Masterclass #4 REPLAY - Writing Sensational Goals - Easy to Measure and Track!

Looked too weird having something here and something here. Yeah, that looks better. I opened it. Oh, thanks. Mom. People are waiting. I'm not letting you in yet. I have to let my girl in first. If you moved it right over to the wall, you probably wouldn't have any dark in it. You just don't want that dark. It crowds me too much. It's fine. It crowds me too much. It's fine. Okay. There. Yeah. Angle. You're kind of stressing me out, Mom. It doesn't matter kind of stuff that just doesn't make that much difference. It. I have to go straight to karate, and I am already eight. Okay. I have it all already. Yeah. Can't see me if I go by. Yeah, that works better. But, mom, keep the door shut because I'll hear myself if you're watching it. What? If you're gonna watch it, keep the door shut because I know I'll hear myself in it. Echo kind of echoes. Yeah. I'm wondering whether, with the door shut, whether I should even be watching it. I can always watch the rerun. Let me know. But, you know, you're having any trouble, I don't know how I'd let you know without being disruptive. So. I don't know. I guess I could chat with you. I guess I could chat. I could say something in the chat. It did. It worked. Okay. As long as the door was shut, it should work. You know when we did the other thing? Yeah, it. It's. Hello, can you guys hear me? Hopefully they'll be connecting soon. Hello? Hello? Can anybody hear me yet? Be sure to put on. Let your video on here. It's a lot more fun to see you than to just see your name. And we can visit for a couple minutes. You guys can unmute if you want. Hello? Hi, Jennifer.

Hi.

Can you hear me okay, Jennifer? Yes. Oh, good. Oh, here we go. Here's more coming in. Chris and Meryl and Allison, welcome. Hello, Morgan. Give everybody a chance to pop on here. Hey, Morgan, can you hear me yet? Hey, Morgan.

Hi, Mary.

I'm going to try to switch it so you can let people in. Okay?

Okay.

I think I fixed it. So I think if I make you co host, see if you can see people coming on that want to let. Be let in. Do you see, like, a participant's list of names? Like that one? Do you see.

Oh, click. See waiting room. Yeah.

Yeah, Click on that and you see the two that need to be admitted. And then you just keep hitting admit all as they come on. Yay. You can do it. And hopefully. Oh, yeah, I should be able to share my screen at the same time. I think we got this figured out. Well, welcome everybody. Make sure we can see you and well, just visit for a couple minutes here so you can mute yourself. Tell us where you're watching from. Jacksonville.

Sorry. Hi.

Where are you guys? I'm in Alabama. Phoenix City, Alabama. How is it there? Does it feel like fall? It was actually raining today, so it was very humid. It did not feel fallish. But the last few days beforehand it was very nice. Yeah, it really feels like fall today. It's kind of drizzly and leaves are changing. Where are you, Mary? I'm in Washington State, right in the middle of the state, in the mountains. How about Cindy and Allison and Mara? Where are you guys watching from, Cindy? I'm watching from Long Island, New York. Wow. I bet you guys starting to get some color. I'm from the Philippines. Oh, hi. Are you there now? Yeah, I am. What time is it? It's 8 o' clock in the morning. Oh, that's not too bad. At least it's in the morning, not in the middle of the night or something. How about you, Allison?

I'm in Fayetteville, North Carolina.

Oh, nice. It's so fun to be able to do this, huh? Welcome. Morgan's gonna keep popping everybody on here. And let's see, since I don't have to look at the waiting room, I wonder how I make it go close. Okay, cool. Well, I am going to go ahead and share my screen so that you can see, see if this works. I'm going to do it a little different this time. Can you see that? Okay, there. You can see that. Okay. All right, good. So welcome to writing sensational goals. We'll get a few minutes to let people on, but while you are waiting, you can type in the chat where you're from. We get to hear some people tell us where they're from, but as there's more and more, it's harder. We won't be able to talk as much. And what I'd love to know is what is your most common goal that you write? Just something. You just write this goal all the time and go ahead and write it like the whole way that you normally write it and put it in the chat. And then I'd love to know what you do for fun because my big purpose of helping everybody with their documentation is so you can have more fun, not spend all your free time doing your documentation. So go ahead and put that in the chat. Going to Disney. Disney's Open right. Jennifer says, going to Disney. I kind of feel like a bad mom because I never brought my kids to Disney. And now they're in their 20s, but they can bring their own kids someday to Disney. We always into zoos. They liked Zeus. Let's see. How do I make this go the other way? That way. I am just trying to change the way my. I'm arranged here. Yeah, go ahead and type those things in and we'll get started in just a. We'll probably give it like five minutes before we get going. Put this over here. I'm thinking of what's the most common goal I write? Probably a sitting goal. Being able to sit and participate in an activity is probably one of the most common ones. And I love to. I'm in Washington state in Leavenworth, in this cute little Bavarian village, a tourist town, and we are still at level 1.5. So we have a lot of restrictions still, but we're getting through it. And I like. Oh, I forgot the. I wrote. What do you foe for fun? Let's see if I can edit that. I can edit it right now. There we go. What do you do for fun? I like to kayak and do karate and hula. And I like to have a lot of fun. Phoenix reading. Hi, Mom. Fran is my mom. Hey, Mom. I'm echoing. I can hear. Yeah, probably have to watch the replay then. We were experimenting. We weren't sure if I'd be. She's on the other side of the wall, but it's like an echo. Okay, let's see. Rochester, sew and read. Long Island. Cindy's from Long Island. Okay. Oh, here we've got a goal. Student will use regular adaptive scissors to cut out a circle and square within quarter inch. Ballroom dance. Cool. What kind? What style? Antique shopping. Fun. Sandy, attend to task for three minutes. Linda, Arizona. I like to run, hike, kayak. Yay. Travel. I know. Travel. I can't wait till we can travel again. Allison, North Carolina. Emotional regulation goals. Ooh, I'd love to see how you what those goals look like. We're going to help each other. Kelly, New Jersey. Goals are either fine or gross. Motor sensor regulation. Your EMR gold bank. Okay. Allison likes to hike. What does it have to do with anything? So what does that mean? Go ahead and make sure you're on mute, everybody. I'm hearing some background sounds there.

