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OTSH 85: Facilitating Collaborative OT Services with Meghan Fox, OTR/L




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In this episode, I am bringing on Meghan Fox, OTR/L, from Wootherapy.com to talk about her transition from providing primarily pull-out OT services, to a more collaborative service approach.


Meghan shares with us why she decided to make the move and what those collaborative services look like. Also, she gets very real with us and shares what is (and is not) working during the transition.


There will always be students who need pull-out services, but there will also be students who learn best from in-class, contextually relevant services. So let's talk about how we do that.


Listen in for more and check out the show notes at otschoolhouse.com/episode85


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


Jayson Davies

Hey there, welcome back to Episode 85 of the OT School House podcast. My name is Jayson Davies, thank you so much for being here with me today. Whether you're in your car, working out at the gym, wherever you might be. Thanks for joining in and listening to this episode of the OT School House podcast. Today we have joining us, Meghan Fox, she is an occupational therapist here in Southern California actually not too far from me. We'll talk about that during the episode. But yeah, I'm excited to have her many of you have probably already interacted in some form with Meghan on Instagram actually, that is her main platform where she does post under the name wootherapy. She is the brilliant mind behind wootherapy and the woo tape that she produces for her company wootherapy. We're not going to talk too much about the woo tape even though it is a fantastic product where you can actually it's taped that has handwriting lines on it. So you can rip off a piece of tape, add it to a piece of paper and you have a handwriting line. So we're not going to talk too much about that, you know, Meghan is just so humble, so kind. And we're not trying to sell anything, but I do want to mention it because it is such a great product. But what we are going to talk about today and I'm super excited, because we're going to be very open, very candid in this episode, and talk about how Meghan has started to shift from a pullout model of services more to a push in collaborative model service. And you know, this isn't something that happens overnight, you can't just flip a switch and turn all of your students from a pullout model into a pushing collaborative model. That's not how it works. But as you will hear from Meghan today, it does happen over time, and you can make a slow, steady shift, she is not to the point where she's at a full 100% of a collaboration pushing model. And you know what, she may never get there and that's okay. Most of us probably never will, because that wouldn't necessarily be ethical. Some kids do need a pullout model of service and that's okay. So without any further ado, let's go ahead and jump into my interview with Meghan Fox from wootherapy and talk about how she's making the shift from a pullout model to a collaborative model. I really do hope that you find our candid conversations really helpful within this interview. Hey, Meghan, welcome to the OT School House podcast. How are you doing this evening?



Meghan Fox

Hi, Jayson I am good. So happy to be here. I know. We have both been looking forward to this for a while. So excited to finally be on that OT School House.


Jayson Davies

Yeah, I'm really surprised it took us this long to get you on to the podcast. I mean, we've known each other for a little while. A few years now you live literally like, I mean if there wasn't hell in the way. Baseball? Not quite that far. But not that close. Yeah. But no, I'm so happy to have you here. I mean, you are the mastermind behind wootherapy and woo tape. Don't give me that. Look, you are a mastermind. You are awesome. Every OT, we are all awesome. So yeah, so we're going to talk a little bit about that. But first, I want to give you the opportunity to kind of share your story about how you fell into occupational therapy. And even more specifically, how you fell into school-based occupational therapy.


Meghan Fox

For sure. So I feel like I've heard this story a lot from other OTs I've heard on podcasts but it's so funny how it happens because I literally thought I was on the path to PT through college and then I get to my junior year and then they want me to take like quantum physics and like all these crazy science courses and I'm like, like pump the brakes, no not going there. And so it just kind of snowballed into talking to my advisor. What other you know, I've taken all these, I was a cornice major. So took all this human movement, all the anatomy physiology courses, like, what other realm or you know, road and path Should I go down? So she's like, oh, have you ever ever thought of occupational therapy? I'm like, No, what's that? Got more information? and funny story. She literally showed me the pamphlet of the top OT Schools and USC was on there. I'm like, I knew before college that I wanted to be out in California. So I'm like, Okay, done. Like, let's just put in the application. Hmm. Yeah, no, that's just another side story. But yeah, so that's kind of how I fell into it is, I wasn't up for taking all the coursework, not because I'm lazy, but just that wasn't my interest. If that wasn't my strength and my skill base come to find out and turns out occupational therapy is the most perfect fit for my creativity, my coping, you know, interaction with people. So, yeah, that's kind of how it happened. And then for as getting into school-based, so I ended up coming to USC, as you know, didn't even apply anywhere else should have, like, looked into it more, but I was kind of like one-track mind, I want to get out to California. So everything has worked out so far. But uh, so while I was there, I took the school-based course with Julie Bissell. And so which was great. And we've maintained a relationship still to this day. She's a great mentor to me. But what happened was, I did two years in a clinical-like sensory clinic on the west side of LA, and then decided I was going to move down to Orange County. So reached out to her for some, you know, I started applying for school-based jobs, and there was like, four available and I was like, What do you think of these? I, you know, I'm not so sure I'm familiar with these districts, and one was like, OCDE...


Jayson Davies

Orange County Department of Ed.



