Skills for the job of Living

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Have you seen the occupational therapy slogan: “SKILLS FOR THE JOB OF LIVING”?

I happen to love the slogan. However, I know it leaves some people feeling confused. What skills are required for living? That is something occupational therapists ponder every day!

Each of us has things we do each day that take up time and provide meaning to our lives. Those things are our occupations. And those occupations require a certain level of skill to perform in a functional, meaningful, and successful way.

Some occupations are, for the most part, universal. We take care of our bodies. It takes time and energy to dress, bathe/shower, perform hygiene tasks, and feed ourselves. We take care of the environment around us. It’s meaningful to create meals, clean our space, perform household chores, and manage a home. We care for others. Time and meaning goes into the care taking of children, spouses, family, and friends.

Some occupations are specific and unique to our personalities, our passions, and our goals. Leisure activities, exercising, money management, vacation planning, yard work, and shopping are a few. The list goes on and on.

One major occupation to consider is PLAY! A child’s primary “job” during the first few years of life is to play. Play is fun, but it’s also a learning tool. Play is how a child builds experience with the environment, as well as the objects and people in it. It is the mode in which so many developmental milestones are met. The function of play perfectly describes an occupation: it’s meaningful, it takes up time, and is the foundation for successful development.

Limitations, however big or small, affect our ability to successfully perform occupations in a functional and meaningful way. Of course, we naturally work to define the limitation standing in the way of occupational performance. Maybe the limitation has a specific name, like autism. Maybe the limitation has a general name, like coordination. Or maybe the limitation has a common name, like picky eating.

That’s where occupational therapy comes in! As occupational therapists we know that a label associated with limitation never tells the whole story; labels don’t define our clients! Occupational therapists are uniquely qualified to merge two very important ideas: 1) what does an occupation require in terms of successful performance and 2) what STRENGTHS and limitations does the client have with regard to that occupation. It’s in these details that a plan for success can be made. An occupational therapist’s perspective is detailed, creative, and client-centered.

In researching, evaluating, understanding, and creating adaptations/remediations for specific occupations for each, unique client, an occupational therapist can help increase performance. The goal is to create function, meaning, and success for each client.

 

Brandi Breitbach, MOTR/L

Occupational Therapist

Red Door Pediatric Therapy

 

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Free screen? Initial evaluation? What now?

Red Door offers a free speech and occupational therapy screen, every week, all the time. 

We always have! No strings attached, no weird follow-up. It’s just a great way for interested families to get a feel for us and our setting, ask questions about the services we offer, and find out if their child is developmentally on track.  A call we answer frequently during the week from new families is, “ I want to start my child at Red Door. How do I make an appointment?” In order to answer that question, it’s important to gain a little more information.  Here’s the fast answer: you can always, always, always start with the free screen.  It takes a maximum of a half hour and it can even be done over the phone if it’s inconvenient to come in.  It’s primarily made up of a parent interview and child observation (if your child is present.)  

A free screen also provides an immediate rebuttal to “wait and see.” If you have concerns about your child’s development, and your mom, sister, friend, physician, nurse, daycare provider or anyone else in your immediate circle tells you to “wait and see”, just don’t.  Ask questions, do some research, come meet with us and ask us your questions, but don’t just wait it out.  Because so much language learning, fine motor development, and general brain development occurs in a child’s first three years of life, using 6 months of that time to wait it out goes against any professional advice we offer.

Next up: initial evaluation.  

Here’s the first major difference between the screen and an initial evaluation: an evaluation is not free.  The private pay rate for a speech or occupational therapy evaluation is currently $350. The initial evaluation is typically 2.5 hours long, although this can vary slightly depending on the child.  The initial evaluation also involves an extensive amount of follow-up work for the evaluator; including scoring of assessments, completing a full report, and development of short and long-term goals (if the child qualifies for services.) Sometimes a family chooses to move directly to the initial evaluation. This is most common when they’ve had previous/current therapy and want to try someplace new, when they’ve received a diagnosis that typically includes a speech/OT delay, or when they are receiving school services, but want additional 1:1 services.

What about insurance coverage?

The cost of the initial evaluation is typically billed to the family’s insurance provider and they may or may not cover part or all of the cost.  Our insurance specialist goes above and beyond (for reals…way above, way beyond) to contact each client’s insurance company prior to the evaluation to ask key questions about coverage. She then meets with each family at the time of the evaluation and shares that information so that they have the most concise cost estimation that we can provide at that time.  Does it always go exactly how we want it to? No.  Not always.  Sometimes, once the claim is processed, the insurance company changes their tune, but that’s typically not common.  Here’s an important point to note: If you have an initial evaluation scheduled, and you know it may cost you $350, then it’s ALWAYS a good idea to call the phone number on the back of your insurance card and ask the same questions we ask: deductible amount, have I met my deductible, does my plan cover the service, are there limits to those services, and then take note of the representative’s name.  Over preparation? Maybe, but in our opinion it’s always better to be monetarily over prepared than under prepared.