Well, I'm just telling you the truth.

That's what happens. Some cute little kids. Make sure you're on mute. Okay, so I'm seeing, like, what your Goals are about, but I'd like to actually see, like, how you write a goal, like, the actual goal. So what am I supposed to tell you with the truth of what happens? All right, who's not muted here? Sorry. Okay, guys, I think we'll go ahead and get started pretty quick here. So see what else is on here. I'm still reading these. Okay, let's see. Incorporating sensory integration techniques that lend themselves to. Into a functional goal. So I'd love to see, like, how do you write that goal? What does that look like? Don't be afraid. I'm going to share a bunch of stuff here. There's no right or wrong. Upstate New York. New York is the most beautiful I've ever seen fall with the colors. Like, I thought growing up in the. In the Midwest, that I knew it. Like, pretty colors look like or even here in Washington, But New York, it's incredible. So pretty. How we doing, Morgan? Are you. Are you still getting a lot coming in? Should we wait a couple more minutes or get started?

They're coming in slowly.

Slowing down a little bit. Yeah. Okay.

But I can see them, so I can keep letting them in if you start.

Okay, I'll go ahead and start. So welcome, everybody. I am Mary Koska, and Morgan is. Well, we just changed her title. She's our client advocate, so she. She does all our intakes, and she also helps me with various projects, like our big Facebook group. She's the one that kind of keeps everything running smoothly in the background. That's why we can have 10,000 people on there behaving well, because she actually vetted every single person. She made sure that they were OTs and that they were look like good people. I've actually. I don't even think I've had to delete any comments. Everybody's really been good. It's pretty amazing. So I am really excited to help everybody. And you guys can see this, right? So tonight, are you seeing my. Are you seeing the faces of the people, too? With my share screen? Yeah. Okay, so I gotta make sure that's not in the way there. Okay, so here's how tonight's talk will go. I'm gonna do a little introduction, I'll do the presentation, and then I'll share something at the end. That's a little special opportunity that I'm doing that would be probably good for a few people, few of you guys, and we'll do some questions and answers. Move this over a little. I'm sharing it this way because last time when I went into Presentation mode. I couldn't see you guys off to the side. I couldn't see anything so I couldn't see the comments. So I'm gonna try it this way. Give me a thumbs up if this is gonna work. Does this look alright the way I'm doing it? Okay, cool. So just a teeny bit about me. I'm a. I have a practice, a private practice. This is my clinic over here, Ohana OT and I specialize in sensory integration. And in my 32nd year of OT. I love my prep. I love OT so much. I really do. And I feel really lucky that right out of college, I mean, that I knew what I wanted to do and that I've loved it ever since. I feel really lucky that way. And this is my husband, Pete, my boys, my mom. This is us on a cruise that we went into this. This is a. In our clinic. And this is my wonderful staff. And this is my first client that was for my private practice and she was, I was, I was working in a birth to three center and then it closed and so I actually started with her to just keep serving her and then got my contracts going. And that's actually how Ohana OT started. That's just a little about me. And this is what we're going to cover. So we're going to cover what makes goals too specific and too broad and just right. And then for those of the two main areas, when I polled, people wanted information on goals and they also really wanted information on how to write goals for sensory integration. And so I kind of combined those two things into this presentation. So we'll go over the 10 key outcomes, the goal areas for sensory integration, and then I have examples. I'll show you some example goals for each of those areas. And then I came up with a little template for you to kind of help you think through your goals just to make it a little easier to write them. And we'll recap and do a little Q and A. All right, so I'm going to start with the struggle and the trap. And the struggle is that, you know, even after writing goals for decades, three decades, I can still struggle with it because if you write a goal that's too specific, then you get trapped. So who's written a goal like draw a square and the kid hated working on shapes or drawing a square and you couldn't measure it because you could never do it because they hated it so much and you just felt like stuck. Did anybody ever have a goal like that that they're just like, put your Hand up. If you've ever had a goal that you just were like, I'm trapped. I'm trapped. I can't work on this because kid doesn't want to do it. So that's the trap. And the struggle is also making it measurable, not too big, so you can measure it. So that's why we're all here wanting to talk about this, because we don't want to get trapped and get stuck in this goal that we can't do or that it's too broad. So it made me think of the Goldilocks and the three bears. So you remember Goldilocks. The bed was too big and the bed was too small and just right. So we're going to talk about what makes a goal kind of too big, too small, and just right. So an example of a goal that's too specific, the square goal. And working seven, I had 17 years in the schools, and it just seemed like that was always a big jump for the kids to go from a circle to a square. So it seemed like I had a lot of square goals back then. That's just too specific, saying, draw a square and then having your measurements in there because you might get stuck, that you actually can't even work on that for some reason because they're resisted. And then obviously something like improves handwriting. That's too big. So here's an example of a just right goal, of how I dealt with our shapes and letter type goals. So that they're. I really thought about what's the real skill I'm trying to get to. And so say you're trying to transition into like a triangle or a diamond or letters that have angles. You're really just trying to get them to imitate an angled line. So then that's the meat of it. So imitate an angled line in a shape or a letter after demonstration in any medium. See, when you open it up to any medium, and then you can use your multimedia on five occasions, so it's very measurable. You got a lot of wiggle room, but you're really honing in on the skill that you really want, which is that they can. That they can make that transition. They can understand that angle line concept. All right, somebody isn't muted, so please check. And Morgan, you might be able to go in and mute people for me because that'll be distracting to everybody. Okay, so you heard me say the meat of the goal. So think of it as, there's just a lot of extra stuff, all your measurements, all of that kind of thing. The meat is the actual skill, what you want them to do or what you don't want them to do. The rest is qualifiers, measurements, really what you want to see. And if you get too narrow in the context, then that's where you're going to get in a trap. So be careful of that. And don't write test goals, make them functional and meaningful. You know, it's just that whole thing. If we're teaching to the test, they're not going to generalize the skill. For example, like, like it might be really common to write a goal. Like, we'll stack three blocks. What if they have no interest in blocks? What's the skill you're really after? Well, you're after that they can, that they can negotiate their arm out in space holding something with whatever type of grasp you want to say. And then they could do that without support and that they can, you know, negotiate that space. So you have to kind of break it down. I'm not really saying what the goal would be, but I'm just, you have to think of, you know, what it is it that you really care about that makes it so they can stack the goals. And then that's the meat of the goal, not that it's necessarily blocks. Are we doing okay so far? Thumbs up? Yeah. Okay, good. There's so many ways to measure goals. And I would get really hung up on this. And I honestly, I pretty much use these three things all the time. These are my measurements I use. So I don't go for 100% because to me it's good enough if it's 80%. And for our clinic, when they've met 80% of their goals, that's when we discharge them too, because at that point they have enough to do at home to kind of get to the end. If we try to go for 100% goals met, we get drop offs because they're feeling good and they don't feel like they need to come anymore. So we want to graduate them at about 80% of goals met. And specifically on my goals, same thing, I like to go with 80%, four out of five trials. Most of the time that's how I do it. And I also do it where it doesn't. I don't necessarily do five trials in a session. It'll be four out of five times that we've done the activity. And the other thing I really like is on so many occasions so they, if they tied a bow and they did it, they demonstrated it independently on five occasions. That way I can just do pluses and minuses or say, how much assist in my notes. And I can