COTA SI Success Masterclass - Mary Kostka
A recorded masterclass by Mary Kostka introducing practical, clinic-focused sensory integration (SI) strategies for OTs, COTAs and other clinicians. Mary contrasts SI with generic sensory input (e.g., weighted vests, brushing), emphasizes core SI principles — child as active participant, play-based collaboration, just-right challenge (‘tightrope’), and the three primary inputs (proprioception, vestibular, tactile) — and gives concrete grading strategies (stable→moving, object vs. child movement), testing notes (post-rotary nystagmus), and clinical examples. The session also covers implementation in homes/schools, feeding, auditory strategies, and Mary’s two-year residency program and digital resources (membership, upcoming app).
Right. Awesome. All right, welcome, welcome, welcome, everybody. A couple more minutes before we're officially starting back to seeing where everybody's from. Let's see. Wow. I wonder. It seems like we almost have every state covered here. Texas. Jessica. Hey, Jessica. I know. Jessica. Nancy. Florida. Heather. Pennsylvania. Melissa. South Carolina. Amber. Texas. We have Connecticut. H. Bennett. That's probably your last name, huh? Tiffany, Alabama. Illinois. I lived In Illinois from 10 to 10 to 18. Anne Marie's. Kentucky. Val. South Florida. Liz. Colorado. Jack. Lee. Oklahoma. Okay, I guess I better get started. I can't just watch where everybody's from. Welcome, everybody. I'm excited that you're here, and we are going to get started here. So welcome to the Sensory Integration Success master class. And I'm just really excited that you're here. Before I forget, I want to give a shout out to Christy Rommel. She made all of these slides for me. She is our. Our director of marketing, and she's also our. Our client coordinator, and she just did a beautiful job on these slides. So are you okota wanting to excel? Actually, what I'm curious is, can you put in there if you're a coda, an OTA or an OT or something else? I'd be curious because I'm just kind of used to Everybody having their Cs, but apparently a lot of people don't carry that on after, and so there was a little confusion. There's a little confusion on who could come. Of course OTAs can come. All right, we got some OTs, CODAs, lots of CODAs. OTAs, same thing. Just don't continue the teachers on here. Great. Sweet student. Nice. All right, that's great. I am so excited that you're all here because you all want to learn, and I'm here to help you. All right, so tell me, put in there sbd, if you have a passion for these kids. They are seriously my. My biggest passion in my life. I love SPD kids. Are you passionate about these guys? Just put SPD in the chat. You love them, Jennifer? Me, too. I just see so much potential in all of them. It's just I absolutely love working with them, but they're tricky. Right. So I'm going to help you make a real impact together, give you some new strategies to help elevate your skills. Bunch of cuties. I know. Even when they're upset, they're cute. A lot of autism. Yep. So we're going to make an impact together and give you some strategies. What's going on here? I got to get to the next slide. Here we Go. Okay. Going to help you with some clinical skills. Hopefully this within an hour. I hope that you'll have some strategies that can help you feel a little more confident. And I've been where you are, where you just kind of feel like you're determined that these kids are tricky, so can be a little unsure about it. Knowing what to do sometimes. And you see them struggling with their milestones and really learning. You know, you just need to learn some new things to make a difference. So in my clinic since 2008, we've literally treated thousands of kids, and they're all sensory kids, every single one of them. And we consistently see them thriving. We go. In fact, our. Our tagline is helping helping families thrive. It's what it's all about. We want the parents to feel relieved. In fact, what's so powerful to me in an evaluation is that most of the time, the mom starts to cry when she finally understands that there's, like, a physical reason for why the kids acting the way that they are and it's not her fault. I just. That just, like, means the world to me when they have that, like, sense of relief and nothing's better, nothing makes me feel better than when the kids feel com. You know, more confident. Like when they say I did it, that's just, like. That's just keeps me going. I absolutely love it. So we're gonna help them make their milestones. We can help them get there more quickly. It's literally a difference. I'll talk about it a little bit more later, but some of the things I'm going to tell you about literally has made the difference of, I would say the kids get better, like, 10 times faster. So just a. A lot of you don't know me. I'm Mary Koska, and I just tell you a quick little about me. I've been an OT for 36 years, and the first four years of my career was doing kind of a little bit everything, a lot of rehab, that sort of thing. I just travel therapist. But then the ne. The next 17, I was a school therapist. And I would say, looking back, I did a lot of it wrong. And it's just because it's not like I was bad therapist. It's just that I didn't really know how to help these guys. And. But I got really curious, and I kept learning more and learning more, getting a little taste. And then in 2008, that is when I really went all in on my training and did the air sensory integration training. And now I've been doing that solely for 16 years. And it's just like day and night, the results that we get. So like I said, what changed is that I took the air sensor integration training. And so I'm going to just share with you some of those light bulb moments that I got during that training in this session. And yeah, so that's when I really could see that I was making big changes. And so I think where to start today is with what sensor, what sensory integration is not. And so it's not just providing sensory input or a sensory diet. Those things are still good, but. But they're not the game changers. They're not the. They're not the actual sensory integration. So, for example, it's not just giving a weighted vest. And one thing that I learned during that training is that, you know, a lot of times people are putting weighted vests on kids. Most of these kids have a weak core, so putting weight on weakness is not a good idea. So that's just something to consider. Weighted blankets are great. I love them. It's not sensor integration. It's calming sensory input, though. I love the Wger depressure protocol. I love it, love it, love it. I would say it works with like 80% of our kids. I love it. But it's not sensory integration. And so I just want to kind of separate these things so that as I tell you more about what sensory integration is, you can go, okay, it's not a sensory diet, it's not sensory input. Although those things are great. In fact, I want to tell you a story about the brushing. This actually is what kind of got me super interested in sensory. A friend of mine had gone to the training and taught me how to do it, even though she wasn't supposed to, because they had a thing like that. You weren't supposed to teach other people unless you went to the course. But anyway, so she showed this to me and I. And this was a long time ago, probably 25 years ago, and I was working in school, working in preschool, and we had. This is kind of like when you just started seeing more autism but didn't realize and more sensory. But we didn't like necessarily know that's what was going on. And this preschool teacher had. We had three really hard kids and they were being really hard on the same day. They were throwing furniture, they were biting, they were out of control. There were three of them. And I was walking down the hall and she literally just grabbed me and pulled me in. I need help. And so this one little boy, he was just full on fight Flight. And I had this in my head. I didn't have a brush, but I just started doing some calming. Deep pressure on his shoulders. And he just looked at me and he said, can you do that a hundred times? And I'm thinking, it's not going to hurt. You do a hundred times and you're calming down. So, okay. So I just kind of followed his lead and I did that, and then I did the arms. And then the next time I came to the class, I calmed him down. The next time I came in the classroom, can you do that thing to me again? 