Mary Kostka "How To Rock Your OT Telehealth Sessions"

Hi everybody. Welcome to the Mountain West Virtual OT Conference. I'm Mary Koska and I am really grateful to Carrie for asking me to come on here and share a little bit about how to make your telehealth sessions awesome. And so I have a little PowerPoint for you. So you'll mostly see me in a little box since this is not live and it's virtual. If you have any questions, I will be posting my email in here, but it's just my name, marycocskaol.com so I'm really happy to answer any questions that you have. So I am going to go ahead and share my screen and start my PowerPoint and I am coming to you from the state of Washington. All right. Actually I got to go up a little here. All right, looks like this is working. Don't you just love how how we're all progressing in our technology skills? It's not my strong suit typically, but been figuring it out. So this is pretty awesome that we have Idaho, Montana, Utah and Washington represented here. It's pretty exciting. It'll be pretty cool to do this in person someday. How come this is not going? There we go. All right, so this is how to rock your OT telehealth sessions. Keeping kids engaged with common household items. I'm really excited to help you all in our Facebook group. We've just all been helping each other so much and it's just really fun seeing everybody thrive. I'll be showing you later some actual live footage, but this is just some just quick pictures of actual telehealth sessions and it can be a lot of fun. So here's how my talk will go. I'll give a little more little bit more about me just so you kind of have an idea who I am, do the presentation. I have a number of special opportunities, things, resources that I have. I'll be sure to let you know about that. And like I said, you can email me and it's just my name. Altogetherol.com I often feel like my email shows my age. I'm 55 and but why change it? It works a little bit About Me I am a very, very passionate OT. I graduated in 88 from Western Michigan University. Most of my career has been pediatrics, but I've done a little bit of everything and I actually really love every aspect of OT. Whether I'm working with 101 year old or a 1 year old, I love it all. So this is my husband Pete and I'll tell you what, running a company like mine, building my practices I could not do it without incredible support. So he's really awesome. And this is my clinic. You can get an idea of kind of the big gym there. My wonderful staff. This is Kiddo flying in the helicopter, one of our, in our clinic. And this is my mom. She. This is. We went on a cruise few years ago on the Caribbean. And so there we are just having a really good time. And she does all my billing. She's super helpful and just also good moral support. And these are my boys, Lukash and Nikolai and my dog, Sam, Salmon bear. And they're 21 and almost 24 now. So they are really awesome kids. I love them. And this is my very first oana OT client and my practices. We just celebrated. Oh gosh, what was it? Oh yeah, 12th year. Think about it, our 12th year anniversary. And she was my very first client. So. So she is a sweetie. So a little background. This March, our clinic, like thousands worldwide, made a rapid transition providing telehealth OT services. And with the support of over 10,000 OTs in actually we're getting close to 11 in 60 countries. In our Facebook group, Pediatric OT, Telehealth and Clinic activities. We've come together and helped each other succeed during this pandemic. So this course really highlights what's been working well for all of us because we've all been sharing and it's really, it's been a wild ride because literally someone posted. Is there a group in the big pediatric OT group? Is there a group for just telehealth activities? And I looked and there wasn't. I'm like, oh, you need that group, I need that group. And within an hour there were 300 people. And it's just within six months there were over 10,000. It's just incredible and really just the most wonderful people. Really happy to help each other and it's made this whole thing just so much more enjoyable. All right, so here's what we're going to be covering. First, we're going to go through my five step thought process for selecting household items. That was one of the big things that came out of this group is we don't have our tools. So how do we do our job with just looking around the house and seeing what's, what can we do with a pillow, what can we do with a blanket, a chair? Just things that they have. So we're going to go through my five step thought process for how I select items. I have examples and videos of some activities that work really well. So I'm going to show you that and you'll make yourself a tool to help you select activities by a goal area. What we found really helpful and you'll make one of these is we made a little cheat sheet that we just had taped to the table. So if we're just sitting there like ah, not sure what to do next. I'm working on core and I could glance at it and then just see, oh, we could do around the world. Okay. You know, if you just have that moment where you're just kind of having brain freeze, it's good to have a little cheat sheet. And number three, let's see. I said that one already. Okay, we're on number four. Then we're going to go through my seven step process for keeping kids and parents in gauge. That came to the surface as one of the biggest problems because it's so hard to so different doing it telehealth than in person keeping them engaged. But there's lots and lots of things that work. So I'm going to share with you all of those things that we have found really help. And then you're going to make yourself another tool to help you think through. You know, if you have a child that you're having or a parent that you're having trouble keeping engaged, it'll be another little cheat sheet that you can look at and oh yeah, I need, I call it this, I think I called it the spice up list or something like that. Here's how we'll spice it up because you do kind of after now we've been doing this more than six months. It's you know, kind of need to keep it fresh. And then just in general, how to lower all of this will help help lower your session planning. Excuse me, your stress. And then we will do a little recap and just a little bit more history. When in March when we had to make the decision to go to telehealth, we made our transition in less than 48 hours. I actually was ready to do it like the next day. Once we had cancel in person sessions because we are a little private practice clinic and it really hurts us to lose our visits. So I was just like, okay, we are going to do this tomorrow. And everybody is like no. So I'm like, okay, we get two days to figure this out. And then we did and you know, we did it. So here we go. So first I'm just gonna start with a couple little stories of how this can go. A little story about Malachi and the glasses. So I had goals for following directions, core strength plus, we're always working on self regulation. And he had a terrible day. He was still in daycare at that time. And he came home and he was just. They got to the session late because he had gotten in trouble, was all dysregulated. He was all over the living room and then he lost this little ball that rolled under the couch. And he looked under the couch and he was just. So he's stuck there looking under the couch and I'm trying to start my session and I'm like, what's under the couch, Malachi? And it turns out he was super excited because he found his sister's glasses that had been lost. And so he