see that, oh, you know, in the last two months, they've done it all by themselves five times. Okay, we can mark that one done. I just find that's a really easy way to track it. And then I also, like, over time, and I use one month a lot. One month seems to be a good measurement. Like, no meltdowns or physical aggression for one month. Or did not ask for help with their shoes for one month. And that's a really easy one to ask the parents. They can think back to a month and think, yeah, they actually haven't had, you know, meltdown for the last four weeks. And then it's really easy to measure. So outcomes of sensory integration. This comes from when I originally did my Ayres sensory integration training in 2008. And this was one of my favorite little slides or handouts, because they listed out what's the outcome of this approach of sensory integration. Because the outcome is really what you want to write the goals about. So improved active engagement activities that can be social or physical. Some of the measurements for that could be how much cueing you do. If they come back to an activity, how many minutes they're on a task. Not just tabletop, but just overall activity. You know, just engaged in the activity. You know, if you're doing obstacle courses that they're engaged in doing that and not just running about. Number two, being able to hold still and pay attention. And that's probably one of the main things that kids come to our clinic for, is that they're. They just aren't able to sit and focus. So that is a big one. And also increased tolerance to change. You know, a lot of the kids are very fixated. Things have to be a certain way all the time. So tolerance to change is a really big outcome for sensory integration. Ability to generalize, social language. And of course, our motor skills, gross and fine motor skills. And motor planning is a big one. Motor planning is an adaptive response, which is what we're after with sensory integration. I just want to move these over a little bit. Okay, So I have an example here. Like, say you're pretending you're in a boat and it's sinking, and we have to get to a safe place and maybe have some rugs. And you give them the rugs, and you're like, okay, we got to use these rugs to get us to a safe. And then they have to figure out, like, to put a rug, like stepping stones to get to the Safe place, something like that. Them figuring out that motor planning, that spatial awareness, that whole thing. You give them like a little problem and then they got to figure it out. That's all in that praxis area. Improved organizational skills. And most importantly, and to me, this is why I have a private practice really is just improve the quality of life for the child and the family. That's why we're called ohana. Ohana is the Hawaiian word for family. That's my most important one. So here's some examples. But before I get into actually the examples, just a little note. I've left the baseline and the goal date out of my examples just to make them less wordy and what I do to cheat because I just don't like really long wordy goals. I mean, if you put everything that you're supposed to put in a goal, that's like a paragraph and that's overwhelming to people. So I can cheat a little bit. And I'll put at the top of all my goals, I'll put something like baseline is 0% unless otherwise stated, in other words. Or the baseline is unable unless otherwise stated. Because if I'm writing a goal, they usually can't do it at all. And then for the goal date, if I have just long term, if I have long term goals or short term goals, I'll kind of group it at the top like that. The following goals will be completed within 12 months or six months. You don't have to do it that way. And a lot of your EMRs and IEP writers, you don't have that choice. You have to fill in all the blanks and put in the baseline and the from and the to and the dates. So you just have to make them long. But if you have the ability to kind of do it more like in a word document, that's how I make them a little less overwhelming. So here's an example. For engagement on three occasions, Abel be able to stay engaged with one toy for five minutes. I did put a from in here. I put currently 30 seconds with an adult demonstrating the functions of the toy to increase his interest. That would be one example for holding still and paying attention. I use this goal all the time. Able sit calmly during tabletop activities for 15 to 20 minutes. 80%, four out of five trials. And when you write it like that, it gives you some latitude that you're maybe doing a fine motor toy. You could be doing a craft, you could be even having a meal. But it's a tabletop activity and that they're Sitting calmly. You could be more specific and say in a chair if you wanted to. That's kind of a given though. I think that they're in a chair. Tolerance to change. I will be sending you guys these slides too. Sorry, I didn't mention that. But you can also screenshot if you want to do that. Tolerance to change. We use this goal all the time. Abe will be flexible with activity choice and willing to try new activities on five occasions. An example for generalization, Abe will use a calming technique that he is able to do in clinic in the home on four occasions with minimal verbal cues to initiate. So he learned something at the clinic and we want him to generalize it and be able to do it at home. That's a common goal too. Okay. Social language. This is one we'll use a lot to initiate asking to join and play. So in our clinic, it's a little harder with COVID but with the different. Sometimes we'll kind of preset up a situation where pre Covid where we would have kind of planned for two kids to play a game together or something. And then we're gonna have the kid go over and ask the other kid if he wanted to join in a game. And we would kind of plan it ahead of time, but then suggest that the kid do that and then. And then that kind of develops like a friendship within the clinic if it's a good pair. And then he could start to initiate it on his own and say, hey, can we play? I want to go play with some so and so. And then, okay, go ask them. We're missing that a lot with having to keep everybody so separated. So for fine motor tripod, we're always working on tripod as OTs. So this is a real common one. Able demonstrate a tripod grasp when manipulating fine motor toys and tools. So I like to make it a little more broad. Not just a pencil. Because a lot of kids when they're developing their tripod, they're kind of turned off to pencils. So I'll put other things in there like a spin top and a wind up toy. And I went with the five occasions on that one. And then for a handwriting type goal, able to copy a sentence with second grade motor speed. I like to use the wold to get my motor speed. So so many letters per minute, whatever the goal is there. And I also I'll use From which assessment is it? Is it the print tool that has a nice. I think it's the print tool that has a nice. Like how many inches are or part of an inch. How high the letters are per grade. I like using that measurement. Yeah, it's from the print tool. Gross motor. Here's some real common ones. I use this one all the time. Having no loss of balance on moving equipment. And endurance is a big one. A lot of our kids are just. They tire out really, really quickly. So 30 minutes of endurance without signs of fatigue. And I put. I was thinking of some of the EI folks and like a lot of times I was. When I did ei I was doing a lot of trunk rotations. So we'll rotate trunk for. To reach for toys while in a transitional. We're reaching with toys or in a transitional movement. So sometimes I'll put a variety of situations that it's that I can measure it in without assist. And I did the 80%. Four out of five trials. Praxis. Here's like an obstacle course goal. Able to negotiate his body through a five piece obstacle course with accuracy and fluid coordination. And no loss of balance on five occasions with standby assist only. And then one for fasteners. This, this is another one. Like I can remember writing a button goal or a zipper goal and then they would never want to work on that one thing that I had the goal on. They just wouldn't do it. Maybe they'd work on buttons, but they didn't want to work on zippers. Or they'd work on zippers but they didn't want to work on buttons. So I learned a long time ago with fasteners. I like to just say that they'll get one of those fasteners independent and then list the ones they don't know how to do. And it just gives me a little bit of room instead of getting in the trap. Don't want to get in the trap or you're stuck. Organizational skills. Able to use a My Best Self checklist to complete self care and chore activities with no more than one reminder cue per item per day for one week. We do a little My Best Self checklist where they'll put down. We'll put down like things that they're already doing well and then things that the parents want them to work on. And it might be chores, it might be homework, it might be something self care, just whatever. And we call it My Best Self and we do a point system like each one is worth so many points and then they'll get a prize when they accumulate a certain amount of points. So we'll write the goal that way. Quality of life for the family. This Is a common goal. I write Aven's family, I guess I should say are able. Sorry. Hey, I can