50 times, I'm like, okay, I'll do it. Next time I came in, we were to the normal 10. Anyway, it worked so well with him. I taught the teacher, I taught the aids, I taught his daycare person, I taught his parents. And it was a great tool for him. And so that, I think, awakened in me this thing like, this is powerful stuff. I need to learn more about sensory. And that wasn't even sensory integration yet. Sensory input. Well, little story. He lived in my mom's apartment complex. I saw him probably through. I mean, I didn't treat him, but, you know, I'd see him in town, like I worked in the school, and I'd, you know, I'd see him here and there. And he was close to my kid's age, so, you know, I'd seen a little bit. Not necessarily that he. We had any conversations, but so this surprised me. So I saw him. He was like 28 or something. And I saw him in the hallway at my mom's apartment complex. And I said, hey, Trey, good to see you. And he says, hi, Mrs. Koska, it's good to see you too. And I'm like, wow, I'm impressed you remember my name because, I mean, I literally hadn't seen this guy for over a decade, right? And he goes, well, of course I remember you. You're my favorite childhood memory. You made me feel good. That was so powerful. Here he is in his late 20s, he remembers my name, and he remembered that I'm how I made him feel in preschool when he felt unsafe and completely out of control. So I just want to share that story. And we're not even into real si yet powerful stuff. So now we're going to get into more what sensory integration is and what I learned during that intensive training. And at the time, man, I spent like 4 grand and 120 hours doing it. You can do it now through classy. And I think it's much more affordable. I don't really know. Some of it you can do online, some in person. I'm not really sure what the whole picture is like, but back when I did it, it was a huge investment of money and time because you had to buy the testing kit too. And that alone was a grand. So there is a fidelity statement that kind of shows like when they're doing research that, that a sensory if it's, if we're going to call it sensory integration, it has to have these certain components in it. What I'm going to talk about is kind of a summary of those components. So the child, you have to collaborate with the child. They are going to be an active participant. So if I'm just doing something to them, like the blanket or the vest or the brushing, it's not really in collaboration. So they are active participant and it's play based. I don't know why I keep going backwards. I push the other button. Sorry. Yeah, okay, here we go. And we're really respecting their emotions so we're not forcing anything if we're seeing them become disregulated. We're going to adjust. I often think, how on earth can we even research this stuff? Because in a session I pivot so many times based on, on the child. You know, you don't end up doing what you think you're going to do because you are so in tune with where they're at and how they're feeling. And you're just always in positive regard with the child. It's very important that you're ensuring this feeling of, of trust and safety during the session so they're more likely to participate and do, do, do it with you if they're, if they kind of help plan it, if they help create it. And so I have this little pirate picture here because I love this example of if they, this is just an example. So like say they come in. Well, I'll give you two examples. So the positive regard for their emotions, like say they come in and you. And they're normally, you know, gung ho and ready to do whatever you want to do, but they come in and they had a hard day of skull. They're disregulated. A pivot might look like, okay, we're going to go in a smaller room and we're going to turn down the lights and, and just kind of like bring that nervous system down before we go do what we were going to do. Because they're clearly not in a regulated state. So you're always assessing where they're at in their self Regulation. Another example, this pirate example, I have this really clear memory of this one kiddo. He came in and he was a pirate. He was all about being a pirate that day. And in my mind I wanted to work on, on balance. So immediately I'm like, we're going to be walking the plank. And so we set up a bunch of stuff and we just had a lot of walking the plank. And that's what I love about sensory integration is this collaboration with the child. And so that's just kind of an example. And so I always tell my staff, they're the motor, we're the driver. So we are taking their intrinsic. This is the. The secret sauce to si is you're taking the child's intrinsic motivation and then you're steering it, which is an art. So you always, always tell my staff, you always have like the couple of goals you're working on. So like, maybe I'm trying to get to core strength or maybe I'm trying to integrate a reflex or maybe I'm, you know, have them be able to sit for a little bit and, and they have their own ideas. You want their imagination going and you're just going to collaborate. They're the motor, but you're the driver. So we explain that a lot to parents like that. This isn't just mayhem. We are using their ideas and then steering it. And part of that is having in environment. They need access to a lot of things to be able to initiate. Now we control it. Our rooms, they can be completely empty and we only have certain things in there. Or we can have it like Disneyland. We have a closet that they can go to to select things. But you, you need to be able to have flexibility and a lot of sensory, a sensory rich environment. So you always want to be able to have access to tactile things. We use a lot of kinetic sand, rice, shaving cream, paint, just things along those lines. And one thing just this is kind of a little side. One thing that was really an aha for me is that when kids are, have really, really poor motor planning, a lot of times it's because of their tactile sense. And the example that was given to us in the course was imagine trying to put a key in the doorknob. But you have five gloves on your hand. You can't really quite tell where that key is and where to move it. And so when you provide a lot of rich tactile input, and that's why I like a lot of the swings will have carpet on them or just you're just firing off all those. Those tactile neurons and then it's mapping out the body. And now they kind of know like, oh, then you'll see them get more coordinated. So that was like a really cool aha. When I did the training. Vestibular is huge. You just always want to be able to have vestibular opportunities. One thing you can't really, you're not likely to be doing true sensory integration if there's one hook. That's one thing that I learned. And even if you have two or three, the ideal is every two feet, just a whole bunch of hooks every two feet so that you can do anything. And then you can allow for all types of movement. I like bungees for getting vertical. So just think of it like you got vertical, angular and rotary. So you want to be able to do all those things. You might. If you have one hook, it's kind of hard to get a smooth, straight line to make it more organizing and calming. It's always kind of getting a little cattywampus. So at a minimum, you need two to be able to grade. Grade the activity. There I go going backwards again. Okay. Lots of proprioception. Proprios, Vestibular, you have to be really careful with because you can really disregulate a kid if you, if you, if you like, say, do too much. Rotary proprioception, you really can't do too much of. And it will help regulate the vestibular. So if you're ever a little concerned, like, am I going to overdo with the vestibular? Add pull ropes, add any kind of heavy work to the activity, and it'll calm down the vestibular system. And I think most people are pretty familiar with the basic concepts of proprioception and vestibular. So that's why I'm focusing on some of the other things that people aren't necessarily thinking about. I have these two pictures here just to tell a little story of the difference how the environment looks to a child can make as to whether they'll participate or not. And so I had this little kid that just pretend there's like a regular normal blue mat underneath this one on the left. And so the activity we were going to work on was. Was the horse. And it was a foot off the ground. I thought it was pretty low. It was a foot off the ground with a regular mat. And he took one look at that and he went and he hid in the corner under the crash pad, like totally withdrew. And so I thought, hm, maybe it just looks Too scary to him. And so I put a crash pad underneath, like, a bigger crash pad underneath it. And actually it was about twice as thick as this one in the picture. So there was only maybe an inch between the swing and the crash pad. And then he kind of peeked out, and then he literally ran and just jumped on that thing. So. So grading the activities is so huge. Like, they ha. You have to keep them in this just right place of where they can perceive the activity as something that they can do. And so I always tell my staff we're on the tightrope with every one of our kids, and so when they get upset, we just. All it is is that we fell off the tightrope. And man, some of these K thread for a tightrope. It's so hard to keep them in the just right challenge. But that's a big part of SI is this constant upgrading the activity and downgrading it. You know, are we making it easier or harder? And a lot of that has to do with being able to adjust everything. So you want a very adjustable environment as far as, like, how much stuff's in the room, how high things are, what