Episode 181: The most effective strategies for addressing developmental concerns in children.

In this episode of Child Care Conversations, hosts Kate and Kerry discuss a challenging situation in a school with guest Vicki Morris, an occupational therapist. Vicki provides insights on addressing developmental concerns in children, emphasizing the importance of understanding a child's developmental milestones, observing their behavior, and assessing their routines and environment. She suggests involving outside professionals for assessments and advises on the timing and approach of discussing concerns with parents. The episode also highlights the importance of directors managing their emotions and seeking support when needed. Vicki also discusses the need for individualized adaptations for children with the same diagnosis.

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Transcript

Marie (00:00:01) - Welcome to childcare conversations with Kate and Kerry.

Kate (00:00:05) - Have you ever had one of those situations that you're just sitting here trying to figure out? What is the best thing to do? Yeah. So. So I actually was, um, I've been working with a school, and this school has actually had two families unenrolled because of the behavior of another child. So these are three year olds. Uh, some of these are three year olds who have never been in a classroom setting. And the child that we're talking about not only had never been in a classroom setting before three, but he also, um, is an only child. And so three means he was born during Covid. And so we decided that this makes a great topic for you as a director to listen to on what are things that you can do? When is it time to tell that family? You know what? This may not be the best, best program, the best method for your son. He may need one on one care, because you sure can't lose a classroom full of kids and expect to stay in business.

Kate (00:01:11) - So. So today we have. You want to tee it up for Vicki?

Carrie - Yeah, we've got a special guest, um, which is someone who we sometimes refer senators to. It is Vicki Morris. You've heard her on the podcast before and episode 155. Okay. Episode 155. And this won't be the last time you hear from her, because we like working with Vicki and we think she adds an awful lot to programs. So she's an occupational therapist. And this school that Kate was talking about, she made a referral for Vicki to come in and talk to the director and help them see what they can do, because since the child is over three, they're a couple of the options we have available aren't available. So welcome, Vicki. So thanks for having me back. There's first, before we get too far into it, I want to define a term for our friend who's listening to this podcast in their car while they're driving to work. What does an F? What is an FLQ? What is FLQ stand for?

Vicki (00:02:13) - You know, that term was started so long ago, and I honestly thought that the cohort group that I was working with, that that was a term we invented.

Vicki (00:02:22) - But evidently I have found out that is a nationwide term that some of us that are, um, have been in the system a long time have known quite well. And it's, you know, a funny looking kid. Something's off, but we don't know what it is. There's something, um, my daughter will tell you. I don't think I told her she was in FLQ in full words, but we knew she was a little different, but couldn't hone in on what it was. She was the child. They wanted to put it in school suspension and kindergarten for helping other kids. But she was doing it as a deep rooted issue from something else. So as as an occupational therapist, if a lot of you don't know, is we work with people from birth through death and we work with what is your occupation? So as a child, their occupation is learning through play. And I actually started out teaching at a preschool, and I taught a preschool for four years before I went on back to school to become an occupational therapist.

Vicki (00:03:21) - So I had those kids with those behavior issues that you just wonder, you know, what are we going to do? Why is this kid biting all the time? And I currently am in a school district, and I have a heavy concentration in the SC program where it is three and four year olds and, you know, birth to three, we can make a referral to early childhood intervention after three. Technically the school district is responsible for them, but they have to qualify for school based services.

Carrie (00:03:52) - And how do we get them qualified if the director just knows I've got an FLQ?

Vicki (00:03:58) - So if the director knows you, can you you have to plant the seed first. And a parent and a parent has to be receptive. And it may take a while for the parent to become receptive. And it depends if that's their first child, if it is their second child, but their first child has some other medical complexities, they don't always see the development as it should have been in the first child to know what it should be like in the second child, or if it's that only child, you know, we have a grandson who's the only grandchild and you know, he craves other kids attention.

Vicki (00:04:28) - So we have to decide what is it? So we got to plant the seed and the parents with the parents and talk to them first about what is developmentally appropriate and what is not. We do look at the developmental milestones. Is this child three years, one month or three years, 11 months? And that's a big difference in development. We don't think about it, but it is.

Carrie (00:04:50) - That's a huge difference. That's you know, last year day versus yesterday.

Vicki (00:04:56) - Oh yes we get yesteryears. Oh that was yester year like you said. Sound like an old man, honey, from the 1900s. So you go. No. Yester year I did it. No. And he's four. So it's just a terminology thing for him. Um, but there are those kids who do get kicked out of centers because of behavior, and I have been working with the family intimately on their child because he had been bounced around from center to center because of his behaviors. But we can't tell a center what exactly to do unless we look at them through a different set of eyes.

