All posts by Guest Blogger

Using RTI-P to Manage Therapy Caseloads

S'Cool Moves

A physical therapist called me from Ohio wanting to know more about the S’Cool Moves products, but what she really needed from me were some insights that I’ve gained from doing what I do for the last twenty years. She was a therapist making the huge shift from clinical practice to educational practice in schools. She told me that she was the ONLY physical therapist for the entire district and was spread really thin. Let’s call our therapist Amber. Amber said that the teachers seemed to want to know what they could do in the classrooms for all the students to improve foundation skills. But how was she going to reach all these teachers and satisfy the IEP goals for her huge caseload?

It was interesting. Do you know where my mind went to help Amber create a framework? It went to sharing about the Response-to-Intervention model (RTI). RTI was designed as an alternative to the discrepancy model used to determine if a child qualified for special education services. With RTI, methods of intervention are validated and data collected prior to referring a child for special education testing. Though some report RTI working well, for others it’s a mixed bag depending on how it is being implemented.

What if we could use RTI personally? Let’s call it the RTI-P model. During our conversation, I found myself explaining to Amber how RTI models work and personalizing the model for her. She got off the call with clarity and new tools to help guide her as she navigates her new position.

Today’s thought is, “How can we use RTI-P to organize our jobs and therapy caseloads?” Think in terms of tiers. RTI has three tiers. The first tier includes interventions and strategies we can use with all students in the classroom. The second tier includes modifications we need to make for small groups of students who are having difficulty with the class-wide strategies. The third tier focuses on individual strategies for the most involved students.

In your caseload, what students do you have that you could support in the classroom setting, Tier 1? Are there opportunities for you to present some strategies during staff meetings or on PD days to support teachers and students in the classroom?

Now think about Tier 2. What students need small group support either in the classroom or within designated smaller group environments?

And finally, Tier 3. What students are very involved and need your one-on-one, hands-on support?

Once you create your own personal framework, then you can figure out what materials or products will help you reach your goals, but first create your RTI-P framework.

For instance, Therapro’s Drive Thru Menus works well with all student in a classroom so this could be considered as an important tool for Tier 1 intervention. For small groups of students who are working on improving visual-motor integration, consider

  • Origami Fun for Beginners – 55 fun-to-do projects! Includes 96 sheets of authentic origami paper in a gorgeous array of colors and designs.
  • Letter Treasure Hunt Game – Handwriting fun!
    1. Sail your ship to an Alphabet Island,
    2. Follow Captain’s orders when you draw a card,
    3. Collect your treasure by writing the letter in the Captain’s log.

For students needing one-on-on intervention, add Developing Visual Motor Integration and Trace the Eights to your intervention strategies.

 

Let me know if the RTI-P makes sense to you and how you’ve used it to be more effective in your job and less stressed!

Thanks for all you do for children, Dr. Debra Em Wilson

Guest Blogger: Dr. Debra Em Wilson. I’m excited to join Therapro as a guest blogger. I am a reading specialist and the founder of S’cool Moves. I enjoy collaborating and appreciate this opportunity to connect with the Therapro community.

Autism Challenges in Public Entertainment Venues

Ironically, the reasons why we go to these venues are the reasons people with Autism do not like them! Here are a few challenges that may be faced in public entertainment venues:

  1. Sensory: People with Autism often struggle with sensory input and how to deal with it.
    • Many of these venues may smell strange (or someone may be wearing perfume) and cause a negative reaction for some people. This can be so subtle that the person with autism may not even know that it is causing him/her to act out of control.
    • Sudden and loud chaotic noises can cause confusion for them in addition to all the chatter and background music in the room.
    • Sitting too close to other people can cause unwanted light touch that we know can be very irritating. Speaking of touch, a theatre setting may have textured chairs that are uncomfortable
    • And not to mention all the visual stimuli that occurs – all the bright lights, some moving and others flashing can put a nervous system into overload.
  2. Social Skills: These venues involve social environments which is an area of real challenge for people with Autism
    • They may be highly anxious in knowing how to interact with the rest of the group.
    • As a result they may seem aloof or, on the other hand, blunt.
    • In an attempt to communicate, they may not be able to read the body language or facial expressions of the other person and then their behavior may appear to be inappropriate.
    • People with Autism take things very literally which may cause misunderstandings with others at the venue.
  3. Routine and Anxiety: Routine is very important for people with Autism
    • Going somewhere new outside of routine can cause a lot of anxiety.
    • Even if a person with Autism is used to going to a venue each week, even the absence of a staff member, different layout, etc. could cause anxiety.
    • Unexpected events are anxiety producing for them.

