OT beyond the handwriting
===

Meredith: [00:00:00] We are demystifying the world of fine, motor skills, sensory integration, and school-based support. Grab your cup of coffee 'cause today we're gonna be joined by the Douglas County Occupational Lead to help us make sense of it all. Welcome back to Special Ed IEPs, five oh fours.

Oh my Conversations with DCSEAC. Today we are joined by the occupational therapist lead for our district Patty Kreinbrink. ~And ~Patty, would you like to tell us ~a little bit ~about yourself and your role? 

Patty: Yeah. ~So, um, like I said, like you said, ~my name's Patty. I am a native of Colorado. I have been an OT for, ~oh my gosh, I think ~29 years.

All but five of those have been in based practice. ~Um, ~I was in another district for 16 before I came here, ~uh, ~returned to Douglas County ~just as an. ~Until the opportunity came up for the leadership role again, which I had in another district, and it's ~just ~such a great fit for me. ~Um, ~I love this work. I love what we do, but I also love teaching training and [00:01:00] mentoring others.

~And ~we've grown a really incredible staff here in Douglas County, in my opinion, the best OTs ~than you know ~in any other district. ~So ~I'm really proud of our staff and ~I'm proud of ~the work we do for kids with special needs, ~um, ~and their ability to participate and function as a student. 

Meredith: ~I love that. So ~most parents see OT on an IEP and think handwriting.

Can you pull back the curtain on what else you're looking at? What are the invisible things that OT does in the classroom? 

Patty: ~Yeah, so that is a great question and ~that is the one that ~comes off, ~comes up the most. ~Um, ~it's ~definitely ~the most visible part of what we do. ~Um, ~but honestly, it's often the smallest piece.

~And ~remember that OTs don't necessarily ~like quote unquote ~teach handwriting, ~um, ~because we're not teachers, but we do support the motor components of writing, like posture, hand strength, core strength, bilateral skills ~in ~hand manipulation. A school OT is really looking at how a student participates in their entire school day.

That includes ~things like ~posture, core strength, ~um, ~sitting upright, ~um, ~classroom [00:02:00] routines, attention regulation, how materials are managed, independence, ~all of those things. Um, ~think of all the occupations a student has that may limit their ability to access and participate. A lot of our work is ~actually ~indirect ~as well, um, ~which can be ~one of the most ~valuable ~service delivery options.~

~Even then direct services because ~that involves coaching teachers modifying tasks, adjusting seating, changing expectations, ~so, ~so the student can succeed, ~um, ~without needing ~that ~constant adult support. ~So. When an ~when OT is working well, you often don't even notice it because the classroom ~just ~runs smoother and that student is able to access and participate in all aspects of their school day.

Meredith: I like that the core strength was something, ~a moment ~when my son was in kindergarten, ~that was something ~they were working on. ~I'm like, who knew? ~Core strength was part of handwriting ~and like working on that. ~So ~that was something ~that was really interesting to me. ~That ~that piece that goes into holding a pencil.

Patty: ~Yes, yes. Everything, ~every functional movement pattern starts with the core and sometimes we forget that. ~So really important to ~focus on that core first because you need that. Core proximal stability before ~you can have ~[00:03:00] distal fingertip mobility and function. 

Meredith: ~That's always so fascinating. ~So we also hear the term sensory processing.

How does OT distinguish between a student who is misbehaving and ~then ~a student whose engine is ~just ~running too high for the room? 

Patty: Another big topic ~for sure that we talk about all the time. In fact, ~I was just talking one of my directors about this. ~Um, so. ~Just like the behavior team, the autism team, school psychologists, we ~also ~look at function of the behavior instead of asking, ~um, ~is this child misbehaving or is it just sensory?

We ~often ~ask, what is the behavior communicating ~and, ~and then ~of course, ~working alongside the behavior specialist, autism specialist, school psychologist, mental health team, school admin. ~I, ~I think sensory is a safe word, and ~I think ~it feels ~good and better ~sometimes to call it sensory than other things, but ~super ~important to ~really ~find the root cause of what's going on.

