Posted in Assistive Technology, Occupational Therapy

The Challenge of Moving Toward Self-Sufficiency with or without Assistive Technology

This blog is concurrently posted on Handwriting With Katherine.  Check out Katherine for some excellent resources.  She is the Handwriting GURU!

As school districts begin to think about transitioning students with disabilities out of school and onto the next phase of life, the idea of becoming as independent or self-sufficient as possible comes to mind. I prefer to use the term self-sufficient as this term implies a sense of power and strength in addition to not requiring assistance from others.  At the age of 14 years, school districts are required to begin developing a transition plan.  Educators, therapists and parents investigate vocational as well as, social and self-care tasks.  In many high schools, Life Skills Programs concentrating on just this effort are charged with the task of fostering self-sufficiency.

Collectively, we explore both basic [BADLs] and instrumental activities of daily living [IADLs]. BADLs include basic self-care tasks, such as feeding, toileting [including maintaining continence], dressing [donning/doffing and selecting clothes], grooming/bathing, walking and transfers (such as from bed to wheelchair). These are the skills that we have begun to develop since birth. IADLs are more complex skills that we are taught as our thinking skills become more developed and include things like money management, driving/using public transportation, shopping, meal prep, communication using a telephone, computer or tablet, managing medications, housework and basic home maintenance.  The IADL and vocational skills are the focus of the Life Skills Programs.

What happens, though, if despite our collective very best efforts, an individual is unable to complete these tasks without some type of assistance? We begin to explore compensatory strategies and levels of assistance that are needed to increase the individual’s ability to become self-sufficient. Assistive technology is a huge area of practice that can be considered and includes both low and high tech devices. Low tech generally means that the strategy or item is simple and generally does not require any type of power source like batteries.  Low tech items can include things like a pencil grip or hand-held grabber to a paper calendar or checklist.  High tech usually involves a technology device with apps [a computer, cell phone or tablet]. Adaptive technology is another term that is used. Adaptive technology is developed specifically for persons with disabilities and is rarely used by a non-disabled person.  Adaptive technology is electronic and includes things like a personal emergency response system [PERS]. A fall detector is a good example of PERS.  The purpose of all these technologies is to help the individual develop or maintain their ability to give the individual the power to be independent for as long as possible. Without these technologies, persons with disabilities would be dependent on others to meet many of their needs.

Each and every day, we are challenged with the task of identifying ways for these students to become self-sufficient.  There are always budgetary concerns and so we begin with the least restrictive strategy. Let’s use Marty, a life skills student, as an example.  Marty is 16 years old and is exploring vocational options.  He is enrolled in a retail work experience program through his school with a job coach.  We begin to explore his work readiness skills.  Is Marty capable of completing all BADL and IADL skills to get him ready to go to and then to get him to work? We look at Marty as he comes to school each day.

Marty comes to school neat and cleanly shaved with hair combed and appears to be well organized. We interview his parents, we may learn some things about Marty that we did not know.

  • Is Marty able to prepare for school each morning?
  • Can he bathe and dress himself?
  • Does he choose his own clothing? Tie his shoes?
  • Can he groom himself?
  • Can he pack his backpack?
  • Make his own lunch or remember to bring money to buy lunch?
  • Does he require any sort of assistance?
  • If he requires assistance, how much and what type?
  • Is there anything that can be done to improve his ability to get ready for school without help from his parents?

Marty is able to shave himself using an electric razor.  Initially, he had some difficulty and shaved off part of his eye brows. Marty’s dad worked with him and helped him learn the correct way to shave.  He is able to pick out clothing appropriate for the weather but his clothing is not always coordinated in color and patterns.  Marty’s mom hangs coordinating clothes on a hanger to help him appear well dressed.  It seems that Marty’s parents have many strategies already in hand to deal with his deficits.  Marty is able to make his favorite salami sandwich, taking two slices of bread, spreading mustard and adding salami without help.  He is able to place and seal his sandwich in a plastic reusable container, add 2 napkins, a cold drink, a piece of fruit and a packaged snack in his insulated lunch bag.  Mom checks his backpack before Marty gets on the bus to make sure that he has everything that he needs to get through his day.  At the end of the day, Marty is able to empty his backpack and lunch bag.  He places the reusable container into the dishwasher and removes any trash that he did not do so when in the cafeteria.  All of this shows us that Marty is capable of following a well-established routine with just supervision.