was looking for the ball, but he found the glasses. So, you know, there's no way that I'm going to pull him away from that to try to start my session. So immediately I just started thinking of, well, I'm working on core strength, I'm working on self regulation, and I'm working on following directions. So I used his high interest activity, which was getting those glasses out from underneath the couch, and worked on all my goals. So I had him push the couch out of the way, taught him how to sweep. So he helped mom, because of course, when you move the couch, there's lots of stuff under the couch. So we got a broom and he worked on following directions by teaching him how to sweep. And. And he felt super successful and happy because he found those glasses and what could have just been like a disastrous session because he was already dysregulated. He had had a bad day, he was completely distracted. If I tried to do that session with just what I had in mind, it just wouldn't have happened. So then my original idea was we were going to do the. Make a little tinfoil boat and float it in water. And that's kind of what I had in mind for the session. So the ball that he found, I ended up saying, hey, let's make a boat for your ball. And then I was able to transition by the end of the session into what I did have in mind and then work on our sitting goal too, that we had. So he was able to follow directions and sit. And he was all. He had all his self regulation because he did all that heavy work with the couch and sweeping and. And yeah, so it just ended up being a great session. And then, let's see, I wrote on their plate with the holes. So there's another activity. I don't think I have a video of this one, but it's really simple. You Just take a paper plate, put like three different size holes in it and they have to tilt the plate so that the item, it could be any kind of item, it could be a rock, could be a penny. In this case it was ball and then tip it and then it goes through the hole. That's been a very engaging activity. So we ended up doing all of that and saved a session that could have been just a disaster. Another one, Abe dysregulated. So he was just hyped up really just all over the place, just crazy. And so what I ended up having him do is just grab as many pillows and blankets as he could. And we did a turtle crawl. So we just had mom pile it all on top of him and then he crawled around like a turtle all around the, all around the kitchen in the living room and we did laps. They had like a, an island, kitchen island. And so we were doing laps around the island until he was self regulated. Another just fun example, Eric in the back of the car. So they're on vacation and they would drive to. And this boy has, he's older, he's in high school and he has autism for the most part, non verbal, has a few words. And so we pop on the session and they're in the back of the car because they had to drive to where they could get wi fi. And so I'm thinking, wow, we're in the back of the car, what can we do? And in clinic, the big goal for him was we were working on getting him to where he could be tolerant of he has some heart issues, but be tolerant of the doctor putting or the nurse putting the blood pressure cuff on, taking the temperature, I mean, taking the blood pressure. And then we also have another goal where we're having him tolerate getting an echocardiogram where they don't have to actually put him out to do it. So we've been simulating that. So just trying to get him cooperative in the medical setting. So I'm like, oh, how are we gonna do this? So what we did is I pulled up a video on YouTube of exam of somebody getting their blood pressure taken and the echocardiocardiogram too. And I did a screen share. We use doxy, so it's, it's free doxy me. And then there's a small fee version that bumps it up a little where you can take payments and do a little bit more. I can't remember if the screen shares on the free version or the upgraded version. But anyway we. So I'll say that One more time. It's doxy D O X Y dot me. That's, that's what we've been using anyway, so, okay, they're in the. And they're on their phone too. So in the back of the car on the phone. So we played the videos and so we just kind of reviewed it since we didn't have the equipment there to try it later when he was at his house, mom would actually put it on him there. But what we found worked really well was Simon says, because we were working a lot on following directions, attention, engagement, all that kind of stuff. And so even in the back of the car, you can do. Simon says. And it was really fun because I would have him be the leader. And then he and his mom would kind of decide. She'd say, do you want to do this or this? And then he'd pick which hand. So, you know, do you want to do. Actually, that was more for the 20 questions. I'll explain that in a minute. But so Simon says, you know, be like, put your hands on your head, tap your shoulders, touch your nose, just anything that we could do. Like that. So the 20 questions, this is interesting with a nonverbal kiddo. So we, so we did it like based around. We did animals. And if you don't know 20 questions, basically you're asking, you know, is it bigger than a bread box? Is it. Does it have four legs? You're just asking yes and no questions. And he could say yes and no and his mom would make sure he was saying it accurately. So that was a really good activity for us to do in the back of the car on the phone. So you just, you're just creative. So I just wanted to start with just kind of giving you a flavor of what it can be like. So this is my five step thought process for selecting household items. The biggest thing is you have to do this big mindset shift from being the expert to your empowering the parent. And really this is my frame of reference. Anyway, I learned this from Vicki Mead, Gosh, more than 25 years ago, probably. I had an NDT class with her. She's so amazing and I love this phrase. She said, you have to learn to feel with your eyes and treat with your voice. And it's such a beautiful thing because the parents are the ones that are with them all the time. Anyway, so this model works really great in telehealth. So an example would be like, say you're working on core strength with a little one that you would lift up. So I would Just have a doll. Like when she did her class with us, she said she never even. And these are in person visits. She never even touched the baby. She had a doll and she would show the parent everything to do. Like it maybe a tilt carry, so you're holding them at an angle and then they have to write their body and just simple things. But you use your voice to give them cues and you model with an object like a doll or something. I use, I use a monkey a lot of the times and, and you empower the parent and that's just the best way to treat anyway. So this kind of forces us into being. Doing more of that kind of. You could call it like a coaching model, empowerment model. It's really a lot more effective because then the parents are much more engaged and they're doing it every day then. And then you're going to also really focus on using what's in the home. It's important to not do too many items because then they're spending all their time feeling frazzled, running around the house trying to get a bunch of stuff. And just really keep it simple, safe, fun goals. Keep it safe, keep it fun, focus on your goals and don't have too many things. Okay, self regulation first. Well, most of my caseload are sensory kids, but I think this is important. Whether they are or not