We understand that the process of determining if your child needs speech/OT services and navigating the world of insurance can seem daunting. Our priority is to make it as easy for our families as possible.  So whether you want to put a face with a name and just ask some questions or you know you need more in depth information right off the bat, we are here to make it easy! Come meet us! We think you’ll love it here.  We do!

Heather Arnt,  M.S., CCC-SLP

Team Work!

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Partnerships…alliances…joint efforts…collaboration…team work!  All these terms can be used to describe when two or more people come together for a combined purpose.  Teamwork is an important component to helping kids learn and develop!   

 

Teams can be comprised of a variety of individuals!  Teams can be formal, such as an Individual Education Plan (IEP) or a medical team (physician, dietician, counselor, speech or occupational therapist).   They can also be informal, such as a parent and a teacher, a daycare provider and a grandma, a bus driver and a teacher, or a therapist and a mom.  

 

Teams can meet in a variety of settings or modalities.  Meetings can take place in a conference room, a medical office, a daycare facility, a waiting room or within your own home.  They can occur in person, over the phone, over the computer, or over coffee.

 

Teams can serve a variety of purposes.  Some teams meet to determine whether there is an issue and if more information is needed to proceed.  Teams meet to determine what areas to assess (speech, OT, behavior, health).  Other teams meet to provide education and information.  Meetings can provide opportunities to share test scores and normative data, while other meetings are strategy driven and have an outcome in mind.  Meetings can be for the review of goals and progress, or can be purely schedule related.

 

So what components make for a good team?

  • Good listeners:   A good team gives each participant time to speak and listens intently in order to provide feedback to those topics discussed.
  • Purpose driven:  A good team sets a goal to help address topics with a resolution in mind.
  • Analytical:  A good team looks at all sides of a topic to determine priorities and the best way to move forward.
  • Willingness to observe and contribute:  A good team will collect information through anecdotal and observational means, with different settings and with different people.
  • Ability to share information:  A good team will be able to explain their professional discipline and role effectively.
  • Parents a core part of the team:  A good team will understand that children and parents are the heart of a team and are the most valuable in making a difference.

 

By: Kelli Ellenbaum, MS CCC-SLP

Speech Language Pathologist

 

How do you know your therapist is a good one?

There are any number of qualities that define a good therapist!  Some of these qualities are obvious, while others are specific to each therapist.  At Red Door Pediatric Therapy, the training protocol for our therapy staff is a BIG DEAL! We recognize that it takes a lot more than being “nice and fun” to be considered a top notch therapist. Here are our top 5 qualities that make a good therapist!

  • Knowledge about the profession  A good therapist is able to describe the activities targeted during a session and effectively explain why those activities help with skill development.  She is able to provide answers to questions regarding what skills are expected at certain ages.  If she does not know the answer, she finds the answer and provides feedback in a timely manner.  She is willing to try different approaches with her clients and researches programs to determine their value. A good therapist will apply new learning experiences to her practice in therapy.  She will use certifications and special trainings to expand on her experience with children.  She is always willing to learn new things and she educates you along the way.  She keeps you informed about your child’s progress and listens to you when you have specific concerns.  She helps you navigate how to educate others about your child’s difficulties. She allows you to observe her in action so that YOU can learn her creative way of getting results.
  • Flexibility and creativity  A good therapist has the foresight to plan meaningful and fun activities, but is also able to change her plan at the last minute to adapt to a new situation.  Some of these situations include:
    • Behavior changes (ex. Kate is having a hard time transitioning, maybe a detour to the sensory gym comes first.)
    • A useful skill that may come in handy in the near future (ex. It is picture day at school tomorrow for Phillip, maybe a Social Story is a better target than the planned fine motor activity.)
    • An upcoming doctor visit (ex. A progress check on goals for Kyle may be appropriate to his plan of care before his pediatrician appointment on Friday.)
    • A patient has brought his favorite toy (ex. Gavin’s therapist may incorporate the toy into the therapeutic activity she had planned.  This will keep him motivated to work hard.)
    • The original plan for the session will not yield positive results (ex. Charlie got stitches in his lip last night, he cannot put his lips together to practice the “B” sound today, ouch!)
  • A positive approach and positive language  The power of a positive interaction can go a long way in gaining the trust of children.  A positive environment reduces anxiety and increases the chances that kids will try new skills.  At Red Door, we focus heavily on “positive speak.” We frame language to focus on what is “expected” versus what we “don’t” expect from kids (ex. “Let’s walk down the hall,” as opposed to “Don’t run!”).   A good therapist will also use “we” statements to let kids know that she is on their team (ex.  We can build this puzzle!  Let’s do it together!).   