~Um, ~if a student ~sense ~sensory system is overwhelmed or, ~uh, ~under activated or overactivated, their nervous system may ~literally ~[00:04:00] not be ready for learning. ~Um, so ~sometimes a child who's constantly moving might be trying to stay, ~um, ~alert ~when a or, ~or a child who is shutting down might be overloaded. ~So.~

~Really ~we'd look for patterns. ~Like ~when it happens, what's happening in the environment? ~Is it, you know, ~is it a certain time of the day? ~If it's, ~if it's always just during math and no other times of the day, we know it's probably not sensory, it's more of an escape. ~Um, so, and ~typically those sensory sensitivities happen regardless of what class they're in or environment they're in.

~It's more consistent and it. ~Sensory types of behaviors, ~um, ~they're ~just more or ~more obvious and we would know if something is working, if a sensory tool is used proactively. ~So. ~It's the only way those tools and strategies work. ~For instance, if we, um, if they're, um, ~if a child is ~just ~melting and shutting down and we decide, well, let's try some sensory tools, and we might put a compression vest on a student for 30 minutes, ~um, ~that kind of input stays in the system for up to an hour and a half.

~So ~after the child wears that. We [00:05:00] see a difference for a good hour and a half, then we know it's probably a sensory need and maybe they need ~some ~additional proprioceptive heavy work input. ~Um, ~but if a child is given a sensory tool, ~um, ~after behavior and it stops the behavior, then we know, ~um, ~it's probably not sensory.

They're using that as ~like ~a regulation tool, ~which is great. ~So it's still a puzzle. ~And ~it's really about teamwork and ~really ~looking at root cause. 

Meredith: Is there a difference ~then ~from ~like ~the sensory input, like you ~just ~said, ~like ~they put the vest on and ~then it, ~they were okay, versus ~like ~wearing the vest and ~then ~they were good to go.

Patty: ~Correct. Yes. And of course, you know, any, ~anything we put on a student, we would always get parent permission ~things. But yeah, ~if, ~I mean, and it could be the opposite. ~We put the vest on and we don't see a difference, probably not sensory.

~So, and ~there's a pretty strict wearing schedule ~for some, for some of those, you know, ~sensory needs. ~So, but sensory thinking of ~sensory ~as those ~tools need to be used proactively versus reactively. If they're used reactively, then they're used as a reward. ~Um. And so ~we're ~really ~trying to change the language to, ~um, like ~regulation ~versus three ~because so often the, ~the, um, ~words are thrown around and they're ~so ~[00:06:00] very different ~and really.~

It's sort of like an umbrella, like a student could have, ~um, ~autism or they could have ADHD. And then there's other things that fall underneath that category. Some sensory sensitivities, some ~um, ~anxiety. So ~it's sometimes ~it's really hard to tease out what is what, and sometimes it's a little of everything.

So that's where ~like ~a really strong team, ~um, ~and teamwork comes in. Really handy and is just so important. 

Meredith: So you're working with ~like ~the counselors who are doing ~like ~the tier one and the teacher to get those inputs in first, right. And seeing what works. And then it wouldn't always go immediately into an IEP or a 5 0 4, like ~maybe ~a teacher's just like, Hey, noticing this kid is, ~you know, ~seeming to struggle during this time of day.

And then you guys would ~maybe ~go in and observe, ~is that.~ 

Patty: Correct. 

Meredith: Typically. Yeah. 

Patty: ~Correct. Yeah. And really sensory, um. ~Sensory is challenging in the school setting because ~it's more of, we don't, we're not gonna like ~pull a student out just to work on sensory things. Those would ~really ~more be accommodations.

~Um, he often, ~we wouldn't even ~like ~see a student indirectly just for that, but be a part of that team. So ~we, that ~[00:07:00] we ensure that the correct accommodations are in place, ~um, ~versus like a clinic. ~And I know we're gonna get to that later, but. They can go and ~they can run and jump and crash and, ~um, ~try to get that sensory threshold met.

