[Adam Hurtubise]: نعم، أشكر الجميع على المشاركة. يسعدنا أن نقدم شارلوت كلاين ودينيس ديجاردان وكيلي ديبينتو. إذا كنت مخطئا، كيلي، من فضلك قل لي. ناقش معنا ما يحدث من وجهة نظر المعالجين وأخصائيي العلاج الطبيعي في مدرستنا. سأسمح لكم جميعًا بتقديم أنفسكم. بالإضافة إلى ذلك، أود أن أشكر أعضاء لجنة مدرسة ميلاني على مشاركتها، وبالطبع جوان، مديرة الخدمات الاجتماعية، على مشاركتها. لذلك اعتقدت أنني سأرسلها إلى شارلوت.
[Unidentified]: حسنًا، دعني أشارك شاشتي هنا.
[6ToLK-34czQ_SPEAKER_12]: Все ли это видят?
[Unidentified]: Wi.
[6ToLK-34czQ_SPEAKER_12]: តើអ្នកអាចឮខ្ញុំទេ?
[Adam Hurtubise]: Wi.
[6ToLK-34czQ_SPEAKER_12]: All right. I'm trying to minimize the pictures. Oops. Already, already messing up. All right, so welcome. Thank you, Tanya and Alex for inviting us. We are going to talk about occupational therapy and physical therapy across Medford Public Schools this evening. And that ranges from preschool, which starts at age three through post-graduate, which goes up until 22. Denise, would you like to introduce yourself?
[Denise DesJardins]: I am Denise Desjardins. I am a system-wide physical therapist for the past, since 1998. I think it's 22, 23 years. There are two of us in the district. Right now, my primary role is to cover the McGlynn Elementary and Middle Schools. I cover the Andrews. I cover Medford High School, the Roberts, and the McGlynn Elementary.
[6ToLK-34czQ_SPEAKER_12]: Okay, Kelly, would you like to introduce yourself?
[SPEAKER_00]: Hello, everybody. I'm Kelly Giaquinto. I've been an OT in the district since 1997. And I currently just do preschool. I shouldn't say just, I do preschool. But I've worked in all ages through my time here. and mainly in the elementary setting. But again, for the past several years, it's just, it's been primarily preschool.
[6ToLK-34czQ_SPEAKER_12]: Okay, and I'm Charlotte Heim. I'm already having a little delay with the toggle. And I have been in the district since 2004 and I've covered ages three through 22. And right now my role as OT and transition specialist at the high school. We ask that everybody mute themselves unless, except for the speakers, we're just getting a little bit of feedback. That's great. So in Medford, we are unique and lucky that we have a team of very experienced OTs and PTs that work together. As Denise said, we have two physical therapists, we have six occupational therapists, we have two certified occupational therapy assistants, and myself as OT and transition specialist at the high school. And we are led by Dr. Jan Hollenbeck, who's coordinator of related services. secondary transition, section 504, and assistive technology. I'm having a hard time with my screen. There we go. Okay, so OT credentialing consists of being a graduate of an occupational therapy program that's accredited by occupational therapy education. It's either a master's or a doctorate level, entry level. There is also a requirement for supervised field work and completing that, passing a national certification examination, and also meeting ongoing state requirements for licensure and registration. A certified occupational therapy assistant, an OTA, sometimes called COTA, C-O-T-A, is a graduate from an accredited program with an associate's degree entry level. That position also requires the successful completion of supervised field work, passing a national certification exam, and also meeting ongoing requirements for licensure and registration. Denise?
[Denise DesJardins]: So PT credentialing is pretty much similar. You have to be a graduate from a licensed and accredited physical therapy program. Currently, PT now is a doctorate only, a doctorate entry level. So you'll see a lot of PTs, especially an outpatient with the doctor beside their name. Again, at this point, it's It's mainly the entry level. When I got my master's degree, my master's was also entry level. You can also achieve clinical specialist certification via a national exam. And for PTs, typically we're asked to complete multiple internships, including acute care, rehab, sports medicine, pediatric, home healthcare, and outpatient. My internships mainly were involved in acute care and a clinic. So pediatrics was sort of for PTs, you kind of learn on the job.
[6ToLK-34czQ_SPEAKER_12]: Thanks, Denise. So as Denise said, OTs and PTs, you mentioned a lot of different environments where we work, and that also there's a variety of requirements for internships with OT in different environments. Tonight, we're talking about schools, but OTs and PTs work in hospitals, rehab facilities. OT actually, as a profession, got its start way, way back in World War I in mental health, and OT has continued to work in that environment. and also home health services, private clinics, assistive technology programs, holistic health centers, and more and more adult services organizations for individuals with disabilities. And there's just also a broad range as OTs and PTs become more entrepreneurial as a profession. Okay. All right. What is the role of OT and PT well, it depends on where we work and you've seen a broad variety of places but tonight we're talking about schools which is unique, and the role of OT and PT in the school is defined by special education law. IDEA, Individuals with Disabilities Education Act, and we are related service under IDEA. We are support service under IDEA, not a primary service. So how does IDEA define a related service? Well, it is a developmental, corrective, and other supportive services that are required to assist a student with a disability to benefit from special education. You can see here there's a list of related services alongside OT and PT. We've got speech and language, orientation and mobility, which is a service that usually relates to low vision, psychological services, counseling, social work, and Also, specialized transportation. This is kind of a surprise for some people that, yep, the van service is in the same category under IDEA as a related service like OT and PT. But it's really the perfect metaphor. It is providing a support service to assist a student so that they can benefit from special education. It's providing access. OK. So related services also need to be relevant and necessary to permit the student access to education support service. We also support students with the individualized learning outcomes, and that would be the IEP goals and the objectives. Again, the explicit requirement of IDEA is that it's required to assist a student with a disability to benefit from special education. And also the role of related services under IDEA is to work collaboratively with the education team to support student participation in the least restricted environment. So related services like special education services must be delivered in a manner that's the least disruptive to the students. Typical day, I sometimes over the years, I said, well, we need to mess with their day as little as possible. in a way that supports progress towards their goals. Okay. So there's a lot of, there's sometimes confusion between the role of OT and PT in a medical or a clinical model versus the school. So there's some similarities and differences. We're all under the same licensure laws and the professional and ethical standards for the national organizations, but in schools, like I've already said, the eligibility is