Vicki (00:05:28) - So as a director, I recommend a classroom observation. But before you do an observation, find out how this morning went, how last night, what how much sleep do they get? Are they where they should be? Because there's so many kids that aren't on a good schedule which impacts their tomorrow. So what sleep I do or don't get tonight will impact my tomorrow all day.

Kate (00:05:49) - So I'm a grown up and that that that impacts me.

Vicki (00:05:53) - All the time, right. And if we don't think about it, we don't acknowledge it. Right.

Carrie (00:05:58) - So the first thing we do is we observe, we see there's something going on. We say to the parent, there's something that is not what we would expect. And I just want to like, what's going on with your family routines. Like, do you need help with bedtime routines or dinner routines, or coming up with foods that your child will eat because they're going through a picky food phase and you are done going to McDonald's for the chicken nuggets because your budget can't handle it.

Carrie (00:06:28) - So how can the school help with the food if it turns out to not be the routine or the diet you're suggesting bringing in somebody to come in and do an assessment.

Vicki (00:06:38) - So as a director, you can pull up some developmental assessments that you as a director or certified to do as a screening tool, not as a full assessment and look at the environment first. What is the room like? Is there too much noise? Is there too many smells? Is it too loud? Is it XYZ? And look at social emotional developmental skills right? Look at some sensory profiles to see if you may ask just somebody that is from the outside being just someone within the world to come and do an assessment on the class. And is it too white? Is it too bright? Is it what someone who's not even in that room? Maybe you're going to get your nutrition person from the kitchen to come in and say, just look at the room. And what's your first impression? Someone who doesn't frequent that room a lot.

Vicki (00:07:26) - Does that make sense?

Carrie - Yeah.

Vicki And then you need to to talk to the parent. And I have told many people you may not be the place right. You may not be the messenger. Also, you got to find out who has the best relationship and how you say what you say when you talk to a parent. How was the parent's day? Is today the day to say it, or was their day at work really cruddy? So there is a time in the place I.

Carrie (00:07:51) - Think that's.

Vicki (00:07:52) - On Friday and not on Monday.

Carrie (00:07:54) - I think that's definitely a key point of when do you have this conversation? Do you do it when they come in and it already their hair already looks like a rat's nest? That is a sign that perhaps they're not having the best day. If they couldn't figure out, you know, how to get a hair, a comb, or a brush through their hair, probably not the best time to have that conversation.

Vicki (00:08:14) - And as a director, how many monkeys have been on them all day? Absolutely.

Vicki (00:08:18) - So if I've in the last hour had five monkeys come into me. Uh, if y'all don't know monkey management, right, then that's not a time for you to say it. So you don't only have to check the parent responsibility, you know how they're going to respond, but you got to also check how what kind of mood you're in to have that conversation. Oh, I think.

Kate (00:08:37) - That's really, really important, Vicky, because we all know that perception is huge. And so if it's coming out of your mouth as a director and you sound exacerbated because you've lost, you know, if you lost another family that says, hey, we're leaving and they tell you why and they're leaving because of that kid, that is not the day and time to call the parent or even talk to the parent. Um, you know, give yourself an opportunity to write down your notes, uh, talk about it with somebody else. And so if you're listening to this podcast and you're one of our directors, if you have not used your coaching hours, call carrier I and and and practice your your pitch right.

Kate (00:09:17) - Practice what you're going to say. Don't go to your spouse. Don't go to the teacher. You're the director. You're in charge. Either. Go to your supervisor if you have one, or call Carrie or I, because we don't want you to have your spouse trying to fix it. You definitely don't want the teacher to start having opinions. They've got their own stress with the student and with this family. They don't need your added weight. That's why you're the director. You have to have those difficult conversations.

Vicki (00:09:51) - And I'm gonna guarantee you hearing it from the director is not the first time they've heard something about their kids. They've heard this from family members. They have been. Excluded from events or birthday parties. So they've already had the inkling. And either you're going to confirm my feelings or you're going to send me into that downward spiral of, I've already heard this 50 times. My kid's not a bad kid. Yeah, kid's.

Kate (00:10:17) - Not a bad kid. I don't ever have this problem at home. Right?

Vicki (00:10:21) - You know, but then you go into what challenges do they have at home? Meaning, how much do you expect of them? Are you expecting them to clean up their toys? Are you expecting them to get along with others? Or are they saying I want and they get right? Yeah. So there's a big difference in how it comes out and what kind of parent you are. But we also have to look at the child as a medical altogether medically also. So I've been working with the family who the young man cannot see from his chin down. There's no vision there. So you walk past him as an adult and your hands are swinging. As you're walking, that hand comes up from that hidden vision. He automatically grasps. He doesn't have much peripheral vision. So therefore, if you're coming at him from the side, he is on a fight or flight mode, right? So there could be something else happening that we're not thinking about.

