Ep. 7 Parent-Powered Potty Training: The 4-Step Coaching Model in Telehealth

Forget everything you thought you knew about toilet training—this evidence-based pediatric occupational therapy approach is changing the game. In this episode, we dive into a hybrid telehealth intervention that transformed toilet training success rates through occupation-based coaching strategies that every peds OT should know. Learn the 4-step  framework that empowers parents to become the experts in their child's potty training journey, showing significant improvement in just 12 weeks! We'll break down practical occupational therapy ideas that therapists are using to guide families through this challenging milestone and reveal which resources parents actually use (spoiler: it's not the handouts!). Whether you're an OT in early intervention or an outpatient setting, this episode delivers evidence-based pediatric occupational therapy solutions that respect each family's unique dynamics.

We share our own thoughts in the Research Review and encourage you to read the article too.

 Little, L. M., Wallisch, A., Dunn, W., & Tomchek, S. (2023). A Telehealth Delivered Toilet Training Intervention for Children with Autism. OTJR : occupation, participation and health, 43(3), 390–398. https://doi.org/10.1177/15394492231159903

KEYWORDS: Occupational therapy; evidence based practice; OT ideas; Peds OT; pediatric occupational therapy; telehealth; toilet training; autism

Stay informed, stay curious, and stay playful!

Email us at IdeasAtPlayPodcast@gmail.com

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Transcript

Lacy: We all dread those toilet training goals. It can feel like an endless battle for therapists and parents. But what if I told you you could significantly cut the intervention time and still see real progress? In this episode, we'll share an intervention that actually works.  Stay tuned to hear how to make toilet training smoother for everyone.

Michele: Welcome to Ideas at Play where we discuss pediatric research and help you apply the ideas to your daily practice. Each week, we'll review evidence-based ideas to make you a better therapist. I'm Dr. Michele Alaniz, director of pediatrics at a rehab hospital in Southern California. And with me is my good friend and former coworker, Lacy.

Lacy: me. I'm Dr. Lacy Wright, an occupational therapy professor in Kansas City. We're peds OTs who love research and making it fun. We've helped thousands of [00:01:00] therapists just like you to become more informed, more playful, and more effective in their sessions.

Michele: And this week we'll be discussing the dreaded toilet training. Let's get started.

Lacy: I usually listen to podcasts when I'm driving or working on chores around the house. It makes laundry way more fun and it's a good way to make the most of the time. But it's not good for taking notes. If you're in the same boat, we've got you covered. Sign it for our weekly newsletter and we'll provide you a quick summary of the research and links to any products or places we discuss in this episode. Email us at ideasatplaypodcast@gmail.com. 

Michele: Now it's time for our Nailed It or Failed It segment where we discuss what worked and what didn't in our practice this week. Because sometimes if you're pushing for that just right challenge. Sometimes you're gonna nail it and sometimes you're gonna fail it.

 Lacey. You're up [00:02:00] first with the Failed It for the week.

Lacy: So I found myself in a meeting with a coworker where we were both struggling with an issue that needed to be addressed with another person.

Michele: Oof, that's so hard.

Lacy: I was kind of dreading , but also looking forward to it too at the same time. It was feedback where the person needed guidance on professional behaviors, which was the part I was dreading. But the thing I was looking forward to was putting into action what we discussed in episode six about professional behaviors and how it, is good to clearly and directly address them. So I was gonna put what I learned into practice and I was so excited to try it out. So the conversation was unfolding and this little voice in the back of my head was saying, be clear and direct, be clear and direct Lacy. The words coming out were just like, so nice and flowery and dancing around the topic. And I was

Michele: It's so hard.

Lacy: never clear and [00:03:00] direct, even though that was my whole goal of the meeting. Fortunately, it turned out okay 'cause the other person in the conversation with me was very clear and direct. So I got to see how she did it and how to put it into practice.

Michele: Wah.

Lacy: I know. And then the thing that made it even worse afterwards, I was debriefing with my coworker and she was like, that was a pretty good meeting. It was kind of like, good cop, bad cop. You are the good cop. I was the bad cop. And I was like, no, I don't wanna be the good cop. I wanna be clear and direct cop. Oh, so maybe next time?

Michele: Maybe next time, what do you think you would do differently, like, so that you don't run into this next time?

Lacy: So I adopted a new mantra, which hopefully will help.

Michele: Ooh. I love a good mantra.

Lacy: Yes. I will keep repeating this to myself, and it is being clear is kind and I think that will help me, that way [00:04:00] I'll know that I'm being kind and have the person's best interest in mind when I'm being clear and direct.

Michele: That's good. I like that. Being clear is kind. I'm gonna remind myself that too, when I have to have a tough conversation.