governed by state and federal law and the team decision. Whereas in a medical or clinical environment, the eligibility is typically determined by the third party payment, like the insurers, or also the individual therapists. There can also be referrals from like a doctor referral. In schools, the purpose is to enable participation, whereas in the medical clinical world, OT and PT purpose is to remediate a disability, an injury, a chronic condition. Service delivery in schools is least restrictive and providing it often through consult or in-contact services, whereas service delivery in a medical clinical environment is usually individual or a group or clinic-based treatment. And then also in schools, again, what is most, the service delivery is the most, what's most efficient. If everybody can turn off, we got a little bit of feedback here for some new entrants. So if you can turn off your mic, that'd be great. And then in the medical clinical model the focus is to remediate a disability, a medical condition or an injury. Okay. So school-based OTs and PTs, we work on many levels. If you see us going through the hallway, we cover a lot of territory. I don't know about you, but I just stopped, about you, Kelly and Denise, but I just stopped wearing my Fitbit because it was too many steps, particularly in the high school. We evaluate OTs and PTs. The difference with OT assistants is that they are trained for a specialist in intervention and are not licensed to do the evaluations and the interpretations of the results of an evaluation. We provide services, that would be grid B and grid C, grid B being less restrictive, grid C being pull out or more restrictive environment. We consult to teachers, staff, parents, guardians, caregivers. And then we also work on a systematic level to support and do also consultation. So this is just a few examples, recommendations for environmental changes, working on, committees and groups, multi-tiered systems of support, the schools often call it TAT team, response to intervention, and also providing ongoing professional development. A few more examples of building or district levels is just supporting health and wellness, social emotional learning, self regulations like zones of regulation, and just promoting universal design for learning and a few more slides Kelly's going to show a picture of I think it was at hand washing Kelly. Yeah, and so if there's a checklist for hand washing in the preschool bathroom that's put there for one student that may need it on their IEP, it's going to help all the students that are going through, the children in preschool that are going through and washing their hands. So that's just an example of an intervention that is helping all students across the board. So universal access, environmental design, thinking about the playgrounds, how classrooms are laid out, maybe adding a quiet corner, a sensory break, participating OTs and PTs, participating in some curriculum committees, just an example is handwriting curriculum, and then also professional development for staff, parents, and caregivers.
[Alexandra Lauric]: Can I ask a question? Do you mind? Sure. Is it OK if we interrupt the questions, or would you prefer? So I was wondering, particularly in preschool or in elementary school, would a PT or OT go into a class, into a gen ed class, if there are no kids with IEPs there, just to provide any type of consultation to the gen ed teacher?
[6ToLK-34czQ_SPEAKER_12]: Kelly, do you want to answer that in preschool?
[SPEAKER_00]: Well, I mean, I'm thinking of Charlotte, when you used to be in elementary school, you would go into all the classrooms first thing and adjust all the desks, right? So it's for all the kids, not just for our children who have IEPs. So there are definitely, I have definitely gone into classrooms and taught zones of regulation or different systematic things like that. But it's very rare that there's a classroom without a child on an IP, actually. So that's not typically the case. Did that answer your question?
[6ToLK-34czQ_SPEAKER_12]: And also, that's an example of a tier two or tier one, where the teacher might say, hey, could you help me out with this challenge? Or could you give me some advice? And then it doesn't rise to the level of needing an evaluation for a specific student. Thank you, Alex. That's a good question. So evaluation. So why do we evaluate? First and foremost is to help the team better understand the student and how they learn and if there are any impediments to learning, and also to help the team develop an IEP for an eligible student. And what is it that we do we evaluate collectively ot and PT were there for to support classroom for just to participation and education so we're looking at student performance in the school observations. In context, the environmental factors and looking at the environmental factors. where they naturally occur in the school day. A student that's sitting on a stool in a loud cafeteria might have a very different lunchtime experience than in a quiet room where there's not as much activity. Secondary, we're also looking at the underlying skills and the factors contributing to the school performance challenges. Okay, so I'm going to talk about occupational therapy evaluations in just in general and then Denise will talk about physical therapy evaluations. OT is always, it covers so much broad area. Over the years, people will say, oh, This student or my child has such bad OT, and I'm thinking, well, what is that? Because it could be anything. Is it sensory? Is it handwriting? being able to get out of a locker. So anyway, it covers a wide area, but the evaluation focuses on the need based on the student's individual current participation, the referral questions, and that might be based on school participation, self-help, skills, classroom performance, hand skills, physical access, social participation, play, and self-determination. And those expectations change over time as a student rises through preschool. The expectations change in preschool from and up through the grades and into middle school and high school. So it's always kind of those skills are within different contexts. And then in the high school, I'll talk about it in a few slides, the transition-related skills. It broadens a bit in high school, particularly after the age of 14, to include independent living skills in a broader sense for future independence, community access, and preparation for employment. Go ahead, Denise. Denise your mic is off.
[Denise DesJardins]: Sorry about that thought I clicked it on physical therapy evaluation again are based on areas of need of the individual students current physical school participation and referral questions and based on these. What we tend to look at is obviously the ability to travel appropriately throughout the educational environment, whether or not you're using an assistive device, i.e. a walker, crutches, cane, or wheelchair, including stair navigation, as well as maintaining pace with classmates during transitions. Participation in recess activities, such as accessing the playground, including the climbing structures, participation in physical education class, as well as positioning for access and participation in school activities. Next slide, Kelly. I mean, Charlotte. Okay.
