It takes the whole team

I'm a little concerned that this post may appear to be a bit of a rant - but I guess that's therapeutic, too.
It takes a team to make change. In the school setting, it is the OT's job to help the student to be successful in their educational setting. I look at a student and share my professional assessment of that student's strengths and areas of need in meeting their academic demands. This means that I try to keep kids involved in their curriculum, even during 1:1 OT time - in their classroom, using classroom materials, or otherwise incorporating strategies that the team has agreed are in his/her best interest. In an effort not to detract from academics, OT is usually 1/2 hour per week or less.
In 1/2 hour per week, I can not affect change alone!
I need the team to be on board and I need to be kept abreast of new strategies or needs!
Today I walked into the classroom of a student that I see every week for a half hour in his classroom. I talked with the aide and the teacher to follow up on strategies that I had worked hard to implement and individualize. What I discovered is that, after a lot of stalling and "Uhhhhhh....."s, none of my work had been carried over.
I cannot improve this student's handwriting in 1/2 hour per week (at least not without that magic wand we all wish for). He has a handwriting goal - it should be addressed every day. It IS part of his IEP.
My visiting this student every week and working on a skill that is never addressed in the classroom is like me hiring a tutor to come to my house and teach me trigonometry for 1/2 hour per week. It doesn't matter how brilliant the teaching methods; if I am not going to use the trig on a daily basis, the tutoring is useless.
To make this experience more meaningful and productive, I have decided to take the following with me: In the future, I not only need to demonstrate, talk about, and leave written instructions for implementing OT strategies daily. I also need to be more consistent with following up. I am visiting the classroom tomorrow to observe their newly-established language arts rotation. I am aiming to be a helpful and student-centered member of the IEP team.

Sometimes it's tough choice - determining if OT is appropriate for certain kids.

Pediatric OT is exciting because we get to see improvement. In addition to the help that we and other team members provide, children are in a constant state of skill development. Sometimes, though, we are thrown a curve ball.
I am currently dealing with a couple of kiddos that have tricky conditions. It is my job to make recommendations to the team regarding whether or not OT is appropriate for these students. Keep in mind that it does not take the skill of an occupational therapist to monitor conditions or to implement a daily practice regimen. However, the role becomes blurry in certain situations. Let me share the two issues with which I am currently dealing.
1. A girl on my caseload has been receiving OT on a weekly basis for many years. She now has beautiful handwriting and her sensory processing is definitely functional for her special day class setting. Her motor planning, visual motor skill, etc. are fine. She appears to be a typical 4th grader with autism. But she has Rett Syndrome, see http://www.rettsyndrome.org/index.php?option=com_content&task=view&id=16&Itemid=375. Although in the 9 months I have known her, she has appeared to be stable in her skills, her speech therapist says that indeed, she has lost many communication skills over the past cople of years. It can soon be expected that she will lose meaningful use of her hands. Although there is no direct need for OT now, I want to stay on the team to support the teacher when these changes do occur. I have chosen to stay on in the consultant role.
2. A 1st grade boy is receiving chemo for a brain tumor. He has been referred to me for an assessment. I have known him for a while because I work with other students in his class. His affect, motivation, and skills vary from day-to-day because of his health conditions. His visual motor, sensory processing, and functional classroom skills were commensurate with intellectual functioning prior to this round of chemo (looking at his IEP goals, he was performing uniformly at a kindergarten level and, therefore, was not demonstrating the need for additional support in these areas). I don't know what his prognosis for functioning when he is done with chemo. Outside of school, he also receives OT to address his medical issues. (he has had this ongoing OT to address issues with his Erb's Palsy (see http://www.erbspalsy.net/erbspalsy.cfm), which completely unrelated to the tumor and does not hinder his school functioning). I haven't decided what my recommendations to the team will be. I'll keep you posted.

Does Therapy work? Yes, yes, yes!

After reading your post, I asked several parents of my private occupational therapy clients (age range 5-17) how therapy has changed their lives. Most of them had early intervention services (before age 3), but all currently have school based and private services. All of the parents that I spoke to believe that starting therapy early helped to bridge the developmental gaps that their children experience. They vary in their belief about how MUCH therapy, but all agree that having high quality, skilled therapists makes all the difference. These are all dedicated parents who understand that school-based therapy addresses educational and academic needs, but that other skills(activities of daily living at home and in the community) can be addressed in private therapy. These parents have been happy to supplement the therapy they receive from the school district with private OT and other community classes such as yoga, karate, swimming, etc. When asked if the crazy schedules, cost of treatment, and transportation snafus are worth it, they all say "yes, yes, yes!"

Do families think therapy works?

Although I truly believe from moment to moment and day to day that I am doing my best as an occupational therapist to help children be functional and successful, I sometimes wonder if I am affecting change. When I come to see a child in his classroom for a half hour and we work on improving pre-writing skills by strengthening his hands and tracing a few letters with proper pencil grasp, I know he is on the way to becoming a more successful student, but did he change between 1:00 and 1:30 on that Thursday? Was my intervention more useful to him than the help of a classroom aide? Did the teacher learn new strategies from my time in the classroom? or does she think I am wasting precious math time?

When I work in schools I rarely have the opportunity to talk to parents to learn how they feel about their child's therapy. Often, I only get to talk to parents at IEP meetings where the most frequent therapy issues seem to be requests for increased service time or not to discontinue services. So, I guess these parents are in favor of their child's therapy.

Any way, I have recently had a couple of fabulous opportunities get parent feedback lately. Of course, with that introduction, you know I heard good things.

First of all, on April 12th, I went to IEP Day (Involved Exceptional Parent Day) in San Diego. I was working at a booth for Sunny Days, which provides early intervention services for 0 - 3 year olds. Although many people were disappointed that they hadn't known about Sunny Days before their children turned 3, there were a few parents there with children who were currently enrolled or had already graduated from early intervention. They raved about the help they and their children had received. One mom said that the behavior therapy consultant changed their lives. Getting the help they needed when they needed it changed the dynamics of their home. The child is now 4 1/2 and very successful at school.

Another person I ran into was the mother of one of my Sunny Days clients. He graduated a year ago now, but I see her occasionally at preschool. She said she frequently gets questions about whether she thinks that the speech and occupational therapy (20 hours per month, combined) really helped him. She said she always tells them that we (the therapists) were great and really helped him overcome his challenges; that we really did affect change.

This whole post may sound as if I am just giving myself props, but I think that it is a serious question for many of us. We can use research-based methods as much as possible, but that doesn't assure success. I also think that if I have these questions, parents, teachers, administrators, and other therapists must also wonder...