Presentation on theme: "An OT and SLP Team Approach to Educational Success 2014 Georgia Organization of School-based Speech- Language Pathologists March 6 th, 2014 Presented by."— Presentation transcript:
An OT and SLP Team Approach to Educational Success 2014 Georgia Organization of School-based Speech- Language Pathologists March 6 th, 2014 Presented by Cindy Terry, Coordinator of Therapeutic Services Gwinnett County Public Schools and Doris Osborne, Supervisor of Related Services Cobb County School District
What is a Related Service? Under part B of IDEA, OT & PT are related services for eligible students, who, because of their disabilities, need special education and related services. Related services are support services that help the student to “benefit from special education”. (AOTA)
??Eligible?? A child does not become eligible for OT or PT. He or she becomes eligible for special education. The results of an OT or PT assessment or evaluation presented to the IEP committee for consideration drive the need for school- based therapy support.
What is “educationally relevant” OT or PT? A student with a disability has a need for improvement in his functional skills as related to his performance in the educational environment. The student may have an educational need as well as a medical or clinical need. However, some motor difficulties may not directly impact educational progress and may not constitute educational need. (CA DOE) School- based OT and PT services are performed in the educational environment with educational staff.
What is the GA Consideration Tool? Guidance tool for determining the need for educationally relevant therapy and time required to support the IEP goals/objectives Summary of educational considerations based on a review of student records, evaluations, observations, progress notes, parent/teacher information, and other data Visual aid to display the clinical reasoning process as noted by AOTA & APTA Best Practices for school-based therapists.
SLP and OT Co-Treatment Research in this area is limited. Studies reported most collaboration between school- based SLPs and OTs are with students with ASD. 1999 AJOT study reported SLP and OT with a 98% collaboration during the evaluation 100% during intervention for students with ASD 2011 Study by Laura Czernik LEND Fellow found advantages with the most common being increased participation by the child
Leo Kanner- 1943 Coined the term “autism” “biological impairment like physical and intellectual handicaps” Noted perceptual difficulties and overreaction to loud noises and moving objects. 50’s and 60’s- viewed as an emotionally based disorder resulting from cold “refrigerator mother” 70’s- back to recognition as neurological impairment Literature focused on social, communication, behavior and cognitive issues. Attention to perceptual and sensory processing difficulties (abnormal response to visual, vestibular and auditory stimuli; disorder of sensorimotor integration; problems with modulation of sensory input and motor output)
Occupational Therapy 1970’s- Jean Ayers- behavioral problems associated with inadequate sensory integration. 1980’s Knickerbocker- behaviors exhibited by individuals with autism may be related to hyper- or hypo- reactions to sensory input. Planned sensory input provided through specific activities could help normalize reactions to sensory input and improve behavior. Autopsy studies of individuals with autism have found developmental abnormalities in the cerebellum and limbic regions of the brain. Significant roles within sensory integrative process including modulation of sensory input. Adults with autism have written personal accounts of sensory experiences- Temple Grandin, Donna Williams, Zosia Zaks, Judy Endow, Sean Barron, Stephen Shore, John Elder Robison, Larry Bisonnette & Tracy Thresher.
Examples of functional skills needed for school Hand function Visual skills/ visual perceptual skills Handwriting Attention span Organizational skills Sensory awareness Sensory processing Self care skills Positioning Social Skills Motor planning Functional Mobility (walking or WC skills) Stair climbing Balance Coordination Oral motor skills Gross motor skills Fine motor skills Assistive technology Pre-vocational tasks Leisure skills
“All learning has it’s basis in sensory development.” From Sensory Secrets.
Sensory Processing: The organization of sensory input for adaptive responses: learning, motor skills, perceptual skills, behavior, social skills.
The brain locates, sorts and orders sensations somewhat as a traffic officer directs moving cars. When sensations flow in a well organized or integrated manner, the brain can use those sensations to form perceptions, behaviors and learning. When the flow of sensations is disorganized, life can be like a rush hour traffic jam. -Jean Ayers, 1979
The brain acts much like a computer! Input goes in through the sensory systems… Which is processed in the brain… Resulting in an adaptive response… Which provides feedback/sensory input… Which is processed in the brain… Resulting in an adaptive response… The process is cyclical.