We ~just ~have to make sure that the student's sensory needs are, ~um, ~being met so they can access and participate in their instruction. 

Meredith: ~Right. And so you did give a good segue into that. So ~a lot of parents are confused because, ~you know, ~they go to the school and they're receiving a certain amount of services and then they're not receiving.

What they would in a private occupational therapy. ~And so ~there's confusion about that. Like time, what kind of therapy they would get in school versus the medical model. Can you explain that difference? 

Patty: ~Yes. ~You have all the hot topics. ~This,~ we're getting it all out there. I love this so much. ~Um, gosh, ~I think that's probably the most common thing that I have to explain and I explain it ~over and ~over and over.

But it's okay because it is really confusing. It's so confusing. ~Um, it, it ~school, OT and private ~are ~OT are ~one. They're ~built on different systems with different [00:08:00] goals. ~In, um, addition ~school, OT is regulated by state and federal laws. ~So like, ~think of private or medical OT as improving underlying skills across ~like ~all of life.

~Um. ~Areas, home play, self care, development, ~um, ~even interacting with friends, social participation, mental health, OTs can do in the private clinic. ~Um, ~school-based ot, however, is tied to. ~Um, ~education, everything has to be tied to education. So our role as a school OT is to support a student's ability to access and participate in their education and specialized instruction.

So I think sometimes the question is, ~well, what, ~what would help the child most? Is it the private? ~Is it, ~is it the school? ~Um. But, ~but what level of support is required for this child to make progress in school? ~Um, ~I think it's a difference in ~per like ~purpose. ~Um, ~thinking about, ~um, ~recommendations and what's gonna help them most is there.

~So like ~we could have a [00:09:00] student that comes in with a diagnosis, ~um. ~It wouldn't just be an automatic, say they have this disease processor diagnosis, they're gonna get school, ot. ~Um, they, ~there still has to be ~a bit ~an impact. On their ability to access instruction. ~And ~a lot of kids come in with diagnoses and disabilities and they can still access and participate, but they might still need ~like ~strengthening or, ~um, ~some other, ~um, ~tasks that they need to ~really ~practice and repeat over and over to participate in all aspects of their life.

That's where the clinic would come in. ~Um, ~the other thing is that we're not. Primary service providers in school, we are, ~um, ~related service providers that support the student's ability to access their instruction. ~And so ~that key word being support we're that supportive person versus a clinic. ~They can pretty much do.~

~I mean, ~the gamut is huge for clinical OTs, which sometimes I get a little jealous ~because they are so tied. ~But ~that's, ~that's the purpose, right? The student [00:10:00] is first and foremost a student, a learner. ~Um. ~And so our role is to help them access and participate with all those motor skills that they might need, ~um, ~in order to do that.

Meredith: So you're ~typically ~tagging onto a goal, ~um, per se, ~like maybe in an IEP, ~um, ~to support the outcome.

Is that what you're saying? ~I. ~

Patty: ~Correct. ~So yes, ~about ~when I took over as the lead, we ~really ~made a shift. ~I mean, ~I'm all about evidence-based practice and best practice and ~also ~what's best for kids. ~I mean, ~that's why we're all here. ~Um, we're here in this environment ~to support kids and to make sure kids can be the best student they can.

~So about, um. It was ~about four or five years ago, we made the shift to all collaborative goals, ~and I'll talk a little bit about that too. Um, in fact, I think it probably ties right into our next segment. But, um, uh, ~the American PT Association, the American Speech and Language Hearing Association and ~uh, ~OT Association came up with a document on best practice, ~um, ~on collaborative goal writing.

~And ~it was ~so ~great because, ~um, yeah, we, and no. ~We don't necessarily have to attach to a writing goal. It could be a math goal, it could be self-determination goal. ~It could be, ~but yes, we're writing ~just ~collaborative goals now. We're collecting data collaboratively, ~so. ~And that's best for the student [00:11:00] because then those interventions ~are, ~are happening across the school day versus just pulling them out and working on an OT goal that maybe the other team's not necessarily addressing in their sessions.

