School closures, self-isolation and occupational deprivation

Occupational Deprivation: being precluded from participating in activities that are important to us due to reasons outside our control.

We’re living through strange and unprecedented times. The latest government advice on Coronavirus will mean greater social distancing and more pupils and families being asked to self-isolate. And with school closures seemingly inevitably on the horizon, these times are going to be challenging for children, families and school staff.

Schools have rightly stepped up their planning for home-learning; exploring workbooks, online resources and web-based lessons. But school is about so much more than academia and education is not the only thing pupils miss when they are not in school.

“Education is not the only thing pupils miss when they are not in school”

School offers pupils opportunities to play with friends, to interact with a range of adults, to participate in extra-curricular activities and to engage in physical activity. For one it provides safety. For another it provides structure and predictability. A valued role of being a learner, an opportunity to achieve, an avenue to a future career. School holds a different meaning to each pupil and this meaning extends far beyond academia. And by the same reasoning, self-isolation and school closure takes away far more than just academia.

“Self-isolation and school closure takes away far more than just academia.”

The impact of self-isolation and school closures will extend far beyond educational attainment. This has the potential to impact massively on social isolation, mental health and physical health. Just imagine two weeks without being able to contact your friends. No phone, no social media, no email! Just imagine two weeks without being able to participate in the hobbies most meaningful to us. This is what Occupational Therapists term occupational deprivation and its effects can be massive.

Occupational deprivation is when we are precluded from participating in activities that are important to us due to reasons outside our control.

At times like this, communities need to come together to support each other. As major players in our school communities, families need us to support them not only academically, but holistically. This means minimising the risk of occupational deprivation and its impact on social isolation, mental health and physical health. But what can we do?

Here are 4 things we can do as school communities:

Routines: Many families will want to introduce a routine at home. This will look different to your timetable at school – they might intertwine academic, social and play activities differently – but the children will still benefit from the same structure and predictability. How about providing a blank timetable, with tips for what activities to include? Or provide visual activity cards to be cut/stuck onto the timetable?

Social Isolation: Social distancing and restricted visiting in care homes and hospitals will make it harder for families to visit their relatives and friends. Why not challenge pupils to explore a new way of communicating? Has their family used email, Facetime or Skype before? Perhaps they could list which relatives and friends they want to contact and identify slots in their timetable to do this?

Occupational deprivation: Many pupils will struggle to fill their time or will fill it solely with sedentary activities like gaming. Why not provide a list of active leisure activities and challenge pupils to try a new activity each week? They could allocate a 30-minute slot each day on their timetable for active activities.

Feeling like a learner: Motivating yourself to learn outside your classroom (or workplace!) is hard work! Why not explore creative ways for pupils to evidence their achievements and for staff to give them feedback? What about pupils creating a blog or vlog? Families posting photos on the school’s social media? Or regular webinars with school staff?

I’m hoping to create some resources over the coming week to support families to minimise occupational deprivation. As ever, I’m happy to share any resources with schools and families – just contact me @DanWaldronOT. Keep safe and look out for others.

Sensory Processing: Theory and Classroom Strategies

We’re all familiar with our five main senses: touch, taste, smell, sound and sight. But, when we talk about sensory processing, we have to introduce two other players: the vestibular sense and the proprioceptive sense.

The Vestibular Sense: This is the messages our brain receives from the fluid in our ears, about whether our head is aligned. It is integral to our balance.

The Proprioceptive Sense: This is the messages our brain receives from our muscles. It tells our brain where our body parts are in space and how they are moving. Close your eyes and try to touch your nose with your finger. This is your proprioceptive sense!

“You can think of each of your sensory systems like being a cup. The water is like a type of sensory input. If you are under-responsive to a certain sensory input, it’s like you’re a big, HUGE cup…”
See YouTube link below

We all have our own sensory profile – our unique way of processing the world around us – and this means that we process these senses differently. For example, I find bright lights uncomfortable to look at. Others love watching firework displays and action movies. I love listening to loud music. Others find loud music distracting.

I’ve tried explaining this to school staff and Occupational Therapy Students in lots of ways, but keep coming back to one video. In this video, a young boy describes his experience of living with sensory processing challenges, using the analogy of CUPS and a TAP: ***WATCH HERE***

So, what might I see in the classroom?