Carrie (00:11:15) - Absolutely. I mean, and that's one of the hardest things for the center, because we can sometimes feel like we don't have the resources and we're like, hey, that should be a school district problem.

Carrie (00:11:27) - You need to get your kid over to the school district. But the school district doesn't have to take every four year old in the state. So we have to figure out ways to work with that child in our program, or find a safe way to have the child exit the program into a setting where the child's going to be more successful.

Kate - And one of the things we also have to remind ourselves as we think about even the school district programs, they're not designed for a working parent.

Vicki (00:11:53) - No, they're not.

Kate (00:11:54) - You know, so there's a possibility that that child could be part of part of a school district program. And then the parents think that he can come to you. And so, you know, there has to be, you know, that that realization on the parents part that perhaps, yeah, they might do fine in a school district program where there's like, you know, one teacher, three kids, and that teacher is doing whatever's going to work to, to help the kids versus even that same ratio where maybe you've got two or even three teachers to 12 kids.

Kate (00:12:27) - It's still now 12 kids, right? Like an A and a child care program can't operate on the ratio of 1 to 3 on a three year old classroom. It's just not going to happen.

Vicki (00:12:37) - Well, so there's some options. So let me tell you what options I have in my head. So option one is to have the school district test your child. Some districts offer services to kids in childcare settings or private schools. That is a district's prerogative as to what they offer. Generally it is speech therapy and counseling, but you could qualify for speech and OT where you would bring your kid to the school for just that. Now, that doesn't work for a parent who has a job, right? So option two is depending upon your insurance, a child cannot drive. Thus they qualify for home health services. So the home health can be provided depending upon the company at the child care setting or at the home. But who has a more waking hours? Is the child care center right? Right?

Vicki (00:13:30) - And who evidently needs the most help is the childcare setting. So they could apply to different pediatric home health companies and receive home health. That way they could get outside therapies. There are some mobile therapy clinics where like they just come to you and do therapy on the spot, and that's kind of rare. But there are some out there in the larger cities where you can just take your child to an outpatient therapy services, where it could. Also, those people are generally more than happy to come back and do a training for you as a center on that child. And just because you're a child with oppositional defiant, that's just what I'm going to just pick out of my head. Does it mean that the another kid in the center has the same oppositional defiant behaviors? It could totally be something else. So I can give you all kinds of advice. But until I know that child, I can't give you the right advice.

Carrie (00:14:22) - That makes sense.

Vicki (00:14:23) - So I think.

Kate (00:14:24) - That's a great thing for directors to really think about.

Kate (00:14:27) - Just because you've had a kid who might have a similar, who might present in a similar fashion in the past, doesn't always mean that the solutions are going to work. And I think they have things that might be helpful as directors. Remember, you don't have to do it all. And that's why we have experts, and that's why your network needs to include people who can help you with this.

Carrie - Yeah, and you might have two kids in the same year who have the same diagnosis. But that doesn't mean that the adaptations that you that will help that child. Are going to be the same because you can have one kid, so you have two kids with impaired vision and one, it's that range of vision where they can can't see below the chin. And another one, the child is extremely nearsighted. You would you wouldn't expect the same thing to work for somebody who is nearsighted. As for somebody who has limited range of vision and that makes sense to people, they're like, yeah, one I can fix with glasses when I can't, but they don't have the same thought process when it comes to a child with ADHD or a child on the autistic spectrum, they're like, I know what that means.

Carrie (00:15:36) - Well, do they need glasses or do they need a cane? It's the same thing, just in a different realm.

Vicki (00:15:42) - You know, there's an old saying once you've met a child with autism, you've met a child with autism. Just like meeting a Texan, you've met a tax and does not mean we're all the exact same. So don't put everybody in the same group because we're not all the same. Yeah, right. So, uh, my biggest thing is follow your gut. If as a director, you have this gut feeling something deep down is going on, follow it. Um, but you got to know the parent and know how much you can tell the parent at a time, right? Uh, I just know that I can't tell my child everything at once because it's too overwhelming. So I have to slide it in slowly over time. I know if I want to communicate with my son, it's best to do it in a text message. And he communicates back faster, right? But if you're going to talk to a parent, you need to talk to them face to face.