the texture of things are, what the lighting is. We're turning off the lights all the time. You just. You need to be able to adjust every aspect of the session so that you can keep them on the tightrope. And then as they're integrating, as they're. They're. They're organized and they're doing the things, and they're starting to kind of get into this cycle, then they're able. Then you're able to kind of like, bump them up to the next level. Bump them up to the next level. So by the end of this session, you have nudged them to a whole different level. But you have to keep them in a cycle of this just right challenge in order to be successful. We talked about the optimal arousal. That. That. That's a huge thing. Just constantly keeping them in that green zone. And this is what we were talking about, like, constantly adjusting it, the challenge of it. And one thing I've really noticed about all our sensory kids is it's so interesting. If they think it's too easy, they'll shut down. And they're, like, insulted. Like, if they think it's too easy, if they think it's too hard, they shut down and avoid it. They really, really have to perceive this activity is something that they can do. And we want to have organized input, everything, be very intentional. So a lot of people are like, it's really hard. I'm kind of giving this, like, this drives me crazy look, but it does. Like, a lot of people think I'm doing sensory integration. I put them on a swing and they're just swinging any old way. Well, you have to be very intentional about what you're doing. Like, is this a child that needs just calm, organized input? Then I'm just going to be doing straight line, maybe having pull ropes for something to keep them probed, to keep them really organized. Maybe this is a kid that is extremely under responsive. They have no post rotary nystagmus. They. They don't even. They don't even feel it. They never get dizzy. So maybe I gotta make it like we're at an amusement park ride and I've got them tilting their head back and I'm doing these fast blasts. A few really fat. Got the rotary, the spinner, so I can go super fast. And I'm whipping them one way. Whipping it like maybe three one way, three the other way, three the way. Stop. I'm looking at them and I'm like, did you feel it? You know, are they. Do they have any nagus? Are they interacting with me, asking me for more? Or did they feel it? And they're just kind of giving me that look like I'm a little dizzy. If they feel it at all, then, man, I'm going to stop right there. So it's a very intentional thing. It's intentional. Like, am I going intense? Am I going organized and slow? It's not just this random swing any. Any which way. Not random. Yeah. So if. If you're not really constantly tuned into, are you regulating them or disregulating them? Are you on the tightrope? Are you giving them the just right challenge? Then in instantaneously, they're shutting down or melting down. And so whenever. Whenever that happens, I always just tell my staff, that's okay. We just fell off the tightrope. We just got to get back on it. Because some kids have a very tight tightrope. So this is a picture of a clinic that has some sensory opportunities in it. And it depends on the child. That might be like way too much stuff to have in the room, or it might be just right, but you're going to be intentional. It's not going to just be any old thing. One thing I have a really hard time comprehending are clinics that just have like these really super big gyms that just have. And it's all set up the same way all the time because we customize everything so we Might have a room. We might do one swing. We might have a crazy obstacle course with 10, 10 things hung up. We might have. You know, it's just every session is customized to that child. And what's going to work for them. Keep them on the tightrope. So this is a big aha that I had when I got the training that I wanted to share with you. And it's how to grade the activities up and down. So if you think of movement and you think of, I'm not moving, it's not moving. So, like, in this picture, the child is sitting there, and the blocks are on the table, so nothing's rolling or moving. So she can just pick it up and put it on there. That's. That's the easiest level. So if you're on it, say, an obstacle course. Well, no, that'll be another example, because they're moving, but you get the idea. It's just the most stationary thing. The next one is stable moving. So in this case, the play equipment is stable, but she's moving. And so this was the example I was about to say in the other one. So in an obstacle course, maybe I'm holding the swing they're moving to, and I'm. I'm actually stabilizing it and holding it still as they move to get on it. And then maybe the next time around, we can let it move a little bit. But that is one way to level up. They're moving, but the item is still. Another way is like, say they're on a swing and they're swinging, and I'm just holding out a stuffed animal, but I'm holding it still, so they're moving, and then they reach out and grab it. Then the flip side of that is that the object that you're playing with is moving, but you're still. So that would be like catching a ball. And then you can grade that by, you know, if you want it slower, you might do a balloon instead of a ball. Then the highest level, the most difficult, is moving, moving. So on this playground, she's on a moving tire swing, and she's moving between the swings. And if we're doing an obstacle course, I'll often say level one, level two, level three, looks like you're ready for level. The kids like level. So the level one, I may be holding it still, and I'm actually, like, almost helping them be still because I'm holding them and helping them get on it. The next time I'm holding it, and then they're moving to get on it. The next time I might let it move a little bit and they're starting. The next time through I might be like, oh, they don't need me. That thing. I'm just gonna stand by and then they're able to get on it. And then when they can do that pretty well, then I'm then. And each time I'm like, oh, looks like you're ready for level four. What do you think? Do you want to go to level four? So they're an active participant in it. Well, when it gets crazy, crazy, if I got to go moving, moving, there's a point where I'm like swinging the swings and I'm swinging the swing there on. And then they got to time it and figure out how to get from this moving thing to this moving thing. And so that's kind of like the ultimate level. So takeaway from that is not all movement is created equal. So you've got stable, stable, moving, stable, moving. I said moving, stable, stable, moving, moving, moving. Okay, so we talked about what SI is and what it's not. So a little summary. Remember the environment matters. So you want the environment to be intentional. What is going to help this child be self regulated and be able to have some initiation and engagement. So control what's around them and remember the child's the motor and the therapist to the driver. So they come in with some ideas. You're going to work with that. And not all movement is created equal. So understanding these things is a total game changer for me in my session. So I'm. I'm hoping that it will be for you too. So I'm curious at this point what your biggest takeaway, if you thought this was valuable and what your biggest takeaway is so far. If you can put that in the chat, that'd be great. And also I forgot to mention, if you have questions, put them in the Q and A section because. Because then it won't be buried in the ch. And I have a couple more little stories to tell you. Levels of movement. Yeah, you like that? To me, that was a huge game changer. Like sometimes you just have things that the light bulb just goes. Goes off. Totally the intentional. Yeah, I like that. Need more hooks. Yeah, yeah. The motor and the driver for sure. You know, it's so interesting to me knowing what I know now. I literally can just look in a clinic. I can just look at a picture of it and I can tell if they're really doing this or not because you really can't do it with just one or two hooks. What s. Eyes and what. It's not good. I'm. I love this. I think you guys got a lot out of this. I'm so glad. Yeah. And the post ordering nystagmus. Somebody said. Nobody ever explained the post nystagmus to me before. And that makes so much sense now. So I'll just give you a little thing. When. When you test it, you do ten slow turns. You want the head at 30°. So just like. I usually just put something down on this. On the. Like, I have them on a platform swing on one point on a spinner, and then I just have them. I usually make the boats. I usually have the square platform swing with the tire in it. That way if they get dizzy, they don't fall off of it. And I'll just put something in there for them to look at like a stuffed animal. So their head will be slightly tilted when you. When you learn how to test it. Officially, they have. You, like, have them in a 30 degree angle, but I. It's usually about the right angle. They're just looking down. And each turn is two seconds. 