Pediatric occupational therapist Sarah Small, OTR/L, could not help but notice the abundance of social media posts from parents seeking advice on how to help their children who had often been labeled “outside the box” and were experiencing all sorts of issues in school. Knowing how distressed and overwhelmed these parents must have been feeling, she decided to do something about it to fill that gap and that’s when she started Small Steps.

Very often, when issues arise with children, the first professional parents consult with is their pediatrician in order to rule out any physical diagnosis and issues. Once that happens, more often than not, parents will then be referred to an occupational therapist to work on sensory issues. Sometimes parents are left wondering if their child’s situation is too unique or whether they can benefit from a cookie-cutter approach where it will be relatively easy to obtain the services and resources their child needs.

Small was one the OTs to whom parents were often referred. “I usually found a pattern in that it wasn’t necessarily always a sensory issue, which is sometimes the case, but rather a behavioral issue.” She would work with the parents and do her best to point them in the right direction to get the help that their children needed to successfully navigate these issues. “But there are a whole host of different things that one can do that does not involve OT and while OT is sometimes the solution, there are plenty of times when it’s simply not.”

The goal of Small Steps is to connect parents of children who are “outside the box” with the right professionals, whether that be an OT, behaviorist, play therapist, psychologist,or psychiatrist to reduce stress, and save time and money, but above all, get these kids the all the help that they need.

Through a 45-minute phone meeting, Small asks guided questions to get a sense of the child, the dynamics in the home, what the teachers are doing in school for them, and learn about the child’s strengths and weaknesses. She will ask what has been done already and what the parents have been asked to do. “It’s a collaborative process and I look at the full picture of the whole child to really get a sense of what’s happening and plan from there.” Once she has a clear idea of the overall situation, she will design a program giving the parents direction, including specific referrals, and the order of events, from a clinical perspective, that make the most sense.

Typically, issues become apparent beginning in pre-K to kindergarten, which is usually when a child is around 4 or 5 years old. Sometimes, however, signs appear when kids reach first or second grade. Oftentimes, parents begin to receive calls from school in the fall, as the rules and expectations of classrooms have already been established, telling them that their child is lashing out or not keeping up.

On social media, Small found that parents were upset and exasperated after receiving these types of calls, yet there wasn’t a clear set of next steps to help guide the students and parents. Small noted that, “while schools have great support teams on staff, outside help is sometimes warranted. My goal is to work collaboratively with the schools, parents, and the entire professional team.”

Small has read countless reports and spoken with a multitude of parents, all of which have made her extraordinarily well-versed in how to approach the types of issues that these parents encounter. She wants these children to begin to feel positive reinforcement so that they start to feel motivated to change and participate. There are so many reasons, she said, why kids could be experiencing issues and more often than not, parents do not know what questions to ask or what resources are available. “My main goal is to help parents, by learning about their child, discover the best professionals for their specific needs. This saves valuable time and money because the longer it takes to get the child the appropriate help, the more that child falls off track and a bad cycle can ensue for everyone involved.”

But sometimes, getting appointments for certain services and with certain professionals, like developmental pediatricians, is half the challenge. Although visits with developmental pediatricians are usually covered by insurance, getting an appointment with one can take several months and some parents may feel like time is not on their side. Other times parents are told to get their child a neuropsychological evaluation, which can also take months to schedule and costs thousands of dollars. “The goal is not to spend and then fail. The point is to try to reduce the time, stress and expense associated with getting the child the right help using a targeted approach.” During a waiting period, Small will be there to help parents and schools navigate that period of time.

Small recommends parents seek intervention as soon as red flags appear. This allows parents to create a cycle of positive reinforcement and great experiences which helps the child learn and establish patterns of behaviors in these critical years of learning. “I just want to help and see kids thrive in the right setting while getting all the support they deserve.”

To learn more about how Small Steps email Small at [email protected] or call (201) 618-9602.