Other diagnoses that might experience similar challenges:

  1. We as occupational therapists working with people with developmental disabilities are trained to assess their ability to process sensory information as part of their evaluation.
  2. We are finding that many people with no known diagnoses also have challenges with entertainment venues. Recently, I have been privileged to attend professional baseball games in Baltimore, Philadelphia and San Diego. That venue has changed since I went to baseball games as a child – now there is loud music, flashing lights, huge TV screens and people getting up and stepping on your toes which all make me wonder why I am there. It is challenging for me!

Suggested Solutions

Preparation, Preparation, Preparation:

  1. Social Story:
    A social story can be a written or visual guide describing various social interactions, situations, behaviors, skills or concepts and were introduced and described by Gray and Garand (1993). They are designed to improve the social skills of people with autism spectrum disorders (ASD). Social stories are used to educate and as praise. Social stories model appropriate social interaction by describing a situation with relevant social cues, other’s perspectives, and a suggested appropriate response. About one half of the time, the stories are used to acknowledge and praise successful completion of an accomplishment. These have been used successfully in preparation for entertainment venues. For further information, Therapro, Inc. offers the Newly Revised Book on Social Stories here.
  2. Sensory Stories:
    sensory_story_cards
    Sensory Stories, published by Therapro, are similar to Social Stories but with the specific approach to teaching children with autism and over-responsive sensory modulation issues to successfully engage in social activities within the home, school, and community. Sensory Stories comprise 30 individual stories about daily activities. These Sensory Stories instruct the child to use calming sensory strategies in order to deal with the unpleasant sensory aspects of that particular situation. When read on a regular basis, Sensory Stories assist the child in developing effective routines to manage the sensory experiences surrounding typical daily activities. The authors have conducted several studies to demonstrate their effectiveness. They can be viewed on the Therapro website.

The Venue Itself

  1. Call ahead and see if the facility has a visual tour for an iPad of the venue. A 360 degree tour to show as much of the rooms, location of bathrooms, etc. would be helpful for knowing the physical layout.
  2. Find out what the venue rules are, how services operates so everyone knows what to expect of the routine
  3. Ask if there could be dedicated time that can be with just families with autism
  4. Would there be a quiet area or small area available for families and individuals who might experience stress during the venue? Here at the Therapro Showroom, we have a sensory area for individuals including a bean bag chair and a basketful of sensory tools. This helps when the parent or caregiver want to look around the showroom. Also, our showroom does not have all products out as that could be overwhelming to individuals. Instead, we ask the parent to make a list of interested products and we go into the warehouse to pick them. Shoppers can sit comfortably at a table and make their decisions as to what they want – no rush.

Helpful Tools During the Venue Visit

  1. Fidgets:
    During stressful times, fidgets help reduce agitation. Therapro’s selection of fidgets have increased through the years as each nervous system finds a fidget helpful and others offensive. Please see our website for numerous fidgets. Our very popular Fidget Kit includes a variety of fidgets so a person can determine which ones they like or dislike. We have many quiet fidgets that can be used unnoticed!
  2. Additional Tools:
    • Sensory Strategy Cards: These are small cards with such strategies as “I can grasp my elbows and squeeze hard”, “I can put a heavy backpack or fanny pack in my lap”, “I can do an elbow-check to make sure no one is too close.” They are visual reminders of the various strategies that children can use. They can be tucked in a shirt or pants pocket for a quick reference to a preferred strategy or put on a belt loop or backpack.
    • Noise-reducing headphones
    • sunglasses

Guest Blogger: Karen Conrad Weihrauch, PhD, OTR/L