Batten Down the Hatches – It's Annual Review Time

GUEST BLOGGER:

Kathryn Biel

It’s that awesome time of year when we bury ourselves in paperwork and don’t resurface until June. You know–annual review time.

Last week, I put my scheduled meetings (so far) into my calendar and wept. Balancing a full caseload while preparing for next year is a bit intimidating. But I know I can do it. Each session has begun the information gleaning process. What are we working on? What are we hoping to accomplish?

A few years ago, at the School-Based Therapy Annual Conference, I gleaned this statement. It gets included in every report I write:

“School-based therapy is not intended to meet all of the therapeutic needs of a student; rather it is intended to ensure safe and efficient access to one’s education.”

That statement works for me in two ways. When a student is scoring below average, but can access his or her education, I can justify reduction of service levels or discharge. Conversely, and perhaps more importantly, when a child is testing in the average range, but functionally is not able to put it all together to access his or her education, I can justify initiation or continuation of service. I am fortunate to work in a difference that, at this time, still supports putting non-classified kids on caseload (we call them Improvement students) through RTI.

At this past November’s School-Based “Therapies in the School” Annual Conference, I was able to glean a few more soon-to-be-often-quoted important points from Susan Cecere’s presentation on “Complex School Based Challenges: Collaborative Goals, Embedded Motor Interventions, Data Collection, and Frequency/Intensity Decisions.”

Susan spoke of taking a top-down approach in which the first item considered is the desired outcome/goal for participation. We all know that this piece is so important that there is a specific section on the IEP asking what the parent’s goals are. This also includes the team’s goal. Understanding a student’s needs IN RELATION to the educational environment will help to determine what the functional, contextual problems are for a student.

Once the functional, educational needs are identified, the the barriers and strengths can be identified. Then, strategies to overcome the barriers can be planned and the specific interventions implemented.

I’ve been writing IEP’s for years. I’ve written some great ones. I’ve probably written some crappy ones as well. It’s easy to get complacent, especially when we’re expected to crank them out for meeting after meeting. However, identifying the functional educational needs in this framework can really help to re-focus attention and make us stop and think about what we are doing.

So, here are my new bullet points for consideration during IEP writing:

  • What activities and routines are problematic?
  • What is the level of participation and the participation restrictions?
  • How are the needs understood IN CONTEXT to establish EDUCATIONAL RELEVANCE?
  • What is it in THAT CLASS that is causing THAT BARRIER? Once that is identified, it is important to identify who is the best provider of the intervention (e.g., a child who has issues with sequencing–while the sequencing impacts motor performance, it is the sequencing and not the motoric aspect that needs intervention)
  • School therapy is not intended to substitute for medical therapy but to work in tandem with it.
  • If a skill or activity CANNOT be observed or measured during a child’s normal school day, then it might NOT be relevant to the child’s educational needs.

Obviously, I will continue to have parents who disagree with this rationale. There will always be the situations where therapy will be provided, regardless of my recommendations. We all have those cases. It goes with the territory.

Once I’ve figured out whom  I will be recommending services for, at what frequency/intensity/duration, and where the services will be performed, then I will need to establish goals. Based upon the information gathered above, the goals will be easy to identify. Susan Cecere also recommended the use of SMART goals in goal writing. SMART goals are:

  • S: Specific
  • M: Measurable
  • A: Attainable
  • R: Relevant
  • T: Time-Bound

Okay, so I’ve got my toolbox ready. I know the framework for critical thinking. I know how I’m going to go about thinking about my goals. Good luck to you all and may the odds be ever in your favor.

~Kathryn Biel, PT, DPT

 

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2016 CEU courses in NEW JERSEY and NEW YORK for PT's OT's and SLP's

Education Resources is thrilled to offer multiple opportunities for
CEUs coming to New Jersey and New York in 2016 

We are pleased to  offer you our continuing education courses that are evidence based, engaging, relevant, and immediately applicable to your practice.

Education Resources applies to the New Jersey Board of Physical Therapy Examiners for all relevant courses being held in New Jersey and neighboring states.
Education Resources is an approved provider by the New York
State Board of Physical Therapy.
Education Resources is an Approved Provider of Continuing Education by the American Occupational Therapy Association. 
Applications are made to ASHA for all relevant courses.