Components of SP Sensory Registration: Be aware of a sensory stimulus Orientation: Pay attention to new information being received Determine what sensory input needs attention and what can be ignored Utilize functions of inhibition and facilitation = modulation Interpretation: Interpret and describe sensory input Allows for fight, fright, and flight responses (protective system) Organization of a response: Determine if a response to a sensory stimuli is needed, and how: cognitive, emotional, physical Execution of a response: Execution of the cognitive, emotional, or physical response
Sensory Modulation The ability of the nervous system to: Regulate, prioritize, and organize incoming sensory information. Adapt to changes in the environment. Maintain arousal level appropriate to the task. Results in: Registration, arousal, self-regulation, attention, focus, and behavior or emotional responses
Over-reactive to sensory stimulation Under-reactive to sensory stimulation Modulation disorders Integration disorders Difficulties with arousal levels-that “just right” state for learning Use sensory assessments to analyze.
The 2 Functions of the Nervous System: 1. Protection: fright, flight, fight 2. Discrimination: for learning, communication, behavior
Central Nervous System: Sensory Processing Sets Foundation for: Cognitive: academic learning, daily living skills, behavior Perceptual-Motor: auditory language skills, visual-spatial perception, attention center functions, eye-hand coordination, ocular-motor control, postural adjustment Sensory-Motor: body scheme, reflex maturity, ability to screen input, postural security, awareness of the two sides of the body, motor planning Sensory: olfactory, Visual, auditory, gustatory, tactile, vestibular, proprioception
Sensory Systems : From eyes – vision From ears – hearing From skin – touch From nose – smell From mouth – taste From semi circular canals – vestibular From muscles/joints - proprioception
THE TACTILE SYSTEM Provides us with our sense of touch First sensory system to operate in uterus Rooting reflex, calming to neutral warmth Receptors in the skin provide information about light touch, pressure, vibration, temperature, pain Feedback- development of body awareness, motor planning Needed for ADLs including schoolwork, job tasks
Tactile cont. Protective tactile system- more primitive Initially dominant Informs us when dangerous contact is made May be gently alerted or activate “fright, flight or fight” response Discriminative tactile system- allows us to feel the quality of the item we are touching Higher level- necessary for learning and brain development
Tactile Dysfunction Hyper- or hypo- sensitive to touch Problems with tactile discrimination Sensory modulation- unable to screen out sensations; overwhelmed to point of not responding to other sensory systems Tactile defensiveness- (hyper-)regarded as threatening. Can tolerate touch but not receive touch Behaviorally- anxious, aggressive, controlling, inflexible, unwilling to participate in activities Hypo-low arousal levels require intense input Body awareness, motor planning problems due to impaired feedback Delayed reaction to touch- may not realize injury Seeking tactile input- constantly touching- social implications
THE VESTIBULAR SYSTEM Provides information about movement, gravity, changing head positions Tells us if we are moving, still, direction and speed of movement Develops relationship to earth- body position vertical or horizontal even with eyes shut Balance, postural security, self- regulation and modulation Receptors located within structures of ear( semi-circular canals, utricle, saccule) Influences development of eye movements- tracking, focusing, maintaining upright posture Influences muscle tone, “readiness” to perform work Protective- reflexes to prevent falling Discriminative- recognize going faster, slowing down, rotary movements, rhythmical
VESTIBULAR DYSFUNCTION Hyper- fearful with changes in gravity and position- gravitationally insecure- do not like heights, feet off ground May feel discomfort, nausea, or dizziness with movement No exploration of environment, no motor memory= poor motor planning Hypo- seekers, crave movement- climbing, jumping, excessive movement to stay alert and organized Problems with self-regulation- inconsistent responses to sensory input, emotional instability, inappropriate arousal levels, difficulty maintaining and shifting attention
PROPRIOCEPTIVE SYSTEM Unconscious awareness of body position How much force necessary for muscles to exert so we can grade movements Receptors located in muscles, tendons, ligaments, joint capsules, connective tissue Respond to movement and gravity- helps us make sense of movement and touch experiences Position in space, body map- motor planning Regulate arousal levels (stretch, heavy work)
Proprioceptive Dysfunction Poor body awareness poor grading of movements- break items, writing too hard or too light, may fatigue easily May use proprioceptive input to reduce hypersensitivity to other sensations- intense rocking, banging back and head against chair, jump on beds, squeeze between furniture, hide under heavy blankets
Sensory Quota System according to Zosia Zaks “Say my brain has only 100 Sensory Processing Units. If it takes 95 units to decipher the sounds of a conversation, decode the conversational signals that indicate turns and innuendo, pick up the contextual clues that impart social meaning, and modulate my voice, I have just five units remaining to use for other sensory sources.