1001, 1002, and very smooth. And you do 10 of those. Then you stop and. And you look at their eyes. And if they're. If their eyes are beating and moving for seven to 14 seconds, that's a pretty typical range. We test a lot of kids that you can't even. They don't feel it at all. All right. Awesome. Oh, I know. I wanted to tell you a story. Okay. I wrote down my stories to not forget. I just want to tell you, like, some of this. Some. The power of really doing this correctly. One of my first clients that I had, my first. When I was really applying this stuff, one of my first goals, he was so sensitive that they couldn't leave the house because if he saw grass or touch the grass, he'd start to vomit. He was so sensitive. He was sensitive to light, just the environment, period. And so our very first goal was that mom could walk out of the house holding his hand for 50ft without him throwing up or becoming distressed. And the progression of going from that to he got to the point where he was able to fly on an airplane and go on a family vacation. And that was, you know, for him. He was so severe. That was over the course of multiple years. But that's the power of si. Yeah. I love that. That just makes my heart so happy, Kenneth, that you said. I feel like the biggest thing that I can take away is making sure the child is actively participating and not being forced in order to make sure assignment. It's not just input. Absolutely. 100. And how important the tactical input is. Yes, that and then for me also it was the speed of how, how much faster the kids could get better because you don't know what you don't know. It's real so hard sometimes because I want to like go back in time and do a better job with all these other kids. But literally what it would take me 10 years to accomplish working with kids in schools or even five years, we do in under a year. The kids are usually meet like 15, 20 goals in under a year. It's phenomenal. So it's, it's really, really, really worth learning more diving in. But even just making the simple changes that I told you guys is so powerful. Yeah. Any questions you guys have, put them. There's a place for Q A and then I'm going to ask answer questions at the end. Okay, let's see if I can get this to go. So this obviously in this short little time is just the tip of the iceberg. Right. I'm just kind of wedding your appetite. And I wanted to tell you a little bit about when you're learning this stuff, how, how fast, how fast you can excel. So Abigail is one of my employees. She's, she got her doctorate in ot. She's a brand new grad and she relocated. We're in Washington state and she relocated from Omaha, Nebraska and we helped her with a relocation stipend. Been here a couple years now. And she loves Washington state and she is so passionate about our sensory kids. And you know, she's benefited from the intensive training and mentorship at ohana. All my staff, all my clinicians are from, not from where I'm at because I'm in a really rural area. So I have two from Texas, I have Abigail from Nebraska, Nicole from Michigan, and then Kylin and Anita. They're from the other side of the mountains, which is the Seattle side. We're right in the middle of the state of Washington. And one of the things that I do, like if you want to learn more and get rapid results and you want to increase your skills as a coda, like I just had one of my new hires. She's been here since March. Jeannie, that moved from Texas, she, she's got decades of experience, but she didn't have SI experience and she was hungry for it, so she moved here. So one of the things that I do is I have a residency program which is very unique. And so what we do is we do a very, very intensive training because literally nobody comes to me knowing how to do this stuff. And so it helps our therapists become at the top 1% that can get these results. And so what we do is we have just intensive training from the very beginning. They don't even have a full caseload until three, four months because we are doing so much intensive training. And I've actually always done this with all of my staff because they literally don't have these skills no matter where they've worked. They just don't. They don't do it the way we do it because we also do a lot with primitive reflexes. So if you want to get on the fast track to become highly skilled, make a real impact, I encourage you to apply to our residency. And we only take three in the year and I think I have one spot filled pretty close. So if you have a passion for helping kids, I encourage you to apply, apply for that. We're located in the beautiful Washington state and we do a relocation bonus because it is a big thing to move here. It's a very rare opportunity. Other people aren't doing this. And it's a two year program and within two years your skills will be dramatically, dramatically changed. And the other layer to me that has been super powerful is knowing how to address primitive reflex. They're the layer, it's layer below the sensory. So knowing how to help. Most of these kids have a retain morrow or fear paralysis reflex that's causing a lot of their disregulation. And then most of them will have the neck reflexes 18rstr that are affecting their ability to sit and be coordinated. Because every time their head moves, their arms and legs do something, they bend or straighten. And the best part of this residency program is you are getting paid to learn. So I really appreciate you all attending. This is the link to apply. I'm going to come back to that in just a second. I'm going to stay on for Q and A. I'm going to pull up the Q and A and I'm going to leave that up so that you can see it. If there's anybody that's like in that stage of life where they would absolutely love to, to learn, we just pour, pour into our, into our highers, into our OT assistance and ots. All right, So I am going to. Oh, good, Haley, put that in there. I'm gonna find the Q and A and pull that up. We got 16 questions. Okay. Better get busy here. Well, Haley, Haley and I tested this earlier to make sure I could pull it up, but it's not coming up. I think you have to unshare your screen. So I'll make sure the link is in the chat. Keep it active. You're right. That's what we figured out. We have to stop. Okay, so you'll keep posting the link in there so we don't lose it. Okay. Yep. That was the secret we had to unshare. Okay. Okay. 16 questions. I better get busy here. Okay. Can you do sensory integration in homes? Yeah, absolutely. I mean, it's. It's a little bit more challenging, but, boy, did we figure that out during the pandemic. There's so much you can do. We had. I'll just give you a couple ideas. Well, for one thing, when I did home visits, when I started my practice, I did home visits. There's a thing called the gong or the tumble top. It's a giant red cone, and that's what I would carry around with me because I didn't have, like, swing. So then I could get core and I could get prop, and I could get some rotary stimulation that way. And then, you know, there's a lot of different ways that you can get movement. But I think maybe spinning's the hardest one to kind of figure out in the home. And what we figured out during telehealth was if you get an office chair, and because we do a lot of stuff prone, we'd have them. The kids are little enough that they would get under the armrest of a spinny chair and they would lay flat on the chair, and then they could get some movement that way. So, yeah, you can be really, really creative. I actually have a membership that has tons and tons of videos that I've made. And in there, there's a whole bunch of live videos I did during telehealth, during the pandemic, because I did a lot to help people. I had. I have a group. Some of you guys might be in this group. There's 12, 60 countries in it, and it started during the pandemic. We just all started helping each other. So it's an activity, but the. We can email you the link. The membership is like 49amonth, something like that. You can stop it at any time. But there's a whole thing for handwriting, all the different ways to help with handwriting, all the ways to help with telehealth. There's some stuff about documentation in there. There's all kinds of stuff in there. Kind of a collection of my videos, kind of like a library. How Melody wants to Know, how would some of this look working in the school system as an ot, working in shared space or going into the classroom? Well, you know, working in the schools for so long, I did try to apply what I was learning in the schools. You definitely have to be a whole heck of a lot more creative, you know, doing stuff out on the playground. But it's just challenging because, you know, I just remember trying to give like the bruinicks in the. I'd have the hallway and then the whole class would walk by. And I just think the school environments can be really, really challenging. But you can get creative. I think there's a whole different level of acceptance now than when I was in the schools because a lot of times they'll have sensory rooms