Meghan Fox

Yeah, sorry, jargon for those listeners don't know. And so she kind of steered me in a direction where she was collaborating with my current district to actually start an OT-PT department. They had been contracting for so many years, and not being able to keep reliable, consistent therapists in place for all the services that they were needing to provide. So she collaborated did the whole needs assessment, like, this is how many therapists you would need that this is what you would need to pay them, this is what some of your spaces should look like. And they bought, like all this equipment, it was really rad. She was very instrumental in developing our department, and then was very instrumental in helping me get the job because I didn't have any school-based experience. So she was kind of offering them, you know, my personal strengths. And, you know, so anyway, it worked out because, at the time, I think they hired in waves, and in my wave, they hired like, six, and I think I was the only one without school-based experience. So they really took a chance on me, which I'm grateful for. Because now being on some interview panels, it's like, oh, I don't know if I would take someone without experience and not disparage any listeners who are new to school-based or hoping to get into it. But it's, it's challenging. If you don't know, you know, you have to start somewhere. So obviously,


Jayson Davies

we actually do have a lot of people that listen to this podcast, specifically, because they think they're about to have an interview. And they know they need to learn some of the lingoes. And this is the perfect place for those people to be in my opinion, because we talked about IEPs. We talked about treatment. And we talked about the hard stuff about school-based OT, so I kind of want to lead you right into that you're kind of going there. But tell us about those first few years that first year, even in school-based OT what was it like and what did you learn?


Meghan Fox

Yeah, so I think I had an experience, unlike others, that I'm extremely grateful for. So because I didn't have any school-based experience, they placed me at two school sites where there was another therapist there. So we kind of I split the caseload at two sites, and another therapist was also there. So we overlapped at least one day where I could watch her treatment plan, I could watch her right IEPs, I think I sat in on a few IEPs that I wasn't a part of to understand, like, you know, kind of speak when spoken to like you know about you the areas that are relevant to you and just the dynamic of the team and how-to, we would have a lot of collaborative meetings with the whole IEP team prop you know, staffing is essentially before big meetings and stuff. So I got mentoring that I don't feel a lot of therapists get. And to me that made a lot of difference in my ability to then feel successful or confident to then keep going because I know school days can be grueling. For those that don't have any mentorship and they're just handed caseloads of 60 plus students, you know, plus, plus. So kind of piece of advice if you can, if there's anyone that you feel like you can trust or reach out to just say, hey, once a month, can I email you some questions and get some feedback, like any sort of opportunity to get some experience from someone else if you're new to school basis, kind of invaluable.


Jayson Davies

Yeah, and you know, I even found because I was in kind of that position at one point where there wasn't really any other OTs and I kind of reached out to other OTs that weren't in my district, but also to other speech therapists psychologists to, you know, they weren't OT they didn't know that side of it, potentially. But they knew about the IEP, and they knew how to get through tough IEPs and even a little bit that can help you with understanding IDEA and the laws specific to your state, just that kind of material that we don't get necessarily in school-based OT. What about actual therapy? You those first two years? What type of therapy did you actually provide? were you doing collaboration at that point? Or was it a lot of pullout pushing? What did that look like?


Meghan Fox

So it was a lot of pullouts because that's what I felt comfortable with. I didn't know the teachers, so I didn't know when was appropriate, or if it was okay for me to go into their classrooms. And, you know, it's taken many years for me there still find a rhythm with them, like, sometimes I'll schedule kids, and they're not even working remotely on something that's going to apply to my goals. And so it's just like an ebb and flow. And so yeah, those first few years, I was so comfortable with my clinical kind of experience. So I was pulling them into my room, like, so thankfully, I had a space where I could work with them. And I was kind of pulling a lot of that kind of treatment out and working handwriting in until all these different things. And I felt like I saw tons of progress. And at that time, because my district was transitioning from contracted therapists to district employed. Yeah, we saw, how do we put this kindly. We saw a lot of students getting services, maybe that didn't need the intensity, based on contractors aren't going to get paid unless they have students to service. And I'm saying, I'm trying to get it.


Jayson Davies

Yeah, no, no, let's have a conversation about that because I think it is a real conversation to be had. And I've seen it go both ways. You know, I've seen, I have worked with contracted therapists, I've been a contracted therapist. And personally, when I was a contracted therapist, the last thing I thought about was, I need to give this student more services so that I get more hours. However, that being said, when I was a contracted therapist, I was almost an in-house provider, because the entire every single person that worked at that district worked for the same contractor. And we were basically hourly employees at the school site. So it didn't matter whether or not we had 50 students on our caseload or 25 students on our caseload, for the most part, we were, it was like we were in the house. And I've seen other therapists too. I just don't think that they feel like they're personally doing that. But I can see maybe where people are independent contractors, they're their own business owners. And that does happen. And I could see that potentially being something that they think about, you know if I see the student three times a week, that's an extra two services to pick up as far as $50 an hour or whatever it might be. So I can see how that could work out.


Meghan Fox

Yeah. And so I think it was a combination of me just being really green and excited. And like, coming off that sensory type of intervention, that I saw a lot of progress. And then coupled with maybe the students were receiving more services than I thought. So I was able to just decrease the number of kids on my caseload because I felt like I was seeing progress where they were successful in their classroom environments. So So yeah, like I was saying a lot of, what I was doing at the time was pull out because I wasn't sure how to break the ice with the new teachers that, you know, I hadn't built a rapport with them. So a lot of them can be particular about other people coming into their classroom being more disruptive than helpful. So it took me a few years to find my groove with that, and, you know, build up the report. And it's hard for those that travel to different schools, there's not a lot of opportunities to really get to know the teachers on campus. So I would say if you are planted at a certain site, even if you're there for a full day, at the most and then you go somewhere else, do your best to go eat lunch in the lounge and be able to talk to teachers so that they can open up to you and feel comfortable letting you into their space.


