Small Steps - The First Step

Our new series continues with a focus on goal setting, how to reinforce goals, and monitor progress along the way.

Bethany Darragh 0:20

Welcome to the Theralinq podcast, where we explore practical strategies and real-life solutions to help families thrive. I'm Bethany Darragh, a pediatric occupational therapist, and I'm excited to bring you this special series called small steps. Join me and my co-host, Brennan Barber in this three-part series, we'll focus on how small, intentional changes can lead to meaningful progress for families, especially for those navigating life with children who have disabilities or therapy goals, whether it's creating a consistent routine, working toward therapy milestones, or simply finding more balance in your daily life. We'll guide you through practical, manageable steps that build toward big transformations over time. If you've ever felt overwhelmed by where to start or how to keep moving forward, this series is for you. Every big transformation begins with a small step, and we're here to take those steps with you.

Brennan Barber 1:21

Alright, so last month, we talked a little bit about setting consistent routines. What's on the agenda for this episode?

Bethany 1:28

Today we're going to take the first step of goal setting. So how to pick a goal, how to reinforce a goal, how to monitor progress, all those things.

Brennan 1:38

That sounds great. So how can involving the whole family in goal setting strengthen relationships and create a shared sense of purpose?

Bethany 1:47

Yes, I think that family goal setting is super important. If everyone is motivated to accomplish a goal or reach a goal, it will be more productive for everybody. So that means all the adults in the household, the kid, for sure, if it's if it's a therapy goal, if it's a therapy experience, the kid that's participating in the therapy has to be motivated. And then it's also important to involve any of your other caregivers or therapists. So, if you have, if you are going to therapy, it's really important that the therapists that are involved are a part of the goal setting and also the teacher. So, this may seem obvious, but I will tell you, as a therapist, this is not as obvious as it sounds. So oftentimes, a family will have goals that they want to achieve. Therapists will have a separate set of goals that they want to achieve, and teachers at school will have a totally different set of goals that they want to achieve. And it's not because, you know, they're all think that their own goals are most important. It's that they just assume that one, everyone's on the same page, or two, that it's - there aren't goals happening at the house that therapists assume that they're the only one setting goals, and so you've come to them for their expertise in goal setting, and you know just will follow what they want. So, it's obviously and should be part of the therapy process for families, priorities and in cultural situations to be considered when goal setting. But I will tell you it's not always true. So as the parent going into therapy, setting make your goals known, and when you as a family see the goals that the therapist has recommended, and those aren't your priorities, it is okay to say, “hold on”, this is not what we really want to focus on, it's definitely appropriate to have those conversations, just so everyone can get on the same page. And I'll give you an example of a situation I'm thinking of that where this might happen. I was working in a Montessori school, and they really prioritized kids’ independence with self-feeding. And so, I was getting called to the one-year-old classroom regularly to do evaluations on kids who could not feed themselves with a utensil. So, a lot of kids are learning how to do that at age one and aren't very good at it. So that was part of the education that was giving those families. But there were some kids that were challenged with it to an extra level, and upon interviewing the families, I realized that it was a cultural consideration for them that the children be fed until three or four years old. That was just something that was important in their family. It was a bonding strategy, a bonding activity for their family, and had been passed down from generations to generations of an elder feeding a child, and that's kind of their part, the way that their culture expresses, you know, comfort and safety is like I will feed you, and that's something that you know, no matter what the teacher or the classroom or the therapist wants, we're just not going to touch that because that's something that's important to that family. There may be other skills that they are on board with the kid learning that are very similar to self-feeding, just that they can learn those motor skills. But we do not need to change this, this cultural practice for these for this family.

Brennan 5:18

Great, so when talking about goals or why is it more effective to focus on one goal at a time rather than addressing multiple goals simultaneously? Or is it?