Vicki (00:16:32) - And I'm very big about not you sitting across your desk and talking to me, because that's like going to the principal's office, um, have that open ability where we're sitting across from each other in a circle, at a round table, something that doesn't feel like I'm in trouble. Because the first thing I think of when you to call me and say, hey, can you talk? I have to honestly say, I got okay, now I'm in the principal's office again, right? And I know I'm not, but, you know, I have that gut feeling that what did I do? And it's nothing, right? Parents feel the same way. And there's nothing wrong with feeling that way. If if, you know, the bank calls you as a director and says we need to talk, your heart automatically drops. What happened to my account? Right? Same thing when you're talking to me about my kid. I'm going to go on the defensive because that's my child. So know how you're talking to a parent.

Vicki (00:17:28) - First, make sure you yourself have one had something to eat as a director and you have gone to the restroom. Don't let those two things and you think it's the craziest thing, but I don't want to talk to you when you're hungry, and I don't want to talk to you when you're rushing because you have to go to the bathroom. Right?

Kate (00:17:44) - And I think that and I think that holds the same to the parents. I mean, I, I totally hear you on environment and where you're where and when and all of those bits and pieces. But when they come, offer them something to drink, give them some time, ask them if they need to. You know, use the restroom, you know, again, because you know, you don't want them getting up in the middle of a conversation for those, you know, natural consequences.

Vicki (00:18:10) - Other thing is, don't do it the day the child did something. Yeah. Don't do it that day. Wait till the following day.

Vicki (00:18:18) - And that's more for the parent and the kid together. Because you know that deal with what you can deal with while you have them. And I have parents say, well, I've not been told this. Well, you kind of had, but you haven't heard it. So just come with some facts. And what can we do to help you? We are a team. We're not against you. We need to work with this together to make it the best for your kid. And if we're not the right fit for you, then we're not the right fit. And let me help you find somebody else.

Carrie (00:18:46) - Yeah. And so if they don't know an occupational therapist or someone else who can help the teachers make accommodations in the classroom, what do you think the director should do to support their staff while they're waiting for the diagnosis and the, you know, this is what the game plan is or to help the teachers go, okay, I've read the game plan. I don't understand it. Like where can they get support? We know that if they're in Vickie's area.

Vicki (00:19:13) - Yeah, because they call me Vicky.

Carrie (00:19:16) - But if you don't, if you don't live in Vicky's part of the state, how can they find their own Vicky?

Vicki (00:19:24) - You know, so my thing is, as and I know I've had this discussion with you before, I see things differently through my medical background than you see through your educational backgrounds. Right. So know that that's important to bring both worlds together.

Carrie (00:19:39) - Absolutely.

Vicki (00:19:40) - And because I think I listen to everything y'all tell me, and I take it to heart and I dissect it and see how it applies to how I see people. Right? So there's a lot of occupational therapists out there, and there's a lot of OTs who love to educate. So my first place would be if you have. A college near you that has an occupational therapy department. I could call them. I could look at pediatric occupational therapy. I could call the school district or ECI and see if their OT wants to come do a observation. No. First and foremost, you cannot ask me to look at a child, right? You can ask me to come look at the classroom and whatever I perceive as the OT is what I perceive.

Vicki (00:20:27) - And I will either say, you know that young boy and the green shirts. I noticed that he had a hard time with transitions. Here are some good ways to help with transition. But never naming a child that you're coming to observe unless you have parent permission. And I would rather you observe my classroom and not a child, because if I'm observing that child, I'm focused on them and not what's happening in the corner, which could be setting off that child.

Carrie (00:20:51) - That makes a lot of sense.

Vicki (00:20:53) - We have a young man who, the biter pincher that has the visual loss, his paraprofessional at school has found the right chewy for him. You know what? He's not biting. He's not pinching. It took the right chewy, not any chewy. You took the correct one for him.

Carrie (00:21:10) - That makes sense. Yeah.

Kate - All right. Well, Vicky, thank you so much for joining us. And I'm hoping that the directors that are listening a have started to think, okay, I've got to add an OT to my, my my network.

Kate (00:21:24) - And again you may not use them ever. But if you don't have one then you don't have one to call when you need them. So

Carrie - and we will have in the show notes ways to get Ahold of Vicki. So if you need to reach out to Vicki, she also has a network of other occupational therapists that she knows. So you can reach out to her and she might be able to connect you if you're not in her area. So that will definitely be in the show notes. And like I said, will have her back on the show soon.

Vicki (00:21:54) - Thanks for having me.

Marie (00:21:55) - Thank you for listening to Child Care. Conversations with Kate and Kerry want to learn more? Check out our website at Texas Director. Org and if you've learned anything today, leave us a comment below and share the show.