~Uh, so it's, ~it's really great. ~And ~it was a hard push at first, not just with parents, but with staff too. ~It's almost like that. ~You're not writing your own goal, ~you're, you're getting out of something. ~Until we shifted that thinking to, ~oh, ~now we're all working on this together. ~What I mean, what could be better than, um, ~cross training and learning what everybody else is doing and incorporating, ~um, ~some of my OT stuff into the speech session and vice versa ~and.~

So yes, ~we would attach, that was a long answer, but ~collaborative goal and we would attach onto a goal. 

Meredith: I ~kind of ~remember when that transition happened. ~I think it was like what, um, ~maybe four years ago. ~'cause I remember my, like ~my son repeated kindergarten ~and so I remember ~the first year OT was like, this is my goal.

We're working on core strength. He's with me. And then the next year she was like. It's now collaborative. ~And so I think ~parents ~at that time also ~had a lot of ~that ~confusion ~and it just was like, well wait, ~everyone ~kinda ~seemed a little confused ~about that, ~but it does seem to have gotten a lot better ~with, you know, as you say, like you're rolling it out, ~it's collaborative and it, ~it just ~takes learning and adjusting to, ~but I, ~I ~distinctly ~remember when that happened and I'm sure other [00:12:00] parents can too.

~So like, ~if a child can't tie their shoe at home, why might the school OT choose not to work on that goal during the school day? ~And I think ~you kind of touched on this because it's not education, but ~is it a, ~it's a skill.

~Like it, ~a teacher doesn't wanna always tie ~another ~a student's shoe in kindergarten. 

Patty: ~Yes, so true. And we still get this one too. So, I mean, ~typically shoe tying doesn't necessarily. Impact a student's ability to access their instruction or participate in their, ~um, ~you know, ~listen to their ~lectures ~or things like that.~

~Now, ~if it's ~like a, ~like a lower level SSN students and part of their specialized instruction is working on activities of daily living, like washing hands, opening containers, manipulating, ~you know, ~lunch stuff, ~um, sipping their coat, things like that. Um. ~There may be a life skill goal that OTs can then support the motor components of.

~And so we might, ~we might work on bilateral coordination, ~we might work on the ~core strength, ~we might work on the ~finger distal, ~um, ~strength, ~um, ~crossing midline, ~so. ~It's not like a never, but because those SSN students have that as part of their specialized instruction, ~then ~that's typically where we would focus [00:13:00] on the motor skills ~on ~some of those ~life, ~life skill goals.

~Um, if it, I mean, ~a lot of times ~it's, ~it's better addressed outside the school setting. ~So ~that might be another, ~you know, private school com or ~private, ~um, ~ot. Conversation. ~So yeah, ~definitely not a never, but ~just ~it's more rare ~for sure. ~

Meredith: ~And right. ~And you touched on ~something ~SSN being significantly different than what supports you guys are providing to the mild, moderate, and general accommodation 5 0 4 support ~than is kind of what I'm hearing you say.~

~Um, ~because. The functioning is so different. Is that correct? 

Patty: ~Yes. Okay. ~Yes. And their specialized instruction is so different. 

Meredith: Mm-hmm. 

Patty: The significant support needs, ~um, ~programming incorporates, ~you know, ~life skills, life skill development, ~um, ~very different and modified, ~um, ~curriculum. And they're working on, ~um, ~the extended evidence outcomes for standards with the state, which are different than the evidence outcomes that ~like ~our typical mild mod, ~um.~

Students work on. 

Meredith: ~Yeah. ~And then you have ~like ~those borderline kids ~that like are ~in between who might need more support. ~And so ~those ones are a little wonky. 

Patty: ~Yes. ~But ~like that being said, I, ~I want you to know that ~we have done, we ~we're [00:14:00] still available to ~like ~support and give strategies and give ideas and send home, you know, ~Hey, ~here's some great videos.

