Posted in Eleanor Cawley

Pushing the Birds out of the Nest

Leaving the nest copyThese opinions are my own based on my personal school-based experiences and recent postings from other therapists on social media 

When is it time to discharge?

This is always one of the biggest questions when it comes down to CSE Meetings and whether or not to recommend services for students next year. Of course, in a school-based setting, the big ‘money makers’ are handwriting and now keyboarding. Before making that decision, I think that it is important to look at the student’s level of function in a particular environment. I feel that when we report progress a rubric is very important but so is the environment or context in which the skill is performed. When I look at either handwriting or keyboarding I look at the following:

  1. Can the student perform the task automatically with my assistance in a therapy room?
  2. Can the student perform the task automatically in the therapy room without my assistance?
  3. Can the student perform the task automatically in a classroom with my assistance?
  4. Can the student perform the task automatically in a classroom without my assistance?

This is an important factor that is left out of documentation on goal progress. Anyone that knows about me, knows that I love to use rubrics. I love documentation to be clear and concise, understood without my being there to explain. So I often base my documentation on the level of self-sufficiency-does the student have the power to perform the task over a wide range of activities and settings. In other words, is the handwriting or keyboarding at the level of being automatic? The DeCoste Writing Protocol is an evidence-based tool with some very good research supporting its development. Based on this research, both handwriting and keyboarding should be at the level of automaticity. If these skills are not automatic, then the focus in on the motor components of the task and therefore the student cannot meet the cognitive demands of the writing task. Basically, we will not know what the student has absorbed because he or she cannot get it on paper.

I remember hearing somewhere that in order to do your best on a test, you should take the test in the same location that the teaching or learning took place. Could that mean that a student may hand write better if he or she is in the room where they actually learned the skill? It is certainly an interesting point and possibly one for a good research study. Our goal is to have the student generalize the skills to all handwriting or keyboarding tasks-to become proficient. The Written Language Production Standards provides us with what is expected of a student with regard to handwriting and keyboarding at a particular grade level. Does your student meet those standards? Do you think that your student is capable of meeting those standards? Why or why not? Is the student capable of meeting those standards in a variety of settings without your support? Why or why not? I feel that I am not doing my job well, if I can’t answer these questions, my student is not performing as expected within the classroom and I have not offered alternatives.

There is also something else to consider and that is the student’s expectations and preferences. Is this student so overwhelmed with handwriting or keyboarding that they have just given up? I use The Student Interview to explore the student’s preferences and understanding of their own skills, i.e., what the student thinks they can do to what the parent thinks they can to and compare that to what I and the teacher see them do. The level of anxiety and frustration that a student experiences with not being able to express themselves on paper should be considered.

So while I would always like to think that OT RULES and I have all the answers, I don’t. What I do know is this, keep the student involved with determining goal progress, assess the skill across settings and keep the student in mind when determining where to go next, if anywhere. If you think that you can discharge a student when they can type 10 words a minute and they are in the 4th grade or above, think again. That student is not ready to handle the keyboard in the classroom.

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

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

Imagine the Life of a Student with an Executive Function Disorder…..

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If you click on the photo above, you can read the infographic on a student, named Josh, who happens to have an executive function disorder.  This is all too common for many parents and teachers–the student unintentionally comes to school without ……. Homework is one of those things that is typically forgotten. Imagine how the student feels when the teacher asks for the homework and it’s not there.  There has to be a solution and there is.  There are a number of ways that the forgotten homework problem can be resolved through technology.

A great way to resolve this problem is by using Microsoft OneNote.  Microsoft OneNote comes with all Microsoft Office Suites–from the least expensive to the most expensive suite.  If you have purchased Microsoft Office then you have OneNote.  Most school districts use Microsoft Office so that they already have it as well.  A student’s homework notebook can be stored in a number of ways:  1.  The school district may allow access to the district server with a student log in from home.  2.  The district can allow access to a Windows Live account from a school computer or iPad.  The OneNote iPad app is free!

So now, the student, through whatever means, is able to access his or her homework assignment in their OneNote notebook.  As soon as the student enters any response to the assignment, it is instantaneously updated on any device that the student or teacher has access to.  So that means when the teacher says, “Josh do you have your homework?” Josh can say yes I do!  If it is not the paper version [easily printed from OneNote], at least Josh would be able to retrieve his assignment from OneNote.  This problem is then eliminated thus helping Josh feel more secure in his abilities.

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Remember that this is only a very basic rubric and will need to be modified to meet the individual needs of each student

It is very helpful to use rubrics to help a student see progress.  This rubric can be saved as a template within OneNote and be completed immediately after the homework is complete.  An additional rubric can be used to demonstrate Josh’s progress in locating his homework at school. In my opinion, we have to stop sweating the small stuff and find ways to help students with Executive Function Disorder be more successful in school.  If we can eliminate minor problems by using technology then that’s what we need to do.

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

School-Based Professionals Using Microsoft OneNote

As I have always said, Microsoft OneNote far out shines its free counterpart, Evernote.  I use OneNote for all my documentation needs. In fact, I wrote about it in my book, ‘Using Rubrics to Monitor Outcomes in Occupational Therapy.’  OneNote acts as a notebook or file folder.  Each notebook can have an infinite number of tabs [sections] and pages.  The best thing is that you can carry all your files, well organized, on a thumb drive [USB Drive].  Student work samples can be scanned into OneNote and other work samples can be printed into OneNote.  I can enter a page from any program or website. For me, the best feature of OneNote, and the one that makes it so much more flexible than Evernote, is the ability to create templates that can be used in every notebook.  Templates are universal.  That saves much needed time, as I do not have to redo the template for each of my students. OneNote conserves your energy since you never have to take large files or notebooks home.

 

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.