Lacy: Sounds good. let you know how it goes when it comes up. So Michelle, that means you are up for a Nailed it this week. Tell us about it.

Michele: This week I was covering in our autism preschool. I was helping out, this is where we have toddlers who have autism and we're working with them on getting ready to transition to the school district. And I walk in and it's like there's one kid in the corner who's climbing all over the equipment and there's another kid that's crying and there's another one that's like literally running in circles. And you know how it is when you go into a preschool classroom, it just looks like chaos. And as I was working with these kids, I just delighted in the fact that because I have experience with sensory [00:05:00] integration, I was really able to see what was going on for each child and their own unique way that they were interacting with the world around them. And to be able to coach the staff to say, like, this kid, like, you see how he's so shut into himself and he's, he's constantly moving and fidgeting. That's a kid who, you know, I think he has a high threshold with a narrow band of tolerance. You know, he needs a lot of sensory input to hit that threshold, but then he gets overstimulated so quickly once he hits it. So I was able to give them tips on how to help him regulate himself in class, how to bring him up to that threshold, but not push him over the top. And then this other kid, you see how he's always like vigilant and avoiding everything and kind of on edge all of the time. Like he seems like he has a low threshold across the board. And here's tips for how you can speak with him and how you can modulate your voice and how you can avoid light touch and just different [00:06:00] strategies to help each child's unique sensory needs. And I felt like it was a superpower. I was so excited to be able to have those eyes to see, to really help these kids feel like they were having a successful and fun time in class.

Lacy: That's fantastic. Having a set of fresh eyes and even having that perspective with all of your background and training, I'm sure the staff and other therapists really valued having that.

Michele: Yeah. And it's so fun for me because I get to go in and just be impressed, like crazy with the staff and how amazing they have set up the room and the activities and the way they're interacting and the, just the, the way that they, they emphasize building connection and helping these kids feel safe. It made my heart so happy and I felt like a proud mama watching all of these, you know, people doing their jobs so well and then to still have something that I could contribute was also really cool.

Lacy: That's awesome. I'm so glad [00:07:00] that worked

Michele: Mm-hmm.

Lacy: you guys. 

Michele: Our next segment is the Research Review where we break down the latest in pediatric research and explore how to apply it to your sessions. This week, Lacy has an article about using telehealth for potty training. Lacy, tell us about your article.

Lacy: The title of the article is A Telehealth Delivered Toilet Training Intervention for Children with Autism. And it comes from us from the OT Journal of Research from 2023. And this is one of their articles that has free open access.So please check it out for yourself.

Michele: Hooray for open access.

Lacy: Yay. Yes. I picked this not only 'cause it is free and open access, but because I think toilet trading is something that is occupational therapies, bread and butter. But it is hard to do. so

Michele: Yeah, it is.

Lacy: Yeah. And a lot of the interventions are very like behavior based. Like I never really feel [00:08:00] comfortable, like it's not a nice worn pair of jeans, even though it's so an occupational therapies wheelhouse.

Michele: Yeah, it's funny 'cause you know, you work in the hospital with adults and you're constantly chaining, changing dirty diapers, dealing with toileting, helping 'em transfer to the toilet. All of the things, you know, it's an activity of daily living. But then when you get into like outpatient pediatrics, it kind of becomes the dreaded thing to do because it's hard. Every family is unique and you don't wanna step on their cultural boundaries or impose what you think should happen on them. But at the same time, it's like you have ideas of what might work or might, might not work, and also you're just not with them like in real life to help them with it, you know? Or sometimes I find like I have boys that I'm working with and they're of an age where it feels inappropriate for me as a woman to be providing this intervention solo with this child who, you know, is of an opposite sex. So yeah, it [00:09:00] has a lot of pitfalls.

Lacy: Yeah, it's tricky. So here's the general overview. The occupational therapist had a 10 to 12 week intervention  period where they met synchronously with caregivers via telehealth every other week. They knew synchronous telehealth intervention is a good intervention, but they were curious to see if a hybrid telehealth intervention was also good. So the way that they made it hybrid was alternating with synchronous telehealth meetings with a week off where they're just checking in via email and pointing them to resources, 

Michele: Okay. I see. So when you say synchronous, you mean that they were both on Zoom, for example, at the same time and they were coaching 'em through it versus like where they've prerecorded something that the parent might be accessing that would be asynchronous. Right?

Lacy: Definitely. And they

Michele: Okay.

 Lacy: between like 30 to 45 minutes. The population that they met with was [00:10:00] families. They had 34 families, and they all had kids with autism between the ages of two and eight years old. So kind of those potty training years.

Michele: I love that range because that's real. That's what you see in the clinic.

Lacy: And it's also interesting that it takes children who have autism on average a little bit longer.To complete potty training than other populations. One study, it's an old study from I think 92. It said that it takes 25 months to complete the whole potty…

Michele: Yikes.