[SPEAKER_00]: Okay, Kelly. So I'm gonna talk now a little bit more about preschool. Preschool is its own little world sometimes. It's a little different. Preschool is a little bit different in that We, although a child is eligible for preschool at age three, or they can come into the metropolitan schools at age three. And then we have regular education preschools through in all the schools as well. They, we start evaluating them often at two and a half. If there is a child with needs so that we can prepare for what they may need in a preschool classroom. If they're evaluated, it doesn't mean that they're going to get a program or even services, but we want to be prepared for that. So we try to evaluate them before they turn three. We also may have a a child in a regular education preschool who might be struggling, and we could evaluate that child as well if the team decides that that is a need. So it depends on when the needs are identified and where the child is at the time. So ideally, a child, whenever they're evaluated, would be evaluated in the setting in which they're having difficulty. So again, if they're two and a half, they're not in school yet, but we might see them in their daycare or at home or in early intervention. Over the pandemic, unfortunately, we haven't been doing that as much, but We definitely have gone out to the homes in the early intervention settings to observe the child to make sure we know exactly where they might be breaking down. And we'll assess whatever concerns the child is having, whether that's motor skills, sensory processing skills, self-help skills. We really look a lot at play, play as a child's work. And we don't want to undervalue that because that is incredibly important. And a lot of children do have some difficulties playing, and it may be because of their motor deficits or maybe because of sensory deficits or maybe just because they're not able to figure out what to do yet. We're also going to evaluate, not evaluate, but work with parents at that young age or whatever caregiver the child has, other professionals they've worked with. Because of course, a young child like that isn't necessarily going to give us all the information if we interview them. And a lot of children at that age aren't even talking fully. So we definitely want to have the parents involved. It's a big shift, especially if they've been in early intervention, for parents to understand going from an IFSP, which is an individual family service plan, to an IEP, which is an individual education plan. That's a big shift because the early intervention works with the entire family. And it's not to say once they get into school, we're not going to work with the family anymore, but the goals are for the child. And it's for the child to be able to access the preschool curriculum. So that's a large shift that a lot of families need to work with and understand. But that's also, you know, when we're evaluating I think we talk a lot with the families to help them understand that. Another difference in how we evaluate preschool children is that we often have the opportunity to evaluate preschool children as a whole team. So, for example, the OT, PT, if PT is involved, speech therapist, educator, we will all evaluate that child almost at the same time and kind of in an arena type style. When I say an arena evaluation, technically an arena evaluation is one person evaluating and everybody else kind of taking notes and giving that person things to do. But when we evaluate, we're kind of a very well-oiled machine and we just jump in with each other and evaluate, give the child different things to do and work with that child, play with that child so that all the disciplines are working together. And we also write one evaluation. So parents get one full set of evaluations from everybody in one document. So that's a little bit different than you might see as they go up in age. Anybody have questions on the evaluation process before we go on? Services in preschool. I love I love being in preschool. If you talk about least restrictive environment, preschool is the easiest way to get in there and do that. In a preschool setting, I can be directly involved in every aspect of the preschool day seamlessly. It's not as easy as they get a little bit older, and I'll talk about that more. But in a preschool setting, all the therapists, OT, PT, speech therapists were in there and working in the classroom with the children. We helped them with their daily routine. As soon as they're coming in, can they separate from their parent? Can they come and take off their coat and hang it up, take their backpack off? Can they access their backpack? Can they get out their snack? Can they eat independently? Can they wash their hands? We're looking at all that, including those self-regulation skills, which preschoolers are all learning at this point. Those are crucial foundational skills that we really want to build up. And if children are having difficulty with it, this is a great time to boost it up. So we also might fluently go from one child to the next, depending on the needs of the child. So oftentimes in the preschool, the activities, because of the nature of preschool and the attention level of the children of that age, the activity might be just like 10 minutes and then they go to snack or they move to something else. So we're moving with them. And we might go from one child to the next during that activity time and then go from one child to the next during circle time or what have you. If a child requires specialized equipment or quieter settings, we also would see a child outside that classroom. So alone or in a small group. So for example, a preschooler might have in their IEP OT twice a week, once in the classroom, once out of the classroom or in the OT room. So that it works beautifully in my opinion. And I think that it's a really wonderful model for preschool. Next slide.
[6ToLK-34czQ_SPEAKER_12]: Okay.
[SPEAKER_00]: All right, a huge piece of my job as an OT in the preschool is consultation. It's a major component of it in that we constantly as a team talk to each other, but we also have weekly or monthly times to talk about particular children and how to carry over what we're teaching So we want to teach those carryover skills to the prior professionals in the classroom, the teachers in the classroom, the other therapists working with the children so that we're all on the same page. Alex, you asked about, would we go into a classroom of children where there's no IEPs? So there aren't any preschool classrooms like that that we have, but I often do whole class groups and teach whole class activities. And in doing so, I'm targeting several different children, but everybody in that class is benefiting from the information. So I've done whole groups on how to use scissors, how to pick them up. They're just learning that in preschool. How do you hold a marker appropriately? Zones of regulation, we talked about as my husband's just coming in, so if we're interrupted, I apologize. Zones of regulation, I teach through the whole class. It is embedded within the curriculum of every preschool class. And at this age, we'll work with individual students as needed, but the whole class and the adults in the classroom need to be using the language and modeling because co-regulation is needed for little ones as well. We wouldn't expect a child to be able to completely self-regulate at age three and four years old. We're co-regulating for them, and what I mean is we are showing them, this is how I take a deep breath. This is something I can do to calm down. I'm going to go over here to the tent and take a little break and showing them what they can do. Let's see what else is on here. I also do a lot of seating in conjunction with PT, but there's in preschool classrooms, especially on the rug at meeting times, there's multiple flexible seating options. So you'll see maybe three kids sitting directly on the floor, the rest have different types of seating that they're using to help give them movement or stability or whatever they need. And that's every child in there understands that and the regular children who are in regular education can also use that seating as well. It's options for them. Any questions on any of that? Okay.
[6ToLK-34czQ_SPEAKER_12]: Kelly, we could teach a whole session on each one of these sections of our presentation. Elementary, Kelly.
[SPEAKER_00]: All right. So as the student moves up in grade levels, of course, the expectations increase. All those foundational skills they've learned in preschool are expected to be solid. So they're expected to be able to sit for longer periods of time, attend to what's being said, focus on the teacher, rule out all that extraneous noise and attend to what's supposed to be attended to. And they're supposed to write with better precision, keep themselves organized and regulated. But Charlotte mentioned this earlier. They're doing things bigger now. So they're not just eating snack with 10 other kids. They are eating lunch in a cafeteria, way louder, way busier. They're expected to do a lot more. They have to go through the line. They have to carry their stuff. So sequencing gets a little harder. Gym is very noisy. Denise will talk about that. Music is noisy. Art is busy. And those are often really challenging times for a lot of our students. So we will be in those specials with the children as needed. So OTs may be asked to assess or work with a student who's having difficulty in any of those areas and provide recommendations. facilitate access and participation in any of those classrooms, not just in the regular, you know, third, fourth, fifth grade classroom where they're sitting there doing math and writing. We could be across the board or in any of the specials as well.
[Unidentified]: Okay. Yep.
