Interview between Speaker 1 (Meg) and Speaker 2 (Greg Santucci)
Episode 37: How Behaviorism Hurts Kids
[Introductory note]
Hey there! Meg here. I just wanted to check in and see if you’ve checked out the Learn, Play, Thrive Education Hub. We are an AOTA and ASHA approved continuing education provider, with courses on strengths-based goal writing, neurodiversity-affirming interventions, and a brand-new course on teaching AAC. Our courses are self-paced and absolutely jam-packed with practical strategies you can use right away. All courses are either taught by or audited by an autistic therapist before they’re put out to you. Check it out at learnplaythrive.com/trainings.
[Introductory music]
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify autistic voices, and change the way we think about autism in life, and in our professional therapy practices. I’m Meg Proctor from learnplaythrive.com.
Meg: Before we get started, a quick note on language. On this podcast, you’ll hear me and many of my guests use identity-affirming language. That means we say, ‘autistic person,’ rather than, ‘person with autism’. What we’re hearing from the majority of autistic adults is that autism is a part of their identity that they don’t need to be separated from. Autism is not a disease, it’s a different way of thinking and learning. Join me in embracing the word ‘autistic’ to help reduce the stigma.
Welcome to Episode 37 with Greg Santucci. This episode is for all of the therapists who need a model of how to be a real change agent, and also to be kind and build relationships with the people around you at the same time. It’s for the therapists who want to build relationships and safety with our clients more than you want to force them into compliance so that they meet their goals. In this episode, Greg and I talk a lot about the things we want to tear down — restraint, seclusion, behavioral strategies — and then we build something new with Greg’s model of child engagement, and a few de-identified and deeply poignant case studies. You may remember Greg Santucci from Episode 5 on why OT must be different from ABA. Greg is an occupational therapist and the founder of Power Play Pediatric Therapy. Greg provides workshops and trainings to parents and professionals all over the country on compassionate, collaborative, and neuro-developmentally informed approaches. I loved this talk with Greg. Here is the interview.
Hi, Greg! Welcome to the podcast.
Greg: Thanks for having me back, Meg.
Meg: It is always fun to talk to you. Greg, you are a really strong voice for supporting kids in authentic and caring ways. Tell us a little bit about your own journey and how you became the advocate that you are.
Greg: The journey, yes. It twists and turns all the time. So, I’ve been an OT for 22 years now. So, and all of those 22 years have been into schools, also sensory clinics, outpatient centers, 30 to 50 treatment sessions a week for 22 years. So, that was the OT journey. So, I’ve worked with a lot of kids. I also have two kids of my own, 12 and 14. I’ve been through the early childhood development years in my own house and I have a teenager now, so I’m navigating the Tik Tok, Snapchat, don’t-embarrass-me-Dad stage of development, and surviving. [Laughs] Fairly.
Meg: [Laughs] Minor two and four. So, you’re a decade ahead of me and making me nervous.
Greg: That just made me feel so old, but okay, that’s beside the point. So, you know, in the schools, I’ve seen some amazing teachers do amazing things in their classrooms under incredibly difficult conditions. It is hard to be a teacher right now. I’ve seen some very well-intentioned teachers, some amazing human beings, do some things that are less than optimal because that’s what they’ve always done and that’s always worked for them in the past. And then, you know, I’ve had some situations in my career where I’ve actually had to call the state institutional abuse line because things that I’ve seen done to autistic children are just not okay. So, I’ve seen a lot, 22 years deep, fired up to make change, and to bring some of the knowledge that we’ve learned from the neuroscience literature into the classrooms, into our living rooms, because it’s not there like it should be. Behaviorism is there, but behaviorism only looks at observable behaviors. So, we need the people who have kids in front of them to dig a little deeper than that. So, that’s kind of where my journey has taken me and it’s where I am now. And, you know, to people who are newer in the field, I know you have a ton of OT’s who follow you, and they are wise for doing that, the journey gets progressively better so that if you’re feeling burned out, keep digging, keep fighting, keep grinding. I’m more proud and more fired up to be an OT now than I ever have been.