for the parent and the child during this pandemic. The most important thing you need to do when you first get on is really just check in and see how they're doing, how the week's been, are they getting outside? You know, in the beginning it was really simple things. Like I had this one mom and I'm like, do you guys have everything you need? Because it was such an abrupt shutdown. And if you remember all the toilet paper craziness, well, that was real. This mom went to six stores and couldn't get any toilet paper. And she has three kids. And we had, just because of the, of everything changing, we had ordered a big case of toilet paper, but then we had switched to telehealth. So we had a big case of 50 rolls at our clinic. And I said, I'm like, okay, come to the clinic. We've got your back. We'll give you some toilet paper. And so, you know, simple things. You got to just check in and see how they're doing. And right now what's really hard for the parents is that they're trying to work and do online school. It's hard. I have one mom that has six boys that are in school. And just doing. And she's. She's not working at home, but she's, you know, just trying to manage those six kids in their online school. It's crazy. And then I had another moment. Who is. Has five foster kids and one of her own, and she had to do all the visitation supervision for these kids. She had like, 18 visits, and that wasn't even considering school. And the one that the child that's hers is a baby. So we just talk about it and then just laugh at the ridiculousness of how hard it is and just, you know, just check in with them and connect because they need our support through this for sure, and they don't need pressure. So we try to. Try to just, you know, talk about it, get a good laugh in if we can, before we get started. And that helps a lot. In this example, Dion's dad. Oh, my gosh. So this one, as I'm in the habit, the first thing I'm going to do is really tune into the parent and see where they're at. And this parent, she's like, well, my husband's in critical care in Seattle. And I'm like, what happened? And, well, the Tuesday that we had seen him that evening, he had fallen and hit his head and had a really bad head injury and was flown over to hospital in Seattle, which is like three hours away. And at that time, they didn't know what had caused it. Later they found out he had had some strokes and that's what caused it. But here she is with a boy with autism by herself, she can't even go see him. And, I mean, it was a crisis. And so forget our telehealth session at that moment. And it was all about supporting her and getting. I ended up getting some wraparound services for her, some respite care so she could get over there and connected with a local support group. But, you know, we need. We needed to tune in, and so. And we're still supporting her because sadly, he did end up passing away. And I just feel like, you know, we're just doing everything we can do to be a good support to the two of them. And they're in clinic now, which is nice, but I felt like we were kind of a lifeline during that time. So, yeah, worry a little less about your telehealth session and a little more about them and just really see what's going on and how are they doing, how are they coping and be supportive. And then if the child's all over the place, definitely start out with some breathing or Heavy work. I love Bubble Mountain, has been just awesome on telehealth it works really well. So it's just a bowl of water, not that much water, squirt of soap, hand soap, dish soap, whatever. And then I like putting two straws together because then your face isn't in the bubbles and you start blowing. And in telehealth it works really well because it's so visual and you know, I'm blowing mine and my bubbles getting bigger and you know, I'm trying to peek over it and theirs is getting bigger. You just have to be careful that the computer's not like where it's going to get wet, that the parents prop it up a little bit. But that's been a really good self regulation activity that works well in telehealth. I like doing pushover, which is the parent and the child pushing, pushing against each other like this and getting a lot of good proprioception that way. I gave the example of being a turtle with the blankets and pillows on top. So I gave those examples already. So I like focusing on two things. I do this in clinic anyway, but you know, I might have 15 goals, might have 20 goals, might have 10 goals. You know, I'll have a bunch of goals. I don't like to have to write them again. So I personally like getting all my goals written up ahead of time instead of adding them later. Sometimes I do add them later, but. But I only focus in a session on two things at a time. It doesn't mean I don't do more, but when I'm taking data on, I'm really trying to progress on, I narrow it to two things. And that way during this session I have just these two things in my mind. And no matter where we end up going, you know, I have plan A and like Malachi, we ended up doing all this other stuff. But I had in my mind that what my goals were, that I wanted him to follow directions, that I wanted him to be able to sit. Whatever my focus was for the session, that's what was in the back of my mind the whole time, no matter where the session took me. So I can always come back to just really keeps you focused. So what I like to do is have two goals usually one that's a foundational area that we're working on. So that might be core, might be reflexes, proprioception, vestibular grasp, strength, endurance, ocular motor, motor planning. Really you're probably going to hit up most of those anyway. But as far as one that I'm tracking And taking data on and really trying to make sure we hit the session. I really have one on my mind, usually for at least four sessions in a row. And then I always make sure one of the things I'm focusing on is very functional. A lot of our kids have goals for being able to sit calmly, you know, so being able to sit for 15 minutes. Or it might be that they're able to use their tip pinch. It might be that they can do some kind of imitation. Maybe it's letters, lines. Maybe it's a motor movement like an assignment says. It might be being able to handle frustration without a meltdown. That's a common goal. Being able to follow multi step directions. If you are boxed in by a tiny goal, like draw a square, you got to change your goal because that's just going to make you crazy. It's so much better to make it a little bit more general, like able to imitate straight lines or horizontal lines, vertical lines, angled lines in letters and shapes. Because what if they hate working on drawing a square? I had so many, so many times when I was a school therapist, I had that as a goal. And I'm like, no, not anymore. Now it's a little more general, but it's still measurable. Just don't box yourself in too tightly. I have a whole class just on, just on writing goals, a masterclass. So that's one of the resources if you want to see that class. And I also have this one's combining my first two master classes I did in the group, but I've done two others. The other one's on writing notes efficiently. And then the one I'm going to be doing here pretty soon is going to be on doing evaluations. Let's see. All right. You got to have it be meaningful. Hey, what's, what's the core of occupational therapy? It's our occupation, meaningful occupations. If it's not meaningful, they're not going to be engaged. It has to be fun and they have to feel successful. And that's the art of what we do. The just right challenge. We