[SPEAKER_00]: Okay, so least restrictive environment again. As in elementary and it gets progressively more difficult to be in the classroom with the students as they go along, they're expected to really sit there and learn and listen to a lesson. So we can help them with you know, the note taking and following the directions of a lesson. But if they are in a class, listening and learning and writing down what they're supposed to be doing, it's a little harder to be in the classroom. So you might see a shift of more of pullout sessions or more consultation as they get a little bit older. excuse me, but we're still working on all those underlying skills as well. Those motor skills and self-help skills, organizational skills become a little bit more important. Self-regulation is a little, it's obviously more expected for a child to be able to regulate their activity level and their emotional selves as they get older. So we will work with them in those regards as well. Anything that's impeding their ability to access the curriculum, we're in there. We do a lot of out-of-the-box thinking in terms of how to help a child. Commonly addressed areas are writing legibility. Oftentimes, that's what people think of when they think of OT in schools. Oh, you help them write. Yeah, but there's a lot more to it. And it's writing legibility. OTs aren't going to work on the content. They're going to work on legibility and speed and assistive technology if that's needed. We're also still working on following routines, completing classwork, timeliness, management of their belongings. We might be out in the hallways with a student who can't quite access their locker or figure out how to organize all their materials within their binder. And again, consultation continues to be a cornerstone of what we're doing, working with the whole team to carry over what's been taught to the student. And of course, for us to get feedback from other people on the team as well. Okay, yeah.
[6ToLK-34czQ_SPEAKER_12]: Okay, so OT in middle school, I feel like there's almost if you look at the levels of support for both PT and OT it's almost like an hourglass there's well. particularly for OT, is that there's more at the early ages, and then in middle school, there's a little less, because it's a continuation of an academic environment. There's been a lot of intervention early on, perhaps, for some students. And then OT, at least under transition, broadens a bit in high school. So in middle school, some examples of evaluation, again, it's back to those areas of need and referral questions. Classroom participation is always what we're looking at in elementary and middle school. Again, as Kelly mentioned, the expectations for written output increase. As a compensatory strategies, there's more use of assistive technology, for example, a student that's had a lot of individualized or intervention in the classroom and individualized for handwriting at a certain point, we need to get them a manner of providing written output that is least restrictive and assistive technology can provide that opportunity. We're still looking at hand skills organization becomes even more important when students are starting to change classes and get in and out of their lockers that are in the hallway. It's a little bit noisier. So again, the challenges of sensory processing increase self-help includes more expectations of independence in the classroom. And then we also want to start with, it's never too early to start developing self-determination, but according to the law, the self-determination and participation in the team starts at age 14. I'll talk a little bit about that in upcoming slides. So services again are similar to what Kelly's talked about in preschool and elementary school, but it's provided depending on the need in the least restrictive environments. There's a larger caseload tends to be in middle school for consult with teachers. with accommodations, making sure that they're supported, checklists, again, that gets back to that organization executive function, and also consult with our staff and students to support more and more independence with assistive technology, such as an example, the Read&Write Google extension that is available to all of our students that provides word prediction and read aloud. and also inherent in Google, our Google tools is voice typing. So we're in on a systematic level, OTs are consulting with teachers and staff and providing professional development. Most recently, some of the professional development that's been done is supporting self-determination and also doing transition related training. Okay. So we're just going to talk, we could talk a whole, do a whole session about transition. Excuse me. Uh, when I let someone in, it also, whoops, forwards the, sorry. Multitasking. You're good at it. Sure. No, I'm not. It's not, there's a reason why you go into OT guys and.
[Adam Hurtubise]: Charlotte, are you letting people into the call? I am, yeah. We'll do that. You don't have to worry about that.
[6ToLK-34czQ_SPEAKER_12]: Ah, okay. Well.
[Alexandra Lauric]: I have a question.
[6ToLK-34czQ_SPEAKER_12]: Good time for a question, Alex.
[Alexandra Lauric]: So PT and OT, are they only on IEP or you can find the services on the 504s?
[6ToLK-34czQ_SPEAKER_12]: over i have provided um consult on 504s but not direct service i've provided direct services on a 504 alex mostly related to um a child who um
[Denise DesJardins]: academically is doing fine, but has some sort of a physical disability, such as using a wheelchair or using crutches or having some sort of limited mobility for whatever reason, then my services or physical therapy services could be offered under a 504. And they may include, you know, assessing an environment, helping modify an environment or helping the child, you know, adjusting a walker or adjusting a wheelchair. So yes, the short answer to your question is yes.
[Alexandra Lauric]: And I was wondering if somebody was to them, for instance, breaks his hand right, which would affect both PT and OT but it's like right limited right disability is there going to be an IP or 504 or.
[Denise DesJardins]: Not typically, Charlotte, I don't know. So again, and Joan and Jan, please feel free to jump in if I'm getting it wrong. Typically the nurse. So if a general education student breaks their hand and can no longer do MCAS. because it's their right hand. I think, and Avery I know is on the call too, I think it more comes under the nurse's prevalence or am I wrong, Joan and Jan?
[Joan Bowen]: There could be a 504 accommodation plan too, so it depends. I think it's important for all the service providers, the nursing to meet to talk about what what it entails for the in how long the students going to be in a cast and how it's going to impact his educational experience so everyone tries to get together to figure out what what's going to be best so it could be like a health plan, it could be a 504, it varies.