Jayson Davies

Yeah, absolutely. I mean, it's hard when you're at, especially if you're at like more than three sites, you know, you're not at a single site for more than two days a week. I mean, some of us are at a site for half a day, a week, or even half a day, a month for some people who are more in rural areas. And that's tough. And you literally just don't have the ability to sit in the lunchroom and say hello to people. And when it comes to scheduling you, you can't even take into account what's going on in the classroom. Because you can only be there for half a day. And you have to see those six kids while you're there for half that day. And the half that you're there, they're not even doing language arts, and so you can't go in and look at handwriting because that's just not what's going on. So it's tricky. But like Meghan said, Yeah, anyway that we can work to build that rapport. And so Meghan, those first two years, you said most of it was pulled out, was it one time a week, once every other week, for the most part, was a spread out different frequencies, or what?


Meghan Fox

I had a lot of kids that started at two times 45. And those sessions seem to last forever. Not to mention, many of them were Gen Ed kids that were out of their classrooms for that huge chunk of time. And so obviously, it took me time to learn about like, Oh, well, yeah, I guess if they are with me, they are missing a huge part of academic instruction. And, like, that part seemed obvious, but I was just doing what was on the legal paperwork, like, "Okay, this is the services that I was inherited". So yeah, over time, you know, we evened out the service minutes, and everything seemed more appropriate. Yeah.


Jayson Davies

And you said earlier, you said sensory? Did you have some training in sensory? And is that primarily what you were doing with the students that you were pulling out? was some, were you in like a sensory-motor lab? Or is that just one of the many things that you...


Meghan Fox

Yeah, I mean, I am CIP certified and trained. So I did that at the previous job that I was at for two years, just more strategies like, for me, a lot of positive results come from having a good rapport with the student. And so if I'm bringing them in there and setting up some cool obstacle course, and like in this corner, you have found a word in the word search. And then you get all the way over here, and you have to write a sentence about the word, you have to remember it the whole way, like those type of motor learning strategies, but I wasn't in a sensory lab later, when I transferred schools I have, I'm on a site that has something more like that. But at this particular school, where I started, it was just kind of a closet, if you will make the best of it.


Jayson Davies

Right, do with what we have. Absolutely. All right, well, let's go ahead and move on because you kind of already started to allude to it, and as people know because they clicked on the button to press play. We're talking about collaboration today. And so you have been in the schools for a little while. Do you mind sharing exactly a round number for how long you've been?


Meghan Fox

On my 12? school year? Yeah.


Jayson Davies

Okay. So 12 years in the schools, and we talked about how it was very tough to start, or just I'll put it this way, you started off with a lot of pull out sessions, some as many as twice a week for 45 minutes, which, I'm sure there are some people out there listening, like their heads exploding twice, times 45 minutes, like why, but let's move forward to now 12 years later, what do your services look like a lot more now?


Meghan Fox

Yeah, so I do have a range of needs and ages. So I'd say it's typically anywhere from one times 30 to two times 30. And then quite a bit of consultation, which we can get into later. But so those needs and populations range from like a couple, mild mod SDC classrooms, special day classes that are that I say, preschool age, and then up through Gen Ed as well. I'm kind of going out of order if you look at the continuum of restriction, but I'm just going by like my two primary sites, and then, at another site, I have three moderate-severe classrooms that I work with a lot. And so, what was the question?


Jayson Davies

We're talking about kind of what your services are looking at these days, maybe in fact, you can even kind of just off the top of your head, what percentage would you say or pull out? What percentage is collaboration? And maybe what percentage is more than consulting?


Meghan Fox

Yeah, so I would say right now, probably 50% is probably still on a pullout model where they're really needing a lot of direct instruction about what they're learning. But more recently, in the past few weeks, we've transitioned to probably about 25 percent push-in service. So I mean, just today alone I was we have a student that's been having enrollment problems. So the teachers like just for a few sessions, can we see what not transitioning him down the hall will look like. So he can make the most out of his classroom needs and his OT session. And sure enough, it was great, you know, so then I did it for another student in there. And so it's just continuing to see the benefits of the student not having to generalize those, you know, those skills, so, so I'd say about 50%, pull out, still 25% push in, and that number is going up, as you know, the weeks have gone, and then about 25% consult.





Jayson Davies

Okay. And so I want to pause here, then when I get this question a lot, and I find a way to answer it. And I think there is a right answer to this. How do you answer the question when someone asks you what is the difference between pushing into the classroom and a consult.


Meghan Fox

So for me pushing really is that collaboration where a teacher and or another staff member that you know, a lot of the classrooms I'm in have aids, where they're working in the near vicinity of what I'm doing with the child, whether most of the time it's with what they're already doing as a whole or a small group, a lot of my special ed kids work in small groups, and we go from center to center, but, versus a consult, I typically will do outside of the school hours or when the child's not there. So they're not seeing what I'm doing with the child, the language I'm using with them, the types of prompting I'm giving them, I've just gotten so much feedback on how helpful that is, so that when I'm not in there during my one or two times a week, that they're really able to implement a lot of those strategies because we've had time to share them too. Whereas, you know, if a student doesn't have a consult on their IEP, in addition to their direct service, a lot of times, there's no time or opportunity to communicate what I've done to those teachers, with those teachers about what I've done with the students and their sessions. So,


Jayson Davies

absolutely. And how would you go about making a determination for a student to receive that push-in collaboration type of service? Oftentimes, we have students that are a pullout model, how do you make that switch? How do you decide, you know what I want to try seeing the student in the classroom, instead of in a pull-up model,


