Personal Space

Yesterday I saw one of my high school teachers for students with autism wearing a lanyard with several communication symbols attached; this one caught my eye:

I need one of these, desperately, to help me with a Kindergarten student who practically climbs in my lap while we're working together.  That's okay for my personal children (when they were much smaller) but not the students I work with.  From time to time I've noticed that the students who consistently enter my personal space sometimes do so to distract me from noticing that they haven't followed through on the direction I just gave them...

Another great communication tool/behavior helper on her lanyard serves to visually remind students to identify and label their level of emotion (5 Point Scale*):

I could use this all day long, with students and to help my colleagues understand what they're dealing with when interacting with me...

*5 Point Scale:  https://www.5pointscale.com/

Looking Up

On the way to the car this frosty morning I was greeted by this display in the sky:

Even though I live close to an airport I really don't think these were contrails left by precision pilots.

What type of clouds are these???

Reduce Time Spent in Documentation

Interested in spending more work hours face-to-face with the kids you serve?  Looking for ways to spend off-work hours face-to-face with family and friends, or at least a good book?  Let's reduce our time spent in documentation.

The trees outside your office window are calling...

 
These suggestions are based on the documentation requirements often encountered by therapists who work in public school systems.  I hope some of these ideas may work for you.

Ways to ↓ Time Used for Documentation:

 

Big Picture Questions:

--Who are the potential readers of your documentation? excluding IEPs

• Eligibility teams (including families)
• Outside professionals working with student
• Peer OTs who may work with student in future years
• You
• Third-party payers (such as Medicaid)

--Who is most likely to intensely examine and utilize the information in your report/therapy notes?

• Eligibility teams
• You

--What documentation is the most critical to making decisions about the student?

• Initial evaluations
• Subsequent evaluations regarding student’s abilities & ongoing need for OT services
• Your treatment notes in your school system's online software program (or paper-based system), regarding student’s progress on goals and/or use of accommodations.

 

To consider:  If eligibility team members and the individual therapy provider are the most frequent users of documentation then the majority of time spent documenting should be spent addressing the information needs of those individuals.   Documentation should focus on 1) informing school teams, including the families, of the student’s status and 2) creating easy-to-use data for decision making by the therapist.  If outside professionals, peer OTs and/or third-party payers require further clarification or data, the therapist can provide it upon request.

- - - -

In light of the above-listed questions and responses, how can OTs ↓ the amount of time they spend in documentation of reports and online treatment notes?

 

Reports:  

• Adopt use of a streamlined, customized report template that reduces verbiage while emphasizing essential components of the report.  
• Decrease subjective input.

 

Online treatment notes:

Focus effort on documenting sessions related to:

• a significant breakthrough, change in student’s independence with a skill
• critical information gained via parent/teacher consults
• EOY summary of progress and plan for treatment focus following summer break [this is not a EOY report but a bridge to facilitate speedy resumption of services in the fall]

 

Reduce length and detail in documenting sessions by:

--Documenting the key facts in the session, without adding extraneous details.

Example--try writing, “Student put arms through both sleeves of compression vest, without protest, with less adult prompting as compared to 11-17-16 session" instead of, “Student arrived in classroom, sat at assigned chair and ate his ‘Power Donut” with glee, getting crumbs all over the table, as usual.  After washing his hands independently he demonstrated good interpersonal skills by carefully hugging his best friend and then ambulated over to the therapist, with both arms raised and both hands still coated with sticky crumbs, to assist with putting on his blue compression vest that was lost for two weeks but finally found under the seat of the bus #151.”

 

Use telegraphic writing--pack as much information as possible in the fewest # of words.  Use abbreviations that are commonly used in medical settings.

The 1o reader of your documentation = you.

 

Finalize your online note immediately after writing it.  It takes five minutes to fix a mistake in day/time/minor detail in a note once you alert the help desk of your online documentation provider, or correct the error in your paper-based system.  How long does it take you to go back to a large number of unsigned notes via your online site, review each note and then finalize them all? 
 

If you are using an online documentation system, batch your progress notes--write at least two at one sitting, preferably more.

