Re-Air: Making the Most out of OT Services

Speaker 1 (00:00): There were a lot of times where their test scores came back, completely average, above average. But on the intake call, mom was crying or sent me so many reports from the school of this kid struggling and it just was not matching up on paper. This kid looked great, but functioning in the community and at home he was struggling. So that’s something important. It was never a one-way conversation. I was never like, okay, here’s your test scores. Sorry, your child doesn’t seem to need ot. Okay, bye. It was a transparent discussion when I didn’t think that they needed services where I said something like, look, I know you’re here because you mentioned your child has been having meltdowns at home and has a hard time with X, y, and z. I didn’t see it in the clinic when I assessed him, and your sensory questionnaires came back within normal limits. (00:49)However, I do recognize that kids can behave differently in new environments and here’s what I saw, blah, blah, blah, blah, blah, and we talk from there. Welcome to the Sensory Wise Solutions podcast for parents where parents can get real actionable strategies to support kids with sensory processing disorder. I’m Laura OT and mom to Liliana, a sensory sensitive kid who inherited my anxiety and my love for all things Disney. Consider me your new OT mom bestie. I know my stuff, but I also know what it’s really like in the trenches of parenting a child with sensory processing disorder. Speaker 2 (01:28): Okay, mom, enough about me. Let’s start the podcast. Speaker 1 (01:35): Hello everyone. We are still celebrating Occupational Therapy Awareness month here on the podcast. This is episode 71, but it is a re-air from last year’s episode 24, which I’m going to teach you all about all of the different ways you can leverage the occupational therapist who you might already be working with with your child. I am going to talk a little bit in the beginning about how to access occupational therapy services, at least in the United States. And yeah, I’m going to jump straight into the episode. It gets cut off right at the beginning, but I wanted to give you a little orientation that this is 2023, Laura speaking to you now, but I am about to play you 2022 Laura’s episode 24 on making the most out of OT with your child. We are going to talk about some different routes you can take to get to occupational therapy services and more importantly, what you should look for when you are getting OT services and how you can make the most of your time working with them. (02:38)So as usual, I have a couple of caveats or things to just keep in mind before we start the episode. So first, I am specifically referencing therapy in an outpatient or private pediatric occupational therapy clinic. So there are OTs that work in schools, in hospitals and some therapists who go to your home. I’m not talking about those my entire career and frame of reference, even in my personal experience with OT, has always been in a private clinic. So that is what I feel confident speaking to. And the other thing to keep in mind is that I’m located in California, so different states and different countries have different routes, different regulations, different requirements. They might even refer to some professionals differently or use different words. So if there’s some things that don’t sound familiar, I’m sorry in advance for that. I’m speaking from a California private OT clinic experience. (03:40)So I hope this is still helpful in some ways because that is a very specific reference, but I’m hoping that some of the tips I share with you can still apply. All right, so let’s first talk about just getting into an OT clinic. So I’m going to keep this part pretty brief because I have a lot of tips that I want to go into detail and share with you for when you’re actually in therapy and also because this part of the process can really, really look different based on so many different factors. So I can’t really cover all of that here, but just very quickly, here’s my spiel, which by the way has actually changed over the years. I used to recommend a different route. I used to always go, I used to always say, go straight to your pediatrician and tell them what you’re saying and they’ll direct you and tell you what to do from there. (04:28)And now, after hearing so much feedback from other parents and experiencing some challenges myself, I say things a little differently. So I still absolutely want you to clue your pediatrician in and talk to them about your child’s sensory behaviors, but you don’t need to depend on them to guide you or to refer you to a clinic. You might need their input for a certain code or something that you plan to seek reimbursement from insurance, but there, there’s no one stopping you from contacting an OT clinic like their phone number isn’t hidden and only given to your pediatrician. You could still talk to them directly and that’s what I recommend. I usually recommend going straight to the OT clinic that you want to be seen at. So start with the Google search. Just type in pediatric private OT clinics in your area with your city name or even go through a local next door app or Facebook mom group and search for local private pediatric OT clinics. (05:31)I would get a list of as many that you can find within driving distance or something that you’re comfortable with and then just start cold calling. Just call their number and see who picks up and ask them. So you could start by just simply saying, I have a son, I have a daughter. My child is five years old and they have challenges with X, Y and Z, and I think that OT might benefit him. Do you accept my insurance or can you tell me what steps I need to take to get an