Resources for School OT with Students with Complex Needs

In case you haven't heard, I am leading the next #otalk2us on Twitter! I am a school based therapist, and while there are lots of topics that could be covered, this was one that is not often seen.  

 I work in a number of schools, including several which have "regional certificate classrooms" and one "public separate day school." While these sites may not be the most inclusive setting possible, these students and teachers do need a lot of support from related services to access their education. Most of my students do not have only one issue or primary disability. Some are classified as "Multiple Disabilities" with a combination of orthopedic, visual, hearing, and learning impairments. Others may be coded as a student with Autism or Intellectual Disability, but have additional issues and behaviors. It is definitely challenging to be a teacher in one of these classrooms, to balance all the needs and supports for each student, to integrate behavior plans and IEPs. And it can be very challenging to be a therapist for these students as well, to make sure that goals are SMART, to make sure that the student has best access to all the daily occupational pieces that go into a school day, to give your best so that the student can do the best possible. It can be hard mentally, emotionally, physically. Here are some resources that may help you when working with students with complex needs, to complement the chat (9/13 at 7pm!).

If you're new to twitter or chats, check out these resources and then just jump right in!
An Occupational Therapist's Guide to Twitter 

What’s New in Digital and Social Media for Occupational Therapy? Focus on Networking 

Occupational Therapy and Twitter 


Tweetchat  Just enter #OTalk2US

Multisensory Approach
What is a total communication  approach? http://www.icommunicatetherapy.com/adult-communication-difficulties-2/adult-learning-difficulties-intellectual-disability/total-communication/

Talking the Language of the Hands to the Hands: The Importance of Hands for the Person Who is Deafblind http://documents.nationaldb.org/products/hands.pdf

Teaching Learners with multiple special needs blog http://teachinglearnerswithmultipleneeds.blogspot.com/

Paths to Literacy resources for visually impaired students http://www.pathstoliteracy.org/

Long youtube video: How People with Severe/Profound disabilities learn https://www.youtube.com/watch?v=52hASSHA_nE

Group by Group blog - interdisciplinary group education approach for students with multiple disabilities, great pictures and instructions https://groupbygroup.wordpress.com/

Praactical AAC blog http://praacticalaac.org/

Switch Access

Switches, what are they and how do I use them? Very in-depth info http://atclassroom.blogspot.com/2012/10/switches-what-are-they-and-how-do-i-use.html

Switch Activities and accessible software http://www.bltt.org/switch/activities.htm

AT basics: Overview of switches and interfaces  http://atto.buffalo.edu/registered/ATBasics/Populations/Switch/printmodule.php

Errorless choices and activities
What is Errorless Learning?

iPad apps for Significant Disabilities

OTs With Apps blog


Toys and Tools that I like- no paid endorsement or affiliate links, I just like this stuff!
Modular Hose Mounting Systems

APH for the Blind Carousel of Textures 

Enabling Devices- Pull Ball 

Enabling Devices- Carnival Tube 

Blue2 Switch 

Finding time for myself, and also myself

Summer has come and while it can't be everything I had dreamed of, it's going well overall.

I have such a history of imagining that I will get so much done, be so productive, get so much time benefit when I have time off. Even when I was younger, I would imagine catching up on tons of work and fun activities that had been pushed aside for the daily grind. Does it ever happen? Of course not. I should know better by now.

It's really hard for me to balance my over-ambition with any kind of realism of what might actually happen. I don't want to not aspire to do things because that is also not a healthy spot for me, I need at least a little direction. But I get really frustrated at not meeting these arbitrary hoped for accomplishments. 

I continue to struggle with balancing parenting and other endeavors, but I think there has been some progress made. Yesterday, I realized that I could do some stretching and pseudo yoga while my son was watching his "one Mickey" of the day. Hopefully this is a habit that can be continued so that I finally find time to exercise without feeling like I need a sitter or that I'm missing out on time with him. 

I brought home a magazine file full of articles and research to read which hasn't been opened yet. I have a drawer full of books from last summer and collected over the year that are still unread. I made my first trip to our gorgeous new (2013... cough) library and walked out with 3 books of 400+ pages. How many books have I read since last summer's vacation? One. One measly, not even good, blog turned book of about 200 pages. 

I periodically envision myself as a crafty person, able to create and make various items. At times, I even fancy myself a writer, though probably much less than any readers might think. But too frequently, I am distracted by other things that need done, things from that urgent & unimportant category. And then I fail to come back around to these projects.

I really am trying to be involved in more ventures to fill my inner tank that is so often depleted by the therapeutic use of self on a daily basis. I need to move away from TV, mindless social media browsing, and reading of inconsequential articles. 