edit it right now. What did I do there? Are able to participate in community activities together without distress. I use that without distress for a lot of things. So, like, also, like with the. With, like, grooming activities that you know, that they'll be calm and won't show signs of distress. So I put some examples. That could be a grocery store. So if I wrote the goal really specific, like, he'd be able to go to a grocery store without distress. But then he can't do that. But he was able to go to the restaurant. This way I can give him credit for whatever the community activity is that he was finally able to do. So that gives me a little wigger room, but I can still measure it. Now, what about underlying conditions? And I'm sure this is what most of you guys were thinking about when you said sensory integration, writing about vestibular proprioception. Here's the thing. Insurance is really only interested in function. And the school and the families. Nobody really cares about the stuff we care about that makes it so they can function. So I put it in one goal. I just say, normalizes dysfunctions causing functional impairment. I actually learned this goal from my PT mentor, who was going through the exact same thing that he learned that the insurance companies didn't care how many degrees of motion the person could turn their head. What they cared about was, could they turn their head to see a car when they were driving function. So he did not even write goals regarding, like, soft tissue or range of motion or any of that kind of stuff. So he would write this goal normalizes dysfunctions causing the impairment. And then he'd write the functional goals. And that covered his underlying things he was working on as a pt. But I have found that works great for sensory integration, But I do track it for myself because it is the most important thing. So I track for myself on a grid, things like proprioception, reflexes, post ordering, nystagmus, localization to touch, core strength, all those underlying things that are critical and the most important things I'm working on so that they can do these functional things, because that's the foundation. But what I might have is, like, normalizes dysfunctions causing impairment on my goal sheet with all the other functional goals. And then I'll say above grid. And then that's where I'm tracking it for me. The insurance company doesn't ever see that, but that's what I'm paying attention to. Okay. Are we doing okay still so far. Thumbs up. Yeah. Okay, so this is the. If you got a piece of paper or if you want to screenshot this. But like I said, I'll with the replay, I'll send you the, I'll send you these slides too. But this is the little goal writing tool that I made up for you. So the most important thing you want to think about in your goal is what's that meaningful functional skill? What's the meat of it? It's not a test item. It's, you know, what's the point of it? And so for this example, I did like that, that he can participate in the community activities. Right. And then who? Abe and his family. And then what measurement are you going to use? And I threw in what my favorite ways of measuring are. But you know, any measurements, fine. Those are just the ones that my go to's. And then what's your baseline? You have to have the baseline somewhere. Like I said, I just kind of cheat and put it at the top. But might have to put it in the goal depending on your system and then by when then any conditions. So that might be level of assist the environment, signs and symptoms that you're seeing. So in this case I have without distress in the environments, the grocery store, church or restaurant. So I think if you use this kind of grid to kind of help you think through it, it'll help you with the goals. All right. And then of course maybe you thought I was going to talk about the smart goals best. So I thought I'd throw this in there too, make sure it's smart too. So smart goals, they're specific. Want to make sure they're specific and narrow for more effective planning. But then I also talked about don't make them too specific because then it's, you get stuck, get in the trap. Of course we want them to be measurable so that you can measure progress. Of course we want them to be attainable. Here's a little trick that when I'm writing goals and I'm trying to figure out where to start with my goals, I always have a goal in there that's something that they're partially able to do. So something that I like, maybe they do it occasionally, they're just not consistent with it. I'll make that my lower end goal. So then I know that I'm going to have some goals that they're going to meet for sure so I know they're attainable. Then I'll have some higher reaching goals after that relevant. That would be you know, they say goals should align with your values and your long term objectives. Well, relevant would be like meaningful. And that's the heart of ot, is that it's meaningful. And I think that's the most beautiful thing about OT is that we really care about what's meaningful to the clients and their families. And then an end date, you know, it has to. A goal isn't a goal unless it has a date on it when it's going to be reached. Dream with a deadline. So just as a recap, remember the whole idea of Goldilocks and make sure they're not too big, too small, make sure they're just right. And to not trap yourself, don't trap yourself to make it too small, but still make sure you can measure it, make sure it's meaningful and functional so that you have that meaty part of the goal of what matters. And then you have the 10 key outcome areas for sensory integration. I'm going to review those real quick. Just say them real quick. Sorry if I'm making you dizzy. So we have the active engagement, being able to hold still, pay attention, tolerance to change, generalize, social language, fine motor, gross motor praxis, organizational skills and quality of life. That is what doing sensor integration is going to help with. Again, sorry if I'm making you dizzy. Okay. And then we went over examples of each one and like I said, I tracked the underlying components progress for myself, but it's not something that I include in the formal goals. And then you have your goal writing tool and Morgan, did you see the email I sent with the link for the feedback? Can you go ahead and put that in the comments? So what I did is I made a. I made a little Jotform kind of feedback form that you can fill out and it just has three questions in there. If you would fill it out and let me know if it was helpful and what your takeaway is and anything we can do to improve those are the three questions. There it is. She just popped up. If you can just click on that and fill that out and I'll be able to see them coming in on my phone here, I'll. That would be super helpful if you could take a minute to do that. It makes it so that every time I do these I can do a little bit better job and be thinking of your questions because we're going to do a Q and A here pretty soon. And the other thing is that the thing that I said that a few people might be interested in is I do do coaching and if you are feeling like you need some help so that you can get more time back in your life. It's pretty amazing how helpful this is when you have somebody help you, guide you through how to look at your actual documentation and how you can streamline it. And I, with the people that I've been working with, we've gone from writing a daily note from taking it 20 minutes to taking three to four minutes, writing reports that were taking two or three hours. I get mine done in like 15 minutes. But the person I'm working with, she's under an hour now. She's like the person I'm working with right now. She's at about 45 minutes. That's super cool. And her goal was under an hour. So I'm excited about that. And when we did the, when we did the poll on how much time people were taking, calculated it out and there's a lot of people, if you add up all the time in the evenings and on the weekends that they're taking to do their documentation, it added up to five weeks in a year, which is really something when you think about that. So this is my invitation. It's a six week coaching program where you and I work together to streamline documentation. You can use this link, the Bit Ly. Bit Ly. And then my name. And then, and then Morgan's gonna put a link. It will look a little different. It won't be the short link, it'll be a long link. But she's gonna put the link in there. If anybody's interested in that, you can. And then we're going to open it up to questions and answers and I haven't seen any of these come in yet. So I'd really appreciate it if you guys did some feedback. That'd be super cool. I am going to make this big. I think we can. I'm going to stop sharing and. Hi. Did you just. I just let you in and you guys can unmute. We're a little bit smaller group so I think we could probably just talk for questions. I'm not seeing any of these come in yet. Has anybody filled it out, the feedback? Yeah, just not showing up yet. Working on it. So my problem with trying to fill it out when I do you cut out. I only heard problem. Who was having a problem? Oh, cool. Thank you. Sandy probably just is on a little delay. Yeah, thank you. I appreciate you guys giving me some feedback. So does anybody or Morgan, were there any questions that, that you saw in there?