Meghan Fox

A couple of different scenarios Go on, where I'm like, Yeah, I think they're ready for that, or no, this needs to happen because I'm actually not getting the results that I'm hoping for during our one-to-one pull-out session. So the first would be that they've pretty much mastered the skills that I'm working on with them in a one-to-one setting. So for instance, say a kid has a goal where they'll write a few sentences, maintaining the spacing between their words, and they can do that when there's not a noisy environment. You know, I'm next to them. So I'm actually a visual cue for them of what's expected. And so they've mastered that, but I can't, I can't in good faith report on that goal as being met, if I don't see that goal met within the classroom consistently. Without me there, you know, samples and all that. So I really, that's like my first cue to, yeah, let's go push in. And let's find a time that works when you're working on writing skills, and show me that you can actually do this in the classroom. When you have your peers around you when the teacher is giving instruction. Maybe when the kid next to you is fidgeting in their desk, can you modulate and tune out all those extraneous things and still execute the skill? successfully? So


Jayson Davies

Yeah, I 100% agree with that. Man, I've got so much going in my mind. I like I want to ask you so many questions, I want to make sure I get to all of them, but also ask them in a logical sequence. So with that collaboration, now, let's go beyond that to the next step, which is consultation potentially that's less restrictive, right? Because you're no longer even working directly with a student. How do you make that determination from whether it's a student that's on a pullout model or a push-in model? How do you make that jump to the consultation?


Meghan Fox

Yeah, so that'll come after I've, you know, pretty much ensured that they've been successful in generalizing the skills. You know, there can be a range of skills, it doesn't have to just be handwriting, but that they're being successful in their classroom. They're accessing everything they need, fairly independently, every kid requires a few prompts here and there, right? So, and then at that point, a few things could happen where, you know, I just want to ensure for an, you know, another cycle of an IEP that that's the academics are going to increase in the demands are gonna get harder, can he keep up with that? Or she, whatever, sometimes a parent wants to keep it, you know, I wasn't willing to let go or, you know, a lot of things happen, you legally have to. And for us, we have to do an assessment to discharge, yeah, all those things. But I think it's the right thing to do to keep on as a consult, especially for the transition to a new classroom. So that teacher knows, what are all the supports, you know, they can be outlined in an IEP accommodation page. But what does that look like in real-time? Are those you know, if he requires maybe he required he or she requires a checklist of some sort? You know, is that checklist physically attached to the IEP? Is that kid going to remember after a whole summer, how to implement all those things, so I think it's a nice want to call it a safety net, but just a nice transition to ensure that they're successful all along the way.


Jayson Davies

Yeah, and you know, that's funny with the OT School House podcast, obviously, I hear from therapists from all over the country. And, you know, the pullout model is pretty straightforward, right? We have a goal, we pull the student out, we work with them on a scale, hopefully, we see it generalized back into the classroom. The Push-in model gets a little bit different. Some people just sit by the student, and it might look like you're almost doing a pull-up model but inside the classroom. Other people are more collaborative, they get the aid or the teacher involved, kind of like what you were talking about. But when it comes to consults, there's a lot of difficulty there that I hear from school-based OTs, and they're done completely differently. You know, some people have goals, other people's don't have that other people don't have to have goals within their schools and districts, maybe they're tagged on a goal, maybe they're not tagged on a goal and, and they're just kind of there to check-in. Sometimes there's a very outlined detailed not rule that they have to follow up a structure that they have to follow. And it might be you know, what, they're incorporating a sensory plan of some sort. And they're making sure that the teacher is able, to implement that sensory plan. So consults are, they change, they have a big variety, from what I, from what I hear from everyone. I personally like to use consults, it's kind of like what you're alluding to, I think, is to make sure that all the accommodations that are in place are actually working, because it's one thing to say, Hey, here's an accommodation, but who's going to introduce that accommodation, who's going to let the child know that they even have access to that accommodation, let alone how to actually use the accommodation. So that's where I think that, that the consult model really, really comes into play. I don't know if you want to add...



Meghan Fox

No, I was just gonna say, in our district, specifically, we, if we are linked on a goal, we have to be on a service box. So like, we can't just recommend a consultation, if we are part of the success and execution of a specific goal, then we need to be direct service. I mean, that can look like one times 30 per month, you know, whatever. But we should be having some face-to-face time with the child to ensure some success, not just with the teacher. And then the second thing I wanted to say is when we write a consult, it's my preference and my department's preference that you specify like not just say, "consultation between teacher and OT", but to expand on that and say, "What are you specifically consulting for?" Because, like, if it's for consistent pencil grasp and spacing between words, or whatever it is, so that when that I get it all the time, I've had five this year, kids who moved from out of district and you're just given a new IEP, that therapist needs to know. I mean, it's so helpful to know just exactly what they're going to be going in to do. It saves a lot of time, you know, trying to figure everything out. So


Jayson Davies

yeah, yeah, I'm on the same page with you with trying to almost over-explain on the IEP exactly what's going on. Because you really do want the therapist that that student might move to and we never know when a student is going to move when they move, it would be nice to be able to pick up that IEP and kind of see at least what the OT was thinking. So yeah, over-explain that a little bit.


Meghan Fox

We got to work together as OTs to like, lessen our workload, because, you know, just make things clear for each other. Got Your Back.


Jayson Davies

Yeah. Yeah, absolutely. You kind of mentioned a grid box versus not a grid box when it comes to consultations. versus regular services. I, some people will know what that means as far as the grid box. I think most people will kind of get it. But I want to explain that a little bit further and go beyond that, why would a consult beyond or not beyond the grid box?


Meghan Fox

Okay, so basically, it's just a way that we differentiate the services. So a lot of times, you know, I have a, I have a lot of kids with visual impairments. So we have a visual teacher for the visually impaired, she rarely gives direct service, but she will consult with anyone on the team about what the needs of that child are. So because she's not working directly with the child, that she is not deemed a service provider, which would require minutes to interact with the student. What does that mean?