Lacy: training sequence. Yes.

Michele: Holy moly.

Lacy: Two years.

Michele: Oh, that's, that's a long time. Wow. You gotta really be in it to win it. I feel for these parents,

Lacy: It's a lot. It's a lot. And a lot of the other studies that this article was talking about is with the goals. It's either they're potty trained or they're not. But we know over the course of those potentially two plus [00:11:00] years, there's a lot of little steps that are happening along the way. So they were trying to capture that information in their telehealth intervention.

Michele: So like a little bit more sensitive of a tool to see where change is occurring.

Lacy: They did pre and post-testing with three different tools. The first one is the Toilet Behavior Questionnaire this questionnaire is still under development and I really wanna learn more about it. I tried finding it and it's not out yet, but it's based,

Michele: Oh

Lacy: I know I wanted it and it sounds so cool because it measures all of those little, all the baby successes along the way that an individual

Michele: Hmm.

Lacy: has over those 25 months, potentially, that they're working on toilet training.

Michele: Yeah, so it's like more incremental than just like goal met or not met. It's like every little step along the way.

Lacy: exactly. [00:12:00] The second tool that they used was the Goal Attainment Scaling, and this is now the second time that goal attainment scaling is coming up in a research article. So we're gonna include,

Michele: because it's so bomb.

Lacy: Yes.

Michele: It's so good.

Lacy: in our newsletter, we're gonna include a checklist on how to do goal attainment scaling. 

Michele: Ooh, a little cheat sheet.

Lacy: cheat sheet bonus.

 Michelle, I know you've used goal attainment scaling in your aquatic research. Do you wanna give us a quick rundown in how to do that?

Michele: Yeah, absolutely. I love it's just OT through and through. You start out, you interview the parent, you understand what their goals are, and then you gather your baseline data and you scale it into a five point scale where you have your baseline and then you have like slightly regress, like what would happen if they were below baseline at the end of it. And then you have like slightly improved. And then above that would be goal met. And then the final level of the scale would be like goal exceeded. So it's [00:13:00] a five point scale, but there's like a really specific way that you're supposed to make these scales. So definitely check out the tool that we have if you wanna use it.

Lacy: Perfect. And then the last tool that they used in the article is the COPM, the Canadian Occupation Performance Measure. This is a semi-structured interview where the therapist is talking to the parent to identify the priorities for treatment. 

Why is it that the Canadians are so awesome, man? They have all these tools with their names on it. Everyone knows the COPM. 

Lacy: The Canadians do have good stuff, and this one's no exception. After they talk with the caregivers to identify their priorities,And the caregivers rate the identified priorities. About the child's performance and the satisfaction with those different occupations.

Michele: Nice

Lacy: So that's the general rundown. They had three different objectives that they identified. The first was do caregivers even like doing a [00:14:00] hybrid telehealth toilet training intervention. And the answer at the end of all of this was, do you have any guesses, Michele?

Michele: Um, I would guess that they do like it because it's pushing into their real life environment, so you can actually see the setup and cue 'em on like the real thing.

Lacy: Yeah, you're right. The caregivers did have very positive reports about the telehealth piece. What was interesting was they didn't really access the different supplemental resources very, very much.

Michele: Uh, so they had like some way of tracking if they were opening it up and using it.

Lacy: Exactly.

Michele: That's cool.

Lacy: which resources were being used and how frequently, which ties into our next objective, 

 which was measuring how often caregivers used the asynchronous sources. So these were the handouts and they also had podcasts and a lot of them, out of the 34 families, they were only accessed like two to four times, but the sensory [00:15:00] processing info was accessed the most. It was like 10 times.

Michele: Hmm.

Lacy: the thing that the parents were most

Michele: Interesting. Okay. Whoa, whoa. Wait, wait. Are you telling me they made podcasts and people didn't listen to 'em?

Lacy: I know. I was thinking that too. This is a little bit…

Michele: Too close to home.

Lacy: yes. And I love making handouts too. What therapist doesn't like a handout to give to a parent? I feel like they're so wonderful and so valuable and now I'm hearing that parents were actually not that into it.

Michele: I'll say this though. I'm not surprised at all. I would not think that parents would use handouts that much. I never give a handout. When I was a new therapist, I made that mistake. I would make beautiful handouts with all of these, uh, options so they could just choose what they wanted to do. And I found that parents are overwhelmed. I mean, I'm a parent, I'm overwhelmed. I get it. And having to keep track of a paper, like that's not very likely. You're think about getting something in your email, like, I get 200 emails a day. So [00:16:00] I'm really not surprised that that was maybe not the most effective. I'm curious about the ones that they did access. I understand that thematically they were sensory processing, but did they say they were handouts or podcasts or did they have certain, like what is it the medium of it

Lacy: Yes.

