Cheese and beer. Beer and cheese. Beer-battered cheese?? Brewers in the play-off season? Do these hints tell you anything about where I was Sept 26-29? You guessed it! Milwaukee, Wisconsin!
I was fortunate to attend the AOTA Children & Youth conference, which will now be an annual event. Yeah!!! AOTA had, on occasion, hosted a specialty conference for school-based therapists (the last one in Orlando with those Irish step-dancers J), and now, in this newly-morphed, more inclusive children and youth content, will be an annual event. Right now, AOTA is soliciting input on the best time of year to host this conference, so you can contact them to let them know your preference.
This fantastic conference kicked off with two all-day pre-conference sessions, one on addressing trauma and resilience in children and youth and the other on strengths-based evaluation for children and youth.
I really wanted to attend the session on trauma-informed care, but I *had* to attend the other session, especially since I was co-presenting with one of my partners-in-crime, Dr. Jan Hollenbeck. Shout out, Jan!
So I’ll start there, even if I am biased. The speakers moved through the importance of identifying, understanding, and using strengths, including some active learning, and the positivity that a strengths-based lens fosters for the self-esteem, self-advocacy, and self-determination of our clients.
The majority of each of the two conference days included concurrent sessions. A session on occupation-based tools paired nicely with that strengths-based presentation from the pre-conference day :). (Occupation-Based Assessments in Pediatric Practice with Emily C. Skaletski, MOT, OTR/L; Laura Nagel, MS, OTR/L).
Assessing Occupation and Participation
There is abundant research that tells us we are somewhat stuck in using body function and structure assessment tools in our pediatric practice (Alotaibi et al, 2009; Bagatell et al, 2013; Kramer et al, 2009; Piernik-Yoder & Beck, 2012). When we use a body function and structure assessment tool, guess where we make goals and design intervention?
Yup, at the body function and structure level! And not necessarily at the occupation or participation level. And that stinks!
It sounds like such a cliché, but it’s true; our distinct value lies in our ability to understand, assess, and intervene with our clients around their wanted occupations. So, let’s measure their occupation and participation!
For participation in wanted and needed occupations, check out the Canadian Occupational Performance Measure (COPM), the Child Occupational Self-Assessment (COSA), or the Participation and Environment Measure – Children and Youth (PEM-CY) and its younger version Young Children’s – Participation and Environment Measure (YC-PEM). Layering in just one of these tools to our already-established evaluation habit moves us toward best practice.
Readiness for C-H-A-N-G-E
Patty Laverdure and Pam Stephenson blew me away with their concurrent session on CHANGE (Inspiring Change—Implementing Inclusive and Contextual Services with Patty Laverdure, OTD, BCP, OTR/L; Pam Stephenson, OTD, OTR/L).
C-H-A-N-G-E. They discussed an individual’s or organization’s readiness for change and, along with that, how to assess our own readiness.
Indeed, best practice is about continual change. If we are doing the same interventions as we did 5-10-15 years ago, we need to think differently; we need to change.
But no one can tell us to change, even though our parents tried (and are still trying J). We have to be ready. Enter the Irving Readiness for Change model; what a concrete way to describe readiness for change. Read his blog and check out the Readiness for Change graphic.
Lunch break was delish! How can you go wrong with beer and cheese, cheese and beer?!
Today + Student = Mindshift
For me, the Mindshifts in School-based Practice (with Robin Leinwand, MOT, OTR/L; Heidi Sanders, MA, OTR/L; Joanna Cosbey, PhD, OTR/L) concurrent session was the icing on all this good cake. This session was a primer in how to do educationally-relevant, contextual, embedded service provision. This was the session that answered the questions,
- “What does it look like?”
- “How do we get in the classroom?”
- “How do we stay in the classroom?”
- “How does what we do in the classroom feel like OT, and not like a glorified aide?”
Admit it, tough as it is to hear (read), we have heard this question. And many of us are not sure the answer. Everyone who has moved the majority of their services into a contextual lens has had to answer this question for themselves: What does it look like?
The mindshift comes in thinking about:
- “What is the student’s day like today?”