upgrade and downgrade the activity in little teeny increments, in increments that people often don't really realize how they can grade it. And that's what's skilled about what we do. So the goal is always to have them feel successful. And then as soon as they feel that success, we like to level it up. And with kids, I really like saying, ah, you did level one. All right, let's do level two. You're ready for the next level. So I think we take for granted our skill level in this, but that is really the huge part of what we do in occupational therapy, is we make it fine. We make sure they're successful by making it the just right challenge. But we don't just sit there. We inch it up, we downgrade it. If they're. If they're getting frustrated and it's too hard, we downgrade it. And so a lot of the upgrading, downgrading will have. Have to do with physical assist, visual assist, verbal tactile cues, how difficult the task is. So that's the fun part of what we do. We're always thinking on our feet. All right, I already said that. Secret to keeping them engaged. Do what they like. What are they distracted by right now? That example with Malachi being distracted by the glasses, if they're super into. I got distracted myself. There's a deer out my window up on a mountain. Anyway, we might hear my dog barking soon. So, you know, whatever they're into. So if they're into Pokemon or they're into Minecraft or they're into. We like to, you know, of course, we want to expand their interest beyond what they're. Especially if they're stuck. But you can use those things to help you accomplish your goals. So you can kind of use that as a theme, like in your session. And then, you know, we're just trying not to be too serious. We're pretty silly with the kids. We like doing dance parties, and we like using imagination a lot, using their stuffed animals. Just have a lot, a lot of fun. All right, so we're gonna just do an example of one thing that's really fun that I like to do with the kids. And this is dragon breathing. So want you all to do this right now. So you're just gonna take a deep breath in your nose. It's gonna be your flames, and then you're gonna be a dragon and blow it out. And what's really fun with the kids in Telehealth is if I go, they do that to me, and I go. I just act like, you know, they blew me away with their flames. And then they're like, oh, I'm gonna do it again. Harder. And then harder. And it just. It's really. You can find some ways to be very engaging in Telehealth. It's pretty fun. Okay. All right, I am going to switch over to. Let's see. I think I have to stop my share and then pick a different screen to show you. Yes, here we go. Okay, yes. So that's not it. Bear with me for a second here. I figure out what I'm doing. I want to get into my. Oh, here it is. Okay. So this is my membership website or that I have. Basically, it's my vault where I put everything I've created. And it has 36 examples of telehealth activities in here. So I'm going to show you. This is what it looks like when you're in it. And so just an overview. I'm going to go into this section where there's telehealth activities. These are my parent empowerment program, my pep talks. So at the end I'll go and I'll show you kind of everything that's in here so you guys can see. But basically it's everything that I've created in one place. But I want to show you these telehealth some of these examples so you can kind of see. So like, and these are really short, so if you're. They're divided by topic. So it doesn't take you any time at all to get to see it. Here's an example of real telehealth session with Bubble Mountain. And it's fun to be able to use the siblings. So this is. I'll show you this section. So there's self regulation, heavy work, prop core, vestibular, outdoor play, following directions, ADL's, IADLs, fine motor. That is what I have. Let me show you another one. So here's an example of us doing the zones of self regulation via telehealth. Jen has a play doh, mustache. Nice blue zone. Good job. He's doing faces for each zone. Here's an example of a dance party. A lot of times you would end with a dance party that would be like the fun at the end. That one, there's. There's more people in the. In the screen because he was really missing a receptionist and just some different people in the clinic. And we were all working from home and so we surprised him. And a couple extra people popped on at the end for the dance party just to join him. Let's see, I talked about Pushawar. Here's the push of war. All right. Okay, push to our. Push, push, push, push, push. This one, we've used the laundry basket a lot. It's been pretty handy. So in this one, we ended up having all the siblings joining in, taking turns doing the different parts. He says, ho, ho, ho. Because they were pretending it was like a Sam slay. We have such generous families willing to share and be filmed. And we'd always tell them that, you know, it's to help other therapists be able to do this. And they were just super happy to be able to help. Let's see. Let's show. This will show Superman on a chair. So, you know, normally we would be maybe doing surfboard flying and getting some vestibular with it, but that we were working in core extension for that one. It's fun to just use if you need to add some weight. Cans are great. So this one is like a core flexion activity, and he's stacking cans. Pretty challenging. That's some core. Really? That's amazing. Vestibular. So many different things you can do. One of my favorite things is if they have an office chair, you can. You can get some rotary this way. We ended up scooting him back a little bit and then putting it on the rug. So it was a little more stable after this little video. And he was also able to get a little bit more speed that way. We really like doing chalk obstacle courses. Getting the kids outside, and especially if they're just doing the telehealth on their phone, it's pretty easy to do that. So he had made. We had kind of given them a homework assignment to make an obstacle course. And so this is him demonstrating his course outside. Yeah, I think I got the bike. You guys have a nice big driveway, too. That's cool. Oh, a spiral. I love it. Spiral. Some of the kids or families, it took some persistence to a couple of weeks to finally get them to follow through with making outdoor chalk obstacle courses. But once they did it, they really loved it. And a lot of them would see people walking by of all ages doing their course on the sidewalk, which is really cool. Wow. Sorry. The video is kind of get dizzy and then walk on the line. Are you dizzy? 