My Items

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 164 of the OT Schoolhouse Podcast. Have you ever wondered how integrating reflex patterns could enhance your approach to therapy? Join us as we discuss the world of reflex integration with Kokeb McDonald. She shares her journey and discusses the importance of understanding the root causes of developmental delays. You will learn about the MNRI program and how Kokeb has adapted its principles to create effective treatment plans within occupational therapy practice.  This episode offers valuable insights into how addressing reflexes can lead to significant improvements in motor skills, attention, and overall functioning. Tune in to learn more! Listen now to learn the following objectives: Learners will be able to understand what reflex integration entails and its role in school-based OT
Learners will understand the importance of reflex integration in occupational therapy, particularly in addressing self-regulation and sensory processing issues.
Learners will understand how movement activities can be integrated into classroom settings to support reflex integration and improve student outcomes. Guests Bio Kokeb Girma McDonald is a pediatric occupational therapist and the founder of the Reflex Integration Through Play™️ (RITP) program. She is the mother of two wonderful children, and has extensive professional experience working with young people of all ages and backgrounds since 2004.  Recognizing the need for practical and universally accessible primary motor reflex integration programs, Kokeb created the Integrating Primitive Reflexes Through Play and Exercise book series and the Reflex Integration Through Play™️ method to empower and reassure frustrated parents, and to offer fellow professionals a tool to expand their clinical reach. Quotes “ Think of it as, building a house…if the foundation is messed up, cracked, anything you build on top of it will be faulty. Yes. It will stand, but you're going to be fixing things all the time.”  -Kokeb McDonald, OTR/L “At the end of the day, it's all interconnected…When you impact one thing, it impacts another.”  -Jayson Davies, M.A., OTR/L “Reflex patterns are a response to sensory input.”  -Kokeb McDonald, OTR/L “I learned that it's important, especially for OTs, to go back and review anatomy and movement patterns, like the functional movement pattern because we've forgotten what that looked like, what functional movement pattern looks like, what is the most efficient movement for this specific task.” -Kokeb McDonald, OTR/L “All of a sudden you start to see results in other areas as well. Things start to come together…and the client doesn't have to struggle as much.” -Kokeb McDonald, OTR/L Resources 👉 MNRI 👉 Choose wisely AOTA  👉  Integrating Reflexes Application  👉 Integrating Reflexes  👉 Integrating Reflexes Game 👉 Integrating Reflexes Certification    👉 Integrating Reflexes Books *Don’t forget to use promo code otschoolhouse to save 10% on your purchase. Episode Transcript Expand to view the full episode transcript.   Jayson Davies     Hey there, and welcome back to the OT schoolhouse podcast, where education is an essential occupation. Today, we're taking on a topic that has been stirring up much debate in the school based ot world, reflex integration. It's a concept that's gaining traction, but it also raises questions like, How does reflex integration fit into school based occupational therapy, and more importantly, how do we ensure it supports meaningful occupation based outcomes for the students we serve to help us unpack this. I'm excited to welcome Kokeb McDonald, a seasoned occupational therapist and creator of the reflex integration through play program, over at integrating reflexes.com With nearly two decades of experience and a passion for empowering ot practitioners and parents alike, cocoa has developed practical strategies that make reflex integration accessible, effective and yes. Occupation focused in this episode, we'll address the controversy of using reflex integration in a school based setting. Then we'll shift into how you can integrate reflexes within your play based interventions in a way that respects your time, your expertise and your students goals. If you've ever wondered how, or even if reflex integration belongs in your practice, this is the episode for you. Kokeb, insights might just change the way you approach your next session. So settle in, and let's dive into our conversation with our OT colleague, kokeb McDonald    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     Kokeb. Welcome to the OT school health podcast. How you doing today?     Kokeb McDonald     Great. Thank you for inviting me.     Jayson Davies     Absolutely. It has been a minute since we addressed reflex integration here on the podcast, I'm excited to have you on, especially because actually, the last person that we had on to talk about it wasn't an occupational therapist, so I'm excited or an OT practitioner in general. So I'm excited to get your point of view here, kind of your background into it, and how you implement it into ot practice. So this should be a fun one. Great. All right. Well, I want to kick it off by first asking you how you even kind of got into the world of reflex integration. You know, occupational therapy is a wide range world. There's so many different ways you can go, but you have really, kind of, I want to say, narrowed your focus to just reflex integration, but it's definitely an area that you now kind of specialize in. So I'd love to learn how you kind of got into that.    Kokeb McDonald     Great, yes, I started out from maybe 20, 2005 or so right after I became an occupational therapist, as I'm working on treatment planning, and I think I felt just stuck with my treatment planning, and felt like I'm working on specific activities, but not really figuring out the causes or the root causes of why certain kids are delayed in their development, and why am I doing this specific exercise? So I think I was researching a lot with one my co worker was an OT clinic. I was working for an OT clinic, and we found out in Poland at someone called maskadova, who's doing this program. This was before the svelana moskatova was the mnri program was here, and that's when I started taking the courses. It just made sense to me, and made sense the root causes of the development and how to even create a treatment plan. And I think that's what got me and when I put those treatment plans in my sessions the clients that I was working on, like task after task, like tying shoes, time shoes, or like handwriting, hold them, you know, the pencil grasp and focused on when I actually implemented these reflex patterns, like when I'm looking at it and I'm putting the treatment plan as part of the implementation, the kids start to doing really well. And it just made sense. It made sense that I fell in love with it.    Jayson Davies     Yeah, and say that name of the program again. I've never heard of it as    Kokeb McDonald     MRI. It's moskatova method. Svetlana moskatova, she.    Jayson Davies     I've heard of the shorthand. I've never heard it all the way out, okay.    Kokeb McDonald     longer. Mnri is a longer one, but I just go with her name. I took several courses through her program, and then I start to implementing it as part of the OT I mean, it's done differently, and mnri, the process is different, so I start to implement it as part of OT process.    Jayson Davies     Well, yeah. I mean, it sounds like you've been on this, been working with Reflex integration for close to 20 years, about and now and and it's interesting because, I mean, I've been an occupational therapy practitioner Since 2012 is when I graduated. And I can say with pretty certainty that. In 2012 like primitive reflex. Reflex integration was not a common word, and that was in 2012 and you started, you know, almost a decade before that. And so it wasn't till, like, I feel like, around like 2018 maybe 2020 that we started to hear more about reflex integration. And so it's just really, it's really amazing that you kind of learned about this before it became kind of a trendy thing, which is very cool. And so it sounds like you've done a lot of training, and now you're kind of doing your own trainings, right?    Kokeb McDonald     Yes, yeah. So about 2019 it's when I first published my first book and creating a treatment plan that therapists can easily follow, especially if I was thinking OTs in mind, and I was thinking of a home program and parents, what are the activities that they can easily incorporate in the classroom, at our home, or in the clinic, with mnri, with other work? I mean, they're very effective as well. It's a very hands on work, and it's not as easily. You're not easily able to implement it in our session, because we have 30 minute session. We're do functional skills, and we're in the classroom. We're doing group session. The idea for me was like, How can I implement what I've learned, but for OTs and because we have to charge insurance, right? So we have to stay in our framework, but we can still do that. There is a very effective way, and play base is one way that we do with us, like reflex integration through play, and how to do it in a play based and more functional way. So I've been actually doing that for a long time, and when I start writing the book, though, I start to because, you know, I didn't tell you the story. It's because I injured myself and I couldn't see clients as much. So it became like, Okay, what am I going to do with all this knowledge? It became to like, I might as well create this treatment plan for other therapists to use or for parents to use. And ended up being, you know, I was able to share it so it created a snowball into what it is today.     Jayson Davies     Yeah, yeah, yeah. And you mentioned something really key there. A moment ago, you talked about how you really kind of adapted it to fit into the occupational therapy world. And I think that's important, and we're going to really dive into kind of how you did that, but I just want to touch on that fact alone, because we do see a lot of or at least I'm seeing a lot of different reflex integration programs out there on the web and whatnot, a lot of trainings, but a lot of times it doesn't have that occupation focus, and it's a lot about doing the exercises without putting it into the functional outlook and whatnot. It sounds like that's kind of what you've managed to do here, right?     Kokeb McDonald     Yes, yes. So for for OTs, we focus on activity, daily living, functional skills. So what do we focus on? Play place for kids, especially if you're focusing on pediatrics, even though adults do the same work as well, classroom engagement, social skills and sensory processing and modulation and regulation. And for therapists like, how can you, I mean, we talk about it more too, but as How can you address, or even when you start screening, how can you screen these motor patterns, these reflex patterns in your client's body doing play. Why is this child having a difficulty climbing the play structure? Or why is he hesitant? Why is he setting a certain way? Those kind of questions we constantly are looking at as OTs, and for a new ot can be very overwhelming. And no, I was very overwhelmed and not being able to, you know, where am I starting, right? So that was a big question for me. But when I looked at, when I learned these reflex patterns, it just outlined it. It gave me like a framework to follow that was really easy. And then the idea now, with with our certification program is like, Can we get a lot of OTs come and teach them exactly how I learned it? And then it's been exciting to see teaching them this framework and having them screen, having them be able to observe in a playground, in the classroom, walk in. Our goal is like, I want you to be able to go on a playground and observe a client and see what these patterns and then now you can create a treatment plan accordingly, and a play based way, like they're already, you know, triggering all these reflex pattern already. But how do you address it? How can you address it? And the way you already are doing and probably in a clinic, you just don't know what you're looking at, because sometimes they just don't know what they're looking at. And so we talk about that as well.    Jayson Davies     All right. Well, let's go ahead and actually, in a way, take a step back here. You know, because I sometimes, and I do I'm guilty of this too, is I assume that? P. People who are listening know what everything is, and that is not always the case. So I want to first ask you here, how do you explain reflex integration to someone who just kind of isn't familiar with it, whether it be an occupational therapist, occupational therapy assistant, or maybe even like a parent, what's like the easy way to understand reflex integration.    Kokeb McDonald     Okay, so the easiest way to explain it is to the for parents, I tell them, think of reflexes. Because we're in the bay area here a lot of tech people. So I tell them, like, think of a code. You know, it's like we are born with this reflex patterns in our body that are there for survival mechanism, and babies in the womb were born with all these reflex patterns, and it helps the baby survive for the first year and then supposed to integrate in the whole body so that more voluntary movement patterns in sensory processing and integration and learning and higher functioning level needs to happen. So think of these are codes that they are there. The child is coded, you know, and then it comes out. So each reflex has its own sensory trigger and it has its own motor response. So you can learn to find out what these all these reflexes are, patterns are and how they're influenced by sensory triggers, and then what their motor response look like. So that's one way that the therapist will learn, one of the things that would teach them. But when these motor reflex patterns, when they're stay active, because after a certain time they should say dormant, and more postural reflux or sensory processing, the child starts to learn the environment. They start to respond that should happen. But if that doesn't happen and it's improperly integrated or not integrated and their body, they start to interfere with motor skills, coordination, sensory processing, self regulation, attention, and the child, or even later on, adult, starts to get overwhelmed and start to have a lot of compensation. You know, ways out how to deal with the body as well. So I don't know if that is a longer way of explaining it, but that's that's in brief, that's how I explain it.    Jayson Davies     Yeah, yeah. And let's go kind of a little bit deeper. Let's kind of talk to maybe someone who has a little bit more of that information and the medical background, per se, when it comes to talking about more the brain, the spinal cord and all that, are you able to kind of share a little bit about how the mechanisms within the body, I guess, how the reflex and reflex integration and retained reflexes, what's going on in the body with that, and how it impacts.    Kokeb McDonald     Yes. So the reflex, these primitive reflexes, are housed in the brainstem. So the brain stem is also considered like the reptilian brain. That's the most primitive part of the brain. That's one of the brain part that develops. So that's the first thing that develops. So that's where breathing, heart regulation, anything that we're not regulating intentionally as housed. So we have to know first that that's the first thing that needs to develop, and then after that is maybe the sensory regulation the midbrain and the cortical one will develop. So usually for a therapist, we get asked to come to work with a client, especially like school based is when a teacher or parents see a challenge in the child's attention, which is in the frontal cortex, right? So the last thing that develops, we usually are called when regulation or anything of you know before that needs to develop, which is the reflexes at the foundational level, right? So that's affected. And then we usually get asked when he can't attend. He can't sit still, he's not focusing on copy from the board, all those kind of reasons. That's when the therapists are called, and what it tends to happen traditionally, as we try to tackle that, okay, he can't catch a ball. Let's practice catching a ball. He can't write. Let's work on writing instead of what is it really going on that this child is falling behind? Because, yes, you can solve one thing, which is the writing, but then this child is going to be struggling 10 other things if we don't figure out the root cause. So with the therapist is that the idea is to learn to go back and the brain stem level and see, can we work on the foundation? So think of it as building a house like if the foundation is messed up as cracked anything you build on top of it will be faulty. Yes, it will stand, but you're going to be fixing things all the time, right? So you don't want a house like that. So you want to go back and build the foundation. So. Think of the foundation as you brain stem, and then you building everything that's up on top of us. So the great thing about creating a treatment plan that goes back to the foundation and making sure that you're not missing any hole is all of a sudden you start to see result in other areas as well. Things start to come together, which much easier and you don't have the the client doesn't have to struggle as much. And even as a therapist, you don't have to waste that much energy or time to work on the client, because by fixing on the foundation level, others, you know, even speech starts to improve, coordination, attention, parents will say like, oh, all of a sudden they're, you know, we're not fighting about homework anymore, right? So he's attending. He's more coordinated. Oh, he's becoming interested in sport, because your goal might be one thing, you know, but then he can start to see other improvements. Absolutely, you know, earlier you started down the path. And I want to come back to this now is, you know, there's reflex integration, and then there's also reflex integration that an occupational therapy practitioner might actually implement, and that's kind of what you've done here. And so I kind of, I know we can't go into full detail on this, but how do you start to connect in occupation, such as a specific piece of play or education on task behavior, whatever you might want to be, what might want it to be. How do you then connect that to specific reflexes, or specific unintegrated or integrated reflexes? I mean, I know it's an entire evaluation process, but what is some of those processes that go through your head? Or are there already some research that has kind of tied some of that together for us? Yes. So when you start to learn about these specific reflex we talk about sensory triggers and then how the body is influenced, which is the motor response, and some of them will have your response as well. For instance, the common one, one of the first book I wrote about, is the moral reflex. So the moral reflex actually is, can be a powerful reflex, because it influences the child and self regulation as well. Because what, as you know, if the reflex stays in and the body stays active, can create, like, the fight or flight response, like constantly on guard, the client will stay on guard in these when that happens, it's not like the child can stop it, because it's a reflex, right? So even with the name, you can tell, right? So they cannot wheel it away. Or it's not like, don't it's not a behavior thing. It's a primitive reflex which is housed in the brainstem level. So we have to really go back and address it if we seeing these patterns in the body. So once the therapist is starting to learn to assess and a client, so what you can start to see is like, Okay, whenever we with the sensory trigger, the child is having all these sense symptoms. So we have symptom checklist. For instance, we can look at any multiple symptoms we're looking at to see, can, you know, is the child getting car sick? Some of the symptoms for us, for instance, it can be like, hesitant to climbing up and down a certain playground can be one thing for them, and then easily startled. That can be another thing, auditory processing issue. They might melt down. They might have a hard time with sounds or and then all these kind of things that we're looking at, and then heart palpitation, ice bulging or like a sudden movement next to them might be threatening to them. So all these things that we're looking at, and we're also testing, we're screening, physically screening as well, to see and then we start addressing those so and that way, yes, one of the main things some OTs are asking the classroom is self regulation. And usually we do other things. We do the symptoms part, okay, let me teach you how to regulate. Let me teach you like the, you know, the cortical levels like, Okay, I'm gonna teach you how to not act that way. Or it could be a behavior thing. So, but then it's we were we really are not solving but my body constantly respond like this, whether I want it or not. I know in my head I get it, but I'm constantly on on guard, right? So you we didn't really solve it. So for us, it's like we do need more research. We do need more work. Even in our program, we're doing a research right now. We're gathering research and collecting data as well in our program, because I find it very necessary, especially for OTs. So yes, we do need to do that and improve in this area. That's like one way motor skills as well. There we have. We can look specifically on motor coordination and crossing midline. There's for everything. Can think of you. Can we have like a framework that you can start looking at to see, like, which one are we looking at? Right? So why can't we have kids who sit specifically on their heels, for instance, that is like a telltale sign of stnr, for instance, like they because they can't sit on 9090, degree, that OTs we look at in the classroom. So we keep saying, feet on the ground, they'll never solve that problem, right? So I can put an icon next to the table and the picture. I mean, we've all done that. At least I've done it's like, if I just point to him, you sit, but he his body doesn't work that way, right? So instead, we have to look back and be like, let me help you. Let your body actually function with efficiency.    Jayson Davies     Yeah, yeah, absolutely. And I really like the way that you are talking about this, because you're definitely talking about it from an occupational perspective, and it kind of brings something to mind. And I just I this wasn't in the questions that I asked you. So bear with me here, because this comes straight from a OTA. They do. They're like, Choose Wisely campaign, and I'm sure you've probably seen this, and it says, don't use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes. And so I guess my kind of question there is, is there ever a case where a primary motor reflex, whether it is integrated when it shouldn't be, or vice versa, doesn't necessarily impact occupation to the point where you say, You know what look this child still has the moral reflex, or this child still has another reflex, or they don't have a reflex, but it's not actually impacting them at this time. Does that ever come up? Or do you tend to see that typically, if they have a an integrated or unintegrated reflex, there typically is that occupational connection?    Kokeb McDonald     Well, what a child does is even with with what we're saying, with the statements like it's related to everything that the child does right, like, as it will be in his plane and being a social skill and classroom as well. I have not seen anything that did not connect to that that person's occupation, or can even be self regulation. I think the way I look at it is because I'm I'm looking at it from how we deliver the program or the intervention. My understanding from that article is like they're looking at the different reflex integration intervention that are out there like that are not typically, there's like on the table you're doing hand on, you know, maneuvering, and you really cannot bill for it as an OT work, because that's the thing I was trained on that too. Are they effective? Yes, effective, but that it's not ot based. So the question is not like, the question is now like, can this work or not? The question is like, how, how do OTs implement this? And what we do? I personally think OTs are, like, perfectly positioned to use this intervention, because now we see a lot of vision therapists are using it, physical therapists are using it. Chiropractors are using it. I mean, people are are going because they can't find enough OTs who who do this work. They're moving somewhere else. And OTs, we specialize in sensory integration and reflux integration. And sensory integration, for me, is combined. I do not separate them. Like reflux integration helps sensory integration and vice versa, like, you know, is, is like reflux patterns are, you know, a response to sensory input. So for me, actually, in my opinion, when I learned sensory integration when I first started, it was difficult for me to wrap my mind around it, until I learned reflex integration, because I now finally can visually see it. I can go in a classroom and and when a teacher, like for instance, I walked in in a classroom, like couple months ago, or like few weeks ago, whatever the child is putting anything and everything in his mouth, like rocks paper. They can't put anything on the, you know, the table, because they have to chase it's not safe. Okay. How do you under How do you explain that? So I quickly.    Jayson Davies     Yeah, so hold on. Hold on. I want to stop you there really quickly. And I want to continue this because I want to role play this, actually, because for me, if I see I'm not trained in reflex integration here, so for me, going into the classroom, things going into the mouth, I'm probably thinking some tactile, you know, wanting to get that tactile sensation in the mouth. Maybe some proprioception, potentially, that's kind of what I'm thinking. Maybe taste might be involved. But from the. Sensory perspective. That's what I'm thinking now, Susanne Smith, Rowley, Zoe Mayu, they can go way beyond that and go more, but that's what I'm thinking as an occupational therapist that is SIP trained, but not like, you know, to the max. But I'm excited now to hear or first of all, is that what you would see from a sensory and then how would you go beyond that?    Kokeb McDonald     Yes. So the first thing I will think is, like, I was assessing this job. I was observing with them, and then they were just concerned, because he has behavior and other things. He's like, see, look at this, you know, like, what is he doing? So what I did is I pulled them quickly, because I need to explain to them that this child is he's not just having a behavior. He cannot control it. So I did a quick screen in front of them. So I screened his rooting reflex. Rooting reflex is a very one of like the first you know, should have been integrated, what, four months. So I screened him like this child. You can see his mouth moving, opening his mouth. He's was seven years old, or seven and a half years old, so I have to, I can explain to them right there. I said, like, this is a primitive reflex, like, so he's constantly doing that. There's also a back end reflex, which is connected with your hand and mouth. So everything you hold in your hand, goes in the mouth, because those reflex patterns are connected. So when you ask him the child, when you ask him, what's in your mouth, he's like, it's almost, he's almost surprised that something in his mouth, because he's not consciously doing he's not like walking around. Oh, a rock. Let me put that rock in my mouth, because he's smart enough in his head to understand, but when he's not thinking, when he's like, focusing on things, something in his hand is goes inside the mouth. They were saying how dangerous it was because he had they found him like a scissor in his mouth during cutting activity or so it can get dangerous. So when I showed them right? Really quickly, I said, like, hey, this should have been gone. And I even went and did that to the teacher, like, I just stroked their face, like, see nothing happened to you. And so in that way, there was almost an understanding of compassion and less frustration with the kid. And then they can understand now he's like in a brain stem level. So we really need to work on creating movement activities and to help, really, this brain to develop so that they can get to the point of like, higher level function of like, don't even expect him to sit for 40 minutes for you, because we're really in a lower level. So we have to change the expectation for the class safety and all that. But that's just one example of because, is it the solution to always give him a chewy toy because he's constantly chewing? Or can we really go a little bit deeper and see why even is there it should have that kind of exploration is very, you know, immature in a sense, like, you know, babies do that, right? They explore. It's a developmentally appropriate a certain age, but should go away, yeah? So, yeah, that's one observation.    Jayson Davies     Yeah, yeah, exactly right. Like, I would have just seen the proprioception, the tactile, but you saw, you know, the reflex, and we're able to go that route. So, yeah, definitely one thing that I have learned from discussions with people who use a primitive reflex model. You know, you hear about these different screenings, right? You're testing like you're testing this reflex, you're testing that reflex. I honestly don't know the answer to this. Is there a standardized tool at all for looking at reflexes, you know, like we have the easy, or we have the sipped, or we have the bot, you know, standardized tools. But is there actually a standardized tool, or a go to tool, even for, you know, looking at primitive reflexes?    Kokeb McDonald     Not that I know of right now, there is no standardized we should have some kind of standardized we should develop. We are developing one for our program. For instance, it's not standardized. It's really based on observation and really training the therapist. The reason, even on my program, we have them stay with us for about 12 months, and have Q and A calls and implementation in video chats and coaching is it really takes time to learn to have this clinical, sharp eye to picking up these movement pattern right? So we encourage the therapist to take a video while they're screening. So I can, we can watch them do the screening and help them pick up as well. So it really takes time. I really, I really, highly encourage therapists to not assume that you just gonna read it up and then you gonna pick it up. I mean, took me years and years, and this Like any skill, right? So it's gonna take time to learn this, but we do right now. Observation. You. We do an actual screening method and then have them train them in how to look at these reflex patterns. We also, in my program, I learned that it's important, especially for OTs, to go back and review anatomy and movement pattern like the functional movement pattern, because we've forgotten what that looked like, what functional movement pattern looks like. What is the most efficient movement for this specific task? And once you have to have that baseline, and then, you know, these reflex patterns, you can really easily screen better instead of just looking for screening. Sometimes what happens I see now a lot of posts on social media, as well as like stnr, and then they do just one thing. But for us, we screen the entire body, because there's so much that happens with the body the way they compensate. So even if you're screening one thing, you can also start observing other reflexes, kicking to compensate, right? So the same way our body does that all the time, right? So you're doing some exercise. The mouth is moving, the toes are curling, and, you know, you're moving from the shoulder. We want you only need to write from the wrist, like stuff like that. So we want to look at different patterns. We can also look at, look at in this screen.    Jayson Davies     Yeah. Yeah. I mean, I could definitely see a tool that almost looks similar to, like the sensory profile or the SPM, right, where it asks the teacher or the parent, you know, about behaviors that the teacher or parent can see, and then it kind of categorizes it into different Yeah, reflexes that that is associated with. I mean, maybe you kind of have something with that. It sounded like you kind of alluded to something similar to that within the program. But yeah, I think that would be an absolutely helpful tool for anyone who's kind of, again, you got to have the education to know where to go with it. From there, you know, once you know that it's the more reflex, you got to know what to do beyond that. But yeah, very interesting idea, if someone hasn't developed that, that would be a great tool. I'm sure that a lot of OTs would find helpful. So.    Kokeb McDonald     Yeah, yeah, we have this symptom checklist, and we're doing the screening, and the school based too. We're working on a tiered intervention, like, you know, tier one, tier two, tier three, kind of way of evaluating an intervention, because our program, we have a school program, for instance, that service the entire school, not just kids with IEPs or services. Because I really do believe everyone should get this as almost like a school based and school wide movement break. So now we everyone can get it, because we have a lot of actually, it's interesting. We have a lot of kids who are falling behind, who are not on service, they don't really qualify for service, but then are struggling and can still benefit from it. So like with a school program, for instance, we encourage everyone to use it, and then if the kit really needs service and it can get pulled out and do more of intensive work. So.    Jayson Davies     Yeah, that's awesome, a follow up to that. Specifically, I have so many follow up, but are you? You're doing tier one, tier two, tier three, just to confirm, because everyone kind of thinks about tier one, tier two, tier three a little bit differently. I think of tier one as, like, supporting the teachers. Tier two, maybe supporting the entire classroom, or a group of kids, and then tier three gets more individualized. Does that kind of align with with your tier one, tier two, tier three?    Kokeb McDonald     Yes. So luckily I have, like, I have it here, so I'm looking at it. So yeah, tier one. I was just reviewing it, editing it, so Tier one is more of like a general classroom we're doing. Tier Two is like for at risk kids, and then tier three will be individualized support. Yes.    Jayson Davies     Okay, so then, if I can really quickly ask you, how do you measure whether or not in the group sense progress is being made or not being made? Is each individual student going through a screening process, or is it like a group screening process?    Kokeb McDonald     Yeah. So what I'm in the middle of development inside of our program right now, so usually, ideally, as I'm training our therapist to go in and do like a school, like, if you have a school wide contract, for instance, and be able to if you're doing a push in. And right now, I do that with a school, and I have the entire school, like pre K to high school, so we are implementing these ritp program for the entire school, so every teacher is trained, they have access to our program. They implement that as a movement break throughout the class, and when they contact me as like, Okay, I have clients on kids so and so. I need support so and that way I'm creating it. Actually, for me, I'm like, I have the entire school, so I wanted to make sure I create this. So I'm gonna give the teachers to do a quick. Okay, have we done a school like, you know, the general classroom intervention and then, but there's some kids that we need to actually in addition to what they're doing, because we're trying to create the same activity so they won't be confused. They're already doing it. And so now we're creating a program they can pull out. And then we give them, like, five minutes or something, so do additional movement break, and they can come back again. And then when I'm screening the classroom, I can, for me, at least, because I can do it, I can be able to do a quick analysis of the child, and be able to say, like, oh, okay, we need to target this, this reflexes. So and our program that we give them so we have, like, the done for you school program that we can actually give them a playlist for the specific kid to go outside and do his exercise and come back. So the idea is, like, when we do, you know, sensory diet we've heard about that, that's where OTs do. I always been thinking. I always want my sensory diet or movement break to be meaningful and really connect brain body connection. I want, I don't want it to be like, just jump and come back. I'm like, why am I having this kid jump and come back? As is really targeting a problem. But how about if I can give him, like a five or 10 minute of exercise that really targets the challenge. And if we can create frequency that's actually can get a better result with that than seeing him once a week with me, if I can create a movement break that the teacher can easily implement, the child can go do it and come back, or the Para educator can do a comeback, or send a home program and do a comeback, you get a better result then, yeah, you know, you just shooting in the dark. Sometimes I kind of feel, I felt like that I sent ot right now, like, Okay, try this. Roll here, run here, you know, and then I'm like, we still having the same problem next year.    Jayson Davies     Yeah, yeah. And, and so I was just wondering how you how you kind of kept track of whether or not the student need to to progress from, you know, tier one to tier two to tier three, or if they're doing okay well enough in tier one. It sounds like it's primarily your observation as a therapist, whether or not you go in and observe the entire classroom, and you kind of pick out which, you know, students who may need a little bit more and which students who don't need as much. So does that sound about right?    Kokeb McDonald     Yeah, that that would be definitely a skilled therapist. Like that would be something this can can help. Because sometimes even the teacher will their kids will pull out, and then the teacher will say, like, oh, he doesn't need it anymore. He can the what we're doing already, he's can maintain. We also will teach the kid to say, like, okay, to teach, to tell them like, Oh, do you want movement break? Okay, when you want movement break, this is what you can do. So even educating them. But then they're outside of that. There are some other kids who definitely need a structure, pull out one on one sessions.     Jayson Davies     Yeah, yeah. And it's hard, because I think as therapists, we want to develop like a tier one system, or maybe even a tier two system, where the teachers can do the measuring, as opposed to us needing to do the observation and measuring. And that's really hard, especially when you're talking about things that are happening within the brain, right? Like, it's one thing to see a pencil grip, it's another thing to understand reflex integration, sensory processing, all that other stuff, right? So it's very hard to conduct a screening other than just, you know, an individual student, screening a group of students, or screening an entire classroom without the occupational therapist, or maybe even an occupational therapy assistant, even getting into the classroom to really kind of observe what's going on. So, yeah, yeah, thanks for diving into that. I know that was not planned on today's conversation, but I appreciate going down that route.    Kokeb McDonald     Yeah, yeah, definitely building it, and then we're testing it out all the time and then improving it. So that's, that's where we're at right now. Wasn't actually supposed to be public. Now you got me talking about.    Jayson Davies     All right, uh, well then, no one heard any of that. You can obviously, if you heard anything about, um, all right, going back you talked a little bit about integrating your approach with play and as pediatric occupational therapy, practitioner, school based, clinic based, home based, anything. Of course, play is huge, right? Like it is the primary occupation of a child, and it is one of the ways that we can help children make progress. So how have you kind of done that? How have you incorporated reflex integration into a play based approach?     Kokeb McDonald     Yes, just like you said, it's a natural progression for the kids, and the best way to learn is through play, and the best way for OTs is think of it when. Let's say when you are creating an obstacle course, we do that a lot, right? So we have a group session, and you create an obstacle course, and you pick out exercises. So what we teach is we really dive and break down each game you're doing an activity. Let's say you have them crawl through the tunnel. We can break down each of those movement patterns, and you can relate it specifically and to specific reflex patterns and how to even screen and observe. I think that that is the skill that we want our therapist to learn as like, Okay, I I picked five games, and I want to know my therapist to tell me I'm for each of the five games. I want you to tell me exactly what you're looking at, right? So let's say we the crawling. You know, we crawling can be working on and observing STN, R like one of the reflex that helps with the crawling is sdnr. You can look into the Galant, even in crawling, and you can also work on the atnr and during crawling, that's like, but then for the client, I tell them, for for you, it's very like, you're like a detective. You're observing every part of the body, and you're learning to pick up all these and how to observe the parent, the child, for the kid, is play. You're creating an obstacle course, but you're picking specifically the exercises that you want that is triggering the reflex pattern. It's going to challenge them just enough. But then for you to work on these brain body connection so we, I mean, the entire ot gym that you have, we can create a play based work just for that. But then for the therapist, we're teaching them how to observe these pattern, how they make it difficult for the child, let's say, to hang from the monkey bar. Why? Why is that? And their reflex parent can look through that. And which one are you working on in ball games, you can do the same, similar things. You name it. We can do it. You know, it's just really teaching therapists a tool to to assess even their work and to track.    Jayson Davies     Yeah, and, and again. You know, you don't necessarily have to have a clinic to do a lot of this. And, and maybe I'll let you share in a second, you know, like, what you can do if you don't have a clinic to do to look at some of these. But you don't necessarily have to have a si or reflex integration type of clinic to do a lot of this. What would you recommend to therapists to don't necessarily have a nice therapy space, space.    Kokeb McDonald     Okay, then a park. Do they have access to a park or playground? Playground? Yeah, so playground. So Monkey Bar is, like, one of the most common activities or even goals that I've seen written for OTs, right? So like, he will, you know, work on a monkey bar, hang from there. Like for, for Monkey Bar. One other thing we train is like, Okay, what does it take for the child to be able to hang on the monkey bar, and what reflects make it even difficult for them. So mostly, if they're more reflexes really active, or the TLR is really active, anything that makes them leave the ground would be challenging. Balance is hard. Vestibular is affected. So we work a lot on vestibular, right? So specific reflexes, the patterns you can work on. And another thing is, like the Grasp reflex as well. Like, in order to be able to alternate the hand and to cross over the monkey bar, you need to have a shoulder strength, obviously, core strength and bilateral coordination, which is etnr and all that. But the palm of grasp is one too. So we can do like, Okay, which one do you want to work on first? So sometimes we have to, you know, go back and working on the pomegras before we even work on the morrow, because the child has to be able to hang on with both hands. Because, let's say the pomegrass still active. So when one hand opens, the other one will open with it, so they won't be able to hang on, on both hands and be able to balance. So their strength is affected. Their core strength affected so being able to gradually walk them through and even how to set up a simple, like five minute session that is really like, what can actually give them, like this domino effect into the goal that they're working on. So, yeah, you can do on the playground, climbing up and down the playground, whether or not you're doing I'll ask the therapist too, like, Okay, why is that some kids have a hard time pumping on swings, right? So that can be if the sdnr is really active, or the TLR is really active. It's really hard for them to differentiate the upper body and lower body. And then you can see this awkward movement pattern like and their mind. You can see they're really, really trying, but their body is totally not following through. So you can see this disconnect with the body the brain. Body. So that's what we're going to help them. It's like, Okay, now we're going to downgrade the activity and help them.    Jayson Davies     Gotcha. Sorry, I have so many follow ups. I'm going to preface this with I am very uneducated when it comes to primitive reflex, and I really am, and I'm really asking questions that I'm genuinely interested in, and I think others that are listening might be interested in as well. A lot of what we talked about today has been more gross motor stuff, crawling, doing the monkey bars, climbing up and down different areas. You know, attention that's not really it's not gross motor. It's not any motor, but we haven't discussed fine motor at all. And I'm curious to know if there has been correlation between fine motor and primitive reflexes.    Kokeb McDonald     Oh, yeah, 100% I'm actually writing the next book on hand, which will include perfect at least. This is a plug that was not planned, but yeah, so I'm working on the hand because it took I decided not to write on the hand. Because, yes, OTs, we can tend to focus on the hand, but there's so much also we need to work on the postural reflex as well. But the hand, which is the palm of grasp, effect the hand the fine motor, the back in the one we talked about, like, have you seen kids cutting but their mouth is opening with it every time the mouth opens. Yeah, that is the AP reflex. That's the reflex that sometimes makes them like even want to put things in the mouth constantly, because something in the mouth, it goes in, you know, hand. It goes in the mouth, the hands pulling reflex, as well as connected to the hand as well even other reflexes, like atnr, which affects eye hand coordination, being able to time, that affects the hand as well. So the fine motor is also related to speech. So our grasp as there's a lot of actually, I'm researching on this because I'm about to write them. I'm writing the book as there is a correlation between the grasp and fine motor and and speech articulation, not the perception, but the articulation, which is why you see a lot of kids with fine motor challenge also have speech. Speech is a fine motor skill, right? It's a fine motor skill. And then you can see or how grasp or also affect overall strength. And then later on, even in older adults, the first thing for the quality of life is reduced 60 I think, if I'm not mistaken, are older adults because their grasp strength goes down. So how important it is actually to work on grasp for overall quality of life. Because if your hand strength is down, you know your functional skill, and you know taking care of yourself, care will go down as well. And this is really highly. Is, you know, connected. And if you notice too, like, if you had, I don't know if you have baby, or if a child, like the grass string, is so strong when they're born, you can literally an infant. You can literally lift them up and you can see how strong they are. This, like a tiny like infants, they are just born, literally, because they're so it's not because they're strong as it's the reflux. It's really strong pattern, yeah, and that helps with even breastfeeding. It helps because they tend to, you know, help with breast, you know, milk production, because they grasp on the mom's breast and then they squeeze. And that is something it helps with self regulation as well, because it's connected to it helps with the Moro reflex integration as well, because the Grasp helps, because the baby, you know, the infant, even with other animals, then research that they hold on to their caretakers. So that is all connected to grasp and hand strength is highly related.    Jayson Davies     Wow, yeah, you know. And I just casually went along with you and said, like, yeah, you know, speech movements is fine motor and like, I just, you know, went along with you, but, and it is, but I had never thought about that. And so when you said that, speech is fine motor, I think that's the way you phrased it, like, yeah. I mean, all the different movements that you have to make with your lips, your tongue, your jaw, all of that definitely not gross motor. I mean, maybe just opening your mouth, you might consider being gross motor, but everything else going on in there is definitely micro, small movements. So.     Kokeb McDonald     Yeah, very complicated. It's its own field, right? So, yeah, yeah, it's fine motor. Yeah, that's related. And then you'll see, if you go now look at your caseload and see how many kids who have fine motor challenges also have speech challenges. The correlation is very hot. Okay, yeah.    Jayson Davies     And I think we're all, you know, everyone right now, including myself, we're all thinking about one or two specific kids right now as you talk about this so absolutely and and it leads my head to a whole nother conversation, which has become kind of popular. I don't know if we'll dive into it, but about speech, kids who have speech only IEPs, whether or not they should also be able to have ot on their IEP, or if they need to have RSP or sai in order to have OT, whole other conversation. But this kind of backs up the idea that students who have a speech IEP might also need occupational therapy. So, yeah, just something to throw out there.    Kokeb McDonald     Yeah, I think it's important, like we have some speech therapists in our program as well. They take our certification program, because now more and more speech therapists are actually noticing that they need to do more than just the articulation piece of it there. There is more to speech development, like working on, I mean, co treating speech and OT is the best, and I actually enjoyed the most when I did that, especially the kiddos who have speech delay. And I can actually screen out, pull in the speech therapist, and then I show her, look at this, in in, let's co treat. So those aren't great. And then even encouraging speech therapists to do more movement activities and consider co treating with OTs and vice versa. And when our kids start doing really well and integration and coordination, bilateral coordination, I asked my team and my therapist to go and talk to their speech therapist and see if their goals are improving. And sure it is.    Jayson Davies     Wow, yeah. It's amazing how the how the brain works, and everything kind of comes together, you know, we, yeah, we like to, you know, it was always big, right? Express, I mean, it's still a big thing in, especially in, like an OT school, right? People get frustrated when they say, oh, PT works on the legs. OTs work on the arms, and, I mean, it's just another reason to be more frustrated by it, because it's all interconnected, right? Like we can't separate speech therapists from i You can separate what we each do, yes, but at the end of the day, it's all interconnected, and what what you do might impact speech not because you are a speech therapist, but because that's just the way that this child or person's brain works. Right when you impact one thing, it impacts another. So yeah, absolutely crazy. One last topic that I want to address before we move on today is a little bit about collaboration, because within school based occupational therapy, we are often tasked with supporting teachers, and we talked a little bit about this with the tier one, tier two, tier three, that we discussed earlier. But I'll ask you this way, if there's an occupational therapist, you know, listening out there today and they want to support their teachers, maybe they already have some some education with primitive reflexes. But what maybe one or two tips do you have for maybe helping an occupational therapist support a teacher, whether it be one specific kid or the entire classroom? I know carry over is always difficult with teachers. Is there any suggestion that you might have to help with the carryover?    Kokeb McDonald     Yes, so I can tell you what I've learned by working with lots of years, and what I noticed is, even when why we developed a school based program is is really understanding what the teacher goal is, right? So usually we go in a classroom and focus on our goal, like I'm an OT. Here is my kiddo. This is my goal, and I'll go, do you know? But then we forget true, yeah, that is because that is our care, and then that's why we're there, and we assume the teacher is equally concerned about that. Yeah, and then what I but then, when I did this work, I think I spent about a year going to classes and just observing teachers and what they do and the amount of tasks they have on your plate, and they're just overwhelmed by like 30 kids, and we have that one kid, we want them to do something. And so what I've learned, and even I changed my approach with teachers, and we just decided, okay, what do teachers really need? And each of the teacher working with, just like your clients, they're different, right? So there, are teachers who are like, gonna learn and read everything, and they will implement everything to the team. I mean, those are great. But then there are teachers that they are overwhelmed themselves. So what can we do? So what I've noticed, in general, what works really best for teachers is when you provide a. Done for you. Curriculum based. Here it is five minutes. Just do it, because I got a first I was focused on. Let me explain to you. Let me help you understand why this is important. I'm like, they don't care because, because there's a lot of other things they need to do. So the best way is to understand your teacher, know their pattern, your own teacher pattern, what works best for them, and then suggest and ideally for me, what I do is give them a done for you program, like, we just give them, like, Okay, you have five minutes. I'm going to doing this time. Just do this exercise with the whole class. And if you want to learn more, come here. I'll show you how to do it. And when I, when I work on a client, I first, with the teacher, actually address their goal first, because they care about what they care about. So I I'll, instead of, like, telling them what I'm concerned about, I tell them, like, Okay, the reason you want them to sit still, okay, this is what's going to help them. You want to, what are the things you're concerned about? I'll help you with that. And indirectly, you'll work on on the goal. And I think that same thing with everybody else too, right? So, and, but you definitely have to, you have, I have to remember there the classroom is the teacher's domain. I don't dictate it. And then if it does, if I'm overwhelming them, I lose already the same with home program, right? So you have to figure out the parent and what they can handle. And then I if you overwhelm them, and then you're not meeting, you're not addressing the main concern. They're not going to do it. So sometimes that's why I screen in front of them, to show them, because when they say I'm concerned about this kid, like the the oral motor situation, that he puts everything in his mouth, I just pulled the kid in front of him and did the screening right quickly in front of him and proved to them that, hey, this is a not behavior. And then you can see their their demeanor starts to change. They they feel like, oh my gosh, I didn't know a poor baby, you know. Like they care more so now they're not having this battle, you know, like, you know, battle with him about behavior issues. He's not listening to me. Situation that's, that's our approach. And then offering a denfoy, easy to follow program, it's ideal, and that's we create that for.    Jayson Davies     Absolutely, yeah, and, you know, it takes a little bit of time to do something like that as a school based OT, absolutely. But I found like, once you create your template for what your program is going to look like, then it's relatively simple to plug and play. Once you have, you know, this student versus that student like you, you've got the infrastructure there. You just need to change out a few different routines that you might want this student to work on versus this student. And it's relatively simple. It takes less time. There's always that setup phase of getting it, you know, ready, but by by developing the template that can be simplified. We'll just put it that way. Definitely be simplified. And 100% agree with you on figuring out what the teacher's goal is. That is my number one go to support that I provide to OTs oftentimes like, they ask me, like, I don't know what to work on the court or what to work on with this student. Ask the teacher, start with the teacher, because the teacher sees the kid every day. They know what they want that student to do in the classroom, that's the best place to start. So, yeah.    Kokeb McDonald     And if you can solve other things for them, yeah, they will. They will definitely buy into what you're going to do.    Jayson Davies     Yep, yep. 100% All right. Well, COVID, it has been amazing talking to you a little bit about reflex integration. Thank you so much for coming on. And before you go, I want to give you a little a little moment to talk a little bit about what you're doing over at integrating reflexes.com and what you have to offer for therapists. You've mentioned books, but what else?     Kokeb McDonald     Yeah, we have a mobile app that is now public for everybody we that's where we have our therapist create treatment plans, and then they can easily share it with their clients to be able to access that. We also have made it available that parents who don't have therapists who wants to actually start a home, they can be able to access it as well and learn and be able to implement it with their client, with their child. It has activities. It's done for you, movement activities and some explanation. And constantly adding to it, we have a little bit game set there can be able to do as well. We have a certification program that we teach therapists to screen, create a treatment plan, implement and be able to, you know, create a home program and school program as well, and then be able to do that inside our program. We do coaching. It's 12 months right now. Is 12 months program access that we give them. Some of them finish it really quickly. Some of them takes them a while. To learn to implement, but they have 12 months access to our coaching and support where they can come. We have life coaching times that they bring in their cases. We do treatment planning and brainstorming, ideas and support, so that is something we provide. We have books and resources that we create for therapists to be able to implement constantly, creating those what else we have game. We have a memory game and game, a tile game that we have for a lot of therapists actually like it, because it's easily they can take it with them and they do memory game, and it's exercises, but all the exercises are picked so it can challenge different reflex pattern as well. And I think that's it for now. Yeah.    Jayson Davies     Is integrating integrating  reflex.com that's the best place for everyone to go?    Kokeb McDonald     Yeah, or you can go ritp dot info and then sends them to our website, which is integrating reflexes.com .    Jayson Davies     Perfect. Well. Kokeb, thank you so much for joining us today. Really appreciate it. And yeah, we will link to all those in the show notes, as well as any other resources that we've kind of talked about today. And yeah, definitely go check out the website. Kokub also has several videos where she like shows the game and whatnot. So head on over there. Learn more about the game, the app, all of that, and especially the program, if you want to learn more about reflex integration. So Kokeb One last time. Thank you so much for coming on. We really appreciate yourself and all the knowledge that you shared.    Kokeb McDonald     Yeah, thank you so much for the invite. I appreciate it.    Jayson Davies     And that wraps up another episode of the OT schoolhouse podcast, a huge thank you to kokub for joining us today and sharing her expertise in reflex integration. Kokeb, your insights into making reflex integration accessible, practical and occupational focused have truly given us all something to think about and to apply into our school based practices. As an added bonus for listening to this episode, Kokeb is graciously offering all of our listeners 10% off her reflex integration books and games at integrating reflexes.com just use the code. OT schoolhouse, all one word to save today. And thank you, of course, for tuning in and taking the time to grow alongside us. If you enjoyed this episode, be sure to leave a review or share with a colleague who could benefit from learning more about reflex integration and its place in school based occupational therapy. And if you're looking to take your professional development to the next level, I'd love to personally invite you to join the OT school house collaborative, our growing community of school based OTs and OTs, who meet every single month to learn from experts, dive into research and implement evidence based practices together. It's the perfect way to get the support and resources you need to grow in your role while connecting with others who understand your unique challenges. You can learn more and become a member over at ot  schoolhouse.com/collab , that's ots.com/C , O, L, L, A, B, with that, I hope our conversation today sparks some new ideas and approaches for you to consider in your practice. Remember, as ot practitioners, we have the incredible opportunity to make meaningful changes in the lives of our students, teachers and families we work with. Thank you again for listening in, and I will catch you in the final episode of 2024.    Amazing Narrator     Thank you for listening to the OT schoolhouse 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. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

