Talk to me about in-clinic OT - UPDATE

[MistyMountain]

Aside from the timeout issue and not handling it well the benefits of a center is that they have equipment you do not have. I would think rigidity could be addressed at home but the sensory needs could be addressed in the center where they have equipment you would not.

[wapiti]

not sure if this will help:  SPD provider directory and how to choose an OT

 

from the second link:

 

Uses play and success to produce change and foster self-esteem. In good, sensory-based OT, children think they are playing. If a child is crying during treatment sessions, the OT may not be skilled in providing challenge with success, which is a keystone to treatment effectiveness.

Edited March 14, 2017 by wapiti

[PeterPan]

There are OTs busting it out all the time with minimal equipment. My ds is pretty over the top for sensory needs, and we've been using an OT who can do stuff with almost NOTHING. It's not what you have but what you know you're trying to do. Sure equipment is great, but I think sometimes it's a mask for less training in the real issues. You're not going to have that equipment at home, and you have to have strategies you can use every day of the week.

 

If someone is SIPT-certified *and* they have lots of equipment, that's something. But if my choice is less training with more equipment or more experience and the reverse, I'm going with the latter.

Edited March 14, 2017 by OhElizabeth

[Guest]

nm

Edited August 17, 2017 by Guest

[Guest]

Here is my issue about going with someone that also has ABA in their list of qualifications- I would have to supervise every moment of my child's therapy to ensure that things I disagree with do not spill over into the therapy. I am not willing to put myself in a position to have to micromanage a therapist on my kid's dime. It would not a good relationship make! In my case, aversives are not the only issue.

[Mom28GreatKids]

Hey Aimee, I could write a book about this stuff. . . serious. Therapists who say they are experienced with ya da, ya da, ya da, and then clearly, when the rubber meets the road, have no clue! In any case, have you heard of the PLAY Project? This could really really help Marco get to a place where other therapies are more effective. I don't know if there is a PLAY program where you live, but it is good good stuff.

[PeterPan]

I met some PLAY project therapists at a social thinking workshop. They were fine, but they seemed to have lower training and experience. I'm sure what they're doing is good in and of itself. It's really about *how much training* the person working with your dc really needs to be effective and successful. And sometimes it's not so much that the actual person working with him needs to be super, super highly trained, but they have to have someone SUPERVISING who has that superior level of training to help them problem solve and be effective. So, for instance, an aide in a school or an ABA worker is not necessarily highly, highly trained but they have someone supervising them who is.

 

So it's not just whether the therapy concept is good but whether the person doing it has the experience to work with that level of situation or has someone supervising them who can make sure they can problem solve.

 

My ds is still considered ASD1, but he's high end, pushing into ASD2, with aggressive behaviors that hit level 3. He's pretty challenging to work with. People who come in with no experience/training struggle. Even when they think they know, they will have situations and struggle. One of our workers is finally doing a lot better, and she admitted that part of it was that the behaviorist told her she had to let go of some pre-conceptions, assumptions about what had worked well with OTHER kids with autism and to roll with what HE needed. So even someone who had been working with the autistic population for several years was struggling.

 

I also think the danger is, and this is sort of a rabbit trail and sort of not, that people with lesser training maybe know *their* gig and what *they* are trained in, but they don't realize the other things they're NOT providing you. So then, instead of your sessions hitting all your goals (language, behavior, etc. etc.), then maybe you're having less goals and less accomplished. And the more complex the situation, the more concerning that is. I watch for that with my ds, because he's complex. People meet him and think oh he couldn't have language deficits, he doesn't need this or that. But any other dc in that situation, they'd be running language testing and working on communication and manding and self-advocating and finding these holes. But because he's gifted and can script and has a 99th percentile vocabulary, they just assume.

 

So I like all the smaller therapies, but at some point it's REALLY WISE to make sure you're getting that bird in the sky, overview approach where someone is helping you go through things and make sure you're hitting ALL the areas. Otherwise, the things not getting worked on WILL come back to bite you in the butt.