Meg: Well, thanks for coming on the show today, Greg. We’ll just end it right there. [Laughs]
Greg: Hey, no! [Laughs]
Meg: So, yes, the question that I hear maybe the most from OT’s and SLP’s who are following along, especially people who are earlier in their journey, but not exclusively, is, “How do I fight this?” They’re saying, “I want to make the changes that I’m being called on to make by autistic people and by my own ethics, and I’m up against something so big. I’m up against the culture of the place I work; it’s so hard. I don’t know how to do it.” And you’re a great model for this because you were on the ground working as an OT, and you’re putting up a good fight in real, meaningful ways to change things.
Greg: I appreciate that. And I can tell you, the answer is very easy. Like, we’re fighting some big battles, and we’re fighting a broken system. And that that takes time. At the end of the day, before I did this interview today, I was hanging out on a playground with a teacher. And we were just talking about the kids and talking about what’s working, what’s not, wasn’t judgmental, it wasn’t calling them out on anything. It was just bringing my knowledge into their knowledge base and kind of blending. So, the answer is, even if you have an administrator who believes a certain thing, or a school believes a certain thing, at the end of the day, your relationship with the teacher and the teachers’ relationship with the students are what’s going to make the biggest change. So, for throughout the two decades I’ve been doing this, it has always been finding that teacher, or finding that one little phrase or that one little strategy that works so that you can get teacher buy in and have success with them, and then bring that success to another teacher. So, that has changed, you know, entire grades, and then entire schools, and you build from there. But we’re wired for relationships. That’s what we say to our teachers about their kids all the time. Same thing with our coworkers and our colleagues. It’s all about the relationship you have with the teachers. So, if you go in there with an open mind, knowing how hard their job is, and just go in there with supporting them and knowing that you have information that they need, you can make the change that you want to make.
Meg: I love that. We talked in Episode 34 with Rachel Coley about therapeutic use of self and how we learned this in graduate school as an important thing, but none of us really knows how to do it, at least at first in more than a token way. And that’s really what you’re describing. How can our relationships with everybody be therapeutic and move us towards this end of supporting our autistic students and all of our clients in more caring, authentic, less harmful ways?
Greg: That’s the word, authenticity. Just being authentic with the teachers, not just handing them a list of strategies. Getting real with them, being authentic with our kids, being authentic with our colleagues; it makes a huge change. And the most important thing — it feels good. It just feels better to go into work every day knowing that you’re working together with a teacher to support a kid who needs support, as opposed to all of the sticks, and the carrots, and the rewards, and the punishments. That’s not authentic, and it doesn’t feel as good as, again, using your relationship to guide your practice.
Meg: I love that. I want to talk about some of the work that you’re doing to try and change practices beyond that individual level. Because a lot of us know the experience of seeing something that needs to change, not really having the agency to change it, not wanting to hurt our relationships with the teachers or whoever we’re working with, and feeling pretty stuck. And you’re doing some great work around restraint and seclusion. Start us at the beginning, give us the overview of restraints and seclusion in the schools and tell us what you’re working on.
Greg: Okay. So, in 19 states in this country, it is still legal to paddle a student as a discipline measure. So, 70% of those paddles happen in four states — Texas, Georgia, Arkansas, and Mississippi, I believe are the four states. But in 19 states in 2021, we can still paddle a kid as a discipline measure. And that is horrifying. Those statistics — and there’s a lot of statistics around, you know, we still, before COVID, we expelled 150,000 kids a year. We suspended either in school or out of school over 5 million kids a year. The amount of restraints and seclusions, just to give you a number that haunts me, we did 20,000 restraints and seclusions in a school year. 20,000, in just one state.
Meg: In just one state?
Greg: Just one state. That state was Wisconsin. So, imagine what’s going on down South, where it’s a little bit more, you know, culturally accepted. So, it’s really bad. So, that just blows my mind. And that led me to the work of Guy Stephens in the Alliance Against Seclusion and Restraint. Guy Stephens and Beth Tolley are amazing advocates, parents themselves, so they get it on a much deeper level. So, I always give them a shout out. In fact, a piece just landed today about behaviors in the school and functional behavior assessments, and how we can do things differently. But there is federal legislation right now that is happening. There’s the Keeping All Students Safe Act and the Protecting Our Students in Schools Act. So, this federal legislation is — these two bills are trying to stop putting kids in padded rooms, and stop restraining kids when behaviors escalate, and really being more proactive. So, there is federal legislation.