As school-based OT practitioners, we’re responsible for much more than direct services to students. Our days are filled with evaluations, IEP meetings, consultations, documentation, and, for a vast majority of us, travel between schools. Yet, in many districts, our responsibilities are still assessed solely by the number of students who have OT listed on their IEP - AKA your caseload. The truth is, your workload  encompasses much more than just your caseload. Understanding and tracking your workload is essential to advocating for the support you need, ensuring not only your own well-being but also better outcomes for the students and schools you serve. Let’s dive into what it means to track your workload and how you can begin taking steps toward meaningful change. School-based OT Caseload vs. Workload: What’s the Difference? What Is Your Caseload? Your caseload refers to the number of students you are directly responsible for serving through IEPs or 504 plans. For example, you might have a caseload of 50 students across three schools, each requiring different types of intervention or consultation. While caseload numbers are often used as a quick metric to determine staffing for a district, they only tell part of the story and, to a degree, set us up for failure from the get-go. Caseloads fails to capture many of the tasks and responsibilities that allow you to succeed in your role as a school-based OT. What Is Your Workload? Your workload, on the other hand, includes all the tasks and responsibilities that come with your job. These go far beyond direct services to students and may include: Writing evaluations, IEP reports, and progress updates. Attending IEP meetings, MTSS sessions, and team discussions. Collaborating with teachers, parents, and other staff to support student goals. Traveling between school sites. Participating in school-wide initiatives like RTI or professional development. Providing staff training or workshops. A workload approach  accounts for all these tasks, offering a more complete and realistic picture of your responsibilities. Why a Caseload-Only Approach Falls Short Using caseload numbers as the sole measure of your responsibilities can lead to unrealistic expectations and unnecessary stress. Here are a few reasons why a caseload-only approach doesn’t work: 1. Invisible Responsibilities Caseload numbers don’t account for the time spent on evaluations, documentation, and collaboration. These tasks are crucial to your role but are often overlooked in caseload-only models. 2. Burnout and Missed Goals According to a 2020 survey published in the American Journal of Occupational Therapy  (AJOT), 60% of school-based OTs reported feeling their caseloads were unmanageable. Even more concerning, 55% said they couldn’t meet all the mandated IEP minutes for their students. This gap not only impacts students but also contributes to OT burnout. 3. Missed Opportunities When your caseload is the only focus, there’s often less time and support for broader initiatives like tiered interventions or teacher training—programs that can positively impact more students while reducing referrals. The Benefits of Tracking Your Workload Switching to a workload approach offers numerous benefits for both you and your school community: Advocate for Resources:  Data from workload tracking can help you demonstrate the need for additional staff or policy changes. Improve Time Management:  By understanding how your time is spent, you can prioritize high-impact activities and identify inefficiencies. Enhance Job Satisfaction:  A manageable workload allows you to focus on delivering high-quality services, leading to better student outcomes and a more fulfilling career as an OT practitioner. Support System-Wide Goals:  A workload approach highlights how your work contributes to broader school initiatives, helping to align your role with district priorities. Looking to ditch the Caseload Model and move to a Workload Approach? While at a rural school district with a caseload of over 100 kids , I knew something had to change. That's when I began to study where my time went and create a plan to get support. After changing how our program operated and convincing my boss to hire another OT, I created this course to help OT practitioners and other providers do the same. Click here for support in making the transition! How to Measure Your Workload Tracking your workload is simpler than it might seem, and it’s a powerful way to take control of your responsibilities. Here’s how to get started: Step 1: Use the Workload Calculator Our Workload Calculator  at otschoolhouse.com/calculator  is a free tool designed to give you a quick overview of your workload. Input your current caseload data and select the responsibilities that most align with your job, and the calculator will provide a snapshot of how much time it should take to complete your job in a given week. This is a great starting point to screen whether or not your workload "should" be manageable. Step 2: Conduct a Time Study For a more accurate understanding of your workload, track everything you do during your workday for one to two weeks. Be detailed—record time spent on direct services, writing reports, traveling, attending meetings, and collaborating with teachers. This time study will give you precise data on where your hours are going. Step 3: Identify Areas of Concern Compare the results from your Workload Calculator and time study. Are certain tasks consuming too much of your time? Is there an imbalance between direct services and other responsibilities? Use this analysis to identify areas that need adjustment. Step 4: Advocate for Change Present your findings to administrators in a clear, data-driven way. Highlight how your workload exceeds your available time and suggest actionable solutions, such as hiring additional staff, reducing your caseload, or redistributing responsibilities. If you'd like help with this four-step process, I offer a workshop titled Making The Shift: Caseload to Workload . In that course, I walk you through each step and provide templates and tools to help you and your team along the way. Learn more here. Overcoming Barriers to Change Advocating for change isn’t always easy, especially in districts that have relied on a caseload-only model for years. Here are some tips to navigate common challenges: Speak Their Language Administrators are often focused on compliance, cost savings, and student outcomes. Frame your argument in terms that resonate with them, such as how a manageable workload can improve compliance with IEP mandates or reduce burnout-related turnover. Start Small If a full shift to a workload model seems overwhelming, propose a pilot program for your department. A small-scale trial can demonstrate the benefits of the approach without requiring district-wide changes. Work as a Team Collaborate with your colleagues to present a unified case for change. A collective voice is often more persuasive than an individual request. Take Action Today If you’re ready to take control of your workload, the Workload Calculator  is the perfect place to start. This free tool helps you analyze how your time is spent and provides the data you need to advocate for meaningful change. By combining the insights from the Workload Calculator with a detailed time study, you’ll be well-equipped to make the case for a workload approach that supports both you and your students. A Final Thought The work we do as school-based OT practitioners is invaluable. Unfortunately, it is also sometimes difficult for us to quantify its impact. Understanding and tracking our workloads is the first step to both advocating for ourselves and measuring the quality of our services. Unless we understand the time we spend on specific activities, we are not able to identify what tasks are making the most impact. Maybe it is 1-on-1 services. Maybe it is groups or classroom collaborations. But without the data, we won't know. By tracking your time, you can make the necessary changes to ensure your time and energy are spent where they matter most—on the students and schools you serve. Let’s make the shift. Your work matters, and so do you. References American Occupational Therapy Association, American Physical Therapy Association, American Speech-Language-Hearing Association . (2014). Workload Approach: A Paradigm Shift for Positive Impact on Student Outcomes . Retrieved from https://pediatricapta.org/special-interest-groups/SB/pdfs/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-.pdf
Seruya, F. M., & Garfinkel, M. (2020). Caseload and Workload: Current Trends in School-Based Practice Across the United States. American Journal of Occupational Therapy , 74 (5), 7405205090p1-7405205090p8. https://doi.org/10.5014/ajot.2020.039818

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 163 of the OT Schoolhouse Podcast. What if there was a way to make sensory integration more accessible, effective, and inclusive for every student you support? In this episode with Dr. Colleen Cameron Whiting, OTD, OTR/L, shares her research on integrating sensory integration within the school setting. From implementing a flexible 15-week intervention model to adapting strategies within a Multi-Tiered System of Support. Join us as this episode is packed with practical insights to empower us to make a meaningful change. Listen now to learn the following objectives: Learners will identify how sensory integration can be effectively implemented within a school setting using a multi-tiered support system (MTSS).
Learners will understand the importance of collaboration between occupational therapists, teachers, and parents to enhance student engagement and classroom performance
Learners will understand how to integrate SI strategies into everyday academic activities and tailor them to fit individual student needs. Guests Bio Colleen Cameron Whiting, OTD, OTR/L has worked as an occupational therapist for over twenty years and currently works as an assistant professor in the doctorate program at Johnson & Wales University. Her expertise lies in holistically supporting children, particularly those with sensory integration and processing challenges, autism, and who have experienced trauma, using theoretically based, evidence-informed interventions, and advanced professional reasoning.  Throughout Whiting's career in early intervention, mental health, schools, private practice, and academia, she has modeled the importance of being a lifelong learner and innovating new ideas through her scholarship and service. She has published several peer-reviewed journal articles and chapters as well as a multiple baseline single-subject research study. Whiting has also presented internationally in professional development trainings for practitioners, parents, and educators. Quotes "They really felt like they had a breadth of knowledge of really understanding the impact that sensory integration and processing can have on occupational performance and how some of the strategies and approaches that we do, using the ASI principles, can have really nice gains."  -Colleen Cameron Whiting, OTD, OTR/L "They now had this tool belt of strategies of adapting and modifying the school environment to be more sensory supportive for that particular student, but also understanding that it's really important that we're engaging the student."  -Colleen Cameron Whiting, OTD, OTR/L "We want to make sure that we have this intentional generalization of what’s happening; otherwise, we’re just in this kind of box in the corner, and we’re not making sure that things are connecting back to the classroom."  -Colleen Cameron Whiting, OTD, OTR/L “An IEP is designed to be individualized for the student. So long as the IEP team agrees on something, go for it. You might have to get a little crafty in how you do it, but go for it.” -Jayson Davies, M.A., OTR/L “Using terminology familiar to educators, like 'common core,' instead of technical terms, can better communicate the impact of occupational therapy in schools” -Jayson Davies, M.A., OTR/L Resources 👉 Dr. Whiting Faculty Page 👉 Linkedin 👉 Sensory Integration Intervention in School's -Article  👉  Star Institute course  👉 Lucy Jane Miller  👉 Dr. Sarah Shone 👉 Asi fidelity measure  👉 Star Institute Fidelity Check-in 👉 Scope-MOHO  👉 BASC-3 👉 Goal Attainment Scale  👉 CLASI Episode Transcript Expand to view the full episode transcript.   Jayson Davies     Hey friend, welcome to episode 163 of the OT school house podcast today, we are addressing one of the most pressing issues in school based occupational therapy, whether or not sensory integration can be effectively implemented in a school based ot setting. Now, since gene Ayers first began documenting protocols and data related to this theory, countless articles have been published about the effectiveness and efficacy of sensory integration. However, none of those articles accounted for the unique system that we as occupational therapy practitioners in the schools find ourselves in while working in the schools. Well, that is, until now, in today's episode, we're taking a close look at the first published article aiming to prove whether or not a sensory integration approach can have an impact within the school setting. Joining me to do just that is author of the article, Dr Colleen Cameron Whiting. You may remember Dr whiting from Episode 35 of the OT school OTs podcast, when we discuss trauma informed practices. However, today is all about sensory stay tuned to learn why Dr whiting decided to pursue this research, what the SI program actually looked in the school setting, and the potential implication for this research for both you and the future of SI in school based OT. So let's jump into the research with Dr Colleen Cameron Whiting, owner of the spark sensory clinic and assistant professor at Johnson and Wales University.    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     Welcome back to the OT schoolhouse podcast. Dr Whiting, how are you doing today?    Colleen Cameron     I am doing well. Thanks for having me back. I'm excited.    Jayson Davies     Absolutely. It's always a pleasure to follow up with those who have been on the podcast before, because, you know, people do different things over time. So today I'm excited to talk sensory with you, because last time you were here, we actually discussed trauma informed care. But today we are here to discuss your recent article titled A sensory integration intervention in the school setting to support performance and participation, a multiple baseline study. Now this is the first time I have seen an article with both the terms school setting and the other term sensory integration in it. How did that come to be actually?    Colleen Cameron     Sure. I mean, as probably you're aware, most of the research has really been done on sensory integration intervention in a clinic setting, so I was really anxious to conduct a study whose intervention was being delivered in a school setting. And I also wanted to highlight and utilize a model of service delivery available in the school setting that I use that is multi tiered systems of support, otherwise known as MTSS, and this approach looks to integrated and embedded supports before considering sensory integration intervention as a pull out model. So for my study, the participants had undergone support through MTSS in those lower tiers, but the progress monitoring data had indicated they needed a more restrictive level of intervention in order to make progress in their academic engagement. So this part was really important to me, because I wanted to make sure in the study and the way that we were doing it, we were aligning with least restrictive environment mandates.    Jayson Davies     Yeah, absolutely. And I think a lot of practitioners listening today know that it is really difficult to implement sensory interventions within the classroom, other than doing maybe some accommodations, like incorporating a wiggle cushion, or maybe even teaching the teacher, or having the teacher incorporate some movement breaks through, go noodle, or other methods. But with this article, you went beyond just sensory based interventions, and you took it all the way to sensory integration. So before we dive into the methodology of the article and whatnot. I'd love for you to share your experiences implementing si in a school setting.    Colleen Cameron     Sure, so I definitely was lucky enough. Might be helpful to share a little bit of my journey of how I got to being able to do you know ASI to fidelity. I was really lucky enough to be attending bu for my master's 25 years ago, when they were offering the SIPP certification courses. So I was able to receive that certification. And when I graduated, I had started working in a public school in Massachusetts that had a small sensory gym for its ot room, and I also on the school had arranged for me to be mentored by an ASI therapist from then ot a Watertown which is now the Kumar center. So I was very fortunate that I know many school based practitioners start working out of a closet space, and they're certainly not receiving mentorship from OTs at like a renowned airs si center, with their school district footing the bill, right? So. A way I knew I was, you know, in more of a privileged position to be able to align to those principles of errors as I in the school setting, even before there was a fidelity measure, really, to measure my practice to. And then I had moved to another school district where, again, I had found a place to have sensory space to call home as my ot room in that district as well. And really continued my professional development learning journey in era si, I completed mentorships through on the star Institute. I was really lucky enough to have some wonderful mentoring by Dr Lucy Jayne Miller and Dr Sarah shone, which really shaped my thinking. I developed a course for the star Institute around use of sensory integration intervention with a tiered approach in the school and in teaching this and all of this education, I really found that it was limiting my advocacy for use of OT with an ASI approach, because there wasn't that direct evidence available. So that's really what propelled me to go ahead and to conduct my own research and the study you're discussing today.    Jayson Davies     Wow, yeah. And to be honest, like it wasn't really until I saw the title of your article that said in a school setting that it really hit me that there hadn't been research related to this topic between school setting and SI, it had always been more clinic based. So, yeah, very unique, and also very much needed. And you know, you mentioned a lot of your experience with SI, I actually want to ask you about the fidelity measure. I think it was around 2010 when that came out, maybe a little bit.    Colleen Cameron     Yes, yeah, a little bit later. Yeah, a little bit later. So, yeah. So I'd align my intervention with both the ASI fidelity measure and the star Institute's fidelity measure, which would come out a little bit later than that as well.    Jayson Davies     Gotcha. Okay. So my question is, did the fidelity measure make it easier or more difficult to practice in the schools as a practitioner using a si frame of reference, or did it not really change anything at all.    Colleen Cameron     So I the fidelity measure is definitely incredibly helpful when you're looking to determine whether what you're doing is actually errors. Si, in without the fidelity measure, you know, there's been a lot of problems right in research as far as articles that are not specific to all of the use of all the era principles and the structural elements. And so there's been conclusions drawn about something that's perhaps not effective, but it wasn't actually, in fact, Eris si so I found that incredibly helpful to have the fidelity measures available. I think that the other piece that proved to be more of a challenge is that it is a lot of the research that has been done is specific, more to a clinic based setting. And so when I was trying to determine, really the volume and kind of intensity parameters around what I was going to use for my intervention, and I was looking in the research, there was a lot of discussion around seeing a child three to five times a week for an hour, which you know is not not appropriate or really available for us to do as school based practitioners. And so I really was trying to figure out what was the least amount of times that I could see, them per week and total time per week, in order to ensure still the significant progress that I wanted, but making sure that I was not taking away valuable classroom time in that moment. So I had really good luck with two times 30 minutes a week that I had found success with through the years, of really having some nice demonstration in my progress monitoring and data collection around really incredible performance and participation gains back in the classroom. And so that was really the model that I ended up settling on. The difference for this study, which was a little bit different, is that it's not aligned to that whole year that you have with an IEP. It was a 15 week intervention, which actually is a really exciting approach. That kind of short term piece perhaps offers us a new way of looking at intervention the school, and not just tying us to that year long intervention thinking that we could see some really nice occupational engagement gains over a shorter period of time of intervention.     Jayson Davies     Perfect. And, yeah, you hit exactly like my thinking on the nail right there, right it's like Si. When we think of Si, we think of, you know, hour long sessions multiple times a week. And let's be honest, anyone listening here is going to be like, I can't do that. Most people right? So, yeah, absolutely, that was a big part of this. And I know that some will be a little frustrated with me if I don't ask you this question. You mentioned that there's two fidelity measures. Actually, I'm familiar with the ASI fidelity measure, but you also mentioned a star fidelity measure that one I'm not as familiar with. So I want to give you a second to kind of compare, contrast similarities, or just speak to both of them a little bit. It sounds like you're familiar with both.    Colleen Cameron     Sure. So the star fidelity measure encompasses. A lot of the ASI principles, but they do a really large kind of parent component. So the way, when I had written the course for them, we had kind of tweaked it to really having a lot more of the teacher engagement. So that was part of why, when I was developing this intervention, and, you know, airs si has this piece around working with teachers as well, in their structure, of their fidelity measure that I wanted to make sure that it was a collective approach, that I included consultation weekly alongside my intervention to make sure that these pieces were were generalizing. But the other facet that was is really highlighted with the star approach that I've done a lot of work around, is really that focus on connection and relationship building and really meeting kids where they're at in a really intentional way. A lot of the roots are drawn from a lot of the DIR floor time model and some of those facets. So when I was going into this intervention, I was really collectively using both of those models, having been trained in both and because they dovetail so nicely the intervention, because I had the interventions were taped and seen by an expert in both ASI and in star, and they were rated as far as on that fidelity measure from that third party. And so it dovetailed really nicely so that I was able to meet the fidelity measure for both measures with my intervention.    Jayson Davies     Wow. That is not easy to do. If anyone has read those fidelity measures, that is not the easiest thing to do. I mean, there it is very structured in what your therapy needs to look like. So kudos to you for making that happen. All right, we've alluded to to the research a little bit, but let's really like dive into it, kind of section by section. And I guess the first thing that I want to ask you is just, you've already kind of hinted at it a few different ways, but I just want to explicit. Explicitly ask you, like, what was the specific research question that you had as you began diving into your research.     Colleen Cameron     Sure. So our research question was, will sensory integration intervention paired with teacher consultation implemented with children? We looked at kids between five and eight years old for this study who had documented sensory integration differences that had been demonstrated in their comprehensive evaluation. Would this intervention be effective in improving a student's functional regulation and their active participation in the general classroom? And that part of the question was a little bit challenging for me, because I wanted to find specific variables that I knew would represent occupational engagement back in the classroom, we videotaped the kids in the classroom for our data out for our outcome measurement. So it was really important for me to find things that were meaningful, aspects that we could operationally define in order to be able to measure some of the outcomes that we would see as a result of sensory integration interventions. So I also wanted to make sure that I was intentional about my wording, to make sure that they were neurodiversity affirming in the language that I used. So we had really settled on those two of the two measures of functional regulation and active participation. And I had done a single subject design for the study, because this methodology, as you know, as a school based therapist, much more feasible than a randomized controls trial. I am a therapist of one in my school district, and so, you know, and many of you, you know, many of us have a small caseload. We don't have this, you know, big case to draw from. So the guidelines, when you're looking at, because I do get a lot of questions about this, what, it only had three participants, and then it actually follows the guidelines that, in order to, you know, really conduct a high quality single subject research design, the study needs to include three attempts to demonstrate an intervention effect at three different points in time. So for my study, I had three participants that were really acting as their own control, because I took data at it during a baseline period and an intervention period, and it actually worked out really nicely, because my baseline period was the time when I was getting the referral for the evaluation, and we were going through all those processes of IEP meetings and so forth, and then they had qualified, and I had started the intervention, so I wasn't withholding any intervention. Any point was just part of the normal timing process of the IEP process. So having those three participants in the study allowed it to be included alongside other single subject designs as a moderate level of evidence, which is great.    Jayson Davies     Yeah, absolutely. And diving into kind of the next section that we often see within a research paper, I want to talk about the participants a little bit. You did mention that it was a small sample. You did mention, you know, five to eight years old. But I want to ask you, well, just a little bit about the inclusion, exclusion, maybe, right, like, what type of were you looking for? A specific type of student? Did they have to meet some sort of criteria?    Colleen Cameron     So for my inclusion study, they were included, they had to have had a comprehensive evaluation that had revealed significant sensory integration and processing challenges that was affect. Significantly affecting, in fact, their performance and participation in the school setting. And what I actually did for the subjects, we did an exclusion around if they had an autism diagnosis, they were not included. And also, if we had seen embedded support at that tier one and tier two level was successful in mitigating their participation challenges, they were not included for that.    Jayson Davies     How was that defined? And when you say tier one, tier two, are you talking from an OT perspective, from anywhere.    Colleen Cameron     So for these particular students, it was one of the reasons why I really needed them to be in the kindergarten phase. Because, as you know, that on the MTSS support, the kids come in just with a referral, and things just start happening at the preschool level. But there's a little bit more opportunity for us to be moving in and doing some whole class strategies. I do a number of, actually, whole kindergarten I go into all the kindergarten classrooms with my school psychologist and my speech language pathologist, and we do whole class pieces. So we had a lot of tier one pieces included with, you know, all classrooms having integrated supports available in them. They had been referred to kind of that pre referral system. I know they call that different things in different school districts, but pre referral before they go to sped, which we use for our tier two piece, which is more of that focused, small group piece. And so I had gone in and done some consultation with the teacher, and we tried, had tried some small group activities and some different pieces, taken some data around that, and really had shown that it was not really moving the needle for these particular students, that they were still really struggling with their participation in a number of occupations in the school setting.     Jayson Davies     Gotcha. Okay, so you're looking for students who weren't necessarily making progress with you, already supporting that kindergarten class, or those classes a little bit perfect, because that leads directly into the next question. You often don't hear the terms si and MTSS together either. And so again, when we think of Si, we think a lot of you know swings, you know, all that fun stuff, bolsters, we don't think about necessarily supporting teachers or seeing kids in a group at a table or something like that. So I want to give you an opportunity to kind of share how SI can or how it did with with this study fit into an MTSS model?    Colleen Cameron     sure. So I think part of that would be helpful to maybe talk a little bit about what the collaboration with the teachers look like, because that hopefully will help thread how we're not talking about really passive experiences that you get with more sensory based strategies. But how can we use the ASI principles but apply them in a tier one and a tier two fashion, that were active, looking for active engagement. So for the study, we had those weekly consultations, and I would meet with the teachers. We talk about, you know better, understanding the student, their strengths, their goals, what sensory integration and processing is, and we collaborate on a lot of the generalization, the modifications, problem solving challenges. And so for example, one week, I had a teacher that had raised questions in our consult about how one of the participants was having difficulty while sitting on the rug for whole class activities, and the activity was involving multiple steps. So I knew from her comprehensive evaluation that I had done that she had challenges and postural control as well as praxis. So I'd really align my suggestions of the ASI principles of addressing postural control and Praxis along with supporting intrinsic motivation, collaboration and activity, choice and just right challenge. So we discussed opportunities that we could develop more robust postural control and Praxis for the student during whole class academic games, we made sure they were activities that the student had voted for and wanted to participate in and reportedly enjoyed. I provided suggestions such as different visual supports and slower pacing and really the benefits of the rep of repetition for this particular child that I learned from working with the student directly and finding that just right challenge for her. And we also offered different choices of seating options that help the teacher to engage the student more in a partnership in the decision of which new seating options helped her participation and her comfort during rug time. So in part, we really did a lot of discussion and training around the teacher, helping to work with the student to kind of cue into those internal body sensations. So she was playing, the student was playing an active role in all of these elements, so that it was a really a collaborative piece that that the teacher and the student and I were kind of embarking on with that.    Jayson Davies     Yeah, yeah. At the end of the day, it sounds like most of that's directly related to the student, right? So it would be, I would consider that tier three, does that line up with with your tier model?    Colleen Cameron     Yes. So I would, so that was the consultation part of tier three. So the way, I kind of just, and I know people kind of discuss in different ways, so it's. Good. We're kind of making sure we're on the same page of terminology. I really align with the fact that if we're moving toward individualized suggestions, that we need to be in tier three, going through that comprehensive evaluation process and making sure that we're really informed as to the suggestions that we're making to that child's specific sensory profile. So when I talk to talk about these consultation pieces and connected to the direct service I am referring in my wave that I've captured it in more of a tier three approach.    Jayson Davies     Perfect. That's what I had assumed. But as you mentioned, right, everyone, kind of, I'm even seeing tier four pop up in a few different models that are coming out now. So just want to clarify. All right, I'm going to prevent myself from going backwards and asking you about tier one and tier two. Maybe we can do that in a little bit, but it's not directly related to this study. So I want to stay on on topic here. You just talked a lot about the collaboration consultation with the teacher, but on the flip side, what did your intervention look like outside of the consultation collaboration, because you were also seeing the students individually, correct?    Colleen Cameron     Yes. So I saw the students individually for the 15 week period, and I saw them two times a week for 30 minutes, and then I had the weekly consultation, and that took place in my space, which, luckily, again, did align with the errors si fidelity measure as far as the structural elements, which I completely recognize is not the case for everyone, but it really felt like, for me, for the our first study, that we were really capturing the school based scenario when we wanted to make sure that we were really able to see some of these important outcomes that we know can result as a as a use of ASI in the school setting, I felt like this first go of really aligning with all of the fidelity measures and making sure that everything was really aligned with research that also was happening outside of the clinic so people could draw parallels was important, but I'm really excited at the possibility of this really inviting more researchers to try the same approach of service delivery, and maybe they're going out and doing that on a playground, or they're doing it in different spaces and collecting some of the same data and seeing if we can Get the same amount of, you know, outcomes and differences that we're seeing in occupational engagement. It's something that, I think, a project that I've been kind of passionate about working on with a group of individuals that were, we really feel like a lot of the the school based pieces, there aren't a lot of coursework to help support what that looks like, right? But also the guidelines that I'm referring to, the fidelity measure was developed for more of a clinic based research approach. So we're actually in the midst right now. Dr Roseanne Schaaf had, had asked me to head up a project of developing an adaptation and extension of the ARIS fidelity measure to make a guidelines document that is applicable for the school based setting and specific to a tiered approach, so really outlining what that looks like in each of the tiers. And we're really hoping that this will be a guiding instrument for working in the schools and using ASI I'm doing on that project with Dr Roseanne Shaw, Dr Sarah, shown Dr Maria serice and Dr Kelly. Alt right. And so right now, we have developed the guidelines document. We're in the midst of collecting data for face and content validity, and we're hoping that this will be something that's available soon. So we're really excited about it.     Jayson Davies     Yeah, absolutely. And I want to get into that a little bit more, but first, I do want to take a step back, because a step back, because as you're completing this project, you don't have that right, like you're in the process of creating it. You had a space, you have the training. But even with that, was it still difficult to meet the fidelity measure to it? I mean, not necessarily to a T but But was there anything else within the school what, I guess, kind of, what else within the school makes it difficult to meet the fidelity measure that maybe you had to deal with, whether it be the time that you have with students, whether it be maybe the support from administrators, what do you see as being some of those barriers that really do need To be overcome?    Colleen Cameron     So I think that there are barriers to conducting a study as a school based therapist that, you know, I was the researcher and the treating therapist, so that carried a lot of stress with it. Fortunately, I had an incredibly supportive administration and the teachers and all the assistants and everyone that was kind of really trying to support that. But you know, staying to fidelity as far as two times 30 a week. Vacations happen. Kids get sick. Fire drills happen in the middle of the time that you're supposed to be seeing them. So that was a real struggle to meet the fidelity measure from that lens of making sure that I was consistently offering that two time. 30 a week. And then I would say the other piece that I took very seriously was that we were I wanted classroom videotaping to happen that was representative of an everyday activity, so kind of settling on what that looked like. But the fact of having to go and set up a videotape and then having it there for a period of time beforehand, so all the kindergarteners weren't noticing that the videotape was on and, you know, and all the facets to kind of the technicalities of that were particularly challenging but doable. I, like I said, I was the only therapist in there, in there doing it, but I hear a lot of practitioners not having space or access to equipment, not having administrative support, and even that's even how we kind of redesigned the guidelines that we're working on for the school based setting that we took a step back and said, do we need to have this frog swing specifically, or could we look at the affordances that the frog swing brings to the experience of the treatment session, and can we find those and maybe different different types of equipment that maybe is a little bit more accessible to others? So we kind of changed the narrative on a lot of the structural elements for the fidelity measure to look at more affordances of equipment, to open that so it wasn't as tied to specific pieces of equipment.     Jayson Davies     Yeah, and you mentioned the two times a week 30 minutes. Now, some people are going to hear that and say, Yeah, okay, I could potentially make that happen. Some people are going to say, that's no way. Irregardless of that, I want to ask you, why two times a week for 30 minutes? Where did that come from? I'm sure it just wasn't random. So how did you come up with and you can even also speak to the one time a week. I believe it was collaboration, but why was that the intervention model used, or the frequency used?    Colleen Cameron     So when I initially started working in the schools, a lot of my kids that I inherited were a consultation model, or one times 30, and I had really seen through the years of taking data at different different frequencies, of seeing the kids that my one times 30 kids, I would come back and see them the following week. And it was kind of like Groundhog's Day, that a lot of the gains and things that we had seen in the week before really had been lost in the process. And many times, we were taking a number of steps backward. And I found that even just adding that additional time a week made a real difference for my students, as far as being able to really push forward more efficiently and effectively in the outcomes that we were measuring. And I think having this 15, you know, week interval that I was kind of now moving into, because I wanted to have a reasonable amount of time that we're kind of collecting data, and hopefully having that shorter piece. I know many people will say, you know, they see their kids one times 30, but they see them for years, right? And so this was a model that I was able to move these particular students after they had this more, you know, whether you call it intensive or not, the two times 30 model of service delivery that they were able to shift down by the end of that IEP or to a consultation model only, so we made some really significant gains in that shorter period of time, and that, yes, they did lose some time from the classroom, which I recognize is not ideal for that period of Time, and it's part of why we really take seriously the approach of making sure that that's necessary in order to be able to make these effective gains. But I think having being able to demonstrate those that difference in just 15 weeks, and we asked the teacher in our interviews and the questions at the end in our semi structured interviews with the teachers, did you feel like the time that we they lost in the classroom was worth the gains that they received from having this intervention? And all of them said it was a resounding yes, that they felt it was so that was important too.    Jayson Davies     Wow, yeah. I mean that that's important. I'm glad you also got some data from the teachers. That's great. We're gonna dive into the raw data actually here right now. But before we do, I do just want to, before we get into the numbers, I guess, or the outcomes, I want to give you a moment just to kind of give a brief overview of all the different ways that you did collect data. Again, you mentioned a little bit of this already, but kind of just in one short synopsis, what were the various ways that you were looking at data?    Colleen Cameron     So we had collected data. We videotaped the students in the classroom, so that was the main data that we use for the single subject design. And I took data at baseline and during the intervention phase, but then I wanted to get a fuller picture of their occupational performance, making sure that I use goal attainment scaling when I'm developing goals, so making sure that the goals that the families and the teacher and everyone had contributed into developing were making meaningful gains. So we, I had done the scope, which is the short child occupational performance is based on the Moho model. For those of you that aren't familiar, it's very accessible for use in the school setting. We did the Basque and I did. That with the support of the school psychologist, as far as we just talked about categories of interpretation, I didn't go down the road of making a lot of, you know, drawing a lot of conclusions out of the data. And I did do that with the support of the school psychologist. I did goal attainment scaling with them, and then I also did semi structured interviews at the completion of the intervention with the teachers and the students, and I really wanted to do it with the students, but they're younger, right? So they're not as good with their report. They're not very accurate reporters. And so I decided upon actually doing a card sort activity for them. So I had pictures of things that were happening in the classroom, and I had them sort whether they were hard or easy for them. And then I had pictures of things that they had done in the intervention with me, and whether they liked it or didn't like it. And I got these really wonderful kind of capturing of kids moving towards, you know, having less thing feel difficult for them in the classroom, through their lens, through their lived experience, but also that they really enjoyed the intervention. And there was a lot of comments around, you know, joy and kind of relationships and enjoying their time, even with me. And so that was really wonderful that we had. I was really glad we had added that part to like, share their lived experience. It was really the first time that children's perception and their lived experience had been looked at in a study. So that was exciting.    Jayson Davies     Awesome, great. And you kind of went in the direction I wanted to go. I want to kind of break each of those different areas of data down a little bit you, you kind of just went over what the children said, Unless there's anything else to add to that. We can move on to one of the other three areas. It sounds like that you kind of took data in, maybe starting with the videotaping, what were you actually looking at with those videotapes, and what did you see as the intervention went along?    Colleen Cameron     So what we saw was significant changes in the children's functional regulation and active participation for all three participants that we saw their performance, kind of hovering down below and then shooting up and being really significant across the course of intervention. So when I had an outside rater rate the videotapes on different intervals of time, and I think she had operationalized definitions for that, and so that was really the crux of the single subject, kind of outcomes of the research. And then we also saw really significant gains on the scope that they had made some gains from pre to post for that as well the goals that we had set for this children, they had in their we had they were actually in their IEPs centered around occupations of play, education, social participation and health management. So some of the pieces that we saw that were, you know, changes that we noted included increased interoceptive awareness that supported health and wellness, increased social participation with peers, increased participation in non academic and their academic activities, and increased play, exploration and participation. And so that was exciting. You know, we know that there were some proximal gains that we saw with increased skill and praxis, and we saw improved regulation, but these definitely had an impact on these distal outcomes, and that's really what we were looking at measuring so.    Jayson Davies     With the distal outcomes, is that what you use the gas methodology for collecting data, or was that part of the video recording?    Colleen Cameron     Kind of a combination? We just really were trying to capture the so for the goal attainment scaling, we had the teacher and the assistant that was working in the classroom doing that rating, and for the scope as well. So we were able to get some of the teacher's perspective on some of the things that were changed, but we were able to complement that with the kind of hard data that we received from actually measuring the number, you know, amount of times that the children were functionally regulated or actively participating back in the classroom. And they definitely aligned really nicely that we saw gains across the board.     Jayson Davies     Gotcha, okay, all right. And I think that brings us to the final piece of data that you really looked at. And again, you already alluded to this one a little bit, with the teacher questionnaires, interviews, where they felt that the time away getting the intervention was worth the time that a student missed in the classroom. Aside from that, what else was some of the results from those teacher questionnaires that you found meaningful?    Colleen Cameron     So specific to their experience with the consultation they had shared that they really felt like, even though they had worked with me for years, that having this consistent time and really problem solving and talking about the particular student, that they really felt like they had a breadth of knowledge of really understanding the impact that sensory integration and processing can have on occupational performance and how some of the strategies and approaches that we do using the ASI principles can really have really nice gains. So they came away with a better understanding of all of the bigger knowledge base, and they also had said that they now had this tool belt of. Strategies of adapting and modifying the school environment to be more sensory, supportive for that particular student, but also having the understanding that it's really important that we're engaging the student. We're not just passively, you know, throwing this ball chair in the corner, that this is an informed, really thoughtful decision that we're collecting data around and and hopefully making some real differences happen back in the classroom as a result. And, you know, kind of off, you know, not in the taped part of the conversations of semi structured interviews, but they had mentioned that they really liked having this, you know, it's a ripple effect, right? So now they have all of these knowledge of strategies and modifications and things that they can bring forward to future students as well. So I think that's a nice benefit to point out as well as we continue to collaborate with teachers and really engage with them and and pair with them really in this task that we're really helping in them to with future students as well.    