Bethany 5:28

Personally, I like focusing on one thing at a time. I think kids, their brains, can make more progress when you're focusing on one area at a time. Oftentimes we see kids have spurts of development, and it'll all be in one area. You don't often see them gaining skills in gross motor or fine motor or cognition all at once. It's usually they'll slip kind of what looks like behind their peers in a couple of areas, but then jump ahead of their peers and in a different area, and that's kind of where you know their growth is happening. And sometimes it's helpful to shift gears a little bit and follow the kid through that growth. So, for example, in my pre-K class, I have a kid who's just now learning how to walk, and before he started to learn how to walk, he was beading, so putting beads on a string, and he was doing that consistently, and he would also he was learning the hand motions to songs, and he was doing that consistently. And, you know, the teacher was really upset, because as she was doing the progress report for this quarter, she noticed, oh no, these goals we had for his beading and his hand motions, they are stagnant. He hasn't made any progress. He's actually maybe a little worse this quarter. And I had to tell the teacher, wait a minute. Look at how much progress he's made in walking, you know, he was not able to walk unassisted at all last quarter, and now he is cruising around the classroom without a walker. He's walking all the way down the hall with a walker, without any help. So, I just, you just have to kind of notice where the kids at and follow them and those things, they really don't have a whole lot of control over it when they're that little. It's just kind of where, where their brains kind of focus at that time. But you know, we we're gonna just maximize this opportunity to make everything as gross motor as possible for this kid, because this is what's motivating for him, and what his brain is learning right now, and we will get to the other stuff soon, because he will get tired of walking, and we'll kind of plateau, and then we'll get back to wanting to do the songs and the beading, and we can work on those things.

Brennan 7:50

And as we follow kids interests and motivations, how does aligning goals with the child's natural interests or motivations improve their engagement and their success?

Bethany 8:00

Yes, so intrinsic motivation is something that is so important to progress if, if it's not motivating to the child, you're just not going to see a lot of progress at all. So, if there are certain goals that we have as therapists and parents due to a child's, you know, medical condition. So, you know, some children have very poor motor skills with their hands, and so we really want to focus on that. We're going to choose whatever activity they find interesting to work on that we're not going to if you know, if they are not at all interested in writing or drawing, we don't have to put a pencil in their hand. And for some of our kids that are school age, they've already recognized the fact that their writing is less than their peers. And there might be a little self-conscious, and they might be a little aversive. Maybe even you see some behaviors, some tantrums, some resistance when you put that pencil in their hand, I say that's fine, don't, don't force that. There are a million other things that they can hold that mimic that same, that same grasp that could be way more fun. I have tiny little screwdrivers that I have the kids put together little dinosaurs or little tractors or whatever. I have them pin punching, which is, you know, you give them a picture, and instead of cutting it out or drawing it, they're just going to poke little holes all along the edges, which is the same grasp as a pencil. They could be throwing darts or something more gross motor or physical like that. We can find a way to work on pretty much any skill and in a, in a way that's motivating to the child, you just kind of have to search for a little bit. One more thing I wanted to say about goals before we moved on from that, is a lot of times adults think that the concept of a goal is a little too mature for a child, and I would challenge that kids really do attach to these goals at a pretty young age. And they also like it when they understand the weight of it, if we can commemorate the setting of a goal. So, I have, even with very small children, signed a contract, and I just showed them this is a really important document that says we're going to try to do this thing, and we're going to work really hard to meet this goal. And when you put your name on this, it's really it means something. And so, I'll have them, you know, scribble on the contract, if they can't actually write or draw and make a big deal of it. Put it, you know, post it up, put it in a frame. Do the signing at an ice cream shop, you know, make it memorable. Those things do hold weight for a child, and they see us doing these things day to day, and they do look important, and if we include them in that, we're more likely to get more motivation out of them, even if that tasks aren't super fun, they can see this is an important thing that I'm working towards.

Brennan 11:18

And what factors should families consider when designing a reward system, and why is it important to reward effort and progress and not just achievement of a goal?