Teach your kid this way, you know, we're always still available to help and support for sure. 

Meredith: I like that. ~Are you, and ~I know there's ~like a, ~a clear difference and no one's gonna diagnose someone's kid and be like, you have to go do this. But, ~um, you know, ~a parent who's really struggling with ~perhaps that ~sensory processing need at home are in ~a, like ~a IEP meeting or a 5 0 4 meeting.

Are you going to recommend like maybe outside because they are different, so it's not like the district's not providing support. ~What is that? Like a resource or you're just like. ~You wouldn't tell 'em they have to, ~obviously. ~But I'm sure ~like ~that's a discussion ~that, like you said, ~you explained this so much.

So a parent knows, ~like ~outside occupational therapy is more beneficial than what they would get in the school ~due to that excess of education.~ 

Patty: Yes. ~So I mean, re ~we can never recommend, ~you know, anything, ~but we can certainly have a conversation, ~you know, ~and see if they could talk to their pediatrician about.

Some of their things that they're seeing at home because ~it, ~it is different and ~um, ~school is very different than, ~um, ~home. ~And ~sometimes it's [00:15:00] better at school, worse at home. Sometimes it's better at home and worse at school. ~So ~it just ~sort of ~depends. But we would definitely have a conversation about maybe talking to that pediatrician.

~So~ 

Meredith: we keep talking about this ~education ~educationally necessary. So ~in your world, ~what does it mean for a service to be necessary for a student to access their learning? 

Patty: ~So ~educationally necessary means that without the service, the student would struggle to access, participate, or make progress at school.

~I mean, that's sort of a, a very brief, I mean, ~we look for, ~I guess, ~a clear connection between the skill and the learning. ~Um. ~Things like, ~you know, ~completing written work, managing classroom tools ~regularly, ~regulating enough to attend to instruction, participating in the school routines. ~Um, ~the service must remove a barrier to education, not just improve the skill in general.

Meredith: ~I get that. Okay. ~So as a parent that might be new. Does OT look different when it's tucked into an IEP versus ~like ~an accommodation in a 5 0 4 plan? 

Patty: Yes, for sure. ~Um. ~For with an IEP ot, I think we've talked about [00:16:00] considered a related service under special education law, meaning that we support a student's specialized instruction tied to those, ~um, ~individualized but collaborative goals under a 5 0 4 plan.

OT typically supports, ~um, ~access through accommodations. Things like alternative seating tools, ~um, ~maybe there's some sensory or environmental supports. ~Um. ~But it's more a general education support, not necessarily a special education support, ~but yeah, absolutely. ~We would be involved in, ~um, if needed, you know, ~attending that meeting, being a part of that process.

~Um, ~all of those things. But yeah, accommodations versus like director indirect support. 

Meredith: And ~that, that's ~that change again, as a district lead, how do you ensure that OT services are being provided and are meeting the state standards while they're still being ~indivi ~individualized for each kid? And again, we know it's, ~it's, oh my God, now I forgot, ~collaborative.

~Um, ~but ~how, ~how do we ensure that, 

Patty: oh man, my job is ~big. It's ~big. ~Um, but ~I think ~two of the, ~the main things that I focused on ~in addition to, you know, best practice and evidence-based things and supporting students ~is balancing two things. It's consistency [00:17:00] and individualization. ~Um, and. ~We have to ensure, I mean, I have to ensure that my therapists are following state and federal guidelines, that they use data to guide decisions and that they document educational impact.

So ~those, ~those things ~are, ~are huge. ~Um, ~at the same time, like ~no student, ~no two students look alike. And so, ~you know, ~no services are determined without like a full team discussion and evaluation data, ongoing progress monitoring. ~Um. I think, ~I think the compliance piece gives us like the framework, but ~um, ~how do I say this?

Collaboration allows us to ~like ~individualize. ~Um, and ~we talked about the collaborative goals, which ~um, ~promotes connection between all team members, ~which is really awesome. Um, ~and fosters the skill throughout all of the settings. ~So I think it's. ~It's making sure that we meet all the compliance spaces, but also making sure that we still look at every single student as an individual.