that you can go to. A lot of times they'll do like the sensory break things in the hallway. It's, it can be done. It's just harder. There's no doubt it's harder. I think the heart, personally, I think the hardest thing about being OT in the schools is that we make the hard stuff fun. Well, we're winning the schools and we're making it fun. We're distracting. So to me, that was kind of my struggle when I worked in the schools. But it can be done. You can be creative. Okay. Lorena. My son is non verbal and he is, he has this seeking for biting stuff, putting things in his mouth, picking his fingers. What could be the exercises to help him with that? So you know what's really interesting is a lot of the, the things that kids will do. Sometimes they don't have to do with the actual thing. Sometimes it's their way of trying to cope with something else that's bothering them. So a child could be trying to self regulate through deep proprioception, through biting, when maybe it's the lighting or the noise that's bothering them. So you kind of have to be a detective and try to pay attention to when is it happening and is there anything, any trends? Because sometimes it's simple changing things in the environment that can help kids. But you can also do, I can't give like specific advice, you know, for kids that I'm not working with and, and all of that. But just in general, you know, there's jewelry, there's, there's a thing called the Z vibe grabber. Sometimes they like the sensory input of the vibration, lots of things like that. But more often than not, what I end up doing is paying attention to, you know, they're, they're doing it for a reason. It's self regulating to them or they wouldn't be doing it. So usually I'm trying to figure out like what's bothering them. Okay, Heather wants to know, what do you recommend when the sensory room remains the same. So is this like a school sensory room and they're just kind of have the same old things in it? I think, you know, I think you have. It's interesting, you know how I said like we individualize these rooms for the, for the clients. Like sometimes we have them empty and sometimes we have a lot of stuff in there. I think you have to just kind of consider what is going to work for the child that's in the sensory room and make the changes that make sense to you. You might, you might get a sheet and put it over a bunch of stuff that's distracting and then just have the things that are going to be helpful to that child. Does this help with visual and vocal stimming? Absolutely. Like I said, all the things that the kids are doing, they have found a way to help. They're just, they don't, they don't do things to be like annoying. Like there's always a purpose in what they're doing. And like with vocal stimming, I've learned a lot about the vagus nerve. And humming helps calm the vagus nerve, which helps calm the nervous system. So it, I had this aha. Like all these kids that make these weird throaty sounds and, and humming and just make all these sounds. Well, they've actually figured out a way to calm their nervous system. So when you can figure out like what is it they're needing? You know, if they're needing probe or vestibular or changing the environment, then that's when the stimming will go down. Anonymous says. Is there any training out there for the wheelbarger brushing protocol? You know what, I wish there was because I would have taken it a long time ago. And when my friend taught me, she had just come back from the course, you know, it was, it was so weird because she's like, we can teach the parents and we can teach the teachers, but we're not supposed to teach our fellow therapists. So she just thought that was kind of weird. So she just showed me. But there I, I can tell you the most important thing is to use deep pressure. The way it's done wrong a lot. And you can look up videos and such is that use the brush very lightly and that's so you want to make sure it's calming and you want to get deep, deep Deep pressure and. And I actually am including it in an app that I'm. I'm not it. We don't call it Will Barger because we do. I call it Brush and Squish. And we don't do it exactly the wilbarger way. It's a little different, but it's the way we've done it in our clinic for the past 16 years and the way I've done it since that, you know, forever. And I'm actually including how to do it the way that I teach parents in an app that I'm making. I'm like a. My goal is to have this done by December 1st. I'll show you. Anybody can do this thing. It's intended for parents, but I think it's gonna be great for therapists too. It's going to be called the Sensory Hero app and it looks like that. And it's going to have. And we'll. So I'm starting out with this 30 day challenge that has 15 minutes every day. And then there's. There's just going to be these lessons and they'll be how, like here's day one. Like, how to tell the difference between a meltdown and a tantrum. So there'll be videos. It's really short. I found out from my parents what they like and they're like just a little bit. Just a little bit. And so they can go through it. And I'm really motivated, but I have how to do it in there. And that was something I like talked to a lawyer about because I'm like, can I do this? Because they don't teach it anymore and I don't do it exactly the same way. So I'm gonna have that in there. Okay, let's see. Oh, what happened to my questions? I'm afraid I might be missing some because it like skipped down. Okay. I'm sorry if I miss a question because it's not where I left off. Okay. How can I apply these strategies to home based sessions with limited equipment? So when I started, I did not. I did. I had it actually. I learned all this stuff and I had to hold it in my head because I didn't get to have the space to do it the. You know, with the suspended equipment for two years. And so like I said, I really liked using like the, the Gong Top. And like I said, I have a lot of videos on how we did it in tele health because we had to do it with. With just what was at home. Oh, Haley, I wonder if you can pop in Here, the, like the Facebook group. Because when you join the Facebook group, it has like every. We would go through these things, like, what are all the things you can do with pillows? What are all the things you can do with cotton balls? And all These people from 60 countries would brainstorm, like, how do we do OT with things that are in the house? And when you join that group, you get that list. My son jumps on the. Sandy says my son jumps on the trampoline non stop for like two hours or so. He will stop sometimes and then he'll start again. So when kids do something, there's like intensity and duration. When they do something for hours and hours, they're not getting the level of intensity that their body's really craving. And so they just keep doing it. And so you might just switch it up with something more intense, like tug of war where you're like literally contracting every muscle of your body. But there's nothing wrong with jumping a lot. Chris Dre, is that how you say your name for the child that was sensitive to the environment? Would you mind giving an example of how to apply SI to grass or an outdoor setting? Okay, so with him. But what is really calming and regulating is your best bet is proprioception. And I always tell the parents anything that makes them grunt. So anything that's contracting a muscle or compressing a joint. So. And it might be jumping on the trampoline. So we would do a lot of pro before we would try to do something that would stress his nervous system. And we also graded it so we might just step a few feet out the door, then go back in. Next time go a little further and go back in. And it might be things like having a. Honestly, it's been so long I can't remember exactly what we did, but it might be having like, maybe you have like a squeezy toy with you as you go out into this environment that's stressful. Okay, Sandy, how do we address this or interpreted this? Should we let him do it? Oh, oh, that was the trampoline. I think I answered that. Anonymous. I have a two year old client, very picky eater. Can any of this be added to therapy to help sensory feeding? Oh, yeah, definitely. Our kids that are really picky eaters, their. Their body's reacting to the food as if, as if it's dangerous. And so you can definitely do, you know, the sensory activities that are calming to them before you do the eating activities. And there's so much with feeding therapy that you can do. But the biggest thing is Doing things in a very, very, just right, challenge way. So literally, I might have, like, a piece of food that's the size. Size of a. Size of a rice screen on a plate to make it less scary and then slowly build up. So you. You have to kind of figure out, like, what can they handle. The other day I was working with a kiddo that it smells were what were overwhelming her. And so we do Food Explorer, where you're. You're looking at the food and you're like, you know, is it soft? Is it hard? Is it. You're trying to describe all these. This little older