Since looking at someone’s face, decoding facial expressions and coping with the pain of the fluorescent lights requires (hypothetically) at least 75 units, in this case I would not have enough Sensory Processing Units to look at the other person, or even open my eyes, while we conversed. This helps explain why most autistic people are unable to look at someone in the eyes while also talking, a characteristic behavior of autism spectrum disorders.”
When SPUs are used up: Sensory overwhelm or sensory meltdown Need to calm self ALONE Scrambling- difficulty sorting sensory input into meaningful chunks of information Sensory cross-firing (synaesthesia)- experiencing a sensation in one sensory system yet perceiving the sensation in another modality
Research continues to demonstrate that people with ASD tend to have more issues with sensory processing than the general population (Kientz & Dunn, 1997; Watling, Dietz & White, 2001). Those with ASD demonstrate sensory symptoms specifically indentified in taste, smell, tactile and auditory processing (Rogers, Hepburn & Wehner, 2003).
…people with ASD often over- or under-process sensory input from the environment (Ornitz, 1989; Wainwright-Sharp and Bryson, 1993) or have trouble regulating sensory information (Lincoln et.al., 1993, 1995).
Behavior Everything we do. Behavior may be learned, a nervous system response to an environmental stimuli, or both. Behaviors have specific functions.
Functions of Behavior: Escape: avoidance of a person, task, situation, or environment Tangible: desire for a specific item, activity or feeling Attention: desire for positive or negative attention from peers or adults Sensory: desire for a feeling, taste, sound, or environment to meet a sensory need or a fear or avoidance of sensory input Power/Control: desire for clout, authority, the last word, influence over their environment
Problem Behavior: Student does not conduct himself properly for the environment or situation. Student’s behavior does not match what we expect from his peers. Student does not do what we want him to do, when we want him to do it, or how we want him to do it. Consider: Who’s problem is it?
Prioritize need for Behavioral Change/Hierarchy: 1. Behaviors that harm self. 2. Behaviors that harm others. 3. Behaviors that harm property. 4. Behaviors that are disruptive. 5. Behaviors that are distracting.
Behavioral Model Behavior is conditioned via external stimuli Based on the work of B.F. Skinner When external stimuli are identified, they can be manipulated and result in an increase, decrease or maintenance of the behavior (used in ABA, PBS, etc.) Positive and Negative Reinforcement Punishment and Extinction
Behavior Assumptions Sensory Assumptions Serves a function (obtain or escape) Function is valid for the individual Is learned and can be unlearned Problem behavior is often viewed as a form of communication. Problem behavior results from a lack of basic social skills. Problem behavior may be a source of internal pleasure. Problem behavior can be something a student does when he or she does not know what else to do. (Alberto & Troutman, 2009) Problem behaviors may result from an underlying sensory processing disorder Sensory behaviors serve a function Sensory behaviors may be productive or nonproductive Productive- meet a regulatory need Nonproductive- may be a source of internal pleasure Sensory behaviors will be acceptable or unacceptable Sensory behaviors can be used for communication purposes. (Murray-Slutsky & Paris, 2005)
Some common misconceptions about negative behavior and sensory concerns: Sensory strategies will reinforce negative behavior. “He enjoys it, there’s a smile on his/her face the whole time.” “She can do it, she did it before…she just doesn’t want to.” “He’s just being manipulative.”
A-B-C Model A- Antecedent: Events that occur before behaviors and that may cue or set the stage for certain behaviors. (Who, what, when, where?) B- Behavior of concern C- Consequence: Events that follow a behavior that determine whether the behavior will be repeated or not. (Murray-Slutsky & Paris, 2012)
Antecedent Control: Set the stage for success! Environmental influences Scheduling considerations Activity considerations Can reduce the need for specific sensory diets or behavior plans as we manage behavior.