~Because I mean, we, ~a student could come in with the same disease process, same diagnosis, and yet their needs are different, their roles are different. Their ability to participate is different. ~So yeah, it's, and ~it's [00:18:00] part of ~our, um, also ~our evaluation tool. All of those compliance pieces are part of our evaluation tool.

~So ~every staff is evaluated every year. ~And so, um, ~we have to make sure that ~all of that is, ~all those boxes are being checked. 

Meredith: And you're reviewing other data that everyone else is collecting in that ~collaborative ~team ~as well, ~to ~kind of ~see where it might be ~a little ~different from someone else's to ~like ~fine tune it better.

Patty: Correct. We've really worked hard as a team too. ~Um, ~come up with frameworks for being consistent in how we qualify students and how and when we might remove or discontinue services for students because ~it's hard, you know, as, ~as any provider, we all have sort of a different lens. We all come with ~our own.~

~Um. Our own, not baggage, but you know, ~our own background, our own biases, ~our own, which, that's just life, right? ~So, ~um, ~how do we put all that aside and be, ~and be very, um, ~objective and consistent in what we're doing? So we did create, ~um, ~a tool. ~Um, ~we finally got permission to use it this year. It's called the cert, ~CERT.~

We got it from another district, but we modified it to [00:19:00] fit ~our. Our district and our, um, ~needs. ~Um, ~the directors approved us to use it and what it has helped us do, it's a tool that helps us ~sort of ~after we evaluate a student, after we have all of our data that we've collected, ~um, ~especially when ~on the cases where ~we're on the fence or maybe some of the scores are ~sort of, uh, ~right on the fence, but yet they're functioning really well in the classroom.

This tool allows us to ~go through and ~answer a lot of questions about the student. ~Um. ~It gives us ~sort of ~a framework for confirming our decisions. So we're not just like, eh, ~I think ~I'm just gonna say no to the student, or I'm just gonna say this one. And ~actually ~it's ~actually ~a great tool for telling us whether or not they might need ~direct and ~direct, how much time they might need.

~And, ~and most of the time it's been really nice to see that our clinical reasoning has been right on the money, ~but. ~I think having that additional tool and letting parents know that we don't make these decisions, ~like ~without a huge body of evidence, without using our new tool to help, ~you know, ~confirm our decision making.

It's really helps when I have therapists who are like, I just don't know what to do. And I'm like, well, [00:20:00] have you gone through this cert? ~And, ~and then they're like, oh, I'll go back and do that. And then they call me. They're like, I got it. So ~it's, ~it's been ~really ~helpful ~just ~to have that. ~Other ~tool. And I think it helps, ~um, ~parents understand too that ~it's, ~it's a ~very ~thoughtful and reflective decision.

Meredith: ~That's great. ~It kind of is a bummer. Like it just is now implemented, but it's really exciting ~it sounds like, ~for moving forward to have ~like ~that support to ~kind of ~see this is why our decisions being made. And I think that even goes with that compliance piece ~a little bit. ~Like, this is why we're making these decisions.

~I like that. Um, let me see. I forgot where I was at. ~Okay. So if a parent is sitting in an IEP meeting and feels their child is struggling with the fine motor or Sensory needs, what is the magic language they can use to start the conversations with the team or even when they're not at the IEP table, like with a teacher?

Patty: ~Um, I think that, um, ~I always encourage parents to describe what they see ~that is ~impacting learning. ~I mean, ~parents know the students the best. ~They they, I think so often we. So often they mis ~they need to feel heard, they need to feel listened to. ~So things like, you know, ~are they avoiding written work?

~Are they, ~do they fatigue really easily? ~Like what if, ~what does their sitting posture look like? ~Um. So maybe ~describing, ~Hey, like ~my child avoids writing work, my child gets really [00:21:00] tired. ~Um, ~they seem exhausted after school, ~really ~describing in detail what they're seeing. ~Um, now we're, ~we're still gonna ask a lot of questions, but ~I think, I think that ~listening to parents is ~really, ~really critical.