kid, you know, all the different characteristics. Is it mushy? What happens when you squeeze. Squeeze it. What color is it? What does it smell like? Well, she couldn't do any of that because she couldn't stand the smell of it. And so I figured out, let's put it in a plastic bag, take the smell away. Then she could do Food Explorer in a safe way. And then we could open up just the little corner of the bag and then start kind of far away and then come a little closer and like, tell me when you smell it and then tell me if you want me to back up. And you just work with them to kind of find out what can they handle. Sometimes it's just so hard to imagine just, just how sensitive the kids are, but you can find, like, the level that they can tolerate. They call it the. For feeding the just right challenges. A tolerable but a noticeable change. So, like, say they want the same kind of bread every single time. The same way every time. Maybe you take a. Maybe you take a. A cookie cutter and you make different shapes every time. So it's the same bread, but you're making a tolerable but noticeable change. So it's not exactly the same every time. Okay, Lindsay, how do we provide a sign the classroom with multiple children with different sensory needs and very limited equipment? Not very easily. Not very easily. I. I've done like, I did like a classroom consultation, and when I went there, I saw like five of our kids that we see, and I was just like, this is like an impossibility because we are. It's challenging to work with them sometimes, you know, one hour individually. And I'm like, wow, all these kids are in the same class. So I think it's very challenging. You just do the best that you can do. There's a lot of things in my. In my website, ohanaot.com there is a. In my blog, there's two really good articles on classroom settings and how to make them, you know, how to make them more sensory friendly. So I would suggest looking at that. So Hanaot.com and, and just look in the, the stuff that I wrote up about classrooms. I think that would be a good start. And it's things like having like, you might have like a crazy corner and you might have like a calm corner that has like a pup tent in it or like a bunch of pillows and blankets or whatever's allowed. I know they're kind of picky about all that stuff, but. Or you might have light. Light covers the florists. I can tell you the main two things setting off all of our kids is lighting. Fluorescent lighting. They hear it and it hurts their eyes. And, and sounds, you know, so like, especially like toilets, vacuums, hand dryers, blenders. Those are the big ones. All right. Tiffany says, can you recommend any good accommodations for Si in the school? My son struggles with completing his work. He prefers to fiddle with his hair or draw instead of the school work. His teacher and I are trying to brainstorm ways to help him focus better. I think the thing is you have to kind of find out what helps him regulate. So I think a lot of kids just need a little break. And so maybe like a little sensory break in the hallway where they do, there's some really cool. They call them like, I think they call them like sensory pads, but it's sort of like an obstacle course. They have like stickers that you can put down on the walls and on the floor. And so it's like jumping lily pad to lily pad standing on one foot wall push ups, you know, just like quick little sensory breaks you can do in the hallway. That's one really good thing that they've been doing. But you have to kind of find out what, what's helpful to him. But I can tell you, like I said, it's the light and the sound that bugs these kids the most. And so for an example, like at a birthday party, this one mom that I had, she's like, I just found if we just took a five minute break in the car where there's no sound and I didn't talk to him, then he was able to go back in. So like, it might just be like leaving the room and doing something, like even an errand or something, but just getting a little break if it's noisy. Headphones can help with that too. Any trainings for parents? Yeah, my app that I'm making, we'll. We'll send it to you guys when it's ready. I have a lot of parents on here. Help our children with autism. Lorena wants to know how to help children with autism. Honestly, I think the biggest thing is, like, learning as much as you can about all the sensory things, because, you know, I'm gonna look up this one book. Oh. Oh, no. I shouldn't have done that. Oh, I lost you guys. Oh, you're back. Oh, good. Okay, I'm not gonna do that. There's a weird thing that happens with my computer where if I click on the Internet, then all of a sudden, everything goes to the side. I don't know why it's doing that. I'm not doing that again. Haley, what I was thinking about was that book that we always recommend that the parents call their bible. And I'm trying to think what it's called. Oh, I know. We could drop an Amazon link in here to this one book, because it. It's. It's based by the symptom. Like, if your child is struggling with this, it might be because of this. Try these things, this book right here. So it's understanding your child's sensory signals, and it's by Angie Voss. What she did is she. She took all kinds of different things, like, kids are having trouble with taking showers or getting their nails trimmed or whatever. And she surveyed all these ots, like, on what were the best things that they were finding helped these kids. And she summarized it all. And out of all our books, this is the one that parents like the most. So your child with autism. Probably a lot of good ideas in there, if you can see that. Okay. Oh, but what I was going to say about autism is, okay, so a sensory processing disorder. Every child with autism has sensory processing disorder. It's part of the diagnosis that they have over sensitivities. They're under and over responsive to different things. However, there's about one in every 24 kids that has sensory processing disorder. Just that, like, they don't have autism, too. So just because you have sensory processing problems doesn't mean you have autism. But if you have autism, you definitely have sensory processing problems. Okay, Lindsay, how do we get teachers to carry over the skills, and how often should they perform si. Daily? Well, the teachers have their hands full, and I think the most we can expect from them is to try to do one or two accommodations. When. When you give a teacher, like, a list of, like, all these things to do and they have all those kids, it's just. It's just overwhelmsome. They're not going to be able to do it. So the best thing with teachers is you just kind of pick one or two accommodations that are really going to help your child and have them do that. You have to really be trained in sensory integration to be able to do it. What's my favorite si? Kelly wants to know what's my favorite si? Self regulation activities for students who are in the red zone. Okay. My number one favorite is bubbles. So I always kind of refer to the three Cs. I call it the HANA three C method. You've got calming yourself, calming the environment and, and calming the child and bubbles. Our, our main go to at Ohana. It's in every single room is we just little thing of bubbles. And the reason why is if I blow some bubbles then I'm breathing and I'm staying calm. And the, the mirror neurons, they're going to mirror me instead of me mirroring them and getting Escalade. I'm going to stay centered. I'm calmly changing the environment because now there's these soft bubbles that are floating around and the primitive part of the brain cannot not notice. Like even if they're upset or whatever, they're still going to notice those bubbles which starts to pull them out of their meltdown, their red zone. And then if you can get them to do at least three breaths that is going to flip the switch on the vagus nerve just to be able to start to calm it down. They just need three good slow breaths. So bubbles will hit all three. So that's my number one. Go to and lowering the lights and not talking at them because they're, when they're melting down, they're overstimulated. So if I'm like take a deep breath, calm down, I'm just going to make them worse. And sometimes just removing them and taking them to another space that's then have a bunch of people around and you know, a little bit calmer space. Evelyn wants to know, please let me know when you're sharing again. You're awesome. Oh, thanks. When I'm sharing, I'm not sure what you mean. When I'm sharing again. Val, can you give an example of what a treatment session using SI methods would look like? Sure. So for us, the three main ingredients are proprioception, vestibular and tactile. And we'll have a couple of goals in mind. And so say I'm working on core extension and, and I'm working on having linear calm movements with their, their core extent or with, you know, vestibular that they need more than linear. I might do something like have them on a platform swing in a superman position, and they're just flying. And then they're depending on how I want to grade the