 

  • Collaboration  A good therapist knows when two (or more) heads are better than one.  She understands when a referral to another specialized professional is helpful.  She knows how to access resources for her families.  She understands the importance of collaborating with teachers, daycare providers, and parents in order to help the child succeed.   A good therapist is willing to meet with you and talk about solutions and strategies!

 

  • Personalization  A good therapist figures out what makes your child tick.  She creates sessions with motivating activities that interest your child.  She is crafty like that!  She will figure out how to incorporate her goals in fun ways–kids may not even know the are “working.”  She takes her training and experience and finds creative ways to individualize its delivery for each child.  All children are different and a good relationship breeds trust and progress.  

By:  Kelli Ellenbaum, MS, CCC-SLP

As always, Red Door Pediatric Therapy offers a free screening!  Please visit our website for more information: www.reddoorpediatric.com

Happy Anniversary!

10 years??! 10 YEARS!! When Kelli and I opened Red Door Pediatric Therapy in November of 2006, we never imagined what it would look like 10 years later.  At that time, I had a newborn, Kelli had a toddler and was expecting again, and we were just focused on the here and now.  In looking back, we are able to see what a fun and exciting ride it’s been, and just how much we continue to learn as we grow.  We get a lot of questions about how we got our start, but by far the most frequently asked question is, “How did you choose the name Red Door?”

In 7th grade, my family moved to a different house.  It was on a visible street in our small town. and my mom went about deciding what color to paint it. While the house would go from green to gray, the door color she proposed to my dad was “raspberry.” “So…. pink? You want to paint the door dark pink?” he said.  My mom replied, “You have to have a door that people want to come in.”

It’s true, you do! A door is a first impression; you have to have a door that welcomes people in, makes the process less overwhelming, and encourages collaboration, respect and individuality. Each child and family are different. Communication between families, therapists and office staff is KEY to working through challenges, as well as celebrating the successes and sharing in the joy and humor of the journey.  

We opened Red Door with two therapists and two clients, but today it’s our phenomenal team that make it great. Each year we sit down in both the Bismarck and Minot clinics to collaborate on our vision for Red Door.  One of our activities included the creation of a word list that best described our clinics. The list included these attributes: teamwork, organized, flexible, chatty, family-focused, positive, collaborative, thoughtful, ethical, communication, fun, enthusiastic, well-rounded, caring, efficient, creative, leaders in our fields, patient, responsible, outgoing, problem-solvers, productive, good listeners, initiative. What a list!! Ten years later, this is what we hope to convey everyday.  We want these qualities to set us apart with regard to service delivery and community involvement, as well as internal business management. This is what makes people want to walk through our Red Door!

We are beyond proud to be celebrating 10 years in Bismarck! We have new and exciting plans for Red Door! If you’ve been a part of our journey, we are feeling a bit sentimental and want to thank you a million times over! Thank you for walking through our door and being part of our family.  Our house is your house!

Wait now…one more thing. Another question we get asked on a regular basis is, “Do you and Kelli really get along this well and like each other this much?” And the answer is a resounding yes–we really do!  We wouldn’t have it any other way. Cheers to TEN YEARS!

When Back-to-School doesn’t go as planned…

While January marks the start of the “new year,” for  parents, back-to-school is the real beginning of the year.  A new year brings new classes, new teachers, the re-establishment of  home and classroom routines, new activities; new everything!  All of this change  leads us to  hope that maybe the attention and behavior issues experienced last year will work themselves out with a new start.  In some cases, they do!  Maturation over the summer may work in your child’s favor and perhaps your child’s behavioral difficulties are a thing of the past? On the other hand, maybe the new year has brought a new set of challenges.

Sensory processing disorder occurs when the brain has trouble appropriately  responding to sensory stimuli.  These sensory systems can include sight, hearing, feeling, taste, smell and movement.   Difficulties with sensory processing may affect one system on its own or multiple systems at the same time.   Sensory systems can be over-sensitive or under-sensitive.  While it’s typical for kids to experience some difficulties as a normal form of development, it’s not typical for these sensitivities to significantly affect aspects of everyday life.  How do you determine if it’s just a “quirk” or if it’s an actual sensory processing issue? When sensory difficulties interfere with a child’s ability to participate in typical peer activities or to complete daily tasks, it’s important to dig a little deeper.

