Why School and Clinic Therapists Can’t Easily Communicate
School is officially back. That means new teachers, new classrooms, new IEPs, and new therapists. It’s also that time of year when parents ask their clinic therapists to “touch base” with their child’s school therapists.
So, how do you connect your child’s school and clinic therapists?
Easy – you don’t.
Ok, ok, so it’s not that cut and dry, but it sure feels like that sometimes, doesn’t it? Allow me to tell you, this communication is not nearly as easy (or helpful) as you might be thinking. While we can all appreciate the theory of why we need to communicate, the real world tends to get in the way of our good intentions.
To give a better perspective on this topic, let’s talk about the basic challenges of this request.
- Yes, you absolutely have to fill out release forms.
This is not a casual chat. This is protected health information that we are being asked to share and discuss. It might not feel that way when we are working in pediatrics and the education realm, but I frequently have to remind parents that we need signed releases to speak to each other on both ends. There is often a delay in even initiating contact with another therapist while we wait for the proper forms to be signed and returned.
- It’s almost impossible to get a hold of each other.
School and clinic schedules are basically incompatible. They work the school day, and we are slammed with after school appointments. We could maybe, just maybe, catch each other at a cancellation, or late in the evening. But we often have families to go home to, kids to pick up, and we are constantly just missing each other.
Speaking of schedules, we are both swamped. School therapists are unsung heroes. They carry extremely large caseloads (50 kids a week, anyone?) have meetings, paperwork, and travel time between schools. In the clinic, we are usually scheduled back to back with patients, with a lunch break typically used to cram in notes or paperwork. Finding that time to reach out to someone is definitely a challenge, but it doesn’t mean we don’t try!
All of this boils down to the fact that our communication typically consists of a quick conversation that starts, “I just have five minutes…” or a string of emails returned a few days/weeks/months apart from one another. It’s not ideal, but it’s what we’ve got.
- There are only a few things we really need to discuss.
To be honest, there isn’t much we need from one another. We are both professionals specializing in our respective treatment settings. We have assessed your child in the setting in which we work with them, and have developed a treatment plan accordingly. So what would prompt a collaborative conversation?
-Specific problem solving.
Maybe there is an area that the child is struggling with in school or in the clinic that we just can’t figure out. Teaming with each other, we might be able to come up with a creative solution, or maybe one of us stumbled upon an awesome and unique technique that we really need to share.
-Prompts/Programs we are using.
This can be a simple report. Are they using Handwriting Without Tears? The Alert Program? Which pencil grip are they using? Any specific adaptive equipment? If we can use similar techniques, it helps the child reinforce consistent concepts across all settings. (Although don’t expect these techniques to always match up, as I’ll explain below…)
- No one wants to be told how to do their job.
Let’s be honest, this is a touchy subject. I’m certainly not going to call a school OT and tell them what to do with a child, although I have had parents request I do just that. Regardless of a therapist’s approach to teaming with another professional, the very nature of these calls can lead to uncomfortable and defensive conversations which don’t feel productive at all.
There will always be therapists that disagree with each other’s courses of treatment. Some are strictly against pencil grips. Some disagree with certain aspects of sensory integration theory. Some want a child to learn their name in upper and lowercase, some will start just with upper case. It’s the nature of pediatric occupational therapy – there are multiple evidence-based frames of reference to choose from, and there isn’t always a general consensus on the “best” course of action when it comes to many of the areas we work on.
- We both follow a different set of rules.
By the definition of our practice settings, we work on different things. A school therapist must work on goals that are directly related to a child’s academic performance. In the clinic, we don’t have those bounds. So that means what the school therapist must work on doesn’t always match up with what we are working on in the clinic. The rules are simply different.
With all of that being said, we will still continue to try our best to connect and work together. To my wonderful school OT colleagues, I fully appreciate how hard you work – you guys are amazing. Let’s talk soon.