Jayson Davies

So that would be if it's on the grid box, then it is a service that's outlined as weekly, monthly, yearly, whatever services are outlined on


Meghan Fox

With directly working with the student.


Jayson Davies

Okay, and so then if they're not on the grid, explain that,


Meghan Fox

then, you know, they just changed us a few years ago, but then you're basically on accommodation, but on our new IEP forms, whatever, there are three different breakdowns. So I used to, if I was proposing a consult, it would just be basically an accommodation to the student's IEP. And that's where it would go under the accommodations. Now it's kind of differentiated as personnel supports. So it is technically still just an accommodation. But there wouldn't be direct, really working with the student on anything, it would be supporting the teacher and the classroom needs and implementing the other accommodations. Does that make sense?


Jayson Davies

All right, so I'm going to get on my soapbox. Because I have strong feelings about this. Because from my experiences is if it's not on the grid if it's not direct service, A) it either gets lost or B), when the student goes to a new school, they don't, doesn't hold the same weight as being on the grid. And I've had both of those happen. I've had a student come in who kind of had OT, but it wasn't well explained like we were talking a moment ago about it was kind of on there's consult, but it didn't really define what the consult was. And therefore the special education department actually didn't even tell me about the student. And so I didn't find out about the student till later. And now I'm trying to figure out okay, well, what have I missed. So that was an instance where the kid actually came into our school district. But I've also just been completely forgotten about when it comes to IEPs because the student again is not on the grid, they have a consult. I have them down on my caseload, my workload document. But I don't learn about the IEP till the day of or three days after the IEP was held, because I'm not on the grid. And so it almost bothers me that we're not putting consults on the grid, and be it right or wrong. I put my consults on the grid now for that reason for those two reasons, because I don't want to be forgotten. And I will, I will somehow figure out how to attach OT to a goal to make it so that I'm on board. But yeah, I know it happens again, that kind of goes back to what we started with this down this road is consults get done differently everywhere. pullout services look pretty similar no matter where you go. Consults and collaborations, they get a little, they get a little dicey everywhere. But yeah, so sorry, soapbox.


Meghan Fox

No, I agree with you. I hate getting left off and getting an email in the 11th hour saying, oh, we're having this try next week. Like, excuse me, like, so I get that frustration completely. So yeah, I think it makes sense in my mind when I'm just doing it within my district. But getting a kid and it's not clear. I don't know why. I know we never case carriers. But why is it so hard for a case carrier to look at? Any person that has access to them on whatever computerized? Yeah, the thing that you use?


Jayson Davies

Yeah. Oh, blame the IEP. The IEP system, it's their fault.


Meghan Fox

All right.


Jayson Davies

All right. All right. Well, let's hone in on the collaboration because I know that's kind of you even alluded to it, that you're kind of moving toward a lot more collaboration. You're slowly moving kids over to collaboration sounds like I'm assuming those are kids that were pulled out, you're slowly moving them into a collaboration?


Meghan Fox

And especially those that I have twice a week. I love one of each, you know, like, one week, one day focus on really instructing the skills that we're working on and the second day, you know, so there's a nice ebb and flow to generalizing, and it's just not all of a sudden I'm, you know, showing up or expecting them to execute something that they've only done in on one to one settings. So


Jayson Davies

I think you just answered the question that I had earlier that I forgot to ask. So you'll do two services, one will be a pull-out and one will be a push-in. Is that what you're saying?


Meghan Fox

Yeah.


Jayson Davies

And do you Okay, so I have another question then is, is that on the grid as two separate services? Or is it one service twice a week, in the class or twice a week?


Meghan Fox

I, the way I write it is two times 30 minutes. And then in the notes saying push in, or pull out based on student needs.


Jayson Davies

Okay, gotcha. I've done it both ways in the past. I've done what you just said. And then I've also had people ask me to actually break it up. And so it'll be OT on there twice. Usually, I don't do twice a week, usually, it's every other week, but I'll put twice a month, push in twice a month pull out. But it looks the same as far as


Meghan Fox

There are people that are particular about how they want things outlined. And so it's clear to everyone.


Jayson Davies

Right, and by the way, there are so many differences, and literally the districts that I've worked in, and the districts that Meghan works in are literally like two cities over. And so you can hear the differences that we have going on between the districts that we've worked for, and we are so close geographically, and so that's just how different the world is when it comes to IEPs and how things work. So all right, back to collaborations, what has facilitated your move toward this collaborative approach? What are some things that either you've done? Have you done any trainings or other professional development? Or are you just reading learning more, or what is facilitating your move to this collaborative approach?


Meghan Fox

So it started more with my special ed teachers that were really on board and eager to know what I was doing in my sessions, and how that they could implement that in their classroom. And so it just seemed like the obvious thing to just be in there when they're doing those types of activities, or, you know, sometimes it was as simple as telling the teacher that the student needs left-handed scissors, it's like because they're just little things that we pick up on. And unless they're explicitly told about it, they continue to do things, they're a very certain specific way for years and years and years. So it started off with literally just because my room is so close to my preschool teacher, my preschool special ed classes. And so it's just so easy to hear her see what they're doing in there and want to jump in. And they're doing so many crafts-type things at that age level, that it's so relevant to what I would be doing in a pullout session anyways. So to give them language and demonstration on how I kind of also coach the kids through some of these things. It's been so helpful to them. So I started there, and I'm slowly working into the gen ed population.


Jayson Davies

Awesome. Awesome. So it started really, it's the preschool. Is that like an It's a special education only preschool?


Meghan Fox

It's a... Well, yeah, so it's district-run kids students are on IEP is, but it's cool because both so it's to pretty much the same class, they just divide the students and they have reverse mainstreaming. So we have neighborhood buddies that come into the classroom, a couple of days a week so that those students have peer models and exposure. And then you know, it's great for those neighborhood peers to be involved in supporting the special ed kids. So that's really great program. Yeah.