Here are some real life examples of how some kids process sensory input:

  • My child will only wear sweatpants, never jeans. The seam on my child’s sock has the capacity to ruin the whole day if it’s not JUST SO.
  • My child will only eat three foods. Total. End of story.  New foods are a big deal and often result in major mealtime stress.
  • My child hates how the lunch room smells; he’ll gag at the smell of certain foods.
  • My child is distracted by noises that I can barely even hear, such as the buzz of fluorescent lights.  Other daily sounds, such as the toilet flushing, scare the heck out of him!
  • My child is clumsy; he’s always running into things and falling off his chair. My child plays so rough that other moms are telling their children to avoid my kid.
  • My child over-fills his mouth when he eats. He chokes often and is such a messy eater.
  • My child doesn’t seem to be able to “feel” when she has to go to the bathroom; this results in accidents and now she’s embarrassed and anxious about it.
  • My child is really routine-based.  A break from that routine is incredibly stressful and often results in a meltdown.
  • My child has a hard time following through with the morning sequence.  He requires constant reminders (no, seriously…CONSTANT REMINDERS)  to move on to the next thing.  It’s as if he doesn’t hear the direction until the 5th time.

While these sensitivities can cause some serious stress for the entire family, they can also have significant classroom implications. When a child has a disrupted sensory system, three key areas can be affected:

*Organization: It’s hard to stay organized when your sensory system is on overload. It becomes difficult to remember what you were doing or what you should be doing when you are constantly distracted by all the sensory information your coming your way.

*Attention: Attention is measured in many different ways, especially at school.  For kids with a sensory processing disorder, the ability to keep their “eyes on the board,” actively listen and participate, and follow multi-step directions all the while remaining in their seat can be a real challenge. The ability to filter out the distractions to concentrate on the  most important information may not come easily.

*Behavior: It’s hard to regulate your emotions, stay on task, do what’s expected, and respond appropriately when your environment makes your head spin. Regulating  your behavior ALL DAY LONG is a full time job!  It can be physically draining to keep it together.  Parents often bear the biggest brunt at the end of the day when kids finally succumb to that end of the day meltdown.  

If back-to-school has left you feeling concerned about  your child’s emotional, functional, academic and/or social success, or if there are parent-teacher conversations circulating around *attention *organization and/or *behavior, it might be time to take a closer look at their sensory functioning across different environments. If you’ve noticed these sensitivities, but thought your child was just being high maintenance or poorly behaved, we encourage you to seek out an occupational therapist with experience in sensory processing disorders. Lucky for you, we know some phenomenal ones!

By: Heather Arnt, M.S., CCC-SLP

As always, Red Door Pediatric Therapy offers a free, no-strings-attached screening. Learn all about us at our website:  www.reddoorpediatric.com

Benefits of Co-Treatment Sessions of Speech/Occupational Therapy

There are endless benefits to co-treatment therapy sessions with the pediatric population. Co-treatments are sessions conducted with 2 or more therapists/disciplines to maximize therapeutic collaboration. At Red Door Pediatric Therapy, co-treatments are performed when therapeutic goals are similar or complimentary. In this article, I will discuss what benefits therapists have seen at Red Door with regard to implementing meaningful and functional gains.

At Red Door, we typically conduct our co-treatment sessions with two therapists/disciplines. In pediatric therapy, there is often a hierarchy of skill acquisition. For example, in order to take a successful bite of food from a fork (OT), one must be able to complete lip closure (ST). This hierarchy lends itself nicely to co-treat sessions, as multiple goals can be targeted cohesively with the same functional activity. In order to best explain specific benefits for children, sessions will be described specifically according to treatment plan themes.

The first set of benefits includes the Speech/Occupational Therapy “Feeding” Session. During a feeding session, there are many oral motor sequences that take place in order for a child to be successful from the start to the finish of a meal. A meal involves several sequences of fine motor and oral motor control, strength, and coordination. There are also several language components present which are not limited to vocabulary, following directions, understanding and implementing sequences, making requests, understanding and use of directional concepts, etc. Positive outcomes include:

1) Teaching a child to formulate a meaningful expressive request for desired meal items. Whether a child is verbal or non-verbal, the ability to make a choice is key. Since eating is a functional activity that occurs 3+times per day, there are multiple opportunities to integrate the skill of eating and the skill of meaningful requesting. All children have food preferences and dislikes. Co-treatment allows the opportunity to help a child convey these preferred and non-preferred selections. While the occupational therapist focuses on teaching functional use of spoons, forks, knives, plates, napkins, etc, the speech therapists reinforces the language component by helping the child use communication through answering yes/no questions, pointing to preferred items through gesture, making verbal requests for desired items, teaching vocabulary labels, demonstrating the function of meal utensils etc.