Environmental Factors that Impact Behavior Behaviors are More likely to Occur Large Room Unstructured tasks or schedule Poorly planned transitions Low child-adult ratio Proximity of others Stress or frustration Environmental factors: noise, clutter Change: people, place, activities Bored, lack of Stimulation Excessive Waiting Behaviors are Less Likely to Occur Small rooms Structured tasks One to One child-adult ratio Engrossing, task Stimulating, interesting activities No waiting time Quiet environment Area free from distractions and clutter Repetition, routine Pre-planned transitions Familiar People Assistance Provided
Environmental Influences Promote an environment which facilitates sensory modulation. Utilize calming and excitatory influences throughout the day, depending upon the specific task and requirements. Adjust lighting. Utilize music or white noise when appropriate. Utilize aroma therapy. Offer an array of seating and positioning options, including those that offer movement. Make weighted lap pads or snakes if possible. Offer water bottles, gum, chewy or crunchy snacks.
Scheduling Considerations Intersperse all “sitting and concentrating” activities with movement or heavy work activities Use visuals to communicate schedules so students can prepare for changes and transitions Verbally prepare students in advance when non-typical activities will occur, i.e.- fire drill, outings, visitors
Ways you can help….. Routine: Provides student with understanding- gives confidence and security Gives sense of predictability BUT…have to help with what happens when changes occur…prepare, prepare, prepare First/ Then routines Individual Schedules Use photos, icons, words Length of schedule Various ways to use them For the day’s events For specific routines in the room
Activity Considerations: Give choices when possible Mix non-preferred with preferred Make tasks short & manageable, especially if frustrating Use reinforcers Make expectations and consequences/rewards clear Reduce the Anxiety SCHEDULE DOWN TIME- will melt down if have to earn Sensory Input- determine function, use tools- nubby seats, balls, tramps, velcro, pressure, sensory diet Fidgets Students with ADD/ADHD may exhibit improved focus by allowing them to hold fidget
Principles for Using Sensory Strategies: 1. Make sure strategies are not used to reinforce negative behaviors- be proactive, not reactive 2. Provide a sensory diet- schedule frequent breaks (movement/ stationary), heavy work throughout day, use strategies that can be used during learning tasks. When in doubt- use proprioception! 3. Utilize strategies to regulate arousal level, teach self-regulation: mouth, hands, move, auditory, visual 4. Teach the student to communicate needs.
Interventions Based on information gathered, the therapist collaborates with teachers and parents to design an intervention plan to address the child's sensory processing problems. The goal of a sensory based approach is to provide the “just right” amount of input in order to help the child regulate his sensory system and adapt to improve attention and focus for learning to occur.
Sensory Diet Term coined by Patricia and Julia Wilbarger in 1991. Individualized, planned and scheduled activity program developed to help a specific child meet his/her sensory needs. Combination of alerting, organizing, and calming activities. Dynamic- Adapts with the child’s sensory changes Everyone has one.
Sensory Diet Metaphor- nutritional diet. Sensory diet requires the right combination of sensory input to keep an optimal level of arousal throughout the day. “Sensory snacks” – short term “Sensory entrees” last longer, very powerful Powerful behavioral tool!
Sensory Diet Over-responsive/ hypersensitive Schedule sensory activities throughout the child’s day to modify arousal levels to fit the child’s needs. Activities with intensity and long lasting effects Be proactive to keep child calm and organized. Deep proprioceptive activities are calming and organizing: heavy work, wall push ups, weights, climbing, pushing, pulling Tactile: deep touch pressure, massage Vestibular: Proceed with caution beginning slowly with proprioceptive activities. Jumping on trampoline, swinging
If your student is overly sensitive to or overly stimulated by sensory input: Touch: Use firm pressure. Always approach from the front. Ask permission to touch. Allow to be in front or rear of lines. Noise: Keep classroom noise to a minimum. Try using white noise. Try using earplugs, earphones, or cotton balls in ears when in noisy environments. Always prepare in advance of a fire drill. Muffle your classroom speakers. Position desk on outer periphery of classroom and away from doorways/hallways. Vision: Keep classroom and walls uncluttered. Have student keep minimal items on his/her desk. Use simplified worksheets. Use a reading or writing window. Position desk in front of classroom and away from doorways. Try using a study carrel or an “office”. Use sunglasses outside if needed.