~Um, ~framing concerns around that. ~Partic, I mean, ~I'll still go back and frame those concerns around. Participation and school function. ~Um, ~but ~it, ~we still have to help them understand that educational impact, right? So ~they might be, ~they might come home and ~they're, ~their writing is sloppy ~and it's, ~but they also just might be really tired of school.

~So again, ~taking it back to, ~um. Reeducation ~reeducation on that impact of school ~and you know, ~that's our job. We can certainly support at home. Give ~some, you know, ~practice sheets or whatever might be helpful. ~Um. Really just ~having that open file, right? ~We just, ~we wanna listen ~and, ~and help them at home. ~If, ~if it's not gonna be an educational need, how can we still support ~them, ~them at home?

Because it's still our role to help and to be a resource. 

Meredith: What's the one thing that a parent can do this week to support the work the OT is doing at school? 

Patty: ~So ~I like to not give [00:22:00] parents ~like ~extra work ~or extra like things ~unless they ask for it.

~Because I was like, ~I had two little kids. ~I had two, you know, ~it was crazy. I was working full time. ~I have, ~both of my kids are grown now, ~which is great. I have all this time, but ~I like to ~just ~say, Hey, ~you know, ~build in. Independence into your daily routines, things that you're already doing. ~So like ~letting them open the containers in the kitchen, carry their backpacks, help with chores, manage materials, stir items ~in the ki ~in the kitchen, especially items that have resistance like pudding or ~you know, ~if you're making bread dough ~or anything like that ~because they're using bilateral skills, right?

They have to stabilize the bowl and stir a resistive texture. ~Um. ~The other great thing ~I, ~I tell parents all the time is ~to. ~When they're playing games or playing cards or drawing or coloring, have them lie on their belly to do those tasks propped up on their forearms. It's a great way to strengthen that whole core.

It, ~um, ~promotes ~in pre, um, wrist extension, ~better wrist extension, which is necessary for writing ~that whole core, um, ~proximal stability. So it's an easy way to incorporate it. And the other way is, ~um, ~vertical. So anything you can put up on the wall and do vertically or like an [00:23:00] easel ~if you have that ~play tic tto with them up there.

Color on that, because again, it works on shoulder strength. ~Um, um, ~a wrist extension ~and then. You know, ~another easy way is breaking their crayons and calling them muscle crayons because they promote that really nice functional grasp when things are little. ~Um, ~so easy. ~Things like that. I mean, ~the summer's super easy.

Sidewalk talk is great. ~Um, um, ~painting the house with water. ~You know, just to work. Any of those things are ~squirt bottles, tongs, tweezers. Look in your kitchen door to see what you have that they can pick up. ~You know, ~the strawberries with tongs. Simple stuff. So they're not like, they don't see it as work and then the parents don't have to ~like ~do extra work.

Meredith: I like that. If you could clear up one ~single ~misconception about school-based ot, what would it be? 

Patty: ~There's.~

I think the first one is that the misconception is that school OT is like ~a, ~a smaller version of a clinic ~really. It's a, so it's, ~it's a different specialty, ~but ~a different goal. ~Um, ~we're not fixing ~like ~the child, but removing barriers so they can successfully participate. ~Um. ~And then ~the, ~the [00:24:00] second one we talked about a lot.

~It's, ~it's that ~the, ~we don't teach handwriting, ~you know, ~in OT school we don't take any, ~you know, ~classes on handwriting or, ~or like ~instruction ~or, um, things like that. We, ~we support the motor and spatial and perceptual components and there is a lot that goes into it. ~Um, and ~often we get a lot of, ~um, like ~pushback on.

~Moving to like assisted technology too soon. I know ~parents, ~they ~really want their child to be able to write and ~we, like, ~we won't give up on it, but at some point we have to look at, ~okay, ~how can we ensure this child is able to participate and ~if, ~if speech to text, if typing is ~just ~a better option, ~which is our world, ~then ~that's, ~that's the way we're gonna go.