evaluation? Usually the person you’re talking to, the receptionist or director can then tell you exactly what you might need or something to sign off from your pediatrician and then you can just retroactively get it that way. And this is what we did in the private clinic that I worked at in the Bay area. So if you’re not even seeking insurance reimbursement, even better, you can just go straight ahead and call them and just say, I think my son needs an evaluation because he has a hard time with X, Y and Z. How can I get started? That’s all you have to do. (06:39)And if your child does have sensory challenges and this is your main concern, I would be very clear with them that you want the evaluation to assess their sensory processing abilities, not just their fine motor or gross motor skills. So there’s only one that I can think of now, standardized assessment for sensory processing skills and not many occupational therapists are certified in it. I I do not have a certification in using a sensory integration assessment, but when I would get a referral, and this family has sensory challenges, our clinic has a certain set of clinical observations that we used to assess their sensory processing abilities from a clinical observation perspective and also some questionnaires that we sent home to parents. Then the standardized test we would use would also be fine motor and gross motor abilities, but I would also still be making clinical observations while I’m doing those tests to see if there’s anything that stands out from a sensory perspective. (07:51)So I would definitely look into that and make sure that they can at least observe your child sensory processing skills. Then another side note I have is I then always get asked what you should look for in an OT or if you should ask for a certain background or education or special certification. So what you should know is that all occupational therapists, again speaking from the United States, we get our license and pass our boards based on a general graduate program. There’s no specialization that we get from grad school. We get education and course curriculums covering every diagnosis and age throughout life, and we do a research study on a particular topic of interest, but we don’t like major in a certain, I did not major in pediatric ot, I just got a general education through my graduate program. Then we take a test and we get our license and then we apply to work in any field that we want to work in. (08:57)Usually it’s related to an internship that we had, so we have some working experience in it, but I am just as qualified to work in a geriatric setting as I am pediatrics when I graduate from ot. But then after that we do have to keep up with professional development courses where we usually find relating to our niche field. So I look for a lot of courses in pediatrics and then we just take a lot of courses to further our development in one specific area like sensory integration. So if you are calling a clinic and they have a brand new OT straight out of grad school, they probably don’t have any specialized courses under their belt yet, and they probably were trained by the therapists in that clinic, but they’re not going to have a list of like, oh, I’m certified in this and this, but try to give them a chance. (09:48)I once was that student was that first therapist. I had a first client and I didn’t have any certifications under my belts and I don’t want to brag, but I think I was a very good F straight out of grad school ot. Thanks a lot to my mentors, but if families didn’t take a chance on me, then I wouldn’t be doing what I’m doing now and looking back on some of my first few clients, I didn’t make huge mistakes with them. I was still a really good therapist, so don’t use that as your first filter and then when you call the clinic to see how to get an evaluation with them, this is also the time you’d want to ask them what their wait list looks like in the event that you do end up seeking treatment with that facility. (10:37)Sometimes wait list can be six months to a year. Sometimes there’s no clear answer on how long the wait list is, but it’s still good for you to understand. All right, so this brings me to my next point. So you get the evaluation done, what do you do if after the evaluation the therapist is like, Nope, I don’t think your child needs services. They don’t recommend occupational therapy services for your child. Sometimes kids just know how to turn it on, just enough to pass the test, aka not qualify for services. So this looks different of course with different clinics and whether or not you’re going through insurance, but speaking from my experience at a private clinic where families paid out of pocket, there were a lot of times when I did not recommend services based on several different factors. So first of all, I never dismissed a family just because their child’s scores were average or even above average or if because they weren’t below a certain number. (11:42)I always, always, always took into consideration what the family mentions, what the teacher mentions, and I would make the best call that way. There were a lot of times where their test scores came back completely average, above average. But on the intake call, mom was crying or sent me so many reports from the school of this kid struggling and it just was not matching up on paper. This kid looked great, but functioning in the community and at home he was struggling. So that’s something important. It was never a one-way conversation. I was never like, okay, here’s your test scores. Sorry, your child doesn’t seem to need ot. Okay, bye. It was a transparent discussion when I didn’t think that they needed services where I said something like, look, I know you’re here