Dec 2     24 min read

An Occupational Therapist Explains Early Intervention

Updated: Dec 3

Yuna, an Occupational Therapist, talks about Early Intervention with children born with delays, had a traumatic birth, etc., and why it is so important!


Host:  0:20 

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Jamie:  1:28 

Good afternoon, everyone. And welcome back to I am able I am Jamie Lord Tovar, and today my guest is Yuna Kim. Hi, Yuna. How are you? Pretty good. Thank you. So today we are going to talk about early in intervention. But before we get started, can you give us a little bit of background about yourself? You know, what, what is it that you do?

Yuna:  1:54 

Yeah, sure. Yeah. So my name is Yuna. I’m an occupational therapist, I work in outpatient pediatrics and focusing mostly with early intervention. So kids zero to three years.

Jamie:  2:12 

Okay. So okay, so that’s your connection to early intervention, then is that you’re a therapist, and you’re working with primarily, children zero to three. So. So, um, why is early intervention so important?

Yuna:  2:30 

Or even early intervention is important. You know, like, the name says, it’s because it really, we provide services. As soon as you know, their home and out of the womb, we can provide services, you know, if they had any traumatic, like, birth history, or even a complicated pregnancy, research shows that the earlier that we start therapies and treatments, the better outcomes and prognosis that we can get. And so as soon as you know, a baby or even a child presents with any delays, or any issues in terms of their overall development, as OTs and even other therapists, we can intervene as soon as we can. And we see that outcome is a lot better when we do it this way. Okay, so early intervention, then is where you’re working with children that are 023. And they have some sort of developmental delay, is that right? So like their physical or cognitive I write normally, that’s one of the first signs that we see. And so if they present with any delays, in terms of, you know, at any point of their development, that’s usually a sign that they may need a little bit of extra help or support in that area. Another way they can get services is if we know that they had some kind of, you know, genetic or chromosomal diagnosis and such as like Down syndrome. So we know that actually from the womb now. And so services can start as soon as they’re born, and they’re medically able to as well. Oh, wow.

Jamie:  4:21 

Okay. So their, their developmental milestones that you’re looking for, is that correct? And is that how you are able to tell if a child is is is developing at the rate that they should?

Yuna:  5:00 

Right, right. So I think a lot of parents and other health care professionals such as pediatricians and doctors are aware of these developmental milestones and they’re just kind of like benchmarks that we look for in a child you know, at certain months or a certain age. We expect to see some of these skillsYou know, and you know, plus or minus couple of months, it doesn’t have to be exactly on that timeline. But we do want them to be reaching these milestones, because a lot of times, these are building blocks and foundations for higher levels, higher level skills that we see as they get older. And so, and we know that with babies and children, young children, there are these like sensitive periods of their development and critical periods. So if they are not meeting those skills in that moment, then it could impede their overall development and growth. And so to prevent that from happening, and to support them in that way, or the intervention can help with that.

Jamie:  5:38 

Okay, all right. So as an occupational therapist, you, you focus on certain parts of the child’s development then correct?

Yuna: 5:45

Yes, yes. Yeah. So occupational therapists, we mostly focus on, you know, the everyday life skills that are needed to be successful in living. And, and that includes for all ages, not just children. Some of the areas that we look at are feeding, dressing, bathing, grooming, and hygiene, things like that. But we also focus on activities that are meaningful to the child. So a lot of times that is playing, playing with toys, going to school, things like that, that children, we want them to be successful successful in. Okay, all right. So you say you, you help with things like feeding so so what kind of things do you do as an occupational therapist? Yeah, so in terms, you know, under the big umbrella of feeding, there are different, more building blocks skills, so there’s self feeding, you know, is a child able to finger feed themselves next, are they able to use spoons and forks, things like that, we also work on oral motor skills. So these are the muscles in and around the mouth, includes your lips, your cheeks, your tongue, your jaws. So we look at those skills and making sure you know, can a child chew and, and manage these textures, and different types of food that we want them to at a certain age, if they have any delays in those areas, we can help strengthen those muscles, or increase, you know, maybe some sensory awareness in those muscles. So we work on oral motor skills, we also work on any selective eating. So if a child may be sensitive to certain textures, or flavors, or they’re resisting a lot of different foods, and they’re not getting a variety of foods, and that’s impeding their overall growth physically, then we can also help them engage with foods and tolerate different textures and flavors as well. Okay, so you said engage with food? What What do you mean by that any engagement with food is any way that we can touch smell kiss, on, you know, bring near our mouth, I know, it sounds kind of weird. And for, you know, for a typically developing person, it’s kind of, you know, imply that we can do all those things. But for a child who has really severe sensitivity, they might not even be able to tolerate the room being in the same or being in the same room with the food. A lot of parents, they just presented to them, like at the same table, and, you know, they run away from the table. And all those things can, you know, point to maybe there are some sensitivities that the child may be having, in terms of tolerating the food,