activity. Maybe I'm having them pick up a. A stuffed animal and toss it into a basket while they're swinging. So we want to have them have to do something in an organized, purposeful way. So, like, for them having to, like, time it and grab the thing and throw it. And then I'm also working on my core extension because they're on their tummy, and then they have to be up against gravity. Let's say another kid needs more of the rotary. I might have it on a spinner, and I might have them have, like, animals in a circle and then have them going around and. But I might be having the parent call out, like, get the skunk. And then they might throw it to the parent, and then they got to go the other way, get another one. We do a lot of obstacle courses. When people ask what it's like to come to ohana or what ohana looks like, I say, it looks like you're training to be a ninja warrior. Because that. We just do these obstacle courses because the obstacle courses allow us to work on pretty much every single underlying component and goal the kids working on. We can work on sequencing, we can work on memory, we can work on core strength. We can work on tactile pro stibular. Like, we literally can hit, you know, we can work on grass strength with the trapeze, which helps with writing. We can literally hit, like, every goal in an obstacle course. So we do a lot of obstacle courses. Heather says, I've always had an interest in sensory related interventions from observing my brother and through the field work rotations. I'm interested in potentially being specialized in feeding and sensory integration. I have one kiddo who, when I first started working with him, I could tell wanted more input but needed support. So I was very intentional with my interventions. He went from standing unsteadily on the trampoline to jumping two times before falling to his knees. And now he's only interested in sitting in the foam pit and barely interacting with me these past few weeks. So, yeah, it's just. It's hard to know without, like, looking at him to tell you what to do there. But it's just a matter of grading the activities and making it interesting to him. So he may. If they experience something that they found uncomfortable, then they'll avoid it. So then you just kind of have to take another path and do another. A different type of activity. He just fell off the tightrope and didn't like it. To stimming. Come down with si. Oh yeah, that is so such a cool thing. I have found it really, really interesting to work with kids that have ticks. I also found ticks really go down. So when I get a kid that has a tick, I can tell you a couple of them. Like one, he would just throw his head back like that, just whip it back. Oh, that makes me dizzy to do that. But I'm like, what's he getting out of that? What he's getting was some quick vestibular. So then we did a lot of plus I tested his vestibular and we did a lot of activities that helped with that input. And then he, he just stopped. Like all the kids that have had ticks, pretty much they just stop. So I'm always looking. What are they getting out of it? Are they getting movement? Are they getting input to their muscles and joints? Are they getting tactile? The kids are so intuitive. They're naturally intuitive that they tend to do what they need, but they don't know how to get it the right amount. Cara says I'm at that stage of life. From parent recently. What's your answer to the magic fix question? The one thing I can do to make my kid better. Top secret at the industry. It's kind of like a wide open question. I think it depends on what it. It depends. I would have to know more. And sometimes the answers are really simple, like lighting, decreasing the stimulation, keeping yourself calm, bubbles, getting more movement. You're always safe to go with more proprioception. Things like wheelbarrow walk, tug of war, all that kind of stuff really does great for the kids. Mario SI is working through their proprioception equilibrium, vibration using gadgets. If so, the pathway will be through the sensory to the upper motor neurons. And then the end result is the movement. The main ingredients are the vestibular system, the proprioceptive system and the tactile system. Those are the main things. And so there are, there are. So you're accessing those through lots of different things. I mean you can access that through just log rolling on the floor. So if you were log rolling on the floor, you're getting deep tactile input as you're rolling, you're working the core strength, you're getting rotary vestibular and you're getting a lot of proprioception because you're using your muscles and, and getting pressure on your joints as you're rolling around spinal pathway. This rule which then translates to the refinement of movement. Okay. Can brushing, Heather says can brushing and these strategies help with a child who is displaying sensory related difficulties related to eating? Yes. With our feeding kids we do a lot of this stuff to help get their nervous system in a good place before working on the feeding. Val, can you give an example of what a treatment session using SI based methods would look like? Oh, I think I answered that one, Sandy. My son also has diagnosis of malnutrition because he's extremely underweight. So letting him jump or move around much isn't helping. Right. Because he's expending energy. I understand that's what his body needs, but there, but are there any alternate ways to provide similar high intense input? Yes. So a lot of times people think like say for proprioception that you need to be moving the whole body, but you can be doing things just like with your fingers, you can be doing like scratch art. You know, you could be doing, you could be doing like a hammering activity. You could be doing playing with like rubber bands. So you can, you can get like intense input without like using up your whole body Energy Charity, have you had success with using laser treatment with reflex integration? Do you have a specific type you use? Yes, we have over 10 years used Bonnie Brands QRI with total success. It's just phenomenal. So I love it. And we don't do as ot. We do it as a cash based wellness service. Crystal, in regards to spd, I was under the impression that it's not an actual diagnosis. Meaning it's not in the diagnostic manual. Can we still say a kiddo person has SPD? You're right, it's not, it's very interesting. Dr. Lucy Miller tried so hard to get it in the, in the dsm, but you know, they only update that like I think every 10 years and the last, her last effort and it's kind of voted in by I guess like the board or something. And the last time it was like all but one person and the pro. The problem that they see is they feel like it's too, it's too broad and there's already a lot of diagnoses in the DSM that are like subcategories. So there's ones for like tactile. There's, there's a lot of things that describe components of SPD already in there. It's very interesting to me to see what the doctors decide to call it. On my website there is a section, there's a, in the resource section, you'll see there's like there's one for doctors, there's one for schools. There's all kinds of information on my website. But I do have one in there even for the doctors to show them, like some. Some diagnoses that people use that the insurance typically covers. There's one that's just called unspecified disorder of the nervous system, and the insurances go with that one. So they get creative. They use a lot of descriptive diagnoses based on the behaviors that they're seeing. But, yeah, there's. There's not. It's not in the diagnostic manual. Do you need to have your license for the OTA residency? Yes. Yes. So you have to have completed. You have to be. I mean, say you're taking the test soon. You could still apply and we could still accept you as. But it would be contingent on that you pass the test. You know, it'd be contingent on that you got your national certification and your state licensing. But, yeah, definitely, new grads can do it. Okay, I gotta find where my. I gotta find where I left off because it jumped. I find where I was. Okay. I did that one. Okay. Do you have. Sam says. Do you have treatment examples for auditory avoidant kiddos, specifically those that go into fight flight? We've mostly done pro paired with noise games like Operation, which isn't getting better, but having a hard time progressing him. It's. It's interesting. A lot of the kids that have auditory sensitivity or that go into this fight play, a lot of them have retained moral reflex. And. And so that's another. That's not necessarily si, but it's another component to consider for a lot of our auditory kids. They kind of. They kind of need some protection. Like they need to wear headphones or. And then just kind of have a graded thing where they, you know, they can tolerate it for a little. And they can put them on. There's also one. The integrated listening systems works really well. And the. The SFP Safe and Sound Protocol. Those are two auditory interventions that work really well. The SSP Safe and Sound protocol is. Will actually exercise the little muscles in the ear. There's. The tiniest muscles in our body are attached to the tiniest bones in our body, and it gives them a little workout and tightens up the eardrum. Sounds come in a little different. So those two auditory programs work really well. You live in Florida? I go to Florida all the time because my business coach is in Florida. I hope you're okay from the hurricane. Man, that was crazy. Okay. I. I think I answered all the questions. Maybe I'm going to kind of scan through this because I feel like some of these questions like disappeared. So I hope I got them all. I'm just going to scan through this. Oh, I don't think I did this one. Okay. Heather says I've always had an interest in sensory related interventions. From observing my brother and through my field rotations, I'm interested in potentially being specialized in. Oh, did I do this one? No. Okay. I'm interested in potentially being specialized in feeding and sensory integration. I have one kiddo who when I first started working with him, I could tell he wanted more input. Oh, I did that one. Sorry. Oh, you know what? I should mention if you. For those of you that are super, super interested in feeding, my friend Deb Dorset has a phenomenal course called 20. Oh, what's it called, Haley? 