Saturday Seminar: Post-Secondary Transition Planning

Tee Stock, MS OTR/L, MBA presented a Therapro Saturday Seminar last weekend that provided a comprehensive look at Post – Secondary Transition Planning (PSTP) for students. Her extensive experience with transition planning in public schools, a private special education school, and a local collaborative, in addition to her doctoral work in this area, offered attendees an abundance of useful and current information including a guide to the numerous resources available. An essential component of her presentation was the role of the occupational therapist on the transition team.

In her review of the PSTP process, Tee reviewed some interesting statistics, some of which were quite alarming, including: “People with disabilities are twice as likely to drop out of high school; ”Those with disabilities are three times more likely to live in poverty;” and “After high school, students with disabilities are less likely to continue their education, find employment, or live independently.”    Transition planning is federally mandated to begin at age 16, but in some states, including Massachusetts, planning begins at age 14, or even earlier with the goal of preparing the student for life after high school by teaching the student a set of skills.  These skills encompass finding and keeping employment, living independently, learning to access community resources, and learning to self-manage medical and other personal needs.

When taking a look at the skill set that PSTP addresses, it seems clear that the occupational therapist should have an important role on the transition team.  However, Tee explained that sometimes lack of understanding of what the OT can offer to the process or lack of funding to increase OT services when preparing for post-secondary transitioning could stand in the way of including this professional on the team.  AOTA supports the role of the occupational therapist in TP as stated clearly in the OT Standards of Practice Guidelines and by providing valuable resources on transition planning.

Tee highlighted a large sample of OT activities for transition services that included: performing activity analysis for job, school, and self help skills; administering assessments that support life skills and transition skills; providing consultation on assistive technology to promote a student’s access, progress, and participation. The I Can Work! curriculum was endorsed by Tee and other attendees as a valuable 5-module program for integrating communication skills with hands-on pre-vocational training for middle school, high school, and young adults with special needs. Some assessments that can be administered by OTs that Tee recommended include the Transition Planning Inventory (TP-2), the Kohlman Evaluation of Living Skills (Kels) 4th Edition, which was developed by an OT, TEACCH Transition Assessment Profile – 2nd Edition (TTAP), and the Reading-Free Vocational Interest Inventory 2 (R-FII:2).  Attendees freely shared information about assessments they used, liked, and did not like. OTs can consult on selecting Assistive Technology that may be useful for TP. Tee recommended a broad variety of Apps including: Stop, Breathe & Think, a free meditation app that we actually tried out; Visual Schedule Planner, to create a custom schedule with audio and video of events; and My Homework Student Planner, designed to help students from middle school age through college keep track of classes, projects, test, and homework.

Tee left us with a great deal of information on the whole scope of post-secondary transition planning including the importance of a full team that includes the parents and student.  We also learned the important contribution the occupational therapist can provide for the student to help ensure a successful transition from high school to the community.

Take a look at a few of the many positive remarks from those who attended Tee’s seminar:

“It was a pleasure listening to this comprehensive seminar, presented at an excellent pace with thorough notes.  Thanks so much!”  Beth B., Occupational Therapist

“Organized, lots of resources.”  Karen D., Occupational Therapist

“Informative, a lot of resources.”  Jackie P., Occupational Therapist

Thank you, Tee!

Filomena Connor, MS, OTR/L

Saturday Seminar: Interventions for Toddlers and School-Age Children with Feeding Difficulties

Kerry Pearl, MS, CCC-SLP, Therapro’s Saturday Seminar speaker on February 11th   drew attendees representing a variety of backgrounds who work with children having feeding problems. She spoke about Interventions for Toddlers and School-Age Children with Feeding Difficulties to a rapt audience.

Kerry, of Boston Children’s Hospital, specializes in evaluation and treatment of pediatric feeding and swallowing disorders as the Coordinator of the Food School feeding therapy program. Her goal for today’s seminar was to provide information about feeding principles applicable in various settings and how to promote successful oral feeding across disciplines. Kerry has generously made her PowerPoint slides available at this link.