Jayson Davies

So how is it going with moving into more Gen Ed, with the gen ed teachers and Gen Ed Students?


Meghan Fox

It's going well, it's a lot easier to do, the younger they are because they're kinda want to say this.


Jayson Davies

I think it's honestly to me, it's because it's play-based, it's a lot more play-based activities going on. And it leads to occupational therapy, like the activities that they're doing are just so much more similar to the activities that we might traditionally do in a small group pool




Meghan Fox

And those foundational handwriting skills of Okay, you start your letters at the top like that, just counting and those things that need the repetition that maybe a kindergarten teacher with 30 kids, that's not she's repeating Johnny sit down or, Sam, stop playing with that, you know, rather than being able to focus on the letter formation and all those things that you want to get really solid in the beginning, but I think the challenge with moving as you get a job, it's, the kid is more embarrassed or to you know, have an extra adult next to them in class or, again, they flip their schedules all the time, so they're not always working on something that's going to be related to what I need to address. So then I feel like, Oh, well, that was kind of a bummer of a session that I, you know, I didn't get done what I wanted to with the student. So that's pretty much it. And so that's kind of where I do, like a lot of my booth therapy stuff is, I want to give teacher gen ed teachers little snippets, little micro size, easily digestible information on how the kids’ desk should be set up, or quick tips to adjust a grass, you know, those types of things where it's short, as the training, I think can be valuable. But a lot of the times, you know, it's more of, I guess you could do a volunteer one, but sometimes I've been asked to speak at like staff meetings, and some of the teachers are just checked out. And I don't feel like it's a valuable use of everyone's time if they don't want to be there receiving the information. Plus, if it's too much info, are they gonna even remember half of it to go back and implement it? So that's where I've just found small bite-sized pieces of content are easy for them to be like, Oh, that makes sense. I can go try that with this kid. I, you know, it sends up a little flag-like, Oh, I have a kit, I know exactly who I can use this for. So, yeah.


Jayson Davies

Gotcha. Okay, I found that training really works for me when I'm able to get to just like, the kindergarten team of teachers, or the first-grade team of teachers, where I can sit down with them during their planning time. And just ask them, Hey, what's going on in your classroom? How can I help? And just let them vent? Almost let them share with me, what are they having? What behaviors? What are they saying? What? What weird pencil grasp? are they seeing what I mean? Who's the kid or what kids are using scissors to cut toward their body or like, and it just leads to, they have a desire to learn about whatever you have to give them at that point? Because they're the ones bringing the concern to you. And they actually want to hear an answer. So that's really helped for me is actually just going in and talking to the three Kinder teachers or the three first grade teachers or whatever. I found that to work out.


Meghan Fox

Well, that makes a lot of sense. And I like that as well. Because now that you're mentioning it, this was the first year that I reached out to. So my one of my school that's pretty small, but there are only 200 teachers and I just my caseload was a little smaller to start off with there. That's where I have the preschooler. So that caseload will build over the course of the school year. So because I was lowering the beginning, I was like, hey, like, I was super excited to try a new handwriting screener. So I did it with the whole class and like, to just educate them on what really the expectation is for a kindergartener, and, you know, kindergarteners, when they first come in can be a hot mess, I have one of my own, so I can speak freely on that. I think the expectation that the kinder teachers sometimes have is what the end of the year is going to look like. And you know, you those kids have 180 days to make that progress. So within the first few weeks of school, yeah, it might look kind of bad, but the barometer for what they should know is only at about, I use the handwriting without tears screener, and then part of Miss Jamie OTs new handwriting screener, she has out just with a starting spot assessment. And the handwriting without tears screener says like, at the first benchmark, they should only be about 61%. So most of the students were meeting that, and so well, we'll see where they go. So I have collaborated in those smaller settings. But those larger training, I haven't found to be as effective as I would like, for the time I put into them.


Jayson Davies

Yeah, yeah, they do require more time. And yeah, you're, you're more likely, it's kind of like the whole person on the side of the freeway who needs help, you know, if there's only one person going by that one person is likely to pull over and work with that, or help that person that has a flat tire. But if just cars are going by, the odds of one person stopping are slim or so nil because they think someone else is going to stop. And I think that is kind of the same thing when it comes to large training if you're trying to help everyone. Plus, it's just really hard to give a first-grade teacher and a fifth-grade teacher the same information and expect them to find both find it helpful. So there's some I really do think that that the way to go about it is to be a little bit more specific. Maybe you can do even to grades, kinder first, second and third, but to break it down a little bit. Okay, so what have been, what are three things that you have had to learn in order to make these collaborations with teachers successful?


Meghan Fox

Okay, so the first one is what I do for, you know, the rapport, making sure that they understand you and respect you. And that's the number one, the number two is like you suggested going in and letting them vent, hear their concerns. Like, what's the point of spouting off all your knowledge, if it's not what they're looking for? So really listening to them? And then the third, to be effective follow-up,


Jayson Davies

I just came up with a random number, if you have


Meghan Fox

no following up after you provide your suggestion, like, did what I say work? Like, how long did you try to implement it? You know, how much support did the student require? So and if that didn't work, let's try something also offering other strategies. So that follow-up pieces is super important because it's kind of pointless to offer a strategy, or multiple suggestions if you're not going to bother going back to find out if they worked?


Jayson Davies

Yeah. In your eyes, what has been one of the top struggles for making this work?