Yeah, the first question was when you were talking about the goal about going out into public with your family. And someone asked when you state on five occasions, would this be consecutive or within a time frame?

I think you can just decide how that's going to be. Usually I just kind of leave it open to five times because I never know when they're going to go do something. You know, it might be a birthday party, but you can be as specific as you want to be. It really depends on the child. So that's usually a goal that gets met in the last two or three months that we're seeing a kid. And so usually for me, it usually is in that time frame in like a two to three month period. But it's up to you. You know, you can, you can say within whatever time frame you want. What else?

There was another question that said, how do you handle handwriting? Goals for school based.

For school based. Just like that example that I gave, I kind of get down into the problem with the actual what they're having problems with. Like I gave that angle line example and I did write letter goals like that. They would get, you know, a certain percentage of capitals A to Z and lowercase A to Z. But if you think about that, anybody could write that goal. It's not very Otish when you think about it. You can, you can just look at what the function is if you want to. You know, that they're able to complete assignment or be able to do their homework or that they could do something within a certain time frame in the classroom or outside of the classroom. It really depends on the child. But I really, after doing it for 17 years, towards the end of the time, I haven't been in schools for 12 years. But during, I'd say like the last five years of the 17 I was in schools, I started writing more and more goals that were more just trying to get to the nitty gritty of where the problem was, but still making it functional. So I'm not sure if I. How I answer. If I answered that I did a lot of, I did a lot of size, letter size and speed goals because that really got down to more the OT part of it that they had the motor control for the size of the letter and the motor control for the speed of the letter or the letters.

The next question was, do you ever write gas goals?