Jayson Davies     Yeah, yeah. I completely agree, and almost to the point where, like at this time in my career, it's really hard for me. I'm not practicing right now. But if I was practicing and I was seeing a student individual, by the time I stopped practicing, almost every student who I was seeing individually, especially in a pull out model, I was adding a consultation to that service, because you see that value in actually talking to the teacher. I think as a newer practitioner, it can almost seem easier to avoid the collaboration, avoid the consultation, and just see the student, one on one, no one's watching you. You just have the kid right like you do your therapy, you send them back, and as you start to really see how much of an impact collaboration can have, consultation, talking to a teacher, one on one about a specific student, or even their entire classroom, potentially that just has so much power. So I'm so glad that you incorporated that into the into your work. I guess a question was that kind of leads me to is you put them all together, right? You did both the pull out and you did the collaboration. Are you familiar with any work? And I'm assuming the answer is no here, but maybe I'm wrong where they have potentially separated those out, or maybe multiple researchers, because I doubt there's been one. But have you ever heard of like si in the school, but eliminating or not using that collaboration piece?    Colleen Cameron     I know it happens just anecdotally, talking to other practitioners, right? But it's certainly not a model that the you know, if you're following along with the airsi fidelity measure, even as it's written now, it says parent or a teacher, you know, correspondence. So it's definitely an expectation for you to be collaborating, and we're making and it's really it's important, because we want to make this sure that we have this intentional generalization of what's happening and that otherwise we're just, we're just in this kind of box in the corner, and we're not, we're not making sure that things are connecting back to the classroom. And as I mentioned, we have, you know, in that collaboration, you have so much power, more power to make even more of an influence, because they're with the student all day. You're only with them two times 30. So I really think that that is, you know, important, and people will, you know, speak to and I totally get this that there's not time that's dedicated in their day. I know I've worked in school districts before where they don't have kind of a dedicated meeting time that that's happening after school, or they're having to give up lunch, right? These are the realities that we see as school based therapists. So I one of the pieces with this that I've talked about with school based practitioners. You know, it's definitely doable. I did it. I'm a school based I was a school based therapist. I did it when I was did for the study, and did it for years. But I think that short term intensive support model can be really interesting and available to some to maybe think about more and ideally, if you're using a really robust MTSS system, your the number of students that actually come to needing this more intensive service delivery, you know, model should be lower. So I've encouraged some practitioners that are kind of newer to trying this that, you know, you just say, maybe I'd like to go to the administrator and try it with just this one student, and take the data, interviewing the teacher afterwards, seeing how effective it can be. And that can really help build support in the district. So you don't have to go from, you know, not doing any of these pieces to everything with every one. So I think that that's important. And then also, you know, I conducted the treatment in more of a typical other si space, so considering other places that they could potentially work, or advocating, if there's one particular piece of equipment that they feel like when they look at the affordances of the guidelines, when they come out like, this is one piece I'm really missing, maybe it's advocating for just that one piece. Of equipment that fills that gap for you.    Jayson Davies     Yeah, and you talk about, thank you, first and foremost, for like, kind of giving a little bit of guidance to everyone out there listening who's maybe really wants to do this and has had some struggles, but I wanted to it made me want to ask you here is, was this actually embedded on an IEP. That just depends on how I phrase the next question, were these 15 weeks on an IEP, or was it kind of off the IEP as a tier three without being on the IEP?    Colleen Cameron     It was on the IEP.     Jayson Davies     All right, perfect. So I often get that question then, like within an IEP, do I have to keep the same service for the entire year. Can I have multiple services on an IEP? And I know my answer, my answer is always, an IEP is designed to be individualized for the student. So long as the IEP team agrees on something, go for it. You might have to get a little crafty in how you do it, but go for it. And so that kind of, I want to see how you went about doing this. How did you put this onto an IEP for a short period of time, but then it sounds like you moved them to potentially a consult afterwards, or whatever it was. I don't know if you want to share kind of how that conversation went with IEP team, potentially, or kind of just, yeah, how that worked.    Colleen Cameron     So over the years, I've kind of approached this in different ways. For this, for the purpose of this particular study, I had written out the service delivery to be for the entirety of the IEP term, because I wanted the to ensure that everything, timing wise, was going to work out okay. And typically, how I will usually approach this is kind of talking to the parents about how we I'd like to the research around ASI use in general, is really around more of this intensive model of multiple times a week, and that's where all of the efficacy results have shown. And so I would like to propose seeing the child a couple of times a week for initially, but thinking about this as more of a short term intervention span, with the hopes that then I would be able to move toward more of an inclusion model and just see them maybe one times 30 in the classroom to help support those and then be able to fade that I would prefer to go with more of an evidence based model use of ASI, and get some really effective gains, and be able to shift from that. You see speech language pathologists have, you know, their whole model where they have kind of that fading level of support that they're kind of built and write it into the IEP. So the way that I've done that is, you know, say that I give myself a little wiggle room, where we have maybe a 20 week period where this was written in for the IEP within it shifts in the IEP to one times 30 inclusion for the rest of the IEP period. And I put a caveat in there that if the data is showing that they're not making significant gains, and if at any point, the parents would like to revisit the service delivery model, that that's something that they're they're open to doing. But yeah, so it's, I think it's the way that you're framing it as as it begins, and really trying to provide the reasoning and the understanding behind the choices that you're making, that you're not just, you know, on a whim, deciding that you're taking the child out, and that they understand that you're taking this seriously, that they're losing time from the classroom, and that we want to make sure that the reason that they're doing that is for an effective service delivery, that they're going to be making some gains back in the school setting.     Jayson Davies     Yeah, yeah, absolutely. And yeah. I mean, an IEP is meant to be adapted, and so it's always they call it right, a living document, an addendum can always be called right, to change it up if things aren't working, and you have the power to call an addendum, the parent has the power to call it an amendment. So, I mean, everyone kind of It's a team effort here. And yeah, I I don't think I ever actually put into an IEP where a student would be seen for maybe twice a week, or even once a week for part of the IEP, and then it would decrease after that, but I could see how it would work out again. Every district might want it done a little bit differently. But yeah, if you talk to your administrators, talk to the special education department, I'm sure you can find a work of a workaround for it. So yeah, all right, before we get into a few more practical, you know, takeaways, I want to give you an opportunity to also share a little bit about just some of the overall limitations. You know, in hindsight, now that you see about this research that if someone, whether it be you or someone else, were to kind of take this and say, I want to replicate it, what were some of the limitations that you think maybe in the future could be updated?    Colleen Cameron     Sure. So I mean, an obvious limitation is the generalizability of the results, given the small, you know, number of participants that are involved in a single subject design. And that's really why I'm hoping that other practitioners will take up the charge do some replications of the study to increase. The evidence they've got the model already set for them. Just trying to do some replication, we had really good results that many times you see studies having challenges with the particular outcome measurements that they had, the variables that they chose to measure, and ours held pretty well for all of all three of the participants. So, you know, I invite people to replicate the study. I've recently moved into full time academia at Johnson and Wales University, so I'm no longer able to do the direct service and do another study myself, but happy to offer mentoring of anyone who wants to replicate my study reach out to me. And I think another limitation of the study is that I wish I had taken some more longitudinal data to be able to see to make sure that they realize the gains that they realized post intervention. You know, I only took it through when they when they finish intervention. I know, anecdotally, you know what happened with the students, but I don't have specific data on that. And so I think going forward, if someone was to do another study like this, that they would take into account and maybe do some longitudinal data, maybe six months post, or even three months post, to see how if the gains, you know, continued. But in general, I think, you know, given its limitations, I'm it's a start, and I totally recognize that it's just a start, but I'm really hoping it sparks more research, and we really need occupational therapy practitioners advocating for the use of ASI in school based practice. And there's actually an article coming out in January, in eight OT, an issue is article on this topic that's titled occupational therapy using air sensor integration in school based practice, a call to action. So keep an eye out for it. I'm actually first author on that, and my co authors are Dr Sarah shone, Anita Bundy, Shelly lean Zoe mayo, Susanne Smith, really, Theresa May Benson and Roseanne Schaaf. So we had really a wonderful collaboration, lots of really rich discussions in writing it. It was a blast, and we have a bunch of detailed next steps that are needed in practice, advocacy and education, because there's definitely work to be done.    Jayson Davies     Oh, my goodness, I got like chills when you mentioned all those names. I was like, Man, I would love to be a fly on the wall in that Zoom Room or whatever, because there's just a lot of knowledge between that group of y'all. And I've spoken to several of you, not all of you, but yeah, it that is a lot of, a lot of knowledge to be shared in that room. So thank you kind of going a little bit, and you went practical here a little bit, right? People that want to take this, take your research and do something with it, outside of, you know, someone taking a research and saying, I want to replicate it, but for, you know, the the practitioners out there who are just like, All right, I've got this now. I've been looking for research related to si in schools, and now we have this. Everyone, if you haven't already, print this out, put it in your research like little binder, right? So the next time you're at an IEP, when someone asks, Is there research on Si, you're like, hey, just happen to have something. But I guess let's kind of break this down, because there are different levels or different affordances that people have, and so let's assume someone has some si training. They have a room that can kind of meet the fidelity measure, but maybe they're struggling to get some people on board with whether it be getting that two times a week for 30 minutes so that they can kind of have that fidelity a little bit, or just getting even that idea of pulling a student out to do sensory integration, what recommendations do you have for them when it comes to kind of overcoming those barriers a little bit?    Colleen Cameron     It's a great question. I recognize that they're really significant barriers for many practitioners, and so for kind of at that starting place that they've had some advanced training, because we know that that's an important piece to have when you're enacting and using ASI in the school setting. And they have some of the structural elements that can approximate what is needed. I think it really comes down to first, that really larger scale of working with administrators in your district and having an open conversation about multi tiered ASI and how that can best fit so not going and just talking about, I want to add this pull out model, but really talking about it as this, the entirety of this plan, of this kind of scope and sequence where I'd like to work with the teachers to help them, you know, have a greater understanding. Could I offer some professional development trainings? You know, at that tier one piece, I'd like to start going in and have advocate with my special education director to have some time to go in and do some work in the classroom, because it it doesn't work, right? If this, it's just this model that we're just kind of dropping in, and it's really disconnected from the rest of the school and not individualized to the culture of your school. So everywhere is going to have different different states even have different mandates and ways that they've set up support. So I think it's offering a conversation. And not coming in with this is the way it has to look, but really off making it a conversation, an open conversation, where we're going back and forth and really coming together on a model that can work for everyone. And as you said, kind of printing out those pieces of documentation. As far as articles, I know that CLASI just put out a summary of research and effectiveness, kind of a cheat sheet of the latest research that my article was included on that's an incredible resource. And sometimes it comes down to just becoming comfortable with having your own elevator pitch of what is multi tiered use of errors si in the school. Why is it important? And how can I help the students you know, perform better in the school setting. I really want to move away from this whole conversation, and we talk about this in the issue is as well, as far as this medical model versus the school model, and from my lens, and we talk about this in the article as well, from my lens. It's really almost a justice piece of if this is an evidence based model of service delivery. It should not just be available to those that have these wonderful funding of OTs, that have a lot of support, and they have one home school that they're working in, and they have all these pieces. We need to find ways that we can bring this to other districts and increase the support of these kids. And you know, we know we see increased needs of of sensory needs across the way from the pandemic, certainly, and we know that it impacts in the school setting, their performance and participation. So we need to be moving away from, we're not the handwriting specialists. We are holistic. And this is holistic practitioners. And this is one piece, you know, it's certainly and I've spoken a lot to the sensory piece, and I understand that it is one element to the to the full breadth of what we're looking for, but it is one approach and intervention that can be an evidence based approach that we can bring to the table to particularly help support the sensory and really making sure that we're hitting home the fact that this is to bring back gains back here in the school setting. That's what that's what it's about, and it's we need to be client centered and make sure it's individualized as well.     Jayson Davies     Yeah, yeah. And I think the same would go for if you're kind of in a similar position that we just talked about, maybe you have the training, but you don't have the space. I think you kind of follow that same type of model there, right? You need to figure out who you can talk to to try and get a space. There are a lot of different ways to get funding for a space. I didn't even I was working at my school, working in an SI prepared gym, if you want to call it that. I didn't realize it, but the parents had actually funded it. They had gone through, basically asked parents for donations, and that is what funded the room. You know, in other situations, a grant can fund a room, and another situation, like, there's so many different ways to fund a room, and so you just got to get in front of the right people. The other thing that I'll add to it is, I think it's Dr Amy Pilar and Dr Sultan alfrez. I'm sure alfrez, I'm pretty sure you're familiar with them. They are in the process of working to link really related to sensory integration, linking sensory integration to Common Core state standards, which is another perfect way to kind of get in the door, right? Because speaking Common Core is the way that you speak to teachers and educators, right? Like they understand common core, they don't understand proprioception, vestibular all that good stuff. So we kind of have to speak in that language. And I don't know if you want to add anything to that Colleen?    Colleen Cameron     Yeah, no, I know they did a wonderful presentation on that at the last a OT. I think that their their planning, their plan, is to follow up with that upcoming in a OTA. And so, yeah, I would encourage people to follow their work as well, because I know that many school districts and states require for you to make those connections back to the standards, so hopefully, again, the more tools that we can put into I feel like there is the conceptual of what's the best practice, and then there's the reality of being a school based practitioner, and we're all coming with these different challenges. I guess. I'm hoping this article shifts the narrative of, yes, this can be appropriate and can be effective now, is it something that would be appropriate to use in our school district, or how can we, you know, kind of make that plan to make that come true in our district, but it might look different for different individuals, for sure.     Jayson Davies     Yeah. And then the other piece that we talked about, just talked a little bit about, like, if you need to develop a room right, who to go to, what to talk about. But for those who are maybe interested in some training, you mentioned you have a course with star, I believe, obviously there is the CLASI training out there. What are your recommendations to someone who's just like, hey, I'm newer to school based occupational therapy. I'm newer to OT in general. I really want to get some education in sensory integration. Do you have any tips for them?    Colleen Cameron     Yeah, so it's definitely a need. One of the pieces that I feel like is is so important, is that we need things that are accessible and affordable, because a lot of professional development trainings are incredibly expensive and they're not accessible for school based practitioners to be able to take off. Four days, five days from their school day, right? So I'm actually in a work group that's working on developing more of like an entry level course, so this would be a step down from a certification level course, but an entry level course that's specific to multi tiered use of ASI and its principals in the school setting. So we're hoping that will help meet this that need. And then I'm also presenting with some of those same individuals at a ot Inspire. We're doing a yes, I can a road map for incorporating areas sensor integration in the schools. So we're hoping that we can put out some general entry level coursework, but also some professional development short snippets to help people start to be able to understand and figure make an action plan for themselves. Right. As far as how we can make this happen.    Jayson Davies     Absolutely, and you can pencil me in for being at that session. Definitely. If anyone wants to join me, you know where to find me, but awesome. Well, the last thing I want to discuss with you real quick. You've already mentioned it a little bit, but you are working on that fidelity measure. And I just want to give you an opportunity to kind of share just a little bit about maybe the evolution and the progress of how that's working out.    Colleen Cameron     Yeah, so it's really exciting that, as I mentioned, Dr Schaaf had had asked me about, how can we make what we people are saying the ARIS fidelity measure, it's not accessible for the school setting, you know, how can in but people feel like they're really resonating with your article and the research that you did. How can we help to kind of bridge that? And so we talked about an adaptation, or kind of extension of the fidelity measure, not for, necessarily for the purpose of research purposes. So we're, you know, labeling it more of a guidelines document, but starting to really discuss, so in a measurable way, what does this look like at tier one? We kind of go through each of the elements at tier one, what this can look like. What does this look like at tier two and tier three? How can the structural elements be different? And so we, we had a lot of really important conversations about, I think the original fidelity measure was maybe 40 or 50 hours of training. Like, do, how many hours is kind of like the minimal amount of hours we can to get people, like boots on the ground going to work with that. So we really tried to break down each of those pieces and look at it through. We have a number of school based practitioners on this work group. How can we really look through the lens of a school based practitioner of the practicality of this, while also not losing the integrity of the intervention itself? So it's been kind of dancing and gentle line across that, but right now we're in the midst of doing face validity. So what we've done is put it out to a number of school based practitioners that have had some training in sensory integration intervention over the years, and seeing their Yes, and you were one of them seeing where, seeing their feedback as far as the feasibility or the usefulness of this. And then going forward, we're going to be taking a lot of the original authors of the original Aris fidelity measure, and returning to them and seeing from a content validity, is it in this form, after we've made some adaptations, given the feedback from the school based practitioners, are these more theorists? Are they still feeling that with these changes that we've made? Does it still align with errors, sensory integration, intervention, can we still capture it as that even with this, these accommodations, so we're going to be going through that content validity piece after we're done with the face validity, and then hopefully be able to pull those two together and make this, these guideline documents, readily available for school based practitioners.    Jayson Davies     Yeah, yeah. Well, Dr Whiting, it has been a pleasure. Thank you so much for all of this wonderful information. Before I let you go, aside from creating a Google Scholar alert for any time you publish something, where can everyone go just to kind of keep tabs on on things that you might be working on, like the fidelity measure and whatnot, is there a place where people can kind of just learn a little bit about you and keep maybe not keep in touch necessarily, but just know when things are coming out about you.    Colleen Cameron     Sure, definitely my contact information and I have background information on my current research projects that I'm working on are on my Johnson and Wales University occupational therapy, my faculty page. But I try to keep up with LinkedIn if I'm posting new projects, or if I have a publication or I'm presenting somewhere, I usually do some sort of a post there. So I welcome people connecting with me on that.    Jayson Davies     Absolutely. And we will definitely post the links to those places over on the show notes. So be sure to check out the show notes. And I will also be sharing most of whatever you share that comes from your LinkedIn and whatnot, because, as you mentioned, that's where you like to post a lot of your updates. And we like to post your updates because they typically have to do a school based occupational therapy. So yeah, thank you so much for being here. We really appreciate it, and can't wait to learn more about that school based si fidelity measure. It's gonna be awesome.    Colleen Cameron     Excellent. Thanks so much.    Jayson Davies     All right, and that brings us to the end of another insightful episode of the OT school health podcast. A massive thank you to Dr whiting for sharing her invaluable research and practical strategies on integrating sensory integration within the school setting. Truly, Dr Whiting, your expertise and dedication are greatly appreciated by the entire school based ot community for what you are doing, and also thank you for tuning in and taking a keen interest in enhancing your practice to better support the students you work with. Remember, every small step that you take toward bettering yourself as a practitioner has a profound impact on a child's school experience. Honestly, you all are the real MVPs. So keep it up. Don't forget to check out the OT schoolhouse collaborative over at ot  schoolhouse.com/collab there, you can earn a certificate of completion for listening to this very episode of the OT school house podcast, as well as other episodes, and also find some very helpful resources. It's an excellent way to continue your professional development and get more support on implementing the strategies in your own practice. Remember stay inspired, keep learning and together, let's make a difference, one student at a time until next time, take care and keep up the great work.    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 Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

"Is It Time to Transition to Keyboarding?" How many times have you heard something like this from a parent or teacher? For students struggling with handwriting, typing can appear to be a straightforward solution. However, before recommending that switch, it is important for us as school-based OTPs to ensure that a transition to typing is not only feasible but also demonstrably more effective than handwriting. While typing may seem like a simple accommodation, it is far from easy for many of our students to learn and functionally use. Mastery of keyboarding requires fine motor coordination, visual tracking, motor planning, and working memory— and other skills that are often just as challenging as handwriting for some students. As such, the transition from handwriting to typing warrants a thoughtful, data-driven approach to ensure we’re supporting the student in the best way possible. In this article, I cover: Evaluating handwriting and typing skills Average typing speeds Performance skills & environmental factors When and how to make the transition Evaluating Handwriting & Keyboarding Skills As always, making a decision of this magnitude should not be initiated without supporting data. Determining whether to transition to keyboarding begins with a thorough assessment of the student’s skills in both handwriting and typing. Using standardized tools and functional measures, we can gather objective data to guide this decision. The goal is to determine the student's current ability and potential for improvement in handwriting and typing. Here are a few tools that can help. Handwriting Assessments: Test of Handwriting Skills-Revised (THS-R):  A standardized tool that measures handwriting speed, legibility, and functional writing abilities. Evaluation Tool of Children’s Handwriting (ETCH):  This assessment evaluates legibility and speed for grades 1–6, examining letter formation, alignment, spacing, and other mechanics critical to effective handwriting. Typing Assessments: Use free online tools like Typing.com  or TypingClub  to measure word-per-minute (WPM) speed and accuracy. These timed typing tests can provide baseline data for comparison.
Conduct a functional typing task, such as having the student type a paragraph or answer written questions, to evaluate their ability to use keyboarding for real-world tasks. What to Compare (Handwriting vs. Typing) Speed:  Compare WPM for handwriting and typing. Typing should ideally be faster or at least comparable to handwriting to justify a transition. Here are some typing averages for reference: Grade Level Typing Speed (WPM) Accuracy 3rd–5th Grade 8–15 WPM 85-90% 6th–8th Grade 15-30 WPM 90-95% High School 35-45 WPM 90-95% (Source: Typing.com ) Legibility and Accuracy:  Does typing result in fewer errors and more legible output compared to handwriting? Task Efficiency:  Which method allows the student to complete tasks with less frustration and fatigue? With the data compiled, you can use a table like this to help the IEP team come to a decision. Task HW Speed HW Legibility HW Fatigue Typing Speed Typing Accuracy Typing Fatigue Copying 8 WPM 80% Mod. Fatigue 12 WPM 92% Mod Fatigue Dictation 3 WPM 60% High Fatigue 5 WPM 60% (Spelling errors) Mod. Fatigue Free Write N/A N/A High Fatigue 3 WPM 60% (Spelling errors) Mod. Fatigue With all of the data compiled in an easy-to-read chart, it is much easier to make a recommendation. For example, let's assume the chart above reflects a 4th-grade student. Not only does typing allow this student to copy at a quicker pace and with more accuracy, but typing also limits the student's fatigue and enables him/her to attempt a free-write. This data-driven approach would be very helpful for the IEP team. Performance Skills & Environmental Factors Typing, like handwriting, is a complex skill that requires a combination of motor, visual, and cognitive abilities. Before recommending a transition, it’s crucial to consider whether the student has the foundational skills needed to type effectively. These areas should be evaluated: Motor Skills Typing requires precise fine motor coordination and finger isolation, which some students may struggle with. Assess whether the student can consistently: Manipulate and use a mouse/trackpad appropriately Use appropriate finger placement on a keyboard. Coordinate hand movements efficiently across multiple rows of keys. Maintain stamina during extended typing tasks without undue fatigue. Ergonomic supports, alternative keyboards, key guards, and Other tools might help students with motor difficulties succeed. Visual Skills Typing requires students to shift focus between the keyboard and the screen to check their work. This demands strong visual tracking and sustained attention. Evaluate: Can the student accurately locate keys without excessive visual searching? Does the student lose their place on the screen when typing longer sentences? For students with visual tracking difficulties, larger key labels or high-contrast keyboards may help reduce errors. Cognitive Skills Typing is not just a physical task; it also requires cognitive processing and multitasking. Assess whether the student is ready to handle: The sequential motor planning required to type words and sentences fluently. Navigating typing software or classroom platforms independently. Sustaining attention for extended periods to complete assignments. For younger students or those with significant executive functioning challenges, typing may initially require more direct instruction and support to build proficiency. Practice Opportunities and Access Unlike handwriting, which is often taught and practiced consistently (🤞) in early education, typing instruction varies significantly across schools. Before transitioning, ensure the student has: Access to a device and appropriate typing programs, both at school and at home. Scheduled practice opportunities to build typing fluency, particularly if typing is not yet part of the regular curriculum. Before I recommend typing for a student, I always ask the teacher and parent(s) when the student can sit at a computer and practice daily. Weekly intervention alone will not help a student learn to type. They need to engage in daily practice. Ergonomic and Environmental Factors Typing requires proper (or at least decent) posture and positioning to avoid discomfort and support efficiency. Check whether the student has access to: A workstation that fits their physical needs, such as appropriately sized desks and chairs. A keyboard that supports their hand size and finger dexterity (e.g., full-size versus compact keyboards). For students with physical or environmental limitations, adaptations like height-adjustable desks, alternative keyboards, or speech-to-text software might be necessary. When and How to Transition to Typing If typing is identified as a more effective solution for a student’s written communication needs, a collaborative and structured transition plan is essential. Begin by working with the IEP team to review assessment results and establish clear goals , such as improving written output or reducing fatigue. Accommodations, such as extended time or assistive technology, should also be discussed. Involving the student in these discussions can build their confidence and engagement. A trial period is often helpful to determine the effectiveness of typing. During this time, the student can use typing for specific tasks while the team observes its impact on speed, legibility, and task efficiency. If typing proves to be beneficial, structured instruction becomes the next step . Typing programs like Typing.com , combined with regular practice, can help students develop fluency. Emphasizing proper ergonomics from the start can prevent inefficient habits. Typing doesn’t need to replace handwriting entirely. A gradual approach works best , starting with specific assignments where the student can succeed with their new tool. As proficiency improves, typing can become the student’s primary method of written communication. Like other IEP goals, progress should be monitored regularly, and goals should be adjusted as needed to ensure the student continues to benefit from the transition. When to Maintain Handwriting While typing can be a viable alternative to handwriting, it is not always the best solution. Likewise, there are situations where typing shouldn’t entirely replace handwriting. It's not uncommon that after assessing a student, your data points you toward focusing on handwriting over typing. The data could also lead you to consider Speech-to-text as an option. Whenever possible, students should still develop basic handwriting skills for tasks such as signing forms, taking quick notes, or filling out paperwork. Often, a student may be able to use handwriting effectively for short assignments while utilizing technology for longer writing activities. Final Thoughts We all know that typing can be a game-changer for the right students, but it’s not a universal solution. To best support each student, we must rely on individualized assessments and thoughtful decision-making. By evaluating handwriting and typing skills and providing appropriate support, we can empower students to communicate effectively and confidently. Resources for Further Reading: Typing.com : How Fast Can Kids Type? Qiat Resource Bank: Handwriting vs. Keyboarding Rates Typing.com : WPM Averages by Grade Level Activities to support typing skills

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 162 of the OT Schoolhouse Podcast. Join Jayson and Amanda Gibbs as they discuss building a school-based OT toolbox. Together, they dive into tools and resources—like the interactive Osmo, 'Tools to Grow,' goodwill, and more—that make therapy sessions both effective and budget-friendly. Amanda shares her journey from navigating limited resources as a new grad to finding creative solutions that enhance her practice. Don’t miss this episode full of insights and practical tips to elevate your OT practice on a budget! Listen now to learn the following objectives: Learners will identify cost-effective tools and resources for supporting skill development in school-based occupational therapy.
Learners will understand district budgeting and resource processes to advocate for necessary occupational therapy materials, including recognizing key contacts for resource support in schools with limited budgets. Learners will identify tools and strategies for implementing a multisensory learning approach. Guests Bio Amanda Gibbs is a School-based Occupational Therapist that currently practices in Virginia working with ages 2 to 22. She is certified as an Autism Spectrum Disorder Clinical Specialist and is Tier 1 certified in the Size Matters Handwriting Program. When she is not working in the school system, her passion lies in creating content on instagram @ot.enlightenment. It has since grown to be a platform to provide mentorship to students, guest speakers for OT programs across the US, provide guidance for new graduates, provide resources on school-based OT information, treatment ideas, advocacy, and promotion of learning opportunities to become confident and competent occupational therapy practitioners. Quotes “If there are any new grads or therapists that are going into the space and you find you don't have much support, then please reach out to where that support is and find out what the budget is, and where we fit within that, and get that conversation going to to really decrease not only the burden on yourself, but future therapists as well”  - Amanda Gibbs, OTR/L, ASDCS “So for my elementary schools and another tip is to make it easier for yourself is to, again, stretch that same activity, but adapt it in so many different ways depending on the kid and the skills that you're working on.”  -Amanda Gibbs, OTR/L, ASDCS “I find that there are so many free resources out there that I have found from so many different people that, sometimes I feel there's an abundance of information, which is wonderful, but kind of overwhelming.”  -Amanda Gibbs, OTR/L, ASDCS “There's just so many resources online that you can learn a lot about something, before ever hitting the buy button or going to Target.  -Jayson Davies, M.A., OTR/L Resources 👉 OTenlightenment IG   👉 OTenlightenment.com   👉  Learning Resources Bonus Activities  👉 Learning Without Tears chalkboard    👉 Dollar tree 👉 Fun & Function  👉 Spot it  👉 Perfection Game 👉 Scramble Game 👉 Magnetic Wands 👉 Squigs 👉 Scratch Art 👉 Sensory metal rings 👉 Calm Strip 👉 ADL Boards 👉 Osmo 👉 Tools to Grow  👉 OT Tool Box  👉 Your Therapy Source   👉 Fun and Function   Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey, OTPs, welcome to episode 162 of the OT school house podcast. I'm your host, Jayson Davies, and I'm thrilled to be joining you on your drive, your walk, maybe your gym sesh or whatever other meaningful occupation you are currently participating in right now. Thanks for tuning in. I appreciate it now. I want to kick off this episode by asking you to picture this. You've just landed your first job, or maybe not your first job as a school based ot practitioner. You're eager, you're passionate, and you're ready to make a difference. But then reality hits and you quickly realize you have absolutely zero therapy tools to actually, you know, provide therapy with an hour later, you've got a full shopping cart on Amazon, but just as you're about to hit purchase, that pesky frontal lobe of yours reminds you that your bank account balance is close to nil. You've been there right scrolling through websites, streaming of all the activities you could implement, only to watch your budget woes bring you back down to earth. Now I don't know about you, but I would even add items to my quote, unquote, does the Dollar Tree have these items in hopes that I could find something similar, yet maybe a cheaper knockoff of a tool I absolutely wanted. It's a familiar struggle for many of us, especially those of you starting out in your first ot job. We all know that supplying our OT toolbox with essential tools is important. I mean, we even talk about it in OT school, but how do we do that on a new grad salary, or even a seventh year salary with loans and a mortgage? It's frustrating, and it can absolutely make you question whether you're equipped to provide the services your students deserve. But here's the good news on today's episode, we are set to uncover some brilliant tips of building a cost, efficient and well rounded ot toolbox without breaking the bank. I'm thrilled to introduce Amanda Gibbs, a dedicated, school based occupational therapist who has navigated these very hurdles and created the OT enlightenment Instagram page to help show how she does it, Amanda is here to share her practical strategies and top recommendations for versatile, budget friendly tools, drawing from her experiences of stretching a modest $200 stipend to successfully leveraging district support and today, she'll guide you through maximizing your resources and ensuring that you have the tools you need to be an effective ot practitioner. So grab your ot shopping list and a pencil as we welcome Amanda Gibbs to the OT school house podcast to share her best practical advice on assembling an effective therapy toolbox on a new grad budget.    Amanda Gibbs     Hello and welcome to the OT schoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.    Jayson Davies     Amanda, welcome to the OT school house podcast. How you doing today?    Amanda Gibbs     I am good. How are you Jayson?     Jayson Davies     Doing very well. Thank you so much for joining us. Done a few collaborations recently, and I'm really appreciating it. And of course, I just have to point out your Instagram enlightenment ot like I love it. It's awesome. You're doing wonderful work over there. Thank you so much for putting all that together. I know many, many ot practitioners are just loving everything you're doing over there.    Amanda Gibbs     Thank you. It's definitely a passion project, and it's become much more than I ever really thought it would be. But here we are, and we're keep on going with it. So yeah, I'm excited to be here.    Jayson Davies     Awesome. Well, thank you, and let's kind of dive right into it. I think the first question is always a fun one, and that is just kind of, I'd love to hear how you landed into school based occupational therapy, and you kind of want to tag on to that when the whole Instagram and social media things kind of started to tack on as well.    Amanda Gibbs     Well, I will be honest, I had no idea OTs were in the school system up until probably my last semester of graduate school an OT school. I found out about OT. I'll kind of backtrack a little bit, but even my junior year of college, I had planned to be a psychologist my whole life. So whole mental health world, I was, you know, involved in that. And then I was like, Hey, I wonder if there's a profession that addresses all of these wonderful things that we know OTs address. And it just so happened that at the time I was discovering OT, you know, a few personal involvements of my family came about. And so I had a brother in law who had a traumatic brain injury, and so I learned about OTs and the Brain Injury Unit, and then I researched that, and I came about OT, and I started observing, funny enough, my pop up at the time, as I was applying to OT school was getting home health OT, and he was living with me, and then I was also babysitting. And I was babysitting individuals that are autistic. You know, of different age ranges while I was in college. So I found out about ot went to OT school, and then not until my junior or, sorry, not junior year, but end of school that I finally did a field work in school based and I have not looked back since.    Jayson Davies     That's awesome. Yeah. I mean, I had no idea OTs were in schools either, until, probably even, yeah, during college. Like, I always thought that I was going to go into a clinical type of realm. That's kind of where a lot of my field work experience was. A lot of my volunteer hours for ot were there as well. And so, yeah, again, I didn't think that I would end up there. And I think you and I kind of both started down the same route. I believe you started in the contracting world first, right? In schools, I did, Yep, yeah. So how did that experience go?    Amanda Gibbs     So my very first year as an OT, I started out as a contractor. I got the job a few months after passing the NBC OT. I actually started out part time, three days a week, and then I was doing PRN outpatient pediatrics the other day, once a week. Yeah, and I found that that was actually tough just juggling two different settings as a new grad. I thought I was, I guess, invincible as a new grad, and thought it'd be easy, but it to me, it wasn't. And at that time, they really needed full time support, and I found that I gravitated towards school based better. It came more easy to me, and I was kind of all in so I jumped and took the full time position in a very rural area of Virginia. It was kind of a small team of us, just four or five OTs, no cotas, and I was kind of on my own as a contractor.    Jayson Davies     As a contractor? As a as a district employee?     Amanda Gibbs     As a contractor.     Jayson Davies     Oh, so you went from being a contractor, kind of doing split between school and clinic, and then you went to being full time contractor for a district.    Amanda Gibbs     Okay, let me back up. So I was a contractor for a recruiting agency, okay, for a school, yeah, and then I worked for the clinic separately, so two different entities, yeah.    Jayson Davies     And then you went full time, just in the school.    Amanda Gibbs     Still as a, as a contractor under, under a recruiting agency.    Jayson Davies     Gotcha Okay, and correct me if I'm wrong, but now you're actually in house with the district, right?     Amanda Gibbs     I am.     Jayson Davies     Okay, cool. So throughout this we're going to kind of talk about both of those experiences, and feel free to kind of chime in if you want to go back and forth between those at any time, because I think it's very different when it comes to talking about buying your own supplies, using the school supplies, district supplies, all of that. Sometimes there's a lot of overlap. Sometimes things are very different. So I kind of want to dive into this, and I'll let you kind of choose which role I'm assuming it'll either be the full time contractor or now as the role you're in now, but when you were just getting into the school district, or as a contractor, again, as a contractor, or in the schools. How did you figure out what you had access to when it came to therapy, supplies, maybe even some evaluations? Was it very easy, like you came into this room and like everything in this room was yours, or did you have to find things? Or what was that experience like?    Amanda Gibbs     That's a great question. So as a contractor, again, it was myself and about four or five other contracted OTs. You know that we got together sometimes, but budget wise, you know, which I found is very different in a, not only a rural versus, you know, urban area I'm in now, but there really was no budget, there was no items, there was no at really for us as a contractor in this rural area. And so I really found I was coming across a lot of barriers of how to even provide access to my students to provide them the tools that they need. So luckily, the recruiting agency I was a part of, they did give us about a $200 stipend for see CEU reimbursement. However, we could use that to buy supplies. So I went ridiculous on that 200 I made the most of that $200 I possibly could, and really use that to my advantage. But again, there was still a lot of barriers with just providing my students with what they needed, rather than, you know, being in a large district where I work for the district and walking into basically a house, and having everything you could imagine, plus being able to have a budget to get anything I need for a student, it makes the world of a difference for our job.    Jayson Davies     Yeah, I'm assuming now, like you really do, just have, maybe your classroom that's dedicated to OT at. One or multiple school sites that just has all the different things, and you can kind of come in, if you're going to another school, grab some things and go to another school. Is that kind of where you're at right now.    Amanda Gibbs     So our district is so large that we have two whole trailers, like housing trailers, that have, it's lined with, you know, wheelchairs and, you know, different tomato chairs and rift ins and stoic chair. I mean, you name it. At equipment ot testing kits. I mean, it's two whole trailers that we have access to. And, you know, there's a lot, quite a few of us, you know, it's about 48 OTs now in our in our district. So, yeah, it's, it's ginormous, but you know, it's it goes to show how much, one we need, and two, we're able to kind of have some flexibility and where we can get the stuff and kind of what we need to help our students.    Jayson Davies     Yeah, wow. You mentioned the $200 stipend, and I experienced that. Well, I think mine was $400 for the contracting company that I was working with at the time. And yeah, I mean, you said you used it very well, and I'm curious to see how you did it. I think my first purchase was an iPad, but I'm curious to see here what yours was.    Amanda Gibbs     So I looked at it like this. I said, Okay, I have $200 where can I, and just, you know, a little background story. I'm, I wouldn't say I'm a cheapskate, but I am frugal. So I have that natural tendency to just make a penny or $1 stretch. So I knew I had a few options, Dollar Tree, goodwill, and I'm also a goodwill member. By the way, if anyone's listening, you can become a goodwill member for free, and you get 75% off of that color of the week. So if I was getting something for $1 and it was the color of the week, I was getting it for 25 cent, wow. And I got so many good I still do. I get so many good finds at Goodwill, even adapted crayons, like the larger egg crayons, so many good, good little finds there.    Jayson Davies     Wow. So there you go. Everyone gotta go make use of that. I mean, I have been there a few times. Usually we're in the back dropping stuff off, but every time I go in there, I'm like, I don't know why I don't come to the goodwill more often. Like, it's amazing what you can find there. So, you know, the dollar store is a good deal, but 25 cents, yeah, you can't beat that in 2024 or beyond. So, yeah, now the $200 so sounds like you went to Goodwill. Made good use of that. Was it enough?    Amanda Gibbs     Kind of, it was it as being someone that was my first year, it set me up, at least with a good toolbox. And it, honestly, it actually helped my creativity, I feel like, because I really had to think about how to best use those tools or items I found. So I was really looking for things that are, one, very compact and small, and I can help travel with me, and two that are versatile, and I can, you know, use it in a million, in one ways. So I was looking at tape. I was looking at stickers. How many I was thinking in my mind as I was just going down the aisles, how many different ways can I use stickers? Or how many different ways can I use tape? I might be able, oh, I can definitely do a gross motor exercise with tape on the wall. Maybe I could also, you know, work on pre writing strokes, looking at putting tape on the table. And then then, you know, maybe we have cars, and then we, we take the cars down the pre writing strokes that we make without the, you know, with the tape. So just really getting creative in that process, I found that I at least got the basics, and I got a few good manipulatives, and I tried to make sure I also was able to get things that touched on each area I needed to support for my students. So definitely, fine motor, gross motor, visual motor, some ADL stuff, but I wanted to make sure I at least had a good starting kit, I guess, and it was sufficient for where I was that first year.    Jayson Davies     Okay, would you say you kind of went in with a shopping list, or was it more of a, I see something, let me figure out how I can use that.    Amanda Gibbs     Hmm, good question, because I didn't want to make an initial list and then be more of a hunt. Whereas I felt like, if I went into the store and saw something, it was more of in the process creating, like, Okay, if I see this, then I can grab it, or I can think of it and how to use it in X amount of ways, rather than, you know, making a list and then maybe it not being there or finding it,    Jayson Davies     yeah, that makes sense. And OTs, you know, you, you brought this up. OT practitioners can be pretty darn creative and resourceful, but I know that there's just sometimes we, we might be going through Target, Goodwill dollar store, and we see something like, Oh, that looks super cool. Mm. And then we might buy it before we actually think how we would use it. Or we might stand there for five minutes and try to figure out the 10 ways that we can use it to determine if it's worth paying the $5 for it or not. So I can imagine Amanda like just standing there kind of thinking like, how many different ways can I use this You mentioned a few things. What would you say were probably the best buys at the time that that, like, you know, some things probably didn't work quite as well as you thought they would, and other things did. What were the things that that were good buys?    Amanda Gibbs     I certainly had my, I think, like rose colored glasses on as a new grad, you know, especially, you know, and we're a part of social media. I have social media. We it's, we get over, I get overwhelmed when I see all this fun stuff in games, and you're kind of excited to just get all of that fun stuff. And I, for certain, was a part of that. And so I think there was one time I got there were these many stacking chairs, and you had to really stack on top. And I thought, Oh, that'd be nice, you know, work on, you know, coordination or visual motor skills. Maybe you had to stack certain colors, if I create a pattern, then they do it. And I'll be honest, once I tried it out myself, I was like, This is so difficult. And I think I tried it maybe one time with the student, and it just, it wasn't their thing, you know. And sometimes I will be the first one to say, I I have wasted a few dollars here and there, and it's like, Hmm, I could have probably spent that on something that was more. Could have been used. And again, you know, tons of different ways, rather than that specific game or, you know, toy.    Jayson Davies     Yeah, you live, you task analysis, task analysis, the activity, and you learn, right? So, yeah, that happens, definitely happens from time to time. All right, so you talked about the $200 stipend. You took that really far. But one question, I don't know if there's a question, but more of a debate that is often seen all over social media is, should school based ot practitioners spend money, their own personal money on tools and whatnot? And so I don't want to kind of go over this in like a presidential debate forum, but from your experience, you know, like, kind of, how has that maybe stayed the same or changed over your years? I mean, how long have you now been within the school based OT? OT realm.    