[6ToLK-34czQ_SPEAKER_12]: Yep, that's what we're seeing in high school, too. I think it also varies in terms of how long the impact is going to last, too. All right, so at the high school level, my role is an OT and transition specialist. And under IDEA law and also state law, students become a member of their IEP team at the age of 14 as long as the The IEP team agrees and parents and caregivers agree. So they are invited to their IEP meeting starting at the age of 14 and are considered to have an important role until they graduate or if a student continues on in the post-secondary program. possibly up to the age of 22. So an IEP, particularly starting at that time, is based on a student's post-secondary vision, vision after high school. So what does a student want to do for future employment? What does the student want to do to learn more about? What do they want to do for continuing education? And if it's relevant, what are their plans for independent living. So transition services are defined by IDEA law as a coordinated set of activities designed with results-oriented process to facilitate a student's movement from school through post-school activities, post-school activities being the post-secondary vision. And that's sort of what we're here for anyway, right? The big goal is to support students so they can go beyond high school and be as independent as possible, working paid work out in the community as independent citizens. So transition services are based on that post-secondary vision and on the student's individual needs and preferences and interests. So for example, so the IEP is based on that vision. And so as an example, a student with a specific learning disability that is having a hard time, is having challenges with reading and math, but wants to go on to college. Well, the transition, you need to look at the whole IEP as a transition plan, essentially. And the reading and math goal on an IEP is a transition service, in a sense, in that that student is headed toward college and that's needed in order for graduation, which is required as the step, a required step to go on to college. So these services help young adults to live and work and participate in the community. And we take a look at that participation in the community at the high school level would include some things like. joining a club, traveling on the MBTA along with other students back and forth to their home. So it's a bit of a broader lens, particularly in my role as OT and transition at the high school level. Again, we could spend all day on this one. Okay, so some high school examples of evaluation. They're based on areas of need, which may not be as wide as preschool, but it also may expand because we're thinking about transition skills. It's based on the student's post-secondary vision and also those referral questions. The areas of need might include written output. It's again, all the way through we're looking at greater and greater expectations, use of assistive technology, hand skills, organization, organization that is associated with longer, more complex projects. Again, the sensory processing, it's a school of what, 1,300 kids now in the high school? So it can be noisier, a little bit more traffic in the hallways. Self-help skills, the expectation is higher. community participation, self-determination, we really want to develop that student's ability to come to their IEP meeting and identify their plan for the future, and also talk about their strengths and their challenges and accommodations that help them. So again, as all the way through across from preschool to elementary and middle school, OT services are, they're wide range depending on the needs, but it's always within the least restrictive environment. There's also a great deal of consult with teachers, academic and vocational. For example, we want to make sure the accommodations are being supported, providing checklists to complete tasks, supporting use of assistive technology. Again, such the Google Classroom, Google extensions for proofreading and environmental adaptations. One of the things that we've been doing over the last few years is we have a protocol for bringing in like Pilates balls into classrooms and the students would know. Also we offer them, we introduce them, we talk about the purpose, but then it's also followed up with a self-reflective checklist so that the student is deciding, hmm, did this help? Did this help me get more work done? Did this, did I feel more calm on this chair? So that's a part of that. self-determination, we want them to take more control and make decisions about what works best for them. So on a systematic level, these are some examples that are actually happening this week. We're doing, I do a lot of work with Catherine Cook, speech and language pathologist. We go into classrooms, substantially separate classrooms. to do transition seminars where we cover a broad range of topics. What's happening most recently is College 101, where we talk about all the different vocabulary that is required at the college level. And we're, on Friday, we're going with a group of students to Bunker Hill Community College, which will also include a meeting with the Office of Disability, so that students start to learn about their role and rights between IDEA, which is in public school, and then transitions to ADA in the workplace and post-secondary education. I also work on a systematic level, just sharing information about community-based programs and workshops that are available for students with IEPs and 504s. We do events such as school-wide events, such as we do a going to college information session along with the college fair for students with IEPs and 504s. And it hasn't happened for a couple of years because of COVID, but we've done also a transition fair where we bring in approximately 30 to 40 adult service providers so that our students and families can get to know what's what's out in the community after high school.
[SPEAKER_00]: Go ahead. I was just thinking about this. I haven't done high school evaluation in many years, but I just wanted to add one of the most fulfilling evaluations that I've done was a high school transition evaluation of a young lady who's, she had a syndrome and was quite challenged. academically and her mom did everything for her at home, literally everything. And one of the things that came out of the evaluation was her, the child's student's determination. She wanted to have more responsibilities at home and she wanted to have a job. And when I put that out there at the meeting, The mom was floored. She had no idea. So it made an enormous impact and opened the lines of communication between them so that she was able to say to her mom, this is what I want. This is what I want to be an independent person. And we found ways to do that. And many years later, that same mother contacted me telling me what you know what that student is doing now no longer student but and how independent she is and and thanking me for that. So that was one of the most fulfilling evaluations that I've done, even though I do mostly younger children. So that self-determination, that transition work is tremendous, Charlotte.
[6ToLK-34czQ_SPEAKER_12]: Kelly, you pointed it out. That is my favorite. It is the most satisfying as a practitioner to bring out the voice. And I also do, we do a transition seminar on civil rights. And I try to, you know, sort of almost build some righteous indignation with students. Like, yes, people marched on Washington to have these civil rights. And you can do it too. You can do it, right? Yeah, Melanie, you do a nice presentation on that history too.
[Melanie McLaughlin]: Thank you. I think we need to do a disability pride parade, but that's another day. Yeah. Alex has a question.
[Alexandra Lauric]: Okay, Alex. Yeah, sure. Yeah, I have a question, because Kelly, what you said was so meaningful and important. So I was wondering if you can comment on the relationship between school and home, like are there consultations, particularly for the transition? It seems like almost, you know, we're going back to like the relationship becomes so much more important, right? Because then the student is going to graduate and you know what I mean? So are there consultations outside of the IEP meetings? with the parents?
[6ToLK-34czQ_SPEAKER_12]: Well, so it varies according to the need of the student. And so there's often consult. So let me just talk about, so there's a lot of similar, there's some similarities kind of with the relationship with parents, with preschool, parents of preschoolers, and also parents with project transition students. So project transitions is a program that is after 12th grade. If the student hasn't, met requirements for for a diploma if the team feels like the student needs to stay to continue to work to work on their post secondary goals, and the students. It is individualized, but students can stay until they age out to the age of 22. So back to your question, Alex, we do quite a bit of consult really on a daily basis. Danielle Pelletier, our OTA, is an integral part of that program too. There's OTA support that's integral, but also in addition to, to providing targeted direct services for goals, but there is almost constant community. There's a lot of back and forth in communication with parents. The evaluation also is somewhat similar. There are some similarities to preschool in that we do do a multidisciplinary sometimes depending on. what's appropriate, a multidisciplinary evaluation where it's OT transition, speech and language, and education combined. That type of the evaluation, a transition evaluation for a student in project transition is focused on independent living, community, employment, self-determination, And that includes just greater expectations for independence with self-care. We do a lot of travel training because that's like the key to get places. We will develop skills for travel and sometimes we'll get calls from our staff to say, so-and-so is out on the street by themselves. Like, yep, well, yep, that student is going to work. And we're sort of proud of those, those phone calls to because that means that students is independent. Um, but also a lot of consult, and just. really supporting the parents to increase those expectations. Like Kelly said, I often in an evaluation, one of the most common recommendation is increase expectations for chores at home and put a checklist on the refrigerator or increase expectations for making your own purchase, allowing student to make their own purchase in the community. So we're consulting with parents, throughout high school and into project transition, and also working with staff, working with community-based programs, connecting with community-based programs for training, and also training paraprofessionals. So again, this is a topic that we could spend a whole nother session on, and we have in the past, right, Tanya and Alex? Okay, so that is kind of an overview for OT. across preschool, elementary, middle school, and high school, and post-secondary project transition. And now talking about PT, Denise.