11. Okay, I'm gonna go ahead and stop it there and go to another one. Let's see. That is just. Simon says feeding. Feeding has worked really well for. Especially if we've already had some time in the clinic first. This kiddo worked really well, and he wouldn't do it at home. So it was kind of a cool thing we discovered by doing it by doing it on telehealth. It was a way for us to be with them at home and transition them to doing it at home. All right, I'm going to show one more. Let's see. Let's do the. Let's do the water rainbows. This was cool. This mom actually had this idea, and hopefully it Won't be too slow here. This was a really big hit in telehealth, where you color both ends of a napkin and then you have two cups of water and then they bleed up and join to become a rainbow. So this is another example. You don't have to be in the house. You could be outside. Of course, now it's getting cold, so it's a little different. But you could go sledding outside in the snow. It's going to be a rainbow. So I have posted all of these on our Facebook group. But, you know, they get buried and I couldn't even find them. So that was part of my motivation for making this site where everything could be organized and I could. I will even sometimes show a video of one of these activities and screen share so that they can see an idea of it or show it up on my phone. But I am up on my mountain today where the Internet is not as great. So it's a little slow to show you this, but I'm gonna skip ahead, see if it'll let me skip ahead to show you kind of how it turns out. So you get the idea. It's pretty fun. Okay, so that gives you some good examples. And I'm gonna go back to my PowerPoint, I think, which was here. Yay. Okay, so implementation. So you're gonna want to make a list for yourself. So what I would suggest you do is get either do it on your computer, you can do it making a table, you can just do it with a piece. Just originally we just grabbed a piece of paper and just wrote it out by hand. But what you want at the top are what your most common goal areas are that you're. You're using. So for us, or treat or treatment areas. So for us it was the probe. Vestibular gross motor reflex integration, fine motor self regulation, following directions, core bilateral integration, outdoor play, and the ADL's IADL. So for us, those were our main things that most of the kids were working on. And so then we just started listing some of the different ideas that we have, like the laundry basket activities, the building a fort, squirt bottle. We like doing, like having them clean the, clean the windows, push or wheelbarrow walk, animal walks, vestibular. You saw the office, office chair ride, the chalk. Some of the different reflex exercises are on here. We've also done the tape obstacle course where you take some masking tape or painter's tape inside the house and go all around like skating with paper plates. Fine motor. Another fun thing you can do Is you can take a straw and you can bend it in half and then that becomes tongs. We've done that. You can poke. Poke toothpicks. You could have like tin foil and poke toothpicks through the tinfoil so they fall through and it makes a little shaker. Just all kinds of different things here. Cutting up straws, doing. You can put the. The toothpicks through the straw, kind of shoot them through. That's pretty fun. We did little like for thumb isolation. We draw little faces here and. And do little puppet shows. The water rainbow one you just saw self regulation. I showed you Bubble mountain dragon breathing turtle craw. We talked about. We like to do the zones dance party. You can use paper tubes to blow through brush and squish is what we call our will bar. Our version of Wilburger depressure protocol. And I'm trying to think what I meant by WC because it's making me think wheelchair. But that's not what that is. Okay. I'm not sure. I'll have to think about that. Maybe it'll come to me by the end of this. We have this really great set of mindfulness cards that we like. If you're curious about that, I can send you info on that. But they're just different relaxation activities. Following directions. Simon says going on a trip is fun. Going on a trip is I'm going on a trip and I am bringing my puppy dog. And then the next person says, I'm going on a trip and I'm bringing my puppy dog and a sandwich. And then the next person has to add, I'm going on a trip and I'm bringing my puppy dog a sandwich and a balloon. And then you just keep going back and forth and adding and adding and adding. I showed you 20 questions. Just any kind of simple crafts we like using for following directions or games. Core around the world. There's a video in there about that. But basically it's just they're back to back and they're turning, rotating to hand an item. So it's going around the body and then you can go over the head in between the legs. For north south pole. I showed you Superman on the chair. Laundry. There's a lot of things you can do with the laundry basket to carry on and on. See, you can pretty much just read this and kind of see what they are. If you have any questions about any of them, just let me know. I don't think I'll go through and read all of them. But you want to have your own list so that when you're sitting there thinking, I need to have them work on their core, what can I have them do? Or oh, they're dysregulated. You want to have something you can glance at that are your go to's to help you so you won't get stuck. Okay, so we're gonna switch now to seven step process for keeping kids and parents engaged. So the first one is you have to connect like we talked about earlier, and you need to be present. Don't multitask, don't be checking your phone, don't look down. It's easy if you want to write something down to end up doing this, but you see how disengaging that is. So when I want to write things down, I try to still look at them and then I might glance or I try to do it when they're doing the activity and they're not looking at me on the screen. That's when I'll write stuff down. And you definitely want to. It's a very dependent on your visual interaction. So you want to always really look interested, be smiling. And then I already gave you this example of the head injury. The three questions deep. This is really a powerful thing that I learned recently. So if you were to say, hey, it's good to see you. Have you been. That's one question. But then you're on to blah, blah, blah. It doesn't really show interest. If you really want to show interest and show you care, you want to go two more questions deep. So you might want to say something like, well, what's new this week? Or what did you do this weekend? And they might say something and, oh, was that fun? Did you like it? Or whatever. But you want to go three questions deep in. And that just shows you actually care and you're not just hi, how are you? Kind of thing. You know, even with little ones, like I had a 16 month old, I was, I was coaching the mom with and we would play peekaboo. So I would kind of get out of the screen and pop in and then in and out and she started doing it with me. And so you just want to be engaging as much as you can be. Okay, so what about when it falls apart and they're having just a huge meltdown? And you know what, it's okay that you're observing it, you know, because a lot of times in the clinic we don't get to see what's really going on. And it can be really helpful to observe. And then maybe in the midst of it, you can't really do anything because they're in the midst of it. But you might be able to debrief with the parent after, or you might be able to kind of redirect it in the midst of it and coach them through it. Depending. Kind of depends on the situation. But I'll give you an example. Like, one kiddo didn't want to do anything. Mom said if she wanted him to put something away, he'd have a big meltdown. And I said, well, what would you like him to be able to do? And she said, to clean up his room and put things away in his room. And I thought, this is a great opportunity. This is telehealth. I'm like, what are you on? Are you on the computer, the phone? And whatever they were on, they were able to move it to the bedroom. So I said, let's go to the bedroom and let's check this out and try it. And so she wanted him to clean up his desk. And I'm like, well, go ahead. I'll just. I'll just watch and see how it goes. And he didn't know what to do. She basically just said, you know, clean up the desk. And I said, well, let's break it down. And we'll have him put the pens. There