What about taking on new and variable tasks, like those required for his work experience program? In his retail work experience, Marty has a number of tasks to complete on any one day.  He needs to take inventory, stock shelves with new merchandise, re-stock shelves when merchandise is sold, organize that merchandise [i.e., matching pairs of shoes in color, size and style] and decide which merchandise needs to be returned.  Can Marty perform all these tasks with just a verbal directive?  Can he remember the steps to each task? Can he remember when to take lunch? Can he focus on each of the tasks and complete each, meeting the demands of his job?  We explore his abilities and begin to develop strategies beginning with the least restrictive.

  • Completing job tasks with without supervision requiring only simple verbal directives and a demonstration
  • Use a checklist to complete tasks
  • Use distant supervision, requiring only someone to monitor his job performance from a distance?
  • Use close supervision, requiring someone working in the same area and prompt him to follow his checklist and to complete tasks

Once we get to the level of close supervision, we look at how many tasks is Marty capable of completing?  How much of the task is he capable of completing? Does he need to focus on only one task at a time?  For example, does Marty need to focus on only matching pairs of shoes and then go back to put the shoes in the correct location?

Here is where we begin to look at low tech strategies. Will a checklist work? Will picture prompts work? Should Marty be partnered with another worker in the store? Finally, we may arrive at high tech solutions, such as needing a tablet with a picture schedule and video modelling to help Marty complete his work with the least amount of assistance from another worker or job coach.  At this point, we need to collect data on what Marty is capable of doing, how much assistance is required and what supports have been put in place and failed to get us to the determination that a device is warranted.

Hopefully, at this point, everyone is also focusing on Marty’s abilities to complete IADL skills.

  • Is he capable of handling money? Can he create a shopping list? Does he know what a recipe is? Can he differentiate a recipe from a shopping list and can he develop a shopping list by looking at the recipe, determine what he already has in the pantry or refrigerator and what he needs?
  • Does Marty take medication? Is Marty able to remember what medication he takes and when he needs to take it consistently? Does Marty know when he needs to order new medication? Does he know when he has to return to the doctor to get a new prescription? Can Marty keep track of his doctor’s appointments? Can he arrange transportation to get to the doctor’s office? Does Marty need a medication reminder?
  • Is Marty capable of making plans to organize his schedule? Does he know when others are available to drive him or accompany him on public transportation? Is Marty capable of using a cell phone and Google to navigate from one location to the next? Does Marty need to review a family or group schedule to figure out if, when and who is available to help him?

Many of the questions asked above can be addressed using simple, free or low cost and easily available apps that are available on either Apple or Android devices.  Highly structure training and data collection is required to determine if Marty will be capable of using this technology to become self-sufficient.  If it were not for technology, Marty may be dependent on others for all his needs and be independent in none.

For more information, please feel free to contact me.

Posted in Eleanor Cawley, M.S., OTR/L

Creating Digital Notebooks

Reduce frustration for you and your child

Organization Group NewsIt is difficult for some students to get through school well organized.  Parents, teacher and even students become frustrated with missing homework assignments, notes out of order torn or even missing altogether.  When frustration ensues, it is easy to become argumentative, which is counter-productive to getting work done.

It is my goal to support your efforts to help your child by taking that task over. Creating digital notebooks with your child, there is little worry about losing important work.

Children with Executive Function Disorder have difficulty performing “activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space. ”

Using technology I can help your child manage all that paperwork and not feel so frustrated.  Just think, once a document is loaded into the correct digital notebook, it will never be lost.  If your child loses a paper document that has been uploaded, all he or she needs to do is print out the document.