Meghan Fox

I think mostly the willingness of some of the students,


Jayson Davies

oh, the students

Meghan Fox

that are aging up the ones that I'm like, yeah, it's time to, like, get off this IEP. But like I said, I can't do that in good faith, unless I know you can generalize the skill within your classroom. And so they're more resistant to having that additional adult sitting nearby them or any of their friends knowing that I'm particularly there for them. That's kind of a roadblock for me.


Jayson Davies

What age do you start to see that at?


Meghan Fox

starts in about third grade?


Jayson Davies

Okay.


Meghan Fox

Definitely fourth and fifth. Third, you can sort of get away with it.


Jayson Davies

And so how do you deal with that? Or how do I mean, you just kind of sorry, kid, we need to, we need to get to this, where do you compromise? Or how do you? How does that go for you?


Meghan Fox

I pull them out, you know, after the fact or on our next session, maybe we don't push in that time that he pulls up. I mean, I don't really see too much, I guess I kind of does. But if they're leaving the classroom for something special or specific, anyways, then their friends know that they're doing something else. But, you know, I'll just be real with them most of my gen Ed. So this is related to Gen Ed kids, mostly that I'm getting pushed back my special ed kids that they like having Yeah, they do. I know. It's nice to feel loved. But you know, I can be real with them. Because I'll just tell them what the expectation is like you do this, for me show your teachers and your parents all the hard work we've done like, this doesn't have to be hard. And I, I can get off your back sooner than later if you execute. So kind of putting it more back on them if they don't want this, this lady around.


Jayson Davies

So for those when you go into the classroom, are you specifically working directly with that student? Do you sit near them? Do you try and hover around the classrooms? to kind of make it a little less obvious? Or? And what does that look like?


Meghan Fox

I guess it depends on what the assignment is that they're working on, and how much direct oversight that they're requiring. But I am trying to pull back a little bit because I'm trying to see what they can do independently. So yeah, I don't need to be exactly next to them. But I need to make sure that, you know, they have the accommodations that I've trained them to use out and available and they're implementing them. You know, I'm hoping I don't have to provide cues for them to pay attention and those types of things or follow along with what step the teachers are on. So, yeah.


Jayson Davies

Yeah, that makes sense. I want to ask you about goals because we are talking about collaboration, when it comes to if you know, you're going to be collaborating with a teacher, for a student, whether it's Gen Ed or special education. Do you write more collaborative-based goals? Or are you writing separate goals? OT goals, per se?


Meghan Fox

I would be a huge fan of writing collaborative goals. I just, we're not there yet. With all the teachers, and for some reason it comes down to Okay, like even when we're just staffing like, Okay, well, what goals are you going to write? And I'm like, Well, what, what is the student need to be doing in the class that they're not doing? And how can I support that is how I try to approach it. Um, but yeah, at this point, um, unfortunately, I feel like many of us are still writing our own goals. And I don't necessarily know that's what or think that's what's best for the child. Because if the teacher is also on there, then it gives them some accountability, shared responsibility to, you know, be working on those things. And that's where that push and collaborative collaborative model comes in. Because then the progress and the generalization is going to be greater.


Jayson Davies

Yeah, no, I completely agree. And it's tough and within the same school, you know, you'll have maybe one teacher who's all up for collaborative goals. And then the other two teachers that you work with primarily are like, Nope, I don't want to do it. And it really comes back down to what you're talking about earlier, that rapport building, oftentimes, you know, it's, it's not that they're against it, it's just that they're kind of, we all get set in our ways, you know, and it's, it's easier to continue down the path that we're on than it is to make a change. And it takes time, and it's hard, and I'm sorry, what's that?


Meghan Fox

Well, I was sorry to interrupt you, but I feel like that they feel like it's more work for them, you know, like, well, I'm on an OT goal on it's like, No, no, no, this is what the student needs to be doing in class. Yes, it's something that I'm maybe more of the expert in if you want to call it that. But I think we need to work together for them to achieve it. So it's kind of how you reframe what you're looking for, and when goals come up. But I do have some teachers that really dig their heels in and have the separate goals and like, even when you go around in an IEP meeting, and they're like, okay, would you please report on the goal, and I'm like, Okay, here we go again.


Jayson Davies

I'm right there with you.


Meghan Fox

My goals were. So


Jayson Davies

Yeah, and I can't remember who originally started doing this that I caught on with, but it's starting to reframe the idea of you know, what, it's not an OT goal. It's not a speech goal. It's John's goal, it is John's goal. And I'd rather have, you know, five collaborative goals that are going to be addressed, no matter where the student is, than 15 goals, where three of them are going to be addressed only in OT three are only going to be addressed to speech, and then five are going to be addressed in the classroom, and another one's going to be addressed may be in the cafeteria, you know, like what's, we want to help the student make progress. And the only way to do that is to incorporate the goals everywhere, doesn't matter where they are, we all need to be working on similar goals. But we all come from different backgrounds, different expertise. And we have a different way of helping the student to achieve those goals. And if we're lucky, we can share that knowledge with each other, so that we can all make progress from each other's specialties. So yeah, yeah, I know, it can be tricky, but I do think it is the right thing to be doing. And I know a lot of OTs are working on it. And yeah, and just continue on with it. If you're writing collaborative goals, keep going.


Meghan Fox

Rock on props.


Jayson Davies

Making this just gave you all right. Well, Meghan, you know, thank you so much for all this information, collaboration consultations, a little bit, pull-out model. Earlier, you mentioned some like mini trainings, is that something that's coming along with wootherapy? Or how's what's going on with wootherapy these days?