So, imagine you have a ‘small cup‘, what might we see in the classroom?

Touch: Anxious when others are close to them? Irritated by clothing, especially tags? Avoiding messy play?
Sound: Unable to concentrate on work when there is background noise, like electrical items humming or classroom chatter? Alarmed by unexpected noises, like school bells? Makes noises to ‘drown out’ the noises of others?
Sight: Looks at lights, bright displays or colourful worksheets using peripheral vision? Uncomfortable looking at the whiteboard? Gets regular headaches?

Now imagine you have a ‘big cup‘, what might you see in the classroom?

Touch: Fiddling with objects, like pen lids? Touching others’ hair, clothing or objects?
Sight: Struggles to extract key information from lengthy text? Flaps their fingers in front of their eyes? Easily distracted by movements outside of the classroom, such as out of the window?
Vestibular: Rocking backwards and forwards on their chair? Regularly moving around the classroom?
Proprioceptive: Repeatedly tapping feet and/or fingers? Fidgeting and changing posture? Clenching fists?

And now time for a disclaimer! Clearly, this list is far from exhaustive. It’s also a simplification of how our self-regulation impacts on our behavioural responses. Finally, many of the behaviours above could have a cause that is not sensory-based also. Right, small print over, let’s talk about strategies we can use in the classroom…

So, what strategies can I use to support sensory processing in the classroom?

Here we explore 3 steps to supporting sensory processing in the classroom:

1) Am I using universal design principles?

Let’s start with the tricky one and the contentious one. How can we create a classroom environment that is enabling for all pupils in the class, when we have already said that every pupil is unique? Well, we can’t! But we can create a sensory-friendly environment for our pupils with ‘small cups’ and then facilitate adaptations to enable those with the ‘big cups’. For example:

Is the area around your learning wall free from visual distractions? For example, can the pupil with visual processing challenges ‘pick out’ your visual timetable from the other displays on the focus wall?
Do you have a system to manage turn-taking and pupils’ volume during lessons?
Do you turn off background noise and light sources (e. g. projectors, computers) when they’re not in use?

2) Is the behaviour really problematic? And for who?

If a pupil is showing a ‘seeking behaviour’ (e. g. rocking on their chair) or an ‘avoiding behaviour’ (e. g. looking down when listening to instructions), that pupil is meeting a need. Before we intervene with our newly-honed sensory processing knowledge, think: is the behaviour problematic?

If the pupil is fiddling with a pen lid during a lesson or flapping their fingers in front of their eyes, is this creating a problem for the pupil, the other pupils in the class or you? Probably not. So we don’t need to do anything. Phew!

But sometimes the strategies pupils use can create challenges. What about the pupil that taps their fingers on the desk throughout the lesson or repeatedly touches the hair of the child next to them? Let’s have a look at step 3:

Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. *Canadian Journal of Occupational Therapy*. 63(1):9-23

3) Do I need to use an individual sensory-based strategy?

Your universal design principles are in place. You’ve identified a behaviour that creates a problem. Now is the time to look at individual sensory-based strategies…

Let me introduce you to the Person-Environment-Occupation Model. In short, it highlights that behaviour is the result of the interaction between a person, their environment and the occupations (tasks) they are doing. Here is principle #1:

Sensory-based strategies should adapt the environment or occupation, NOT the person.

Don’t be fooled by programmes that claim to change a child’s sensory profile – it doesn’t work! Think about your cups and how you can adapt the environment or the occupation to fill them up or empty them! For example:

If your pupil has a ‘big cup‘ for touch and keeps touching their friend’s clothes, which is making their friend uncomfortable… could we fill up their cup by giving them a tangle toy or piece of blue tac to fiddle with instead?
If your pupil has a ‘big cup‘ for proprioception/ vestibular and keeps moving around the classroom… could we fill up their cup by offering them a disc cushion to sit on or movement breaks?
If your pupil has a ‘small cup‘ for sound, which means that they become frustrated when trying to work with background chatter… could we empty their cup by allowing them to listen to music during independent work?

So, what’s next?

I hope you’ve found this article useful, in either validating some of your existing practice or developing your skills.

If you would like to learn more… click here to find out about our training sessions in Birmingham and Coventry. The training (£20-£40/half day) is aimed at school-based staff and Occupational Therapy students and focuses on theory and classroom strategies.