Jamie: 8:49

okay, so sensitivities, like, they just don’t like the way that it, maybe it looks the way that it smells, I mean, not the taste. So it’s, you have all those different things that you have to deal with before you can get them to actually start to eat, is that right?

Yuna:  8:59 

Right. Right, definitely. You know, there’s a saying, like, use, you eat with your eyes before the knot in your stomach. It’s very true, you know, like, we look at a food and, you know, for us, we want to eat food that looks and like, smells good. And that’s the same thing for a child. You know, if for some reason it doesn’t look good to them, or smell or, you know, whatever, any of those things, then, you know, they’re less likely to try it.

Jamie: 9:35

Okay. All right. All right. So you there’s feeding then you also said that there were some other things like so taking care of yourself as a as a child. And so what kind of things do you do for that?

Yuna:  9:55 

Yeah, yeah, I think we think like, oh, you know, they’re just kids, you know, you know, as parents, we should be taking care of them. But you know, there’s a lot that kids can do. And without even thinking about it, they’re actually participating in these daily life skills without us even knowing. So for example, even just cooperating and dressing, right? A lot of times when we present a shirt or pants, they’ll start initiating putting their arms through the sleeves, or they’ll lift their feet up to you, indicating, you know, I can get my socks changed or shoes changed. So these are some of the skills that we look at. And, you know, for older kids, we do want them to start being more independent in these dressing skills, or in any of these life skills. So we target that as well.

Jamie:  10:40 

Oh, okay. All right. And then, so we have like eating, having like dressing, and then. So do you help like with with toileting? Or like, anything like that?

Yuna: 10:55

Yeah, yeah, definitely. toileting is definitely part of, you know, those everyday life activities. And we can help with clothing management, when it comes to toileting, you know, being able to maybe unbutton or unfasten your pants and pull it down before going to the restroom. And then also putting it back on after because we don’t want to walk around with no pants on if we’re in school or in public. washing our hands, you know, and sequencing those steps, you know, what do we have to do? First, we have to turn on the water, get some soap and things like that we so all those things could be seen under toileting?

Yuna:  11:36 

We don’t at this clinic. We don’t necessarily do actual potty training, but all those skills that are related to toileting we can work on and that just kind of differs from clinic to clinic.

Jamie: 11:47

Okay, so So you work? Do you work primarily at just the outpatient clinic?

Yuna: 11:55

Yeah, I Yeah, most of my clients are seeing at the clinic, I do sometimes do in home, depending on the need of the family. But majority of the clients are they come to the clinic to see me. Okay. All right. And so how long does a treatment? How long does it usually last? So the session is usually a whole hour, but that also includes like, you know, just having the child come in and leave, disinfecting toys in between sessions. Actual one on one treatment time can vary anywhere from like 40 to 50 minutes. And during that time, we’re providing parent education talking to the parents as well. So it could be anywhere from there.

Jamie:   12:40 

Okay, all right. And then so how frequent, how frequent do frequently do you normally see a patient that’s like once a week, twice a week,

Yuna: 12:52

I really depends on the need, I would say, generally, once a week is most typical, but depending on the child’s needs, so if a child needs more services, maybe they need a little bit more support, I can see them up to twice a week, or sometimes. And this happens a lot with my babies who are born premature, we just kind of need to monitor their overall development. So they may not have maybe huge red flags at this moment, but because we know that they were premature, we want to make sure that they’re developing typically. So that can be maybe once a month or twice a month.