What's the gas? I'm not sure what that stands for. Goal attainment scale. Oh, oh, oh, yeah, yeah. Like, oh, yeah. That's kind of like if you have a lot of time, it looks nice. I haven't Done it? No, but it looks really nice. And I. And what that is for those of you that don't know, it's kind of a grid and it's like a narrative in each level of what it looks like when the child can do it or what it looks like when they're not doing it. And it's how they're doing a lot of the sensory integration research to, to make it real functional. But I don't write them that way mainly because I don't really. It's very time consuming way to do it. So I think it's really good though. Do you. Do you write them that way? I tried for a little while. Soon as I finished because you've got your proximal and your distal goals. But I'm curious to jump back in and hear how you address goals. This is why I got on because I find goals the hardest thing still. And I've been in this profession for a very long time. So you popped in at the end, right? Yes, I apologize. I got caught up. Oh, that's okay. You'll get a replay. Okay. And just let me know if you have more questions. But if I was doing research I would write them that way, but it's just, it's just very time consuming. I think the person asking about that was. Is in the chat. Oh, I thought you asked. Your agency requires it. Oh, interesting. I've never heard of it being required. Yep. Well, it's just going to take a little more time. It is. I mean it's a good method for sure. But you know, sometimes I, I think that's the thing, like for me being in private practice, I kind of get to do things the way I want to do them. And when you're working for. That's why I said like I take these shortcuts. But you might not be able to take shortcuts because of like the IEP writer. We had to like plug in from. To the date, you know, fill in all these blanks and then the goal was ginormous. But you know, you're going to be. You're going to have to use whatever your agency is requiring. But hopefully the things that I shared will help you think through it a little bit more functionally and give you some ideas of easy ways to measure. Anything else? Yeah.

Someone asked what were the two tools, tools you use to measure handwriting?

The two tools that I mentioned. Well, I just mentioned the height and the speed. I use the. Oh, probably the assessment tools. The wold. You can look it up online. W O l D It's just a one sentence copy that will give you, it gives you norms for each grade level, like how fast they should be able to copy it. But I just would use that and then I could see how big their letters were and I'd analyze it like, you know, are they having spacing problems, letters on the line problems? And I would take some stats off that for myself. The print tool is another one that's very extensive. It's really good for learning how to analyze handwriting. But again, it's kind of like time consuming to actually, you know, if you're, if you don't have a lot of time to go into that depth. But it, it really helps you gain a lot of skill in analyzing handwriting. But it has, it actually has like a scale for like how big the letter should be for each grade, which I think is really helpful. So I think that's what you meant. Those were the two, two assessment tools that I used a lot in the past.

So the next question was, you said you keep track of components. What are some ways you keep track and stay organized?

Well, I can show you. Let me see. I'll show you what my grid looks like. I'm going to pull it up and then I'll share it. Can you see that? Can you see that, Morgan?

Yeah, yeah.

So this is kind of my template that I use for work, how I track goals. So what I'll do is I'll paste my goals down here on my functional goals. But then like that first one is normalizes dysfunctions causing impairment. See above grid. And like I said, this is for me. And I just, you know, I have norms for all of this from clinical observations, the aers. Clinical observations, it's the one trying to think what the author of that tool is. But anyway, there's norms for flexion extension for each age. You know, and I know like I know that proprioception should be for a five year old within a centimeter post rotary nystagmus, one leg balance. So just some key things and then I score. I've developed a way of tracking their primitive reflex progress on a scale of 1 to 4. And so it's just in clinic how I track their progress so that I know if they're progressing on their reflexes. So when they've met all of this stuff, then I'll check that one goal off. So whatever your. I'm lost. I'm trying to find how to get back with you guys. Where did you all go? Stop sugar. So whatever you're track tracking for yourself you can make little, you know, for underlying things, you can make a little grid. I mean, I used to put them in the goals like core flexion and lot of those things. And then in. And then. But then I felt like then I had to justify and say, like, why does that matter? And then my goal ended up getting longer and longer and I'm like thinking, well, I need to educate people and blah, blah, blah, blah, blah. And then after all these years, this is what I find the easiest to do. The stuff I care about, I put in the grid that's underlying and all their goals are functional, but I just keep track of it so I know how they're doing and that I know that I'm making sure that I work on all those underlying things that they need. I just found separating it made me less crazy.

So another question is, I tend to create so many goals, like bottom up, starting with postural control, up to more defined skill level. What is your average amount of goals? When a child meets a goal before the year, do you add another one to up the expectation?

Well, for us, we tend to see kids on average if they don't have a lot of other conditions. If it's mainly sense integration, about 36 visits, which is depending on if they come once or twice a week, can be like four to nine months. And I would say I'll have like probably 15 to 18 goals for that amount of time. I really don't like having to write goals again, like once I like when they're written, like I want them to last for their whole time, so I'll do it like that. So I try to make enough goals that it's going to take them, but. Oh, I didn't mention this, but it's really important. It's really, really important when you are doing your assessment to find out what the primary functional concern is of the parent. Because as OTs, we can just address 100 million things. But if we don't have like that main target that matters to them as the main thing that we're working toward, then, then we're really not helping them. So when I do my assessment, I'm always getting the, you know, just trying to get down to what's most important to you. And it might be something like, you know, I want to be able to leave the house with my family. Okay, that's the number one goal. And then I work back from there and then I have that as my primary, primary functional goal. Everything else is just building up to that.

So the next question is emotional regulation is big. Do you see a hierarchy of what needs to happen when a child shows distress several times a day? These questions are so hard to write because I realize so much depends on the child's profile and strengths and limitations.

