The Juggling Act Begins
I guess most jobs involve much more than what first meets the eye, and what most people assume. School-based occupational therapy is definitely one of them.
My first day began with a District-wide convocation for all the employees at all our schools. (My special ed. agency was included, even though we, as therapists, are not employed by the school district.) This gathering was everyone's chance to meet the new superintendent of schools--someone who, it appeared, is taking more of an interest in school-based therapy services than have previous administrators.
After lunch I met (and met with) my OT and PT colleagues at our area office. The primary purpose of the meeting was to distribute caseloads for the year.
So now I know what it means to "get your caseload"! In my case, I was handed ten pieces of paper representing the ten different schools to which I have been assigned (!), with lists of the students in each building who receive OT services.
I spent the rest of my week getting Organized--yes, with a capital "O"!--a multi-faceted process that is still "in process."
First there's the organization of paperwork: Making sure that each student has a current release form signed by the parent/guardian, and a current prescription from their pediatrician. Looking in the student's files for last year's annual progress report and this year's OT goals. Putting together notebooks which include this information as well as various record-keeping forms. Double checking that the "service agreement" noted on the caseload summary form (how often each student will be seen, and for how many minutes) matches the information recorded on the IEP.
Next there's the organization of the schedule: Visiting each of the schools. Figuring out where to park and which door to go in. Meeting the school secretary and school principal. Ascertaining whether the students on one's list are indeed enrolled at that school (and if not, filling out a form for the area office). (One of my schools had a list of only two students. Neither was enrolled there. That put me down to just nine schools!) Finding out where and when (which day[s]) there is a room available for pull-out OT sessions. Getting the students' teacher and classroom assignments. Checking in with each teacher and negotiating the student's weekly, or monthly, OT appointment time. Making out a tentative schedule in which each school is allocated a day (or part of the day), and each student has an appointment time.
Of course, there's also the organization of the therapy sessions themselves: What are the goals for each student? What activities will I use in each session? What materials will I need? But I haven't had much time to think about all that, yet. I won't be starting any treatment sessions until this next week, but even so, I will still be trying to work out the schedule and won't be able to get to everyone, at least at first.
No doubt about it--for a new therapist like myself, there's a huge learning curve here, and I have to trust that I will be able to learn what I need to know in order to be successful here, bit by bit.
In the meantime, I am in awe of my colleagues who have mastered this demanding juggling act.
I have read all the studies – but won't list them here because they may not apply. Still, the studies state that there is sometimes temporary/immediate benefit to grade retention but that those benefits disappear in subsequent years.
The problem with the studies is that they are done on such a large and heterogeneous group that it is difficult to say exactly who these results apply to. Parents and teachers and administrators get lost in the issue because they inject all kinds of ancillary concerns including
* what will it mean if he is the physically largest child in the class?
* is it true that the extra year will allow him to be more 'developmentally mature?'
* our district does/does not have a retention policy so we don't do it that way
* at the cost of $$ to educate a child who has a disability each year, we can't afford retention!
Clearly this is an example where large population research needs to be honed down and we need to look at practices on individual district levels. It would be more accurate for a district to conduct internal studies using consistent curriculum and early intervention/remediation/special education practices. That would allow for a valid basis of comparison between retained and non-retained students.
Parents ask me about retention all the time - and I usually shrug my shoulders. There does not seem to be evidence that can universally apply to all children. In general, I fall back to the basic idea that 'developmental readiness' may or may not be a valid concept because there is no way to measure such a construct. Is it possible that 'developmental readiness' is a smokescreen term to hide our lack of attention to specific individual or curriculum based factors?
That leaves us to curriculum or educational methodology (which includes remediation and special education). It certainly makes no sense to retain if we are going to deliver the same curriculum a second year! Rather, a best-practice approach should include intensive case-study to determine the individual factors that contribute to lack of progress and then educational planning based on those individual factors. I believe that this is the best approach to take until we see district-based outcome studies.
I am not sure how soon we will see this - because although we have Individualized Education Plans it is also true that we create curriculum and hope that all the children will fit inside our creations. Curriculum is efficient - but perhaps is a poor way to consider best-practice when administering special education. Is it enough for us to develop special-case curriculum and try to fit as many pegs as possible into the holes we drill? This ultimately boils back down to an issue of resource allocation. Just how far are we willing to go to deliver truly individualized education - and what can we actually afford?
Perhaps it is wrong for us to call it individualized? Would we be willing to admit that it is not?
I sometimes think that if we answered this question that we could begin to have a real conversation about the value of retention.
I have the experience of having had worked as a public and private school speech therapist in the schools for many years. I still collaborate with the schools with a number of kids on my caseload. The beginning of school provides some challenges–setting goals, making schedules, collaborating with the teachers on curriculum, and making therapy sessions fun.
My hat is off to all the dedicated, hard-working therapists and teachers beginning the new school year and wish you the best!
For those speech language pathologists reading my blog, let me know how I can be helpful to you with ideas, research, techniques etc. Just make a comment below and I will try to address it.
Happy New School Year!