Jamie: 13:31

Oh, okay. All right. Okay, so that it can be that infrequently. It’s not necessarily a weekly thing. It could be just once or twice a month. Right. Right. So how do you how does a child get evaluated?

Yuna:  13:44 

Yeah, I would think most of the families that I see it’s usually either the parent or a pediatrician or some kind of other health care professional, that have been observing a child’s development over time, maybe they’re the ones that kind of see, they may see some delays, or maybe a little bit difference in their development. And so the pediatrician can refer patients, their patients to the regional center, which is most difficult for early intervention, or a parent can actually reach out to the regional center on their own and request an evaluation. And so from there, the regional center will, you know, take into the concerns of the pediatrician and the parent and provide the necessary evaluations.

Jamie: 14:35

Okay. All right. So the regional center, like there’s different ones throughout LA County, just depending on what area you live in. Right. Right.

Yuna: 14:41

Right. It’s the regional center system is actually I think, specific to California. But it’s a government funded program. And it is by regions, like you said, so different counties. So there’s a regional center per like county or city. So they kind of oversee couple of cities. So depending on where you live, you can go to that regional center that is associated to your, your location, and then all the services and provided are within that regional centers like jurisdiction.

Jamie: 15:15

Okay. So like then the regional center, basically, once they have decided that a child needs to have intervention, then then they direct a direct services to, to a particular company, like we work for total education solutions, but the right other outpatient facilities, is that right?

Yuna:  15:38 

Yes, exactly. All right. Cool. All right. Um, let’s see.

Jamie:  15:44 

So, we talked a little bit about treatments, and that they can take place at home or in the clinic. So what about the, like parents and caregivers? Do? Are they usually involved in, in the treatment as well? Or how does that work?

Yuna:  16:00

Yeah, definitely. So our company has an open door policy. So parents can come into the session at any point at any time. And a lot of my especially for my young, younger children, most of my parents are involved in this session. And so sometimes it depends on the child’s needs, sometimes they are more observing, and then I do a lot of parent interview with them, I provide a lot of parent education as kind of a session is going on. So they’re observing a lot of things that I’m doing. And then you can know, they can ask me questions, and I can provide feedback. So my sessions, I, you know, it’s more beneficial for the parents to be more hands on. So they will be directly handling their child, and I would just kind of provide some coaching or guiding during the session. But I would say, and some of my parents like to step out, because sometimes kids act different when the parents are there. So that’s a conversation that, you know, therapists can have with the parents, and you know, if there are mutual agreement, then parents can step out, but a portion of that session is, is committed to talking with the parents. So after I see the child, you know, I’ll go talk to the parents about the session, ask any questions and things like that. So I would say parents are always involved with the session in some way or another to your right, right.

Jamie: 17:27

And so, with, with your clients that you typically see, what are some of the most common skills that they need help with? I mean, we talked about some feeding and toileting but, but what are the things that that you right now are seeing that, that your clients need help with?

Yuna: 17:45

Yeah, I would say generally, the skills that I see most, you know, in need of help is probably fine motor skills. So these are skills, using the hands and fingers, manipulating small objects, using our hands together. You know, for a child, we want them to be able to, you know, manage things, small, small items, like buttons, or zippers, you know, obviously, those have very relevant importance of our everyday activities. Also, even just grabbing utensils, and making sure they’re grabbing it, you know, appropriately so that they are most successful when they when it comes to self-feeding. So, I would say fine motor skills are kind of like the building blocks to a lot of those like, you know, self care skills, and, you know, the dressing all of that, that we’re talking about. So I would say that’s probably the number one that I see most, most often.

Jamie:  18:45 

Okay, and so, so if a parent is involved in, like, directly involved in the those kinds of activities, what are what are some of the things that they do then?