Amanda Gibbs     This is my fourth year as a school based OT, Yep, yeah. So,    Jayson Davies     so in the four years, how has that evolved? Do you did you ever spend money? Do you spend money now? Do you how has it evolved?    Amanda Gibbs     It has certainly evolved, I think, initially as a new grad. And this was me, you know, again, not having as much money, so I was kind of in that phase where I really wanted to stick to that $200 but once I ran out, I kind of did find myself buying stuff here and there, and it's difficult if you don't have a budget in your district and you just don't know what to do or where to find the support you need, or maybe you don't have support. So I found that to be really difficult. And I did find myself buying things here and there, and I think that was a good lesson for me going forward to really understand. Well, if I do need something, who do I contact? How do I advocate for us as a profession, and then who's responsible for the budget? I should probably know that, and I should probably understand where we fit within that. And so it's funny, because going from a contractor to that scenario to now working for a district with a humongous budget, I kind of have everything I need at my fingertips, and I don't find myself buying stuff as much because we have it within the budget to put in an order request, and we we can get it, of course, when we create those order requests, we have to fill out. You know, what is the educational need with for that? And it comes out of the budget. But I don't like to buy stuff myself. I don't encourage anyone to do that. I have definitely found that we need to really advocate, because if we are buying stuff all the time for ourselves, and there we really don't leave a space to have that discussion for us to fit within that budget. I think that's so important. And so if there are any new grads or therapists that are going into the space and you find you don't have much support, then please reach out to where that support is and find out what the budget is and where we fit within that and get that conversation going to really decrease, not only the burden on yourself, but future therapists as well.    Jayson Davies     Yeah, and it's really hard to figure out, like that side of things, it's not a most occupational therapy practitioners, I don't know. We're not the people that think. About money all the time, and so we it's easier to go to Target and buy something than it is to put in a purchase order or to even figure out how to put in that purchase order. But yeah, I mean, whoever your immediate supervisor is, is definitely someone to reach out to, oftentimes, a secretary in the special education department, if that exists. It's definitely someone to reach out to. Any other people that you have found that are kind of key individuals to get to know.     Amanda Gibbs     Certainly the finance specialist, which, you know, depending on the district, they might have different titles, yeah. Or, you know, we have our admin coordinator, so we go to her, and you know, that's who we send the forms to. But you know, special education directors, yeah, yeah.    Jayson Davies     Yeah. And again, like every district does this differently. I've now worked in a few districts, you know, and I've seen kind of the different ways that it works. And kind of interesting now is being on the flip side as the OT school house. I'm also now seeing this from the vendor side, because, you know, a lot of therapists will have their district pay for them to come to a conference or the course that we put on at 32 schoolhouse. And so now I'm seeing it from that side. And oh my goodness, I thought, like it would I thought purchase orders would all be similar for districts. And, oh, gosh, no. So different. Like, so, yeah, it really depends on your district, how they operate. You know, small districts do things very differently from large districts, and you've got to kind of figure that process out. But I know a lot of OTs that have, once they figure that process out, oh my goodness, the practitioners just take it like, once you figure it out, it's so easy to do, and you can start to get a lot of support that way. So definitely figure that out. All right, so you've kind of figured out the system for for purchase orders, put it in request. Where are some of your favorite places to put in requests? I don't think you're putting in requests at the Goodwill. Correct me if I'm wrong, but what are some of the places you like to put in for for order requests.    Amanda Gibbs     So it's interesting. My district specifically prefers Amazon. Wow. So, yeah, I wish I could tell you why, but I think it's because of the fast shipping. And there's just so many, you know, we know I'm not promoting Amazon or anything, but you know, we know we can find anything on there, and so I think that's just their preferred vendor. I do know that people also like to purchase from fun and function. I believe they are called for a lot of tools, so that's one I go to pretty often as well. But I have ordered quite a bit of customized name stamps on Amazon, and I particularly like those, not only for their price, but you really can customize it to the student's name, to how large the print is, to the ink, the contrast of the ink, what color. And so I found that actually for Amazon, that particular item is very resourceful in there.    Jayson Davies     Do you have a post related to that on Instagram?    Amanda Gibbs     I do not. I do not.    Jayson Davies     All right, by time this podcast comes out, I think Amanda's gonna have a post out for you all for that, but just to put it on the spot a little bit. But no, the one, the reason I was gonna kind of bring that up, though, is because with Amazon, and that's interesting, that your district likes it. Maybe, you know, it's been a few years, but I remember my district, like hated Amazon as a vendor, and I think it was because the prices changed so often, and so by time the paper way work went from the OT to up the chain of command, the prices could have changed, which then throws everything off, but maybe things have gotten a little bit more consistent now. But the reason I asked you mostly is because on Amazon, you never know who you're actually buying from, and it's really hard to determine quality. And it sounds like you found a pretty good quality stamp here, and that's why I was interested if you had a post, because it's really hit or miss on Amazon, it's, I mean, you could order the same thing three times and it's coming from a different vendor. Each of the three times, quality is very different, so finding the right vendor within Amazon can sometimes be tricky.    Amanda Gibbs     I completely agree that's actually a great point for anyone that is going through Amazon. Or has I have found that at least the stamps have been consistent, or at least if we know that whoever is selling through Amazon like we're aware of that company, if it's a bigger named company, then that's a safer option. Yeah. But you know, I wish I knew why they preferred them. If you know, given all those things, yeah,    Jayson Davies     if it makes it easier for the teachers, OTs, everyone involved, then I'm all for it. So, yeah, all right, another one. And we briefly touched upon this, but I want to kind of go a little bit deeper into it. Is, how can ot practitioners maybe avoid some of those early mistakes that you talked about, that you might have made where, you know, you kind of bought something, maybe thinking. It would be great, but in hindsight, not so much. Or maybe also investing in something, or buying something that seems really cheap, but at the end of the day, is actually more expensive because we're getting the cheaper version of it and whatnot. So just kind of, I guess, a few tips for those people out there. How can they get the most for their money?    Amanda Gibbs     I think something I wish I would have done looking back, is before I bought some specialized games or toys. You know, rather than the more universal things we can use is usually, and I can't speak for all districts, but I at least get a week before the kids come back to school to at least look through IEPs, or if you have time to just look through their IEPs, look through their interests, look at their goals, and think you can work backwards. So you say, hey, this kid loves cars or dinosaurs. Then if you would like to, and if you don't, you know, it's kind of hard to to find the educational impact of needing dinosaurs. So we kind of have to have a little bit of wiggle room. And you know, you can purchase $1.25 car set at Dollar Tree. So that's the way to look at it, just working your way back and looking at those IEPs, the kids interests, and then kind of, kind of picking and choosing what you think is worth the little extra dollar or two, or, you know, for manipulatives, for in general, picking certain manipulatives that they might find interesting. So that's one thing, rather than, Oh, I love this. I love this, and I love this too. And, but wait, what do the students actually like and what will benefit them, and what skills can can you work on within those games to really feed it back into the academic goals that you're supporting.    Jayson Davies     Yeah, yeah. And the other thing too, I think, is just that there's so many resources online, like, if you're wondering if this toy would be good, the odds are someone else has as well, and that person may be an OT. That person may not be an OT, but the odds are you can either go into some of the different social media groups, some of the social media influencers, and see, hey, have they posted anything about this specific item, or how they might use that item? Maybe go on YouTube and look up the item, especially if it's more of a specialized type of game. And you know, is it really going to promote a fine motor pincer grasp or whatever, like some of those. I can't remember the name of the kid, but he's just, like, famous for unboxing toys on YouTube. And like, I'm sure if you're trying to figure out if a toy will be helpful, you can find that page of that kid unboxing the toy or whatever and figure that out. So, yeah, there's just so many resources online that that you can learn a lot about something before ever hitting the buy button or going to target. So.    Amanda Gibbs     Yeah, and it can be overwhelming, like I mentioned before, just there's an abundance of information, and I just there's an abundance of all these toys I feel like sometimes, so really trying to pick and choose what you feel would be most relevant, not only for one kid, but multiple kids. And then even if you don't have the toy in your hands, you know, kind of at least looking at the description, of course, but just doing a task analysis on it, and not only seeing, you know, the game description of what skills it says it supports, but you know, even if it has like small manipulatives in the game, I a lot of the time never use a game for its intended purpose. I consider myself, you know, the queen of just adapting any type of game. So even if we have Hi ho cheerio, I take those cherries out and use them a million ways for manipulating and putty, or maybe taking the cherries and using tongs to put on the letter i in the correct formation, or, you know, just thinking of it that way too, to really make that game stretch, but adapting it to use Even the little pieces within it.    Jayson Davies     Yeah. Yeah, absolutely. OTs, as practitioners, can get very creative with things, but I will also say some of us are very organizational people, and I know for me, I have struggled in the past a little bit with using some toys outside of their specific toy box, because I was afraid that they would never go back to their specific tool. So I will acknowledge that. But yeah, absolutely. I mean, we can get creative and use things outside the box, one of my favorite places, actually, I don't always buy from them, but at least I like to go to them to see what is out there in the world is learning resources, I think, is what the name of the brand is. They always have some really creative stuff. And I just love it. Just gives me ideas, and then I can figure out, okay, well, maybe I don't want this specific learning resource toy, but this other toy at Target, or this other toy that I already had. Have I can basically use in the same way that that one might so, yeah, just breaking down the tasks.    Amanda Gibbs     Or great, great idea. I've also seen some great toys on learning resources where they have the toy, but then I'm like, Hmm, I go digging in my recycling bin, and I'm like, What can I do to make this toy? You know, maybe I need to paint in honestly, I'm not saying every ot has the time or can go that extra mile to me, truthfully, it's just a therapeutic thing that I like to do, and it's just my way of I don't know. It's, I think that's me. That's one of my hobbies. Is just creating stuff anyway, so sometimes I'll go in my recycling bin and I'll get out a shoe box or a cereal box and figure out, what can I do with this and how can I use it in OT?    Jayson Davies     Yeah, yeah. And I just want to give learning resources a shout out, because if you go to their website and then you click on bonus activities, they have a ton of free printables, coloring pages. They have, like at home, learning videos. They've got how to use their tools in different ways. So not an affiliate of learning resources. But definitely check it out, because they have a lot of really cool stuff. So yeah, just wanted to throw that out there. So all right, this is going to come now to the segment where we're going to get a little specific, we're going to talk about specific areas that occupational therapy practitioners commonly address, and talk about a few tools that you really like. Because I know on Instagram you like to post some tools every now and then. So let's just start with the quote, unquote, most obvious fine motor. What are some or feel free to go if you want to make it a little bit more specific to an area of fine motor feel free to but what are some of your favorite tools to have on hand to promote some fine motor skills?    Amanda Gibbs     I will tell you. Since the very first day I became an OT, and this is probably one of the very first things I bought at Dollar Tree are those colorful pom poms. And I cannot, I should, honestly, at this point, create, like, a freebie handout of, like, 100 ways you can use those, but that is one. I use it every week. Kids love it. Kids feed Mr. Munchie, the famous tennis ball with it. We use them to again, use tongs to, you know, maybe make letter formations and then write the letters. So pom poms, those colorful pom poms. I cannot, I could. This could be all about pom poms from now to the end of the case. Let's see. Another thing is dollar tree also has many chalkboards. I will say I also like learning without tears chalkboard a lot, because they have the smiley face on it sit to help with letter formation, but Dollar Tree has them kind of on a stand, and I just break off the stand because it's supposed to be like a frame that sits up, kind of like for writing stuff on, you know, for events and stuff, but.    Jayson Davies     That's just gonna get knocked over with with every kid like.    Amanda Gibbs     So I always get chalk a mini chalk board, pom poms. Those are top three fine motor. This is a hard one, any type of little manipulative that doesn't stick to putty either. So even if it's mark that's key, marbles are kind of large, but I use marble sometimes. There's just so many good ones. And honestly, any type of those little erasers from Target, like the dollar erasers, I you can use it, and especially if it's a fun theme, maybe kids want to again, if it's a type of food, feed Mr. Munchie with those, or we can use those a different ways.    Jayson Davies     All right, the most important question of the day, have you ever bought in a Happy Meal somewhere just to get the toy for therapy?    Amanda Gibbs     You know what? Oh, I was about to say no, because I'm not a fast food eater. However, I used to babysit, and we used to always go to Chick fil A. And inside the Chick fil A kids meal, I was so surprised that they had spotted in there. And they had multiple versions at the time. And so I had that kind of as my first year, instead of buying the actual spot, and I got that one for free. And now, you know, later into the game of being an OT I have the larger, you know, versions of spot it, but that is certainly my best find in a free ish Happy Meal.     Jayson Davies     There you go, all the different versions of spot it. Were they all cows? Were they all, like, different types of cows and chicken nuggets or something    Amanda Gibbs     that would be hilarious. But they were, uh, they were different themes. Like, it was animals, it was it was mainly different types of animals. I think.     Jayson Davies     That's funny. That's funny. I love it. Yeah, no, they're one of the tools that, gosh, I've gotten. So, like, my mom, of course, and my family, like, knows I'm a school based OT and so, like, it's amazing. I order my mom's house, and she has, like, these things, just. Waiting for me to take to use for therapy. And one of them, I think, Albertsons, the grocery store, they were giving away these little like Disney characters, and they were only, like an inch tall, and they had a suction cup on the bottom. I was like, Oh my goodness. So I have a ton of those now, and I use those for everything.     Amanda Gibbs     It is so funny. You say that because I got those basically, except they were Marvel characters. I got them at Goodwill for $1 and I don't know what they're called. I can't find them anywhere else, but I would love more of those. I've used those tons of times again, just using again like letter formations or just that pincer grass. Oh my gosh. Those are great for fine motor skills.    Jayson Davies     Yeah, I mean, they're like, they're like, almost kind of like squigs, yeah, they're really cool. So, yeah, use those all the time, all right, so that was fine motor, and I'm sure there might be some repeats here, but let's talk about visual perception. Visual motor, anything that comes to your mind that you like to have on hand.    Amanda Gibbs     Hmm, a few things that are, again, easy to travel with are the spot it game is one of them. So I'll keep that on me. It's nice and compact. A lot of things that I like to do, too are just, if it's more like copying designs and such, we can use, you know, different tools with that, like popsicle sticks. Put the popsicle sticks in different, you know, shapes, or whatever it might be, and they can copy it on the right side, if I put it, you know, maybe on a whiteboard. And mine's on the left, there's is on the right. Also, I use clothespins a lot, and I might color the ends of the clothespins differently and have, maybe visuals of the different ways we can order those or sequence those, to look at those skills. As far as actual games, I do have scramble, which is a two player, it's two it's a two player scramble, but it's, it's basically, it's perfection, but it's two player, okay? And there's a time component where you kind of so it's nice because it has that processing speed element too. And so I enjoy that one as well. Perfection scramble, I'd say those are my main go tos, but I have so many that I just can't think of at the moment.    Jayson Davies     So hard when you're in the moment, right on the spot, trying to think about it, you know, if you were, if you're with a kid, right? It just comes to you, you're ready to go. But when talking about on a podcast, things take a little bit. They're just not right there, ready to go. But, all right, you mentioned using a dry erase, not a dry erase board, sorry, a chalkboard for handwriting. You also mentioned having some cars on tape, anything else for just a few handwriting ideas that come to mind.    Amanda Gibbs     Again, anything with manipulate I can make anything work I feel like with manipulatives. Or, you know, if we do have a dry erase board and dry erase marker, I always like to do, at least, you know, quite a few repetitions. Of course I feel when we're, you know, working on writing or whatever it might be, so that multi sensory approach. So maybe I also use Play Doh mats, which is nice. So I'll have like, the letters of the Play Doh mat, so we can roll out the putty. And then maybe we can use, like, the magnetic coin chips to go in the formation of the letter and, like, put them in the putty, so more strengthening pincer grass, and then we can work on, you know, writing the letter together. So definitely, those magnetic coin chips are really nice. I use those in a lot of different ways as well. And if you have the magnetic wand to pair, speaking of learning resources, I think they actually have that as well. That's a big go to squigs, as we mentioned, is another big one, especially for larger movements. I feel like some of my kids do better with those larger movements on a vertical surface first, and then we can kind of come back to the table and do more fine motor smaller formations of those letters as well.     Jayson Davies     Yeah, I really like the scratch art we can use, like a wooden pencil right to scratch away the black to get to the color underneath. That was, that's one that I've done a lot. Yeah,    Amanda Gibbs     I've used that a lot, especially for my friends that have difficulty with that pressure of writing. So I found that that can, yeah, those are very helpful with, you know, some of our friends just have a very light pressure. I'm like, I need to press a little harder, and that gives them the input that they need to really understand how hard they have to press.    Jayson Davies     Yeah, yeah, all right, quickly, going through a few more, I broke these two apart, sensory treatment versus sensory more like fidgets, and I don't believe you are sensory integration trained in any format. I don't believe but I'm sure you still address sensory to some degree. And so when it comes to supporting student sensory systems, feel free to kind of go in different directions. You don't have to mention all of them. What are. Few things that you like to have on hand.    Amanda Gibbs     So it definitely depends on the student. It's interest, it's not interesting, I guess. But in our district, we really try to focus on sensory regulation and just how we can support more from a consultative, indirect model. Because we really, and it's more about, you know, carry over with the teachers and that teacher education, because when we're not there, we really want to make sure that they can really integrate those strategies themselves. Or what can we do to to help them kind of go through that process. But what I what I like to have on hand is we have quite a few different, I'd say, more tactile fidgets, you know, the sense a few ones that I have found that I really enjoy are the sensory rings. They're like the metal rings that you put on. And they're very nice, especially if you have older students, like, you know, maybe upper third and up to middle school, high school, they're discrete. They don't make noise, you know, especially if you have a high schooler that really needs that input. I've had high schoolers that kind of find their own stuff that they enjoy. I've had I've had high schoolers, um, even enjoy ripping off the ties of a trash bag and use that as their fidget. Very interesting. Yeah. So those sensory rings are nice, very discreet. Also it's more what do they call calm strips. So you could place those under the desk, or if you have a laptop, I like those for my middle and high schoolers or older students, any student really could benefit. Even I do to put those on your laptop, and it kind of goes with you, wherever you are, even, you know, squishy balls, it really just depends on the student. And honestly, it is more trial and error, and what would benefit the student most and what they prefer. Because I'm sure we have all been through this process where we give a kid a fidget and it's just thrown, and the teacher's like, Ah, they're throwing it. They don't need this, and so going through that process of really finding what is most beneficial, and then what are they really going to use as a tool, rather than a toy? So that conversation as well.    Jayson Davies     Do you have any sort of like, maybe not call them rules, but guidelines that you use to kind of distinguish a fidget, a sensory fidget, versus a toy or something that's going to be more distracting for a student. Do you have any sort of guidelines that you use for that?    Amanda Gibbs     I guess it'd be more of my own personal guidelines, but I really like to observe the kid like one thing I've learned through trial and error, you know, is I can observe a kid with me one on one all day, and then use it, and it would be fine, but soon as maybe they go back to the classroom, it's not fine, and that's when it causes problems. So what I what I like to do, and I know, you know, sometimes we are strapped for time, and not all therapists have the time to do this, but if you if you do have the time, I do like to observe the student. Once I give it to them in the classroom, maybe I push into a session, or it's an indirect session, but I really like to observe how they do with how they use it inside of the classroom, during a lesson, or something that's very academic based to see if it is distracting to them or their peers. And then I can kind of work backwards to decide, okay, maybe this is a little too noisy, or they're kind of focused more on the Fidget rather than their work. And what might be better for that regulation and in focus piece.    Jayson Davies     Yeah, absolutely. And then I think we'll wrap this up with ADLs, any fun things that you found, or helpful things that you found from various places that you just kind of like to have on hand to work on some ADL skills. And of course, you know, there's several ADLs. We don't need to go into all of them, but some of the more common ones that we might address in in school.    Amanda Gibbs     So there's certainly a few. You know, Amazon has those different ADL boards, the button boards, the ones that I like. And I wish I remembered the company, but I found it from Goodwill. I imagine that where it was more of the pillow, and they have the zippers and buckles and the various fasteners on it. Kids seem to really like that one. And how I kind of integrate it more in our session is I might hide like little things within the pillows. And they're kind of like finding something, and then they practice a fastener, oh, find the next fun, manipulative within the pillow. And then they so it doesn't seem so difficult all in one, you know, part. So those are really nice, the more the pillows and what I also like to do is just practice on what they have, also what they wear. Make it fun. Sometimes I might adapt it, of course, to make it easier initially. So I might what I've. Tried in the past actually is tie like a high contrast, like yellow or red pipe cleaner to the zipper. And that seems to help kids a lot on their own jacket, and we can practice that way. What else the pipe cleaner has has really worked wonders, I've found. And then also just again, using their backpack within our sessions, like maybe hiding fun stuff in their backpack and using larger zippers, and then, kind of, as they get more successful with that, and then we can kind of scale down, make it maybe take away the larger zipper, or whatever it might be. But, yeah, hiding some fun stuff in their backpack to get to it, or a toy and then or a ladder, and we, you know, 1,000,001 ways we could, we could integrate that.    Jayson Davies     Yeah, yeah, absolutely. All right, so that was, I don't know if we we calculate like three for each of those, you just gave us like 15 different treatment ideas. So thank you for that. But now let's talk about the wonderful idea of organization and storage, because we all know that every school based occupational therapy practitioner has at least two, I would say, almost at least three different schools to go to. We live out of our car. Our trunk is our most likely disorganized base, but maybe it's organized for some of us. But how do you how do you go about putting this all together? What's your mode of transportation when it comes to putting this all into a toolkit.    Amanda Gibbs     So, you know, it's, you know, it's funny. I did recently get a new car about a year ago, and I specifically chose that car for a large trunk, a tall trunk for hauling all of my work stuff. So I do carry around a rolling cart. I just got that two years ago. It is. It's a luxury. It's nice if you want it. It's not a necessity. But I have found it does help my shoulders by a lot. The only things I come across, of course, is yet you have to consider, if you have, you know, stairs in your school and you don't have elevator access, and that can be the main barrier, of course, but what I have found to work around that is I keep a different bag for each of my schools, and nothing crazy, just even like the $1 sturdy Marshall's bags, or, yeah, you know what I'm Talking about, just the sturdier. So I'll keep those, and I have one for my elementary school and then another for my high school. That's what I currently have this year. So very different populations, I need very different things, and so those bags fit very nicely in my rolling cart. I can just get those right out if I need to for the day, and especially if I'm going to my high school, because, you know, we are in 2024 and just security is very high in my high school, so I have to go through metal detectors, and I have to take all of my stuff out. So I have to pack lightly. And so I recommend for any therapist that if you have multiple schools, just make a separate bag for each of those schools, even if it's just a small pouch of the basics for crayons and a scissor and whatever else, if you have the means to but certainly a different bag for maybe each school that would help out a lot.    Jayson Davies     Yeah, I know I, I always had, like, an over the shoulder bag that I took with me everywhere. Sometimes I would use a backpack. I never did the rolling cart probably, probably should have, but yeah, it's I felt like I was just always switching. I never found like, exactly what I wanted, like one thing that would work. And I did start to do kind of the more for the paperwork. I made a folder for each individual school, at least for the paperwork for each school, because it was just so I mean, now everything's digital, but at the time, things were digital, but still a lot of paper, so I just had a different folder. Plus it's hard to type and work at the same time. You can make little notes handwriting while you're working with a student, so a little bit harder to type, but having different bags to go different places was always a little bit easier, I found so, yeah, but then comes the organization side of that, because if you do have sounds like you have high school versus Elementary, kind of easier to separate those out, but if you have three different elementary schools, maybe you're moving things around from bag to bag a little bit More often, but also maybe you don't necessarily need to have two different bags, because you are using similar tools wherever you go.     Amanda Gibbs     And that's kind of how I did it, because last year I had, I had two elementary schools last year in one high school. So for my elementary schools, and another tip is to make it easier for yourself is to again, stretch that same activity, but adapt it in so many different ways, depending on the kid and the skills you're working on. So I didn't find that it was a hassle. I usually I keep the same bag, but I might, you know, for the week, I might add in some extra papers. I usually keep a folder within my bag that says. Like treatment activities for the week, and I just have it in that folder. So you could have a folder for that elementary bag, or a folder for that high school bag, if you need to put a sticky note for what kids it's for to kind of dissect it a little more that way.     Jayson Davies     Do you use an iPad at all? I do. Okay. Do you ever kind of, I guess. Do you ever pair a digital asset, like something on the iPad with physical tools, other than maybe the the obvious, like stylists?    Amanda Gibbs     Um, are you saying like, do I use certain like, writing apps during myself?     Jayson Davies     More of like, do you ever somehow incorporate physical items, like your pom poms or something like that, almost in in, somehow connected with the iPad? So for instance, for me, one thing that I found was because it's hard to always carry around some like instructions for a game. Or what I would do is I would take a picture, so, like, I might put the pom poms into a design, take a picture of it on my iPad. That way, when I go to the school, instead of having to carry around the papers with designs for the kid to copy, I just, you know, pull up my iPad, go to the picture that I want them to copy, and now I've got it right there.    Amanda Gibbs     You know, yes, you know, it's funny. We actually just got new iPads at my job Friday, and I had pictures because So, for example, I did that with the game don't break the ice, and I put the little blocks into different designs for the kids to copy. So I know exactly what you're saying. I also did that, but I just remembered I lost all of that as a Friday, so I have to recreate all that, but it's okay, yeah, yep, that's also a great idea. Yeah, I did that with, like, don't break the ice. Also, if I'm if I did do a craft, I just put the sample of what I did. Rather than carrying the sample around, I took, I had a picture of the sample, depending on what we did. If it's too complicated, I obviously had the physical piece there.    Jayson Davies     Yeah, I could imagine actually, like, using, even putting the pom poms, like, onto the iPad, potentially, but obviously it wouldn't be interactive in that sense. I don't know if it needs to be, but I could see that kind of being almost using the iPad as a quote, unquote game board for the physical items. But, but, yeah, I just wondering curious minds. So.    Amanda Gibbs     Yeah, that's a great question. I know you know apps. We do use a lot of apps in our district as well. We have quite a few learning apps for letter formations and such. We use and for at as well.    Jayson Davies     And then I know some people, or another way that I know some people use like physical items with the iPad is they use the Osmo, which is something that I've used, and you can actually use like sticks and curves to make the letters with the Osmo, and has this little bear and then jumps up, and it uses the camera and a mirror over the camera to actually see what the student is is doing with it. And so, yeah, that's a fun one. I don't, don't know if you've used that one before.    Amanda Gibbs     I have not. Is that a program you would have to get approved? Like, did your district have to approve that? Or, I'm not familiar.    Jayson Davies     I had them purchase it. The app is actually free, or at least it was at the time. The Osmo app is free, but you need the little tools to actually use the app. So basically, it's a little mirror that goes over the top of the iPad camera, so that way the camera is actually looking down. And it also has a stand for the iPad, so the iPad standing upwards, but the mirror is making the camera look down, so then it can see what you're doing on the table. And so they partnered with Disney, they partnered with a lot of different companies. Yeah, it was cool. They had a letter formation game, and basically it was the Handwriting Without Tears wooden blocks except rubber, and you put the pieces together to make the letter D, and then it would tell you, Oh yeah, your D looks good, or your D O make it a little bit better. Um, so, yeah, pretty cool tool.    Amanda Gibbs     Yeah, I've heard of it, and I've seen kids use it, but I personally have never used it, but that is good to know. I will put that in my back pocket.    Jayson Davies     Yeah, there's actually another one of the games on it. It was always tough for the kids, but I could see some of the older kids, if you're trying to do more of an executive functioning with a little bit of visual perception in there, they had a game where a ball is coming down and you basically have to draw on a whiteboard to create a barrier on the iPad. I know this doesn't sound at all like it's hard to comprehend this, but by drawing on a whiteboard under the iPad, it would create a barrier on the iPad screen that would then make the ball bounce. So, yeah, it's very interactive, like kind of that 4d you know, you're getting the interactive piece with the digital so unique. And I don't know I like it. I think it's really cool. I think it adds an extra. Component that kids really like, so and it's really easy to carry around. If you already carry around an iPad, all you need is the little piece that goes over the iPad, the little stand, and then the manipulative So.    Amanda Gibbs     Right, right. Yeah.    Jayson Davies     Okay, I think we are going to start to wrap up here. We've covered a lot any other tips or tools that you want to share with everyone listening about kind of developing that, that toolbox that they can have with them and take with them,    Amanda Gibbs     I would say definitely, try to keep it low expense. Try to find what's within the budget if you're looking for outside tools, because I know I can't think of everything in my mind all at once all the time. There are other great resources I will shout out tools to grow. I think they have some great tools that I use weekly. And they also just recently came out with a tools to teens portion, which I find is helpful for the high school population. And they have tons of life skills stuff on there that I've been trialing this week, actually, and it went phenomenal. So I'm going to shout out tools to grow if you know, for low prep, or just you know, you're in a funk and you need some extra ideas or tools, they're great. I'd say that was my main that's my main go to but there are others, like ot toolbox, I know, is great, and your therapy, your therapy source, is also great. I find some great visual perceptual worksheets on there. A lot of the time, I have to give a hand to OTs in general. I'm going to be honest, I find that there are so many free resources out there that I have found from so many different people that sometimes I feel there's an abundance of information, which is wonderful, but kind of overwhelming, but yeah, but it's great that we have so many wonderful minds out there making Just resources to help the profession.    Jayson Davies     Yeah. Yeah, absolutely. And I do have one more final question for you, and that is, I think a lot of people, when we think about a toolbox that we put together, we think about it specifically or more in relationship to a pull out model of therapy. But is it, is it specific to a pull out, or can we also bring our toolbox into the classroom and work in the classroom with kids?    Amanda Gibbs     Absolutely. So I do push in about 50% of my time, especially with my a lot of my self contained classrooms, my preschool population, even at the high school level, I'm pushing in and doing more group lessons with my students. So a lot of time I will have my rolling cart with me, if it's appropriate, but I really do like to just bring the basics of I have my clear little pencil box, and I'll have my highlighters, my different types of pencils and grips and adapted paper, a few different manipulatives, but nothing. One tip that I have found is I definitely do not bring larger, more distracting games into the classroom. I think if you want teachers to not like you, that is a fast way of housing how for them to not like you. So I do keep it simple and just bringing what I need within the session, maybe I have some planned worksheets, small little manipulatives, again, more of those things that we can use across various different populations.    Jayson Davies     Absolutely. Amanda, thank you so much for joining us today, talking about the OT toolbox and how we can start to put that together, find different things from unique places and and just know that we don't have to, you know, spend a fortune. I think, honestly, the 15 different items that you talked about earlier, when we went through fine motor, visual perception, all that fun stuff, you probably maybe combined for a total of, like, $50 I would assume, like that wasn't a lot of money. You gave a lot of different, you know, tools that combined might reach $50 I would assume a lot of that stuff was very low key, very inexpensive and simple to to source. So thank you so much. And before I let you go, I want to give you the opportunity to share a little bit about where people can go to learn more about you and the resources you have.    Amanda Gibbs     Sure, and you know, thank you so much for having me. Jayson, I love talking ot all day long, of course. So if you guys would love to hear my voice even more, you can find me on Instagram at ot enlightenment, or you can head over to my soon to be refurbished, redone website at ot  enlightenment.com with new stuff to come very soon, and if you are still kind of just needing more support. As a new school based therapist, I do have myself and another partner. We have school workshops, and it kind of goes over all about the stuff we just talked about, but in a little bit. More detail about how to really address the organization, but in all the different ways we have to organize a school based therapist as well as, what do all those tools mean? What do all those pencil grips mean? How can you use them differently? And so check those out if you find that you need more support in those areas.    Jayson Davies     Absolutely and granted. This was 167 weeks ago. Amanda, so it might not be still $8 but you posted a target Hall eight items for $8 it's probably like eight items for $22 now because of inflation, but those are the types. Some of the things you can find over on ot dot enlightenment. Amanda posts some amazing content every day related to school based occupational therapy. I'm sure she has several posts where you can learn a little bit more about what is in her ot toolbox, and then some. So be sure to check her out over at ot enlightenment, Amanda, it's been a pleasure. Thank you so much for joining us, and we'll definitely have to keep up.    Amanda Gibbs     Thank you Jayson.    Jayson Davies     Well, that's a wrap for today's episode of the OT school house podcast. A huge thank you to Amanda Gibbs for joining us and sharing her valuable insights and resources. Be sure to check out all that Amanda has to share over at ot period enlightenment on Instagram. The link is in the show notes, in case you need it. And again, thank you for allowing me to spend some time with you during your daily happenings, whether you're a seasoned occupational therapist or just starting out as an OT practitioner, I hope you found today's conversation practical for your own practice. If you're looking to dive even deeper into today's topic or just need more support, I'd love to invite you to join the OT school house collaborative. Inside the OT school house collaborative, you can earn certificates of completion for listening to episodes of the OT schoolhouse podcast, get early access to our library of resources and professional development courses, and even access our very popular goal bank for school based ot practitioners, find a wealth of additional resources to aid your journey in school based ot as part of the OT schoolhouse collaborative. It's a fantastic opportunity to reinforce what you've learned and further integrate those tools and strategies into your daily practice. You can even get support from me inside our monthly live collaboration hours. Until next time, keep making a difference in the lives of your students and stay inspired. We'll see you next time on the OT school house podcast.    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. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

School-based OT practitioners are well-acquainted with the challenges of balancing direct student support (like 1-on-1 services) and indirect responsibilities (like showing the teacher how to use an accommodation). Over the past decade or so, as caseloads have grown and administrative duties expanded, the 3:1 model has gained traction as an effective way to manage both. In this article, I’ll share insights on what the 3:1 model entails, the research supporting it, and why it’s worth considering in your practice. What is the 3:1 Model in school-based OT? The 3:1 service delivery model structures school-based OT work (or any related service provider's work, really) into four-week cycles, designating three weeks for direct intervention with students and one week for indirect tasks . This “indirect” week allows practitioners to handle essential responsibilities like teacher consultations, classroom observations to monitor goal progress, IEP meetings, and material preparation, all of which contribute to student success. The 3:1 model emphasizes a workload approach over a caseload focus , acknowledging the full scope of tasks that OTs manage in school settings ( Seruya & Garfinkel, 2020 ). Evidence and Support for the 3:1 Model While there is research on practitioner and teacher beliefs regarding using a 3:1 model, there is no research (that I could find) on the student impact of using a 3:1 model. As Seruya and Garfinkel ( 2020 ) analyze, practitioners strongly desire to transition from a caseload approach, which prioritizes direct service minutes, to a workload approach that recognizes indirect services’ critical value. While caseloads typically count the number of students treated directly, the workload approach encompasses all activities necessary for effective school-based practice, such as documentation, teacher collaboration, and program planning. In the study, many school-based OTPs reported being overextended due to large caseloads (Average = 41-50), high direct service demands, and insufficient time for non-direct service tasks. Practitioners also noted that balancing direct intervention with indirect responsibilities was crucial for providing quality support but cited barriers like limited administrative support, procedural knowledge, and time constraints in implementing workload-based models ( Seruya & Garfinkel, 2020 ). Additionally, a 2019 survey indicated that OT practitioners' ability to collaborate with teachers and provide services in the natural environment is impeded by high caseloads and inadequate support ( Schraeder, 2019 ). The 3:1 model directly addresses these issues by dedicating structured time to indirect tasks, potentially reducing workload-related stress and enhancing practitioner job satisfaction. Practical Benefits of the 3:1 Model for OT Practice As you might imagine, having a week dedicated once a month to non-direct treatment may provide you time to: Screen incoming kindergartners Support teachers Ensure the progress students are making in direct therapy is generalizing into the natural setting. And more However, I want to discuss three key ways the 3:1 model can impact OT practitioners and school communities. Enhanced Collaboration and Integration: With a designated indirect week, the 3:1 model could facilitate deeper collaboration with teachers and school staff. Teacher perspectives reveal a strong appreciation for OT collaboration in developing classroom strategies and enhancing student success when OT practitioners have time to consult and integrate their expertise into the classroom environment ( Bradley, Hassett, Mazza, & Abraham, 2020 ). Practitioners can use this time for proactive consultation on goals and whole-classroom support, aligning with the model’s aim to support not just students on our caseload but EVERY student on campus. Balanced Workload and Reduced Burnout: High caseload numbers and intensive direct service schedules often lead to practitioner burnout. The 3:1 model’s indirect week allows OTs to manage administrative tasks within regular work hours, aligning with best practices that advocate for sustainable workload management. This structure can alleviate the “always-on” demand of direct service and enhance job satisfaction among school-based practitioners ( Seruya & Garfinkel, 2020 ). When an entire School uses a 3:1 model, IEPs and other meetings can be scheduled during the "Flex week" (as some call it) to avoid missed services. Improved Service Delivery Quality: Research indicates that when practitioners have time for indirect tasks, the quality of direct interventions improves. During the indirect week, OTs can fine-tune therapy plans, observe classroom environments, and refine strategies with educators, ultimately creating more cohesive and impactful support for students across their school day ( Seruya & Garfinkel, 2020 ). This time away from direct therapy allows therapists to make data-driven decisions. Looking to ditch the Caseload Model and move to a Workload Approach? While at a rural school district with a caseload of over 100 kids , I knew something had to change. That's when I began to study where my time went and create a plan to get support. After changing how our program operated and convincing my boss to hire another OT, I created this course to help OT practitioners and other providers do the same. Click here for support making the transition! Current Research and Limitations While the 3:1 model holds promise, research specific to its implementation in OT remains limited. Studies in related fields, like speech-language pathology, have shown positive effects, but OT-focused research is still emerging. Seruya and Garfinkel’s survey underscored the need for further exploration into how workload models impact student outcomes. This research gap suggests a strong need for advocacy, both for adopting the model and for studies to validate its effectiveness in diverse school environments. Another consideration is that successful implementation may depend on administrative support and understanding the workload model's benefits. As a profession, we need to work toward sharing the 3:1 model's benefits in a way that administrators can relate to. We can also partner with our related service provider counterparts to do this together. Please note that the 3:1 model is not a quick fix for larger staffing issues! It is not designed to help you “see more students in less time.” Rather, it is a program to help you provide more comprehensive services to the students you already serve. Implementing the 3:1 Model: Considerations and Best Practices Implementing the 3:1 model effectively requires careful planning and advocacy. Here are key recommendations based on the research: IEP Documentation Adjustments: Adjusting IEPs to reflect both direct and indirect service needs helps parents and administrators understand that the indirect week is integral to quality service. By clearly outlining both components in IEP documentation, practitioners can facilitate broader acceptance of the 3:1 model ( Seruya & Garfinkel, 2020 ). I would typically do this by listing OT on the IEP service 3x a month or 30x a year. I would then add OT support to the IEP as a consult 1x a month. That consult would allow me to be flexible in supporting the student during the 4th week of each month. Advocacy and Education: Advocacy is crucial to gaining administrative buy-in. Many practitioners in Garfinkel and Seruya’s study highlighted a need for better advocacy resources, such as data on workload distribution and outcome tracking. Providing clear, evidence-based insights on the model’s benefits can build support among stakeholders, increasing the likelihood of successful implementation ( Seruya & Garfinkel, 2020 ). One tool you may consider using is the OT Schoolhouse Workload Calculator , which helps you identify your workload based on your current caseload. Feedback and Adaptation: Regular feedback from teachers, parents, and administrators is essential for ensuring that the model is meeting the community’s needs. Adaptations based on feedback can enhance the model’s effectiveness and foster a collaborative school culture where OT support is fully integrated. Debra B., a colleague inside the  OT Schoolhouse Collaborative,  recently shared how she adapted the 3:1 model. Rather than reserve an entire week for indirect services, she would block off a particular day each week for flex services. For example, each Friday would be reserved for evals, consults, and other tasks. This allowed her to still have five days a month for non-direct services without completely changing her routine for one week every month. The Wrap-up If you are considering using the 3:1 model in your practice, I say go for it! The model offers a structured, balanced approach to school-based OT that supports practitioners, teachers, and students. Although additional research is needed to validate its impact, the evidence and practitioner feedback underscores the model’s potential to enhance service quality, reduce burnout, and foster effective collaboration. Plus, I also don't think I could show you research that says a 4x month direct service frequency is any better. By addressing both direct and indirect needs, the 3:1 model can make school-based OT more impactful for both the students we serve directly and the students who don't need direct OT services. Keep the conversation going! Have you incorporated the 3:1 model into your practice? Are you considering it? Share your thoughts in the comments below. References American Occupational Therapy Association, American Physical Therapy Association, American Speech-Language-Hearing Association . (2014). Workload Approach: A Paradigm Shift for Positive Impact on Student Outcomes . Retrieved from https://pediatricapta.org/special-interest-groups/SB/pdfs/APTA-ASHA-AOTA-Joint-Doc-Workload-Approach-.pdf
Bradley, E., Hassett, E., Mazza, A., & Abraham, G. (2020). General Education Teachers’ Perspectives on Collaboration With OTs in the School Setting. The American Journal of Occupational Therapy , 74 (4_Supplement_1), 7411505163p1-7411505163p1. https://doi.org/10.5014/ajot.2020.74s1-po5124
Garfinkel, M., & Seruya, F. (2019). Therapists’ perceptions of the 3:1 Service Delivery Model: A workload approach to school-based practice. Journal of Occupational Therapy, Schools, & Early Intervention , 11 (3). https://doi.org/10.1080//19411243.2018.1455551
Gjellstad, M. (2023). Impact on Teacher Ratings & Perceptions of Efficacy of a 3:1 Model of OT Service Delivery. The American Journal of Occupational Therapy , 77 (Supplement_2), 7711505150p1-7711505150p1. https://doi.org/10.5014/ajot.2023.77s2-po150
Hubert, W. (2011). A Survey Of Speech-Language Pathologists’ Attitudes Toward The 3:1 Service Delivery Model . https://doi.org/10.58809/jfiu5737
Schraeder, T. (2019). The 3:1 Model—One of Many Workload Solutions to Improve Students’ Success. ASHA Leader , 24 (5), 36–37. https://doi.org/10.1044/leader.scm.24052019.36
Seruya, F. M., & Garfinkel, M. (2020). Caseload and Workload: Current Trends in School-Based Practice Across the United States. American Journal of Occupational Therapy , 74 (5), 7405205090p1-7405205090p8. https://doi.org/10.5014/ajot.2020.039818

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 161 of the OT Schoolhouse Podcast. Have you ever wondered how vestibular challenges might be impacting your students’ ability to succeed in the classroom?  In this episode, Dr. Annie Baltazar Mori and Dr. Jennifer Petersen join us to unpack the powerful connection between the vestibular and proprioceptive systems, sharing insights that can transform your approach to these often-overlooked issues. Vestibular disorders are frequently at the root of classroom challenges, affecting everything from focus to motor coordination. Our guests will guide us on how to help students improve not only their physical skills but also their confidence and self-esteem. Tune in as Dr. Baltazar Mori and Dr. Petersen walk us through the latest research, share their clinical expertise, and offer practical strategies to help our students reach their full potential! Listen now to learn the following objectives: Learners will understand how the vestibular and proprioceptive systems interact. Learners will identify at least 2 standardized assessment tools they can use to evaluate vestibular function in their students.