Also, with that — and just to tell you, there is a conference coming up and you can find it on the Lives in the Balance website. Ross Greene and his work, he’s actually sponsoring the event to learn more about the Keeping All Students Safe Act and Protecting Our Students in Schools Act. Also, Beth Tolley from the Alliance, as well as Emily Daniels from the organization Hear This Now, they have started a dialogue with the US Department of Education, which I have been a part of, and it has been mind-blowing. And what we’re doing is we’re talking to Dr. Renee Bradley and her team in the US Department of Education about what’s going on in the schools, what’s going on with PBIS, what’s going on with behaviorism and trying to make change, and we have their ears. We had an initial meeting with them and it went so well that they asked us for another meeting. And this now seems to be that it’s going to be a regular thing, of us telling stories of the problems which they are well aware of, as well as some of the solutions. And there are some heavy hitters in these meetings.
Mona Delahooke, who wrote ‘Beyond Behaviors’ is in the meetings; Stephen Porges, who wrote ‘The Polyvagal Theory’ is in the meetings; Stuart Shanker, who wrote ‘Self-Reg’ is in the meetings; Terra Vance of NeuroClastic is in the meetings. So, it is a very diverse, highly articulate group of individuals talking to the Feds. So, we are actively trying to make very big positive change on the federal level, as well as trying to make the change in every classroom where we can get some ears and some change of new lenses.
Meg: And Greg Santucci from PowerPlay Pediatric Therapy is in those meetings.
Greg: [Laughs] I’m in those meetings too.
Meg: Yeah, you are.
Greg: And with all those people, I’m there like flapping like a bird, I’m so excited to just be a part of it. But yes, it is amazingly powerful. I mean, I’m talking goosebumps when you hear the stories, and the success stories of doing things differently. And the Feds are asking for more. They’re looking for new ways. So, everyone should be inspired. You know, there’s a lot of drama around government right now and in the world. There are some very empathetic, compassionate, intelligent people right now in the US Department of Education who are looking to make real change. And there are some pretty cool voices that are fighting for the people who are working in the schools as well as the kids who are trying to learn in the schools.
Meg: That is very hopeful. I’ll link to all the organizations and the conference in the show notes. Can you give me an example of the types of stories that you’re sharing?
Greg: So, there are parents who are on the core who are sharing their success stories with their individual kids. Myself, personally, I shared a story of a summer program, that I was in a behavioral school. And there was a padded room right outside of the door. And I had six weeks of, you know, kids with real concerning behaviors. My success story was using models like Ross Greene’s Collaborative and Proactive Solutions Model, how we were able to not use the seclusion room for the entire summer by educating the staff, giving them new language, giving them new lenses, so that they can see behaviors differently. That teed it up for a Kelly, Sarah, and Rachel Polacek, who actually implemented the Collaborative and Proactive Solutions Model, an evidence-based model, into their schools in Michigan. So, we are hitting the fence from all angles, not only personal stories from parents and therapists, but also other evidence-based models, and showing them that we can even fit these models into a PBIS framework. Because a PBIS framework is not a specific program or curriculum or intervention, it’s a framework. So, in order to make change, you have to be able to kind of work within what we have. But we’ve got to get the behaviorism out of the way, and the rewards, and the punishments, and the make good choices — we have to put that aside.
Meg: Yeah, so you talked about the CPS — Collaborative and Proactive Solutions, is that it? — framework in Episode 5 of the podcast as well, that people can go back and listen to and learn a lot more about that. And I will say we also critiqued PBIS in that episode, and people can listen to that as well. But I love that you’re trying to get this change to happen from a policy level, because it is very, very hard to fight on the ground. I was in the schools for, I don’t know, two years in rural North Carolina. And I’m actually from Mississippi, by the way, and have seen corporal punishment in Mississippi schools in the last decade. So, I can verify, we always — Mississippi always makes those types of lists.