Bethany 11:27

Yes, I could talk about rewards for a very long time. So, rewards are important we, like I said in the last episode, rewarding a child for you know, progress or effort or specific behavior needs to happen within 90 seconds of the action. So, they can really connect mentally. They can connect, you know, positive reaction to whatever they did. This is really important for especially with behavior change, but any sort of change. So, finding a system of reward that you can sustain and that you can do all the time anywhere is really important. And if you're going to be working on your goal in a very specific place, it makes it a little easier, because you can have your reward system in that place. But if it's something behavioral that you are looking to work on everywhere it's you're gonna have to be a little bit more creative with how you reward it. So don't let it get too complicated. It does not have to be expensive. It can be as simple as a sticker chart, or maybe there's a certain song or, you know, high five or special handshake that you can do. It doesn't have to be complicated, but figure out what works for your kid. Like I said in the last episode for us, it was marbles in a jar. Now my kids are older, and its money. So, you know, they have their, I have the app on my phone with their green light account, and I will drop 25 cents $1 in depending on whatever our goal is at that time. And that's motivating for them. They understand that now. So, it has to be something that, you know, they all work on together. Now, if you come and sit down with your kid and you say, you know, what would be motivating for you to work on this goal? And they say, you know, a really expensive toy or a trip to Disney World, you know, obviously use that information, but you don't have to just go with that. We can think of something, you know, much smaller or work towards. So, with our marbles in the jar, we would fill up the marbles when they got to the top of the jar. Our family would go to the movies. That was kind of our thing. So whatever thing works for your family, it can be that you build up to something, or sometimes you don't have to build up to something. It's just the act of getting the marble or the act of getting the sticker that is enough. When picking it, I do want to remind everyone that you need to involve all the senses. So, you're going to say, good job. That's auditory. You you involved your sense of hearing, visual. What visual component does it have? Is there, is there a meter where you color in until you get to the top? Is there a sticker? Is there, you know, a token? What is the visual? Is there something that the child can hold or touch? If you have the meter on the way they're coloring it up and filling it up to the top, can they color in the next box so that something physical that they can do? Is there a handshake or a dance or a song or something that they can participate in, so that it all just sticks better? You want to activate as many senses as you can.

Brennan 14:42

So, then a question related to that is, when do we reward?

Bethany 14:46

Yes. So obviously, once we've reached the goal, there's going to be a huge party celebration, but to get there, we really need to reward every single tiny little thing. So, if your goal is motor based, strength, balance, coordination, a reward needs to happen anytime there's practice. So, your goal may be, you know, time, how much time a kid can balance or stand, or how far they can, you know, crawl or wheelbarrow walk, or something that's like a distance or a time, or something measurable, but we are going to reward anytime there's effort towards that goal. If your goal is behavioral, you need to find some small, measurable action that you can reward. So, if you're trying to decrease tantrums, and obviously, if that's if that's what you're doing, you have to figure out what's triggering the tantrums first. So, let's say your child tantrums when they are transitioning away from screen time. So, at first, I'm going to reward the child just for putting the screen in the designated area or turning off the TV, even if they're crying and whining while they do it. I'm going to reward so I'm going to look for the smallest little movement towards change that I can find, and reward for that you they need to experience the process of getting a reward to move forward. So, if I say, okay, time for your screen, time to be up, it's time to go to bed, and there's a huge tantrum, and I ignore all of that, and I'm saying, Okay, your device just goes right here and this slot just come put it over here, and they're screaming and crying and they're putting it in. Maybe it takes a while. Maybe it's like, okay, I'm just gonna wait a minute until you put it, put it in. Do you need me to help you? Put it in? Like, there's a lot you're not just gonna assume, because they had a tantrum, that there's no progress going to be made. Today. We're gonna make progress. Can I help you? Can we do it together? You know, all those things and then rewarding them. And then the next day, you might find that they go, put it in, they're still screaming and crying. And then, as you see the behavior, they're putting it in right away. Every time, you're going to make it a little bit harder, okay, this time, you know, I'm going to set a timer, and when the timer goes off, you're going to put it away without me telling you, you know, you're just going to keep making it a little bit harder, a little bit harder, until you get to the behavior that you are looking for. And the hardest part is ignoring all the other behaviors in the process. So if you're focused on putting the iPad away, you do have to ignore, you know, the whining and the screaming and all the other things that are happening on the way to putting the iPad away, which is really tricky, but I promise you, the behaviors will get better if you just focus on one little thing at a time and make sure it's clear when you reward a kid that you're not rewarding them for the tantrum they just threw. But like I saw you, put the iPad away. I'm rewarding you for putting the iPad away. You put the iPad away, you know, make it very clear what you rewarded them on.