Please click here for a  full listing of courses, course descriptions, faculty bio, course brochure including a schedule and registration information

Further courses may be added as venues become confirmed.
PLEASE CLICK HERE TO PRINT THE FULL LISTINGS

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Visual/ Visual-Spatial Resources

 

We wanted to share some visual/visual-spatial resources recommended by faculty member Carrie Davis

www.eyecanlearn.com (free online resource with activity ideas and a few computer-based games to work on specific visual challenges- tracking, eye teaming, etc.)

Visual-Spatial Portals to Thinking, Feeling and Movement (book by Dr. Serena Weider, co-founder of the DIR model, and Dr. Harry Wachs, a developmental optometrist)

Eye Games (book by an OT and a developmental optometrist) http://www.amazon.com/Eyegames-Exercises-Optometrist-Activities-Enhance/dp/1935567179

We hope that you will find something useful.

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Early Mobilization in the ICU and in Acute Care – A Family's Perspective

GUEST BLOGGER:

Kathryn Biel

As a PT, it’s not uncommon to spend our days in the hospital. This fall, I got to spend more time in the hospital than I’d planned for. My dad had a stroke. Unfortunately, he was at my house when it happened, so I had the task of bringing him to the hospital. I sprung into PT mode, assessing his mobility, his coordination, his speech, his balance. Of course, I was scared. We all were. What I was thinking about the whole time were about the possible lifetime limitations my dad would face. What would his impairments be? What would he get back?

He was admitted of course, and due to unstable blood pressure, was admitted to the ICU. The next morning, he seemed pretty good. There was some barely noticeable dysmetria in his hand. Occasional dysarthria. His balance was a bit off. I was pleased that his PT was in by 9 am. Ambulation and transfers were assessed, and he was able to get out of bed.

Mid-day, he went south. We still don’t know why. What I do know is that while the nursing documentation stated “no change” (long story there), his PT was able to not only provide documentation, but to speak with the physician on our behalf to explain the gravity of the situation. My dad went from being stand-by assist without assistive device to moderate assistance x 2 with a rolling walker. His speech was virtually unintelligible. His right hand barely worked. The PT knew. The PT understood. The PT got the ball rolling and advocated for transfer to the best rehab in the area.

Just under three months later, my dad’s doing great. He’s not 100%. Like I feared in the ER, he may never be 100%. But I know, those first few days in the ICU and acute care were critical. And I know what a difference early mobility made for him.

So, on behalf of my family, thank you to the therapists who brave the machines, the illness, the crazy families (of which I may or may not be one of) to get in to the ICU and acute care. I know you know what a difference you make. Now I know too.

~Kathryn Biel, PT, DPT

 

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NEW COURSE: Linking Play and Self-Regulation to Mealtime Success and Introducing NEW SPEAKER: Susan Roberts

 

We are thrilled to introduce a new speaker to our faculty:

[caption id="attachment_3035" align="aligncenter" width="251"]Susan Roberts Susan Roberts[/caption]

SUSAN ROBERTS

Susan L. Roberts, author, nutritionist, and award-winning occupational therapist uses innovative, research-based approaches for children and teens with autism spectrum disorders, ADHD, CP, Down’s syndrome and other special needs.  Her child-friendly, positive approach integrates physiology, psychology, and social-emotional aspects of mealtimes to achieve better health and behavioral outcomes.

Susan will be presenting her new course developed for Education Resources:

Linking Play and Self-Regulation to Mealtime Success

This course explores the growing problem of food refusals and nutritional deficiencies from a revolutionary new perspective that addresses self-regulation, socio-cultural, and emotional perspectives while incorporating conventional nutrition, oral-motor skills, sensory processing and behavioral techniques. Medical conditions affected by food refusals include obesity, diabetes, autism spectrum disorders, ADHD, and learning disabilities. Participants bring in case-studies from their own practices, applying Susan’s integrative framework which usesplay, the primary occupation of childhood, as a focal point for assessing client needs and preparing intervention plans. The seminar format provides ample time to discuss a variety of cases. Participants take away useful tools they can apply immediately in everyday practice. These include: structured observations of play and mealtime behaviors to determine developmental readiness; food journals for determining individual nutritional, sensory and food sensitivity issues; writing functional, measureable play and mealtime goals for school-based interventions that align with Common Core academic standards; and strategies for implementing related performance objectives.

April 15-16, 2016 – Los Angeles, CA

June 3-4, 2016 – Danbury, CT

November 4-5, 2016 – Cedar Knolls, NJ

Please click here for full course details, to download a brochure or to register

 

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