[Denise DesJardins]: OK. So I think one of the first things to just sort of talk about is there are, as you saw on the first slide, six OTs and two occupational therapy assistants. And right now there are two PTs. So you can imagine we are kind of busy, the two of us. But let me give you a little bit of an example. I think one of the good things about that is we often, myself and Nicole Connington, who was the other PT in the system, are often there from the beginning through a child for as long as they need us. And that often is through high school. So I've had the pleasure of watching many, many students that I've been involved with start at age three, and then graduate, either through at high school or post transition so that is certainly something that to me is is very fulfilling. So like I said, we started age three for preschool. And like OTs, we're pretty much able to integrate ourselves into the daily routine of the classroom. The way that sort of we look at it for any child, whether they're three or approaching 22, is their ability to physically access and participate in their school environment. So, again, you know, physical participation is important for a number of reasons, certainly, as we'll get as we move forward, I'll talk about that, specifically how it relates to sort of social and and making friends and and that whole thing. because if you're not able to participate from a physical aspect, it really kind of puts you at a disadvantage, especially during some of those times when like lunch and recess and specials where, you know, that ability to be there with your friends is important. So, you know, again, in the daily routine, it's increasing independence and mobility, stairs, playground equipment, As well as participation in the classroom gross motor play which oftentimes in preschool is music and movement songs and getting students to be comfortable with foundation what I call foundational gross motor skills which are running, hopping, jumping and galloping. We also start at preschool, although it tends to be a much more heavy focus of mine in elementary school and middle school of ordering specialized mobility and seating equipment for students. So instead of sort of ball chairs or Rifton chairs, I spend a good amount of my time working for those students who really need specialized or customized equipment, such as a wheelchair or a gate trainer, or some, some other way to sort of access their educational environment in preschool classrooms we often will work with a group of children. Again, they also may receive their therapies in a smaller group, but I found certainly over the many years that I've been doing this, that kids are motivated by other kids. And those, I don't, you know, I found that children with significant physical disabilities to children that have, you know, just need a little bit of direct teaching skills, the biggest motivator is another child. By by 1000% so I try really hard to keep most of my most of physical therapy services and I know the other PT do it does as well. Keep it in the context of the school day or in the context of what the class is doing. You know, like Kelly mentioned in preschool once in the classroom and once in a designated room. And again, that is mainly just for the direct skill teaching there are some, there's a lot of students that we need to teach them how to stand on one foot, because standing on one foot allows you to weight shift and be able to navigate stairs. Though I will say very freely, it is again hard to work on that skill one-on-one with a student. It's much easier to have that context occur on the playground when they want to get up to the top of the slide or they want to race up to meet their friend or they want to challenge me or the paraprofessional or the teacher. So again, as much as possible, keeping the session in the context of what's happening in the classroom. Consultation is obviously a major component throughout the child's educational experience. Email communication is huge with parents. I am proud of the fact that I probably have communicated multiple times with all of my students' parents by emails, whether they speak English or not. So I think that that's, to me, is very, very important because they are their child's biggest advocate, and that is huge for them. Next slide, Charlotte. So, as obviously as a student moves up the physical demands increase, and that is that is probably the hardest thing for the students that I see, because preschool is kind of a bubble, and then all of a sudden they're they're they're tossed into kindergarten and kindergarten is hard. even though you wouldn't think kindergarten is hard for those kids who have trouble sort of with their mobility or have trouble with their gross motor skills. Kindergarten is hard. I spend a lot of time, I encourage anybody to watch a kindergarten gym class to just laugh out loud because it is just incredible to watch how the various levels of kids and their abilities to walk, to run, to jump, and I love that part. Alex, I think you asked, you know, how often do we go into classrooms with kids that are not on IEPs? And I think I look at it as the fact that I may be in there for one or two students that are on IEPs, or if I'm in a general ed, if I'm in phys ed class, you know, my role is to kind of look around and see, you know what, if I pair that child with my child, maybe, because there's always the students that want to help the other kids. So I think that it's a huge role for us and being in physical education class. So foundational gross motor skills obviously are continuing to develop and students are being asked to generalize these skills, generalize these skills. And for people who understand that a number of our students on both OTPT as well as other caseloads are autism, that can be really tough. So we spend a lot of time again and that's why I think it's even more of an argument for for teaching these skills in the context of which they need to be used at. So I spend a lot of time on the playground, spend a lot of time at recess. I walk up and down, like Charlotte said, I don't need to look at my Apple watch because on a good day by 11 o'clock at the 10,000 steps are in, go up and down the stairs a lot. as well as transitioning to different areas of the building. And again, my role there is to figure out, you know, is this, is Mary here having trouble because she's at the front of the line? Is she having trouble because she's in the middle of the line or the back of the line? And part of my role is to talk to the teacher and say, maybe, you know, let's try Mary at the front of the line, or let's try Mary at the middle of the line, or let's try Mary at the end of the line. Continued collaboration. So I spent a lot of time collaborating with outside providers, both with high tech, excuse me, both with low tech stuff and that may be through the OTS or through the speech people or anybody else as well as high tech stuff which is customized wheelchairs. customized gate trainers, customized standards to allow students to access their environment, to allow them to be on the same level as their peers is huge. You see delight in students' faces when they can actually be eye to eye with their peers. So I spend a lot of time with that. As far as evaluating, I think both school-based PTs, we typically look at, number one, the ability to navigate stairs, the ability to navigate safely in the hallway, to access climbing structures. What's causing sitting problems? Is it decreased endurance? Is it postural control? Will this seat work? Will that seat work? Do they need me to order them something specialized to make sure that they're in a position to learn? I provide this we provide the services at recess in PE E class direct skill teaching as needed, but again, as much as possible. I'm in the classroom, whether it's at recess, whether it's a gym class or whether it's during music class where there's a lot of movement going on. Um, my consultation, like I mentioned, I do a lot of consultation with parents, especially if, if we, I try to work in conjunction with them with equipment, um, and figuring what they would like to see their child do and what they think, you know, might work for them. Um, as parents, um, I spend a lot of time with the, um, PE teachers, um, especially those at the Roberts and the McGlynn to talk about making it to getting my students independence. Student modifications as needed, the classroom teacher regarding positioning or assistance needed. And as I mentioned previously, at recess and during PE class, I will always pull in other students to model the desired activity. You never have a problem finding somebody who wants to show off what they can do or to motivate another student to come up the stairs or go down the slide or chase somebody. So I never lack for volunteers. Next slide, Charlotte. Again, these are stairs at the one of those is a picture of a staircase at the McGlynn and the other one is a gym and and I mean those stairs are hard to navigate as someone who does the multiple times in a week. You know, we spend a lot of in we're asking our students oftentimes to navigate the stairs very rarely in isolation. I always wanna make sure there are other people on the stairs with us, because that's a normal environment. So we try to transition in line with class. Certainly if I'm just beginning to teach a child how to do the stairs, I will try really hard to make sure that there's as little distractions as possible, which is hard, especially at the McGlynn, which has two schools. But for the most part, I want there to be other people on the stairs, because that's what happens in life. And like I said, we work in the gym as well. Next slide, Charlotte.