Kerry’s talk covered a lot of ground beginning with the components of the Clinical Feeding Evaluation, which include obtaining the child’s medical history, feeding history, and goals of the caregiver.  She stressed that it is important to understand where the child is in terms of his/her skill level and use that as a point of where to begin with treatment for building feeding skills. An interesting thing to consider when evaluating a school-age child, is the importance of exploring what motivates the child…for example, does the child eat their lunch quickly so he/she doesn’t miss recess?  Another important factor in evaluation is knowing the child’s eating environment, because it is essential for feeding success.  This includes positioning in an appropriate supportive seat that supports the child’s hips, knees, and feet at 90° angles, like a Height Right Chair. When considering the mealtime environment, Kerry advocated establishing a routine so the child knows what to expect, providing clear instructions, and a visual schedule.

Evaluation may identify a number of target areas that need to be prioritized with input from caregivers.  Kerry recommended planning intervention in 10 week blocks, which provides time to target several goals and subsequently focus on the skill deficit areas when they become more apparent as treatment sessions progress. Working with the child’s team is important in a number of areas including when it comes to prioritizing what foods to introduce with the child’s dietitian. When initiating therapy, discharge criteria must be in place so that the child’s set, measurable goals can be reviewed to determine whether the therapy has been successful.

A distinctive feature of Kerry’s presentation was her discussion of two intervention models: 1) Operant Conditioning and 2) Sensory Desensitization.  She distinguished between the two approaches by discussing how operant conditioning targets behavior directly, is child focused as well as parent focused where the therapist consults with parents to help the parent change the structure of mealtime and nutrition. It involves expanding the foods a child eats, improving volume of intake, and targeting specific behavior or skills. A prompt and immediate reinforcer (like a Wind-Up Toy) is given in treatment so that the eating behavior becomes linked to the prompt and the reward. In this approach, the child builds skills but must overcome their fear associated with eating. Individual therapy is provided and “homework” is given.

In the Sensory Desensitization approach, the child develops skills while gradually adapting, with the focus being on changing mealtime behavior by using modeling and positive reinforcement. In this model, the child progresses through “steps to eating” that include: tolerating the presence of food, interacting with the food, smelling the food, touching the food, tasting the food, and finally eating the food. The end result is that the child experiences less stress around foods and is more willing to try foods. This approach can occur in either individual or group sessions.

When selecting the approach that will be most effective for a particular child, Kerry recommended bearing in mind the child’s current skills and sensory profile as well as family concerns/goals. Considerations should include the child’s nutritional status, oral motor skills, and sensory processing ability.

Kerry provided many specific examples of therapeutic activities throughout her talk. Some examples of strategies she discussed to develop chewing skills included lateral placement in the mouth of tools such as the Baby Safe Feeder filled with chewable foods, Chewy Tubes, Y-Chew, or Theratubing dipped in pureed food, progressing to placing small pieces of dissolvable food inside the hollow tubes.  Using a Chu Buddy can help the child keep track of the chewy so it is always available.

Kerry’s thoughtful, organized, chock-full presentation provided us with a practical way to approach feeding problems in young children. Her anecdotes, videos, and tidbits of interesting information gleaned from her extensive experience as a feeding specialist complemented her presentation and were greatly appreciated by all who attended her seminar.

As you can see from some the following comments, Kerry’s seminar left attendees with much information and useful treatment strategies:

“The seminar was well organized & relatable. Examples were provided. I enjoyed the contrast of therapy styles & when each were appropriate.” Lauren P., Speech/Language Pathologist

“I would recommend this seminar to a colleague! I loved the specific interventions discussed. I look forward to applying them in my practice.”  Marianna Q., Occupational Therapist

“This was a unique learning topic, and I was thrilled for this opportunity to gain more understanding and techniques.” Marisa G., Child Development Specialist

“It was very informative in many ways – I appreciated the intervention strategies given & how they should be implemented. Also, it was helpful to hear how to identify which intervention is best for individual children.”