because you mentioned your child has been having meltdowns at home and has a hard time with x, y, and z. (12:36)I didn’t see it in the clinic when I assessed him and your sensory questionnaires came back within normal limits. However, I do recognize that kids can behave differently in new environments and here’s what I saw, blah, blah, blah, blah, blah, and we talk from there. So at the end of those conversations, those parent consults, I always gave them at least one resources, at least one resource. Usually it was a handful, at least one resource to go home with. So it’s either a book, a podcast episode, maybe another referral to a different professional, some strategies for the teacher to try in the classroom or so I would send them home with that saying, it doesn’t seem like your child really needs ot, but I see you’re struggling so you could try this at home. Or sometimes I would still offer to the family to try a few sessions with me to work on those very specific skills or challenges that they wanted help with. (13:29)Even though on paper this child was typical and what happens was sometimes within those first few sessions that child may display behaviors or things that I never saw before. So then I ended up keeping them on the caseload and was like, oh wait, I did see some of those things we talked about. It didn’t show up on the eval day, but now after working with them three times, there it is. I totally see it. I know how to help this. But other times after a few sessions, I teach the child certain social lessons or teach the parents some home strategies, and from there I’m saying, yeah, it really looks clear. I think your child just needed this little new way of thinking of things or you just needed the strategy, but I really don’t think that you need skilled OT services. So then I would just discharge them. (14:16)But I share that with you because I know a lot of therapists sometimes will say that your child doesn’t need OT BEC based on their scores, but they shouldn’t be sending you home. So I would still ask them, what can I do to support them? Now moving on to when you’re actually in an active on an active caseload for a therapist and you’re working with this therapist, I want to talk about some common, I don’t want to say complaints, but concerns that that parents share with me on Instagram when they’re asking me what should I do about this? My child’s therapist, blah, blah, blah. So I’m going to share those. A common one that comes up is that parents feel like their child isn’t making progress at all or sometimes isn’t making progress fast enough like, oh, I thought we’ve been working with them for this many months. (15:04)Why is my child still doing blah, blah, blah? So this is really tricky because there’s really no formula or rule book that says a child must be able to improve this skill within one month. A lot of goals are written this way with a specific timeline to add structure, but mostly it’s for insurance and we do set long-term goals because obviously we don’t want to just say, let’s keep your kid here forever, as long as they need it. It is nice to have that structure to work with, but I always warn parents when we do write those goals that if your child doesn’t meet it within this timeframe, it doesn’t mean that they failed or that we’ve failed or anything is wrong. It just means that we need to add more time or maybe try something a little different. But those timelines are a really hard thing to work with as a therapist because we want to be careful with setting up parents for setting up your expectations, but we understand that timelines are a part of every conversation when you’re about to work with a therapist on this specific skill that makes sense. (16:09)But if you have expectations of progress in your child that you’re not seeing at all, this is definitely something to have a conversation with the therapist about, but keep in mind your child might be making progress in different ways that just aren’t as obvious. So they might not be meeting the exact goals that are written down on their evaluation report or that you had hoped for yet, but they’re probably still moving in the right direction and sometimes hopefully the therapist can bring this up to you and explain in ways that make it more clear that your child is doing the right thing or that your child is trending in the right direction and that they are making progress. It just looks not how you might be measuring it. It’s definitely worth a conversation. Then the other common thing I hear from parents is it looks like my child’s OT isn’t really doing much with them. (17:02)I could do that at home or something like, all they’re doing is rolling around on the ground or making crafts and this is not what I took them to OT for, so I get it. OT just really looks like a lot of play and it looks like, and probably even sounds like if you sat in on some sessions that you could do this too or your babysitter could do this at home, but I promise you every ot, whether or not you can see it has a specific set of skills that they’re working on. They are adapting the environment, they are adjusting their posture, they are supporting your child with standby assistance, they are making clinical observations the entire hour that your child is there. There was a lot going on that you just can’t see, and it’s not as straightforward as physical therapy, so it’s not always as explicit to the parents. (17:50)This is something that you can definitely ask your therapist to explain to you and say like, Hey, I see you guys do obstacle courses all the time. My kid really loves it, but I’m just curious how is this going to help with their emotional regulation? Like we’re here because they have meltdowns at home, and that’s