I am still trying to work in my OT ventures into my down time without either taking over. Barring disaster, I will have a highly complicated and not at all about handwriting post on the blog Handwriting With Katherine, and I will be leading an #OTalk2US in September on school system practice with severe or complex disabilities. But hopefully my summer will be at least a fraction of what I imagine, and yours will be too. :)

The Value of the Generalist -or- Why I Am Still An OT

I graduated from a rural state university. I had looked at a couple of other OT schools, but they weren't the right fit for me. 

I've touched a few times on how I finally decided on majoring in OT. During a college tour, I explained the debate between architecture and OT to a professor who encouraged me to look into home modifications. That was my first area of OT that I found particularly exciting, and it stayed that way for the first years of OT school, right up until my Level II fieldwork approached in said field. That fieldwork let me know that I could not continue with that specialty, and I haven't done any work in the field since.

Let's pause for a moment to be thankful that I wasn't in an OTD program with a push to develop as an expert in a single area. Because if I had been 60-75% through a program and found out that I hated my focused area, I would be done. I certainly would not have continued research and another fieldwork in that area. Would I have been as open to the other areas of OT? Hard to tell. It may have seemed better to cut and run into another field entirely- PR, Med School, PT... who can say? It is certainly a common theme that many medical students get into their residencies and dislike their area of expertise, and many do leave the whole field.

However, my program was not focused on developing "experts," but excellent entry-level therapists. My research project was in a field that I have never chosen to work in, my favorite classes were not necessarily what controls my day to day work, and I knew that there would be on the job learning. (PS- ALL entry-level therapists regardless of degree will need to learn on the job). I knew that I had a great base in the basics of OT, clinical reasoning, and enough information to get me started in any job. Our school had an excellent pass rate on the NBCOT exam, and I was confident that I would pass. My first job at a small-town hospital center required me to treat acute hospital patients, skilled nursing patients, outpatient pediatric clients, and hand therapy patients. My background as a generalist paved the way for my success in this hospital system, and my own work following graduation built the skills I needed to continue to be successful.

To have a diverse workforce, you must have generalists. However, I have yet to see the OTD program that didn't have specific narrowed focus topics and advertising to make experts, not generalists. Anecdotally, I have not seen "experts" return to their small rural areas because there is no market for their services. Those areas that are an hour car ride away from a hospital need a generalist. And a specialist is not going to abandon their expertise to provide general services. While people often consider inner-city areas as underserved, they frequently forget that rural areas are underserved too.

Our commencement speaker asked us to embrace the idea of giving back to the small-town rural areas that represent so much of our university graduates. She stated that it should not be considered lesser to pursue a track as a generalist and provide the services that are so needed in a rural area. This idea struck a chord with me. For a long time, I had seen this idea of specialists being the most desirable practitioners in any field. I had not considered the value of a generalist, and that it was not a lesser role, but an extremely needed role for many people.

I'm very thankful for my education as a generalist. While I now feel like I am in my permanent job for the next 30 years, I started my career with 7 jobs in 7 years. It took me awhile to really find my niche and see where I want to specialize. I love OT because there is such a wide range of practice and it has been the best fit for me as I have grown and changed. But if I had picked a specialty in home mods, or acute care, or spinal cord injury, I would not have been able to find a job in our area. And I would not have necessarily kept one I could get. I would have looked for a different type of job entirely. And I would hate to have a person like me leave our terrific field due to hating their specialty or being unable to find a job that will pay specialist level money in their area.

I fully support a post-professional doctorate option for OTs. Several options- a clinical doctorate, a PhD, an EdD, whatever fits best for that person. But I think that pushing specialization early will keep a person from really trying out the OT field and finding the best fit. I know that was what kept me in OT even when my first idea was no longer feasible. Let's not lose this valuable part of our field.

Why I'm not following you on Twitter

I have seen other posts similar to this, but I am on Twitter a lot and still see a lot of these mistakes/personal peeves, so I wanted to share.

1. I personally don't like to be overloaded with an out of control feed of thousands of people. So I'm not going to follow you just because you follow or tweet at me. Sorry.
2. If your posts are all abbreviated and linked to facebook, I will not click through.
3. If your posts are all things you are posting on pinterest (especially if it is just reusing someone else's words about the pin)
4. If you tweet a whole lot, I might not be able to handle that. If I can turn it down by eliminating your replies and retweets, I will, but sometimes the volume is still too much. If you are active in multiple chats a day, I might not be able to accommodate that.
5. If you don't tweet very frequently, I will think you're not actually active. I'm not super demanding. A post within the week, or several quality posts a month is good for me.
6. If you don't have a real picture or profile description, I won't follow you. I need to see that you are interested in something that I am- OT!! or education, special needs, disability issues, early childhood development, or medicine. Consider using a hashtag in your profile to call attention to these interests.
7. If you have additional interests that are outside my own and take up a lot of your tweet volume, I won't follow you. I don't need to hear about your roto league, your politics, or your thoughts on TV shows everyday, but I don't mind the occasional random shoutout to something else.