But when I was in the schools, I had a child who was probably autistic, but I don’t think diagnosed. But he did have an IEP who wouldn’t change classes. I might have told the story before, but they would have an armed police officer come and physically pick the child up and move him to his next class. And this is how they got around the rules on restraint for teachers. And therapists, we had all done the training about when and how we could touch a child, and that was not one of the ways or one of the why’s. And I tried to talk to the teachers, it didn’t go well. I mean, I went in kind of hot on it, I would say, because everyone was justifying it and no one was standing up for this child who was a black boy who was autistic, already being touched by armed police officers in elementary school. And nothing about that was okay to me. And nobody had — nobody had my back. I went all the way up and went up as high as anybody would listen to me. And I got a, “We’ll look into that.” The teachers at that school who I’d had good relationships with didn’t trust me anymore after that, because they were really counting on this intervention — if you want to call it that — of the school safety officer physically moving these kids. It went badly. I was glad it was the end of the school year. I didn’t actually help anything, but I kind of had to fight. So, I love the story that you’re trying to change it from a higher level.
Greg: Yep, stay tuned.
Meg: Yeah, we will. All right. Greg, if people go to your website…
Greg: Yes.
Meg: The first blogpost they see is called ‘Tear Down Your Behavior Charts’. Why, Greg, are we tearing down behavior charts?
Greg: Tear ’em down. All right. So, before I soapbox it, let me give you some quotes and thoughts and reflections from the actual kids. Because I’ve asked that question in some way, shape, or form to the actual kids who are exposed to these behavior charts. So, what the kids will say is that, “They’re not fair”, “They’re stupid”. The new one for this year is, “They stress me out.” I’ve heard, “I hate them.” My own son had said that they stress him out. They hate them. So, there you go. That’s from the people who we use these things on. They don’t like them. So, therefore they’re not going to work long-term and they’re certainly not helpful for a healthy relationship. With the story that you told about the school safety officer actually picking that kid up, did anyone ask themselves if they were that child, how would that make them feel? I don’t know if they necessarily owned that as to how that child is feeling, because safety just blew up in that whole situation.
Meg: It did. And I love that you’ve started with the relationship.
Greg: Yes.
Meg: Not the behavior. Not ‘Is it going to help the behavior’. We moved the child to the next class, so behavior solved. But what about the relationship and the child’s sense of safety? How does the child feel with the behavior charts? It’s a question that gets missed. What about the relationship?
Greg: Totally missed. So, you know, and the kids hate them and they told us that. For me, they don’t teach any skills, especially self-regulation skills which OT’s jump up and down about. They don’t teach anything. They’re just a threat. It’s just like, “Okay, you messed up. I need to do something bad to you because you messed up.” And they’re embarrassing. And I just told you that I’m, as a teenager, I’m not allowed under threats of death, cannot embarrass my teenager in front of their peers. You don’t embarrass kids in front of their peers, and that’s exactly what these behavior charts do. They’re not solving any problems but what you’re doing is you’re defining their reputation as the ‘bad kid’. So there’s a lot of bad with it. They’re also extraordinarily subjective. The teacher can move you up and down whenever they feel like it. I was in a classroom recently, where the teacher moved the clip chart to yellow, and the child was actually — after she talked to them — was having a great day, and never moved the clip back. So, this poor kid who was doing well, teacher forgot to move the clip back. And that stunk. So, there’s a lot of problems. So, yes, tear down your behavior chart. That’s what the educational leadership literature says. There’s a ton of references all over the Google machine about why we should tear them down, so just take them down. You don’t need them.
Meg: Yeah, I’m in. Let’s tear them down.
Greg: Let’s tear ’em down.
Meg: While we’re tearing them down, what else should we tear down, Greg?
Greg: Oh, demolition, okay.
Meg: Yes!
Greg: All right. [Laughs] That’s such a loaded question. Okay. How about we tear down the notion that all behavior is either to get something or avoid something? How about we tear up the data sheets that only take data on observable behavior?
Meg: Say more about that.