5 Top Tips for Supporting Transition into September

Most of us are feeling it. That anxious feeling as the summer holiday draws to a close and a new academic year approaches. “Am I ready to teach this new class or subject?” “Will my new class respond to me and my teaching style?” “Is my classroom inclusive for my new pupils?” It’s natural. Change brings uncertainty. Uncertainty poses a threat to us. We are not alone in holding these feelings; they are feelings we share – to greater and lesser extents – with our pupils.

It’s important to acknowledge that transition – even a ‘simple’ change of teacher and classroom – encompasses changes that extend well beyond the physical and social environment, to include a myriad of complex changes to the pupil’s implicit expectations, roles, routines and subjective experiences.

Most pupils will have met their new teacher. Most will have visited their new classroom. Some will know information about their curriculum. These transition strategies are valuable – arguably essential – but think: would these strategies alone alleviate the anxieties you have about the new academic year? Would they alleviate the worry that your class will not respond to your teaching style? Or the concern that your classroom might not support one of your pupils to participate in learning activities? Probably not. Likewise, it will unlikely be your sole transition strategy for your pupils.

It’s important to acknowledge that transition – even a ‘simple’ change of teacher and classroom – encompasses changes that extend well beyond the physical and social environment, to include a myriad of complex changes to the pupil’s implicit expectations, roles, routines and subjective experiences.

“Change ordinarily occurs across a continuum from exploration to competence to achievement”
Reilly 1974

So, what changes do we need to consider?

Did the pupil have a role in their previous class? Pencil-sharpener? Volume monitor? Plant-waterer?
What was the pupil’s routine for arriving at school, snack time, returning to the classroom from lunchtime etc.?
How did the previous teacher reward positive actions? And what were the pupil’s individual goals that were rewarded (e. g. putting their hand up to ask a question)?
Did the previous teacher incorporate any interests into learning activities to enhance motivation?
Etc. etc. etc.

This “change ordinarily occurs across a continuum from exploration to competence to achievement” (Reilly 1974). This means that, before pupils feel “competent” in their new environment, they tend to progress through a phase of exploration. Exploration is when we try out things in order to learn about our expectations, our capacity and our roles. There are some strategies, though, that can support pupils to successfully progress through this exploration phase.

5 top tips for supporting transition into September…

Gather information like a squirrel gathers nuts! Knowing how impactful the implicit and subjective changes are, the more information you can gather from the pupil and previous teacher, the more prepared you will be to prepare your pupils.
It’s good to talk! For some pupils, the implicit changes might not be so easy to discover so to avoid this exploration phase extending or causing unnecessary anxiety, talk explicitly about the changes. For some pupils, a short chat with suffice; for others, a transition book or social story might be necessary.
Similarities can be the glue that holds your transition together! Whether it be using the same reward chart, starting the day with the same routine, bringing a transition object from their previous classroom or a weekly visit to their previous teacher, think about what needs to change and what could remain consistent, even if only for a transition period.
Slow and steady wins the race! If possible, introduce changes gradually. This gives you time to prepare pupils for a change, then implement it.
Slow and steady wins the race… part 2! “Exploration requires a relatively safe and undemanding environment” (Kielhofner 2008). Introduce the academic demands gradually. ‘Taking a hit’ on the academics and taking the time to create a safe environment for your pupils will pay off in the long run.

From blog to practice…

I hope you’ve found this blog useful. For many of you, the information will simply validate your existing practice, for some it will provide a theoretical underpinning for what you already knew and for others it might change practice going into September. Either way, I wish you all the best for the new academic year.

Please follow me: twitter.com/danwaldronot

Please look at our training opportunities in Birmingham and Coventry: https://www.eventbrite.co.uk/o/selly-oak-trust-school-26136994149

What is School-Based Occupational Therapy?… and does my school need one?

“Think about the 3 activities you value most. Now imagine you wake up one morning and can’t do them anymore. An Occupational Therapist is the person who helps you do these activities again.”

I wish I could remember the person who shared this quote with me! But, although the name didn’t stick with me, the quote certainly did. I, like most Occupational Therapists, have wrestled with how to define our profession to others in education. We know the value of our work, but how do we explain this to our pupils, their families, our colleagues and the commissioners?