Learners will identify effective intervention strategies for vestibular disorders.
Learners will identify key strategies for educating teachers and others on recognizing vestibular challenges and embedding sensory-based interventions. Guests Bios Annie Baltazar Mori OTD, OTR/L & Jennifer Petersen OTD, OTR/L, C/NDT Dr. Annie Baltazar Mori is the owner and founder of playSense, a pediatric occupational therapy clinic in Redondo Beach, CA and ASImentoring.com an online Sensory Integration mentoring program.  She earned her Doctoral and Master’s degrees in Occupational Therapy at the University of Southern California. She lectures, nationally and internationally, on topics related to theory and application of sensory integration and social participation.  She is an instructor for the Collaborative for Leadership in Ayres Sensory Integration (CLASI) and has taught as an adjunct instructor at Thomas Jefferson University teaching advanced practice certificate courses in autism. She regularly participates in research and is a contributing author on several scientific research and professional articles with a focus in the field of occupational therapy and sensory integration (Baltazar Mori et al. 2017; Auld-Wright et al., 2023; 2014; Koester et al., 2014; Mailloux et al., 2014).  She served as the chairperson of the Sensory Integration Special Interest Section for the AOTA. Dr. Jennifer Petersen is on faculty in the Department of Occupational Therapy at St. Ambrose University in Iowa. Her expertise and personal interest have led to leading several projects and studies with her students related to the Evaluation in Ayres Sensory Integration (EASI). Beyond research participation, Dr. Petersen has also published scientific research articles (Mailloux et. Al., in press; Petersen et al., 2020; Petersen, 2017; Frolek Clark et al., 2011).  Prior to teaching, she completed her Master’s in Occupational Therapy through St. Ambrose University and her Doctorate from Thomas Jefferson University. Additionally, she pursued advanced practice certificates in ASI through USC/WPS, Autism from TJU, and Neuro-Developmental Treatment from the Neuro-Developmental Treatment Association.  Dr. Petersen has a natural inquiry of understanding how to provide best practice evaluation and intervention to achieve family and child centered goals. Throughout her advanced education, she has practiced at various pediatric clinics and has thoroughly enjoyed being a part of each child and family’s journey. Quotes “Our senses are the only way that we gather information from the world. Sensory integration is needed to learn in the classroom and to participate with our friends and to participate in life. “  -Dr. Baltazar Mori “Sensory integration is a neurological process that we all have, and for us to ignore the integration of the senses outside of a clinic would be a huge disservice to a child.”  -Dr. Baltazar Mori “Vestibular system projects to that cerebellum. We know cerebellum helps us with balancing and motor coordination, and also projects to the oculomotor nuclei”  -Dr. Peterson “We live in a multi sensory world, and our senses work together. We take in multi sensory information, and it doesn't just fall into pockets. The senses work together to understand what's happening and it's really hard to have vestibular input without proprioception.” -Dr. Baltazar Mori “An average nervous system registers movement for about six to 12 seconds. So you'd expect that nystagmus to go for that long.”  -Dr. Baltazar Mori Resources 👉 Dr. Annie Baltazare Mori website   👉 Play sense kids Website 👉 Dr. Peterson website 👉 Email Jennifer   👉 Clasi Website 👉 Dr. Peterson article Easi 👉 SOSI-M 👉 Spm 👉 PRN Research Episode Transcript Expand to view the full episode transcript.   Jayson Davies     Hey there ot friend. Welcome to Episode 161 of the OT school house podcast. Thank you so much for being here today. I want to start off this episode by asking you to raise your hand if you've felt at a loss when it comes to supporting a student that you know has difficulties processing vestibular stimuli. Trust me, I'm raising my hand right alongside you. Perhaps you've tried wiggle cushions, maybe some go noodle videos, and maybe even some sort of swing apparatus that you have access to, but still, you have yet to see a meaningful difference in how the student responds to vestibular input. Now, as you probably know, but are also frustrated by Vestibular Disorders are often the root cause behind so many challenges that we support within the classroom, from handwriting breakdowns as well as behavioral outburst, vestibular always seems to be at the root. Unfortunately, vestibular disorders can also be very difficult to diagnose or to identify and also treat without the proper tools and interventions on today's episode, that's exactly what we're going to uncover the tools and interventions to support students with vestibular disorders. I'm thrilled to be joined by two amazing ot practitioners who are here today to share their approach to evaluating and treating vestibular disorders in the school setting, Dr Jennifer Petersen, a professor at St Ambrose University, and Annie balance our Mori owner of a pediatric ot practice here in Southern California. Annie and Dr Peterson have decades of experience using a sensory integration framework to tackle vestibular challenges, and together, they're going to walk us through the latest research, share their clinical expertise and give us practical strategies that we can use to support our students. So get ready to rethink everything that you thought you knew about Vestibular Disorders. This is going to be an eye opening conversation, and you won't want to miss it. Stay tuned.    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     Dr Petersen and Annie, welcome to the OT school house podcast. It is such a pleasure having you here today. Really appreciate it. And since the two of you, I'm going to go ahead and kick it over to Annie really quickly and say, Hi Annie. How you doing?     Annie Mori     Hi Jayson. Nice to see you.     Jayson Davies     Nice to see you as well. Thank you so much for being here. Really appreciate it. And since we're with you, Annie, we'll, we'll kind of start with you, and then we'll dive over to Dr Peterson in just a moment. But Annie, I'd love for you to just to just to take a moment and share a little bit about where you are in the world of occupational therapy today and and maybe just a brief, brief how you got here.     Annie Mori     Okay, well, first of all, thank you for having me. I'm really excited to be here and to speak to your communities. So I've been an occupational therapist for about 24 years now, and you know, from day one I knew I wanted to specialize in sensory integration, and so I've spent my entire career studying sensory integration, writing about it, learning about it, being mentored by experts in it, and Then advocating for it. So currently, I own a pediatric occupational therapy practice in Redondo Beach, California. We serve about 150 clients a week, providing primarily, well providing occupational therapy primarily using a sensory integration approach, because that is our specialty, and that's we're kind of a pretty niche practice in our area, and really diving into that.    Jayson Davies     fantastic, yeah. And I was just looking at your own personal website. Annie blitzesare  morey.com THANK YOU. And, yeah, I was looking at some of your publications and your projects and whatnot. And you have been very involved with SI, as you mentioned, and especially with the evaluation of air sensory integration, the easy as as we've come to know it as, and we're going to dive more into that, I'm sure, the easy a little bit, but yeah, I just wanted to kind of mention that a little bit, because that is something that I know has been a long time in the works. And kudos to you and the entire team for kind of getting it to where it is today and where it's going to be in the future. That's awesome.     Annie Mori     Thank you. That's kind of a career highlight for me. I think,     Jayson Davies     yeah.    Annie Mori     It's really wonderful to be able to work on that team.    Jayson Davies     Absolutely, and we will definitely bring that up more as we get into our evaluation piece later today. Moving over to Dr Petersen, welcome First and foremost, but also, please share a little bit about where you are in the in your ot world today.     Jennifer Petersen     Yeah, thank you for having me as well. So I'm a similar story to Annie, and that upon graduating from my master's program, I initially went into learning more about sensory integration right from the beginning. Knowing that it had sparked an interest during my field work, and wanted to continue to learn about it, study it and and practice it. And so I have worked at a variety of different clinics over the years, and am now teaching at a well for me, it's a local university and Iowa, so a small university teaching entry level doctorate students. And beyond that, I still get to practice. So I practice in the summers, and then get to be a part of research opportunities and continue to grow and develop in that way as well.     Jayson Davies     Gotcha, and what does your practice look like when you're practicing in the summers?     Jennifer Petersen     Yeah, in the summers, I get to practice at an outpatient pediatric clinic. In Iowa, it's fairly common to have hospital based clinics, so it is a hospital based outpatient clinic.    Jayson Davies     Gotcha, all right. I want to kind of address this, because this is a podcast primarily for school based occupational therapy practitioners, and both of you have mentioned that you're working clinic based, which, in my opinion, is perfectly fine, because I want to give you the opportunity to share this, not me, because people have heard some of my thoughts on this. But why is, I guess, when it comes to sensory integration a little bit, and what you're doing from a quote, unquote clinical perspective with SI, why is that not just unique to a clinical setting and absolutely applicable to a school based setting?    Annie Mori     Well, I'll start off. I've been a school based therapist also, like for a big, big part of my career, over 12 years, and then I also do individual educational evaluations for the school districts currently, so I'm still very well embedded into the school based model. But you know, sensory integration is a neurological process that we all have, and for us to ignore the integration of the senses outside of a clinic would be a huge disservice to a child. We need our senses to learn. Our senses are the only way that we gather information from the world. So it makes sense that sensory integration is needed to learn in the classroom and to participate with our friends and to participate in life. So, you know, there's always, you know, clinic based model, or medical model, versus school based model. And just kind of my own soapbox on that is, at the end of the day, the outcomes might be a little different because school based is focused on certain outcomes, clinic based might be focused on different outcomes, such as ADLs, but the foundations are the same. That does not change. And so that's where I think that the an air sensory integration approach is really important, universally.    Jayson Davies     Absolutely. Dr Peterson, would you like to add anything? I think Andy did a pretty good job. But if there's anything you'd like to add, go for it.     Jennifer Petersen     I agree she, she stated that very well. You know, in even thinking back to kind of the roots of sensory integration, it started with Dr Jean Ayres, working with children with learning difficulties. And so when we think of that, that certainly is relatable to in the school, the setting in the school, because again, we're working to help children be able to learn, participate in their environments, and be able to have social interaction with other children within school. So going back to our history, I think it also supports it too.     Jayson Davies     Yeah, yeah, absolutely. All right, we're going to start to, you know, we talked a little bit about si just now, but transition to the vestibular disorders. And I guess I kind of want to start it off this way, because I've been practicing since 2012 and and correct me if I'm wrong. You both have been kind of practicing, especially within the SI world, longer and just more ingrained into si than I have. But when I was graduating and going through the SIFT program, there's a lot of talk about the vestibular system within Si, but within the last, I don't know, maybe five years, or maybe even less, I really started hearing more about Vestibular Disorders, not always directly tied to sensory integration. Typically, there is a like a sensory component to it, or there's always a sensory component to it, but I'm just hearing about it, I guess, separated out from SI, I hate to say separated out, because, again, like I said, it's a sensory disorder per se. But how is it that we're starting to view Vestibular Disorders Not just as overall sensory integration? If that question makes sense.    Jennifer Petersen     Well, you know, I like to think of this as sensory integration, and air sensory integration as that umbrella term, that ability to take in information, organize, sort through that information, be able to use it purposefully and meaningfully. But from there, what we have found, and this really started with airs earlier work, is that children that were having difficulty participating within their daily activities that there was four different categories, if you will, or constructs that kept showing up. And so what was found from factor analysis of these different tests that she had used is that there was reactivity, difficulties with perception, and then there was this category of vestibular bilateral integration as well as praxis, and so maybe you're referring to this in that category of vestibular bilateral integration, where you're thinking of it kind of it is still related to sensory integration, but it was its own construct. And now we're starting to hear the term postural ocular bilateral integration. So you might hear it called either vestibular bilateral integration or postural ocular bilateral integration.     Jayson Davies     Okay, so really quickly. Then, when we're talking today about a vestibular disorder, are we kind of calling it that vbis Or postural? Sorry, I already lost it, but is that kind of what we're using these terms almost interchangeably, a vestibular disorder would kind of be equal to vbis, vestibular bilateral integration.    Jennifer Petersen     That is one of the areas that they can have difficulty with. And but there's also, right, there's still vestibular reactivity difficulty, which you may have heard of as like gravitational insecurity in the past. And so that's having that hyper reactive response to vestibular input. So vestibular can be manifested, I guess it within the reactivity as well as perception. But then there is that category really pulling in vestibular, and it's these related motor functions, if you will.     Jayson Davies     Gotcha, okay And I kind of in my question, I kind of said that the last question how vestibular disorder is almost separate from sensory integration. But I kind of want to let you address that, is there a vestibular disorder that is outside of sensory integration, or is everything we're talking about today with vestibular disorder within the realm of kind of gene airs original ASI work?    Annie Mori     Well, you know, I think we need to understand where the where the vestibular challenges come from. Is it developmental, or is it an injury? And if it's an injury, then perhaps we think of it separate outside of air sensory integration, so there would be some kind of head injury or insult, or something that might have come that has occurred that then you would treat it a little differently, yeah. But if it's a developmental issue, if it had to do with something that happened in utero, or whatever it was that the vestibular impact on the vestibular system has affected development, then I think we need to look at it under that umbrella of air sensory integration, because the vestibular system is so entwined in our developmental trajectory that you have to look at the integration of the senses and how they're working together when you're working with a child with vestibular difficulties.    Jayson Davies     Perfect. Yeah. Thank you for bringing that up, because there is that idea of, you know, more of an injury related vestibular disorder. And I, yeah, I hadn't thought about that. So thanks for bringing that up. But so, so let's dive into it then, because we know what it is. Now we're talking about here a little bit. What are some of those developmental concerns that might start to appear with a child, and we can start as early as zero, of course. But what are some of those developmental concerns that we might begin or might see with a child as they're being referred to. OT why might they be referred if it's related to a vestibular concern?    Annie Mori     Well, I mean, gosh, it could be so many different things. I mean, in early, early infancy, there could be it challenges with breastfeeding, latching on to, you know, a nipple, and with feeding, early feeding issues, there might be some regulation issues that might be happening difficulty. You know, I've had a lot of families talk about how difficult it is to do a diaper change because they can't lay their child back in space without the child having a, you know, having a complete meltdown and being very upset. Oh, wow. So, and nobody's thinking, Oh, that must be their vestibular system. They're just thinking of the performance challenges that they're experiencing. And then it's our job as OTs to decide or to investigate what, what could that possibly be?     Jayson Davies     Yeah, yeah.     Annie Mori     And so in those instances, I do kind of a task analysis, and I would say to myself, well, it seems like there's some vestibular opportunities within this task, and so maybe we need to look at that.     Jayson Davies     Gotcha.     Annie Mori     So those are like early crawling is another one where it kind of comes up sitting up might be a little delayed, more delayed than usual. Jenny, what would you add?    Jennifer Petersen     In like, yeah, those postural controls, so being able to sit upright or catch themselves when they're starting to fall, so right when they're learning how to sit or to stand, if they that they can orient to where upright is. And if they're not upright, that they are able to catch themselves. Let's start to tell us a little bit more about that vestibular system in those earlier years.     Jayson Davies     All right, and then, like, let's fast forward a little bit, you know, to kindergarten, first grade. TK, what are some of the things that you might start to hear from teachers that might cue you in a little bit? Hey, maybe I need to look at some vestibular stuff.     Annie Mori     Well, you know, I always talk about like, Are they ready for school? Is their body ready for school? And so even just our preschoolers, right? Or the T cares, right? And and what does that mean? Well, vestibular base. Do they have the balance to sit still? Can they do static postures for an appropriate amount of time for a child that age? What do they look like at circle time? Can they stand in line. Can they stay in a chair, you know, for a relative amount of time to to focus and and take in a lesson, you know? And how are they playing on the playground? What is their visual spatial skills like? And then thinking about coordination related to that, the bilateral integration. Are they using scissors by the time they get to kindergarten? That should happen. Can they dress themselves? What happens when they go to the bathroom at school? Are they able to undo if they have a button on their pants? Can they undo that? Can they get their jacket on and they zip up the zipper? Those kinds of things when they get into school?     Jayson Davies     Yeah. And I kind of want to take a step back, because we mentioned vestibular bilateral integration and and you mentioned a little bit of, kind of, some of the ADL skills that that might be impacted as well. For those listening who you know, haven't gone through sift or easy or any of the other trainings, can we get a brief description of vbis and, kind of, what, what sense, obviously, vestibular, is in play, but what other senses might be at play a little bit. What's the interaction going on there?    Jennifer Petersen     Yeah, I'll go ahead and jump in at this. So what we have found through the research is that the vestibular system is demonstrating an inefficiency within processing the information, and then we're seeing it really through the guy I've been kind of calling them related motor functions, but that can be identified as use bilateral integration, using the two sides of the body together. It can also be seen within postural control, just as I talked about with being able to sit up right. And then also the ocular motor skills as well, so the ability to look at an object and be able to complete a tracking of it from right to left, or even complete some jumping with your eyes from right to left or up to down, so looking at your desk and then looking back up at the teacher. And so those are some of the categories within that, but vestibular, bilateral integration that you would see,     Jayson Davies     Yeah, yeah. And as you were talking there, the other term that popped into my head was praxis, you know, being able to plan and whatnot. Does Praxis add another component to what you were just kind of talking about? Or is that three step activity, kind of that praxis? Or how would you kind of bring that into the... Yeah.    Annie Mori     And I think I would also add the s, which we haven't talked about, of vbis, which is sequencing. Yes, again, I think good job. And I think that as clinicians, we we get sequencing can be a confusing thing to look at. And really we're looking at motor sequencing, the fluidity of movement from one action to the next. And we often measure it as, you know, like, we'll follow a three step craft activity, or, you know, we'll do a three step something or other, multi step, whatever. But we really need to think of it as, like, motor transitions. So even a sequence of going, when the teacher says they're in circle time, and the teacher says, Okay, now everyone, go grab the spelling paper and go sit at your desk and that sequence of stand up, turn around, walk, stand in line, turn around, go back to your desk, all of the balance, the coordination, The ocular motor stability to navigate a busy environment that you need to do that sequence of motor skills is really important, and those aren't really there's not really much cognitive layered into that, like heavy cognitive requirements layered into that versus a three step craft activity, there's some more cognitive demands embedded in that. So it gets a little murkier in terms of what are we really measuring, but when we really are thinking about like fluid motor sequences, how is this child moving around a space? How are they moving from one, one action to the next, and is it stop and go, which creates inefficiencies and delays? So those are the kids that you often hear, well, they're usually the last ones there. They finish, they finish their work, last those kinds of things. So sequencing is another big piece of that pattern that I think is easy to get missed, because those kids can really mask they're just slow, and maybe they're not a behavior problem, or there's no like, really big Academic issues other than that, they take a long time.  Well, sequencing is a Praxis aspect of praxis, and when we do our assessments, you know, we have an assessment for sequencing, Praxis sequences, and we're looking at that motor fluidity. And you know what Jenny talked about earlier, about this factor analysis of testing scores, and how we got these kind of groups of or these patterns of challenges in sensory integration. Typically, we see that test of sequencing Praxis grouped together with other vestibular based tests like balance, postural control, ocular motor skills, vestibular nystagmus. So that's that's kind of how that got folded into that, for lack of a better word diagnostic category, but that's how I got it got embedded in there.    Jayson Davies     Okay, perfect. And again, for those of us who haven't taken an anatomy course recently, or an easy course recently, remind us again, kind of just in the brain, where a lot of this integration is happening a little bit, so that way we just can kind of visualize it a little bit as we go on to discuss more today.     Jennifer Petersen     Yeah, I'll jump in the vestibular system projects to. At this point, we know it projects to so many different areas within the brain, but I think there's some that are kind of Hallmark ones that we certainly should know that it's projecting to. So that vestibular system projects to that cerebellum. We know cerebellum helps us with balancing and motor coordination. It also projects to the oculomotor nuclei, which, again, as I talked about before, impacting our ability to track with our eyes or complete saccades with our eyes, as well as the lateral vestibular spinal track, which is helps us with our extensor muscles of our posture, so sitting upright. So those are just a few of the different areas that that vestibular system is reaching out to when you think of the nervous system.    Jayson Davies     Yeah, the brain is so complex, right? Like everything is going on. And Dr Peterson, Jenny, I have to give you a round of applause, because I did not prompt you with that question beforehand, and you just pulled those out of thin air, which means you obviously know your stuff, because that is one that I have heard 100 times, but could not explain it to you as well as you just did. So thank you appreciate it. All right, Annie, I spoke to your website earlier, and many of the publications that you have, and Dr Peterson, I know you have been a part of some of those same ones, as well as your own. I kind of want to just give you both the opportunity to just share a little bit about the research behind Vestibular Disorders. Maybe some sensory in there. I know we've talked a little bit about this already, but is there anything else that we haven't addressed before we start diving into evaluations and intervention that you'd like to share related to the research behind Vestibular Disorders.     Annie Mori     Well, really quick before we do dive into the research, I do want to mention, and we haven't talked about, this, is the role of the proprioceptive system with the vestibular system, because I don't want that to get forgotten, or for us to think of treating sensation in silos, because it is sensory integration. They we work we live in a multi sensory world, and our senses work together. We take in multi sensory information, and it doesn't just fall into pockets. It the senses work together to understand what's happening and and it's really hard to have vestibular input without proprioception. So we talk about those ocular motor skills, those vestibular messages are going to the muscles of the eye, which are our proprioceptors right and our postural muscles right. That that sensation of falling or balance, that information is getting sent to our postural muscles to right ourselves. So our proprioceptors rely on vestibular information to do the job that they need to do, to hold us upright, to coordinate ourselves, to balance ourselves, all of those things. So I just needed to make sure we included the proprioceptive system in that, in this discussion.    Jayson Davies     Yeah, yeah, the two systems, I mean, and a lot of people are obviously adding the third of interoception, but yeah, I mean OTs, ot practitioners, right? We vestibular and pro go hand in hand. But thank you. Yeah, we can't forget about the all important proprioception, of course, when talking about bbis and vestibular disorders and all of that. So thank you. And yeah, Dr Peterson, I don't know if you want to add anything to that or talk a little bit about just any sort of research that you've done kind of related to Vestibular Disorders and the impact that they have.    Jennifer Petersen     Yeah, well, one of my recent works that I had done was, during my post professional doctorate, I had the opportunity to be mentored by Dr Zoe may you, as well as Dr Roseanne shaft, and in doing so, it afforded the opportunity because of the timing I was able to utilize the developing easy at the time so the evaluation in air sensory integration and examine the vestibular and proprioceptive test on the easy and so some of those tests, just as we had talked about previously, of looking at ocular motor skills, postural control, such as, you know, maybe a prone extension position, and as well as the vestibular nystagmus test. So I was looking at those tests that you may have heard of, and seeing if they differentiated, if we were able to see a difference between children that were typically developing or children with possible sensory integration concerns. And so some of the research that I had done examine, do these tests, can they show a difference between typical and not typical? And in fact, they do. And so they are tests now that are part of the easy so that was one of my more recent research articles. But I believe Annie has some articles that might help us to kind of lead into sensory integration and vestibular impacting students and and learning, If Annie wants to talk on some of those articles that she has found,    Annie Mori     well, you know, I think vestibular disorders have been studied for a long time In sensory integration, and like Jenny mentioned, Dr Ayers studied this with children with learning disabilities, you know, in the in the 70s and, you know, just looking into the research around Vestibular Disorders, you know, in the in the 90s and early 2000s there was some work being done, not just in occupational therapy, But in other fields around learning disorders and the vestibular which is really interesting to see that there's especially around language development, so kids with dyslexia or any kind of reading challenges. So there was, there was, there was some pieces in there, and of understanding that theoretically, this makes sense, that the vestibular system is having a role in in learning. And Dr Ayers had some early research around that as well, showing that kids with vestibular or kids with sensory integration issues, and having identified with learning disorders, actually made, made some nice gains early on with it with an SI approach. So it's in the literature. It's there. For some reason, it just stopped being looked at. You know, I think perhaps autism came on the scene and that became a really big focus. But that, that vestibular system, it's there in the research. And, you know, I had the opportunity to work on a project where we did research around children with cochlear implants and the vestibular and well, we looked at sensory integration challenges with kids with cochlear implants. And what we found, we tested a group of children, and we found, by and large, as a group, they had challenges with Vbi. They fell into that vbis pattern. And so those kids, which makes sense, because the Cochlear, the Cochlear system is, or the Cochlear structure is, is part of the vestibular system. And so, of course, that system would be impacted, and we had hypotheses around it, because we wondered, and we had observed these kids and and so we did the study on them, with them, and it was pretty eye opening to see that that was as a group that was a challenge for them, that they were they had more challenges in that area.    Jayson Davies     Gotcha and again, kind of just because not all of us have the education that that you and and myself, Dr Peterson have with a cochlear implant. What is that process, atomically, and why would they have vestibular difficulties? What I mean, I guess, just really, really briefly, like, why would that that vestibular processing be impacted with a cochlear implant?     Annie Mori     Well, structurally, you know that receptor is right there in the inner ear, your cochlea, your lateral your semicircular canals, your otolus, which are two structures of the vestibular system. They're right there. They're together and so and then the other thing to remember is our cochlea process is sound, but sound is vibration, and vibration is movement, good point. So there's movement going through that space and that structure. So your vestibular system is being impacted and being vibrated when you hear things. So there is an impact on the vestibular system. It's not to say the vestibular system, you know, is a huge player in auditory and I think, you know, I would have to let ot audiologists weigh in on that, because I am not an audiologist, but the structures are close to each other, and they and the vestibular system certainly is getting stimulation from sound. And so when a child has difficulty with that structure and and that vibration might not be accurate or unreliable. That means the vestibular system is not getting reliable information, so it can't provide the rest of the nervous system reliable information to respond.    Jayson Davies     Gotcha. Thanks for sharing. Yeah, and just before you were talking about before we hit record, you were sharing a little bit about working with a student or a client who had dual bilateral cochlear implants, correct? Not cochlear implants. She actually had her cochlea removed. Oh, yeah, and she was a teenager, and so she so this was an injury, right? This was a vestibular injury, but that work that we did together was so illuminating in terms of the impact of the vestibular system. Now she had developmentally sound like nervous system, and so when she lost her vestibular system, her nervous system had to reorganize without this information on balance and coordination. And I mean, the the fallout of the vestibular, of not having a vestibular system was fascinating, and it just impacted everything interesting, everything for her. I would love to learn more about that, whether it be like a paper, I don't know if you put together anything, or if that would be an amazing like feature to just learn more about, whether it's a YouTube video or or an article, but yeah, I mean, that's just not something you obviously see every day, and it's just, yeah, you can't, you can't plan for that, which makes it very unique and very interesting to learn more about.     Annie Mori     Yeah, and because she had had typically developing experiences up until that point, because those experiences had shifted so dramatically, she was really able to articulate what was different and what she was experiencing and so and then, you know, I would step in with questions, because I had my thoughts on what could be happening, and then she and I would really work together to figure out, like how to make how she could participate more fully in life, because it was just so impactful.     Jayson Davies     That's a huge point that you bring up, because as we transition to talking more about evaluations here, we have to remember that our students, especially if it's, you know, whatever the concern is, developmental, they've never experienced anything else, like this teenager that you're talking about that had a functioning vestibular system. And so the students or the clients that we're seeing, whether they be five months old, five years old, 10 years old, unless it is that later on set for whatever reason, right? If it's developmental, they've never experienced anything else, and so they don't know that it shouldn't be scary to be five feet off the ground and whatnot. And so that's just really important for us to all keep in mind when we're evaluating students. That's a That's a tough one to remember. Sometimes agreed. All right, so let's dive into the evaluation process a little bit. Earlier, you spoke about some of the concerns, and I think a lot of what you mentioned earlier, whether it be ADL, difficulty crossing midline, some of those are just pretty common things that we see in the schools. So now as you're seeing those things as a teacher is referring a student for maybe it be some some behavioral concern. Maybe it'd be for handwriting or whatnot. And in your mind, what makes you start to wonder, could this be a vestibular thing? Could this be a vestibular related disorder?    Jennifer Petersen     Yeah, I think just like you started to say, you start to have this hunch of what you're seeing. So maybe the teacher is saying that the child's having difficulty with cutting, and then they're not using, you know, they're not holding their paper with their hand while they're coloring, and then maybe they're having difficulty with zipping their backpack. And so you start to hear from the teacher some of these concerns, and then maybe you get an opportunity to stop by the classroom, and you can actually see some of the challenges that we had described earlier. And that's, you know, that starting to build your that's just the start of building kind of this hunch of, oh, I need to put on my sensory integration lens and look into this further, and from then though, and I know your listeners have had information on evaluation, so because I have listened in the past, right, we have to document you. Has talked about, well, we have to get multiple forms of evidence. So that's great that we've heard from the teacher. We might hear from a parent sometimes, and then we can see the child having these difficulties. And then from there, we want to gather more information. So a performance based assessment is really helpful. And that's there's a couple that would look at these the vestibular system. And of course, I alluded to one with my own research of the evaluation in air sensory integration. There's also the so cm, I believe, has come out, and so it's looked at, also at vestibular so those are some performance based assessments. And then beyond that, we want to, you know, maybe we have a questionnaire, a standardized questionnaire, and so possibly, like the SPM two, would look further into it?    Jayson Davies     Yeah, definitely. And I actually want to dive into maybe not all of those, but definitely some of those a little bit further, especially the easy I know that's one that both of you are very familiar with. And so I do kind of want to deconstruct that a little bit and kind of talk about some of the specific pieces of the easy that might relate to the vestibular sense. And I actually want to start with one that I think everyone knows the initials of PRN. And this was something that recently, like, again, kind of just had a moment where someone asked, what is PRN? At a conference I was at recently, I was like, Oh my gosh, I forgot. Not everyone knows what PRN is. Not everyone knows the research behind PRN. Not everyone knows whether it is a research based, evidence based, way to look at vestibular and so I want to give you two again. You two are brilliant. You know more about sensory than I ever will, but what is the PRN and kind of what's the research a little bit behind it, into what it actually shows.    Annie Mori     So post triggering Nystagmus is a reflex, and it's a symptom of or indicator for the integrity of the vestibular system. Is it registering? Is it inhibiting sensation? And it really only measures when you when you administer this test, because it is, it is standardized. We do have norms around it. You can assess children from six months through 13 years now, 12 years, 11 months. We don't have norms for adults yet, but I'm sure that will happen one of these days. But we do know we have norms for that age group, and we are assessing you, how you position the child, the number of rotations, the velocity you use, that's all very standardized. And then you're looking at how long you have a nystagmus after you spin. And that's that flicker back and forth of your eyes. And the standard amount of time is between six and 12 seconds. An average nervous system registers movement for about six to nine seconds, so you'd or six to 12 seconds, so you'd expect that nystagmus to go for that long. Anything lower than that, we understand that as hypo or poor registration of movement that they're not readily registering it. It doesn't happen fast enough for them anything longer, any longer duration. We tend to interpret that as lack of inhibition, and that's a different part of the brain. It's more of those regulatory centers of the brain that's acting on the vestibular system, rather than the vestibular systems not receiving the information which is or not readily receiving the information it's receiving it. But so that comes from that's that's a different aspect. And so that test helps us to understand a piece of the vestibular system, because we're really only looking at one of the semicircular canals. We have three. And the way that this child's position and the way that we're administering the test, we just really get at the lateral canal, and that is why we don't just use that test to say that child has a vestibular challenge, because there are many variables when you administer that test that make those scores not strong, not very reliable, and so we want to be sure that we pair that test with other measures of the vestibular system, so balance, bilateral integration, ocular motor skills, sequencing, postural control. We want to make sure we're we are building as much evidence for that, for a challenge in that area.     Jayson Davies     Awesome, Annie, as I was listening to you, you kept answering the next question that I wanted to ask you, because you just knew what I was going to add. No, that's perfect. But one thing you didn't answer that I want to ask, because if I recall correctly, the PRN actually stabilizes pretty early on and correct me if I'm wrong. But you said, what was it six to 12 seconds for an average PRN of nystagmus after the rotations? Is there a point pretty early on or later that that becomes kind of like everyone beyond this is up to 13 of course, we haven't gone into adults, as you mentioned. But does that kind of that six to 12 seconds? Is that established pretty early on and pretty consistent beyond that, or does it change all the way up to that 13 years?     Annie Mori     Yeah, we have a article on that, and we tested children as young as six months. And so that was from that age, from six months old through 12 years, 11 months, we know that it's pretty stable between six and 12 seconds.     Jayson Davies     Okay.     Annie Mori     So a school age child, you could definitely expect that.     Jayson Davies     Yeah, yeah, definitely right. So I guess my follow up question then is, is the PRN one of the first, to a degree, it can almost be like a screening tool, maybe, and correct me if I'm wrong. But would that be one of the first, like little pieces that you might use with a student who you have considerations with vestibular disorder, and then from there, move on to some of those other tests that you were talking about?     Jennifer Petersen     I mean, as a screener, potentially, potentially. But I think I just with caution, because, you know, you can still have, like, an average registration in that one time that you administer it and and then show challenges in other areas. So it's, it's that test is not like the the key to a vestibular disorder, it's just a piece of data. So I think I would, I would do that with caution. If there was a lot of reports of related challenges that seemingly are could be vestibular based, then you definitely should look deeper, even with or without problems with PRN.     Jayson Davies     Gotcha. Okay, cool, so let's talk about some of those other assessment pieces, especially within the easy or if you want to venture out of the easy as well. What are some of those other components that you want to look at? You mentioned that the PR end looking at, I believe you said it's the lateral.    Jennifer Petersen     My circular canal.     Jayson Davies     Yes, canal, thank you. Yes. But you mentioned, right? We have to look at the other areas, and it's just one piece of it. So it. So can you go into a little bit more detail as to what those other pieces might be and what they look like?     Jennifer Petersen     Yeah. So, you know, in looking at balance, that's primarily looking at more of a static ability to sustain that upright position. It can become more dynamic depending on your if you're doing movement with it, or if you have the child close their eyes, but that's going to be looking at those OTs. So that's the structures within the vestibular system that is primarily where gravitational pull is being processed and registered, as well as any kind of the linear movement, or maybe even just like a slight head tilt, so balance postural control would be the same way of looking at the OT list is looking at their functioning and and then when we look at the ocular motor skills, that is definitely something that's more again, does go back. So back to kind of my research when I was doing the examining the Construct validity of the vestibular test. What I had also done was looked at these related tests of ocular motor balance, postural control, bilateral integration. And what I found when I looked at the vestibular Nystagmus is what we called it, but otherwise known as the post rotary nystagmus, is that it had the strongest relationship with ocular motor and that makes sense, because we also see that within the reflex, right? So I think that's that certainly is easier to grasp that type of concept. Is why, you know, vestibular we would also see that in ocular motor skills, because of knowing are the knowledge on the post ordering nystagmus.    Jayson Davies     So you called it vestibular nystagmus, aka PRN, within that. And remind me again, either of you how many total a tool, or, I guess, how many total pieces are within the easy?     Jennifer Petersen     there are 20 tests total.    Jayson Davies     20 total test. And then how many of those would you say are kind of help to build up your picture of the vestibular system all 20? Or is it kind of?    Jennifer Petersen     Well, there's six of these that are related to this vestibular proprioceptive test as to kind of what we're describing right now, but there are other there are more than six when you're starting to look at more sensory reactivity and.    Annie Mori     Visual spatial skills.     Jennifer Petersen     visual spatial Thank you.    Jayson Davies     Gotcha. Okay. So then I I'm trying to, like, in my mind, I'm trying to think, Okay, if we have a student, we're interested in learning more about the vestibular system, whether or not we start with PRN, but we have at least six of these different tools within the easy that we could potentially use. We have the SPM to which I think most of us are pretty familiar with. And then, of course, we just have our standard observations and our structured observations, seeing the student in the classroom as well as maybe one on one to look at some balance, even if we're not necessarily using the structured version of the easy, but I guess, how does this all come together? What are we it's hard because I don't want to dive, like, too far into the easy, because I know not everyone has the training of the easy, but I really want to give you both the opportunity to kind of share, like, what you are really looking for during that evaluation. What? What are really keen into and if you want to dive further into the easy, feel free to it. But what are you really starting to synthesize, I guess, when it comes to your evaluation and a child that has a vestibular disorder?     Annie Mori     Well, you know, when I'm looking at I first look at the performance challenges. I'm listening to what the teacher is saying, what the parents are saying. I'm going in and observing something similar and trying to just gather data about the child's performance. And then I'm going into my actual performance assessment, where I'm going to get, you know, standard scores that are going to confirm or deny my Soft Skills of observation, right? So then I go in and I'm I'm looking for and I'm going to choose an assessment that's going to help me understand these performance challenges I'm seeing. So if I see a child struggling with sitting upright in a chair difficulty at circle time, and I'm not going to choose a fine motor test, I'm going to choose a test that's going to look at balance and look at some functions that might like get to that issue. So I might use the brunix. I might go to that and look at the balance test of the brew Next, if that's what I have accessible to myself, but I want to make sure that I'm choosing tests that are going to actually tell me what I need to know. You know, if you have that training in using a performance based sensory assessment, then certainly you should be doing that, because that's going to give you those pieces. Now, on the easy You don't have to give all 20 of those tests. You can, if you have an understanding of what you're looking at and you really just want to hone in on the vestibular test, you can. But I think Jenny and I would both agree that the whole battery gives you a full picture, because, like I said, they don't work in silos. One impacts the other. There's kind of a cascade that happens. And so you do want to, you want to get that, that evaluation piece, in place, and and you know, you're looking at again, depending on the performance challenges, is it, does it seem like it's a bilateral task, right? Are they struggling with, like putting papers into a folder, zipping their backpack using scissors, okay, that could be bilaterally. Jenny said, like not holding their paper down, that could be bilateral. And we also know, like developmentally, we got to go back to those postural skills, because you can't use your two hands at midline if you don't have stable posture. So you got to look at that. Then you have to look at the integrity of the vestibular system, which would be your vestibular nystagmus test. So like looking at the bilateral, the postural, the balance and in a static environment, I think that's what's really important, is that a lot of these kids with vestibular issues, they are probably pretty good, good athletes. They do really, really well, as long as they're moving right or they want to move, they want to move a lot because they're trying to turn on their vestibular system. And once it's on, those functions help them. But in a classroom, they don't get to turn that on like, I mean, it should be on all the time in typical development. By the time you're school aged, your vestibular system should work with relatively little stimulation. But, you know, for some kids, that's not the case. And the older they get, the younger grades, teachers are much more forgiving for those kids that need to move, but by the time they get to, you know, second grade, that forgiveness kind of goes away, and they're expected to sit still, and they're not sitting still. And then, you know, guess what? We get more referrals in second and third grade, because that's when the training wheels start to fall off, and those kids are like, Oh, well, now I can't move, and I need to move to do so that's why those static environments are really important. And understanding how they do when they're still.    Jayson Davies     I love that we just got, like, an entire insight into Annie's evaluation process, and, like, how she goes through that. And I love that, and it kind of leads right into the next, the next step, which is that intervention phase, and how you start to move from what you were just talking about. Especially important. Like, as you mentioned, a lot of our evaluations come in that second, third grade, when the training wheels are falling off, as you've mentioned. And and how do we then begin to take those assessment results and move into the intervention process? And I guess kind of a way to start off with is when we do our evaluation, we can provide direct, direct intervention. We can provide accommodations. We can provide, potentially, teacher training support to a paraprofessional and whatnot. And so what are some of the things that you might start to recommend, kind of thinking of that classroom setting, what are some things that might come out of your evaluation that you might want to start to recommend?     