Edited March 17, 2017 by OhElizabeth

[Guest]

I met some PLAY project therapists at a social thinking workshop. They were fine, but they seemed to have lower training and experience.

Need I say more? You always put down everyone's suggestions in favor of ABA. Providing supporting evidence to your claims would be very useful!

 

Anyway, walking away...

[Mom28GreatKids]

It always depends on the person. Always. I would take my PLAY consultant over anyone, because she was, well, sent. It is so obvious. She IS VERY extensively trained, and is, in fact, one of Dr. Solomon's handpicked consultants to become a trainer for the PP. She is a superstar, so to speak. But even if she only worked for the BDD in my county, or was just in private practice, or whatever, we would take her for she is the crucial piece of ds's team. She is vital and essential. Why? Because she is invested, she walks beside us, she coaches and supports, she teaches and guides, she is in my home and loves my whole family. Skilled people who care like this are hard to find, but invaluable when found. So that is my suggestion for the OP. . . to look for someone who is skilled, yes, but also will invest.

[Guest]

Some visuals for the OP:

 

PLAY Project (based on the Floortime approach)

 

 

 

ABA:

[Guest]

AimeeM, here's a video to give you an idea of Floortime in an occupational therapist setting.

 

 

 

And just to clarify, I'm not looking to convince you on anything. Obviously, these choices will be different for each family. I picked a video that was respectful of ABA. No slamming here! Just giving you some visuals so you can see what you feel fits what you want for Marco and what you feel represents your family.

[AimeeM]

While I'm investigating other avenues, I'm on a researching mission. Reading some books -- and my friend Google :)

 

How do you know if you have a PLAY therapist in the area? When I try to research it, it just brings up a variety of "play-based" therapy everything. Not PLAY specific.

[Guest]

If you are looking for Floortime, this is the link to their directory.

 

http://www.icdl.com/directory

 

If you want the PLAY Project specifically, I'm not sure if they list them as well. I went through the ICDL directory, locally, and found a few. The strongest candidate is over an hour away LOL.

 

I'm not familiar with other play based therapy providers, so I hope others chime in.

Edited March 18, 2017 by Guest

[Guest]

Also, for Floortime, you could check your library for *Engaging Autism* by Dr. Greenspan.

[Guest]

This appears to be the P.L.A.Y. Project website.

 

http://www.playproject.org

[Guest]

Guidelines for a Comprehensive DIR Program

http://www.icdl.com/DIR/guidelines-for-a-comprehensive-approach

 

Just adding this for the comment about hitting ALL the areas. This is what I am hoping to achieve. I am working out the logistics, while waiting for the evaluations.

Edited March 18, 2017 by Guest

[Lecka]

Try "PLAY project."

 

That gets a first hit for me I *think.*

[Mom28GreatKids]

While I'm investigating other avenues, I'm on a researching mission. Reading some books -- and my friend Google :)

 

How do you know if you have a PLAY therapist in the area? When I try to research it, it just brings up a variety of "play-based" therapy everything. Not PLAY specific.

https://www.playproject.org

[Mom28GreatKids]

I don't know where you live. . . I can ask mine for some recommendations. . . she is high up in the organization. Let me know. The think is, OTs, STs, teachers, etc can and are getting trained. Little dude's school ST and teacher are both PLAY trained by my BT. So they make a beautiful team. PLAY should be in their credentials if they have gone through it.

[Guest]

Just a note here for anyone that this might matter to:
"Play Project: Courses offered by the Play Project are also not officially sanctioned by ICDL, but those that complete the Play Project training to become a Play Project Consultant may enter the DIRFloortime® Training Program with advanced placement by enrolling in DIR 202."

Found here:
http://www.icdl.com/education/dirfloortime
 

Edited August 17, 2017 by Guest

[Guest]

deleted for privacy

Edited August 17, 2017 by Guest

[Guest]

Also note, my son has not made any less progress than those that have followed ABA therapies, even though he has not had any formal therapies yet.

[AimeeM]

Update

 

We obviously decided to pursue another OT practice. Marco was terrified to go back. In fact, when I took him to meet a new OT, at an entirely different practice, he made me put his headphones on and kept his eyes squeezed shut the entire time we were in the waiting area. 