 

Since our online documentation system doesn’t always populate the data fields with required information, such as the diagnostic code for students, I keep a reference sheet of students and their diagnostic codes handy while I write notes.

 

If you feel like you are shortchanging your students by writing fewer words or details in a note, compromise.  For a student you see twice a week, spend your usual amount of documentation time writing the first note of the week.  Then, practice a shortened approach to word usage in the second note of the week.  Purposely make the second note more succinct.  It takes awhile to get accustomed to not laying every thought out on the page; discomfort is a sign of adaptation and growth.

 

About IEPs:

Be concise, eliminate subjective information: “Jimmy is a sweet, second grader who always comes to school with a kind word and cookie for his teacher.”

Add information about the student’s independence and areas of need that are focused on school performance--it’s unusual to write in telegraphic style in an IEP but aim for brevity.  Does your input exceed the special education teacher’s input?  If so, it's time to downsize your words.

 

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Additional suggestion:

 

At least two of our therapists dictate their treatment notes into their Google calendars, then cut/paste the info into their online documentation.  They love the time they save. 

Wouldn't you rather be outside right now?  It's fall, and Virginia is too beautiful to miss.

 

Erupting Snowballs--I Think It's Time for a Snow Day

One of my middle school teachers who serves students with mild cognitive disabilities shared this enticing, looking-forward-to-snow-days activity with me today:

http://www.growingajeweledrose.com/2013/01/erupting-snow-recipe.html

Thanksgiving Sensory Flip Book

This post

http://lifeovercs.com/my-christmas-five-senses-book-free-printable/

inspired an activity idea.

Tomorrow I get to go on a home visit and work with a student, her mom and teacher and we're making a small flip book related to the sensory experiences associated with Thanksgiving.

• Crunchy corn on the cob (a sticky wall cling and bits of horse corn from my DH's feed bin)
• Pilgrim hat (soft black felt pieces to make the hat, and shiny foil trim)
• Pumpkin pie (clip art and lots of cinnamon), and
• Turkey feathers (colorful, tacky feathers glued on to a little turkey.

The hard-working teacher for students with intellectual disabilities will have gobs of pictures of the items we're using and will have set up the student's school-loaned device to give her lots of opportunities to choose which materials will be used.

The cards that will comprise the book are started, but unfinished so the student can complete the project within a short time frame.

Clip art pumpkin pie slice with cinnamon glued on top.  Student will add cloves to make it smell even better.

Gummy window cling, outlined for better viewing since the paper background is light yellow, like the corn.



Extra fall-themed gummies, just for fun.  I ended up outlining them with a black magic marker, like the ear of corn.

Why so shiny?  Well, the gummies stick very well to the background paper.  And, without the layer of clear plastic film on top, they will stick to their neighbors, too!

 

11-21-2016 Update:  The high schoolers with autism made turkeys with feathers, spicy pie and ears of cornthis morning:

 

 

My SLP buddy and I saw a range of approaches to adding the sensory features to the drawn pictures--ease with touching spices vs. avoidance, interest in sniffing the spices vs. turning their faces away, knowledge of how to untwist the tight glue bottles vs. cluelessness.  What a great activity for speech-language as well as fine motor and sensory opportunities.



Holiday Slime Time

One of my plans this school year is to bring a weekly sensory activity into an elementary class for students with autism.  This slime resource is a treasure for the entire year:

http://littlebinsforlittlehands.com/liquid-starch-slime-easy-sensory-play-recipe/


Alert:  Some (all?) liquid starch may have Borax which should not be consumed.  Read the labels and match your activity to your student with care.

Keep a Little Hawaii in Your Heart

One of my close family members visited Hawaii last month and sent me photos of the view from her almost-private beach accommodations.  Ah......

So, when I came across this activity--a creative twist on the classic clothespins for pinch standby--it made me think of how nice it might be, someday, to visit the same spot as my loved one did.  Ocean Cards for Fine Motor Fun

Oh, I guess you might substitute some other theme in place of the seashells & starfishes, but using tropical critters makes me daydream about happy times that might be in my future.  I guess our students daydream about being super heroes, so go ahead and break out the Spiderman stickers, if you must.