a logical question. It it’s really hard for someone who’s not an OT to understand the importance of the intervention, but hopefully you can ask your OT this and they can explain it to you before you completely run away from that OT and say they’re not doing anything. I promise you there is a skill being worked on and it is purposeful and they have a plan. Another thing that parents often say is that they don’t really have any idea at all what the OT is doing in their sessions, and so they have no idea what to do at home. (18:40)I work with a lot of one-on-one clients who I consult virtually who this is their story and I’m like, so okay, tell me about your child. What are the things at home? And I’m like, okay, so you said they’re an ot. What are they doing in ot? What is your OT working on? And the parent would say, to be honest, I have no idea. I really have no idea what they’re doing. And that’s because not all clinics are set up to be able to have the parents observe and sit in on their sessions with COVID restrictions or even without it, some clinics just aren’t able to offer this. So you’re basing it on a quick handoff at the end of the session where the therapist has one or two minutes to be like, this is what we did, and in that moment it doesn’t make sense to you or you might not even get that. (19:21)Some parents go weeks or months without actually talking to their child’s OT because maybe a nanny drops them off or another parent or a caregiver. There’s a lot that could be making you feel very disconnected from the process, and this is definitely something that you need to set aside time to contact your OT about. Ask them if you could have a phone call with them. Ask them if you could set a time to send them an email or a Zoom call. You definitely don’t want to be disconnected from your child’s OT services, especially when you’re paying privately at an outpatient clinic. You need to be able to carry over some of those things and those supports that they’re doing in the clinic for it to truly have an impact on your child’s development and regulation. So the other thing that parents often talk about is they say, well, my kid hates going to OT or doesn’t like going it or They’re always dysregulated when they come home, which is a whole other thing, but let’s say your child doesn’t like going to ot. (20:21)I don’t always read that as there’s something that OTs doing wrong. It’s not always the OTs fault. An OT clinic can be very overstimulating and an OT clinic has a lot of structure even though we try to be as child led as possible, there’s still a general structure that has to happen when they’re there. Also, it could depend on the time of day. I worked with a lot of older elementary school kids who would much rather be home playing video games with their friends and I don’t blame them, but I very much appreciated when the parents came and told me like, Hey, ugh, I really had to drag him out of the house today. He’s really not liking it. And as a therapist that clued me into it and allowed me to spend more time building rapport with a child and really understanding why is it that they hate it here? (21:07)Is it something I’m saying? Is it something I’m doing? Is this just really hard for them? Do they not understand why they’re coming to ot? And that usually was the biggest piece when I was working with kids who were five and up, I would always ask the parents, do they know why they’re, you’re pulling them out of school to come here or do they know why they’re coming here every Thursday afternoon? And a lot of the times our kids did not know, and when I had the conversation or I told their parents how to have that conversation, it opened up so much more trust and a lot of possibilities for progress and a lot more rapport between myself and the client because they understood what we were doing and there was more buy-in. Honestly, for some of those older students when you’re really little, when you have the really little ones who are crying, a lot of it is probably because it’s really hard being bombarded by a lot of the sensory inputs. (22:02)So the OT should be offering everything at a just right challenge that’s not completely setting off your child’s fight or flight, but especially in the beginning, this is going to be something that they’re getting used to and it’s a brand new process and it’s a new environment and maybe there’s other kids there who are crying and it can just be a very overwhelming environment. So it’s not always a problem directly with the ot. Then the other one is when sometimes after ot, the parents will say like, oh my gosh, he was so dysregulated the rest of the day. That is probably because the OT clinic or the OT session was bombarding them with a lot of sensory input that is not offered at home or at school, but it’s a good sign that your child is in the right place, meaning that they need help with the regulation. (22:52)I would also definitely clue your OT into this because I have had clients like this where I had to the last 20 minutes of a 50 minute session, I had to make sure that the activities I was offering was a little bit more ramped down in terms of stimulation that was still therapeutically beneficial to them and their goals, but I just always had in mind, okay, he has to go to school after this. I cannot send him completely dysregulated, so we need to turn down the lights or we need to turn off the volume and we need to do something a little bit less overstimulating. So definitely talk to your OT about that if you’re noticing that as well. Make it help kind of tailor the end of the session to make sure that they have a smoother transition out of the clinic. All right, so now I quickly want to share. (23:35)There are a lot of things like I call