Amy V., Occupational Therapist

“Very interesting from a teacher’s point of view. It broadened my understanding of the issue & encouraged me to reflect on how the issue can impact classroom learning.” Maura M., Teacher

Thank you, Kerry!

Filomena Connor, MS, OTR/L

Saturday Seminar: Analyzing Activities for Improving Student Hand Function

Not even an anticipated nor’easter kept 30 hardy New Englanders from attending last Saturday’s seminar at Therapro, Analyzing Activities for Improving Student Hand Function! Marcia Bridgeman, MHA, OTR/L presented an interesting, well paced seminar that engaged her audience fully as she seamlessly mapped hand development from birth to elementary school age, linking the development of hands to functional skills.

Marcia is the author of the newly revised Fine Motor Olympics (2016) that includes a Manual and 64 beautiful color photo cards of children’s hands performing fine motor tasks with instructions on the reverse side of the cards. A Guide to Hand Function, Quick Screening Form, Fine Motor Observation Checklist, Record Form, and In-Service Training Program are included in the Manual. She currently has a private practice through which she provides consultation and direct service to several Massachusetts school systems.

Interspersed within a comprehensive review of motor development and hand function from newborn to age 6, Marcia discussed functional fine motor activities expected at the corresponding developmental stages. For example, around the age of 7 months, many essential new fine motor skills are emerging including finger isolation, open web space, opposition, and thumb isolation.  She matched simple activities to this developmental level, such as tearing paper, turning knobs on an Etch-a-Sketch, and spinning a top, to name a few!

Seminar attendees thoroughly enjoyed breaking into groups and trying out 8 original fine motor activities that Marcia created that are not included in the 64 activity cards included in Fine Motor Olympics.  The activities included activities like creating a spider web in a plastic basket and moving the spider in the web, using a variety of tongs to hunt tiny dinosaurs, balancing marbles on golf tees, and threading straws into toilet paper cardboard rolls punched with holes. The groups engaged in activity analysis and shared their comments with the rest of the group.  Attendees took away new, inexpensive ideas to engage the entire classroom and facilitate development of hand musculature and arches of the hand for optimal function. In addition to the new activities Marcia introduced today, she highlighted a number of fine motor Therapro products she loved, including Wacky Web, Hide ‘n Slide, Froggy Feeding Fun, Wind Up Walking Robots, Boinks, Tall Stacker Pegboard Set, Get A Grip Pegboard, and Magnetic Marbles.  She discussed conventional uses for the materials and also adapted the materials creatively and adeptly to help develop muscles of the hand. Some activities incorporated use of intrinsic muscles in translation activities, for example: moving a small single object fingers to the palm (1.5 – 2 years) and from palm to fingers (2.0 – 2.4).

We couldn’t think of a more fun way of spending a snowy Saturday morning than analyzing both innovative and familiar fine motor activities, and sharing thoughts on how to help develop better hand function in the classroom setting in a fun way.

Take a look at the glowing comments Marcia’s seminar generated:

“Great combination of visuals, interactive experiences & developmental stages. Great workshop for OT rookies or vets!” Karen D., Occupational Therapist

“As a teacher, I’m certainly not an expert on OT issues students may be experiencing. This seminar helped to raise my awareness and sensitivity to these issues. Great suggestions for how I can help these students in easy, quick, fun ways.”  Maura M., Teacher

“This seminar revisited & reviewed a lot of what I learned in school (great refresher) however I’ve had colleagues who did not have pediatric courses regarding this!”  Kelly V., Occupational Therapist

“Very informative; great to be interactive & experience/explore activities!”  Caitlyn D. COTA

“Such meaty well organized info on hand development, screening, and activities to help hand function.”  Alice T., Occupational Therapist

Thank you, Marcia!

Filomena Connor, MS, OTR/L