When teachers request that the student present a notebook, the notebook can be e-mailed to the teacher.  If the teacher will not accept a digital form of this notebook, the notebook can be printed.

Notebooks will be available, in real-time, on the web allowing access in any location with an internet connection by simply using a log-on and password.

Less frustration for all makes home and school life smoother. Please feel free to call for further information.  631-629-4699

 

Posted in Eleanor Cawley, M.S., OTR/L

So Why Should Occupational Therapists Bother to Write Rubrics?

Mostly, therapists read my posts on social media and then move on. Some comment positively and others, not at all. But then there are those times when there  is that one person who challenges you. I must say, that one person tends to get my fight on! I feel that I have to prove my work all over again. But I really love the debate. To those of you who feel that rubrics are not necessary, that’s okay. However, I feel they are.
Rubrics have been around for a very long time. During my research for my book, “Using Rubrics to Monitor Outcomes in Occupational Therapy“I found that rubrics actually began not in the educational field but in the medical field, decades ago. I feel that rubrics were lost in the shuffle in part due to the changes in the provider/client relationship, moving from power over to power with and ultimately to power through our clients. Now that we are searching for ways to become more ‘client-centered’ as a profession, I feel that transparent, understandable documentation is the key.

It has always been our premise, as occupational therapists, to have our clients engaged in purposeful activity. With the increasing intrusion of third-party payment systems into what we do with our clients and the struggle to become ‘client-centered’ having a method of recording progress becomes increasingly important. Yes, of course, we need to get paid for our work but we also have an obligation to our clients, any one receiving our services.

We all have those people, who question what we do.  I am sure that each and every one of us has had this experience.  Sometimes we can explain what is going on, through statements based on clinical knowledge, but then there are other times that we need real data.  Some challengers will accept the “+” or “-” system of data collection [“+” yes the client was able to perform the task or “-” no the client was not able to perform the task]  while

 

My Book Cover2
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others want more information.

So rubrics offer us a method of documenting some of our thought processing with regard to critical thinking, clinical reasoning and judgment. Sharing rubrics with clients and caregivers provides them with a tool to engage them in the treatment process in a way that is greater than just sharing goals.  By encouraging clients to monitor their own progress they become more vested, more engaged and more accountable to themselves and to us, their service providers, ultimately leading to greater gains.

Rubrics may be initially time-consuming to learn and to write, just like any other skill, the experienced therapist will soon be developing rubrics a lightening speed and have at their disposal a wealth of data and documentation supporting our services.  In my humble opinion, if a therapist chooses to use or not to use rubrics, it is okay, it’s their decision.  I choose to use rubrics, engage my clients in progress monitoring, and have data specifically highlighting the client’s progress.  In my opinion, how can I expect my clients to make the best progress if I do not share my expectations with them. I feel that I empower my clients through the use of rubrics, because I want to, not because I have to.

 

 

Posted in Eleanor Cawley, M.S., OTR/L

Revisiting The Student Interview

The Student Interview CoverAI have worked with middle and high school students most often.  At this age, a student’s frustrations increase proportionally to the workload.  They are aware of what works and what does not work for them.  When frustrations run so high and parents begin to panic, it is at this time other professionals, advocate and lawyers, become involved.

The Student Interview was developed because of a number of school-based cases that I had been involved in were quite intense.  Every small detail of the case was explored in depth.  I felt that it was imperative that the student have a voice and that I had a document that asked all the right questions. While it is very sad to see the state of the educational system, as it is right now, I feel that the educational system is in transition.  There are always ups and downs when experiencing a transition.

Over the last few years, I have used this interview with many students.  Since this is a form to complete, it is good experience for a student in the transition process.  There is a variety of questions, relevant to the student’s educational, vocational and self-care needs.  Some questions require a yes or no response, while others are open-ended and call for more detail.  The Student Interview serves its intended purpose quite nicely. Since using The Student Interview, I have not had that “uh oh” moment when something comes up that I should be aware of.  At least nothing that I have not at least asked and have a response to.