them a la carte, things that parents don’t realize that they can ask their therapist to work on or to do with them. Especially this is very specific to only private clinics and if you’re not getting reimbursement from insurance because they’re very picky about the way service looks, but in my previous clinic that I worked in that was private cash based, I did a lot of a la carte things for families if it fit for them. So you could ask your therapist to do a school observation. I did this all the time for kids who are in public schools and private schools. It was a little trickier in public schools, but I did it. So you can ask your ot, Hey, my kid is having a hard time in school. Can you do an observation? And I went for an hour, observed the classroom, observed the child in the classroom for an hour, and then wrote notes on suggestions for the teacher to implement. (24:35)I also worked with clients on creating social stories for very specific scenarios that come up because you can find a bunch of free social stories on teachers, pay teachers or you could find them a lot of different places that are already created, but sometimes there was a very specific scenario that needed to be talked about that there was no social story for. So I would create them with the client including pictures directly from the house for the child and tailored it for them. I also created visual schedules and visual tools for the families to use at home for their sensory strategies. I spent my own time doing this, but again, this wasn’t a private clinic and you do most likely have to pay the therapist for their time to do this, but I want you to know that this is something that’s available that they can do for you. (25:27)I’ve also met clients out in the community somewhere where we had to work on skills at the park in a restaurant, at the grocery store, and we did the one-on-one session out there. And then of course, one of the most underutilized services that you can ask your OT to do if they’re in a private clinic is to ask for a one-on-one parent consult. And I highly suggest doing this at least once every three months if not one a month, especially if you’re just starting out with therapy to make sure that you can have some uninterrupted time with your child’s therapist to touch base on their goals, to spend some time educating about a specific skill that your child is learning and better ways to support them. And I stress the word uninterrupted because there is only so much you can focus on and really get out of a five minute quick discussion at the end of a session, especially when there’s other people around and your car is still running or it’s so hard to do that, especially when your child is there. (26:27)So you need some uninterrupted just time with you and the therapist to talk at length about things that come up while you’re in therapy. This is going to be your best way to bridge the gap between home and clinic, especially when you start seeing progress at the clinic that your therapist is telling you and you’re like, I don’t see that at home. Then I would highly recommend asking for a parent consult. All right, two more things here. I know we’re kind of getting into the long end of this episode, which I don’t like to do, but hang in there. I’m going to talk next about when to think about switching therapists or asking for a new therapist, and then also when it’s time to take a break from ot. These are very common ones. All right, so when to switch therapists. A quick side note for this, as a former therapist who, well, I’m still a therapist, but I don’t have a full caseload anymore, but when I used to have a super full caseload, it was not easy to accommodate a change in schedule or to take on a new client within the same practice. (27:30)So if you were like, oh, I need to see you on Thursdays instead of Tuesdays, it was not a quick snap of a finger on you got it. It took a lot of Tetris and dominoes of switching things around. So the same goes for if you’re trying to switch therapists within a practice. Our schedules are pretty tightly packed, so also if you’re switching clinics altogether, there’s always a wait list to think about, so just keep that in mind. But there definitely are times when a therapist isn’t the right fit for your child and it would help if you want to look into getting a different therapist. So one of the ways to know that you should switch therapists is just your gut feeling. That’s it. If you have that parent’s intuition that something isn’t right or just doesn’t feel like the right fit switch therapists, there’s no specific proof or anything to point to, but if you just have that feeling as a mom, I’m giving you the permission to just make the switch, sure, feel it out for a couple sessions, but if your child doesn’t feel right around them, if you don’t feel right around them, you’re not going to get much out of that dynamic if you don’t trust that therapist. (28:38)So if you have a gut feeling, try to switch therapist the second time. I would say switch therapist is if you or your child repeatedly asks the therapist not to do a certain method or thing and they keep doing it. So I’m being vague here because if I be too specific then it’s going to trigger some people, but this sounds like common sense, but sometimes I think that parents forget that you as the parent ultimately have the last say, especially when you’re in a private clinic. So hear out the therapist and their clinical reasoning, but if they keep pushing for a certain method or if they’re using a certain language or word over and over again and you don’t like it doesn’t fit with your parenting style or how you want your child to be working with another adult with find another therapist. Again, I don’t mean to