Greg: Yes, well, the behavior is not the problem. It’s just a signal. So, again, going back to what I said earlier, you know, we see the behavior and we all agree that kids can’t be calling out, hitting, kicking, whining, screaming. We agree that that’s not okay. But that is a signal that there is a problem, we have to chase the why. So, taking data on observable behavior, whether something is attention seeking, escaping, avoiding to get something tangible, is not telling us why the behavior is occurring. So, the data we’re taking starts us off on the wrong trajectory. So, yeah, I can go on for days about that. But I’ll stop there.
Let’s see, other things we have to tear down. We have to stop tearing down kids when they make mistakes, or are having a hard time meeting expectations. That speaks a little bit more to the behavior. The behavior says they’re having a hard time meeting expectations, you know, let’s stop using threats of punishment or bribes of stickers or rewards to just get the compliance. That’s what’s prevalent in the schools. And what ends up happening with all of this behavioral mindset is we just end up breaking the kids and forcing them into silent compliance, that then when they’re quiet and when they fall into line and we’ve broken them, then we say they’re being good, or they’re making good choices. No, we just broke them. And they’re scared of you. And they’re scared of the chart. And the chart has more power over you as the teacher, because they stare at that chart all the time, and the kid is scared to make a mistake in the classroom or too scared to step out of line. So, the teacher becomes not a co-regulator, which is what they need to be, they become scary. And that’s sad for me and sad for the kids.
Meg: You said, we just end up breaking the kids and forcing them into silent compliance, and then we say they are good. That’s really powerful and really true, and brings us back to this central theme of the podcast — which I’ll admit was not what I was expecting when I started this work — which is that, how are we impacting a child’s relationship to themself? And we know as adults, right, most of us sometime in our 30’s, somewhere around mid-life, starts to learn that our relationship to ourselves is the most important thing that we need to figure out and work on. And it starts in childhood. And it is at the core of a child’s well-being, is how they see themselves. They see themselves initially through the eyes of the people who care for them. They’re learning from this.
Greg: And you know what, I get so mad for teachers — not mad at teachers, I get mad for teachers, because they’re being measured by moving the group forward, they’re being measured by their test scores, and they’re under so much pressure to move the group forward that that’s not the reason they came into the profession. They came into the profession to connect with kids, to help kids, to support kids. And there’s so many voices and forces coming at them that make it so difficult for them to rely on that relationship, that they need to get back to basics. Again, the charts, and the rewards, and the prizes, and the desk pets, and all the crap that’s out there… First of all, it’s expensive, so I’m saving the money. Relationship is free. They just have to get back to basics, that it’s you and that kid. And if there’s 20 kids in the room, you know what? 17 of those kids, you’re going to be able to set up and get them something where they can kind of focus on, and you can focus on those three kids who really need you. And those three, the numbers have changed, that you’ll be able to move back and forth. But really, I mean, tear that — you don’t — you just need the kids and the teacher, you can tear down everything else, because it’s that relationship that is going to make that kid remember that teacher 30 years from now.
Meg: Absolutely. I think it’s hard not to relate to these types of scenarios as a parent, and my kids are still young. Our criteria for schools isn’t who has the coolest art curriculum or whatever, it’s ‘Do I feel like the teachers love my kid’. That is the only criteria. I don’t really care about anything else if I feel like they actually love my kid, and accept my kid, and like my kid. And I hope that never changes. I hope that remains the criteria. Because what you’re describing is not good. And I love how you approach this as feeling mad with teachers, and for teachers who are also in this really impossible setting and learning to fight back, and learning to be the teachers who they set out to be, just like we’re trying to learn to be the therapists who we set out to be, and its hard work. I’m going to put my wrecking ball not far away in arm’s reach, but just like on the desk for a second and we’ll stop tearing things down. And let’s build something, Greg.
Greg: Okay, let’s build.
Meg: All right, talk us through your model of child engagement.