 

Today the former OT called me to let me know that she was dropping Marco from the program (that's fine?) -- and to tell me that she contacted Marco's pediatrician to let her know "the situation." What the heck? I've never had an OT or ST contact his pediatrician. Ever. Not even his EI contacted his pediatrician (occasionally she would call the office for me, in order to get Marco a new prescription/referral for a therapy needed, but not to actually talk to the pediatrician). Is this common?

I mean, it's whatever, I guess -- the pediatrician knew were leaving the one OT, since I called to ask for a new referral (for the new clinic) last week.

 

Any way, the new clinic encourages parents to come back during therapies, as long as the child still responds. In fact, they said that they may pull in a sibling or two if it makes Marco feel more comfortable or be more responsive. It isn't as flashy as the last clinic, but I get a better vibe from it. Marco enjoys the new therapist and she seems very experienced (she uses a floor time model and has had training in it). 

[Crimson Wife]

I missed some of the later posts in this thread but I wanted to chime in on PLAY Project vs. ABA. I own the PLAY Project workshop DVD and am considering doing the certification training once I (hopefully) get accepted to grad school in SLP.

 

I don't see *ANY* significant difference between the *MODERN* version of ABA and PLAY Project aside from the data collection & graphing of the former. Some critics of ABA really don't understand that today's ABA is *NOTHING* like "old school" Lovaas-style ABA even though they have been repeatedly told this over and over and over...

[Guest]

nm

 

Edited August 17, 2017 by Guest

[AimeeM]

AimeeM, I am so sorry this keeps happening to poor Marco!  :(  I hope, with all my heart, that you can find a place that will help your boy, soon.

 

:grouphug:  :grouphug:  :grouphug:

Thanks. The new clinic seems to be very good. One of the head OTs evaluated Marco, had him meet the (very nice) SLP who I spoke to on the phone, and Marco really took to this particular pair. I really like that she's more play-based and positive. 

[Guest]

Thanks. The new clinic seems to be very good. One of the head OTs evaluated Marco, had him meet the (very nice) SLP who I spoke to on the phone, and Marco really took to this particular pair. I really like that she's more play-based and positive. 

 

Good to hear that, my dear! :)  You will both be in my thoughts. 

[Guest]

You could include your daughter now  :)  I'm sure she would love to be involved!

[AimeeM]

You could include your daughter now  :)  I'm sure she would love to be involved!

Oh my.  :leaving:

The minute the OT tells her brother, "No," well...

Edited April 11, 2017 by AimeeM

[Guest]

Oh my.  :leaving:

The minute the OT tells her brother, "No," well...

 

:lol:

[PeterPan]

They're not going to tell him no, mercy. They'll have 40k creative ways to redirect, explain it's not a choice, etc.

 

This new place sounds lovely!! I'm really happy for you!! Now, if you've got a good fit, you can feel comfortable maybe asking for referrals, suggestions of other providers in a variety of disciplines who are of a similar, positive approach, etc. :)

[Mom28GreatKids]

This is great news Aimee. The old clinic sounds a like the first clinic we went to, where one SLP said she could not work with my child because of his behavior and the owner gave me an ultimatum that they would not treat him unless we got behavior therapy. . . we did, and I am thankful, but through that, I learned that some therapists are very rigid (they wanted to strap him in a chair) and he would not cooperate. All of his therapists at school are PLAY Project trained, and his private slp is just magical with him. But they meet him on his level, make it fun, and let him move. And flexible. They can read what kind of day he is having and adjust. He is doing great. I hope this turns out to be as great as it sounds.

[Guest]

I missed some of the later posts in this thread but I wanted to chime in on PLAY Project vs. ABA. I own the PLAY Project workshop DVD and am considering doing the certification training once I (hopefully) get accepted to grad school in SLP.

 

I don't see *ANY* significant difference between the *MODERN* version of ABA and PLAY Project aside from the data collection & graphing of the former. Some critics of ABA really don't understand that today's ABA is *NOTHING* like "old school" Lovaas-style ABA even though they have been repeatedly told this over and over and over...