Meghan Fox

Oh, wootherapy. So there's OT brain, you know, there's lots going on out there all the time. As we spoke about before, pre-recording, I don't have a ton of time these days. So I'm working on scheduling more with every time I do have a course in mind that would be for teachers specifically. That's in the like, pre-development stage. So I'm excited about that. But I cannot give you an idea of a launch date.


Jayson Davies

No worries, no worries. But tell us about what you do have. I know you've got some cool stuff going on?


Meghan Fox

Yes. So obviously, I think I'm most known for woo tape. And that is my little handwriting, adaptive handwriting tape that helps put visual boundaries anywhere a child is needing to produce handwriting that gives them pretty much I see such a difference just in the sizing and the placement and other take some training like regular paper to work on the proportions. But I see almost an immediate difference when a kid has provided the appropriate visual boundary. So I've just gotten so much joy, seeing direct results, hearing about them from everyone who's used it, I bring it into the classroom every time I'm there because they're typically working in like a science notebook or you know, a Venn diagram that has just no nothing. Just you know, some circles fill in all the blanks, and obviously the kids on our caseload that doesn't work for them. So I created it for my OT brain, but it's really a tool for I'm hoping every classroom because that's where it needs to be. I mean, I think any accommodation needs to be in any place. But the child is required to execute those skills. So at home in the classroom, in OT, I think those need to be consistent but yes, I think, woo tape belongs in every classroom. So I'm working to share that more with teachers. And every time what else do we have going on? I don't know writing some more blog posts and hanging out on Instagram. That's where you'll find me at woo therapy. And I'm kind of embarrassed to say I joined tik tok just today. Oh, I joined tik tok. So I'm gonna see how back


Jayson Davies

I saw your dance moves. I saw your pencil-breaking dance.


Meghan Fox

No, the crown break the crown the


Jayson Davies

crown breaking Yeah, sorry, crown breaking, you got to break those crowns into smaller pieces


Meghan Fox

every time.


Jayson Davies

Yes, and you know, I really do like the woo tape for the same reason you just mentioned because it's so easy just to give it to a teacher. And you know, it's like here, here's some tape, this is the tape that your kids need as the right size. And now you have three or four different sizes, three or four or four different sizes. You know, like, you know, kindergarteners, he needs a different size and second graders, but teachers are always giving kids papers that don't have lines on them. And they're expecting them to write and then they write really big because they don't have guidelines on the paper. And then the next thing you know, they ran out of space and well might give them some lines. Yes, so I 100% agree, you know, just handing it to the teacher and showing it one time, you just have to show it to them one time. And then they see Wow, how big of a difference it makes and how easy it is to get that big difference. And what's cool about it too, is that I'm sure the kids love it. I mean, they enjoy it. I mean, it kind of looks like a road. So I'm sure the boys absolutely love that. And then you just kind of put it on there. And they have something, to write on. So yeah. And I have to say thank you also, Meghan, because you actually sponsored the back-to-school conference and gave out 200 rolls of the tape to the first 200 people that signed up for the conference. And then you also gave some away. So thank you so much for that.


Meghan Fox

Absolutely.


Jayson Davies

Yeah, so you know what I think we're we talked a lot today, we talked a lot about what services have looked like in the past when you first got started. And we talked about the transition a little bit to collaboration, consultation, and some of the struggles and some of the things that that we have to keep in mind because we know that it's going to be a barrier to building that rapport, especially when we're not on the campus all the time. But it's so important to build that rapport. And so thank you so much for sharing all the wins all the difficulties, all the struggles, because they are real, and how to move forward. I really appreciate that.


Meghan Fox

Absolutely. And just one last thing, like, I know that I haven't so easy, I won't say easy. Our jobs are very difficult. But I have a lot of things in place that many of the listeners do not. So I want to be available to those who are in, you know, more rural communities or multiple schools. And if they have any questions on how to navigate some of this, please reach out to me at wootherapy on Instagram is or wootherapy@gmail.com. if it's a longer thing you want to email me about so just as a support to newer therapists or those looking to dive more into a collaborative model. So...


Jayson Davies

absolutely, yeah. And I will be sure to link to your social and your website on the show notes. So everyone will have access to that right there on the show notes. Oh, yes. One more thing. Go for it. No...


Meghan Fox

No, Okay, I want everyone to get this desk check. Because this is the easiest thing I meant to mention that I give to all my teachers. So if you're just looking for a way to support some teachers, I have this great PDF, it's just like, quick how-to arrange desks and everything like that, that I just it's a kind of an icebreaker, if you will, like you could put it in teachers mailboxes as a way to say, Hey, I'm available as a resource on your campus if you need something. These are some simple strategies to help your classroom and your kids attend the best. So it's just called desk check. We'll put that in the show notes. I'll send you the link, Jayson. That's a really easy way.


Jayson Davies

Perfect. Well, thank you, Meghan. It's been a pleasure. And yeah, take care. We'll see you soon.


Meghan Fox

You're welcome. Thanks.


Jayson Davies

Bye, everyone. Alright, everyone. Thank you so much for sticking around all the way through to hear what Megan had to say about moving from a push-in model to more of a collaborative model for those who it's appropriate for, you know, this isn't designed to be a one size fits all model or approach. You know, we need to still see kids in a pull-up model. We'll never get to that 100% because it wouldn't be ethical. But it is something that many kids will benefit from and so we should start using it a little bit more frequently. Thank you again to Meghan for coming to the show. I really appreciate having her on. I really appreciate all the candid conversations that she was open to having during this episode. Really appreciate it. Be sure to check her out at wootherapy.com And also check out the show notes for all the things that we talked about today. She had a little checklist that she mentioned, and we'll be sure to add that to the show notes. All right. Take care everyone. Have a great rest of your week, and I'll see you next time. 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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