~Um, ~I think so there's so much that goes on in early development, right? ~With um. I mean, ~handwriting ~is a, ~is a complex motor skill and cognitive skill, but ~there's, you know, ~it relies on motor pathways ~to, um, ~basically the brain's connection to the muscles, ~uh, ~that tell the body ~like ~how to move. And in early childhood, those connections are constantly being changed by the brain to become more efficient and automatic ~and, um, ~and they can change, ~um, ~which is that neuroplasticity when [00:25:00] you're young.

~But ~that typically peaks around ~like ~the age of eight, which is why we ~really ~wanna get, ~you know, ~kindergarten, first grade, second grade, ~like ~get in then, because that's when we can ~really still and ~still make ~that some of those ~changes in neuroplasticity ~and those things. But, and ~not that those connections can't ~be like, ~improve or change later, but once they're established making significant.

Shifts or changes, ~um, ~to an ingrained motor pattern often requires ~like ~intensive repetition that can take away time from learning. ~And so I think that's sometimes what ~I have a harder time explaining to parents ~that ~the motor pathways and the neuroplasticity and the brain development ~and sort of where it.~

~Where it ~not necessarily stabilizes, but ~you know, sort of ~at the age of eight. ~So, um, you know, ~one of our goals is to prioritize their least restrictive environment and making sure that they're in the classroom as much as they can. So ~if, ~if the shift needs to be made to assistive technology to do that, then ~um.~

That's what we wanna do. It'll reduce writing demands. It'll reduce the fatigue. They'll be able to access and participate. They'll spend more time in the [00:26:00] classroom and they'll be able to demonstrate their knowledge rather than focusing on something ~really ~challenging that they can't get their thoughts out.

Meredith: ~I like that ~as a mom of a super neurodivergent child, ~um, ~I've noticed ~that ~this school year, ~you know, ~he's nine, that they are switching to that and ~I, ~I appreciate it more that you're addressing it. ~As, you know, ~they're already fatigued 'cause they're doing all these other things. This makes it their least restrictive so they can be in the classroom ~and, ~and be a part of it and they're not.

Fatiguing as much because it's already a hard day for them. Just learning sometimes. And so I do appreciate that aspect. So I like that. Thank you for explaining that misconception, because that's a great one. Did you have anything else that you wanted to add? 

Patty: ~Um, no. I just, ~I'm so excited to be able to do this.

~I, ~one of my ~like, ~main goals is to really get the word out to parents. ~Um. ~And I'm getting my doctorate right now, ~uh, ~a couple more semesters. So I think I wanna do my capstone on continuing ~this, ~this work, this understanding, ~and this, um, ~I don't know what it'll look like yet. I might reach back out to [00:27:00] you ~for, um.~

Maybe there's courses I can create for parents. ~Maybe there's, um, ~my doctorate. I want it to be on this improved, ~um, ~collaboration and participation with parents and school OTs and really closing that gap on. What we do and how we help. 

Meredith: ~Oh my gosh. ~That's like our motto too, ~is like, ~we also wanna collaborate to help parents and ~like ~teachers and providers.

Yeah. So ~that's, ~that's huge. Yes, definitely. We would love to help ~try to ~make that all come together. ~Um, yeah, ~definitely reach out. That's super exciting. ~Good. ~Good for you for getting your doctorate. That's a lot of work. ~Woo. Um, yeah, ~I think that's all I have for you today. ~Um, ~I appreciate your time so much.

Speaker: Be sure to check the show notes for any resources that have been mentioned. You can also learn more about DCSEAC on our social media or go to our webpage, DCSEAC.org. If you like this podcast, please like, share, follow, and let other parents know about us. We're just trying to get conversations out there.

If you have any suggestions, definitely let us know on those social medias, or [00:28:00] even@infoatdcc.org, that's our email. We're really excited. We have lots of conversations that are coming up. So until next time, BYE