Jennifer Petersen     I think starting, just as you said, starting with kind of parent teacher education is an important piece, because if you can create awareness as to the area of difficulty, the area of challenge that then is impacting the student's ability to participate in in the action required of them, or to be able to sit at their desk, or to be able to complete those bilateral tests that that we keep talking about from there. Then we, you know, the teachers, has this buy in of, okay, so what can we do about it? Then, if I have an understanding of the problem, what can we do about it? And so at that point, we can certainly encourage, within that classroom, encourage participating in more vestibular activities, so that would be getting the head out of the upright position. And to make that, you know, those movement breaks are great, the ability to participate in, you know, encouraging recess for these children. So instead of taking away recess, if it's occurring, making sure that these children need recess, because they will participate better after recess. So I think that goes along with the education component. And I'll let Annie add on some more to this as well.    Annie Mori     Yeah, I think when I'm starting to develop kind of my intervention plan, after I've done my evaluation, I think of two approaches. First, I have the getting by approach, because what is this child? What can I put in place for this child now to help them get by? Do they need a rocking chair? Do they need? They're a band on their chair. What does my assessment tell me that will support them the best? And sometimes looking at the scores that they actually where they perform well, that tells you their strengths, and that might tell you, Okay, this is actually, if I put this into place, this might help them do better. So looking at their strengths as well can help you align those accommodations for them. So you've got your getting getting by strategies, and I think the education falls into that as well, right? So everybody can start problem solving, and then you've got your getting better approach. And this is like, how am I going to directly intervene for this child? What am I going to do to address the vestibular system? So that long term, this child is making gains and that they don't need ot at some point, right, because that their vestibular system is doing what it's supposed to do, and it's supporting them. And then eventually these getting by strategies start to fade away as well. So I kind of think of those two approaches, and I use my assessment results to tell me what to do with that if there's a vestibular based, you know, for example, if the child has, you know, unreliable vestibular input, and I see that their vestibular nystagmus score is low, they have a low score on, you know, postural control and a low ocular motor score, but balance and bilateral integration look good. Well, maybe I'm really going to work on a lot of vestibular, ocular motor activities and postural activities. So I'm going to do a lot of scooter board, a lot of scooter board, and a lot of targets, and in a really fun way, maybe prone over the ball, working on those postural and ocular skills, along with vestibular input to get that system working and making the connections it needs to make.    Jayson Davies     Again, just another little gem there. I love how you broke it down into two different ways to go about it, both the proximal kind of the accommodation get by right now, but then the more longer term of what can we do for the future? And I think that is really tough for school based occupational therapy practitioners, because we're constantly told, call it right, call it incorrect, whatever you want to say right, like we are kind of at the taxpayers discretion, per se. And so it's almost like you need to do the least to do the most. And so I think some people get stuck in that. Let me just provide the rocking chair. Let me just provide the sit and wiggle cushion. And then we don't move forward with the how to get better aspect, and that's important. I think a lot of us have administrators that might say, Hey, if you can do this with a consult, providing a rocking chair or whatnot, then why do you need to do the one time a week service? And so I kind of want to touch upon that really quickly, is what's your elevator pitch? I would love to hear both of yours. Kind of like, what is that elevator pitch for? Why this student doesn't just need a simple accommodation, and you kind of already not an elevator pitch, but a very detailed explanation, but Dr Peterson, if you might like, just a quickly explanation to an administrator, to a parent, to a teacher, as to why maybe just the accommodation isn't enough.     Jennifer Petersen     Yeah, you know one piece I guess, that we haven't talked on yet, that I usually pull in is when children are having these difficulties and students are having these difficulties, they become fairly self aware that it's taking them a little bit longer to do these tasks. It's more challenging for them to do these tasks, and it starts to weigh on them. And then that impacts their confidence and it impacts their self esteem. And as their confidence and their self esteem can diminish then at that point, you know, then, then we're dealing with more occurring, you know, mental health difficulties, and so we know that that can be one of the products if we don't work on improving and providing these compensatory strategies to help that child get through the day, but also to help change that system so that it is working better, so that things become a little bit easier for them. And so that's a piece that I also speak to when talking with parents and teachers.    Jayson Davies     Yeah, and then kind of on, not necessarily a flip side, but another side of the spectrum, is that we have many people, myself included, over the years, that it's just really hard to implement sensory integration in a school setting. We oftentimes don't have the necessary requirement for the sensory integration fidelity measure, right? We don't have that that equipment. A lot of the research is like three hours a week or plus, and we just don't have that time frame within school based occupational therapy, right? So what are some things that we can start to do to use some of maybe the theory, the strategies behind Si, even if we're not following the fidelity measure, how can we start to support students in that way?    Annie Mori     Yeah, I mean, I think you can always use an SI informed approach in schools, and even if you don't have an air sensory integration clinic space at the school, there's a lot you can do with a scooter board and a ball. And I had many years where I walked onto a playground, carrying my platform swing, hanging it over the monkey bars, and doing that. So there are ways that you can get the intensity or the activities that you you need to do to implement an air sensory integration approach, or at least an informed approach at school. And so you have a lot of equipment, actually, as a school based therapist, that you can do, and you don't necessarily need 45 minutes. You know, a good chunk of of a clinic based or an outpatient setting is we're working on self rate. We're working on the regulation. And if you can embed regulating activities ahead of your treatment session, perhaps you're picking up the child a little more regulated. So you can get to some of that work of the bilateral, the postural, if that's the case, so you don't have to kind of organize the child up front.    Jayson Davies     Okay, and I and kind of to go along that with that, because you mentioned maybe getting the student a little more regulated before your session. That just popped into my mind, like working with the teacher, working with the paraprofessional. To what extent might a pair professional be able to support you in this role of being able to provide si self regulating supports? What might you be able to support them in their I guess? How far can they go? How far can should we not be asking them to go? And I know that's all you know, very dependent on the people, dependent on the setting. But if you have any experience or any thoughts on that, I'd love to hear from either of you.    Jennifer Petersen     Yeah. So you know, certainly there is the role, right, and making sure we're sticking within within our role. But a lot of times in Iowa, the role is consultative, and so we are providing education to teachers as well as paraprofessionals. And so that education piece is going to be really important. And when we think of the education piece, yes, we can give the anatomical structures, or, you know, all those components that I talked about earlier, but we can also help them just pick up on cues from the child. So helping them pick up on the cues of the child starting to get frustrated, or the child that's starting to move around or get a little antsy in their seat by being able to pick up on some of those subtle cues that can then allow the paraprofessional to say, Oh, hey, why don't you go up and get a drink? Okay, so that we can at least then provide some activity within the day and provide some of those more regulation strategies, or maybe we're going to put heavy books in the backpack so that way, then the child can carry those books from one classroom to another. Or, you know, we need to find what works for the school, certainly. But I think the beginning piece is picking up on the subtle cues that we are skilled at doing as a clinician, and teaching those skilled observations to someone else, so that way they can then embed the strategies that we might have for them.    Jayson Davies     Perfect. Thank you. And then, of course, just before we wrap up today, the biggest reason for referrals in school based occupational therapy is handwriting. We can't deny that self regulation is up there. Sensory is up there. Other fine motor skills were up there. Executive functioning now is up there. But handwriting is definitely, by far and foremost, the largest reason for referrals. So when talking about Vestibular Disorders and handwriting, where does that come into play? I know you talked a little bit about gene airs, originally looking at learning disorders, so kind of go hand in hand here, but from your perspectives, how does Vestibular Disorders and handwriting go hand in hand? And what can we do?     Annie Mori     Well, the vestibular system really informs that timing and sequencing that we need for handwriting. So like, how do we coordinate the speed of our hand moving across the paper with the strokes that we're making for our letters? And just this letter formation is a sequence in and of itself. And then there's spatial aspects right to handwriting, and that spatial awareness comes from our vestibular system as well. So it's important to look at all of those links, and we often work on handwriting here at play sense and without ever picking up a pencil, we make improvements in handwriting by just being on the swing. And what we always tell parents is children practice handwriting every day, and if we're not addressing the underlying challenges with handwriting, such as the vestibular system, then they will continue to practice imperfectly all the time. So we want to get that, get that underlying challenges addressed, so that that practice becomes perfect.    Jayson Davies     Absolutely, that's awesome. Again, Annie, I just love your very simple, straight to the point, but like, very relatable answers that, like teachers, parents, can understand these, like, these are things that we can share with them, and we're not going deep into the weeds as to what vbis is, what you know, vestibular, what proprioceptive is we can kind of keep it more, you know, neutral level, I guess you call it ot jargon aside, and really explain to them. So that's fantastic, yeah. Well, Annie and Dr Petersen, I want to say thank you so much for being here today. We really appreciate it. And this is, again, I kind of alluded to it up front. I'm starting to hear vestibular disorder outside of just within sensory integration, or maybe it's just that we're highlighting vestibular disorders within sensory integration. Maybe that's a better way of putting it, but it's definitely something that I think people are starting to key into more we're kind of associating it, as you just said, Annie more with like handwriting and other skills, as opposed to just fine motor skills for handwriting, or just fine motor skills for cutting, there is that vestibular component. So thank you so much. Really appreciate you coming in and just sharing about how it all connects with that. I want to give you both the opportunity to just kind of share where anyone listening out there can learn more about you and or the work that you're working on right now. And Dr Petersen, if you'd like to kick us off with that.     Jennifer Petersen     Yeah. So you can certainly reach me through our university website, through so st Ambrose University in Iowa, dr, Jenny Peterson is where you'll be able to find me. You can always email me too with any questions. So Peterson, jennifer@sau.edu and then both of us. You can find us through CLASI as well, because we both are affiliated with the CLASI organization.     Jayson Davies     Awesome. And we'll share all the links to that as on the OT school house podcast website. So be sure to check that out. Also, I will add to that just Google Scholar her name, and you will find many articles come up. So between Annie and Dr Peterson, you'll find plenty of sensory related articles that I think would be a great if you want to learn more. That's a great way to do it. Articles are never a bad way to learn more. And Annie, I don't know if you want to share, maybe your clinic website.    Annie Mori     Yeah, you can reach me at my placeence clinic, my website's placensekids.com or you can email me directly at Annie at place kids.com     Jayson Davies     Great. Well, thank you so much, Annie. Thank you, Jenny. We really appreciate you being here, and definitely we'll be in touch.     Annie Mori     Thanks, Jayson.    Jennifer Petersen     thanks so much.    Jayson Davies     One more time. Thank you so much to Annie and Dr Peterson for joining us today to share their wealth and knowledge on Vestibular Disorders and how we can support our students with vestibular disorders, from understanding the connection between the vestibular and proprioceptive systems to also understanding assessment tools like the easy to get a comprehensive picture, they have given us so many clinical truths to take back to our practice, I personally really appreciate how they emphasize both the need for short term, quote unquote, getting by strategies, as well as the longer term, quote unquote, getting better interventions. I think that that is something we often forget as ot practitioners, that we can kind of do both. I think sometimes we get locked in to try and do in one versus the other, but it is something where we can do both. We can kind of maybe put some accommodations in to support the student right now, while also providing interventions to support the student longer term. So now that you've wrapped up this episode, be sure to revisit the resources that Annie and Dr Peterson mentioned, like the CLASI the easy as well as their own websites. And you can also dive in deeper to the research and keep expanding your toolbox when it comes to evaluating and treating vestibular disorders. We have provided the resources that they mentioned on this episode over at ot  schoolhouse.com/episode161 , so you can head over there to get all the resources that we discussed today. And as an extra bonus for all of you, ot school house collaborative members listening today, you can also receive a certificate of completion for listening inside the community right now. And if you're not a member yet, we would love to have you join us over at ot  schoolhouse.com/collab members of the OT school house collaborative have the ability to earn professional development from listening to select episodes of the OT school house podcast. And you also have unlimited access to our CEU courses, resources, goal, bank, research, library and so much more. Again, you can learn all about that over at ot  schoolhouse.com/collab I'd love to see you over there, and I'd love to help you out. All right. Well, that is going to wrap us up for today. Thank you so much for listening along, and I can't wait to see you in the next episode of the OT school house podcast. Until then, keep being the OT practitioner that your students and teachers want and need. I'll catch you next time. Take care.    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. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

BONUS: Save all 7 AI Prompts to your Google Drive for FREE If you’ve been following along with the OT Schoolhouse, you know I’ve been an advocate for the ethical use of artificial intelligence (AI) by school-based OT practitioners. The truth is, none of us became school-based OTPs because we were passionate about paperwork . Rather, you got into this field for the same reason I did: to help students through direct evaluation and intervention, not to spend endless hours documenting. Fortunately, AI tools like   ChatGPT , Google Gemini , and Magic School can now help us reduce the time we spend on documentation and planning. In this article, I’ll share seven AI prompts designed to save you time while improving the quality of your documentation and interventions. But before we jump into the prompts, it’s important to touch on how to use AI responsibly, particularly regarding HIPAA and FERPA compliance . So, let’s talk about how you can harness the power of AI while staying within ethical and legal boundaries. Ready to dive in? Let’s go. Responsibly Using AI in School-based OT: HIPAA/FERPA Compliance Before jumping into the prompts, it’s crucial to understand that as healthcare professionals, we must maintain strict confidentiality and comply with HIPAA (Health Insurance Portability and Accountability Act) and FERPA (Family Educational Rights and Privacy Act) standards. So as you use the prompts below, please adhere to the following guidelines: Avoid inputting identifiable information Always use de-identified data when interacting with AI so no specific student can be recognized.
Choose AI tools carefully Ensure that the platform you are using is committed to privacy and data security. While tools like ChatGPT and Magic School offer high levels of privacy, always verify. With any AI tool, check the account settings to see if you can limit the tool from “learning” or “improving” from your data.
Double-check AI-generated content AI is not foolproof, and it’s important to ensure that any content produced aligns with your professional judgment and ethical standards. Never assume that what AI gave you is 100% correct. Always read it and make changes as necessary. At the end of the day, “I used AI” will not work as an excuse for why your progress report made zero sense.  Okay, now that we know how to use AI responsibly, let's get to the prompts! The 7 AI Prompts for OT Practitioners Now, let’s get into the practical part—how can AI help you save time and improve your work as a school-based OT?  Below are seven AI prompts you can use today. Please note that wherever you see brackets - (...) - you will need to remove the brackets and input your information to get a real result.  Let AI Write Your Observation Transforming classroom observation notes into a well-structured narrative can take time, especially when you’re trying to synthesize a lot of detailed information. This prompt helps you take your raw observation notes and quickly convert them into a (mostly)  polished narrative for your school-based OT evaluation reports. By automating this process, you can focus more on assessing the student’s needs and less on the time-consuming task of writing up the report. Prompt: Please turn my classroom observation of a student into a cohesive narrative that I can use in my school-based OT evaluation report. (Attach handwritten or typed observation notes) Extra tip : Ask Chat GPT to remove any OT jargon and ensure that it can be easily understood by a parent.  Create SMART Goals for the IEP Crafting individualized and measurable IEP goals is a key part of your role as an OT, but it can sometimes be overwhelming to get all the details just right. This prompt allows AI to assist in creating three potential OT-related SMART goals for a student’s IEP, complete with present levels of performance. It saves you time while ensuring that the goals are meaningful and aligned with the student’s unique needs. Prompt: Based on my observations, assessment results, and synthesis, please write three potential OT-related SMART goals for this student’s IEP, ensuring they are neuro-diversity-affirming. Also, include a present level for each goal, indicating how the student is currently performing on the goal. (Attach/paste your de-identified evaluation or specific sections of your report) Extra tip : In Word Doc, hit Ctrl + H (Command+F on a Mac) to quickly find and replace your student’s name with “STUDENT.” Now, you can input your de-identified report into the AI tool.  Get the FREE AI Prompt Bank with all 7 Prompts Enter your email to receive it now! Is the form above not working? Click here. Create a Custom Goal Measurement Chart Tracking progress is crucial, but creating charts to measure goal achievement can be time-consuming. This prompt allows you to easily generate a custom progress-tracking chart, ensuring you have a structured way to measure how a student is progressing toward their IEP goals. By automating the chart creation, you free up time for more meaningful work while staying organized. Prompt: Please create a simple chart to help me measure the following goal. Ensure it includes enough rows and columns to measure the goal at least [#] times. Here is the goal: [insert goal]. With a ready-made chart, you’ll have an easy, visual way to monitor progress and discuss it with the IEP team. Discover Occupation-Based Therapy Ideas Developing new, creative, and occupation-based therapy ideas for each student can be mentally taxing. This prompt generates a list of 10 therapy ideas to support the student’s IEP goal, organized from least to most task-demanding. It helps ensure you have a wide range of activities to meet the student’s evolving needs without starting from scratch every time. Prompt: Based on the following goal, please list 10 occupation-based therapy ideas that I may use to support the student in achieving it. Order them from least to most task-demanding based on your knowledge of the student. Here is the goal: (Insert goal). This prompt is perfect for streamlining session planning while ensuring that your interventions are appropriately challenging and engaging for the student. I'll let you imagine what a follow-up prompt could be... Imagine the detailed intervention plan possibilities. Analyze Any Task Using Theories/Models Task analysis is a fundamental skill in OT, but breaking every task into manageable steps can be time-intensive. This prompt uses AI to help you conduct a task analysis based on the theory or model you’re working with, such as sensory integration or motor learning. It saves you time while providing a detailed breakdown that you can use to plan interventions. Prompt: Based on [insert theory/model, ex. Sensory integration], conduct a task analysis of a child [insert task]. Example: Based on sensory integration theory, conduct a task analysis of a child tying their shoelaces. - Just try it! Then email me later... Write Quick SOAP Notes Using Just Your Voice Documenting sessions is one of the most time-consuming aspects of OT practice, especially if you type as slowly as I do. This prompt helps streamline the process by turning your spoken notes into a structured SOAP note format. Simply dictate what happened during the session, and AI will organize the information into a clear and concise note. Prompt: (Tap the little microphone to record your voice) Turn these thoughts into a brief and organized SOAP note – [speak to what you did during the treatment, how the student reacted, any data related to their goal(s), how you supported the child, and the plan for moving forward]. Bonus tip : Clicking on the headphones in the Prompt Bar will allow you to have a verbal conversation with Chat GPT . That's right! Chat GPT will speak back to you! It's not super helpful as a therapist, but it's fun to play with. Prepare Trimester/Quarterly Progress Notes Parents are key partners in the IEP process, but it can be challenging to translate clinical progress into language that is easy for them to understand. This prompt helps you create parent-friendly progress notes that clearly communicate how their child is doing in therapy. This helps ensure parents feel informed and included in their child’s progress without getting lost in jargon. Prompt: [Attach or paste previous notes and data] Based on the attached OT notes, please write a progress note for the following goal/s. The progress note should be written with the parent in mind as the primary audience. Goal: [insert goal/s]. This prompt will cut your progress on goal notes in half and make it easier for parents to understand your progress updates in a clear, digestible format. The Final Word As I hope you can see, AI has the potential to transform your school-based OT practice by saving you time, improving your documentation, and helping you to be more evidence-based. The seven prompts above are just the beginning, though. As you become more comfortable with AI tools like ChatGPT, Gemini, and Magic School, you’ll find that they can be customized to suit your needs. Remember, while these seven prompts can be extremely helpful, you must use AI tools responsibly. Ensure you comply with HIPAA and FERPA guidelines and always review AI-generated content to maintain the highest professional standards.
  REMEMBER: Save all 7 AI Prompts to your Google Drive for FREE    Using AI in OT is no longer the future. It is here today. I hope these seven prompts will help you get started with AI ( if you haven't already ) and save you hours each and every week from now on!  Do you have a favorite prompt to share with your fellow OT colleagues? Paste it in the comments below to help a fellow OTP out!

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 160 of the OT Schoolhouse Podcast. Are you feeling uncertain about how to prepare your students with disabilities for the transition to college? As OTPs we want to equip students for life beyond the classroom, including their next steps after high school. In this episode, we’ll tackle the challenges that arise when students navigate the vastly different expectations and supports of college life. Annie will share important insights and practical strategies to help us support our students during this huge transition.  Listen to this episode to help empower your students for success beyond high school! Listen now to learn the following objectives: Learners will identify how school-based OTPs can support our students in the transition to college process
Learners will identify a variety of services for their students, including assistive technology, employment support, and potential funding options for college, to help students prepare for their future
Learners will understand the importance of fostering self-advocacy in students during their k-12 education Guests Bios Annie Tulkin is the Founder and Director of Accessible College, as well as an author and public speaker. She is an expert in the area of college preparation and transition for students with physical disabilities and health conditions. She supports students and families across the country. Annie was the Associate Director of the Academic Resource Center at Georgetown University for nearly 6 years. In that position she supported undergraduate, graduate, and medical students with physical disabilities and health conditions and oversaw academic support services for the entire student body.  She holds a Bachelor's Degree in Secondary Education from DePaul University, a Masters in Special Education from The University of Wisconsin-Madison, and a Certificate in Health Coaching from Georgetown University. Annie was a Peace Corps Volunteer (Mongolia, ‘03-’05) and a Fulbright Fellow (Mongolia, ‘07-’08).  She resides in Silver Spring, MD with her husband and daughter. Quotes “So the data tells us that 21% of college students report having a disability.”  -Annie Tulkin, MS “At any institution, somewhere between 10-20% are actually receiving accommodations.”  - Annie Tulkin, MS “I think that we can encourage students to be a part of those IEP meetings or a part of those 504 meetings.” - Annie Tulkin, MS   “Sometimes goals don't need to focus around multiplication, addition. They need to focus on real world skills.”  -Jayson Davies, M.A., OTR/L Resources 👉 Accessible College   👉 Annie’s Email 👉 Accessible College Facebook 👉 Accessible College IG 👉 Accessible College Linkedin 👉 Reeve Foundation   👉  Navigating the Transition to College Guide 👉   United Spinal Wheelchair Guide 👉 Preparing Students with Physical Disabilities and Health Conditions for College 👉  Perkins School For the Blind College Readiness 👉  JAN-Job Accommodation Network 👉 State Vocational Rehabilitation Program- Pre ETS 👉 A Wheelchair User’s Guide to Preparing for College   👉 How to Secure Housing and Manage PCA Services at College 👉 Department of Rehabilitation Services  ( IL)  👉 Move United   👉 When Students with Health Conditions Transition to College 👉 How Can Students with Health Conditions Successfully Navigate the College Transition? Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey there and welcome back. It's great to have you as we discuss and often forgotten side of education, and that is what happens when our students move on from primary education as school based occupational therapy practitioners, we often are so caught up with the here and now of supporting our students, like making sure that we have, you know, functioning IEP goals in place, that we get all our services in that we monitor the all their the progress on their goals and whatnot, and we often forget that our students will have a life beyond high school and their adult transition program. After all, the whole purpose of education is to prepare students for life beyond said education, that is why, in this episode, we are tackling a common challenge that many of us face effectively preparing our students with disabilities for the transition to college and other programs, the expectations and supports available in the college setting and in other settings outside of high school are vastly different from that primary education that they're used to, and this often leaves families, as well as the students themselves, unsure of how to navigate this crucial life change. Unfortunately, most of us don't have the knowledge to support our families with this change when we sit in IEPs or meet with the students and their families otherwise. So to help us unpack this issue and learn how we can best support our students, I'm joined today by Annie Tolkin, the founder and director of accessible College. Annie has extensive expertise in supporting students with physical disabilities and chronic health conditions as they transition to higher education. Over the course of this conversation, Annie shares invaluable insights and practical strategies that we as school based ot practitioners can use to better support our students. In this process, you'll learn about the key differences and accommodations from high school to college, the living skills that best support students transitioning to college, and the importance of fostering self advocacy skills and students before they move on from high school. Annie also generously provides a wealth of resources and guides that you can share with the students and families you work with. So wouldn't that be nice to go to an IEP with actually some resources at our transition plan meetings? Absolutely. Plus, if you're a member of the otschoolhouse com collaborative, you can earn a certificate of completion for listening to this episode. So let's dive in and discover how we can better prepare our students with disabilities for the transition to college. This is sure to be a game changer for how you think about transition planning and the services that you provide for your students.    Amazing Narrator     Hello and welcome to the otschoolhouse com 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     Annie, welcome to the otschoolhouse podcast. How are you doing today?    Annie Tulkin     I'm great. Thanks for having me.     Jayson Davies     Yeah, absolutely. And this is going to be a very different episode, nothing like we've done before, because we've talked a lot about transition services from the school based ot side, like, you know, being in the K 12 setting, but you are in a different setting. You're also not occupational therapist. I'm going to give you a second to talk about that. But yeah, you are kind of on the side where we are aiming for kids to get to at some point right, to be on their K 12 or age 22 IEP services and to college and so yeah, thanks for being here. Excited to talk to you about this.    Annie Tulkin     Yeah, I'm excited to talk too, and just to just a little aside, like I see OTs and PTs and other healthcare providers really as partners in this process and reaching out to families and students to make sure that they have all the resources and tools that they need to successfully transition. So hopefully this will be an informative conversation for your listening folks,    Jayson Davies     yeah, yeah, absolutely. I have no doubt that it will be so let's go ahead and get started. I just want to give you an opportunity to share a little bit about your background and how you got involved with supporting students with disabilities during and in that college transition process.    Annie Tulkin      Sure. So my background is in university disability support right now. I am the founder and director of accessible College, which is an LLC where I provide college transition support and preparation for students with physical disabilities, so wheelchair users mobility device users, ambulatory wheelchair mobility device users, students with sensory impairments, so vision and hearing impairments as well, and then also students with chronic health conditions, which is another sort of big tent term, which might include things like tots, Ehlers, Danlos Syndrome, Crohn's, diabetes, epilepsy, basically anything that might impact a student in the college setting. And I got into this work because I used to be the associate. Director of the Disability Support Office at Georgetown University, which is called the Academic Resource Center. But more broadly, my whole professional career has been in the field of disability, and so I bring that experience as a former university administrator to the work that I do now with students, which is more along the high school transition phase of helping students think through what their needs are going to be, what accommodations they may or may not need in the college setting, and beyond just the academic stuff, thinking about residential, dining, transportation, recreation, sort of the whole scope of living on a college campus and making sure that students are really prepared for that transition. I think some of what we're probably going to talk about today is like, what does that transition actually look like for people? Because it's different. College is different, and I'm sure we'll dive into that. But the other thing I wanted to mention too is that my background is in education. You mentioned I'm not an OT I'm not I am a friend to OTs, and my background is specifically in special education. That's what my master's is in, and secondary education in my undergrad experience. So I come to this as a support provider, as a teacher, as an educator, and the work that I do is sort of akin to coaching. So yeah, so that's me.     Jayson Davies     Awesome. I love it, and I love because we're going to get to talk to you kind of in two separate phases, right? There's that transition period actually getting from high school to college, but then you also have some of that background of once the student is actually on campus in your previous position as Associate Director. So I actually want to start there with the work that you did while on campus, and just kind of give us an overview of what that actually looked like. And I know you were, I believe, like more of a director role there, but I'm sure you had some hands on, or you worked with a lot of people that did have hands on. So what did that look like in that role?    Annie Tulkin     Yeah, I'm chuckling. And I think maybe to sort of like give this a little bit of preface this part of the conversation. So first, there's about 4500 colleges and universities across the United States. Every college has to be technically ADA compliant. Americans with Disabilities Act compliant at most colleges. That means that there's a Disability Support Office or an office or a person that is tasked with providing accommodations for students with qualified disabilities. So in my previous position at Georgetown, the office was called the Academic Resource Center. The offices have different names across the spectrum of universities. So it might be accessibility services, Student Disability Services, Disability Support Services, Student Access Center. They all have different names. So I usually tell people go to the main College website and just put in Disability Services, and it should come up, or you should be able to find it. But I say that to say like, because people don't even know often that those offices sort of exist. And so that is sort of a compliance based piece of what colleges have to provide for students with disabilities, and that's the office that a student would have to connect with and have conversations with when they are seeking accommodations at that university. And as I mentioned before, the accommodations can be might be broader than maybe what they had received in a high school or a K through 12 setting. So in my role there, I did work directly with students, and I chuckled. The reason I was chuckling is because every disability support office is a little bit different. So I often joke that you've seen one Disability Support Office, you've seen one disability support office, so some of them have large staffs and lots of supports that they can offer, and some of them don't. They might be a one, a staff of one, or a staff of two. And just like data point wise, I think it's important to understand that we do, we do know how many students there are. We have a we have a good guesstimate. So the data tells us that 21% of college students report having a disability. Wow, so, yeah, that's a lot of people. Yeah, so, and that includes learning disabilities, it includes mental health conditions, it includes physical disabilities, sensory impairments, chronic health conditions, the whole spectrum, and those are people who have like gone to the office to request accommodations at any institution, somewhere between 10 and 20% are actually receiving accommodations.     Jayson Davies     Okay.    Annie Tulkin     You had a question, though.     Jayson Davies     No, I was just going to kind of compare that, because I know I don't have the most recent, up to date numbers, but when it comes to students with an IEP, I have seen numbers that are much lower than that, on average, somewhere in the 13 to 14% even though, in my own experience, I always the schools that I work at, you know, looking at our numbers, it seemed to be higher than that. It seemed to be closer to that 20% range that you're talking about. So yeah, just kind of comparing that and. It's interesting comparison.     Annie Tulkin     Well. And here's another fascinating piece, right? So there's this whole other portion of students in the K through 12 setting who don't have IEPs aren't maybe receiving services from an OT through the school, who might have a 504 plan, right? And so they are also students that would potentially apply for accommodations in college. But the data that we do have tells us that there's a big drop off as well from students who received accommodations in the K through 12 setting, who go on to college and then for whatever reason, either they don't think they'll need accommodations, they don't know how to request accommodations, whatever the circumstance is they choose not to request accommodations, or they don't know they can request accommodations in the college setting. And so in my role at Georgetown, I was working directly with undergraduate, graduate and medical school students with physical disabilities and chronic health conditions. I was also in charge, because that office was sort of had many roles on campus, but I was also in charge of academic support for students too. So I would meet one on one with students to talk about time management, executive function skills, study skills, things like that. I also oversaw workshops, and I did all of the housing accommodations. So I worked with Residence Life to start to figure out when a student requested a specific accommodation in the housing setting, how we could make a reasonable accommodation to meet their needs. So all of that information feeds into the role I have now, which is working with students prior to going to college. So during, ideally, during the college search process, is what I'm working with them, so that they can start to think through all of these pieces and ask the right questions and do the right investigation to make sure that they're choosing a college that is holistically supportive of their needs.    Jayson Davies     Yeah, and I'm sure you have, like, I mean, you just randomly, you know, throughout 4500 colleges or so, so you obviously know a lot about the different colleges. Before I get into that transition piece, I want to ask you to share a little bit more about one piece. And I remember in my day at USC, there would often be like, I think it was a flyer back then, like email was available, but people are still putting out flyers like, where we could get paid to share our notes and it was going to the accessibility department or something like that, to be shared with a student who might have a disability, you can kind of assume why that might be the case, why a student might need that. But I just want to hear from you, what are some of the challenges that you saw students experiencing, and what were some of the solutions that you were able to come up with?     Annie Tulkin     Yeah, so we'll start with that, but I do want to go back to that note taking piece, because there's a lot to talk about there that relates directly to OTS. So some of the things that students really struggle with is not knowing what the process is for requesting a common accommodations in college, not knowing what types of accommodations they could request, really lacking the self advocacy skills, because it's essential, because it is more hands off in college, parents, guardians do not have a role in the college Accommodations Process. Once a student is 18 or they sign that dotted line and they matriculate, which is, you know, the fancy word for starting college, mom and dad, Guardians don't have a say or a role in that advocacy process. And I think for a lot of students, that's a big shift, and also for a lot of parents, I'm a parent myself. I understand like you, you play a role in your students life. And so that is a huge shift that I think catches a lot of people off guard. The other stuff is the independent living stuff, right? So, like a lot of students, don't really realize or recognize the sort of shadow work that parents and guardians might be doing to support them, like filling their medication, like making their lunch and putting it in their bag, like, you know, folding their laundry and putting it away for them. And once they start to have to figure those processes out, or once they realize, like, Oh my God, there's so much more work to do in a in an adult, quote, unquote, adult life, then they start to unravel a little bit, right? Like they're ill prepared for those independent living pieces. So a lot of the work that I do with students and families is sort of, you know, peeling back the onion and figuring out what, what are the things that we need to start working on while you're still in a supportive environment at home, and how can we make sure that you have the right structure set up for college, even if that structure is like getting someone to help you do some of those things, we need systems right? Because it's better to have a system in place than to just like, go in there and throw your hands up in the air. Oh, yeah. So those are the things that I think like are really challenging for students. The the piece about note taking was a really interesting thing that you brought up, and so were you ever a note taker?    Jayson Davies     No, I never did it. No, I have terrible notes. So no, I Yeah, no, you wouldn't want me taking your notes.     Annie Tulkin     Yeah. So. So this looks a little bit different in college. Now, some colleges still use that process where they have a human another student work as a note taker. Some students get paid. At some universities, they give them a stipend. It looks different every single place, but now a lot of universities are leaning more towards using note taking services, right? Like glean otter AI are the are sort of the big ones, and they might offer that to a student as an accommodation. And I bring that up because a lot of times students maybe don't have the tech skills or haven't used a note taking software before, and so that might be something that could be really good for OTS to sort of be aware of and thinking about. So they're raising that with students that they're working with, you know, well ahead of time, so that that student can start to, like, get used to using that software.    Jayson Davies     Yep. Yeah. I mean, we're using otter AI right now as we speak. So.    Annie Tulkin     Is this an ad for utter AI?    Jayson Davies     We should be right, affiliate marketing. Um, okay, so, so you mentioned some of the challenges, right? Anything from being on campus to also the daily living skills. What are some things, other than note taking, that are kind of maybe just some easy go to fixes or or even not go to easy fixes that that you've helped students to put in place over your years?    Annie Tulkin     Yeah, so because I focus on working with students with physical disabilities and chronic health conditions, there's a lot of unique situations, right? And there's a lot of things that students need that maybe are unpredictable, right? So if they have a condition that has unpredictable flares, there's some planning that can be a little bit tricky, because colleges provide and if people could see me, they'd know I'm going to use air quotes here, reasonable accommodations, what is reasonable, and that's an ADA and Americans with Disabilities Act, sort of definition of accommodations. Reasonable accommodations. What is reasonable sort of varies based on the physical space of the campus, the program that the student is in, the course of study that they're in. So there are a lot of variables the college is supposed to engage with the student in what is known as the interactive process to determine reasonable accommodation. So having conversations to figure out what does the student need in this course, or in this circumstance, which really relies heavily, especially for students with physical disabilities and health conditions, on the student knowing what they need? Because students with physical disabilities, health conditions, sensory impairments, are the smallest part of the population of students who are requesting accommodations in college. So the largest populations are students with learning disabilities and students with mental health conditions. That's where we've seen like the largest growth in terms of students requesting accommodations. And I'm guessing that people listening are thinking like, Ah, I have students with CO occurring conditions, and I do too. I don't know. People don't fit neatly into one box, right? Rarely. So that's just, it's something to consider, if a student is looking at a school and they have a physical disability, chances are, because of the numbers of students who have physical disabilities, that they might be one of a very few amount of students on that campus who has a physical disability. So you know, in terms of working through things, there are some accommodations that might be specific to students with physical disabilities. The bait, the sort of typical academic accommodations are going to be found everywhere, right? So if it's extra time on a test because a student is using a speech to text software, or because they need to take breaks during the exam because of their medical needs or whatever the circumstance might be, the extra time is sort of a typical accommodation on a college setting. Everybody has a every college will have a process for that. Note takers, there will always be a process for that. The things that I think catch some people off guard are things like flexibility and attendance or extensions on assignments, because that's a little bit more determined by each individual professor and sort of what could be done in that classroom. You are guaranteed your K through 12 education. Students are guaranteed that education in college. You're not guaranteed a college education no one. No one is. It's not something that that the government has to provide for you. And so if a professor feels that an accommodation might compromise the goals of the course, the curricular goals, they don't have to provide the accommodation. So generally, if a student has unpredictable flares and they don't know if they're going to be out of class or whatnot, they need to connect with that professor and have an in depth conversation about what it would look like if they needed to miss class, how they could make up the work. So this is where that self advocacy skills, those self advocacy skills, are going to come in really handy, because the student needs to be able to, like, have those types of conversations, and it also does put a burden on the student. To to be able to like, communicate these things, communicate them over and over again. So I want to acknowledge that piece as well, because it's a lot of work to have to consistently be advocating for yourself, and students really need to be prepared for that. The other thing that I think emerges a lot and towards the end of high school, and then parents call me panicked, is that colleges don't provide one on one aids or para educators. That's not a thing in college if a student needs a personal care attendant or someone to assist them with getting things out of their bag, or using the restroom during the day or whatever the situation might be, eating any sort of ADLs activities of daily living. That's ot speak. I just threw that in, you got it. Then they have to hire manage their own personal care, attendance. And that is a huge revelation for a lot of families that have relied on supports from the school system, and it can also be a big financial burden. This is where that navigation and the support of connecting students with state and federal benefits becomes really, really important. And I see a lot of students who are have physical disabilities, are college bound, are ready for college, academically ready for college, but they don't have enough information or connection with some of the state and federal benefits to be able to afford some of these, some of these services that they might need. And that's a real gap that I've seen in this transition process, specifically for students with physical disabilities who also need personal care supports.     