Greg: Ah, yeah, so the model of child engagement has kind of evolved over time, and then I actually started writing about it. So, the general premise of this model is that if you don’t feel safe wherever you are — school, home — you can’t be regulated. If you don’t feel safe, you can’t be regulated, and you must be regulated in order to build skills and to learn. So, it’s that hierarchy. Safety, regulation, and participation that I have been using in my day-to-day treatment sessions to kind of guide my clinical reasoning. So, as adults, too often — and especially as OT’s — we gloss over that safety piece. What I really wanted to bring forward in our clinical practice, and the neuroscience backs me up, is that to ask ourselves first, “Does a child feel safe with the people in their environment and in their sensory environment as a whole?” And so, the model started working with autistic children who were harder to connect with. Who were, you know, we would describe as ‘in their own world’, or ‘difficult to engage’, or ‘disengaged’. That’s where I started. And, you know, those are the kids that you’re spinning your wheels with. You don’t know necessarily what they’re into. You have all of these fine motor goals and all these visual motor goals, but you just feel like you can’t get them to engage with what you’re bringing to the table. And we use things like preferred and non-preferred activities, which are just settings that I don’t use.
But what does it mean to feel safe is something that, again, I think OT’s and parents and people in general, teachers, that for example, if a teacher is very punitive, if there’s a lot of take away recess, take away choice time, take away class box, the child doesn’t feel safe in that relat — that’s not a safe relationship. That says that the teacher can wield their power at any time, and you’re going to have something taken away from you. And, again, from the kids’ perspective, if they’re impulsive, if they’re neurodivergent, it’s a stress behavior. It’s not necessarily volitional. So, that’s unfair, scary, not safe. If the parent or the teacher is a co-escalator instead of a co-regulator, that child doesn’t feel safe. If the parent is constantly taking things away, or threatening to take away their phone or their PlayStation, the kid doesn’t feel safe. So, safe relationships and safe environments are everything, and it is the starting point.
A lot of times, OT’s go right to sensory. We have to take a step back and go back to safety. We learned at OT school, we know about the vagus nerve, we know how important that is, that feeling of felt safety. So, the model of child engagement is a framework that I originally created for therapists and it’s starting to get legs through other environments and other disciplines. It was to help therapists navigate their therapy sessions, particularly with those kids who seem to be more disconnected. So, in the heat of the moment or during the energy of a session, it’s important to have a model to guide your clinical reasoning. So, that’s why I wrote the model of child engagement. It’s there to help adults identify where the child is, and guide how we provide their support. The first question being, “Do they feel safe?” I ask myself that question every day, and there’s many times where I have to stop and go back to safety before I work on the sensory and before I get into the table for the fine motor skills. Safety first.
Meg: Greg, can you give me an example of a case study using your model of child engagement?
Greg: Oh, sure. Let me do two quick ones, one in a clinic setting for the clinicians in the room and one more in a school setting. The one I can give you really quickly in a clinic setting was a kid I was working with recently, Bobby. Autistic, five-years-old, limited language — limited verbal language. Walked into a typical sensory gym environment, you know, wall-to-wall mats, suspended equipment, crash pads, things to jump on. And you saw right off the bat that he was a little bit apprehensive about even walking in the room. And I was relatively new to him. So, he was kind of clinging to mom. Right off the bat, my safety red flags are flying, that I need to slow down, that it’s not just about showing him all of the equipment in the room. It’s making sure that he feels safe in that environment. So, he clung to mom. That says to me, mom is his co-regulator right now and I have to earn his trust and let him feel safe. So, I took my time. I got low, I got below his eye level so that — I mean, I’m six, I didn’t want to be this intimidating force. I got low and I included mom in the session. So, I’m focused on safety.
As I had my platform swing, a square swing, I put a tire swing on top of it to give him some postural support and mom guided him over. And when he saw that mom was coming with him — again, I’m still in safety mode — then he was able to climb into the swing and he was petrified on the swing. He was on all fours his head was against the tire. He was braced for movement. So, again, doesn’t feel safe with his feet off of the ground. I’m in my sensory mode, because I have that knowledge base. But I’m still focused on safety. So, we stayed there. We stopped again, I’m below his eye level, and we just let him hang out, get used to it. Very slow movement. And eventually, he went from being braced for movement to actually sitting down on the swing. And you saw him take a deep breath and you saw him calm down a little bit. Ha ha! There were all of the cues that he was starting to feel more safe. I still had mom there.