2) Exposing the child to different types of oral stimulation can increase their oral motor control for feeding and increase ability to produce sounds and language. A variety of oral motor therapy tools can be used to stimulate different parts of the oral cavity (tongue, lips, cheeks, teeth). Such tools include, blow toys, whistles, straws, chew tubes, tongue depressors, etc. These tools, when used correctly can increase breath support and control, lip strength and control, and tongue coordination…all of which support expressive language and articulation as well as mealtime activities.

3) A well-trained Occupational Therapist can provide meaningful strategies for children who have sensory (of the 5 senses) difficulties. These strategies can help to address sensory information the child requires to understand their environment. Children may exhibit behaviors that interfere with goal implementation because they are not clearly understanding/interpreting their environment (sounds, smells, touch). An OT can help other therapists to provide means of “calm” so that other goals can be addressed in the therapy session. Some of the tools used at Red Door include: therapy balls, tactile brushes, squishy fidget balls, vibrating toys, swings, etc. When used correctly, these sensory tools can increase attention to task, increase focus and accuracy, increased success in understanding/following directions. Consideration of these sensory differences and providing an adapting therapy session has the added benefit of gaining more “trials” on goal items (which means more reliable and measurable progress).

The second set of benefits is derived from the ST/OT dressing sessions. Dressing and undressing are additional forms of daily living activities that occur 2+ times per day and can provide an opportunity to target skills across disciplines.

1) Sequencing! Dressing involves a complicated set of sequenced movements and manipulation of clothing to orient onto the body. This order insures that the child “understands” the language involved in following directions to complete dressing steps “in order.” This understanding of “order” carries over to “following through” with a dressing sequence.

2) Dressing involves a great deal of vocabulary specific to concept/description words. Some of these vocabulary words include: open, top, around, through, up, down, forward, backward, front, back, bottom. Where language is impaired or delayed, these vocabulary words are difficult for children primarily because they are not tangible like nouns, or don’t involve an observable action like verbs. Co-treatment with dressing skills allows the child to both hear and use the concept vocabulary while engaging in a hands-on experience with the clothing items.

3) Fine Motor and FUN! The possibilities with speech/language and fine motor experiences are practically limitless. Art projects and crafts are excellent ways to utilize and encourage tripod grasp, strength, muscle coordination and control. Language can be integrated with the use of vocabulary, descriptions, following directions, sequencing, sound practice, and much much more!

There are many benefits that result from sessions conducted with Physical Therapy and Speech Therapy. These sessions involve more physical activity, awareness to the body in space, and loads of fun.
1) Physical activity increases brain function! Research has shown that when children become more physically active, their expressive output increases. Physical activity can involve passing the ball back and forth, swinging, climbing ladders and stairs, and many physical and social games that encourage heightened activity level.
2) Motivation! Motivating physical activities can be used as a tool to elicit a variety of language skills. Children can make requests for desired activities, use breath support to manipulate volume and control, and produce more oral motor control while the other muscles of the body operate. Language is easily incorporated into physical therapy goals that assist with body tone, posturing, and coordination.

Intangible benefits of cotreatment sessions:
1) Two heads better than one, four hands better than two! Children can have minds of their own. As they explore behavioral boundaries, an extra set of hands (and bodies) can help to guide and demonstrate skills. These “hands-on” collaborative sessions can help therapists to better understand the needs and function level of kids as well as help to build professional skills.
2) Cohesive flow of expectations When children have the same expectations across people/therapists and environments, they are more calm and productive. This cohesive flow of expectations involves using the same demeanor, the same facial expression, and the same language structure.
3) In-the-moment problem-solving. Having 2 therapists allows for problem-solving to take place as the child is receiving direct treatment. This can be as simple and an extra set of hands to teach or demonstrate a skill to utilizing a strategy to address a negative behavior.

It should be noted that cotreatment is not always the best option. Cotreatment should be used to improve therapy and not to provide less service to a child. You can consult directly with your therapists to verify the benefits of therapy implemented in this format.

Kelli Ellenbaum, MS CCC-SLP

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