Jayson Davies     Yeah, yeah. I can imagine. I mean, I again, thinking back to my college days, I think I almost I knew someone with a physical disability, and he did have someone with him, and we never discussed it. But I think in my head, to some degree I think that the I thought that the college was somehow, you know, helping out with that. And my guess is, I'm totally off on that, it was probably completely all on him and his family and so, yeah, that's definitely very different from being K 12k, through 22 so Yeah, is there any difference between private and public universities and that, or is it all the same? Because they're all covered by Ada, which has the same guidelines, whether you're private or public?    Annie Tulkin     Yeah, the latter. So the last one you said, so if a college receives federal funding, which is almost every college, I think there's like two or three that don't receive federal funding, they also probably aren't accredited institutions, but then they have to provide reasonable accommodations under the ADA. But there are huge differences in the feel of college campuses and the campus cultures and their approach to providing accommodations or being inclusive. So that's a really important factor, I think, for students to consider when they're like, doing that college search process, of like, investigating and looking and seeing, you know, seeing what that college is actually doing for students with disabilities, and how students with disabilities feel about the services that they're receiving on campus.    Jayson Davies     Gotcha. Well, thank you for all that knowledge. That's a new knowledge to me. And I'm sure everyone out there, out there listening, is a lot of new knowledge before we start kind of shifting over to more of that transition, working directly with the student, the parents, as they transition. Is there anything else you want to mention just about what it actually looks like once a student is on campus?    Annie Tulkin     I think, like, practically, and I think, like a lot of people, like school counselors folks, other folks who work in support services in high schools don't often know what happens once you pitch off that kid to the to the college. You're like, that's done. We did it right? And like, we all feel like, great, they're on to the next thing. That's awesome. So when a student with a disability, and this is any disability, if they want to receive accommodations in college, once they commit to that school, they have to provide documentation for that university. Every college has their own documentation guidelines, and I'm going to dispel a myth right now that's going to blow some people's minds. IEPs and 504 plans do not follow a student to college and end of just period, exclamation point and End of conversation. They don't travel with the student. The student can provide those documents as supplementary documentation when they apply for college accommodations, but the college has their own documentation and accommodation process, so for students with learning disabilities, it might be a neuropsych evaluation. So if they had a neuropsych done through their school district, they'd want to get that full copy, the full report, not the abbreviated report they want. The whole shebang and have that ready to go. Most colleges are also asking that that report be with adult scales and done within the last three years. So if you have a student who has a learning disability and they're requesting accommodations on the basis of having a learning disability, you want to look at that documentation with them. Make sure they're up to date. Look at the schools that they're interested in. Look at their documentation guidelines. Those documentation guidelines do vary. It could be three to five years. So every college can create their own documentation guidelines for students with physical disabilities. It's going to be a letter from their health care provider, typically, that outlines what their functional limitations are, what accommodations the provider suggests. You know, what their what the students needs are, and has like a diagnosis. And that might be for many of my clients, it's like multiple letters, you know, from a neurologist, from their you know, from their doctor who treats them for this thing and that thing. So it might be multiple letters. And then for students with mental health conditions, it could be a letter from their counselor, their therapist, their social worker, that has the diagnosis and the functional limitations and the recommendations for accommodations. But again, when a student is in that college search process, they should look at what those things are, housing accommodations are usually separate from academic accommodations. They might go through the same office, but it's usually a different process with different deadlines and things. So the student gets commits, they sign, they say, I'm going to XYZ University. They need to start that process of requesting accommodations at that point, right? So may 1 is like the traditional like college decision deadline. So there might be housing accommodations. If the student uses a wheelchair or has a fatigue related condition, they might need some housing accommodations. Or if they have Crohn's disease, and they're looking at like the bathroom setups and things, or another type of gastrointestinal issue, or if they catheterize, or if they have a bowel routine, or whatever the situation is, we need to be thinking about what those housing needs are. Housing accommodations are usually the first thing that comes up May, June. There are deadlines you don't get in there. You might not get what you need. And so that's yes So, and it catches a lot of people off guard, so the student submits the documentation, starts the process to request accommodations, and then the Disability Support Office staff sets up a meeting with the student. So right off the bat, the student has to be ready to have this conversation. You know, do I know what I need? Do I know what accommodations I'm requesting? What if they ask me questions about why I need this thing? The student needs to be prepared for that. And then once the student gets approved for the accommodation. So let's say they the Disability Support Office says yes to all of the accommodations that the student has requested, the student then either gets a physical letter or they have an online system where they go with their they coordinate their classes, so math, 101 English, 204 and then they can email the professors or bring a letter to the professors that outlines their accommodations. This is different from high school too. No diagnosis gets conveyed to the person who has who gets the accommodation letter. So the student gets to choose, do I want to disclose my accommodation if they have an air disability, if they have an invisible disability, right? Like they can, they can craft the story that they want to tell, and they can, you know, they have more efficacy in that, in that position. But if a student has a visible physical disability, right, they still might want to, like, talk to the professor about what that looks like in that classroom and how that works, but they have to connect with each individual professor to talk about accommodations for that class, and they have to do that every single semester, because you get new professors every semester, right? Yeah, so very different from high school, especially if you're coming from a high school where, like, you know, everybody knows you, and you know you can't go to that system.     Jayson Davies     It really puts the onus on the student and, you know, and in K 12, and I'm sure you'll tell me if this exists at all at the college level, I'm assuming it probably not. In public education, there's a program called Child Find Right? Like districts are required to basically find students who might need supports. Does that exist at the college level at all? Are universities given the directive like, Hey, you actually need to go out and find the students that need support in any way? Or is it just 100% it's up to the student.     Annie Tulkin     100% up to the student.     Jayson Davies     Yeah, that's what I figured.    Annie Tulkin     They're adults, right? So once they turn 18, or they sign that dotted line, they're technically an adult, so it's up to them whether or not they want to choose to request accommodations. And you know, there are barriers for students to requesting accommodations, like if they needed updated documentation, and they can't get to their healthcare provider, or they can't get a new neuro psych or what I mean, there's a lot of situations. Recommendations that occur where students you know either don't know that they could request accommodations, they don't they can't get the documentation. There are things that emerge. Hopefully they're at a university where people are caring and supportive and would support them in figuring it out. But that's not always the case, right? And the student has to know to ask for what they need. And that's often the hardest part, right? Like, you don't know what you don't know. And sometimes students are like, wait, I could just ask for that. Or, like, Wait, there is a person who does that sort of work, or could support me with that they just don't know. And part of that is like, cultural capital, right? Like we're all coming from different backgrounds and experiences, and, you know, some of us have more cultural capital. We know what levers we can pull in order to get something that we want, and some of us don't. And so, you know, it's really important that we're talking to students about like, like Student Services at their university, like, why don't you check out and see what sorts of tutoring programs or supports that they have? Do they have assistive technology? There? Is it in the library, or is it in the disability office? Like, you know, and that's the sort of nitty gritty and and making connections with people on that campus so that they know who they can go to, like, who is your point person? Like, you don't know, if you don't even know what question to ask, Who can you go to? And just like, Yeah, talk through the issue so that they can point you in the right direction, and that's tricky.    Jayson Davies     Yeah, I can imagine. And like, you know, having my background in school based occupational therapy, I'm already starting to think of all the different ways that school based OTPs can can start to kind of, with this knowledge, start to help their, especially their high schoolers, right? Like we've got to start earlier. We've got to start freshman year, or even earlier if we know that a student's interested in college, we've got to start sharing this information with them, especially now that we have it. So I want to get more into that in just a moment. But before I do, I think a good segue is to kind of talk a little bit about what you're doing at accessible college then and when you get involved. When do you begin to get involved? Ideally, of course, I'm sure sometimes it happens a lot later than you wish it would. But when do you start to get involved? And you've already talked a little bit about what that looks like, but ideally, what does that look like?    Annie Tulkin     Yeah, ideally, students and families are connecting with me during junior year of high school.    Jayson Davies     That makes sense. That's the same time they should be looking at colleges, if not earlier. So usually, right?    Annie Tulkin     It's usually about the time where students start to tune in to like, oh yeah, this is the thing. And, and we, you know, and parents are like, let's go on tours or whatever. Or the school starts to, like, talk about it a little bit more. So I provide one on one support direct to students and families. I predominantly work just with the students. I always, you know, can put parents and guardians in on the conversations that they'd like to be but the reason I do it that way is because it's so important that the student starts to wrap their brain around like what the expectations are going to be for them, and so that they're prepared to ask the questions. Because even if they're asking questions of disability support offices, the expectation on the college side is that the students doing the talking, not the parent or guardian, right? And so I work with students to create a list of accommodations, academic, housing, resident, the residential piece, the recreational piece, the dining piece, whatever their needs are, to start to figure out what are the things we're going to be asking for in college, what are the accommodation needs that we might have, and then creating, working with them to create questions for the disability support offices, so that as they're going on tours, they're reaching out to maybe their top couple schools that they're really interested in, and having conversations and doing a vibe check, is what I call it on the disability support offices, because disability support offices will never tell you 100% that they are going to provide a specific accommodation until the student has committed and until they've seen their documentation. So there are some ways that I've uncovered to sort of get more details without getting, you know, get as close to you can as a 200% right? And part of this too, is just the student connecting with those people to see, like, are these people going to be helpers or hinderers, right? So you can see, like, what's that like? Then it's like working on creating documentation. A lot of times, doctors notice, if there's any doctors listening to this, don't know what college accommodations are. They might be well versed in like workplace accommodations, or maybe they've done K 12 accommodations. But College is a different beast. So the housing pieces and thinking through like, what does the dining hall experience look like? And if we need a meal plan exemption because the student is tube fed, how do we ask that? So I help families sort of create language around that, and then once the student commits to the university, I support the students in figuring out, okay, how do we go through the process of actually requesting the accommodations and navigating the. Conversations with the disability support offices. Because a lot of times, like I mentioned before, if the Disability Support Office hasn't had a lot of experience with students with that health condition, or with students who use wheelchairs, they might not sort of understand what's what the student needs or what the student is asking for. And there's some really, you know, interesting examples of this too. So like, I had a student who had muscular dystrophy, and he had gone through most of this process himself and requested housing accommodations, and he called me up. We had our meeting. He was so excited. He was like, I got a single room. It's right next to the community bathroom. It's going to be great, because that that college only had in their first year residence halls, they only had community bathrooms. And I said, Okay, so let's think through this a little bit. So you're going to have a personal care attendant, because you need help with chat, with bathing and toileting. So that person's going to go with you into the community bathroom, with other with other young men, and that woman, that's probably going to be a middle aged woman who's from an agency, right? Like, so I was like, how are you going to feel about that? And then the toileting piece, and how, you know, and how is this? And it dawned the student just had not thought about, like, the logistics, right? Like, what does this actually look like, functionally? So we worked on an appeal where they went back and they said, here are the reasons why this isn't going to work for me, and what else can we do? Ultimately, the university gave the student an apartment and used it as an opportunity to like, retrofit some another space they had on Canvas to make it more accessible for him. Oh, wow, so that he had more space for his PCA and had a private space to do all those other you know, to do all the bathing and toileting and all the things without having to, like, you know, out himself or make himself uncomfortable, you know, with his peers, yeah, but it was, it was interesting to me, because he just hadn't thought about what that would be like, right? So I do a lot of work with families in that regard, and thinking through all those pieces. I also help people hire and come up with job descriptions for personal care attendants. And think about funding streams for that, connecting them with their state's vocational rehabilitation program if they haven't already done that. Thinking about SSI, Supplemental Security Income for funds for, you know, for their their needs, for their housing, eating, PCAs, medical expenses, whatever the things are, yeah. And there are a lot of things.    Jayson Davies     Yeah, and, as you mentioned really quickly, I mean, you don't know what you don't know, right? And, like you just mentioned that that adult with muscular dystrophy, right? Like, you might have spent that entire year in a situation that he would have survived. He would have got through it, but he probably had a much better freshman year in his other placement or the other housing unit that he was able to.     Annie Tulkin     Yeah, yeah, I think. And this is so I actually, I have a partnership with the Muscular Dystrophy Association, and I'm working with they just have a new scholarship that they put out. And I'm working with some of those scholarship recipients, some of whom are current college students, some of whom are just starting college. And one of the things that's sort of emerging in that work, in my work with those students, is that, like a lot of students who have been in college for many years, are having conversations with me and realizing that they could have asked for things, or they could ask for things that they didn't even know they asked for, right? And I was like, this is a really fascinating process, right? Like, so, you know, even people who are in it now who are, like, doing the college thing, like, may not have you don't know all the answers. You know, like, so like having a resource or or someone you can work with who might be able to guide you can be a really helpful tool. I do have a program with the Christopher and Dana Reeve Foundation, and that's open for any student with any type of limb paralysis. And it's a that's a big tent term limb paralysis. So through that project, I've supported students with spina bifida, cerebral palsy, muscular dystrophy, spinal cord injuries, neurological conditions that cause some form of paralysis and more, and those students can work with me for free through the Reeve Foundation for up to three hours. And we could include that, the a link to that in the show notes too, Jason, because that's the space where a lot of folks in schools actually send me students to who then work with you through that, through that program?    Jayson Davies     Great, because really quickly I'll let you continue. But just for any ot out there listening right, like, how often do we sit in an IEP and just think, like, Man, I wish I knew where to refer this parent and student to as they really begin to transition to college. And, you know, Annie could be that person. And it's, it's not that we can't support them beforehand, and we're going to talk about that in just a moment, because I'm sure Annie has a handful of ideas for how we can begin to support them in middle school, high school, even maybe earlier. But for that actual transition piece, Annie can really be helpful. So, yeah.    Annie Tulkin     Yeah, and like, to that end, you know, I again, like I said in the beginning, and I do think, like, we all are partners in this process, right? So it is. It's a team effort, for sure. So the reef Foundation program is really great, and it's free for for students and families. So that's, you know, school districts sometimes worry about, you know, referring people to paid services, but this one's free, so yay. So the other thing, and we'll put this in the show notes too, is that I wrote a guide on navigating the transition to college with paralysis, which was for the REA foundation as well. But it's really good for anybody with any type of mobility impairment, right? So, like, even if you have a student who uses a walker or crutches, or has fatigue related issues. It just has some good like thoughts and things they should be thinking about and considering as they're starting that college search process. So that's a really good resource and tool to and United Spinal put out a wheelchair friendly campuses guide to that's that's a good starting point for folks. So that might be another resource we want to share as well. Absolutely and just like because there might be somebody on here who has a student who is blind or visually impaired who's listening to this, I have a project with the Perkins School for the Blind, and we created a college readiness resource website for students educators and for other professionals and parents that looks at sort of college transition for blind and visually impaired students and students with CO occurring conditions, it's a really great sort of starting point for people who are starting to think about the process of going to college as a student who is blind or visually impaired. So we'll put, we have lots of links that we're going to put in there. Yeah. So, yes, yep.    Jayson Davies     Great. Well, thank you. I do kind of want to get into now, and maybe we don't. We'll do this with the school based occupational therapy practitioner in mind, but I'm sure a lot of these will be relevant to the entire education team as a whole. But what are some of the things that you know a student and their parent and their family come to you? What are some of the things that you kind of hope that maybe you know just in the back of your mind you're like, Man, I hope the student learned something or had access to something while they were in high school, what are you hoping that they had access to or learned?    Annie Tulkin     Self advocacy skills is the big one. And I think like that manifests itself in a couple different ways. I think that we can encourage students to be a part of those IEP meetings, or a part of those 504 meetings. Part of that preparation might be actually having the student think about, well, a read their evaluations, right? So like using some of that time when they're with a school professional to, like, read I it always boggles my mind when a student's like, oh, I never read any. I've never read this IEP. I've never read this neuro psych evaluation, right? Or I don't know, like, what these people have said about me or written about me. And so I think it's like, important for students to be aware of, you know, what's what's being said about them and what's written down, but also, just like having that preparation, so we're there. Maybe the students creating questions, maybe the student is, you know, thinking about things that they think would work better for them, and offering those suggestions, and maybe somebody's guiding them through that process, because that's like the soft skills of learning you know how to talk about what you need. And the same thing sort of manifests itself at home too. Like, is the student able to call the doctor and make a doctor's appointment? Do they have the executive function skills. Do they have a calendar that they keep, whether it's like an assignment notebook or because that that becomes hugely important too, when they move on to college, because they got to keep track of all their stuff by themselves. And for a lot of our students, that's a challenge, right? So, so working with students on on those skills, and then on the other side of things, I would say the independent living skills are huge. And this is where I think, like, occupational therapists are, you know, can be really helpful in some of these systems. But, like, you know, can the student make a basic meal from can they make a peanut butter and jelly sandwich? Right? Like, can they do they have, like, the the functional skills to be able to support themselves as a, as an adult human right ATM use is a is one that, like, comes up all the time. I'm always It blows my mind. How many students have never used an ATM, and because everybody's used to using, like, cash app now and stuff.    Jayson Davies     That's what I was saying. Are people really Using ATM still that much like, I feel like now a lot of campuses have gone completely cashless, but.    Annie Tulkin     Yeah, it just depends, right? But there's some things you need. There's still some things you need to cash for, right? Like, some people have never even been inside a bank, yeah. But so there's a lot of just, like, basic skills, grocery shopping, orientation and mobility skills, right? Like, did they know how to. And on a bus independently, right? Like, public using public transportation is one that comes up a lot, because oftentimes, like, students have been supported in getting from their house onto a school bus to the school getting off the school bus. But like, functionally, how does that look when someone is an adult and the expectation is that they're getting on themselves right, or even even with support, but, you know, relatively independently, and how are we setting them up for success to, like, guide them through that process, right?     Jayson Davies     Yeah, no, yeah. I just want to say just so you know, I know this is asynchronous. People are listening to the six weeks later, but every ot right now. OT practitioner, OTA, everyone's nodding their head along with you right now. These are things that that we stress. And honestly, to some degree, we get shot down when we say, hey, we need to work on ADLs. Here's why. And I hope every ot practitioner right now is like listening and saying, hey, I want to send this, like this segment of the show, to my, you know, principal or assistant principal, or director of special education or something, because, like, the whole purpose, and we said this before on the podcast, the whole purpose of K 12 education is to, you know, produce adults that can function in the world, whether that be college, a job, whatever it might Be. And sometimes goals don't need to focus around multiplication, addition. They need to focus on real world skills, like, as you mentioned, using an ATM, being able to be independent in a housing unit and whatnot. Those are all very important that, that we need to address. So yeah.     Annie Tulkin     Yeah, I rarely do multiplication, but I get on lots of public busses. I can tell everybody that. So the other thing too is like, I created a course called preparing students with physical disabilities and chronic health conditions for college. I created it with healthcare providers, parents, educators, anybody who supports students with physical disabilities or health conditions in mind. And it has, it's a multi module course, so people who take it can go through it and start to think about specific students that they're working with, and use those tools to support those students. Right? So it has a module on Independent Living, but it also has modules on like connecting with the Disability Support Office, engaging in the college search hiring a personal care attendant. So there's, there are a lot of skills there that would be really valuable for for families and for educators and OTs and PTs and other support providers to have if you're working with students. So people can go to my website and check that out too. Absolutely. That might be, that might be helpful. But there's something else that you said, Jason, which I think is really important, because I don't think a lot of people realize this. The ADA also applies to the employment setting. So, so you mentioned, like, the purpose of K through 12 education, and like, you know, and CR in creating functioning adults, and whether post secondary. Their post secondary route looks like college, community college, a certificate program, a supported employment programs, employment period, vocational training, whatever it looks like. Students with disabilities can request accommodations in the in the workplace setting. There's a great resource for this. It's called Jan, The Job Accommodation Network, and you guys can Google that up, and they have a whole sort of spot on their website where you can look at specific disabilities and then types of accommodations that a person might need. There's guides for people with disabilities who are requesting accommodations. So that's just another good resource for people to know about.    Jayson Davies     Absolutely, absolutely. Thanks for sharing that I asked you in my previous or a few questions ago, right? Like, what do you hope that students come to you with, and you said, executive functioning, some ADL skills. But I want to think now as a school based ot practitioner or teacher, whatever it might be, you're sitting in an IEP, and the students there, the parents there, and say, Hey, I really want to go to college. My goal is to go to college. We're talking about a freshman, sophomore, maybe a junior. What should we speak up and say, as I know, it's obviously independent for or it's going to be very different, depending on the student. But should we start to at that point cue them in on, hey, things are different at the college, or, Hey, make sure you take your IEP to the college. Or, I guess, kind of, what should we be telling parents, if anything.    Annie Tulkin     I think part of it is preparing students and families for the fact that they may not get the same accommodations in college, right? So services and supports are not a part of college accommodations. So, like, there is no so an OT would be considered an auxiliary certain a service in the college setting, just like a personal care attendant or a para educator. So there, there is that does. Exist. You won't get OT, you won't get PT, you won't get speech and language support that doesn't, that doesn't exist in the college setting. So you lose all of the services that you may have in the K through 12 setting in an IEP process. So that is important for people to understand. And I would also say, like, if an OT is there, and we're thinking about, like, what are we advocating for? Assistive technology is one of the biggest things, things that can help a student increase their independence, right? So like these note taking softwares, other sort of daily living supports that the student might need, or assistive tech that they might need. And I think a lot of times, people don't realize that state vocational rehabilitation program has has a program called pre ETS. Students who are age 14 are eligible for pre ETS services, pre ETS, pre ETS, that's what it is in every state. So, okay, just backing up, because people might not even realize this, every state has a vocational rehabilitation program. Every state has a different name for it. It might be Department of Rehabilitation Services. It might be access VR. It might be VR services. So you go to your state, you know, type in your state name, put in vocational rehabilitation. It's a federal program, and then the states get money from there, and then they are supposed to do outreach specifically to people with disabilities. A lot of people associate VR services with students with intellectual and developmental disabilities and autism spectrum disorders or more, quote, unquote, significant disabilities. However, state VR programs can also be a great support for students with physical disabilities or for more significant medical conditions where they're having a lot of challenges in the school setting. And VR has access to assistive technology services, employment services, career support services, so it unlocks sort of more resources. Most public schools have a VR person who might oversee, like a number of schools in that district as their connection to that school or to that school district. So if this is new, if you're listening to this and being like, who? Who is that? What? Yeah, look up vocational rehabilitation. Look at pre ETS, which is their youth employment, youth employment services, because vocational rehabilitation, the sole purpose is getting people with disabilities into the employment setting. Post secondary education, college, community college certificates might be a piece of that puzzle, and in many cases, they'll actually provide funding for college or and books and assistive tech and things like that. And I think, like people don't know about so the more people that know about this, the better awful we're all going to be.    Jayson Davies     Yeah, you are giving our work cut out for all the resources we're going to have to go find. But we will get all these resources. We'll get them up on on the web with this episode, because, yeah, nothing else. All the resources you have shared have just been fantastic. So thank you. We appreciate that. I'm glad. All right, well, we'll wrap this up here, but I want to ask you, because I'm sure there's some people that are listening and they're like, I love my school based occupational therapy job, but I also would love to be in a position on a college campus, working maybe in this arena. And so any advice for ot practitioners who might want to be more involved in supporting the college transition process for the students they work with, or or maybe once kids are even on campus, any advice for where they might whether it be look for jobs or maybe just yeah, how do we get into that field?    Annie Tulkin     I would say that a good way for school based people to connect with the higher ed people is to actually reach out to the Disability Support Office at the college or university that's closest to you and see if they would come to your school and talk to students about, like, what the process is for requesting accommodations. A lot of colleges do that, community colleges, you know, four year institutions, whatever, a lot of them are trying because they on the college side, people want to get to the students more easily, too, so that they're they don't have as much work to do with the students when they once they get there. So creating those connections is a really important thing, you know, I would also say that, like, if someone was trying to break into the higher ed field, you know, I think that for ot to continue ot work might be a little bit challenging, because, like I said, colleges don't typically offer those services. However, there are colleges that have ot programs, right? The OT training programs and things like that. So you know they might be looking for resource sites or placement sites too. So like creating those connections too, so that you know you can help mentor college gets know you, you maybe get a job back at the college, whatever. So there's. There's, there's some inroads there as well, you know. And I think, like there's, there's space for innovation here too. There are some programs that like specifically work adaptive sports, programs in particular, that specifically work with students with physical disabilities, and have summer college programs where they are on a college campus, and they're preparing students for the independent living pieces and things like that. So I think there's about 22 colleges across the United States that have adaptive sports programs, mostly wheelchair basketball. So if you look in the United Spinal guide that we're going to link to, you'll see a lot of those schools. Or if you just Google it, you can find it too. Move United is another great resource for finding adaptive sports programs too, but that might be another sort of inroad for someone to break into the higher ed side of things.    Jayson Davies     Absolutely great. Well, Annie, it's been a pleasure. Thank you so much for all your knowledge. The resources, I think this is really going to help the OT practitioners better support, especially their high school students, because they now have a better idea of what some of those expectations might be beyond high school, whether it's college or as we talked a little bit near the end, you know work, what it might what it might look like at work. So thank you so much. We really appreciate it, and one last time, remind everyone where they can learn more about you and your programs.    Annie Tulkin     Yeah, folks can find me@accessiblecollege.com I'm also I have Facebook, Instagram, LinkedIn. I also have a Facebook group. So if you go to the accessible college Facebook page, you can learn about the Facebook group, which is open to healthcare providers, parents, families, students, anybody who wants to talk about physical, physical disabilities, chronic health and mental health is welcome in the group, and you can reach out to me directly to my email is Annie a n, n, i  e@accessiblecollege.com and I look forward to hearing from some folks.    Jayson Davies     Absolutely. And we'll be sure to post all the resources over at otschoolhouse com, slash episode 160, so that is going to wrap us up here at the otschoolhouse com, thank you so much, Annie. We really appreciate your time and your knowledge.    Annie Tulkin     Thank you!    Jayson Davies     and there you have it. I hope this conversation with Annie Tolkin from accessible College has provided you with invaluable insights and actionable strategies to better support your students in transitioning to higher education. Remember the takeaways are be aware of the differences in accommodations and supports available in college versus high school. Focus on developing independent living skills like meal preparation, money management and transportation, some of the things that we're often asked not to focus on while working with our students in elementary, middle and high school, and finally, prioritize building strong self advocacy skills in your students. This is true for any student. We need to be able to have students who self advocate for themselves beyond school. Also don't forget to check out all the fantastic resources Annie mentioned. We've included those in the show notes at otschoolhouse com, slash Episode 160 and again, if you're a member of the otschoolhouse com collaborative, you can now earn your certificate of completion for listening to this episode, just log into the community and head to the podcast CEUs tab to take a short quiz and get your certificate. And if you're not a member yet, head on over to otschoolhouse com slash collab to learn more about joining the otschoolhouse com Collaborative for school based ot practitioners. Thank you for tuning in, and we'll see you next time on the otschoolhouse podcast, take care.    Amazing Narrator     Thank you for listening to the otschoolhouse 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.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

Picture this. A first-grade teacher just showed you a handwritten note from a concerned parent requesting an initial special education evaluation for their child. The note details the child’s difficulties in school—trouble with focusing, struggles with handwriting, and frequent fidgeting during class. And at the end of the note, in clear handwriting, the parent has specifically requested, “Please make sure OT, PT, and SLP are included in the evaluation.” You pause. There are certainly areas of concern, but should OT be a part of the initial evaluation process? While the parent’s request is understandable, you’re also aware that some of these concerns might be addressed through other services or strategies without involving an OT assessment just yet. Do you agree to assess right away, or do you wait for the psycho-educational evaluation to provide more clarity? As school-based OTs, this scenario is a common one, and making the right decision isn’t always straightforward. In this article, we’ll explore:
When an OT eval should be implemented during the initial special education evaluation request When you may want to wait for the psycho-educational evaluation And three ways to respond to a parent’s request for an OT evaluation (during the initial special education request) By examining various situations, we can ensure that our evaluations are purposeful, timely, and aligned with the student’s specific needs. Understanding the Initial Evaluation Process When a student is referred for special education services, the first step is typically a comprehensive psycho-educational evaluation. This evaluation is conducted by a school psychologist (often with the support of a special education teacher) and typically assesses cognitive, academic, and emotional functioning to determine if the student meets one or more of the 13 qualifying criteria for special education services. From a district’s perspective, waiting until the psycho-educational evaluation is completed before conducting additional assessments, like OT, may seem logical. It allows the team to determine if direct instructional services, such as resource programs (RSP) or specialized academic instruction (SAI), can address the student’s needs first. By waiting, the district may hope to achieve one or both of the following: Avoid unnecessary evaluations that could lead to services the student may not need Preventing therapists' caseloads from ballooning and, ultimately, saving the district money. However, as OTs, we know there are times when waiting isn’t in the best interest of the student. Some concerns are simply not best assessed in a psycho-educational evaluation— they are concerns that fall squarely within our scope of practice. When an Occupational Therapy Evaluation Should Be Considered Immediately In my perspective, there are a few areas where an Occupational Therapy Evaluation should be part of the initial evaluation. These are situations where waiting for the psycho-educational evaluation may delay critical services the student needs. Here are some of those situations: 1. Sensory Concerns Impacting Education Access When sensory processing challenges are present, they typically won’t be captured in a standard psycho-educational evaluation. Even worse, the sensory-related concerns may be misidentified as strictly behavioral concerns , which could have service-related implications for years to come. Students with sensory concerns might struggle with attention, behavior, and participation in the classroom. These difficulties often have a significant impact on their ability to access their education. If sensory issues are reported by parents or teachers, it makes sense to assess OT from the start, rather than waiting. 2. Fine Motor Skill Deficits Impacting Education Access Fine motor difficulties, such as challenges with handwriting, using scissors, or manipulating classroom tools, are areas we are uniquely qualified to address . If these concerns are noted early on, conducting an OT evaluation as part of the initial referral can help get the student the support they need right away. Even in younger students where handwriting might not have been formally taught, if fine motor delays are evident, addressing them sooner rather than later can prevent future frustration. 3. Activities of Daily Living (ADLs) Impacting Education Access ADLs, including self-care skills like donning/doffing a sweater, toileting, and feeding, are often overlooked in the typical special education evaluation process. If there are significant concerns in this area, we can provide crucial support that other services may not address. Even if services are not warranted after the OT evaluation, any consultation and accommodations we provide could go a long way in supporting both the student and the school staff. When to Wait for the psycho-educational Evaluation While there are clear cases for immediate OT involvement, there are also times when waiting for the psycho-educational evaluation might make more sense. Here are a few scenarios where it may be best to hold off on an initial OT evaluation: 1. No Clear OT-Related Concerns If the primary concerns are academic or speech-related, and there is no indication that the student is struggling with fine motor skills, sensory processing, or other OT-specific areas, it’s reasonable to wait. In these cases, the psycho-educational evaluation will often uncover the main areas of concern, and OT may not need to be involved unless something specific arises later. 2. Concerns That Can Be Addressed by Teachers For younger students, difficulties like handwriting or scissor use can sometimes be supported effectively through classroom instruction. If a student hasn’t yet received formal handwriting instruction or hasn’t had the opportunity to practice fine motor tasks in school, it may be best to wait until these foundational skills are taught before assessing OT. Similarly, if a student is still adapting to school routines, they may not need OT support at the initial referral stage. A quick note on Delaying Referrals as a Means to Manage Caseloads. Lately, it’s becoming more common for districts to delay OT evaluation requests—regardless of the concerns—until after a student has undergone a psycho-educational evaluation. While I understand the financial pressures and the need to manage service provider caseloads, this type of blanket policy seems to undermine the spirit of the Individuals with Disabilities Education Act. The purpose of IDEA is to ensure that every student’s needs are met on an individualized  basis. While I fully agree that not every student referred for special education requires an evaluation from every related service provider. However, implementing a policy that delays or prevents related service evaluations, regardless of the specific concerns raised, goes too far. The core of IDEA is individualization—the decision to include any service provider in the evaluation process should be made based on the student’s unique needs, not because of a broad, one-size-fits-all policy. Let’s be clear:   managing staff caseloads should never be the primary reason to avoid evaluating a student . While it’s important to ensure we are not conducting unnecessary evaluations, decisions should always be driven by what’s in the best interest of the student. If a student’s needs do not clearly fall within the OT scope, it may indeed be appropriate to wait. But that determination should be made by the team on a case by case basis, rather than through an inflexible district policy aimed at controlling caseloads. Responding to a Parent’s Request It’s no secret—parents often request a full evaluation from all  service providers, including OT, even when their concerns don’t align with our scope of practice. When you receive such a request, it’s crucial to approach the conversation with empathy and understanding. Remember, most parents aren’t familiar with the intricacies of IDEA or the evaluation process—especially if this is their first time navigating special education. Their understanding may be based on a few hours of online research or even a quick chat with AI. Our role is not only to assess but also to guide parents through the process with clear, compassionate communication. So, how do you address a parent’s request for an OT evaluation that doesn’t seem warranted? The best starting point is simple: pick up the phone. A personal call can go a long way in building rapport and clarifying misunderstandings. Take time to listen and understand the parent’s concerns. Often, they may not fully grasp what an OT evaluation involves or may assume it covers areas outside of our scope. By directly addressing their concerns, you can clarify whether an OT evaluation is likely to provide useful information. And if you feel the eval is warranted, this conversation can serve as your parent interview to learn more about the child. However, if after understanding their concerns, you believe an OT evaluation isn’t necessary at this stage, explain how waiting for the psycho-educational evaluation could provide valuable insights that could help guide the need for OT services later. If the parent is receptive and agrees, it’s a good idea to ask them to send a follow-up email confirming that they’re withdrawing their request for an OT evaluation. This ensures there’s a written record of their decision. And if the parent remains firm in their request for an OT evaluation, you have a few options: Conduct the evaluation, even if OT services may not be warranted.  This allows you to gather data and make an informed recommendation.
Collaborate with the school psychologist to include a brief OT assessment section as part of their broader evaluation.  This provides a middle ground, addressing the parent’s concerns without requiring a full OT evaluation.
Discuss with your administrator or special education department the possibility of issuing a Prior Written Notice (PWN).  This would formally communicate the district’s decision not to conduct an OT evaluation based on the lack of OT-related concerns.
Personally, I try to avoid issuing PWNs, especially for initial evaluation requests. Refusing to assess a student can put both you and the district in a difficult position. It not only frustrates the parent, but it can also create potential legal challenges down the line. If, at a later date, the student is found to require OT services, the parent could argue that the evaluation and services were unjustly denied from the start. #MakeupServices This is why I tend to err on the side of conducting the evaluation. I would rather gather the necessary data and conclude that OT services are not needed than make the decision not to evaluate at all, only to later discover that the student did require OT support. Having the data in hand allows you to make a more informed decision—and protects both you and the district should the need for OT services arise in the future. Conclusions At the end of the day, deciding whether to assess a student as part of the initial special education referral process should always be a case-by-case decision. Some students will clearly benefit from an OT evaluation right away, while for others, it makes sense to wait until the psycho-educational evaluation provides more information. Collaboration with the IEP team and open communication with site administrators is key to making these decisions, as is clear communication with parents. When we advocate for a thoughtful, individualized approach, we ensure that our evaluations are purposeful and lead to meaningful, timely services for the students who need them. My hope is that your district is not putting in place blanket policies that prevent evaluations. But if they are, I hope that you take small steps toward explaining such policies can be detrimental to the students who need services the most. And if you do decide to evaluate the student, here is how I would go about doing that .

Click on your preferred podcast player link to listen wherever you enjoy podcasts . Welcome to the show notes for Episode 159 of the OT Schoolhouse Podcast. Have you ever wondered how the knowledge you gain from a podcast can be effectively applied in real-world practice? In this episode, Taylor Poirier, shares her insightful journey of how she has implemented what she’s learned from about 150 OT Schoolhouse podcast episodes into her everyday practice.  Tune in to discover the actionable steps she took, the resources she utilized, and the challenges she navigated to become a dynamic force in school-based occupational therapy. Listen now to learn the following objectives: Learners will identify strategies for applying knowledge gained from podcast episodes. Learners will identify tips to guide new school-based occupational therapy practitioners.