“Occupations are the things we do to occupy our time”

One of the main difficulties is explaining what on Earth an occupation is! For most outside of our profession, the term ‘occupation’ brings connotations of employment and, therefore, confusion with the role of Occupational Health. In Occupational Therapy, however, occupations are simply the things we do to ‘occupy’ our time.

“An Occupational Therapist helps people to participate in the occupations they want to do, need to do or are expected to do“

In the typical roles and routines of their school day, a child participates in many occupations:

Playing with their friends
Interacting with their teachers
Using the toilet
Eating their lunch
Writing
Getting changed for PE

Some of these are occupations a child wants to do (playing with their friends, perhaps), some that a child needs to do (e.g. using the toilet) and some that a child is expected to do (e.g. writing).

The role of a School-Based Occupational Therapist is to use evidence-based interventions to enable children to participate in the occupations that they want to do, need to do or are expected to do.

So, does my school need a School-Based Occupational Therapist?

School staff do an incredible job of taking on more forms than an average Power Ranger! As well as educating our children, they are the shoulder to cry on when they’ve fallen out with their best friend, the first port of call when something goes wrong at home, the first aider when they fall over in the play ground and, in some cases, the child’s most trusted adult. But what about enabling a child to participate in occupations? Well, sometimes they even do this and probably without even realising it!

Have you ever set up a handwriting intervention and seen improvements in legibility on evaluation? Have you ever started a lunch club and returned to see your pupil talking with a new friend, around a topic of shared interest? These are real moments to cherish; moments that make real differences to our children’s lives.

But sometimes, despite the best will and after emptying our toolbox of strategies, we don’t see the outcomes we hope for. Sometimes the pupil that struggles to get changed for PE begins to withdraw from the subject. Sometimes the pupil that struggles to use cutlery stops eating at lunchtime. Or sometimes the pupil who struggles to make friends begins to use ‘negative behaviours’ to interact. These are the times you might refer to a School-Based Occupational Therapist.

I hope you found this blog interesting and useful. For more information, please comment below or contact @DanWaldronOT on Twitter.

Handwriting: Challenges and Strategies

“I know what I want to say. I just can’t write it down. It’s so annoying!”

This is one pupil’s reflection on why he walked out of class earlier this week. But this is one of many similar stories and a story, I’m sure, that resonates with many children, parents, carers and teachers. Indeed, between 10% and 30% of school-aged children experience handwriting difficulties. When considering that up to 60% of a child’s school day comprises fine motor tasks, with the majority of these being writing-based, it is no wonder that children with handwriting difficulties find school incredibly challenging.

So why is handwriting so challenging? Handwriting is a complex task, involving a blend of motor and visual-perceptual skills; balance, body awareness, core stability, eye-hand coordination, in-hand manipulation, to name a few. And this is before we layer the cognitive demand of letter formation, sentence construction, creative writing etc. on top! When you are a novice writer, that’s a lot to focus on!

“Being a novice writer is very much like being a novice driver”

To draw on an analogy: being a novice writer is very much like being a novice driver. If you’re a driver, think about your first driving lesson. Everything requires conscious effort: How hard do I apply the accelerator? Where is the bite on the clutch? Which lever is the indicator? This leaves very little capacity for cognitive demands like having a conversation with your driving instructor or listening to music. It’s a similar experience for many of our children. The demands of sitting still, maintaining a comfortable posture and holding the pen in a functional grip might leave very little capacity for the child to remember how to form the letter ‘a’ that you’ve been practicing all week!

But what can we do to support these children to become expert – or, at least, satisfied – writers? Does practice make perfect? Well, kind of, but not quite! I practice singing every day. I sing in the car. I sing in the shower. I probably sing in my sleep. But would you like to hear my rendition of Nessun Dorma? Not without some industrial ear defenders! That’s because I have about as much knowledge of how I should warm-up my voice and control my breaths as I do about fine wine. And that’s not much! A better headline would be: appropriate practice makes permanent.

“Appropriate practice makes permanent”

So what does appropriate practice look like? Is it massed practice? Daily fine motor programmes? Sensory-motor play? Fortunately, the evidence is quite clear about how we can support appropriate practice:

Fine motor programmes do not improve handwriting.