- “What does the student need to do in order to be successful today?”
- “What is one strength my student has that can overcome this particular barrier today?”
- “How can I assist my student today?”
Today + student is the mindshift. I am not sure the questions can continue to be asked about how to ‘fix’ a fine motor issue over the year, or ‘remediate’ a sensory regulation issue over the next six months, and continue to be answered solely through the body function and structure lens.
Our questions around participation necessarily need to be about participation today. Granted, we are not with our clients every day. But the days we are with them, let’s make it about the participating they need to do that day, that time, that place, with those people, with those materials.
That is one humungous start to the C-H-A-N-G-E Laverdure and Stephenson alluded to earlier in the day. Change not only in our own clinical reasoning and resultant practice, but a change then in how stakeholders (teachers, principals, parents) view our valuable services. I don’t know about you, but I really don’t want to be known as the ‘fine motor lady’ anymore!
Coaching
Man, can you tell I was jazzed after these sessions! To top it off, so icing on the icing on this good cake, was a discussion on coaching (The Power of Coaching to Enhance Occupational Therapy Practice with Scott Tomchek, PhD, OTR/L, FAOTA; Lauren Little, PhD, OTR/L; Ellen Pope, OTD, OTR; Evan Dean, PhD, OTR/L; Anna Wallisch, PhD, OTR/L; Winnie Dunn, PhD, OTR/L, FAOTA) Coaching as a collaborative intervention model. There is emerging evidence for the efficacy of coaching in occupational therapy (Dunn et al, 2012; Foster et al, 2012; Keintz & Dunn, 2012; Simpson, 2015).
This is where the power of the therapeutic relationship is seated equally between the therapist and client. Are we able to let go and let our clients lead us? Can we be quiet while our clients tells us what they need and want? (That is still so hard for me: the quiet thing). Can we support our students to create their own goals? Of course we can.
If we struggle with what ‘it’ is supposed to look like, ‘it’ being movement toward best practice that incorporates evidence around contextual services, embedded services, coaching, strengths-based, whatever floats your boat right now, reach out, find a mentor who is practicing as you would like to practice. Form a support group. Make a plan. Yell it out loud! Go to conference.
Be inspired.
BeTheChange!
One baby step at a time.
Sometimes baby steps are humungous.
References
Alotaibi, N., Reed, K., & Nadar, M. (2009). Assessments used in occupational therapy practice: An exploratory study. Occupational Therapy In Health Care, 23:4, 302-318, DOI: 10.3109/07380570903222583
Bagatell, N., Hartmann, K., & Meriano, C. (2013). The evaluation process and assessment choice of pediatric practitioners in the northeast United States. Journal of Occupational Therapy, Schools, & Early Intervention, 6, 143-157.
Dunn, W., Cox, J., Foster, L., Mische-Lawson, L., & Tanquary, J. (2012). Impact of a contextual intervention on child participation and parent competence among children with autism spectrum disorders: A pretest–posttest repeated-measures design. American Journal of Occupational Therapy, 66(5), 520-528.
Foster, L., Dunn, W., & Lawson, L. M. (2013). Coaching mothers of children with autism: A qualitative study for occupational therapy practice. Physical & occupational therapy in pediatrics, 33(2), 253-263.
Kientz, M., & Dunn, W. (2012). Evaluating the effectiveness of contextual intervention for adolescents with autism spectrum disorders. Journal of Occupational Therapy, Schools, & Early Intervention, 5(3-4), 196-208.
Kramer, J., Bowyer, P., O’Brien, J., Kielhofner, G., & Maziero-Barbosa, V. (2009). How interdisciplinary pediatric practitioners choose assessments. Canadian Journal of Occupational Therapy, 76(1), 56-64.
Piernik-Yoder, P. & Beck, A. (2012). The use of standardized assessments in occupational therapy in the United States. Occupational Therapy In Health Care, 26:2-3, 97-108, DOI: 10.3109/07380577.2012.695103
Simpson, D. (2015). Coaching as a family-centred, occupational therapy intervention for autism: A literature review. Journal of Occupational Therapy, Schools, & Early Intervention, 8(2), 109-125.