[Melanie McLaughlin]: Also, I just sort of wanted to mention looking at that gym and the vastness of the gym and the echoeyness of the gym. I don't know about anybody else, but I know a kid or two that is affected by those acoustics. And so while you're trying to do PT with them, you're also dealing with all these sensory things that are happening, right?
[Denise DesJardins]: We are, yeah, except, you know, I mean, headphones are great. And it's amazing that the more we can accommodate the kids to the sound, you know, I have to be honest, the PE teachers that I work with, especially Rob Ferrante at the Roberts is amazing with helping me accommodate some of our students that have sensory challenges. You know, the music will get turned down or he'll instruct the whole class, you know, not to scream. not specifically saying it's going to affect my student, but just saying, you know, let's not scream when we're running because, you know, it hurts, you know, I'm old and it hurts my ears or something. So I must say I have a lot of buy-in from the gym teachers, most particularly the one that, yeah, it's great.
[Melanie McLaughlin]: And so do you also get, just out of curiosity, I mean, I know that there's a whole process for students with disabilities. with regard to adaptive PE, but I'm also thinking about just that sort of general consult around like not necessarily a student that might need adaptive PE, but whether or not the adaptive PE teacher would consult at all with sort of those kinds of situations. I mean, obviously there are some that you're fully capable of handling around the acoustics. And like you said, some of the accommodations that the teachers already provide, but if there were, or have there been, and I know it's a new position, but if there were certain needs, would that happen?
[Denise DesJardins]: Of course, and I think it's been a learning experience for me, as far as the role of a PE, I mean I had sort of gone to observe a PE. So, but working, you know I work with color a lot. We've known each other for a number of years so so we talk a lot. And I've really found that there's a vast amount of difference by what we do for that. So, like I said, my goal in phys ed class, because that is the least restrictive environment, and many of our students can be quite successful in that, especially with the repetition and the familiarity of people, of the PE teacher and the activity.
[Melanie McLaughlin]: I didn't understand what you meant that there's a vast difference between, can you elaborate? I'm sorry, I didn't understand what you were saying.
[Denise DesJardins]: Sure, so I think I'm skilled at looking at the physical issues of a child. And I can also, after years of experience, sort of kind of tease out what other issues may or may not be prohibiting them from participating. So for me, the most least restrictive environment is for a child to be in a gen ed, is to be in physical education class with their peers. whether it's, you know, from a subseparate program into a gen ed PE class, or whether it's working with a student in a PE class, but trying to make it obvious, trying to make it less obvious that I'm working with a particular student, excuse me, and just kind of there to help everybody, because that's tricky, because, you know, and a lot of times, you know, they don't want me standing by them or they don't, you know, so I think, The way that I look at it is that there are certain students for various reasons who cannot participate in a general education PE class, mostly because of sensory issues. It's too loud. It's just too sensory overwhelming and stuff like that. And I think that's great. And I'm so thankful that we have APE this year. So thankful. But I see my role more as helping those kids that can participate because I'll tell you, it makes a world of difference when these kids are out on the playground, and they know them from gym class, or they know them from, you know, eating lunch in the cafeteria. It's wonderful. It's great. You know, at recess time when they can say, oh, he can come play with us, or he can, you know, because they've seen him or her in a PE class and it, you know, they're not any different. So it's, it's, I've seen it work wonders, especially.
[6ToLK-34czQ_SPEAKER_12]: If I might just chime in, Denise, you're, you're looking at it as like from your extensive physical therapy, neuromuscular, like understanding from that perspective too.
[Denise DesJardins]: Yeah, but I'm also looking at it. Yes, and I think school based physical therapists, obviously that's, that's what our primary role is but again also recognizing that especially for some of our students the social interaction, the ability, the inclusion piece. is huge. And for some of our, from a lot of our students, gross motor is the way in successfully. There's been research papers on that. So for me, I spend a lot of time making sure that those students are comfortable in those kinds of environments.
[Alexandra Lauric]: Does that answer your question?
[Denise DesJardins]: Thank you.
[Alexandra Lauric]: Yep. So I have a question, Denise. So students.
[Denise DesJardins]: Yes. So students. I've worked with Mr. Larekson for many, many, many years.
[Alexandra Lauric]: Yes. So students who are eligible and receive adaptive PE services, they usually CO2, right? So is it true that- No, not all the time. Not necessary? Okay.
[Denise DesJardins]: No. So there are some students who it's not a question of skills, it's a question of understanding or having the receptive language skills to do that. So it's been a pretty clear delineation, and I certainly don't want to take away, I know Carla presented at some point as well, of Carla's role and how wonderful it's been this year, and including all kids having the opportunity to participate in physical education activities, because I know she mirrors very much what the PE teachers are doing. or trying to stay somewhat in touch with that. So no, I don't see all the students get APE. I don't.
[6ToLK-34czQ_SPEAKER_12]: Perhaps that's a topic for PE and adapted PE together as a topic for another conversation.