be completely vague, but I don’t want to say anything that’s too extreme, but this could be anything from them using a different method of language or a different, or if there’s swaying too much into the behavioral realm and you don’t like that they’re using sticker charts, anything like that that you ask them, I don’t really like this. (29:48)It’s completely within your right to ask them to not do that. And then if they keep doing that, then yeah, I would definitely switch therapists, but definitely hear them out and see what their reasoning is behind it and do that. My whole message here is to just always be transparent with your therapist. Don’t feel worried or scared to come to them and ask them why they’re doing something or why they’re not doing something or what a certain treatment method is doing for your child. Definitely have the conversation with them. (30:21)The other reason why you might switch therapists is maybe they’re creating goals or agendas without your input or they hear your input and they are completely ignoring it. So initially when I get a kid on my caseload, I write the goals alongside their parents. So from the whole process, we’re both on the same page and we know that these goals are appropriate for the child and that the parents feel like this is what they really are here in OT for and what they want to work on with their child. So as I work with that child, sometimes those goals change or new areas of focus come up at which point again, we would have a parent consult and conversation and adjust that as needed, and there would be some point where I would be like, Hey, we both agree that he’s having a really hard time at school with this, so I’m going to shift my focus and we’re going to add that to the goals and I’m going to start working on that in session. (31:15)Is that cool? I just kind of get a verbal check off just so we just always know I’m going to start working on that Now is that make sense? So we’re on the same page. If you have a therapist who keeps working on goals that are not a priority for you, eye contact or other things that are just like, why are you working on this? I don’t understand. This is not what we’re here for. And if they can’t give you a reasonable explanation as to why they’re doing that and it doesn’t make you feel right, then this is caused to seek for to seek a new therapist. I think it’s within your right to do that. All right, so now when to take a break from ot. So taking a break from ot I’m looking at is that they’re not completely, they haven’t completely met all of their goals, so they’re not quite being discharged from OT services or sometimes we call it graduating from OT services, but you might need to take a break from services and there’s a lot of different reasons you might do this. (32:07)So being in a private OT clinic who works with parents who pay out of pocket, I am not bound by 12 visit maximum or 24 visit maximum. So this means I have and have had in the past long-term clients who are on my caseload for years. So I had a client on my caseload for five years, the entire time that I was at my previous clinic in the Bay Area, he was on my caseload when I first graduated and he was there until my last day when I moved out of that clinic. So when I have those long-term clients, when I first evaluated them, I didn’t know they were going to be there that long. I didn’t say, Hey, by the way, your kid is so impacted in this and this, he’s going to be an OT for years. No, I did not say that. (32:55)What I say is the truth. I say, I think your child can benefit from OT to help him with blah, blah, blah, X, Y, and Z. And I plan to do that through weekly OT sessions and this is just a fraction of your support. I will give you suggestions to try at home, but I can’t predict how your child will respond to therapy. So we’ll keep checking in and see how things go and then reassess from there. Let’s start for, and then I’ll usually give an amount of time. Usually it’s like three months, six months, nine months. Sometimes I’ll say a year, let’s start for a year and then reevaluate as needed. That’s typically my spiel. And then sometimes those clients graduate before a year. Sometimes there’s those clients who we keep finding new ways to support him and different things that he needs support in and they’ll be on my caseload for years. (33:42)But there are times when you as the parent feel that therapy is getting, I say the word stale, getting a little stale or getting old, and there’s times when it’s okay and even suggested to take a break from ot. So here are some of the times that I’ve suggested parents take an OT break mean. So I’m saying I’ve suggested, but it’s sometimes the parents come to me and we both come to an agreement that it makes sense to take a break from OT right now. So one of those is when progress is plateauing. So again, this is a very subjective term that the term plateau, especially in a clinic where we don’t really take a lot of objective data on every single behavior. So when I say progress is plateauing, it usually means that we’ve met some goals and have been working on tackling other goals, but haven’t been making much progress in one specific goal or area or it’s like a really, really big goal that’s going to take a while for us to truly get to. (34:38)We’re making some progress, but it’s a very slow and steady thing. So having that progress is plateauing in combination with a family just feeling burnt out from therapy, or maybe the child is getting older and now they finally want to join the soccer team and they just need a break from that therapy weekly. That’s when I might say, okay, maybe now’s a time to take a break and see how much organic growth your child can have in that area, or if they can