Fine motor programmes develop fine motor skills, but the evidence is clear that this alone does not translate to improvements in handwriting performance. And, when we think about it, it makes sense, doesn’t it? Imagine you have tickets to see a pianist at the Royal Albert Hall this evening. The pianist has been practicing daily since September for this big occasion. Finger isolation. Grip strength. Range of movement exercises. He’s done it all! But he’s never played the piano in his life… What are you expecting from the show? It’s the same for our children. If our aim is to develop handwriting, we need to practice handwriting!

So, should we scrap all of our fine motor programmes tomorrow? Well, maybe not. The evidence is unclear at this stage about whether fine motor programmes enhance handwriting practice versus handwriting practice alone. So, don’t put away your High Five Jive or your Dough Disco yet; just make sure that if your aim is to develop handwriting, you’re practicing handwriting as well!

Appropriate practice makes permanent!

20 sessions. That’s what the evidence tells us is the minimum necessary to make significant improvements in handwriting performance. That’s a lot! And, in reality, that might be impractical for a school to embed into a child’s timetable or for a parent to commit to in evenings and weekends. The reality is that the most effective handwriting interventions are when school and home work collaboratively and have honest conversations about how, who and when they can hit that 20-session target.

But what should these sessions include? Many of the strategies that have been used in schools for years are effective. Motor imitation, where the child copies the adult ‘sky writing’. Memory retrieval, where the child looks at a letter, the adult covers the letter, then the child writes it. And visual cueing, where the child overwrites dot-to-dot letters or follows arrows (although, interestingly, evidence tells us this is only effective when supported by memory retrieval).

Repetition, fun and evaluation.

I still remember the first time I attempted writing letters in shaving foam with a small group of Key Stage 1 pupils. I clearly underestimated how much shaving foam expands. The marks might well still be on the sensory room carpet! But this was a fun, engaging (albeit messy!) way of delivering motor imitation. And the possibilities are endless! What about asking the child to use a wet cotton bud to erase your letters on a chalk board (visual cueing)? Or playing hide-and-seek letters, where they have to turn over the letter cards that they find and copy the letter on the reverse (memory retrieval)? Learning handwriting should be fun, otherwise it becomes just another lesson learning about yet another thing that the child is no good at!

The process of learning doesn’t end when the child finishes writing, though. The final piece of the jigsaw is evaluation. Which is your best letter? Does your letter look like mine? Did you keep your sentence on the line? The evidence is clear that learning is embedded faster when evaluation is incorporated into the sessions.

So to summarise, handwriting is a complex task, but it is well worth investing the time to support children to develop this skill. If your aim is to develop a child’s handwriting, it is important to plan your intervention to maximise success: What is the specific aim of the intervention (to write a letter, a word, a sentence)? Who will facilitate the 20 sessions and when? How will we make motor imitation, memory retrieval and visual cueing meaningful and fun for the child? And if you’re still having difficulties, don’t forget that your friendly neighbourhood Occupational Therapy team is always available for advice and support!

Thank you for reading and I hope you’ve found this useful.

This blog originally featured in the August edition of the @ChatterpackUK newsletter. Visit chatterpack.net to subscribe free, for SEND resources, blogs, useful links and training events.

So, what shall we talk about?

“To share learning between schools and between disciplines”

The aim of this blog is to share learning between schools and between disciplines. To achieve this, we need posts that are relevant, interesting and by real experts in that topic.

Do you have a topic you feel would be relevant and interesting?

Do you have a topic you would like to provide a guest blog about?

If so, please comment below…

Welcome to my blog

For those of you who know me, my recent foray into the world of social media and blogging might seem uncharacteristic. It still feels strange to me, too! There are times when it excites me and terrifies me in equal measure! However, one important lesson I have learnt from my venture (albeit brief) into the online world is that forums like this have the power to provide a platform for sharing valuable knowledge and resources, and an environment for creating networks with people that both inspire and challenge you.

“A blog that aims to share expertise between schools and between disciplines”

I have worked as a school-based Occupational Therapist for about 5 years now; working across primary and specialist education. In this time, I’ve worked with some incredible children, families and professionals. Each person I have met has brought with them a unique expertise; unique experiences; a unique story. And each of these has helped me to develop as a practitioner and a person, but has also reaffirmed how vital collaborative working is.

The aim of this blog is to harness this expertise and to provide an environment where we can discuss, share and network; a blog based on the belief that no individual has all of the answers. In short, the aim is to share expertise between schools and between disciplines.