I have a right to my opinion, which is based on my own research, way of thinking, and value system. What I see will not necessarily be the same as what you or someone else may see. I give each person the opportunity to process the information I link or quote, based on their own family's values and perceptions. I do not coax, which is more than I can say for others. People have the right to know that there are other forms of therapy out there that are evidence based, and they have the right to choose which they feel best suits their child and family, without being pressured into thinking that their child will not make progress if they don't follow certain people's specific path.

[prairiewindmomma]

I have a right to my opinion, which is based on my own research, way of thinking, and value system. What I see will not necessarily be the same as what you or someone else may see. I give each person the opportunity to process the information I link or quote, based on their own family's values and perceptions. I do not coax, which is more than I can say for others. People have the right to know that there are other forms of therapy out there that are evidence based, and they have the right to choose which they feel best suits their child and family, without being pressured into thinking that their child will not make progress if they don't follow certain people's specific path.

 

Crimson Wife is entitled to her own opinion.  She couched her language in terms of "I don't see" and explained the basis of her opinion.

 

My goodness, Canadian Mom, I rarely call people out but your own opinions have been rather rigid and forcefully proclaimed. One of the strengths of WTM is that we come to the boards with a diversity of experiences, knowledge, and opinions. Chill.

[Guest]

Crimson Wife is entitled to her own opinion. She couched her language in terms of "I don't see" and explained the basis of her opinion.

 

My goodness, Canadian Mom, I rarely call people out but your own opinions have been rather rigid and forcefully proclaimed. One of the strengths of WTM is that we come to the boards with a diversity of experiences, knowledge, and opinions. Chill.

I fail to see where I judged Crimson Wife for having her own opinion! I believe it was her post that stated about what I have been shown repeatedly! My posts were to the OP. I won't even touch the rigid part on this board!

Edited April 12, 2017 by Guest

[prairiewindmomma]

Aimee--I'm so glad that you found a better fit for Marco at the new clinic. I can't believe the first clinic is going to call your ped. That's crazy town, and another warning sign that it's good that you moved on.  We had a similar experience once.  We later found a really amazing place for our child. It shook me for a bit, though, to have a well-respected in the community clinic challenge my decision to leave. I'm so glad that you are such a good advocate for Marco!

[AimeeM]

Aimee--I'm so glad that you found a better fit for Marco at the new clinic. I can't believe the first clinic is going to call your ped. That's crazy town, and another warning sign that it's good that you moved on.  We had a similar experience once.  We later found a really amazing place for our child. It shook me for a bit, though, to have a well-respected in the community clinic challenge my decision to leave. I'm so glad that you are such a good advocate for Marco!

The OT already called the pedi. DH said it was probably a way for her to "cover herself" professionally, considering how upset I was. No clue. Like I said, the Pedi obviously knew things hadn't worked out there, since I called the week previous to request a new script/referral for the new clinic.

[Guest2]

Yikes. When I was an OT, I worked with kids who had pretty challenging behaviors. I have been bit numerous times , hair pulled, head butted.... no punishing. You follow the behavior plan. These things happen and are kind of expected as you get to know each other. If the kids can handle sensory input and challenges, why would they need to see an O.T? The O.T makes sure the environment is set up and encourages alternate behavior if that is on the plan. For example , if someone is getting ramped up, you guide them to a swing, heavy blnket, whatever helps them. You help them learn their own systems so that they can soothe themselves. Edited to add: imho part of the job is to engage the child. It is supposed to be fun while challenging. I have never punished a client. Never heard of anyone doing so. Glad you moved on.

Edited April 15, 2017 by Silver Brook

[AimeeM]

Yikes. When I was an OT, I worked with kids who had pretty challenging behaviors. I have been bit numerous times , hair pulled, head butted.... no punishing. You follow the behavior plan. These things happen and are kind of expected as you get to know each other. If the kids can handle sensory input and challenges, why would they need to see an O.T? The O.T makes sure the environment is set up and encourages alternate behavior if that is on the plan. For example , if someone is getting ramped up, you guide them to a swing, heavy blnket, whatever helps them. You help them learn their own systems so that they can soothe themselves. I have never punished a client. Never heard of anyone doing so. Glad you moved on.