I really love a student’s surprise when he or she is asked to complete the satisfaction survey.  This is often the very first time a student is asked for his or her opinion on services.  I, now, provide each student with this interview.  I find it an invaluable tool not only as written documentation but also as a basis for a deeper conversation regarding a student’s skills, and their perceptions of themselves.

 

Posted in Eleanor Cawley, M.S., OTR/L

Annual Review will be here before you know it–Create Balanced Assessments!

That’s right!  Annual review season will be here in just a few months.  You should start writing your annual reviews shortly.  During annual review, it is prudent to get a student’s feedback on what is working and what is not working.  Make sure that you have a way to gain that additional information.  An interview is always helpful to provide insight on a student’s ability to function not only in the classroom but also at home.  Parents so often paint a different picture of a student’s abilities at home.  Students can behave differently at home.

This is the time to put all your ‘ducks in a row.’  When assessing your students, make sure to have a balanced assessment with some type of real-life [authentic] assessment.  This often means having a rubric to demonstrate how a student’s progress has been judged and the data that supports the student’s progress.

Think about interviewing your student to learn about his or her insights into their skills. Did you ever think about providing your student with a satisfaction survey?  This is quite eye opening.  By developing a rapport with your students, you have the opportunity to create a report that is quite inclusive of all their skills and their opinions.  Listening to and including your student’s opinions leads to better goal development, better outcomes and improved compliance with recommended strategies.

Engage your students in every way possible to participate in collecting data and the development of their IEP.  You will go a long way in developing the respect and the trust of your students.

Posted in Eleanor Cawley, M.S., OTR/L

-Taking Notes from an Occupational Therapist’s Perspective

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http://1stopbrainshop.com/study-skills/making-notes-on-books-or-handouts/951/

Taking notes is a very complex skill rooted in abilities developed in infancy.  While sitting in a classroom, a student is expected to have appropriate cognitive and motor responses to the teacher providing the lecture.  That is easier said than done!

As an infant, we are supposed to alert to a sound, respond to that sound with head turning in that direction, differentiate pleasant sounds from unpleasant sound and learn to express pleasure or displeasure.  Visually, we are expected to respond in a similar way: alert to a visual stimulus, respond by following that stimulus by turning our head to follow it, differentiate pleasurable from displeasing.  Infants are expected to demonstrate a motor response to the stimulus, i.e., eye opening, finger splaying, and activation of limbs.

Just as an infant is expected to display a motor response to stimuli, a student is also expected to respond motorically to stimuli provided by the teacher.  Students learn to respond to certain cues, i.e., “This is important,” “Conversely,” repetition of the information, etc.  It is very difficult for student to respond if he or she lacks the prerequisite skills.  Alternatives for taking notes should be offered to the student.  The least invasive is to have the student copy notes from the board (far point).  Some students have difficulty with visual skills such as pursuits and saccades (visual tracking and changing fixation from one target to another) making this difficult.  First a slant board (often a binder) can be used to address this issue.  If that doesn’t work then maybe copying from near point will work.

The next more invasive intervention might be providing the student with some form of prepared notes, i.e., Cloze Notes.  Cloze notes are fill-in the blank notes.  Students are only required to add one or two words to a statement rather than copy the entire statement.  The next level might be providing the student with a copy of teacher generated notes prior to the class for the student to highlight during class.  The next level might be having the student attempt whatever he or she is able then giving a copy of notes to the student, usually a copy from another student who takes very good notes.

Another strategy is to use on-line notes for a site like www.studyblue.com.  You may be lucky enough to find course notes similar to class notes with flash cards.  Kno.com is a site where you can buy electronic textbooks (usually at a reduced cost), this site also provides lecture (from the book), study materials and social networking for studying.  Kno.com is iPad friendly.  Along with programs like Evernote with Penultimate, this maybe all the student needs to be in class.  A student could photograph handouts and never have to carry another piece of paper.  Assignments could be entered into Everstudent (a digital assignment book/agenda).