And so, I started slow, linear, vestibular input and was watching his stress cues and he was doing okay. So, this probably took about 10 minutes. This is an hour-long session. So, we stayed there. I kept him feeling safe. As that was happening, I started to see more eye contact. I was — just organically, I started to see some smiles, so I knew that I can start kicking into my sensory integration theory and start working on some regulation skills because this guy was a little bit low arousal and I needed to — once he was safe, I needed to kind of lift him up a little bit. So, with the swing, I would nudge him a little bit and I would see him smile. And, again, I would see his eye contact improve. Not asking for it, not forcing it, it was just happening. So, I’m feeling really good. He’s feeling really good. Mom started to step back, which was exciting. And he just started getting more alive, awake, alert, enthusiastic, and now I have bigger swinging, some jostling. And now I have smiles and laughter. So, now, I’ve got a kid whose arousal level is getting to the point where I can go towards participation, the last step in my model. So, we were dancing and grooving, his arousal level was high, which is where I wanted it. And we went to the table, and we did whatever we needed to do. And that took me about 20 to 25 minutes to get there. And I was fine with that. But that was in one session.
Meg: That’s great. Time and sensitivity required, but no compliance-based strategies required.
Greg: Zero compliance-based, zero force eye contact, zero me imposing myself on him. His stress cues, his posture, his breathing, his facial expressions were my cues as to whether I needed to stay here or if I can push a little bit knowing that he was a partner in this process.
Meg: Yeah.
Greg: I know what my goals are. And it’s okay if I have to get to them later. This was so important, just the end result of this. And it was really funny because he loves animals. So, I had Nemo and Dory and Crush from Finding Nemo there. And he ended up coloring and, I mean, gorgeous coloring. And it was funny because I was, you know, it’s coaching through coloring it all in. And he kept missing spots with his orange crayon. So, I would just like, you know, remind him that there was a spot missing there. And he totally schooled me. Because Nemo is not completely orange.
Meg: [Laughs]
Greg: Nemo has white stripes, which is why he was skipping over those spots. So, I apologized to him and validated him, that he was right. And I just like, I just absolutely adore this kid and he totally schooled me and I need to go back and watch Nemo again,
Meg: Brush up on your Nemo appearance.
Greg: Yes, yes.
Meg: That’s wonderful. And I do want to clarify on the eye contact piece because this gets into tricky territory, that your goal was not eye contact, that him making no eye contact might just be his communication style and that is absolutely okay. You’re just saying that him looking towards you was a sign for him that he was feeling safer or more comfortable, and you were reading his signs.
Greg: 100% correct. Eye contact is not a, a measure of anything for me except like connection, and the feeling of safety, and kind of like, okay, you’re my buddy. And that’s it. I don’t require it. I use it as a possible stress cue, as a signal, as a way of communicating that I’m doing okay for this kid. But that’s it.
Meg: Yeah. Yes.
Greg: Thank you for clarifying that. It’s hugely important.
Meg: Yeah, absolutely. Because there’s gonna be plenty of kids who aren’t making eye contact when they’re connecting because eye contact is uncomfortable for them. And that’s fine, too. Tell us your other case study.
Greg: Yeah, so, this — and my friend Kayla — this was a while ago and very instrumental in me actually writing down this model. So, she was in a preschool disabled program. You know, ABA, teacher, RBTs were doing all of the Discrete Trials. And every time it was, “Go to the table to work,” it was a drop-down meltdown. I mean, this was — the kid didn’t have a voice, didn’t have an opinion. It was time to work so they physically move the kid. The kid went, you know, no tone, just flopped down. And it was a power struggle every day. Enter OT. So, we started out, and she always had a transition toy, she had this little plastic cell phone. And there was this kitchen that we had in the room that had all this plastic fruit and she loved that. So, literally, my first session started with her on opposite ends of the room where she was just kind of in the room. I wasn’t necessarily in her space. And she had her cell phone and I gave her that space, and I gave her that time to get used to her environment, and slowly, you know, edged closer to her. I had my cell phone with her so I would pretend to text her and just kind of slowly enter her world, that sense of safety. And, again, I was doing this on the floor because she was on the floor. I always maintain eye level or below eye level with these kids because it just sends that signal that I am not overpowering you. I am here to connect and work with you. So, slowly over time I got into her space. I started playing with her a little bit, sharing things back and forth. She was completely game with that.