Sensory Diet: Under-responsive/ hyposensitive Sensory activities to “wake up the systems”. Intense to increase registration, awareness, overall processing. Be proactive to keep child alert, awake, organized, engaged. Modify environment to alert: bright colors and lights, animation Proprioceptive: weights, pushing, pulling, carrying & lifting heavy objects. Combine with vestibular: jogging, climbing, monkey bars Tactile: sucking, chewing, massage, vibration, sand table activities alternating sand, rice, beans; putty Vestibular: jumping on trampoline, swinging, bouncing on ball
Sensory Diet: Sensory seekers Schedule sensory activities throughout the day to modify arousal levels. Assure availability of activities. Select 1 or 2 powerful activities to maintain optimal alert state. Intense, long lasting effects Be proactive to keep child calm and organized. Proprioceptive: activities for calming, organizing. Heavy work, wall & chair push ups, climbing, monkey bars, pushing, pulling, weights Tactile: deep touch pressure, massage Vestibular: Linear movement, bouncing on ball, jumping on trampoline, riding bike
Sensory Strategies Used in Schools Activity or EquipmentSensory System Purpose/criterion Weighted vest P,T Calming, organizing, attending. Adhere to protocol Weighted lap-pads or snakes P,T Calming, organizing, attending Pressure vests P,T Calming, organizing, attending. Offers sustained input “Wiggle” cushions V, T Facilitates attending. Allows movement while remaining in seat. Quiet or safe area in classroom Designed to target 1or more systems Allows student to control need to re- group, chill-out, prepare for unscheduled event. Favorite calming act.
Sensory InputCalmingAlerting General Characteristics Mild/Soft Slow/ Rhythmical Simple/ Familiar/ Expected Low Demand/ + Assoc. Strong/ Pronounced Fast/ Jerky/ Non- rhythmical Complex/ Busy Unfamiliar/Unexpected High Demand/ - Assoc. Movement: Vestibular, Proprioception/ Kinesthetic Slow rocking, swinging Heavy work: pushing, pulling Fast rocking, swinging Bouncing/ Jumping Tactile Firm, steady pressure or weight Student prepared Warm neutral Soft/ Smooth Light or erratic touch Student unprepared Cold/ Stiff/ Scratchy Auditory Soft/ Slow Classical, soft rock, some jazz Static/ White noise Loud/Fast/Non-rhythm Hard rock/ Rap Visual Neutral or soothing colors Simple/ Soft lighting Bright or loud colors Busy/ Bright lighting Smell Soft pleasant smellsStrong or noxious odors Taste Sucking/ Sweet/ BlandCrunchy/ Cold/ Bitter/ Spicy
Sensory Supports Sensory stories The Alert Program Drive Thru Menus Exercise Programs Stickids Sensational Brain Equipment- tramps, pressure vests, weighted vests, blankets, fidgets, swings, dynamic seating, etc.
You’re Welcome: 30 Innovative Ideas for the Inclusive Classroom – Patrick Schwartz and Paula Kluth The Incredible 5-Point Scale – Kari Dunn Buron and Mitzi Curtis “Just Give Him the Whale!” – Paula Kluth and Patrick Schwarz Practical Solutions to Everyday Challenges for Children with Asperger’s Syndrome – Haley Morgan Myles Great Resources…
Building Bridges Through Sensory Integration: Therapy of Children with Autism and Other Pervasive Developmental Disorders Ellen Yack, Paula Aquilla, Shirley Sutton
Bibliography Adams, Janice I. Autism-P.D.D.—More Creative Ideas, From Age Eight to Early Adulthood. Ontario: Adams Publications, 1997. Brack, Jenny Clark. Learn to Move, Move to Learn!: Sensorimotor Early Childhood Activity Themes. Shawnee Mission, Kansas: Autism Asperger Publishing Co., 2004. Brack, Jenny Clark. Sensory Processing Disorder: Simulations and Solutions for Parents, Teachers, and Therapists. DVD. Autism Asperger Publishing Company, 2006. Children’s Development Team. Learning Through the Senses Resource Manual: The Impact of Sensory Processing in the Classroom. San Antonio, TX: Pearson, 2006. Coleman, Gina Geppert, Zoe Mailloux, and Susanne Smith Roley. Sensory Integration: Answers for Parents. Santa Rosa, CA: Crestport Press, 2004. Dunn, Winnie. Best Practice Occupational Therapy: In Community Service With Children and Families. Thorofare, NJ: SLACK Incorporated, 2000. Dunn, Winnie. Sensory Processing Concepts and Applications in Practice. DVD. The American Occupational Therapy Association, 2009. Emmons, Polly Godwin and Liz McKendry Anderson. Understanding Sensory Dysfunction: Learning, Development, and Sensory Dysfunction in Autism Spectrum Disorders, ADHD, Learning Disabilities and Bipolar Disorder. London and Philadelphia: Jessica Kingsley Publishers, 2005. Fein, Deborah and Michelle A. Dunn. Autism in Your Classroom: A General Educator’s Guide to Students With Autism Spectrum Disorder. Bethesda, MD: Woodbine House, 2007.
