On the Rise – How we can support today’s Behavioral Health needs in our schools

Boy with special needs

During my years of consultation in the classroom, the number one question I would hear from teachers was, “How do I deal with persistent and challenging classroom behavior while trying to meet all of my students’ educational needs?”  These teachers all had the skills and the insight to successfully implement behavior strategies, but they were getting bogged down with feeling overwhelmed.

Applied behavior analysis is best known as an empirically validated treatment for Autism, however, it is so much more than that.

By definition, applied behavior analysis (ABA) is, “a science devoted to the understanding and improvement of human behavior.” (Cooper, 2006).  In short, this science is all about applying principles of behaviorism to make meaningful changes in the lives of individuals.

I know others are apprehensive with ABA because it sounds “technical.” In reality, ABA is simply another way to teach.  I am not a teacher by trade, but much of what I do each day involves helping individuals learn.  When a student is tantruming during a writing activity, it is my job figure out why, and then to teach that student an acceptable alternative behavior to replace the crying. In this scenario, the teacher is aware that writing is challenging for this student, and the student cries every time a pencil and paper are presented, yet the task is presented in the same exact way each and every time.  ABA essentially helps us “decode” these common situations so that we can introduce strategies to combat learning barriers- similarly to the way a classroom teacher would break down a math problem for a student who is struggling grasping order of operations.

School children creating art in a classroom with one child smiling into camera.

I have compiled my top 5 helpful tips when using the principles of ABA to manage classroom behavior. I hope you find them useful!

  • Learn to identify the function of the interfering behavior – All behavior has a purpose and it’s our job to figure out the “why” and to look at all the situations in which this behavior occurs. When we talk about the “ABC’s” of behavior, we are referring to the Antecedent (i.e., what happened IMMEDIATELY BEFORE the before occurred), Behavior (i.e., the interfering behavior itself), and the Consequence (i.e., what happened IMMEDIATELY AFTER the behavior occurred).  These “ABC’s” will offer great insight into the context of behavior which will be the first step in learning to reduce and replace it.
  • Familiarize yourself with what motivates your students! – Each individual has an “M.O.” or what us behavioral gurus like to call a, “motivating operation.”  This simply means different people are motivated by different things, and most importantly, at different times!  Recognition of changing motivation is a critical component to any effective behavior intervention.  Learning how to capitalize on an “M.O.” takes some thought, but will make a dramatic impact on the effectiveness of your rewards!
  • Modify the environment This is an antecedent strategy (i.e., proactive strategy that occurs BEFORE an interfering behavior happens) that changes the way we interact with our environment. For example, students are frequently getting out of their seats during teacher lessons to walk across the room to retrieve forgotten materials.  As a result, they are getting distracted on their way and disrupting peers.  Providing “chair bags” containing additional supplies on the backs of student chairs may be a simple solution that would help reduce off-task behavior.  REMEMBER: make sure classrooms are organized, and students understand expectations.  Sometimes off-task behavior may be perceived as misbehavior, but if directions aren’t clear it’s going to be difficult for students to comply.
  • Consistency is key! – Behavior change takes hard work and dedication. Often times behaviors will get worse before they get better.  One thing that must stay steady and consistent through the process is your response! NOT one single demand should be placed on a student that a teacher or adult isn’t prepared to enforce and follow through on. Its human nature to go the path of least resistance so if students can get what they want with less effort, they will always find a “loop-hole” in reinforcement.  If they can delay a non-preferred math lesson by taking a trip to the bathroom, they will.  If they lost the privilege of sitting next to their best friend in your class, but the art teacher lets them do it, what have they learned?  If there is a behavior you are looking to change, every key player must be intervening in the exact same way.  I have seen many theoretically effective behavior intervention plans fail due to the overall lack of consistency in implementation. All team members should be communicating effectively and continuously sharing experiences in efforts provide a unified approach.

BE PATIENT-  There is no magic wand (although many behavior analysts wish they had one) and the only way to take back control of the classroom is to invest over and over and over again. Behavior change takes a lot of time, so keep at it and stay consistent!

