Occupational Therapy and Rapid Prompting Method

Current practice area: 

Pediatric Occupational Therapist with children who have challenges with sensory processing, social and emotional skills in both school and private clinic settings. 

Years in practice: 4

How did you become interested in occupational therapy? 

I always knew that I wanted to work with children. During my undergraduate program my aunt, who is a preschool teacher, started to tell me about occupational therapy and how she thought that would be her alternative job path had she known about it at the time. After doing some investigating and volunteer with a local OT I decided this was the perfect career path for me. I loved how OT combines my passion for children with science and structure for supporting their developmental needs.

Can you tell me a bit about your career path?

After graduating from my undergraduate program with a B.S. in Psychology, I began working at a very unique school called Hirsch Academy in Decatur, Georgia. I was a teacher assistant for a year and then worked alongside the occupational therapist for a year. Hirsch Academy is based on the DIR and Floortime approach in which they focus heavily on understanding and supporting each child’s developmental level, individual profile, and building the foundations for meaningful relationships. I learned so much while working there, and was ready to back it up with more specific knowledge, so I left to get my Masters in Occupational Therapy at NYU. As soon as I graduated I returned to Hirsch and other schools, as well as began working at a variety of private clinics in the metro Atlanta area. Over the past few years I have been acquiring information on a variety of approaches that I have found useful when thinking about and working with my clients. I have taken courses on Handwriting without Tears, Therapeutic Listening, began my training in Floortime, learned more about Visual Thinking, and most recently been diving into learning and studying more about Rapid Prompting Method (RPM).

What is RPM? 

Rapid Prompting Method is a method of allowing “late” talkers to find not only a way to communicate, but also their voice! RPM incorporates each child’s learning channels (auditory, visual, tactile, and kinesthetic) to help the child organize their thoughts with their motor output onto letter boards. And most importantly is based on “presuming competency” at age level for all kids and adults. 

Long story short (well, I will do my best), I worked for a year with an 11 year-old girl named Graciela, who is Autistic and has apraxia with unreliable speech patterns. She always came to OT smiling and ready to find our lycra swings. She would request the same songs and activities and have a blast rocking and swinging with me, but there was always more depth I couldn’t access. I felt like I wasn’t able to get to know the REAL girl inside.  

This past summer she began working with her mother using this approach to feed the brain with information about anything and everything.  Then breaking down the information in a way that supported Graciela to show what she was learning. The process starts with paper choices and progresses over time and experience to stencil letter boards, laminated letter boards and then eventually to a tech device. Through this process I have watched Graciela unfold into an active participant in every area of her life. She is now able to spell out on the boards to her mother her deepest thoughts about her desires with regards to her education and relationships. She can describe more about what her body is experiencing and how difficult it is at times to control.  Most importantly she expresses the unconditional love and admiration she has for her families continuous efforts to help and support her in finding her voice and working so hard to share it with others. Graciela continues to be the leading force in spreading the word about RPM to others whom are essentially “locked in”. She inspires me every day and while I still believe strongly in the work I have been doing over the past few years, I am eager to see what the future holds!

What is your favorite part of your job? 

The KIDS!!! I can’t express enough how much joy I feel working with my clients. It is one of the only places where I can be completely free of what’s going on in my personal life and just enjoy the “here and now”. Watching them learn and develop new skills, become confident in exploring their environment with their body, thinking and problem solving and establishing new bonds with their peers is so exciting. I even enjoy meltdowns! Because once we find a way to calm, soothe and reconnect I know that it is another experience they have to build on in their future.

Biggest challenge at work? 

Learning as much as I can, as fast as I can! I always want to be reading more, watching more videos, reflecting with coworkers so I can have a better understanding of what is or isn’t working for our students or my clients. Sometimes there just aren’t enough hours in a day for me to get all that I want done and I take a little too much home at the end of each day.  But with time and experience I think this might get easier, or at least I hope I learn to find a balance.

What changes do you hope to see your practice area over the next 5 years? 

I hope to see more of my clients and students actively expressing what they are interested in and have learned in the course of their life. I have learned so much from Graciela’s short 8 months of communicating, and can’t wait to learn more, not only from her but the other “late” talkers. I have already learned so much about what STIMs mean to them and how important or sometimes uncontrollable they may be.

Any advice for OT students? 

School teaches you an overview of all the foundational things you need to know to be an OT.  If you want to find out if you would be truly passionate in this career you need to take time to volunteer, establish relationships with professionals who can mentor you, and get as much hands on experiences as possible. It’s a crazy feeling when you pass your test and realize that you are “ready to treat” your first client, but having some hands on experience will help you be more confident and supply you with people who can support you through the process.

If an OT was interested in pursuing your practice area, how would you recommend they proceed? 

I would recommend looking up books by Stanley Greenspan on Floortime, Soma Mukhopadhyay on RPM and Jane Ayre on Sensory Integration. I think finding local practitioners in your area who have experience in these topics and can not only model, but also answer your questions is helpful. In addition, looking for any opportunity to learn more about different methods and approaches. There are so many approaches out there, so be thoughtful in which ones you choose. So often I see families pulled in a number of directions looking for answers. I prefer to think of how can I support families most effectively… Do they need ideas for at home or school? Do they need tools for calming and soothing? Do they need help finding ways to access their child in unconventional ways? Instead of being the “expert” I prefer to think of myself as a “tool” to help parents and the child connect, relate and engage with one another.

I would recommend looking up books by Stanley Greenspan on Floortime, Soma Mukhopadhyay on RPM and Jane Ayre on Sensory Integration. I think finding local practitioners in your area who have experience in these topics and can not only model, but also answer your questions is helpful. In addition, looking for any opportunity to learn more about different methods and approaches. There are so many approaches out there, so be thoughtful in which ones you choose. So often I see families pulled in a number of directions looking for answers. I prefer to think of how can I support families most effectively… Do they need ideas for at home or school? Do they need tools for calming and soothing? Do they need help finding ways to access their child in unconventional ways? Instead of being the “expert” I prefer to think of myself as a “tool” to help parents and the child connect, relate and engage with one another.

Anything else? 

A few words from Graciela:

DEAR FAMILY AND FRIENDS,

IT'S BEEN A REALLY AMAZING YEAR - KIND OF LIFE CHANGING. ALL OF YOU SHOULD SIT DOWN TO READ THIS. A LOT HAS CHANGED ROUND HERE. GOD HELPED MY REALLY AWESOME, LOVING MOM FIND A WAY FOR ME TO COMMUNICATE. ALL OF THIS MESSAGE IS BEING WRITTEN BY ME ON MY LETTER BOARD. A LOT OF MEANINGFUL, EARNEST AND SERIOUS ARGUMENTS HAVE BEEN MADE ABOUT MY INTELLIGENCE BUT ONLY NOW CAN PEOPLE SEE THAT I AM SMART.

MY FAMILY POURS THEIR LOVE UTTERLY AND AMAZINGLY INTO ME FOR PRACTICAL SOLUTIONS TO MY AUTISM.

LARGE AND FUN WISHES TO YOU THIS CHRISTMAS AND NEW YEAR.

LOVE AND WORLD PEACE,

GRACIELA

Recommended resources: 

  • Emma's Hopebook Blog-- written by mother/daughter 
  • Elizabeth Vosseller's Blog-- an SLP who is trained and proficient in RPM) 

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