Yuna: 18:55

In the session? Yeah, in a session? Yeah. So sometimes I can, maybe visual model for them and activity that can be replicated at home pretty easily. We try to use you know, really like common toys, and even sometimes just household objects, you know, you can use things like pipe cleaner, or cotton balls, or you know, anything really, like, I think OTs are so creative, we make so many activities with just everyday items. You know, I showed me I may show a parent like, Oh, this is a really good activity to work on it pincer grasp using your thumb and index finger to pick up small things. And then I might ask the parent like, Oh, can you try doing this with your child right now, you know, so I may then at that point, the parent can come in and try the activity themselves. And then once I feel like they can implement it by themselves at home, then I would definitely ask, you know, can you do this maybe like a couple of times a week so that we can work on those muscles of the hands and have them be more successful.

Jamie:  19:57 

So it sounds like so you. You give out homework to then

Yuna:  20:02 

yes, sometimes, you know,

Yuna:  20:05 

you know, I, I do tell them like, you know, we only see your child maybe once or twice a week for 40 to 45-50 minutes, a lot of it happens at home, you know, a lot of child development happens at home. So, you know, me seeing them for that one hour a week, you know, obviously, it’s, it can be helpful, but it’s, it’s not going to be the most effective if those skills aren’t being transferred in the home. So I may I do ask parents, you know, could you please work on this at home, and a lot of times they are willing, because they see, oh, wow, my child can do these things. And they see, you know, this, this is really helpful to them, and they can see the progress in with their own eyes as they’re doing it at home.

Jamie:  20:49

Oh, that’s so awesome. Yeah. So, um, what other things? When you assign homework Do you like give out like, handouts or anything like that? You’re saying you have parent education?

Yuna:  21:07 

Yeah, that as well, definitely. Um, either handout like physical copies of handouts, or emails, or email, parents a lot of resources, I think it can be very overwhelming the amount of information that we sometimes tell parents, and it could be a lot of information at once. And so I try to break it down a little bit. So I may send handouts like here and there. Nowadays, there’s a lot of great resources for parents just online. And so I like to print them out and give it to them. It’s really good to just have a physical copy, too. So parents can keep track of things like goals, developmental milestones, you know, what are we working on? And things like that?

Jamie: 21:53

Okay, okay, so, so then the parents, when you’re working with a parent, you talk about what the child’s goals are, and then you work on them from there.

Yuna  22:08 

Yeah, yeah, I, for me, I always tried to have parents aware of some of the goals. So goals are kind of like, we make maybe three to four goals for every, like six months that we see a child so that we kind of have these like benchmarks like to track and monitor progress. Obviously, there’s so many more things that we can work on. But narrowing it down to a couple of goals helps us track progress, but also know what’s most important for the parent. So I will a lot of times ask the parents, you know, what are you guys having with trouble at home? And how can we shape the goals so that it’s, it’s relevant to you guys? Because sometimes, you know, managing buttons may not be the first priority for a parent, it might be more feeding, or, you know, yeah, they can’t do buttons, but they also can’t even just put on some shorts, you know, so making sure that it’s relevant and helping families I think, so that goal making really helps with that. Okay, so the family is totally involved in, in the goal making. So if there’s a goal that you think that might be appropriate, and the parents say, No, I don’t want to work on that, then that’s something you’re not going to work on, or it’s going to be low priority. Right? Exactly. Yeah. So we try to collaborate together. If I, if there’s ever a situation where I feel like it’s really important, but maybe parents may not be aware, then I try to also help them kind of see big picture, right. So, you know, like, you may not see the importance now, but this is actually a building block in the foundational skill for something in the future. So we really want to make sure that they get this right now. And so sometimes when they shape it that way, then they can kind of see like, Oh, you’re right, you know, like, we do want them to be able to manage their clothes when they go to school, right. So right now, a lot of kids at this age are staying home. So managing pants and stuff may not be a priority, but in one to two years, they’re going to be in daycare or preschool. And a lot of Preschools don’t allow you to bring children if they’re not potty train so those are the kind of things that I tried to let them know and then you know, obviously if they’re still not like oh, you know, we can wait and I’m like okay, you know, we can always reevaluate goals later so put it on hold for now, but we do try to step in that way as well.