 

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Loren Gentile, M.Ed, BCBA, LBS recently joined the PTS team as a behavior consultant to help clients navigate the behavior needs of their districts and the students they serve.  She is a valuable team member, offering insight into how applied behavior analysis can be easily and readily incorporated into any classroom, resulting in long-lasting positive behavior changes. Contact PTS today if you’d like more information on our Behavioral Health Services!

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Everyone Can Give Back

PTS OT, Jodi, talks about her idea to implement interventions that benefit others, including our furry friends!

Everyone Can Give Back

I’ve found that many students genuinely seem engaged and motivated to do their best when working on an activity to benefit others. This was true when students composed letters and created cards for local Veterans. One student, a fifth-grade boy, was so proud of his card he asked if he could take it home to show his mom. Four months later at his IEP meeting his mom still had that card and beamed with pride over his neat handwriting and creative work.

My idea to implement interventions to benefit others has since expanded to our furry friends as well. One very successful activity has been baking dog bones (recipe below) for our rescued four-legged friends at Diamonds in the Ruff and Good Karma animal shelters. This activity was carried out as part of a SPOT (Speech/OT) group session in both upper elementary and middle school Autistic Support and Life Skills classrooms.

These groups contained all of the good-for-you therapy skills – discussion of the project, planning, working in a group, following a recipe, kitchen and food safety, fine motor skills for measuring, stirring, pouring, etc. Students working on typing skills typed a short message and ingredient list which was then attached to tags on each bag. The first group even had the opportunity to hand out the treats to the dogs and volunteers of Diamonds in the Ruff when they visited our school for Community Day!

The opportunity to pair student goals with “giving back” activities is my favorite. I love seeing my students excited as they wonder who might be the recipient of their hard work. I encourage you to try similar projects in your schools!

Dog biscuits.jpg

 

Homemade Dog Biscuits

Recipe from Kitchen Confidante

INGREDIENTS

  • 1 cup whole wheat flour
  • 1 cup oats
  • 1/2 cup flaxseed
  • 1/2 to 1 cups beef broth
  • 1/4 cup peanut butter

INSTRUCTIONS

Preheat the oven to 350°F.

In a medium bowl, stir together the flour, oats and flaxseed. Mix in 1/2 cup beef broth and peanut butter. Mix well, adding additional beef broth if necessary to bring the mixture together to a thick dough. Form into a ball and turn out on a lightly floured surface. Roll to about 1/4 inch thickness and cut out to desired shape. Bake for about 20 minutes or until golden brown, flipping halfway. Cool completely, then keep in an airtight container for about one week.

These freeze well and can be thawed in small quantities for treats during the week!

Jodi Gaunt, M.S., OTR/L

GJPQY – Go Below Song

Mary Adolf, M.S, OTR/L talks about the song she co-created to help teach students about descender letters, the letters that “go below” the main body of the letter. 

GJPQY – Go Below Song

So………….  I had an idea. There are 5 letters that go below. And I aptly call them, the “go-belows.”  They are g, j, p, q, and y.  I do push-in whole group instruction for first graders on handwriting.  How can I teach my first grade students to remember the ones that go below?  I show them in repeated visual demonstrations during whole group instruction, and I tell them funny things like “the go belows do not like heights, and like to sit their bellies on the line.”  But I needed more.

I love writing poems.  So I decided to write a little poem about the go belows.

Hey Hey Ho. What do you know?

There are 5 letters that go below:

g, j, p, q, y,

These are the letters that don’t go high!

They like it on the bottom line low,

So make sure you make them go below!

But it needed music!  Being collaborative at Exton Elementary, I decided to send my poem to our music teacher, Jamie Klingler!  He is so good with the students, and has a knack to just “make music” on demand.  So one of the first graders brought my poem to Mr. Klingler, and wouldn’t you know it, within an hour or two I had the music!  He created the tune to go to my poem, and taught the lines to the students in his first grade music class, and voila!  So awesome!  Collaboration at its finest.

The song was used to teach the first graders the go-below letters for the next two weeks!  So much fun!

Tap below to hear the tune!