were a lot of papers and stuff, too. I said, how about you organize the papers? And he has to put the pens and the markers in the. In the bin, and he has to put the Legos away, and he has to put the books on the shelf, and then you do the paper. So we broke it down, and so that was working pretty good. But I have to say, before all this, he was just acting up and yelling and not saying nice things to his mom and hiding under the blanket and going underneath the bed. At one point, she had the phone underneath the bed, and I'm talking to him underneath the bed, which is pretty funny. But after all of that, and we kind of. That was when it was overwhelming. And I said, well, let's. Let's make it simple. Let's break it down. So we downgraded it, and so we're doing pretty good. He's putting the pens away. She took all the papers. He's putting the book on the shelf. And I'm just telling him one by one what to do, kind of modeling how to verbal cue. And then with the Legos, he threw them across the room. And. And then. And then mom took the Legos and she. It looked like she was putting them away. And I was like, did you just put The Legos away. And she said, yeah. And I'm like, oh, no, no, no. He needs to do that. So I said, let's do. Do a rewind, do a replay. And I told the boy. I'm like, you know, this was your job, right? You agreed to it, right? And he's like, yeah. I'm like, okay, I want you to put the Legos away. And so we just kind of went through that. But the mom really didn't really understand how she was reinforcing this behavior. And it was just a beautiful thing to get to kind of be in the room when it was happening and help them through it all. And they don't really have any problems anymore because she's in that area because she's much more clear, and then she doesn't do it for him if he doesn't do it. That is pretty cool thing about telehealth. Yeah. So we covered all of that. All right. Meaningful. We talked a little about this before, including what they're interested in. Pets are the best. It's so fun in telehealth to see everybody's pets and, you know, their toys or stuffed animals. A good question to ask when you're really trying to kind of tune in with a parent is just ask them what's hard right now? And you'd be surprised at the answer, because, like, in the beginning of the pandemic, it was like, we can't find toilet paper. That's what was hard right now. And it. You know, what's hard right now for parents is that they're stretched way too thin, and the kids are, you know, on the screen way too much, and it just keeps changing. And so let's see. Interacting with mom. Getting on the floor, facing baby. I think that was just an example of getting. The baby's gonna be most interested in mom's face, right? So teaching her how to, like, just lay on the floor and so that they can be both prone face to face looking at each other. Use stuffed animals and activities. Make things for pets. Okay, this. This reminds me of a fun one. Making things for pets. So another really distracted boy, they just got a kitten. He wanted to play with the kitten, not. Do tell, ELP Me too. I'd rather be with the kitten. So I was able to save that session by saying, well, let's make a toy for the kitten. And they had some yarn. So we ended up. I ended up teaching him how to make a pom pom. So he had a pom pom on a string. So he made the toy with me and then we went and played with a kitten. So that was pretty neat. First then is always a good format. Well, first we'll make the toy and then we'll go play with them and. Or yeah, an incentive is show me the pet. Show me your pet. If they want to invite, I want to show you my. Oh, I remember this one. Kiddo wanted to show me his chickies and so I'm like, oh great, let's do that at the end. So first we'll do this, this and this. And then at the end you bring in your cheekies and show me. So you can use what they're excited about as a motivation too. And this is just like if you were working on writing, you could have them write a description of what they showed you so that it's meaningful to them or letters that start with what they showed you. So just basically be creative but always tie it to something that they care about. Shared control. Taking turns. This is one of my favorite things I learned. I think I learned this from love and logic the most. And I did it a lot as a parent when my kids were young. And that's giving them a sensation of being in control. And choice A, choice B, which do you prefer? But they're both things you would be happy with. But also like taking turns being the therapist. So. So I might do something first and then they have to copy it, what I'm doing, what I built a drawing and then they can show me. But you can also do with the parent, like show me something you have tried and then I'll. And then I show them something that I've tried. You can take turns choosing with the child, choosing the activities. We do this all the time in the clinic too. So they get to choose something and then I choose something they want to do the frog swing. Okay, now we're gonna do the spandex. And of course a picture schedule or a checklist is always helpful if they need that. But I like to, when I build my schedule, I like to have their buy in so they help make it. Then they have that sense of control. Shared control. We talked a little bit about the just right challenge. This is just a little bit more in depth. We talked about leveling up different levels, making sure they're successful. It's good to do self regulation in the beginning and the end of all the sessions anyway. So like if you're going to do dragon breathing or bubble mountain or something, good to do that at the beginning and the end. It's good to have A visual schedule, like we talked about, of things they're doing. Cross them off. I sometimes do things on the fly a lot. And so, like, when we were doing that desk, I didn't know we were going to go in and clean the room. That came up on the fly. I just took a piece of paper and just drew stick pictures. And I'll do it right now. I just make boxes. And then I would draw, like, pens going in. I don't know. I'm just gonna. It might be something super simple like that. Like, pens are gonna go in the cup and the books are gonna go on the shelf, and we just check them off. I mean, nothing artistic, just super fast. Just as some kind of visual representation. So sometimes I'll do that in the session too. Like, if they just need a little visual structure, you don't have to be all fancy. You can just. You can just draw it. And I like showing that to the parents because sometimes they need to add structure. Like they're doing errands and all of a sudden, you know, something changes in the plan. If they can just sketch it out on a piece of paper so the child knows what's going on and they can check it off, that lowers a lot of stress. Yes. We want to start with easy and nudge things up little by little, for sure. Okay. Keeping it interesting and entertaining. So with parents, when you're doing, like, Birth to three and you're really doing a lot of coaching, it's lot of song. Song play is a great engagement. And one of my favorites is the Little Fish song, which is. I'm trying to think. I changed the words a little. I'm drawing a blank on what they actually call it. I don't think squiggly fish or something like that. But anyway, it's like little fish, little fish swimming in the water. Little fish, little fish. Chomp, chomp, chomp. Oh, no, it's been eaten by an octopus. An octopus. That one. Anyway, I think it's squiggly fish. I made the words a little simpler, but, you know, just