make some growth on their own by participating in soccer, maybe that will help bridge the gap a little bit or any other social activities or extracurricular that would, that would replace the time that they’re spending at therapy. That is a logical time, I think, to take a break. Kind of piggybacking off of that, another time to take an OT break that I’ve suggested with a family is when you’re feeling overwhelmed, so this could be you or your child, but specifically from the parent perspective, if you have multiple children with different schedules, sports activities, or if you have one child, but they’re an ABA speech, OT play therapy and clubs and activities, or hey, maybe you have one child with no other activities, but you are just super overwhelmed with work and having to drive back and forth and dropping him off at this person’s house for after school care and then implementing the OT homework and the therapy just feels overwhelming and it feels like it’s not helping enough, then yeah, that would be really overwhelming, especially when you’re not really noticing a ton. (36:09)But the first thing to do with those scenarios if you’re feeling overwhelmed, is to talk about it with your child’s ot. They might be able to talk you through some of it or give you a modified schedule to go every other week or just some other suggestion to help take that burden off of you. But at the very end of it all, if you the caregiver who is responsible for transporting, feeding financially and emotionally being available for a child, if you are feeling overwhelmed, then yes, take a break. And the same goes for your child. If you have them in multiple therapies and they’re doing a lot of extracurriculars too, and they don’t have one day after school without a therapy and you’re feeling like you can see it take a toll on them, then take a break from therapy. I’m completely for that. That’s okay. (36:58)You’re not going to do any damage if you take a break from ot. Another reason why I might suggest a parent take a break from OT is if we talk about trying a new or a different therapy. So sometimes I’ll get a child on my caseload and work with them for a few months. Sometimes it’s three months, sometimes it’s six months or even a year. And within that time, we might make some progress. It might be slow progress or we might not make progress at all, but in the time that I’m treating them and working with them, maybe new challenges may come up or present themselves or other part of the challenge that we’re working on, become more apparent of the root cause of it. And then in my clinical opinion, I might say like, oh, I think that’s a little outside of my scope, or I don’t have enough education on that, or I don’t have enough clinical experience to work on that. (37:44)I really think that this other profession might be better suited to help that. Then depending on the family, I sometimes might recommend staying in ot, but just adding that on. But sometimes I do say it might make sense for us to take a break from OT now to see what happens when you explore this other therapy and see if that can open up some potential, and then we can talk about if OT can be added back on or if maybe that’s just what your child has needed. It’s always, always a discussion with the family. It’s never one-sided like, oh, it looks like you’ve, you’ve hit your potential in ot. Time to say bye. I will make some suggestions and then always take feedback from the parents and see how they’re feeling. It should always be more of a discussion. Now, the one big caveat, obviously to taking a break from ot, even when it’s my suggestion to my client, I will always say, I suggest it might be a good time to take a break, but just being completely transparent, I can’t save your spot. (38:43)So when you do decide to come back in a few months, in six months or a year, I might not have a spot available for you, and that’s something that we do have to weigh. There’s always a risks, a benefit, and a risk and a pros and con to weigh out. But if you’re really feeling burnt out for some reason and you’re not feeling enough, progress is being made at that time and you’ve given it a good chance than taking a break from OT might be a good idea. And I’ve had many clients who say that after a six month break, they notice so much more progress just because their child had more time to themselves or it gave them their child time to actually integrate the skills that they’ve learned and apply it outside of the clinic. And then they came back in six months and was like, well, now we want to work on this, this, and this. (39:27)But that goal that we were trying to work on that we weren’t making progress in has completely resolved itself just by giving us a break from ot. And that’s okay too. All right. This was a super long episode. Thanks for hanging in there with me. I hope this was really informative for you. I hope it wasn’t too specific that it didn’t apply to you. I hope it didn’t scare you off. I just hope it was really good tips, and if you liked it, let me know. Leave me a review in the podcast, or you could send me a comment or DM on Instagram at the OT butterfly. And if you’re still having a hard time connecting with your OT and still finding that you don’t have the right fit, but still need help supporting your child at home, I do have space on my one-on-one virtual consulting caseload. So if you want to work with me, you can head to the ot butterfly.com/parent consult, and there will be a link in the show notes below. All right, bye. If you enjoyed this podcast, please consider rating it and leaving a review, which helps other parents find me as well, want to learn more from me. I share tons more over on Instagram at the OT butterfly. See you next time.