Capture

And thanks again to Exton’s music teacher, Mr. Klingler!

-Mary Adolf, M.S, OTR/L (OT at Exton Elementary School)

Surviving Indoor Recess!

Winter is HERE!  Sometimes weather can take a toll on our minds, bodies, and our energy.  We are not the only ones who feel the negative effects of the winter, kids feel it too!  Not only do they have to get bundled up in countless layers, which means extra buttons and zippers, but they are also forced to have recess trapped inside in the same room they’ve been all day! Indoor recess is not something anyone looks forward to!

Here are some ideas to make the most of indoor recess, promoting physical activity and fun, in order to energize everyone for the day’s demands.  The best part? There’s little to no prep time for teachers!

MOVEMENT GAMES:

  1. Balloon volleyball
  2. Dance videos for kids on YouTube! Even better, subscribe to GoNoodle for daily brain breaks AND indoor recess fun!
  3. Silent ball: Have everyone spread out in the room. You have one leader who holds a medium-sized ball and counts down, “3,2,1” and passes the ball to another person in the play area. A player must sit down if s/he drops the ball, makes a bad pass, talk, or make noise. Play continues until only one person remains, last player standing gets to be the leader next round.  For young players have them sit or stand in a circle close enough to catch/throw.  For more of a challenge ask players to put one hand behind their back or spread out even further.
  4. Hot/cold game: One student leaves the room and the class hides a specific object. When they re-enter you help them find it buy saying “hot” for when they move closer or “cold” for when they move farther away!
  5. Pictionary: Have the students draw a picture of a spelling word or something from the morning story! What student doesn’t love extra time to draw on a white board?
  6. Human knot: Each student reaches across the circle with his or her right hand to grab another student’s right hand. Students then reach in with their left hands to grab a different student’s left hand. The object is to untangle the group without letting go of hands until a complete circle is formed.

Image result for human knot

The websites below have even more ideas!

http://theinspiredtreehouse.com/creative-indoor-recess-games/

https://www.yourtherapysource.com/blog1/2015/09/15/8-print-and-go-ideas-for-indoor-recess/

http://www.ssww.com/blog/tag/indoor-recess/

https://funattic.com/indoor-recess-games/

https://www.scholastic.com/teachers/articles/teaching-content/10-indoor-recess-ideas/

 

As much as you want the students to get up and move to get some energy out, some students probably want to be quiet and just play a game, and as teachers, your room is probably packed with games already! Here are some board games that really work those fine motor skills, visual motor skills, and visual perceptual skills that are often addressed during occupational therapy sessions!

  1. Operation
  2. Connect 4
  3. Geoboards
  4. Pop Up Pirate
  5. Legos
  6. Twister
  7. Rush Hour
  8. Mancala
  9. Hi Ho Cherry-O
  10. Trouble
  11. Sorry!
  12. Hidden Picture puzzles
  13. Battleship
  14. Mastermind
  15. Jenga
  16. And so many more!

Image result for kids playing connect 4 Image result for kids playing jenga

So while indoor recess can be tough on everyone,  with just a little bit of (or no!) work on your part, the time can be spent having the kids play and have fun while working…without them even knowing it!

 

Colleen Marshall, MS OTR/L

Executive Function and Mindfulness

Last week PTS hosted our first ever Administrators’ Retreat which introduced two amazing speakers to a group of local Special Education Administrators. The one day retreat was the kickoff to our 20th Anniversary of serving students with special needs in the Greater Philadelphia area.

The retreat began with Dr. George McCloskey, a neuropsychologist, who is an expert in the area of Executive Function.  Executive Function is a hot topic these days, and many school based therapists are being asked to work with teams to generate accommodations and to provide staff education on this area.  As an Occupational Therapist, I think this is a fantastic area for our profession to support students and teachers.  I first had the opportunity to see Dr. McCloskey speak at the Special Education conference last year in Hershey. He had a one hour time slot and it just wasn’t enough time. Everyone in the room wanted more.  Why? Because he helped make sense of the students and behaviors that we work with on a daily basis.  Three hours with Dr. McCloskey was still not enough and I’m hoping to one day be able to take one of his day long or even week-long courses.

