Facilitating Growth at Positive Steps

“Evidenced Based Practice in Sensory Processing Disorder” with Sarah Schoen, PhD, OTR

Written by Jessica Addeo

A part of our responsibility and commitment to the clients at Positive Steps is ensuring that we as therapists are current with what is best practice in our field. There are many continuing education courses that our therapists participate in independent of Positive Steps as we each pursue our own interest areas. However, this past May Dana Blumberg (Director) brought a course to us, so that we could all be on the same page and learn together. The experience was invaluable as we brainstormed together, watched videos of our clients with an expert (with parent permission of course), and grew not only as individual therapists but as a team.

Sarah Schoen is the director of research at the Star Institute for SPD in Colorado. The STAR Institute was founded by Dr. Lucy Jane Miller and its mission is “To improve the quality of life for children, adolescents and adults with SPD, and their families”. They do this by assessing and treating sensory processing disorder (SPD), conducting research on this topic, educating others and advocating for official recognition of SPD worldwide. To study with such a high caliber presenter typically a therapist would have to travel to Denver, Colorado for a 1 week intensive program. Dana (who did this 1 week intensive in August 2011) brought Sarah Schoen to New Jersey for a shortened but personalized program.

The weekend included information about SPD definitions and subtypes, treatment and assessment models and clinical reasoning. The big takeaways (that will be discussed in further detail in this post) were that as a staff we want to include parents more in our goal setting and treatment planning, interacting with our clients and facilitating relationships is just as important as the “treatment” we are doing and that taking a course together as a staff was truly beneficial and special (and we plan to do it again in 2018!)

At Positive Steps, we strive to be in constant conversation with the parents, caregivers, teachers/professionals and adults in our client’s lives. After every session, we leave a few minutes to chat with parents about the session, if a parent can’t be there we then email that parent or write a note in a communication book. In addition to this we make ourselves available when any difficulties are occurring by scheduling phone conferences, emailing teachers, reviewing home programs, etc. It was surprising that as Sarah Schoen discussed a concept called “Goal Attainment Scaling” we began to realize that there was an area of our practice where we wanted to include parents more. Goal Attainment Scaling (GAS) is a technique for evaluating therapy progress using a strong family centered approach. Instead of goals being written based on standardized assessments and the therapist’s clinical observations, goals are written with a strong focus on the real-life day to day struggles that brought a parent to therapy. The typical progression of a child’s goals at Positive Steps starts with an initial evaluation that includes a lengthy report and a set of goals that we review with the parents (with re-evaluations being conducted yearly). We use information from standardized assessments, clinical observations and parent report to guide our goal writing and treatment plan. As therapy progresses, as mentioned above, we are in constant communication about what is going on in sessions. As therapists, we know why you are coming to therapy and what your priorities are from these conversations. As we learned more about Goal Attainment Scaling (GAS) we wanted this to be reflected in a more formal way. So, we dug a little deeper and found that the full model of GAS was not the best fit for our practice. Just as we do for our clients, we modified and made a new program that fits us and will be implemented in January of 2018. We will begin setting up “OT conferences” where you as the parent will review your child’s goals with us and we will discuss what has been working since starting therapy, what is still a struggle and what your main goals for bringing your child to Positive Steps are in this current moment. Our goals as clinicians is to support your child’s full participation in all areas of his or her life (school, home, extracurricular activities, community based activities, family parties, etc.). Sometimes we do need to work on foundational skills like balancing on one foot and core strength to support this participation. However, we don’t want parents or clinicians to lose sight of the bigger picture, which is ensuring your child is living their fullest life. These conferences will be a way for us all to step back from the tiny details we get caught in and look at all the facets of daily life to ensure that therapy is best supporting your child and your family.

Another common “trap” that comes up in therapy is this idea of the therapist having this “magical power” that gets a child to behave a certain way that just doesn’t occur at home. Truthfully it is wonderful but insignificant if a child can be more organized in a session at Positive Steps but leaves the center and continues to struggle. Therefore, we have always prioritized home programs and parent education as a part of our therapy services. What was highlighted in our course is the value in bringing parents into our sessions to be there to not just learn what therapy magic is going on, but to become part and parcel of the therapeutic relationship. Sarah Schoen spoke a lot about the importance of relationship and connection to the therapeutic process. She highlighted that these “magic moments” best serve our clients when they happen between the child and his or her parent (versus the therapist). And just as important as all the developmental milestones we are working to help our clients achieve, is the relationships they have with the people central in their lives.

Most often children, especially young children, learn about the world and relationships through play. If a child is motivated in the play it becomes a more meaningful experience. It is our job as therapists to make sure the play is meeting the child’s therapeutic needs. And we are very practiced in this, the biggest perk of our jobs is that we get to play all day. But this therapeutic play doesn’t need to stop when a child leaves OT or when they are done with their “OT exercises” at home. If it can be a part of daily life, the impact becomes more powerful and those family centered goals that we are focusing on start to shift. Some simple ways this can be incorporated into daily life (when possible) is to follow the child’s lead. What is he or she most interested in, what activities does your child participate in the most, what brings that gleam or twinkle to their eye and what are they proud of? If you can tap into that as you interact with your child improved regulation will occur and then dinner time or bath time (insert your trouble time of the day) should get easier. Of course, each child has specific sensory needs and we will continue to educate you on the clinical observations of your child’s specific needs. You can use this information about his or her sensory system to promote the play and play environment that is most supportive. But just using this sensory information, without the relationship piece, isn’t as effective.

Of course, this blog post isn’t inclusive to all the things we discussed and learned at the weekend course with Sarah Schoen. However, it highlights the parts that meant a lot to our staff and some small changes that we are implementing at Positive Steps. This is just the beginning of our staff courses; this May Dana is bringing Integrated Listening Systems or “iLs” to Positive Steps. We stand committed to our family centered approach and continued learning to ensure that Positive Steps will keep growing and helping our clients achieve their highest potentials.

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