Collaborating with School Districts for the Best Outcomes

A collaborative approach is key to helping children with disabilities overcome barriers to accessing education and perform to the best of their abilities.
In our work with school districts throughout northern New Jersey, we’ve found consistently that the best results are achieved when our professionals (e.g., speech therapists, physical therapists, board-certified behavioral analysts, etc.) work as integral parts of a trans-disciplinary team of teachers and paraprofessionals, all focused on each child’s unique developmental needs.

Our conclusions are borne out by research reported in the February 2019 issue of OT Practice, a publication of The American Occupational Therapy Association. Increasingly, teams of professionals with expertise in a wide range of disciplines are collaborating to address the needs of the growing numbers of children with autism spectrum disorder who attend public school. The research shows collaboration works.Through this kind of collaborative approach, children with ASD not only access education and learn; they become more fully integrated in the classroom and other school environments – and thus can participate more fully in school life.

Collaboration is at the very heart of what we do with our school-based therapy services. Our company is built on a collaborative model, and it’s what we excel at.
Our own trans-disciplinary team can go into a school district, program-plan with administrators, engage all of the expertise resident in the school district along with our own, and together provide whatever services are needed to enable each child achieve the desired educational goals.
With many school districts, we’re initially called upon to provide one particular service. As they get to know us, they might call on us to provide more – or even all – of our services, and over time we become active team members, collaborating every step of the way for the students we’re serving.
We’re part of the IEP process for each child we serve, responsible for writing the goals and objectives for our section of the student’s IEP and monitoring their IEP progress four times a year. Often we’re asked to collaborate with teachers in developing educational goals.

We also help draw parents in as team members. We listen to the parents’ concerns and work with them to achieve their goals for their children, as well as the school’s goals.
In a recent example, a North Jersey public school district wanted to create its own autistic preschool class, so our SBTS team professionals went to work – occupational, physical and speech therapists, along with a behavioral analyst – and collaborated with and trained the teachers and the paraprofessionals to implement an effective program.
Now, our professionals and the district’s educators are running this program for the students in-house, which allows the township to keep those students in the district, as opposed to sending them away to a costly private school. Plus, the district is providing the students the same exact service – if not a better service than that of a private school. Additionally, students can enjoy the benefits of attending their familiar neighborhood school, mainstream with peers, and participate in extracurricular activities.

New Jersey law mandates that children be maintained in the least restrictive environment, one that provides all of the supports necessary for each child to access education and learn. In our experience, when our professionals collaborate with a school district’s professionals toward that common goal, it improves the child’s outcomes.

Autism and OT: Collaborating to Support Participation in the Classroom. AOTA OT Practice, February 2019.

Sensory Diets

Several blogs ago we discussed sensory processing disorder.  We described our various senses, particularly the lesser known vestibular, tactile, and proprioceptive senses.  We also discussed common symptoms that may be present in children with sensory processing disorder.  Now, lets take a look at some common treatment options for children.

Many times, after an occupational therapist has evaluated and determined that a child does indeed have a sensory processing disorder, a “sensory diet” is created.  A sensory diet is a schedule of very specific exercises or activities, which are performed daily to promote attention, organization, and to help calm or stimulate a child.   The goal of a sensory diet is to achieve self-regulation.  Self-regulation occurs when a child is able to monitor their behavior, and most importantly, CHANGE behavior based upon the demands of the task at hand.  This is a very high level skill that many children will need assistance with.  To make this goal attainable, I first like to teach children an age appropriate vocabulary to describe their sensory state.  One of the most common methods OT’s use to teach sensory skills and vernacular is the Alert Program.  The Alert Program likens sensory states to a speedometer on a car.  If children are over-aroused, or “hyper” their engine is running too fast.  Conversely, if the child is under-aroused, or inattentive their engine is running too slow.  Of course, if a child is attentive and focused then their engine is just right. By giving children the ability to identify their sensory state, we give them the ability to change their sensory state in an effective and socially acceptable method.  This is where the diet comes into play.  An OT will carefully select exercises and activities to help change a child’s sensory state to a more desirable range.   Exercises will have the right frequency, intensity, and duration to change behavior.  It is really a win-win situation when parents, teachers, and caretakers teach children to regulate on their own.   Check back soon for more sensory strategies.

Stensaas A. & Calder, T.  (2008), Sensory Diet Fun Sheet, Greenville, South Carolina.