Well, getting to the underlying part of the. The reason that they're having the problems is, you know, a lot of what we're doing. So if they have a moro reflex or if they're typically the proprioception and vestibular are out of whack. And so that those three are the main things that cause the kids to be. Know dysregulate so fast. But like I said, I don't write the goal. The goal about those things. I fix those things, but I don't write the goal about that. So my goal will be something like, doesn't have a meltdown for a month. That's a big goal. Or no physical aggression for a month. And then you could break it down into smaller, like a week or whatever, or goes X number of days without. If they're doing it like multiple times a day, then you know, your. Your first goal. You might want to break it down like that. They can make it a whole week without being physically aggressive, something like that. But that's the way I address. Like, you have to look. What does it look like when they're dysregulated? Well, they're throwing things or they're yelling or they're hitting. So you write the goal about not doing those things. And then I always have, like, we do a lot of zones of self regulation with the kids, too. So I'll have. I'll usually have a goal in there about that they're able to demonstrate a calming technique after being taught, you know, like, we can teach, like, say, Bubble Mountain. Like, we taught them how to do Bubble Mountain, and now they're. They've practiced it and they can demonstrate it. And so they're gaining some tools in their toolbox. And then another goal might be that they will use one of their tools, their calming tools, with a verbal cue to initiate it. Like, hey, why don't you do, you know, whatever it is that's in there? Or you might show them, like, their calming tools and then pick one. So they need a little bit of a prompt, but then they go do it. That could be like another one. And then initiating it on their own, which is the hardest goal to meet, could be the other level. So that's how we'll write those. Oh, thank you, Erna. Clinical observations. Erna. Blanche. That is the best training CD ever because she goes in there and she showed. Thank you, Holly. She shows what normal looks like and what abnormal looks like and it really, really, really fine tunes your observation skills. It's really awesome. That was one of my favorite things that I, when I got my SI training that I learned about how do I write goals for feeding? I see that one on there. Typically it depends on what the kid needs. But really common goals would be like that they'll interact with X number of new foods. So interact can be, you know, serving it to somebody else or you know, it might be like we're doing a cooking activity so they're interacting with something new. And then, then they'll be like, it depends on the case and the kid. If that's like all we're doing, I'll break it down into a lot smaller things like that they'll, you know, that they'll touch it or they'll taste it or they'll smell it depending on where they're at with X number of new foods. And then I'll write down like the size of the bite because you know, it's a really big difference if they have like a, well, you know, like a poppy seed type size bite compared to like a real teaspoon or something, there's a big difference. So might be like a pea sized bite that they'll have X number. But usually I'll say of so many new foods and then, and then the ultimate goal might be that they'll incorporate X maybe eight new foods into their diet that they'll eat. But if the problem is like they're not getting a protein or vegetable, I might be more specific about the type of food it really depends on. On if you haven't taken like the SOS course. It's really helpful for learning all the little baby steps between being in the same room as a food all the way up to eating the food. And that helps you write the goals because it's things like being able to look at it, being able to have the food in front of you, being able to, you know, bend down and smell it, Being able to, it just works all the way up. Even like before actually eating it would be like chewing it and spitting it out would be a really high goal. So depending on the case, like if that's all you're doing, you can break it down into lots of little, little steps. But if you haven't taken the SOS training, do that. It's really helpful.

There was a question that said, are the reflexes typically integrated just Using sensory integration or are you having them do separate exercises for primitive reflexes?

Oh, I'm getting these in. Thank you. Oh, I got a bunch of them. Thank you, guys. I just want. I'll answer that in a second. I got distracted. Meryl, Michelle, Denise, Christine, Cindy, Kelly, Allison, Ally, Siri, Maureen, Holly, Jennifer, Jennifer, Sarah, Sandy. I got all of yours. Thank you. I haven't looked at them yet, but I see they came in okay. Sorry, I got distracted. The question was about.

Reflexes.

Oh, the reflexes. Okay. Yeah.

You want me to read it again?

Yeah, sorry. I distracted myself.

Are the reflexes typically integrated just using sensory integration, or are you having them do separate exercises is for primitive reflexes.

I actually do three different things to really get to the reflexes. So a lot of times doing sensory integration activities helps because, like, let's say, for instance, they have an ATNR and they're negotiating their way through an obstacle course, and they're, you know, hanging on to something, and then they're turning their head to reach for the next thing, you know, so they're gonna. They're gonna have some integration that way. But I haven't found that that alone does it. I. We always do really specific exercises. Like, you can get a lot of them out of. I really like ReadyBody's Learning Minds. Has anybody done that one that has great exercises in it. And then there's also other classes I've taken on reflexes. I'm trying to think of rhythmic movement has a bunch, but there's basically, there's just some different reflex activities that has them kind of move through. Through it. And the kids don't like doing it. So that's always, like, for prize. So it's homework. So they'll do like. We call it Kitty Cobra. So it's like child pose into, like. I guess it's called the cobra pose. That one really integrates the stnr. They have to do real slow. So we'll have them do. Usually it takes at least 30 days of doing it and doing 10 slow reps. And so the halfway point, they bring in their chart and they get something out of the prize box. And then. Then they do another couple weeks of it, and then they get another prize. But that's how we get them to do it. But that really works to do those exercises. And then we also do something really innovative in our clinic that we've done for seven years. A long time ago, probably eight years ago, I had a mentor that. Who's a pt, and he used laser a lot for. In his Clinic for pain and for healing and various things. And he's like, if you're, if you're working on reflexes, you need to learn about laser for reflexes. And I'm like, what on earth are you talking about? I have never heard about this. And so I did some research and I use Bonnie Brand's quantum reflex integration and I've done it for seven years. I don't do it as ot. I do it as a wellness because it's not evidence based for ot. So I do it as a cash package wellness program. And, but it's, it's like miraculous. It works so well. So if you have kids that do not want to cooperate or you know, won't do exercises and you have to do it, it's something you can do passively on them. So you just hold the laser on these reflexology points in a pattern and they, they just stay busy doing something while you do it. It's amazing, especially for integrating the moro. And to be quite honest, I have never had a kid that it didn't work on in seven years. So it's pretty, pretty amazing. And took me a while to kind of really embrace it because it is so, you know, I didn't want to be seen as like a really far out there therapist doing this weird thing. But it works really good. And I, every student that I've had at my clinic, I said, please come back and do research on this, please. I'm not a researcher, but it's real safe. Class 4 lasers are very safe. There's thousands, thousands, like more than 4,000 studies showing their effectiveness for other things for edema and healing. It's actually kind of amazing that they're not just standard care, but they're not a drug, so they're not standard care. And these points, there's another procedure where you can rub these points, but they take like a minute each and it's very hard to do. So she basically just took this, this tool and applied it to these points and it works. So it's pretty cool. Oh, I'll type it in. So it's. And like I said, I don't do it as ot, I do it as wellness. But you know what's nice about that? It's nice to have a cash based, you know, something that's cash that insurance doesn't pay for because then you can charge cash for it. I'm just thinking I'm going to find the link for you. Hang on. But it's, it's awesome. She was. I can never think of how to pronounce the name. Somebody tell me how it's pronounced. I know I'm not saying it right. How do you say her name? Anybody know? But it's this. How is it pronounced? Moskatova. Svetlana Moskatova. Thank you. Moskatova. I don't know why. It's like a dyslexic thing or something. I can never say her name. Bonnie was traveled around the world with her. She was a trainer for. So her background is in the Mosk Tova method originally. And then she thought, this is so labor intensive and so slow. There's got to be a better way. And then she came up with this other way. That's pretty cool. Any other questions that I can help you with? Did we get all the ones in the chat, Morgan?