something like anything like that. Itsy Bitsy Spider. The little ones, they really react to that animation. And so. So teaching the parents to do that to make it interesting and entertaining. Finger puppets are great. Puppets work really well in Telehealth. We have, like, this shark puppet that's a favorite. And incidentally, it was my son's, and he's 24 now, and we're still playing with it. It's. But, you know, it'd be like, so you can you can do a lot of interesting things with the screen. Read books via YouTube and activities based on those. I haven't done that myself yet, but in the group there's a lot of sharing on how you can screen share some different things. Different things that are on YouTube. You can even just read them. Read them a story, a short story and then do an activity, do it that way. Oh, I talked about popping up the stuffed animals of figurines, having them run across the screen. Yes, Our shark and an octopus. Sometimes octopus will come down from on top and you know, you just keep them like watching you keep it interesting. Handwriting song. So I'll sing this song for you guys and if you want it, just email me and I'll send it to you. But for the kids that need a warm up, I really like this song. So it goes, are your hands up? And actually I want you to do this with me right now. Give you a little stretch. When I did this live, it was pretty fun. The whole group did it. So are your hands up high? Can you reach up to the sky? Can you touch them to the floor? And do it once more. Can you bounce in your chair with your hands up on your hair? Are your hands up high? Can you press your hands together till you count 2, 4. 1, 2, 3, 4. Press even harder and get ready for more. Put the pencil in the palm of our hand and move it to the tips and do it again. Inch up to the eraser and down to the lead. Do it once more exactly how I said. Tap three times on the table. Flip it if you're able. Now you're ready to write. So that's just a fun little song and it's very engaging and you get your, you get your warm up. Let's see what else do I have on there? Writing clues going from one item to another. Oh, this has been a really fun one. So just having the child view this is a good telehealth. Writing activities. So kind of like scavenger hunt. So they're writing clues to get to something that they hid. So maybe they're going to write clues for their parent to find something. So they would write the first clue and the first clue might be under something soft or something like that. And they write that and then the next clue is under a pillow on the couch. Then that says, you know, it might whatever they, you know, place where we watch movies or something. And then maybe it's on the tv. But they basically send their parent on a scavenger hunt to find something. But you're having them write clues along the way. So that's pretty fun. Using their favorite music. Especially with teenagers, I love finding out what their favorite songs are, and then we'll play it and do something with their music. That is a fast way. Knowing every kid's favorite song is a fast way to pull them out of meltdown. By the way. We've done that a lot with different kids that if they're having a hard time, we turn down the lights, play their favorite music, snaps them right out of it. I haven't done this myself because my computer is a little older, but you can change your virtual background. And people have done all kinds of crazy, fun things with that. You can see that in our group number six, fun and silly. You really got to get out of your comfort zone here. And because with telehealth, you really got to keep things lively. I find this in person, too, with little kids, especially just making noises when you do things really work well. So like say I'm doing brush and squish or something. I'd be going, oh, you're squeaking just. Or when they. When they reach up for something, just giving them some kind of little feedback. So just fun little sounds. I haven't really done this myself, but some of the people in the group have gone to town with this and pretty fun. Like wearing different costumes or hats or glasses or, you know, just looking different. Keeping it fun that way, definitely. I say elementary, but this is really everybody definitely getting them away from the screen. As you could see from some of those. Actually, I think a lot of the ones that you saw, the kids aren't sitting there looking at the screen. They're all doing stuff. So they don't need to be sitting there staring at the screen for most of these things that I like to do. Freeze dance is definitely when you're feeling like we need a little break, get up and do freeze dance. You're dancing and then you stop the music. And then you're dancing and stop the music. And we already talked about Simon says, multi sensory, engage the senses, go outside. You can have teens teach you a popular dance move. That's pretty fun. Or you teach them something. You can also do some online games. I haven't done that myself. You can screen. There is a way to. In some systems where you can actually play a game together on screen. And there's a lot of discussion about that in our Facebook group. I haven't actually done that myself yet because I'm usually with my clientele, it's usually more about Getting up and moving. But that has. A lot of people have done that. Now. Another thing to spice things up is don't do the same thing every time. Have variety and something unexpected. So talking through a favorite animal toy for a little. A little one. So I don't. I should have had some stuffed animals here. But you can. You could hold it up and be like, you know, they're the one doing the talking. Like, okay, now do this. So you're. Or you're out of the screen. And Elmo says so you just kind of make it more fun that way. Talked about changing your virtual background. The surprise visitor at n. That was. I showed you that earlier with the dance party. We had some extra people on there because the child was really missing some of the people in the clinic. So we surprised him at the end with having them pop on the call and then showing the pet. Like I could show you right now. I'll do a little surprise for you right now. This is Leila. So this is my. She was sleeping, so I wasn't very nice. I woke her up. She walked. She. She disrupts a lot of my. Go back a lot of my calls. You'll see a little tail walking by. But it's really fun to see everybody's pets. My. When Jen was doing all hers at home, they all wanted to see her dog. And so that was like her incentive. Okay, when you get done with this, I'll get. I'll bring. I'll bring Vexen. Okay, where are we? Mix it up by having kids answer question by talking and type. Okay, this is fun one. Okay, so it's. It's kind of fun. The kids really get a kick out of typing in the chat. And so sometimes I'll just type them. It's the instruction, you know, Then they'll look at it and read it, and then they'll type me back the answer. Instead of talking to each other. Just sometimes they initiate that one on their own because they think it's pretty funny. Like, I'll ask them a question and then they type in the answer, yes or no. They just think that's pretty funny. And you could do the. Play the 20 questions that way. Especially if you're working on keyboarding. That would be cool. This is. This is an interesting one. If you're trying to, like, connect with the teens, it's kind of. They get a kick out of seeing what you look like at their age and again tuning into their music. Or you might play a song. Hey, this song was popular when I was a Kid, what do you think of