Here are my favorite highlights from his presentation:

  • Executive Functions ARE NOT the skills of planning, organizing, prioritizing, monitoring, etc. Executive Functions ARE the brain managers that supervise the skills of planning, organizing, prioritizing, monitoring, etc.
  • Executive Functions are the bosses that tell the workers (skills) the WHAT and WHEN and then the HOW.
  • Deficits and/or dysfunction in Executive Function is a production issue, not a capability issue. There may be intact skills, but if the brain supervisors are weak then the capable workers may never be able to show the world what they are able to do.

DrMcCloskey.jpg

This information flowed right into the afternoon session of Mindfulness, which was presented by Jenny Mills of Roots and Wings, LLC.  We learned that mindfulness is being fully present and meeting each moment with kindness and curiosity.  We worked on activities that strengthen children’s awareness and attention.  My favorite highlights from Jenny’s presentation were:

  • Children understand the concept of their attention being like a flashlight that they have control over; for example, “Shine your flashlights of attention on the board”. Using that analogy to facilitate students pointing their flashlights to what we need them to be attending to really can work in a much more effective way than saying, “Pay attention,” which is really quite a vague statement.
  • Playing games such as Mime in the Mirror where two partners are working together; one partner is the Mime and without speaking moves their body into and out of various positions (example: arms flapping, swaying like a tree in the wind, etc.) and the partner, also without speaking, must follow exactly what their partner’s movements are as if they are the mirror reflection.
  • Breathing Breaks. It sounds so simple but so many of the adults in the room confessed that they don’t feel like they “breathe right,” meaning that most of us are living our lives chest breathing and never taking a full belly breath, which is so very calming and organizing for our nervous system. Practicing belly breathing by tracing a finger around a circle on a page (inhale for half the circle and exhale as you trace the second half of the circle) all while following the finger with the eyes is a fantastically quick and quiet (and effective!) calming strategy that can be used during transition times, preparation for a test, or anytime that students need to prepare to focus.

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Overall, this was an AMAZING day of learning and I know that we just scratched the surface of these two topics.  I can’t wait until the next time I can see both of these presenters again and continue exploring these two topics that are so relevant to school based therapy at this time.

For more information on Dr. McCloskey, click here.

For more information on Jenny Mills, click here.

 

Candice Donnelly-Knox, OTR/L – Director of Clinical Services at PTS, Inc.

Seamless IEPs – Student Goals vs. OT Goals

As we prepare to head back to school, Liz reminds us of the importance of IEP goals being the child’s goals, not a discipline specific goal! 

Seamless IEPs – Student Goals vs. OT Goals

Seamless IEPs

by Elizabeth Bentz OTD, OTR/L, SIPT

When I first began my career as a school OT eighteen years ago, I believed I could do it all. With the COTAs, our enthusiasm and magic wands, we could treat every student, climb over every wall, break down those barriers to participation.  That was the fun part.  The not so fun adventure was the avalanche of paperwork that continued to bury us along the way.  Documentation, weekly notes, ACCESS billing, parent communications, IEP development, classroom programs, progress monitoring goals, goals, goals.  All necessary.  All part of the job.  During those marathon OT sessions, every step needed to be paved with a paper trail, evidence that we were there with the student working hard to reach those OT goals.

While my team and I were eager to share the stories about our student’s journey, the harried teachers who were stressed and weighed down with their own mountain of forms, just wanted our IEP input for those OT goals.  Despite positive outcomes during occupational therapy, the student would be unable to replicate those stellar marks in the classroom.  This disconnect between participation in OT and in the class setting became another obstacle to overcome.  I had to find a way to bridge this gap because it didn’t matter how wonderfully the student worked for us.  If he or she could not succeed in the classroom, OT would continue indefinitely.  The marathon would turn into a race on a hamster wheel.  I had to get us off this wheel.

