to envision themselves succeeding in life. And so if you can give that opportunity to them to share with you what they want to do long term, you're going to learn so much about those students. I think another key aspect from this article that I learned is that groups are so important, and I knew this to some extent, but I think if you get that small group, as opposed to potentially even a whole classroom group, then within that small group, those students can really learn to, to learn from each other to feed off each other to help each other out. And that is then going to be shown to make difference when those students are in the larger picture. One of the things that they did within this, in this study, some of the therapists talked about talking about bullying and talking about social interactions. And, and at least one of the therapists actually uses video modeling. So, they recorded each other having social interactions, and then watch that back to see what they actually did when they were interacting with their peers. And they learned so much, you know, social communication is not all that you say, but also how you say it. And a lot of times you don't get to know what you're doing or what you're saying unless you listen back or look back on it. Trust me, I know from recording podcasts.

But you know, that's just really awesome what they were able to do with this study, and I really cannot wait to see what they are able to do next. And Doris or anyone who was a part of this research, I would love to talk more to you about this. So please reach out if you're listening to this. Otherwise, everyone, I think we are done for today, I want to say thank you so much for listening to this. If you are a therapist that's about to start in high school or middle school, or maybe you've been in high school or middle school for a long period. I really hope that this does help. Please feel free to reach out to me on Instagram or via email at and let me know what you think about this research. What did you learn from this research? And how might you make a difference in your provision of occupational therapy after hearing what we talked about today, I'd love to hear from you. So please, please, please go ahead and reach out anytime, anywhere. With that, I'm going to say goodbye to everyone. Take care and I will see you in Episode 85 of the OT School House podcast. Have a great rest of your week everyone take care. 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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