this song? Oh, we already did the handwriting song. All right, so this is your. Let's see. I feel like. Oopsie. I see what's going on here. All right, hopefully you're still seeing that really well. Okay. Your spice it up tool. So you're going to want to pause this and make yourself a little grid like this and jot down some of the things that resonated with you that can help you spice it up so it won't be too boring. So thoughts about how you can connect and be present, make it more meaningful for your kids. Control. Oh, little typo there. Just right. Shared control. Just right. Challenge. Interesting, entertaining, fun, silly. And have it. Have some variety and unexpected. All of those things will help you. So you can pause this, make your own and a little recap, actually. Yeah. Okay, we'll do the recap now. So a little recap of everything that we've talked about so far. So first you got to shift your mindset from expert to the empowerment model. And you want to do self regulation first. Focus on two things. I like focusing on a foundational and a functional. And then I keep them in my mind the whole time. Meaningful, fun, successful. Just write challenge. Gonna have your go to list for your most common. So you have an activity list for each area you work on. You want to connect and be present. Make sure it's meaningful. Take turns. Shared control. Just write challenge. Keep it interesting and fun. Silly. Have the variety. Unexpected and make your spice it up list. And I just realized my computer came unplugged and I gotta plug it in before it ends up dying. So I'll be right back. Okay, that would have. That would not have been good. Get close to the end of this thing and then die. And I have the battery die. Okay, so let's see. Where are we? That was the snow falling off the roof. Okay. My resources. So I'm going to show you. Alright, so this is the Facebook group and you can just go in there and request to be added if you're not already in it, called pediatric ot, telehealth and clinic activities. And within that I have master classes and I've done four. Gonna do a fifth one pretty soon. If you would like any of these resources, just email me and tell me what you'd like links for and I'll send them to you. I do have replays for all of them, although the first two are pretty much covered in this presentation. So it would be more the documentation ones that you would probably more interested in. I'M going to show you a little bit more of the level up Pizzo team membership site so you know a little bit more what's in there. But it has a lot of stuff in it. So it has the activity clips that I showed you. It has, like I said, it has replays of all the master classes. I have a really great cheat sheet that I made for myself but a lot of people really love it for all the developmental levels for different things. It has my reflex testing guide, a whole course that I did on helping with handwriting and all my videos where I do parent education and I explain things like what's the difference between a meltdown and a tantrum. And these are great for learning how to explain things to parents. Also just as a, you know, if you're new to help you understand it and then also a refresher. But this also just it's great for parents. And then I also do very few clients but I do do some one to one coaching. Coaching areas that I can do in is documentation, telehealth and private practice and then excuse me, sorry about that. And I'm right now I'm working on my docufast course which is going to be I believe about a six week course that's going to go in a lot more depth on how we can make our documentation better and more efficient and there'll be like a support group within it so we can look at each other's stuff and help each other. So all you have to do if you want any of that information is to email me and I think I will screen share and just show you a little bit more. I gotta switch to what I'm sharing here. There to go. The thing about not doing this live, hopefully you're seeing this. The thing about not doing this live is not having any feedback. Like if something isn't working here, I would not know it until I watch the replay. So hopefully it's all working well. Okay, so I just wanted to show you a couple other things like these pep talks, what that looks like. So I have just explained what sensory integration is. Tantrum versus meltdown, how to make spandex swings, activities you can do that, clothing, having heavy work. So talk about. I explain the proprioceptive system, the vestibular system, how to help your child. Wait, we have headphones, weighted blankets, my favorite tips for learning to cut shoe tying. And we're adding to this all the time. And then this is kind of fun. This is something I did at the beginning of the pandemic. The first 40 days of the pandemic every single day. I went on for about 15 minutes and did a 2 o' clock every day. And it's actually kind of amazing to me that I managed to do this. But every single day, no matter where I was here I'm kayaking when I did it. Sometimes I'm on top of my mountain, sometimes I'm in the clinic. But I did activities for that were self regulating and positive mindfulness. And so I basically went through this, these, this set of cards that had all these great activities. This is the entire handwriting program that I have. I did this several years ago, but it's really wonderful. But it breaks down all the different main problems people have with handwriting and then ways to what to do about that. So we've got stuff about posture and positioning, paper position, what to do when the wrist is bent, grip if you have pressure problems, letter formation problems. They're not writing on the line. It's too slow and labored. What to do, what to do when they're not leaving spaces and letter reversals and switching, hand dominance and how to self correct. So lots of good stuff there. And let's see what else do I have in here? These are some videos about documentation and then these are the masterclass replays. This bonus section. One of my favorite things that I've done here, I did this for myself a long time ago is this, this cheat sheet so you can download. There's two pages here. I'll just show you one of the pages. You see what it looks like. So it's just a really nice. Has all the different areas and then, you know, developmental milestones and it even has like really hoping all this is showing up and even has, you know, how long attention is and that sort of thing. And this is a fun interview I did with with Adam Neoti in Dubai. We had a lot of fun with that. Okay. Oh my goodness. I'm afraid that maybe this got messed up. I'm having a feeling that you didn't see what I just showed you. But I thought I was showing you. Okay, I'm going to stop share. All right, well, I may have to do a second video. I'm not sure that last week part showed up. So I'll go Back to my PowerPoint. Oh my goodness. I literally do not know where I'm at with all of this stuff. Okay, hopefully you're looking at this. Got myself a little bit lost here. Okay, so here's my. Here is my email and feel free to email me and thank you very much and this is that little girl, Renee, my first ohana client at one of our celebrations, our birthday parties for ohana. All right, thank you. I'm a little concerned that when I was showing you the tour of the. Of the level up, Ps ot it may not have shown up. So I might have to do a second recording and add that as a second link. And I will do that. All right. Hope you found this helpful. And I will also be providing a link where you can give me some feedback. All right. Aloha.