Obviously people use Twitter in different ways, and you need look no farther than my "OT Family" to realize that. So these are my guidelines, but others might be drastically different. Twitter is my primary tool, when others prefer Facebook or another platform. What affects your professional social media usage?

Building Pre-Dressing Skills

One of the most obvious ADLs is dressing. And this is often an area that OTs may address in early intervention or school settings. If you're interested in building these skills for your child or a young client, read below for some of my favorite strategies.

Undressing- Before a child is able to dress themselves, they start to undress themselves. In a reverse chaining method, you can allow your child to do the last step of the undressing. This might be pushing pants off from ankles, or pushing a shirt over his head. Socks and shoes are also a favorite for kids to doff.

Play Dress Up - Dress up games serve double purpose- imaginary play and building physical skills. Some examples might be using different hats, or using the commercially available hooded towels or blankets to practice putting things on their head. I made a cape for my son out of an old t-shirt by cutting off the sleeves and front of the shirt.

Another piece in the dress up category would be gloves or booties that come in these kits with a coordinating book. A friend gave us the "Tickle Monster" book and my son loves donning and doffing the gloves.









Pullover bibs- These are such a simple way to practice the overhead movement. They don't catch as much as the ones with a big pocket, but depending on what you are serving they will be more than sufficient. I see these often at discount stores, but there are also a number of tutorials for how you can make your own.

Dolls- Practicing dressing and undressing dolls is a great way to build fine motor skills, use of fasteners (usually velcro) and address valuable social-emotional skills also.

Button Snake- When it comes to practicing fastener skills, the button snake is becoming well known in therapy and mommy communities. I have made these out of scrap materials before because I'm cheap and don't want to spend a lot of time on it. Tonya at Therapy Fun Zone makes much nicer ones and also has ideas such as making a button sandwich out of felt pieces. 

Image via Therapy Fun Zone

What are some of the ways that you use to build dressing skills?

Crafts as a positive outlet

One of the things that has been a struggle for me over the past several years when I started fieldwork and real work was being able to go home, not be stressed, and separate from the previous 8+ hours. Being in a caring profession and also wanting to please the people around me, I often had excess stress that made me worry about burning out. I felt like I was good at hospital OT, but it was hard not to carry the stress with me constantly. Acute care has a very short timeframe- everyone needs something from you and needs it NOW. Today. Yesterday. And you are with people during what is frequently an awful time of their life, and not all of them are going to be OK. It's really hard for me to separate from that. 

So in that respect, the school system is much better for me in that the timeframes are much longer- if I miss a day I can make things up in the coming weeks. There are still heartwrenching stories, but I feel like I'm having a more positive effect to help balance it out. 

The other assist in this balancing act has been taking some advice to have positive outlets outside of work (and for me that often includes the blog) that require some effort and concentration and help with the stress. So despite being the self-described "least crafty OT" I have taken up some crafts as a way to create something and enjoy myself in another way. 

I made these scarves over the summer. I had a t-shirt day where I made 2 scarves and one terrible vest. The pink one required actual use of a pattern and sewing machine, so I felt really accomplished.

I was very surprised at how quickly this arrangement came together. They're all silks for my front porch and though I brought out Christmas colors before Halloween, it was fun. I like having a little extra color out there and hopefully will change it out in the springtime.

This is one of my favorite things, and it was so easy. I printed out an 8x10 of a beach photo I had taken and used double sided tape to secure a perfect sand dollar I found a few years ago. 

The other project I did over the summer was making a board book for my son. I had no idea that you could buy blank board books, but you can for pretty cheap! Then I went to an office store and had pictures printed on full page labels, and just stuck the pictures on the pages. So simple, and yet it gets lots of compliments and he enjoys looking at the family photos.

As much as I enjoy my brain games (crosswords, sudoku, etc) and my OT pursuits (including the blog), having a more physical and tangible task has been better for my mental health. There's tons of research on the ill effects of too much screen time, too much Facebook time, etc and that is an easy rut to fall into when you're tired from working and caregiving. But I hope this is a change that I can continue so that I have continued growth in my own mental health as a member of a very caregiving profession. I'm always going to care about my kids and carry some of their stories with me outside of our time together. But being able to set it aside in a box is crucial to going on with the rest of my life.