24. 24 hour feeding. 24 hour feeding, something like that. But we can email to you guys her course. But she's taken. She had her own feeding kids personally. And then she took like every feeding course out there and she kind of like took the best of all these courses and made her own course and it's all online. Okay, I think I got them all, Haley. I don't know if I missed anything. Hopefully I got everything. Feeding the peds. What is the name of Depp's course? It's like 24 hour feeding something. It's really good. Okay, are we good? Any other questions? Yes. Thank you for joining everybody. Yeah. And if anybody is interested, we do have a couple spots left in our residency program and we, we love Washington State. It's such an amazing. I moved here from the Chicago area when I was 23 and I'm almost 60 now and landed in the middle of Washington and just ah, it's so amazing because you can go like from where we are, you can go three hours in any direction and get something totally different. So you can, you can get rainforest, you can get desert, can get. You, you can. We, we're right in the mountains. There's skiing, there's four seasons. But the winters are not like, like, I just remember like blizzard winters. And when I moved here I was like, what? People go outside and play in the snow? I just couldn't even comprehend it. So people do a lot out in the winter. It's, it's not like that cold. And yeah, we have four seasons and really supportive staff and we just, we just love pouring into people and love teaching and it's all we've been doing for 16 years. So we're really good at it. And we're really good at teaching. Oh, hey, Haley, thanks for putting Bonnie's stuff in there. I'm just going to look at a few more things here before we hop off. See if I can answer any other things. Made our sensory pad. Yeah. You know, during the pandemic we discovered, my friend Kim actually discovered it, that if you can get a vinyl futon cover and it zips, makes a great crash pad and then just throw any soft things in there, stuffed animals, pillows, whatever. Because we were using duvet covers before that, but it is held up. I mean we've had them since 2020. Oh, good. Haley put the link to that book that's like a favorite book. It's a great problem solving book because you can. Because it's by the actual problem that somebody's having. Why would a child suddenly stop responding and engaging in therapy and sensory activities? Oh, they're probably overwhelmed and going into shutdown. Especially if they have an active fear paralysis reflex. The, the response to overwhelm is the shutdown. Yeah. I love spinners for blowing and I also love kazoos. And there are these whistles that are. They're about that long and you can blow out or you can blow in and they're not, they're not super annoying. I love those for blowing too. I'm just seeing if I can answer any other questions real quick. Have I ever experienced a child seeking calming by eating, mouthing only one specific non food item like rocks? Yeah. Kids, they will obsess over one thing because they feel safe because they know what to expect. So they will do all kinds of strange things being the peas. Okay. Okay. Yeah, we'll. We'll email you some of these things that we didn't have links to right away. 24 hour feeding therapist. Thank you, Jackie. She put that in there. Okay, good. Oh, good. Donna's. They're going to a new clinic and she's going to share some of those ideas. Yeah. So I think the biggest thing, like I said, is having a lot more hooks. That makes a big difference. And I think it's always a challenge to figure out like how to install all these hooks. And we've done a couple of different ways, but the more recent way that we did it, I had a carpenter come in to do our. When we expanded, he basically. I think they're like two by sixes. He basically framed the top of the room. It's kind of like building a. How you build a floor with those metal hangers and then the, and then it slides in so he Basically put those around the edges of the room on the top and then built like a wood grid and then hung the, hung the hooks from that. And that's worked out pretty well. Okay. All right, thank you. Thank you everybody. And. Oh, Cara, you're interested. Excellent. You have the link. Great. Yeah, we, we're excited. We have to import all our therapists, so. And it's two years. Yeah. Do you guys have any questions about the residency? I can tell you a little more about it. It's, it's for two years. So your commitment is two years. There is a, a stipend for relocating which is 22, 500 that you get within the first week and then 2500 that you get after six months. There is, you're a full time employee, so you get all the normal employee benefits. You know, like after six months you can access like 401k, get $500 towards your health care. You get, you get all the pto, you know, all just the normal stuff continuing ed. But what you get is the first month you're having daily onboarding, you're having like daily support. And as your caseload is starting to build, you're not alone with a, with a client until we feel like you know what you're doing with that client. So there's no like just getting thrown to the wolves ever. And we have like a stellar, stellar reputation in our community. And so we're going to make sure that you're like very confident before you're on your own with anybody. And then we have basically building up the caseload over. You're not even at a full caseload until three or four months and then you're having, for the first six months you're having weekly one on ones with your mentor and then you're having an OT mentor and then the next year and a half you're meeting with them one to two times a month. And we have monthly masterminds, one to two clinical masterminds a month. And that is where we'll have a couple therapists do a share with something that's working and then they'll have an ask of the group. So it's where we get to help each other. And so you have that opportunity and then you have trying to think what else? Am I missing something? There's just, there's just constant support and constant help and they're literally helping each other between every session. Sandy, you're a pt. You know what I found out? I can't hire. Washington is one of the foremost strict companies with the most regulations for health care and being an employer in the entire country. And I am not allowed to hire out of my discipline. I can't hire a PT or a speech therapist, unfortunately. Yeah. Christy said we have 100 kids waiting to see us. Christy, who made all these slides, is so amazing. She's our client advocate. And our main limitation is just. Just, you know, we just need more therapists because we're in this rural country. We're three hours from any school, and it's beautiful. Beautiful place to live, though. So beautiful. But, yeah, you get a lot of. A lot of training, a lot of support, and we have quite the intentional process to teach people how to do everything. So you'll know how to, like, test all the reflexes. You'll what? The thing that amazes me is that these. These guys, within a year, they can get the results that I couldn't get until I was 30 years into my career, which blows my mind. But it's because I've taken the best of what I've learned, and then I'm able to teach that, and they get to a level of expertise that I. I couldn't feel that level of confidence for over 30 years, but they get it very quickly because they're getting results because they know how to do it. Okay. Anything else, Haley? Anything else I need to do before we sign off? We're all good. Okay. Thanks, everybody. Have a great evening. Thank you so much. Oh, thanks for all the thank yous. Super fun. Super fun to be able to help you guys. I'm glad that you got a lot out of it as well. Okay. Aloha.