 

Ultimately, the goals are about the student.  They are not about OT, PT, Speech, the teachers, or the vision and reading specialists.  But this becomes the norm when parents and advocates want goals written into the IEP specifically identified by each discipline.  We are now left with a Rubik’s cube IEP with parts and boundaries, a “this is mine and this is yours” approach, rather than a seamless individualized education plan supporting the student’s ability to engage and learn.  In the school setting, occupational therapy is supportive. Education is the primary service.  Aiming towards this direction, we collaborated with the team to create student goals, not OT goals.  Initially, we were met with resistance. The COTAs and I had to break through the mentality of “this is how we’ve always done it”.  It was a tough uphill climb, but eventually we made it over the hump to show the IEP team successful and relevant student outcomes where we support the teacher, the student, and the IEP goals instead of creating separate OT objectives.  The federal regulations are clear that “IDEA does NOT require goals to be written for each specific discipline or to have outcomes and measurements on a specific assessment tool”.  This can be found on page 46662 in the U.S. Department Education’s publication Assistance to States for Education of Children with Disabilities and Preschool Grants for Children with Disabilities (2006b).

While the law indicates that separate discipline goals are not required, it also does not prohibit it.  If the school team decides that the OT will be solely responsible for a particular objective, that is what will be written into an IEP.  We have learned to avoid these tripping stones by defining our role as a related service provider. When the teacher asks us, “where are your OT goals”, we identify the student goals on the IEP that we will help them achieve. Our goals are their goals. We are going to cross that finish line together with the student…as a team.

 

 

 

 

 

Elizabeth Bentz OTD, OTR/L, SIPT

Cut out the Stress of Teaching Cutting!

As we all know cutting is a crucial skill for all kids to learn!  Some students quickly acquire the ability to cut and some struggle with the task. To be successful with cutting a student needs to have visual motor skills, fine motor skills, hand strength, and bilateral coordination to name a few skills.

Here are NINE quick tricks to help each child learn how to cut correctly and more independently.

  • Teaching order: ripping, snipping, straight lines, zig zag lines, curved lines/shape, right angles. Don’t expect a kid who cannot cut a straight line to cut out a complex shape for a project!
  • Prompt for good shoulder positioning: if a child starts to wing their elbow out to the side, stick a folder under the arm to remind them to keep their elbow close to their body
  • Remind them to use both hands, one for the scissors & 1 for the paper: Put stop signs/red marks/arrows at the corners of the paper in order to prompt each child to STOP & turn the paper at corners or end of a line. You can also use stickers as targets to help them remember to move their hand forward along the paper
  • Cue for grasp: If child is struggling to position the scissors correctly in the ‘thumbs up’ position, hold the paper above eye level or tape it to the wall so that the child is cutting upwards. You can also put a sticker or smiley face on their thumbnail to look at while cutting J Help your child keep the ring and little fingers tucked away by putting a little piece of paper or pompom under them.
  • Position of paper: Encourage kids to hold the paper with the helper hand; thumb on top and fingers underneath the paper. They should have their hand in the middle of the line or shape for the most stability.
  • Direction of cutting: Encourage kids to cut around shapes the correct way; right-handers should cut to the right of the shape and left-handers should cut to the left of the shape.
  • Modify the lines: Start with thick, straight lines to and progress to thinner lines. You can also highlight lines, draw over them in thicker marker or crayon, or turn dotted lines into solid lines.  If a shape is in the middle of a page, draw a line from the edge of the paper into the shape.
  • Modify paper: Have the student cut on card stock, construction paper, or old file folders instead of regular printer paper. The firmness of these materials makes cutting easier for a beginner because the paper doesn’t flop around as much. Also, providing a ½ sheet of paper or even a ¼ sheet of paper versus an entire page can also make it easier for a young student to manage!
  • Change scissors: If you’ve tried our other tips and find the task is still difficult, there are modified scissors that can be used. Some options include: spring open scissors, mounted tabletop scissors, Benbow Learning Scissors, blunt-tipped Fiskar scissors, loop scissors, lefty scissors for left-handers, or SquEEzers Training Scissors!

 

Colleen Marshall MS, OTR/L & Kelsey Bradshaw OTS