[Denise DesJardins]: Next slide, Denise. Yes, please. So in middle school, similar to OT, but especially, I think, for physical therapy, it's much more consultative, especially for those in gen ed. I do a lot at the beginning of the year. I will often, when writing the fifth-grader IEPs, after discussing it with the parent and the fact that they're now going to middle school and coming out For PT or having me, you know, shadow them in gym class just isn't appropriate. We are incredibly blessed to have wonderful middle school PE teachers in Mary Hardy and Mike McGlynn and Reggie Maidmon and Lauren Bandonian at the Andrews, Mrs. Hoardie and Mr. McGlynn are over at the McGlynn Middle School, and they just are great. And it's certainly because we've worked on building the relationship over the years, where they know me, they know to come to me if they have questions, they know if I go in and I say, x, y, and z, they're like, absolutely. Or if I say, you know, ABC, they're like, you bet. So that when I asked them to report back on, you know, how a student is doing, they're able to tell me that. So again, we are incredibly lucky to have teachers like that, and hopefully in every district. there has that relationship with the PE teachers. So for the most part, though, for most of our students in general education, it is consultation. I'll talk to the PE teachers, I'll check in on it, but most Gen Ed kids in middle school are like, yeah, goodbye. And I've had them say that to me, quite many. One little girl that I went to, one young woman that I went to evaluate in eighth grade sort of very, very nicely told me to get lost, which was like, okay, I get it, I get it, you know, I get it. Because she considered me to somehow be part of the past that she was no longer there. But I do spend a ton of time in the subseparate programs, both at the, particularly at the McGlynn Middle School. I spend a lot of time in our access programs, which are our programs for children with multiple disabilities, including physical. So those children tend to have more intensive physical needs. I am part of the team in that classroom that basically participates with them throughout the day, whether we're doing groups to work on independent living skills, which we do at the McGlynn Middle School, whether it's working in the elementary access programs. I spend a good part of the day there just helping the staff figure out positioning, figuring out what makes the most sense on the playground, what student needs this or what student needs that. Again, we tend to attend PT PT tends to narrow the focus in middle school. Like I said I cover both middle school so I feel pretty comfortable and saying that, you know, I think, and I think this is pretty consistent across. across physical therapists from my communication with physical therapists and other schools, we tend to kind of focus our role at that point to those children that that have significant physical disabilities. Like I said I spent a lot of time. adapting, modifying, getting specialized equipment for students, trying to use a combination of what we have in school, what we need in school, what I can order for a student, what a student needs.
[6ToLK-34czQ_SPEAKER_12]: Denise and Kelly, I have a question regarding the consult. Do you find that you just do a lot, a lot of consult right at the beginning of school just to get getting set up? Like it's consult throughout the year, but I find that I do a bulk of consult for less for for lower need students at the beginning of the year because you're setting it up.
[Denise DesJardins]: Yeah, I think so. So, for PT I think to there may be times when you needed sort of to come back in. That's true. That's sort of honeymoon period at the beginning of the year where the teachers will kind of be like, Oh, I don't see that that's great, you know, they're doing great, you know, and then all of a sudden you get the email it says yeah Can you see me about. You know, so and so I have a young man on a 504 who uses a wheelchair in middle school over at the McGlynn. And, you know, the principal was like yeah you might need to talk to him about how safe he's being with the wheelchair. So, the principal was like, you know, you can be the heavy you can tell him that he needs to be. you know, that he needs. And so I went in and had the discussion of like, you know, we got you this really nice chair, but you're not allowed to, you know, use it like you're here at the, you know, like it's a speedway. So that's where I tend to see more of the consultation come in. You know, he doesn't need me for direct services, but I am, you know, I do when the principal says, obviously, you know, can you talk to him about the way he's kind of going around the school with his wheelchair? I'm like, absolutely. So yes, that's where I see it there. You can go to the next one, Charlotte. So by the time they reach high school, I will oftentimes hand off most of my involved students to Charlotte and her cohort up there because they tend to do more of the wraparound stuff. They're there consistently, which makes a huge amount of difference. Certainly those children that continue to have positioning or equipment issues, you know, I'm there for. But I think it's more problem solving. And sort of, you know, if the teacher will reach out or Charlotte or Danielle will reach out and say, I need you to come and look at this child in this in this situation and try and figure out what's going on. Again, the students that tend to be more in the subset but or those with more intensive physical needs. Very rarely in high school and I'm sorry that may have been a misprint in in in when I was writing up the slide but. You know, most of the time, it is again within the context of the class, even for those physically involved, it may involve training the staff on how to get them up in their standard training the staff on how to transfer them, how to use a high low table, which is just a table for children that need assist with toiling can go up and down. which is great now that we have one at each school. So that minimizes our teacher injuries and staff injuries, which is very helpful for that. Yes, so again, a lot of focus on the equipment. Ready?
[6ToLK-34czQ_SPEAKER_12]: Yep. We've covered a lot of territory. Um, from, from age three through 22, um, as I, hopefully you can see our passion for this. And again, we're really unique in that we have this, uh, department that works collaboratively together. We are constantly texting, emailing, um, reaching out to each other for, for advice and, um, expert opinions. We all sort of have of our own, um, specific expertise. So just to kind of review some of the larger points OTs and PTs, even though you can hear that we get really deep into the lives of the children in the Medford public schools, we are related services service to provide service to students to make effective progress in school, in the least restrictive environment, and we are there because of IDEA. And if you widen that scope back to the flyover view, we're evaluating, we're providing services, we're consulting to the team, which includes ongoing conversations with parents and also working on an administrative and consultation model at the organizational level. Okay, any other questions? Thank you for those questions as we went along. Sometimes we need a moment, think time for questions, right?
[Melanie McLaughlin]: No? I think you guys were so comprehensive. OK. All right, Tanya.
[Adam Hurtubise]: Do we have any questions? So we don't have any questions in the chat. I think it was really good that people were able to ask questions as you went along. because they were asking questions that pertain to where you were in the presentation. As we always say, if anybody thinks of questions after we're off the call, you can certainly email us at medford.dpac.gmail.com. We can get that information to you. Also, if you would like a copy of the slide presentation, Charlotte, we're going to be able to provide that. Did you already provide the link?
[6ToLK-34czQ_SPEAKER_12]: Yeah, the second link works, and that also includes our emails at the end of the presentation. OK, great.
[Adam Hurtubise]: And if anybody misses a link or is having trouble on their end, just let us know, and we can get back to you as well. I'm trying to see if there's anything else. I think that's it. That's great. Thank you so much. Yeah, if no one has any questions, thank you. Thank you, mostly thank you to the speakers, obviously. We know all of you personally and have admired your work for years, taught us a lot. We would like to be able to keep the door open in case there is another opportunity to have you present, that would be great. We appreciate you coming and everybody who took time out for the call, thank you for joining. part of your day and have a great night.
[6ToLK-34czQ_SPEAKER_12]: Thank you, Tonya and Alex. Thank you.
[Unidentified]: Thanks.
[6ToLK-34czQ_SPEAKER_12]: Great job, you guys.
[Adam Hurtubise]: You guys did great.