No. Someone asked if you could share your my best self checklist.

See if I can find one here to show you they're different for every kid. Here's one that we had for Zoe. Let's see if this is gonna. Oh, there it is. Okay, I'm gonna screen share so you can see this. Lost on my. Here we. Can you see it, Morgan? Can you guys see that? Okay.

Mm. Yep.

So this was an actual one that we had for a kid. She was a teenager. So the. So like I said, like, three quarters of these things are things she's already doing well. That way she gets momentum for gaining points. And then we just decided how many points each one of these would be. But she had hairbrush, clean clothes, teeth, brush. This was the big one. That was the big problem. Getting out the door on time and then accepting no for an answer. So saying okay, so those were like her pain points that. Where she wasn't doing well. And then staying calm when she doesn't want to do something. So those were like the hard ones for her chart night write things in the planner. This was an activity she liked going to, so going to young life. So most of these were things that she did anyway. And then the hard things are sprinkled in there. And then we had just handwritten. We had decided how many points each was worth. And the harder things were worth more points. And then they would just write in points each day. So it's really customized to whatever it is they're working on. But like I said, the key was like having three quarters of it be something that they're already doing successfully because then then they're. They get momentum, they get the points. And then we just had like, we calculated like the way I calculated it was, I figured out based on how many things she was already doing, how many points she would already be earning, naturally. And then what if she did everything perfectly, how many points would that be? And we picked somewhere in the middle. So it wasn't, we weren't looking for perfection, but it was beyond where she was. And then when she got that many points, there was an agreed upon reward of some kind. So it was either a reward at the clinic, like our prize box, or an activity, special activity she wanted to do, or the, or the prize might have been something that they agreed on as a family, like they're going to go to a movie or every kid's different. We just agree ahead of time. You get this many points, this is what happens. But it's worked really well with a lot of kids that are difficult. All right, anything else?

I think there's also a question it said, I think it's like asking, how do you write parent goals or home based goals?

The same way, just that we've been talking about, but you know, just finding out what's important to them. I guess if it was a more specific question, I could answer it maybe a little better. Is there like a particular goal area you're trying to figure out how to write it, like. Yeah. Holly, do you have like an example sometimes what you, you may want to see a parent shift their approach on a child or you know, as how they support the child for success at home. And so in some ways it's almost giving the parent their own goal. Not necessarily that they will, you know, continue with what you're doing, because that's different. But what if, I'm just curious if you do parent goals or home based goals that given X, Y and Z, the parent will provide? I don't know, I'm just curious if you've ever placed the parent in a situation where they have some work to do as well. Well, I don't write goals about it, but every session we have homework. Like we have this little sheet that has like the child's name and date and then it says highlight homework. And it's little, so it's really enough for just two sentences. Maybe not even because we want to keep it really simple. And then it has their appointment at the bottom. And so that's like their little appointment slip to remind them. But we'll put, we'll try to say, oh, this is your brag sheet. What was great about this session today? Oh my gosh, you held the Superman for 30 seconds or you met this goal you know, whatever they like. Woohoo. And then we'll have whatever we want them to follow through with at home. But we always, I always keep it. The key to follow through is that you only give them one thing to do and then it's reasonable. If you give them more than one thing to do, it's just too much. So I just keep it really simple. Like your homework is whatever it's gonna be, you know, like you can do kitty cobra. Are you gonna do brush and squish, Willbarger? If we have them doing that or you're gonna do. Or you're going to. And if there's something for the parent, that's where I'll write it down. Like you're going to remember to ask what they meant to say or something like that. Like, say you have a strategy, like the kids barking at them. And then, you know, the strategy is like to give them a second chance. Like, you know, what did you mean to say? Or how did you mean that? You know, like giving the kid a chance, like a second chance to think through it instead of like barking back at them or, you know, whatever it is that you want them to work on. That's where I'll put it. But I don't do it as a goal necessarily. Okay. They're like mini goals in a way. Yeah, it's just like a little piece of homework. Or if you're giving them a tip, like we'll say a lot of times we'll try to change how they word things, like saying you can instead of can you or would you. Could you. You can do this, you can do that. So it's like an affirmation. So if, like we're giving them a tip or something that we're trying to have it, we're trying to get them to change, we'll write it on that and then we'll just ask them how it's going. Thank you. You're welcome. All right, I think we're nearing the end here. How are we doing?

That's all the questions that I saw in the chat. So anyone else had one or I missed it.

Well, thank you guys so much for. I look forward to reading the feedback and hopefully it was really helpful. And let's see, let's do, let's do a picture. I don't have enough people. There's a lot of people blacked out here. Oh, well, those of you that are here smiling will take a picture. Okay. Smile. I like getting a group picture. Oh, people are coming on. All right, come back on. I'll take a picture your video. Stop hiding. All right. We're getting a group picture. Although I have to do two. All right, I'm going to take it again. Right? Smile. And I'm going to do the other side here. Okay. Smile. I understand why you're hiding, though, because it's kind of weird, like when you watch these and then, I don't know, you might be stretching or doing whatever, and you don't really want everybody in the world to be seeing that, so I get it. But when you're presenting, it's so much nicer to be able to see people. So it's good. All right. Well, I hope that you guys all have a great evening, and thank you for coming on. And I'll send you the replay probably tomorrow, and we'll go from there. Thanks. Oh, I'm glad you liked the Q and A there. Thanks, you guys. I look forward to seeing your. Seeing what you wrote. I appreciate it a lot. All right, cool. All right, bye. Thank you, Morgan. Appreciate your help.

Yep. See you Monday.

Yeah. See many. Have a good weekend. Me, too. I'm so glad the smoke is gone. I guess I'll wait for a second. Morgan, you gotta stop recording now. Where's my recording?