Parental Involvement

When school is back in session and students transition to a new classroom, with unfamiliar faces and routines we see an uptick in the number of occupational therapy referrals. This is true in both school referrals and clinic referrals. Family schedules quickly get jammed with after school activities. Often time one parent shuttles one child and the other parent shuttles a sibling somewhere else. As a parent and therapist, I understand very well that our lives are very full. So, how do I manage to get parents involved in their child’s therapy sessions? And, why do I want parents involved in treatment sessions?

Typically, therapy sessions for children are 30-45 minutes in duration. The frequency may range from one time to two times per week. If my math is correct, each week has 168 hours, although sometimes the week feels like it has much less. This means I spend, on average, one hour per week with my clinic children. I focus on each and every goal during my sessions. The child gives me 100 hundred percent. Then they leave and have the balance of 167 hours left outside of therapy. We want to see progress. Generally, most want progress sooner rather than later. I tend to combat this issue, by inviting parents into every therapy session, even if it is for the last 5 minutes. I run through the daily activities the child completed. Most importantly, I give a related home program to be completed daily by the child and parent. This mini parent-child co-treatment session is key to achieving my therapy goals with each child. Parents receive much valuable information regarding their child’s diagnosis and methods to help. It’s a win-win situation for all parities.

Recently, I came across a research article that substantiated home programs in a profound way. Scientists investigated whether a relationship existed between parent-child attachment and sensory modulation (see last blog on sensory processing disorder). As predicted, a relationship does exist between the two Let me share an example. A newborn, with sensory issues, may cry and arch their body when cuddled. A new parent may become less confident in their caregiving ability. This puts the attachment relationship at risk. Maybe the parent will offer less contact because of the infant’s feedback. A negative cycle could potentially start at this point (Pineda et al, 2015). As a clinician, this drives home the point of parent co-treatment and education. It is my role to inform the parent that their caretaking efforts are on point and needed, but just slightly modified to suit their child’s particular sensory state.

Center for Children’s Therapy parents don’t forget to look in your child’s therapy folder for tonight’s therapeutic activity. Maybe I gave you a specific exercise to strengthen a muscle group or to enhance a sensory diet. Perhaps you will find worksheets with vision exercises or writing or cutting tasks. Most importantly, have fun while practicing your child’s occupational therapy goals at home. I can’t wait to see the progress in sessions.

Pineda, R. et al, (2015). Correlational Research to Examine the Relation Between Attachment and Sensory Modulation in Young Children.
American Journal of Occupational Therapy, 69 2-8.


One of the most common referrals for occupational therapy is “messy handwriting.” Teachers will often report this concern to parents and child study teams. Teachers and parents alike will have children complete handwriting books, worksheets, redo messy assignments, give constant reminders to write neatly, type assignments, etc. etc.

So is poor handwriting something a parent needs to be worried about? Should it be addressed with an evaluation and intervention? Let’s discuss.

OT’s look at handwriting with a unique set of eyes. We breakdown the skill into small components. Handwriting is a by-product of well-developed fine motor skills and visual perceptual skills. Fine motor skills refer to the efficient use of small muscles within the hand. We first assess the anatomical structures, range of motion and strength of the upper extremity. Special attention is paid to movement patterns like reach, grasp, release, in-hand manipulation skills (moving a coin from the finger tips to the palm without dropping), pencil grip and using both hands together to perform functional tasks.

I ALWAYS check the visual system. This is often overlooked in many OT assessments and is absolutely vital. An intact ocular motor system is needed for legible handwriting and overall academic success. Again, we begin with the anatomical structures of the eyes, acuity, eye muscle movements and then move on to more complex functions like perception and processing skills.

Only after I gathered all the information on fine motor and ocular motor status, do I ask a child to actually write for me. I prefer to use standardized assessments with age norms. This tells me valuable information regarding the child’s ability to copy, write and draw figures and words when compared to his/her same aged peers.

Finally, I put all of the above pieces together and I have the answer to what is causing “messy handwriting”. I can then make an intelligent decision on whether skilled intervention is needed. At this point, I devise a treatment plan, which is always going to consist of fine motor exercises, ocular motor activities, visual perceptual tasks and then lastly some small amounts of writing. Addressing ALL the underlying components listed above will improve “messy handwriting.”

An informative picture of various pencil grips which may, or may not impact handwriting.