Jamie:  24:29 

So typically went save you have like a two-year-old child that that comes to the clinic. Do you do typically then provide services for them for like an entire year? Or? Or is it like six months in the reevaluate where?

Yuna:  24:52

Yeah, so typically when we first receive an authorization from the regional center, they usually authorized for up to To the year, or up to their third birthday, whichever comes first. And so for regional center clients, they only see kids up to three years, at least for the regional center that we’re servicing at this company. I know with some other regional centers, there might be different ages. But yeah, so up to three years. So we usually see them for about a year, and then after a year, we reevaluate. And if there’s still a need, then we asked a regional center to extend the services to up to their three, or if we feel like they’re doing really well, we can also decrease services, maybe they might just need some monitoring once a month, just to make sure that they’re, they’re continuing to stay on track, or we can terminate services completely. If parent feel if parents feel comfortable. And if the therapist feels like, Oh, they’ve met all their goals. You know, other skills are age appropriate now.

Jamie:  26:02 

Okay. All right. Cool. Nice. All right. So let’s do I think you answered a lot of my questions. Another one that I was really interested in finding out is, do you have advice for parents who feel like their child is not developing as quickly as they should?

Yuna:  26:20 

Yeah, I would say, you know, I really think that parents should trust their instincts. You know, no matter if this is your first child, or your third or fourth child, you know, if you ever feel like something is off, or different, I would, I would just go seek medical professional, as soon as you can, you know, just at least bring it up to the pediatrician. It’s it, you know, there’s no harm in getting evaluated, they may be evaluated, and it may not, it may not be nothing, you know, but at least now you have that peace of mind. But if they do get evaluated, and there are issues, and we can start intervention right away, and, and just thinking long term, that’s gonna be that’s going to have the best outcome for your child. So the earlier they can get services, the earlier they can get some support, not just for the child, but for the parents and for their family as a whole. You know, we really, I think in early intervention, especially, we provide a lot of family centered therapy. So we’re not just taking into consideration your child, but your whole fat, your family as a whole unit, you know, what’s going to help you guys as parents, so I would say seek help. And if you need help, you know, just ask those around you, you can do a lot of Google searches, go contact your local regional center, they’re everywhere. So an any parent can refer themselves, they do not need to be referred by a pediatrician. Yeah, any parent can just call Regional Center and request an evaluation. So I would say I would just advocate for parents to do that

Jamie:  28:07 

So you so parent, parents advocating for their child is probably like the one of the most important things in early intervention, then? Yes, yes. Agreed? Yes. All right Is there anything else that you’d like to share with our listeners? Um, anything that we didn’t cover?

Yuna:  28:21 

I would just say, thank you for this opportunity to talk about early intervention, because I feel, you know, especially to those people around me, when I tell them that I work with kids, zero to three years, they’re often very confused, like, why do they need occupational therapy? Are they too young? You know, I get a lot of those questions. But hopefully, this podcast and some of the information and questions that we answered can help, you know, have some answers to those some of those questions. And early intervention is really important. And I feel like we’re usually the first ones to really talk with parents and and we’re usually the first like their first stop. So yeah, thank you for letting me talk about it.

Jamie: 29:00

First, my pleasure. Yeah. I mean, you don’t you don’t really think of you know, we all have at least an occupational therapy. We say that everyone has an occupation that we all have something that we have to do. And as a child, it’s to learn and to have fun, right to play and explore, to prepare us for be adults. Right. Exactly. Yeah.

Jamie:  29:36 

Right. Well, I want to thank you once again, for agreeing to talk to me today. And I want to thank all of our listeners for listening to our podcast. And we want to make sure that you guys all follow us on our journey as we bring awareness and acceptance to the community. About people of all abilities and we also would like you to check out our I am able podcast at www.iamablepodcast.com where you can listen to us on your favorite streaming platform. So thanks again Yuna for taking the time to talk with me. Thank you everybody out there for listening, and we will talk again next time. Have a great day.


                 

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