And, again, about 10 or 15 minutes of a half-hour session in school during the initial sessions to get to this feeling of safety, where I felt I could move it forward. Moving it forward went to us bringing some food, plastic food, into a little three yards of Lycra that I had — not really a body sock, more like a sensory sheet, something that you can just, multiple people can sit in — and we just sat in there. And we’re just like in each other’s world. Really low demand. She had a lot of, you know, she was able to rock back and forth in the Lycra, get some good deep pressure proprioceptive input there, and we just hung out. As I saw her get more comfortable with me, she very quickly got regulated. And by the end of the session, I got her to the table and was able to work on some of the pre-writing goals that I had in the IEP. So, we went from using the model of child engagement, I stayed laser focus on safety. Once I got safety, I quickly moved to regulation. And once I had her, she was ready to go. And she, you know, we were buddies at that point, we were partners, so there was no drop-down meltdown, it’s time to work.
It was, you know what? I am gonna — you’re leading. I shared my power with her. I felt like I maintained control at all times, but I shared my power with her and she busted out some great work. Held my hands leaving, you know, there was never an issue with transitioning. And it was just, it’s based on respect. I just respected her. I respected her sensory needs, I respected, you know, her apprehension of being in a new place with a new person. Sometimes we lose that concept of respect that we want kids to respect us. Well, we have to lead by example and respect these kids in return. So, that’s how the model of child engagement works. I start on safety. I laser focus on that. When it gets to the regulation stage, that’s where I’m using my knowledge of sensory processing. And then we get to participation, which is the goals. I understand the pressure to meet those goals. But our clinical expertise, our secret sauce as OT’s, is to focus on the safety of the relationship and the safety of the sensory environment first, before we ever get to the fine motor skills.
Meg: That’s wonderful. It’s a great model because your endpoint is very OT. Its participation in real, meaningful occupations and activities. And for SLP’s listening too, there’s such an obvious way to apply this for them as well, right. We’re not going to be working on language and communication without safety and regulation first, and it’s really helpful to hear your case studies to be able to imagine that in practice. So, Greg, we’ve torn things down, and built them back up, and bucked the system, and complimented teachers, and we’ve done all of these things. And if people listening have just one big takeaway, what would you hope that would be?
Greg: Well, the first one, I probably said this in the first podcast, is Ross Greene’s mantra, and that is the most important thing to remember. Write it down on a sticky note and stick it on a teacher’s computer or stick it on the coffee machine in the staff room. Kids do well, if they can. The bigger take home message for me or equally as important is that so much of the concerning behavior that we see in schools and in our treatment sessions can be improved upon, and skills can be built, if we the adults change our approach or work to change the environment first. That we need to stop reacting to the behavior, automatically blaming the kid, and trying to extinguish the behavior that we don’t like. And it’s always relationship first. Ask yourself, “Does the child feel safe?” It is a game changer. Safety first, no matter what.
Meg: Thank you, Greg. Tell us what you’re working on now and where we can find you online.
Greg: I’m happy to say that I am back doing live in-person trainings again. I was just in California last week and I’m going to be in nine states in the next four months. So, I’m doing a lot of writing, and travelling, and getting hotel points again, which I’m excited about. So, on Facebook, I am at Greg Santucci, Occupational Therapist. Every once in a while, I remember to post it on Instagram, which is just my name, @GregSantucci. It’s — I have gregsantucci.com now, which is funny to me, but there is a gregsantucci.com, and that’s it. I’m doing a lot of writing. I will keep everybody posted on what’s happening with the Feds. You know, find me, ask me questions, reach out, go down the rabbit hole of all the resources I post on the page. And, you know, nerd out with me about this wonderful thing called OT and helping kids.
Meg: I love your enthusiasm. We will link to all of that in the show notes. Thank you so much, Greg.
Greg: Thank you for having me.
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