Brennan 17:38

So I guess you know you mentioned taking away the iPad and ignoring some of the behaviors that, negative behaviors, that may be associated with that. You know, what happens if it all sucks, if it's all just negative, and what do you do at that point?

Bethany 17:54

Yeah, so this is another moment to reflect. And whenever things aren't going well, it's time to kind of reflect and see if there's some kind of change that could be made. And the first thing that I ask parents to do when they're kind of at this point where there's been no progress, it didn't go well, and they come back and tell me, really, that didn't go well at all. And so, I asked them to kind of visualize what I call like the mountain in front of the reward. So, I say the goal, the reward for your kid is, you know, the pom pom, or the break or, you know, whatever it is that they're working for, and they look at that in the distance. Now, the task you're asking them to do is the mountain that's in between them and the reward. So, if you want them to participate more, you either have to make the reward bigger so you can see it past the mountain, or you have to make the mountain smaller, so you have to make the task easier. So, assess the situation. Can you make the task easier? So maybe with the iPad example, you know, they will never make it to the place where the iPad goes, but maybe they could hand it to mom. Okay, so we just made that task easier. If you hand it to me, you get a reward. Or maybe we can make the reward a little bit more exciting. Maybe stickers aren't really working. Maybe the marbles aren't really working. Maybe, you know, they need something a little bit different. Again, I would not immediately go to something more expensive or more complicated, I would just try something different that's like, easy and available. Maybe it is something like a reward song that you make up in a little silly dance. Maybe that's what they need, you know, experiment with those things. So the you have a mountain in front of you, you have a reward past the mountain. If you can't see the reward, you either have to make them out and smaller or the reward bigger. So those are the two things you need to assess first. Again, this is a time when you're going to want to give yourself a lot of grace. There are going to be setbacks. There are going to be days where things just aren't working out. Take an inventory. Are there added stresses in the kid's life? Are there any changes in your routine? Take a break, just rest, give it a day. Try again another day. Maybe we need to talk about the goal. Maybe the goal wasn't the right fit. Maybe we need to talk about a different goal. Maybe now that the kid understands what that means, there's actually something that's more important to them. You know, we can always go back, scratch it, start over, but just simplification instead of complication. So don't, don't take everything and make it, you know, more complicated. Let's see what we can strip back. Get back to the beginning. Maybe a different goal is needed. Maybe we had too many goals. Maybe we need to simplify it. Maybe we need to make the task easier. Those are the steps I would take to move forward. I would not make the system more complicated. I would try to make it less so.

Brennan 20:42

Well, that's awesome. So that kind of sets the stage now, I guess, for next month's episode, what do we what are we going to focus on then?

Bethany 20:50

Yeah, so we've set the stage, we've taken the first step, and now we're trying to sustain momentum. Like I said, we're going to have lots of times where things just aren't improving, or maybe things improved crazy fast, and we get frustrated when they plateau. We're going to talk about how to monitor and how to make adjustments and keep moving forward.

Bethany 21:35

Theralinq app is coming soon. We're working on a tool to support your therapy journey by reminding you to do your therapy exercises, providing simple videos to guide your home practice while tracking your progress. So don't forget to visit our website at WWW dot Theralinq, T, H, E, R, A, L, I, N, Q dot com, to sign up to receive updates about the app, ask questions, share your personal success stories, or connect with us. We'd love to hear from you. You.