Learners will recognize ways to stay organized to be able to best implement podcast insights. Guests Bios Taylor graduated from University of St. Augustine, Miami Campus in December 2022. She began working as a pediatric OT within the schools and home health setting with Alyssa Campbell Therapies in the Tampa, FL area.  She loves learning and creating new ways of therapy for the most client-centered approach. She has now created resources based on the information provided in this podcast and can truly see a difference in the progress her kids make. She loves making other therapists feel confident and excited about the world of OT!  Quotes “Teachers are truly our biggest fans when it comes to what we're able to do for their students. Because their whole goal is to get that student to learn and participate and be functional within their space.”  -Taylor Poirier OTD, OTR/L  “We gotta give our teachers a little bit more grace. We gotta give a little bit more grace maybe during that IEP meeting too, just to make sure we're all on the same page and we're all understanding everyone's perspective.” - Taylor Poirier OTD, OTR/L  “Because we all know co regulation, if the teachers are dysregulated, so is the child.” - Taylor Poirier OTD, OTR/L  “You can always advocate for yourself, and making the connections is a really a big part of that as well.”  -Taylor Poirier OTD, OTR/L  “When it comes to collaboration, you have to meet the other person on their level. If they are another provider, what do they know about OT? Have they ever collaborated with occupational therapists before? Do you guys have the same goals based off what your child in your case looks like...” Taylor Poirier OTD, OTR/L  “We're going to make mistakes. You can't not make mistakes. You are human.”  -Jayson Davies, M.A, OTR/L “Don't continue doing something that has always been done at the school for the sole purpose that that's the way they did it.“ -Jayson Davies, M.A, OTR/L Resources 👉 Tools to Grow  
👉 Ot toolbox 👉 Ot enlightenment - IG 👉 Taylor spotify OT Schoolhouse Episode Playlist  👉 Podcast Episode 32-Primitive reflexes 👉 Podcast Episode 106- Goal writing in School-based Therapy 👉 Podcast Episode 145- Crafting Your Goal Bank 👉 Podcast Episode 111 - Back to our Mental Health Roots 👉 Podcast Episode 139- Fostering Autonomy through Child-Led Therapy 👉 Podcast Episode126- Applying the Kawa Model to School-based OT 👉 Podcast Episode 23- Discovering the Zones 👉 Zones of regulation Website 👉 Podcast Episode 141- Innovative Strategies for Improving Handwriting 👉 Podcast Episode 114- Dysgraphia: How you can Support Teachers and Students 👉 Taylor IG 👉 TPT Resources 👉 PESI Primitive reflexes course   Episode Transcript Expand to view the full episode transcript. Jayson Davies     Hey there, have you ever listened to an episode of the otschoolhouse com podcast, gotten some great documentation treatment, maybe even some evaluation ideas, but then never actually took action on those ideas? Well, today, we are addressing that very unfortunate series of events head on with Dr Taylor Poirier, when Taylor became an occupational therapist. A little over 18 months ago, she had some big ideas. You know, she was ready to take on the school based ot world by storm, but with so much knowledge from various outlets the podcast included, she had to put a system in place to actually take action on everything she was learning. That is why, when Taylor reached out about recording an episode related to implementing what you actually learn on the podcast, I was extremely quick to say, Yes, please. So that's what you're going to hear today. In this episode, you're going to hear how Taylor selects episodes, takes notes, creates action plans and moves forward with those plans to support both herself and the students she supports, from incorporating primitive reflex strategies to finding innovative ways to engage with colleagues and students. She has mastered the art of learning on the go and applying the knowledge practically. If you enjoy the otschoolhouse podcast, but find yourself struggling to actually implement what you learn from every episode, this is the episode for you stick around as we explore how to transform knowledge into action and enhance your impact as a school based occupational therapy practitioner. Without further ado, let's dive into this enriching conversation with Dr Taylor Poirier.    Amazing Narrator     Hello and welcome to the otschoolhouse com, 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     Taylor, welcome to the otschoolhouse podcast. How you doing today?    Dr. Taylor Poirier OTR/L     Doing great. How are you doing?    Jayson Davies     Fantastic. You know, this is fun. We are having a little bit of tech issues, but we are making it work. I love it. I'm like, looking at your face, but hearing you from your other Zoom account. And, yeah, this is fun. Thanks for being here, and thank you for also attending the back to school conference. I hope that was a lot of fun for you.    Dr. Taylor Poirier OTR/L     Yeah, back to school conference was amazing. And thank you so much for having me on the podcast today. I'm really excited to get into our conversation.    Jayson Davies     Yeah, so you actually reached out to me, which happens sometimes with podcast guests, and you're like, I'm a school based ot practitioner, and I have listened to a lot of episodes, but it's sometimes hard to actually implement some of what you know you learn there's 150 some odd episodes. Like, how do I know which one's the right one to listen to? And even if I do listen to all of them, like, how do I know where to begin with starting to implement them and and I think a lot of people kind of probably are in a similar boat, right? Like, you take in all this information, but how do you actually put it to good use? So you're going to help us with that a little bit today, I think, right, yep, absolutely awesome. Awesome. Well, let's go ahead and get started, and I just want to give you an opportunity to kind of share a little bit about yourself and where you are in your ot career right now.    Dr. Taylor Poirier OTR/L     So I am about a year and a half into my ot career. I'm based in the Tampa Bay area. I currently work with a company called Alyssa Campbell therapies. So we service the the Tampa Bay area. And what's unique about our company is that it is school based as well as home health based. So we really get the unique opportunity to be in all of the most natural environments of our students and our children that we service. So I can be in the school one day, it could be at their house the next, and then we could be at the park. At the park, the grocery store, the library the next day. So I, I've always loved pediatrics. I've always felt most comfortable in pediatrics, and so I've just, I've entered the school based setting, and now I really don't see myself ever leaving. Awesome, awesome. I love that,    Jayson Davies     because you get the kind of the both sides of it. And this isn't a question that I was planning to ask you today, but since you kind of are experienced in both the school realm as well as the more the community outside of the school realm, what do you see as some of the differences, if any, or do you see it as being more similar?    Dr. Taylor Poirier OTR/L     So I definitely think, speaking, you know, for myself, I see it's very similar. I think sometimes, as school based therapists, we kind of put ourselves in a box that we don't have to be in, and the things that you may work on at someone's house or at a clinic setting, you can do that in the schools with spaces that you're given. We're very creative and we're very flexible people in this field. So it's a lot of the same needs, I think, just in a different place, all right? And    Jayson Davies     if your boss, Alyssa, listening, I'm going to ask her to cover her ears right now and ask you, Taylor, if you had to choose one, would you choose clinic, slash outpatient, slash community or school based?    Dr. Taylor Poirier OTR/L     Oh yeah, that is such a tough question. My I started off in OT like, pre grad school in an outpatient clinic, and I loved it, but I think my heart is with with school based so I would have to choose the schools, all right.    Jayson Davies     Awesome. Love it. You're on the right podcast. Then cool. We can continue this. We don't need to end the conversation right now. No, just kidding, Alyssa, you can uncover your ears right now. So, yeah. So you know, you've been in this field for about an A year and a half, you said, and it sounds like you found out about the otschoolhouse pretty quickly, but what were some of the challenges that you started to face as you were transitioning from being a student to helping students?    Dr. Taylor Poirier OTR/L     Yeah, so I really didn't know anything, to be honest about school based. OT, it wasn't something that my university covered, you know, in depth. So I was really just looking for a setting I could be kind of an out of the box type of therapist. And so when I found this company, and I found these schools that I'm working with, I immediately was like, Oh my gosh, there is 101 things that I need to look at. The screenings are different. The documentation is different, the language and verbiage is different. And so I was like, I have got to find some sort of mentorship. So that was one area that I, you know, was really difficult at first. You know, navigating, we work primarily in the private schools, so navigating what their policies, procedures and protocols all look like, because they don't always, you know what we get taught in school. It's not always they abide by the same type so more so like five oh, fours, and then, as well as I'm a therapist who works out of her car, so trying to stay organized, how to travel with 101 treatment ideas for seven different kids at one school was definitely a very big challenge at first.    Jayson Davies     Yeah, yeah. And I know, you know, we've already mentioned you, you did find the otschoolhouse, and I know that's been helpful. But beyond the otschoolhouse com, what were some of the, some of the ways that you sought out, some of this mentorship, some of this help, what just kind of you can list them all off, what, where did you go for help?    Dr. Taylor Poirier OTR/L     So I, you know, from school, we learned about, like, tools to grow, or OT toolkit, things of that nature, which are all websites with, you know, a plethora of information that are fabulous. So I really looked to those before I found out about the podcast, as well as just different content creators on Instagram, whether those were OTRS or codas, there are so many wonderful accounts I'll some of my favorites are, like, ot enlightenment, and there's sensory, which is not our field, but sensory, SLP, like, oh yeah, full information about that we can apply just to our field too. So those were kind of the big two that I would pull from.    Jayson Davies     Did you use any of like the Facebook groups or anything?    Dr. Taylor Poirier OTR/L     I personally don't really use Facebook, but I have, I have colleagues that do, and they love it, and they love being part of those groups, and they get a lot out of it.    Jayson Davies     Yeah, there's a lot. I mean, there is just an uncountable number of people in them. Okay, there you can count them. It's like 40,000 but, yeah, those are just really, really big groups, and there's a lot of knowledge in there. There's also a lot of them have a lot of shared resources in there, which can also be helpful. They're just kind of hard to find sometimes, but definitely helpful. So very cool. So then, when did you stumble upon the otschoolhouse about?    Dr. Taylor Poirier OTR/L     So I, as I kind of alluded to earlier, I travel out of my car. So I'll go to one school half the day, maybe another school, another and then I'm going to children's houses in the community. So all of my resources I had to have in my car. All the time spent commutes in the car. So I'm like, I gotta fill time. I can't just listen to music or sit in silence the whole time. So my first thought was like, let's see what kind of podcasts are out there. Let's see what ot resources for podcasts are available. And when I saw that there was a school based specific I was like, this is this is going to be fabulous. I can listen to this on my ride whether anything comes out of it a nugget or two, perfect. So then the more that I started listening. I'm like, oh my goodness, this is so much more than just a quick 30 minute throw on with my commutes or in between kids. This is continuing education. This is collaboration, and this is this is mentorship that's indirect. So once I found it, I have not stopped listening. I think I've listened to almost about every episode, about 150 or so, if you say it's definitely here to stay.    Jayson Davies     Wow. And now you're on the podcast. So full circle, right, right? Awesome, awesome. So, I mean, did you start at the beginning? Did you just start with, like, episode one? Or did was there a particular episode that kind of drew you in? And maybe, or maybe you don't remember that specific episode.    Dr. Taylor Poirier OTR/L     Yeah. So I I started, I scrolled through all of them, and was looking more so like, what's something I haven't thought of lately? Or what is something that you know? Oh my gosh, I'm seeing a lot of this in my case. So let me list tune in. And at that time, I was probably like, my gosh, maybe a month. Or less into my, you know, my time as a practicing OT. And there was an episode titled Introduction to primitive reflexes, and something in my brain unlocked, and was like, Oh my gosh, I completely forgot that this is something that we handle and what we do, because I'm not sure if any of your listeners also went to grad school in the prime of covid. So everything was online. I remember my primitive reflex course was on a stuffed sloth that I had bought in trying to elicit the Palmer reflex and the Babinski and the Morro, everything on, you know, a stuffed animal. So I was listening to this podcast, and as I was listening, I was like, this is the this is the component missing in my caseload. There was this part that I couldn't identify with, you know, our common tools and assessments, and that's what really drew me in, because now that's completely changed my practice in the sense that I now forever include a primitive reflex screening, and now I'm actually going above and beyond and doing the certified primitive reflex specialist course, because I found it was to be just so crucial in my school based practice.    Jayson Davies     Wow, wow. So, because we want to get into you know how, how other ot practitioners can can learn from different episodes, but that first time that you listened, I mean, were you able to walk away from that episode and start making changes to your practice right away.    Dr. Taylor Poirier OTR/L     Yes, absolutely. So it may seem you know at first glance like, oh my gosh, that's that's a little bit much. Maybe. How did you do that? But there were so many key reminders about just our education that we get as OTS that was enough to at least attempt a screening on a child or two the next day. You don't have to be perfect. You don't have you can trial an error. And that's definitely what I did, trying to put the kids in certain positions and try to identify the illicit reflexes and things. But it was enough to just get started and to kickstart that area of knowledge.    Jayson Davies     Yeah, and like you said, now you're working on the getting certified in it, and I think that's an important concept to remember with every single episode that we have here at the otschoolhouse com. Like we have a one hour interview with someone or a 45 minute interview with someone, and there's no way that it can be everything. And I think a lot of people want me to do more solo episodes, and I want to do more solo episodes. I really do, but especially in a healthcare field, especially in OT like none of us are an are an expert in everything, and so that's why we bring on these people. But even in that one hour interview, it's impossible to get through all of their knowledge to make everyone an expert that listened to this episode, and I think that that's really cool, that you were able to get enough to kind of get you started, and now you took that and you're like, Okay, I want more, and so you were able to find a way to go get more. So very cool.    Dr. Taylor Poirier OTR/L     Yeah. Thank you. And I think too, it's the podcast does such a great job of kind of opening your horizon of what the subjects are that you're listening into, and I think they're all that we have touched on in our education at some point, whether you know initial graduate level or degree and continuing education, but it just, it kind of helps remind us of what we're capable of. So I think it's, it's definitely a great place to start for people.     Jayson Davies     Yeah, so you mentioned listening in your car, and I'm sure you still listen to some episodes in your car and whatnot. But do you also, I guess my question is, like listening in your car, is that enough? Or do you feel like or maybe sometimes you do? Do you sit down at a table and listen with a notepad? Or how do you actually remember what you're listening to while driving between school and a and b?    Dr. Taylor Poirier OTR/L     Yeah. So I think it really depends. There's some podcasts that I kind of throw on as a refresher, almost, or kind of a revamp of some some knowledge before going seeing a kid, if it, you know, pertains particularly to them. But if I park I will quickly pull out my notes and do a little voice, text of tidbits, or an intervention idea that it gave me, or things that I can go back later and kind of work up whether that's creating a resource, adding it to a note, adding it to a report, things like that. And then there have been some other episodes that are very in depth, and they have so much information that you truly have to sit down and listen. And some of those kind of are like, there's an episode on autism strategies, an episode on handwriting research, there's an episode on trauma informed care, and so many others where it's really beneficial to sit down and just jot your notes. That way you have something very concrete. But I think there's a way to do it both, if you have a more photographic memory. I am not that person, but you can totally do it in your card by voice texting or doing it with pen and paper.    Jayson Davies     Yeah, and kind of add on to that, we're actually trying to help now, especially with the use of AI, we've had people ask us for transcripts of the episodes, and for a long time, that was just going to be like, honestly. Okay, it was too hard for us. It was costly. It required, like, you know, someone to sit down listen to the episode. And I had to kind of be someone who knew how to spell proprioception and vestibular and all those hard words that we used absolutely but now, but now we've got AI and so we are going back, and we're actually adding transcripts all the episodes. I know not everyone listens on Apple podcast, but Apple podcast is actually now transcribing every single podcast on Apple podcast, so we're trying to make it easier for everyone to kind of have that information in different ways. Because, like you said, not everyone learns the same way, and it's hard to sometimes listen to an hour long episode and remember what you actually listened to? So, yeah, good strategies. Okay, you mentioned a few episodes already, the primary one being the primitive reflexes of the episode. That kind of got you into it. But what have been some of the otschoolhouse com podcast episodes, or the topics even, because we've had some episodes, or some multiple episodes on a single topic that have had the biggest impact on your work in the schools?    Dr. Taylor Poirier OTR/L     Yes, so there have been, I believe, two to three, maybe even more, on goal, writing and documentation. I'm not sure if you know it's just me or there's other people out there listening, where documentation is just a beast in itself. You know, we spend all day working so hard with our clients, and our cognitive load is already so full. So the moment we go to sit down and get those onto paper, it's, for me, it's really, really tough to articulate exactly what I'm thinking. And so I've actually, after listening to those, I created a goal Bank, which, there's an episode, I believe, solely on creating a goal bank and what that looks like. So now I have this ongoing document of just goals that are measurable, that I've seen progress in tracking, that are developmentally appropriate, age appropriate, and can be individualized for each child. And so that's been really helpful. There's been episodes on talking about our roots and mental health. I completed my doctoral Capstone within the mental health realm. So everything that I do naturally within my sessions is very mental health based. So to hear, and like you have other people talking about how they incorporate mental health, and are we mental health? You know, practitioners and providers, it's very reassuring that knowing you know what I'm doing is is appropriate with our children, and it's a need. So that's been really, really helpful, too. And you know one more for you to fostering autonomy and child led therapy, that is a specific name of one of the episodes, and when I tell you that opened Pandora's box of neurodivergent affirming care, it's really changed the way that I go into sessions and the way that I view my kids. You know, I think sometimes we we kind of have a checklist in play when we go into our sessions, or when we go into a whether it's an IEP meeting or we go in to have a parent meeting or a teacher meeting. And you know, we have these things that we want the child to do because maybe it's more rooted in a neurotypical world. And so this has really led me to follow the child's lead and think with the child's perspective of what they're doing, being led by the child, whether that's play or toys, and even a coloring activity is it's has enriched my my sessions, and I think the progress and also the buy in of the child. So I would say those, those three main topics, have been absolutely incredible for my practice.     Jayson Davies     Wow, it's into, I don't know, from from the host perspective, from my perspective, it's like so weird to actually hear these things from you, because these are episodes that I put together and, you know, I put them out into the world, and then I never actually hear from a lot of people like how it's impacting them. And so just to hear, you know, three different ways that you've taken a handful of our episodes and put them into practice. It's just quite amazing. So thank you. Let's talk about others. Let's talk about the OT practitioners who are listening today. And like I mentioned earlier, you're you're probably not the only one who has listened to episodes and maybe been a little bit overwhelmed or or didn't quite catch everything. And so do you have some strategies for those listening today that maybe they can put into practice as they listen to help them as they move forward.    Dr. Taylor Poirier OTR/L     Yeah, absolutely. So when you because you can listen to a podcast and be like, Oh, I listened. It was fabulous, but you don't gain anything from it, and you feel like you can apply it, it's, it's difficult to, you know, kind of carry on. So I think, first off, find an episode that you are really passionate about, and you already have some baseline knowledge, because maybe it'll, it'll show you a different perspective. So while you're listening, you can voice, text the notes, just one or two little tidbits, and start small. And then go into your next child and and try to apply that. I think something key is the fear of trial and error, something that I had to learn, and I think all of us learn, you know, throughout our days, is we can't be afraid of the afraid of the trial and error, because just because something doesn't work for one child doesn't mean that it doesn't work across the board. So I think having that in your mind when you're listening is a great kind of tidbit to move forward. I think look for available resources already based off of the episode that you're listening to. A lot of the times, the show notes have wonderful information. Use those show notes. I know I have, and I've reached out to other you know, practitioners that have been on the podcast and attempted to connect with them, and that's even something else that you can do to apply your practice. If you have a question about something that you heard or you'd say you really would like to collaborate with them in some sort of way or pick their brain. OT, is such a small field. I feel like we hear that a lot. There's somebody that knows somebody who also knows the same person. We're very connected, and so don't be afraid to connect with the people that you're listening to as well, because I think that'll also help your understanding of what you're listening to, and also help grow your practice too. Because then that's kind of that's a building a community that's maybe virtual, but still very impactful.    Jayson Davies     Yeah, absolutely. I, I constantly am, like telling people, like they'll reach out to me and ask me about something on the podcast. I'm like to be honest, the person on the podcast said you could reach out to them. I highly recommend that you reach out to them, because, like you said, the OT world is small. Like, none of us got into ot to be Mr. Mrs. Bigwig, like, I'm too good for everyone, every single person that that we have on as a guest is always open and always sometimes I'll like, I'll send an introductory email, like, between the two people, the listener and the person on the podcast. And they're always so appreciative that, oh, thank you for connecting me with this person. And then the next thing I know, they're doing Doctor work together, something like that. It's just, it's really cool to see where things are going between people who listen and the people that are actually on the podcast. So, yeah, any other strategies for people that are listening and kind of just trying to implement,    Dr. Taylor Poirier OTR/L     yeah, I think staying organized while you're listening to the podcast. I know our brains run a million miles a minute, and there's always so many thoughts, and, you know, to do lists popping up in our head, but being able to, you know, if this is your time, to really invest in your work and invest in your career and your kids, take the time to find an organization system with it, whether that's, you know, podcast episodes, so and so on your notes, or you have a little journal that you keep in your car. If you're listening at home and you have that little space, organization will be key, and then you can keep track of it, and then you have that information forever. And it's not like it went in your one ear and then out the other, it's with you forever.     Jayson Davies     Yeah, do you ever find yourself listening to, like, the same episode over and over and over?    Dr. Taylor Poirier OTR/L     there's one or two that is just so good. And I'm like, I'm gonna write that down, and then I go see my next kid, and I'm like, Oh, what am I gonna listen to? Oh, my gosh, this would be a good one. I have to admit, not perfect. Every time I listen, I have those same days too. But sometimes info is just so good, you gotta hear it twice.    Jayson Davies     Yeah, I mean, there's definitely some. So I can't stand hearing my own voice. I will be the first to tell you that, and so I don't go back and re listen to episode of the OT school house, but I have my own personal podcast that I'm very interested in. And with otschoolhouse com, a lot of the way that I learned how to start the otschoolhouse with business was through episodes. And there were definitely some episodes that I would like favorite, and I would go back and listen to them, not just not because I forgot what was in it or anything, but for the sole purpose of maybe either A, when I listened to it, I wasn't ready at the time, and so I knew when I would be ready for it, and when I was ready for it, I'd go back and listen to it, or b Maybe it just, I felt good when I listened to it, and so I kind of just put that into my mind, hey, this one episode, it's just like, it's got some positive vibes. And so I'm going to keep that one on my list so that I can go back and listen to it later. So yeah, just kind of why I brought that one up. But yeah.    Dr. Taylor Poirier OTR/L     yeah, absolutely. And I feel like, so now that you say that, I think the episode that kind of is the same for me, has to relate to the Kawa model and teachers. I think, you know, there's us and teachers, we it could be a love hate relationship, just trying to get supports in and trying to understand their schedules, or just scheduling in general. And that episode really just kind of brings me back to the teachers are truly our biggest fans when it comes to what we're able to do for their student, because their whole goal is to get that student to learn and participate and be functional within their space as well. So the Kawa model, and how it relates to OT, I think, is definitely one I listened to, and I'm like, Yeah, we got to give our teachers a little bit more. Grace. We got to give a little bit more grace, maybe during that IEP meeting to just to make sure we're all on the same page and we're all understanding everyone's perspective. So I absolutely agree with you.    Jayson Davies     Yeah, yeah. And kind of tagging along that's a perfect segue for this advocacy on the podcast, we've often discussed advocating for yourself and you're in a, I wouldn't say unique. You know, there's other OTs, other ot practitioners in a similar situation to you, where you're contracted, you've got some time in the schools, time outside the schools, but we've often talked about advocating, and, you know, understanding your role, helping others to understand the OT role, or even expand our scope in the school setting. And have you been able to take that and kind of apply it to your practice at all?    Dr. Taylor Poirier OTR/L     Yes. So funny enough. You know, the biggest question is, what is ot what is it? I don't understand what you do. You do it. I thought that was for, you know, people who had strokes, and how are you going to help my child? Is it just handwriting? I think that's a train of thought a lot of us get a lot of the time. And I think the podcast has made me more confident and knowledgeable about just what we do, as well as if we are not currently in a space, there's ways that we can advocate for ourselves to be in that space. And so specifically with my schools, there's there's been times where it hasn't been understood why ot should be involved in maybe specials or extracurricular activities at the schools. And so I've been able to hold meetings and advocate why behaviorally sensory and provide these, these tools and strategies to teachers who have teachers and, you know, volunteers at the schools who have no concept of what that means, but they see the children struggle. So I that's a really unique opportunity that I've, I've had within my schools, as well as, you know, creating a different, what's the right word, maybe a different perspective on the children that receive support services, being able to collaborate with teachers and bring them into what the child needs and how their space is impacting not only the teacher but the child. Because we all know co regulation, if the teachers are dysregulated, so is the child. So I've, I've made some really great connections at my schools, and I think because of that connection and my willingness to educate and advocate for OT. But also, my child has kind of created a different realm of OT on these campuses. So I, you know, you can always advocate for yourself. And, you know, making the connections is a really a big part of that as well.     Jayson Davies     Yeah, yeah, you've mentioned some of the resources that like, because we do with the show notes if, if a speaker makes something available to us, whether it be a handout, whether it be a list of resources that they have, whatever it might be, we'll often put it on the show notes at otschoolhouse com, slash episode, and then the number, who knows there might be something there with this episode with Taylor, I'm trying to get her to convince a Spotify playlist for us. We'll see if it happens. But you mentioned those earlier, and have you ever actually used those to help you to describe what OT is, or use those as a resource to help you to help a teacher understand how you can better support a student?     Dr. Taylor Poirier OTR/L     Yes, absolutely. So I know there's some specific episodes that have their own understanding of OT that, you know, provide little handouts, or there's like tidbits in the podcast episodes that give kind of their elevator speech. So I've definitely come to refine my own and having that kind of like in my back pocket anytime someone's ready to ask me. But when it comes to resources to, you know, we there was episode on zones of regulation, and so they have, you know, 1,000,001 free resources on their website. And so I was able to take that and apply it with my kids. But what led me from that was I had some kids that were having a really hard time understanding the concept of being a color that abstract thought was just it was really missing with them. So having that basis knowledge of these resources, I'd be able to create my own. So I kind of have a blended behavior, silly scale, that still uses colors as an option, but with words and bringing the child into that to identify their behaviors and appropriate spaces as well as, you know, all of their handwriting episodes. There's so many different ones about using, you know, writing on black paper with chalk, and how that provides a completely different contrast for the brain, and how to apply it. And so I've done that with creating my own handwriting checklist with grocer movements to, you know, evolve the type of learning, a multi sensory learning approach. So there's so many opportunities to identify the resources, but as well as taking them and individualizing them for either your caseload or specific children who would benefit from it, but they need some tweaks for themselves.    Jayson Davies     Yeah, wow, that's really cool. Again. Just kind of, for me, it's like an out of body experience, hearing people talk about the podcast in this way. But yeah, so collaboration, this is always a topic that that's difficult. I think all of us want to collaborate more, but it is very difficult because collaboration is a two way street, right? Like we can't just make a decision to collaborate, we have to have other people who also want to collaborate with us, whether it be teachers, administrators, parents. I know you also work with parents, because you're not just in the schools, but yeah, what are, what are a few tips that you've heard over the episodes to help you kind of with this collaboration process.    Dr. Taylor Poirier OTR/L     So one thing when it comes to collaboration is that you have to meet the other person on their level, if they are another provider, what do they know about ot have they ever collaborated with occupational therapists before? Do you guys have the same goals based off what your you know what your child and your case looks like with parents? Are parents 100% on board with the diagnosis that their child was given, or with the supports that they need? Do they understand what their child is experiencing, getting on their level first, and establishing a baseline and building that rapport with them, just like we do we're kids, I would say, is step one. If you don't have that any type of information or adjustment or need that you throw on them is not going to be reciprocated in the way that we may think it is. Yeah, so once, once you've kind of established that, you know, sort of baseline, I think, trying to have a meeting with them of some sorts, or just through email, I know that's so hard with everyone's schedules, and you know, everyone's caseload is different, but, you know, really identifying what that looks like for each other and then testing it out. Maybe you do, you know, a co treating type session together and it doesn't go right. Awesome. Regroup. Trial error is the same way as it comes with collaboration. I know I'm really lucky, and my the owner of my company, Alyssa, she's a speech language pathologist. So her and I actually get to co treat fairly often on our sessions with our kids, who we share. And I think the first one, in my perspective, it was crash and burn, because that was the first time as a true practicing ot what I needed to do, trying to help her goals, trying to maintain mine. And I think the more that we've done it, and the more that we felt comfortable identifying our common ground, the better our sessions have been, and the better the progress has been for our kids.     Jayson Davies     Yeah, absolutely. I love it. I love it. I kind of want to back away from the podcast just a little bit, because you do. You're a new school based OT, but you're not a new school based OT. You've got a year and a half, you've done a lot of research, you've learned a lot in the last 18 months or so. And so I do just want to give you an opportunity, especially right now. This episode is coming out in September. I believe there's a lot of people starting their first month, their first two months, in the school based system. And so what are just a few tips you have in general for brand new school based ot practitioners?    Dr. Taylor Poirier OTR/L     Absolutely so first off, welcome, welcome to the craziness that is otschool based, you know, but my top three, first one, seek out mentorship, whether that is past employees. That is past co workers, current co workers. You know, external ways like this, podcast, Facebook, groups, Instagram, anything. Find something that you can bounce ideas off of or absorb, because imposter syndrome runs rampant in our field. And you know, we'd say, maybe all of healthcare, I know for myself, that was one thing I needed. Because there's days where I'm like, Oh my gosh, did I ever learn this? Am I even? Do I even, am I even certified? Knowing that's not the case, obviously I am, and I'm practicing. It's you need to feel grounded in that, because your education is valuable, your experience is valuable, and the way that you're being a therapist is valuable. So seek out mentorship any way that you can. You know another tip is trial and error. I know I've mentioned it several times throughout this episode, but I can't emphasize it enough, especially being so new, we see all these opportunities. We see all these resources and tools. And if we apply it once and it didn't go great, don't count it out. Try it again with a different student. Approach it in a different way. We are so brilliant when it comes to activity analysis, use that and trial and error through all of those processes, whether it's games, ideas, assessments, screenings, you name it, trial and error, will be your best friend, because that's the only way that you you can truly learn my last one. Get back into play. Don't get caught up in all of the the task to do, lists, whether that's the documentation, the writing, the meetings when you're with your child, you. Play in the school setting, children can still learn through play in any way that may look like to them. You can always incorporate academic components, or maybe that's handwriting, or whatever it is that you're trying to accomplish with them. Children learn best through multi sensory and play, and so don't forget that at the root, that's what you're able to do?    Jayson Davies     Yeah, Yeah. I love those. All great ones and, and that second one that you mentioned where, you know, don't be afraid to make mistakes, like we're going to make mistakes. You can't not make mistakes. You are human. But as you were talking about that one, something popped into my head, kind of taking this back to the podcast again. But have there been any episodes where you almost have, like, shiny object syndrome from for it where, like, maybe the maybe the episode was just awesome. It was, like, some great stuff, but right now wasn't the right time for you to go down that path, or right now maybe it didn't apply to your situation, even though you loved every second of it, and the guest was amazing. Have you experienced that? And if so, kind of, how did you deal with it? Potentially?    Dr. Taylor Poirier OTR/L     Yeah, absolutely. So there, there's been a few, there's, you know, there's episodes talking about dysgraphia and supports, and that one specifically, I currently don't have any children with dysgraphia or diagnosed dysgraphia on my caseload, but to me, I'm like, Oh, this is so amazing. What if all of my kids have it and they're just not diagnosed, and that's not my that's not within my scope. But I'm like, This is so amazing. And I think that's just kind of a nugget that I have in my back pocket for a time where I'm going to be working on a handwriting activity, or we're reading something, and I'm going to be like, Huh? Let me pull out some of these supports that I once learned and let me apply it then. So that's definitely a back pocket episode.    Jayson Davies     Awesome, awesome. All right, I've got a last few questions here, and we're gonna have a little bit of fun, especially with this next one. You've listened to a lot of episodes you mentioned. What is one episode we haven't had that you wish we did have?    Dr. Taylor Poirier OTR/L     Interesting I would love if there was an episode about, you know, someone from the ABA realm and an OT who are actively collaborating together within The schools. I think that would be such a beneficial episode for both parties to understand how we can work together and how we can transition our minds and our strategies and our language to be very neurodivergent affirming. I think that's something that would be a very, very impactful episode.    Jayson Davies     I love that you chose, like, the hardest potential episode to choose. Like, I can't make that happen overnight, no. But we did have an ABA therapist on a long time ago. Gosh, I'm blanking on his name even. But you threw in the extra component of how an ABA therapist and an OT or an OT practitioner are collaborating, that is a good one. And I know there are some that are doing it. I have a few people that are even coming to mind, but yeah, I think that'd be a great episode. And not just for the How to practical part of it, but as you kind of alluded to. I think it would be great for both professions in general, like, there is a lot of, I'll just be very frank here. There's a lot of animosity between the two. Everyone knows it. No one's saying there isn't, unless you're in front of the other professional. But, yeah, I think that would be a great topic. Thanks for sharing that. We'll have to. We'll have to work on that. And then I want to go back. I wrote down, as you were talking earlier, you mentioned the primitive reflex episode and then how it's leading to taking additional coursework on that. And as you were talking, I kind of jotted this down. I wanted to know kind of how you went from listening to the episode to then researching and choosing a program, because there, I mean, we can talk about anything on the podcast, but there's 18 different programs out there for just about every single thing under the sun, right? So, I mean, sensory is a great example of that. There's like, three or four different primary sensory courses that that people know of. But how did you go about deciding which one you wanted to take and go about taking that one.    Dr. Taylor Poirier OTR/L     Yeah. So I when I was researching, you know, different courses or continuing education opportunities, specifically for prone to reflexes, I mean, there was 1,000,001 options, yeah, to kind of see a theme with them, that they were either all like only OTs, only, you know physical therapy, or, you know, a hard sensory behavior lens on it, which is a, obviously a component. But when it came to choosing my specific course, it incorporates OTS. Neurology, sensory behavior and trauma, informed care. And to me, you know, once researching it, that's really what it encompasses. It, it's a really holistic view of primitive reflexes. So I wanted a very broad view, and not just from one specific lens, because I think we there's a lot to learn from, you know, neurology and psychology and physical therapy, and we have the ability to kind of encompass all of that. So that's what I thought would be the best actually, Dr I believe she goes by Lyons now, but verlicia Gibbs lions, yep, yes, she was at our back to school conference, and she's actually the OT that that does that, course, along with Karen Pryor, the physical therapist. So it's a wonderful course, if anyone's interested.    Jayson Davies     Is that the is that the pessi one, or is it a different pessi? Okay, well, we'll be sure to link to it in the show notes, so that we can get anyone interested access to that. Very cool. All right, as we start to wrap this up here, I'm curious, and maybe others are curious as well. But you have been a school based ot practitioner for 18 months now. You've done a lot already. I mean, you're using the podcast to do things. You're taking a primitive reflex. Course, it seems like you're kind of moving forward. What are some goals that you have in your ot career? Just kind of things that you're interested Do you want to one day own a business? Do you want to stay in the schools forever? What? What are you thinking?    Dr. Taylor Poirier OTR/L     Yeah. So I, even before grad school, I worked as a sensory motor aid for an outpatient pediatric clinic, and the woman that owned her practice, I was enamored with. I loved everything about the way she ran the business. When she was kind of teaching me the back end, and I was like, I am going to own my own business one day, and it's going to be amazing. And now that I'm I'm in the school system, and I have this beautiful mix of, you know, school, home and community, I feel like I just want to progress the company that I'm with and find something specific in the schools that I can almost create a alternative look to treatment from what I mean by that is kind of, it doesn't have to be in a room. Let's get us out on the campus. What can we do for the campus? How can we help admin? How can we kind of elaborate that so kind of expanding more. So what school based ot looks like is really my long term goal.    Jayson Davies     I love it. I love that. And, and I'm sure you've already listened to the episode, but get in contact with Sue basic. Sue basic is she's got programs, but I think that a lot of people who are implementing her programs are putting their own spin on it. And I think that's really cool, you know, it's things are designed to evolve, right? Well, what was great yesterday may not be great tomorrow, or it may still be great, but in a slightly different way. And I think that that is something that I've said a lot, is just, you know, don't, don't do something, especially when you get a brand new job at a school, don't continue doing something that has always been done at the school for the sole purpose that that's the way they did it, right? Like if you walk in and the caseload is 30 kids one time a week, 30 minutes pull out. That doesn't mean that you have to have 30 kids one time a week, 30 minutes pull out. Next year, you could have 15 kids, push in, 15 kids, pull out. You can do whatever you want so far or so, be it, as long as you are doing best by the children. So I love your idea of kind of doing things a little bit differently, right, to support others. So very cool. All right. To wrap this up, is there anything else you know you shared a lot of very helpful tips today, but is there anything else you'd like to share with our listeners, just in general about school based occupational therapy.    Dr. Taylor Poirier OTR/L     Yeah, school based OT is, is fabulous. I feel like we get, I mean, we're in the nitty gritty with our kids when their main occupation at this stage of life is their education and playing, and we have the beautiful opportunity to blend both of them as well as engage with the people that spend 99% of the time with them, their teachers, their extracurricular activity, teachers and their parents. And you've entered a beautiful space, and you have this beautiful resource at the podcast. If you're listening even only to this one, go check out all the other ones and all the beautiful resources and feel confident in what you're doing. You have earned it. You've earned your degree, you've earned the job that you're in, and you've earned the space to advocate for yourself and for your kids. So don't let the tough days dictate you know the career ahead of you.    Jayson Davies     I love it. I love it. And we like to say, a lot of us as ot practitioners, the like play is my favorite occupation, and we work on a lot of play in school based OT, but a lot of times when we do that, I feel like it's very one on one play based. And I think in a lot of ways that you're talking about it today is, you know, getting away from just the one on one play and just really facilitating play. At a larger level, and making sure that all kids have access to play, and that teachers understand the importance of play on their academic achievement over time. And I think that's just fantastic. So Taylor, thank you so much. We really appreciate it. And before I let you go, what is the best way for anyone to learn more about yourself?    Dr. Taylor Poirier OTR/L     Yes, so I have a Instagram account that's ot related. My username is Dr Taylor, underscore, OT. I It's newer, but I will be loading it up with information. Day in the Life, says an OT, all of that fun stuff. And I'd love to connect with you guys on there as well as a I have a teacher pay teacher account. So the username for that, and I believe all this stuff will be in the show notes as well, if you're not near, something to write down, but it's a CT therapies. I have my resources that I've created by listening from the podcast, as well as a intervention activity for you guys on there as well.     Jayson Davies     Awesome. Well, you can find her on Instagram. You can find her on TPT, and we will definitely link to that. Taylor, thank you so much for two things. One, reaching out and kind of just bringing this eye opening idea to the podcast, you know, just coming on here to talk about how to use the podcast to learn. I think that is just a great idea. I'm glad we did this, and I I'm glad that you were the one to to bring it up and to be on this episode. So we really appreciate you being here today.    Dr. Taylor Poirier OTR/L     Yes. Thank you so much for creating the space, having this podcast and these platforms, and for for having me on. I had a great time, and I hope everyone else gains at least something from it. I know talking and Chitty chat with you, it definitely has the ball rolling in my in my head for ideas. So thank you so much.     Jayson Davies     Awesome. Thank you, one more time, a big thank you to Taylor for sharing her knowledge with all of us. It is exciting to hear how she is using the podcast episodes to her advantage and implementing so many great practices within her role as a school based occupational therapist. If you're interested in checking out Taylor's playlist that I teased about a little bit during that episode. You can check it out within the show notes, we actually put together an entire Taylor's playlist of otschoolhouse com podcast episodes, and you can find that over at the show notes, at otschoolhouse com slash Episode 159, also on the show notes, you can learn more about Taylor and how she is supporting school based ot practitioners through resources on teachers, pay teachers. One other thing, if you're looking for a group of school based occupational therapy practitioners to learn, collaborate and share resources with, be sure to check out the otschoolhouse com collaborative. The otschoolhouse com collaborative is the go to online community where school based ot practitioners learn together with aota approved CEU courses, support one another through live and Asynchronous means, and share goals, research and other helpful resources. Not to forget, members of the collaborative can also earn professional development hours for listening to the otschoolhouse Comcast, plus it's the only place where I consistently go online and regularly answer ot practitioners questions. So if you'd like my support and the support of 200 other school based ot practitioners, be sure to check out the otschoolhouse com collaborative at otschoolhouse com slash collab. I hope to see you there. Thanks again for tuning in, and we'll see you next time on the otschoolhouse com podcast.    Amazing Narrator     Thank you for listening to the otschoolhouse 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.  Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts , Google Podcast , Spotify , or wherever you listen to podcasts. Click here to view more episodes of the OT Schoolhouse Podcast

As school-based occupational OT practitioners, we rely on a variety of tools to assess our students’ needs and guide our interventions. Among these, standardized assessment tools hold a special place, offering a consistent way to gather data, develop IEP goals, and track progress. Tools like the Sensory Processing Measure (SPM)  and the Bruininks-Oseretsky Test of Motor Proficiency (BOT)  are well-known options that many practitioners turn to for a structured approach to student evaluation. But just like any tool, these assessments aren’t set in stone. The recent release of the SPM-2  in 2021 and the current (summer 2024) launch of the BOT-3  remind us that updates are part of keeping our practices aligned with the latest research and student needs. And while I know some of you are eager to get your hands on the newest tools, others may have different feelings. In this article, we’ll explore: Why standardized tools are periodically updated Why some may not be Whether or not you need to update to the newest tools How to thoughtfully transition when an update occurs. And the possible ramifications to using an older assessment Whether you’re an advocate of standardized assessments or prefer to rely on your keen observations and less structured tools, understanding the “how” and “why” of these updates ensures you can make informed choices about the tools you use in your practice. Why Are OT Assessment Tools Updated? Standardized assessment tools are periodically updated to reflect advancements in research and technology, better serve the populations we assess, and enhance their practical use. The Sensory Processing Measure (SPM) , originally released in 2007 and updated in 2021 as the SPM-2 , is a prime example of how assessments evolve to align with current research and practices in sensory processing. Similarly, the Bruininks-Oseretsky Test of Motor Proficiency (BOT) , which is currently releasing its third edition here in the summer of 2024, introduces several important updates to improve its utility. The update for the  BOT-3 was designed to optimize test administration and improve scoring. New items were added to address floor and ceiling effects, the quality of test equipment was improved, and the coverage of both fine and gross motor items was expanded. The BOT-3 also includes new supplemental scores, updated normative data, and an extension of test norms to age 25, making it a more comprehensive and versatile tool for practitioners working with young adults. Updates like these ensure that the assessments we often rely on are as accurate, valid, and relevant as possible. They allow us to account for changes in population demographics, address gaps in the original test design, and incorporate advancements in both research and technology. Why Some Tools Are Not Updated While assessments like the SPM  and BOT  receive regular updates, others, such as the School Function Assessment (SFA) and the Sensory Integration and Praxis Tests (SIPT) , have remained unchanged for years. 🙄 This can happen for various reasons. Often, the resources required to update an assessment are considerable, and if the tool serves a smaller or more specialized role, updates may not be prioritized. Additionally, newer tools may emerge that fulfill similar purposes, gradually shifting practitioners away from older assessments. We are seeing this happen right now as the Evaluation in Ayres Sensory Integration (EASI) and the Structured Observations of Sensory Integration – Motor (SOSI-M) replace the SIPT Even without updates, some of these older tools can still hold value for specific cases, especially when practitioners have experience with them and find them effective within their practice. Enhance writing skills and progress monitoring for all students! In this course, Bridgette Nicholson shares how you can quickly and easily assess the written expreseeion of any student with the Online Assessment of Writing Methods. Access this course and more when you join the OT Schoolhouse Collaborative today! Why or Why Not Update to the New Assessment When a new version of an assessment tool is released, school-based OT practitioners are often faced with a critical decision: should I update to the latest version? While there are many advantages to transitioning to the most recent edition, it’s not always a requirement, and the choice depends on a variety of factors. First, consider whether your school or district mandates the use of the latest version. Unless you ask, you may never know if this is the case in your district. Some districts might require updates to ensure assessments align with current best practices, while others might allow for more flexibility. In some cases, there may not be a strict timeline for switching over, so you may have to advocate for why you think your department needs the updated assessment. Another important factor is the nature of the updates themselves. If the new version addresses significant gaps in the previous edition—such as improved scoring, expanded range of items, or better representation of the population you serve—then updating may offer more accurate data and better support your decision-making. For example, the BOT-3  now includes expanded fine and gross motor items and extends test norms to age 25, making it more versatile than the BOT-2  for a wider range of students. So, if you have been trying to find a tool to use with your young adults, then it may be worth upgrading sooner than later. However, if the updates are minimal or if you feel confident that the older version still meets the needs of your students, you might opt to continue using the older edition, particularly if you have a well-established process in place. Just be mindful of any differences in norms or scoring that could impact the validity of the results over time. Ultimately, updating to the latest assessment tool is a decision that depends on the needs of your practice, the requirements of your district, and the advantages offered by the new version. While staying up to date ensures you’re aligned with the latest research, there may be cases where sticking with the older version is still a valid choice. Click here to read what Pearson has to say about this.
How to Transition to a Newer Version Transitioning to a new version of an assessment tool can be done smoothly with the right plan in place. Below are some practical steps to help guide you through the process: Familiarize Yourself with the Updates and Necessary Training Start by learning about the key differences between the old and new versions of the tool. This could include changes in content, scoring systems (going digital is in right now with new tools), and how data is interpreted. It’s also important to find out if there’s a recommended date by which you should be using the updated tool—or if it’s entirely up to you. Most publishers offer comparison guides, training workshops, or webinars that will help you get up to speed on the new version. Pearson has both free and paid training opportunities related to the BOT-3. Click here for the free BOT-3 training . Create a Transition Plan with Stakeholders It’s essential to have a plan in place before switching to the new tool. Decide on a timeline for the transition. You may opt to transition at a natural school break, or perhaps you just wait until you run out of the older protocols. Either way, make sure you order the new tools ahead of time and schedule any necessary training for yourself or your team well before the transition date. Collaborating with your team and administrators ensures everyone is on board with the plan. Decide If Older Tools Can Still Be Used in Some Capacity Some older tools, especially those with physical components like the BOT-2 , may still be useful in certain situations. However, it’s crucial that these materials don’t interfere with the standardization of the new tool. For instance, the BOT -2 pennies, mat, and red basket can still be used for other therapy activities, but maybe you don't use them in the same way that you would while giving the BOT. By following these steps, you can ensure a smooth transition to the updated assessment tool, making sure you have the proper knowledge and resources in place for a seamless switch. Potential Ramifications of Not Using an Updated Assessment Failing to upgrade to the latest version of an assessment tool can have consequences. Outdated tools may not reflect current research or population norms, which can lead to less reliable or valid data when assessing students. This could affect the quality of intervention plans and the appropriateness of IEP goals, potentially causing interventions to be less effective. Additionally, parents and student advocates may question the validity  of results from an outdated assessment. Using an older version might give the impression that the assessment is not aligned with current best practices, which could raise concerns about the fairness and accuracy of the evaluation. These challenges may lead to disputes or delays in getting students the support they need. Finally, using older assessments could result in non-compliance with district or state policies , especially if your school or district has adopted newer tools. This could impact your credibility as a practitioner and may complicate your ability to advocate for resources or support for your students. The Wrapup Whether you’re someone who frequently relies on standardized assessments or prefers a more flexible approach, staying informed about updates to key tools is an essential part of maintaining best practices in school-based occupational therapy. Transitioning to new versions of these assessments might take some planning and adjustment, but it ultimately ensures that you’re providing students with the most accurate and up-to-date evaluations possible. If you know that your state, district, or school has policies, or even just expectations for using the most up-to-date tools, then you can refer to those policies when requesting that your district purchase the updated tool. As new tools and updates continue to emerge, be sure to take the time to review the changes, plan your transitions, and engage in any necessary training. It’s all part of evolving alongside the needs of our students and the advancements in our field. . Resources SPM-2 examples and videos from WPS Pearson's guide on when to update An overview of standardized assessments from AOTA BOT-3 training and other resources OT created template for the BOT-3  (From Schoodles) Watch this video on pairing the BOT-3 with the Schoodles Fine Motor Assessment