That's what confused me. This OT was supposed to be experienced with the severity-level of autism (characteristics -- rigidity, sensory seeking, feeding issues, etc)... but then her reaction when he was rigid... was to physically force him into a time out... for being rigid... 

I was more confused than angry at first. I became really and sincerely angry when I realized that he never would have went to a time out willingly (because he doesn't know what one is -- we do not use that phrase at home, and certainly not a chair), so she had to have physically placed him there. Unfortunately, that didn't click for me immediately.

 

I didn't realize he should have had a behavior plan? What is that and how does it differ from goals? She talked with me briefly about goals, but nothing called a behavior plan. This was our first go 'round with in-clinic OT and our goals/plans with Early Intervention (and Speech) were more broad and all-encompassing. 

Edited April 15, 2017 by AimeeM

[PeterPan]

A behavior plan is created by a behaviorist. The ps has a step called a BIP where they formally make one. As you're seeing, it can be a very important protection. 

[AimeeM]

A behavior plan is created by a behaviorist. The ps has a step called a BIP where they formally make one. As you're seeing, it can be a very important protection. 

Ps as in a public school? Is this something that I could obtain privately, without going through the public school?

[Guest2]

That's what confused me. This OT was supposed to be experienced with the severity-level of autism (characteristics -- rigidity, sensory seeking, feeding issues, etc)... but then her reaction when he was rigid... was to physically force him into a time out... for being rigid...

I was more confused than angry at first. I became really and sincerely angry when I realized that he never would have went to a time out willingly (because he doesn't know what one is -- we do not use that phrase at home, and certainly not a chair), so she had to have physically placed him there. Unfortunately, that didn't click for me immediately.

 

I didn't realize he should have had a behavior plan? What is that and how does it differ from goals? She talked with me briefly about goals, but nothing called a behavior plan. This was our first go 'round with in-clinic OT and our goals/plans with Early Intervention (and Speech) were more broad and all-encompassing.

Well, i was referring to where i used to work. Some of our kids lived in-house and we had a school pyschologist develop a behavior plan for all staff. As a parent, you would probably just talk to your therapists about his challenges and agree on how to handle them each and every time they came up so that it would be consistent and predictable for Marco and everyone. Edited April 15, 2017 by Silver Brook

[PeterPan]

This is just me, but I find it really helpful to be able to pass the buck off to the behaviorist. For instance, right now ds is learning to ask for breaks when he needs them. The plan, the instructions to other workers, is that if he asks for a break he gets it. However you're going to be amazed at how much outside people (teachers, coaches, Sunday School, whatever) feel free to have their own opinion! So then it's no, the behaviorist says what we do is... So like if our coach says oh but sitting on the bench is getting out of work and then the other boys will want to, TOUGH. Our behaviorist says for him that is his best, safest calming break and the one he should be given if he asks for a break or is clearly needing a break. Doesn't matter the coach's opinion or anyone else's opinion.

 

I hate a lack of consensus among professionals. If you are like oh OT what do you think the plan should be, then oh SLP what is your plan, on and on, everybody has their opinion and nobody is working together. You pick ONE PERSON you trust. BIP is a legal process in school, part of the IEP process, a protection. (We don't have one and I think we should, but that's another story.) If you're doing the Play Project work with someone and that person is acting as your behaviorist, your lead, your coordinator, then that's your person. If you don't have that person, maybe you move up through the ranks and find that person.

 

Anyways, one person, one plan, everybody else follows it. That way it's not confusing. That way your goals are consistently targeted and he's getting consistent responses and consequences no matter where he is. I've had providers think up behavioral plans and consequences and motivators on their own. Sometimes they're really consistent with how we're working, and sometimes it's like whoa you should have asked first! Then I have to say no, that contradicts the plan, isn't what he's ready for, etc.