Glasberg, Beth A. Stop That Seemingly Senseless Behavior!: FBA-Based Interventions for People With Autism. Bethesda, MD: Woodbine House, 2008. Harris, Sandra L. and Mary Jane Weiss. Right From the Start: Behavioral Intervention for Young Children With Autism. Bethesda, MD: Woodbine House, 2007. Handft, Barbara and Jayne Shepherd. Collarborating for Student Success: A Guide for School-Based Occupational Therapy. Bethesda, MD: The American Occupational Therapy Association, Inc., 2008. Holzhauser-Peters, Leslie and Leslie True. Making Sense of Children’s Thinking and Behavior: A Step-by-Step Tool for Understanding Children With NLD, Asperger’s, HFA, PDD-NOS, and Other Neurological Differences. London and Philadelphia: Jessica Kingsley Publishers, 2008. Marr, Deborah and Nackley, Victoria. Sensory Stories. Framington, MA: Therapro, 2009 Miller, Lucy Jane. Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD). New York: Penguin Group, 2006. Miller-Kuhaneck, Heather. Autism: A Comprehensive Occupational Therapy Approach. Bethesda, MD: The American Occupational Therapy Association, Inc., 2001. Murray-Slutsky, Carolyn and Betty A. Paris. Exploring the Spectrum of Autism and Pervasive Developmental Disorders. USA: Therapy Skill Builders, 2000. Murray-Slutsky, Carolyn and Betty A. Paris. Is It Sensory or Is It Behavior?: Behavior Problem Identification, Assessment, and Intervention. Austin, TX: Hammill Institute on Disabilities, 2005. Myles, Brenda Smith, Diane Adreon, and Dena Gitlitz. Simple Strategies That Work!: Helpful Hints for All Educators of Students With Asperger Syndrome, High-Functioning Autism, and Related Disabilities. Shawnee Mission, Kansas: Autism Asperger Publishing Co., 2006. Quirk, Norma J. and Marie E. DiMatties. The Relationship of Learning Problems and Classroom Performance to Sensory Integration. 1990. Self-Calming Strategies: 16 Strategies on Cards and Posters to Encourage Self-Calming Skills. Schaghticoke, NY: Your Therapy Source, Inc., 2010. Tomchek, Scott D. and Jane Case-Smith. Occupational Therapy Practice Guidelines for Children and Adolescents With Autism. Bethesda, MD: The American Occupational Therapy Association, Inc., 2009. Willis, Clarissa. Teaching Young Children with Autism Spectrum Disorder. Beltsville, MD: Gryphon House, Inc., 2006.
Additional Resources S’cool Moves for Learning: Enhance Learning Through Self- Regulation Activities Wilson, Debra Em and Heiniger-White, Margot C. More Minute Moves: Seven Weeks to Classroom Management Success Wilson, Debra Em www.schoolmoves.com Too Loud, Too Bright, Too Fast, Too Tight: What to do if you are Sensory Defensive in an Overstimulating World Heller, Sharon Sensory Secrets: How to Jump-start Learning in Children Schneider, Catherine Chemin Oh Behave! Sensory Processing and Behavioral Strategies: A Practical Guide for Clinicians, Teachers and Parents Trott, Maryann Colby Self- Calming Cards Crary, Elizabeth and Katayama, Mits Sensory Challenges and Answers Grandin, Temple Building Bridges Through Sensory Integration: Therapy of Children with Autism and Other Pervasive Developmental Disorders Ellen Yack, Paula Aquilla, Shirley Sutton Need assistance locating these or other resources, contact Cindy Terry @ firstname.lastname@example.org. email@example.com Or Doris Osborne@ firstname.lastname@example.org@cobbk12.org