One of the last options would be to type notes on a laptop or a computer.  If the student lacks the prerequisite skills for note taking, they cannot be expected to be successful if you give them something to type on even though they can type at a good speed with good accuracy.  A sixth grader is expected to type at a speed of 25-30 words per minute with 93% accuracy.  If a student has only handwriting concerns, is able to meet all the prerequisite skills for note taking, can type 25-30 words per minute with 93% accuracy then maybe the option for using a keyboard or laptop is the answer.

Posted in Eleanor Cawley, M.S., OTR/L, New Beginings, Occupational Therapy

Should Middle and High School Students Participate in the Evaluation and Annual Review Process?

Should Students Have a Voice?

Absolutely!  Most students at the middle and high school level are looking for a sense of independence.  Students of this age are often at a point where they want to know why they should continue therapy, and if they continue, why they can’t decide what they need to work on.  In a school setting, the goals need to relate to a student’s educational and/or vocational needs.  There is so much more information that a therapist needs to know to determine a student’s perception of his or her abilities and further determines whether or not a student really needs to continue.  Standardized test scores, although important, are only a snap shot of the student’s abilities at the time the student participated in the assessment.  It is not a clear and thorough picture of the student’s ability to function in a classroom.

I have often found that a student will provide more information if the questions are presented in a written format, particularly with sensitive areas, like activities of daily living, presented in checklist format.  Students will review the document, quickly at first, check an answer [which the therapist or teacher can expand on later] and then move on.  The written format provides a canvas, if you will, to create a dialogue with the student.  For example, let’s say that the student checks off that he or she can make a sandwich, ask the student how he or she makes that sandwich and you will get a better idea if he or she really is capable of making that sandwich.

I have developed a written interview, which I began using with some of my students over the last few years.  I was able to better assess a student’s abilities and perceptions of being able to care for him or herself and support classroom skills.  It prevents that ‘oh no’ moment when something is revealed in a CSE meeting that you should know but don’t surfaces.  When interviewing a student verbally, many of those items are glossed over and the interview proceeds.  A written document is a bit impersonal and the student may just answer more truthfully and feel more comfortable in doing so.

Let’s go back to that sandwich; a student checks off that he is able to make a sandwich.  Later, when reviewing the interview with the student, you ask, “How do you make that sandwich?”  The student lists all the items that he needs for the sandwich but is unable to describe how to actually make that sandwich.  This may indicate that a student has a form of dyspraxia or apraxia that has been addressed in other areas through years of therapy, but not yet in the area of self-care.  In very basic terms dyspraxia (problems with) or apraxia (unable to) refer to sequencing the steps to perform a skill.

This is enlightening and indicates other areas need to be explored.  When evaluating a student, all methods of gathering information should be used.  Standardized and non-standardized testing is important but so is the interview of the student and the teacher and authentic assessments, such as a rubric, to provide a balanced assessment of the student’s abilities.

A school-based assessment includes a reason for the referral [the problems that the student is having in the classroom], and his or her motivation for educational activities.  In my opinion, motivation can be broken down in to at least two components:  skill and desire.  If a student has limited or no skill in a particular area, there will be no desire to engage in the activity.

Motivation becomes a particularly important factor in the middle and high school years.  In order to encourage participation in therapy, students need to participate in and feel part of the evaluation process.  For one reason or another, a student may become disillusioned with therapy.  Comments may be made by peers, making the student uncomfortable with being pulled out of class.  Pushing into the class may not be an option either and may further target the student for comments and potential bullying.  At this point, if the student is so resistant to the therapeutic environment, consults may be the only option other than discharge.

Bibliography

Cawley, M.S., OTR/L, E. (2013). Using Rubrics to Monitor Outcomes in Occupational Therapy. Huntington Station: Eleanor Cawley, M.S., OTR/L.