Michele: that they preferred?

Lacy: I was surprised, Michelle. 'cause I thought for sure the handouts would be accessed more, but it's actually podcasts. Oh,

Michele: podcasts win. 

Lacy: which makes me

Michele: Woohoo.

That's fun.

Lacy: Um, the sensory processing was the top one. The second one was communication and potty training.

Michele: Yeah, that makes sense to me too, because I'm thinking about a busy parent. You don't have time to read something, but you can throw a podcast on in the background. You know, like when you're cleaning or when you're in the car or whatever, to get the information. So that makes sense. Good job researchers.

Lacy: And extra shout out to these researchers because they also have a supplemental resource at the end of the article, [00:17:00] and it lists out what they did for like the eight different handouts that they made. It's not the pretty handouts,

Michele: Nice.

Lacy: but it's the outline of what they had so that you can have that information.

Michele: I love it when they make it where you can replicate what they did.

Lacy: And then the third objective that they looked at was. How good was the intervention? Did it even influence the child's toilet training skills? The answer for this is yes, on all three of their measures. The goal

Michele: Wow.

Lacy: The goal attainment scaling the COPM and the mysterious magical toilet behavior questionnaire.

Michele: That is so awesome because it wasn't that long. Like you said at the top of this, that sometimes it can take 25 months for an autistic kid to pick up toilet training. And then I think you said this intervention was like 12 weeks or something like that. And that's not even like, they weren't even meeting every week. Right? It was like every other week. So they really only had like maybe six sessions. That is some [00:18:00] incredible outcomes.

Lacy: Well, they didn't say if they mastered toilet training, but they all made improvements and the parents were really happy about the improvements.

Michele: Mm-hmm.

Lacy: So we can assume it was very significant. There were a few families that didn't complete the intervention, but they still did the questionnaires at the end and they showed little to almost no improvement.

Michele: Interesting. So they had like a quasi control group there.

Lacy: quasi control group for the win. Yes,

Michele: So those are really amazing results. I'm still not really clear what they did in the telehealth session to get those results. I mean, I know they were meeting with them, but did they have like a specific strategy they were using?

Lacy: Yes, the article talked a lot about occupation-based coaching.  This intervention was a fun find for me moving to Kansas because I found out that it is what all of the early interventionists do. So occupation-based coaching is basically a structured way for therapists [00:19:00] to have therapy sessions, there's four main steps that you follow every time to guide the conversation. So the first one is when you meet your family, you greet them, have a positive conversation, and talk about a positive event related to the child. So you're establishing rapport, essentially about the child, and getting off on a good foot.

Michele: That could be harder than one would think, because I don't know how many IEP meetings I've been in where they ask the parent, what do you consider your child's strengths? And there's just like crickets. They cannot not think of anything because they've come in guns blazing, ready to talk about everything that's going wrong. I was just walking through the clinic on Friday and I overheard one of my feeding therapists working with a new mom and she was like, so worked up and said, oh my gosh, the baby's regressed since I saw you last time. And she was just, you know, she just needed to like share. So sometimes it can be harder than it seems to just like establish that rapport starting out on a positive note.[00:20:00] 

Lacy: Yeah, I could see that, especially with a new family that you're working with. But with this intervention, you're repeating these same four steps over and over, so hopefully you're setting up routine where getting off on a positive foot.

Michele: Mm-hmm.

Lacy: Because these are the same steps you're using over and over. The second step is discussing what that joint plan was that the therapist decided on with the caregiver at the previous session. So you're checking in, “Hey, we decided last week that you were gonna try X, Y, Z. How's X, Y, Z going?” And then you hear from the parent.

Michele: You know what this reminds me of? Remember episode one we did that video modeling intervention for autistic kids with motor skills, and it was the same thing where you like reviewed the video from the week before and talked about it. So it's like the same kind of steps, but just in a different context. That's cool. I like that.

Lacy: I was thinking that too. It is very similar. The third step to the [00:21:00] intervention is, 

 as the family is describing what's happened, therapist is not offering new ideas, but rather asking reflective questions back to learn a little bit more about what's going on and to problem solve, and then to determine the next steps that they should take to move forward.

Michele: Hmm. Yeah, I've definitely seen this, like even that session, I was just talking about the feeding one where the therapist is doing like active listening skills basically where she's reflecting back. “Okay, so I heard you say that she's throwing up more, but are you finding that she's throwing up more volume or throwing up more frequently?” And so she like asks a reflective question to help them. First they feel heard, so their nerves calm down and second, they're able to be more detailed about the feedback so that she can problem solve with them.

Lacy: Yeah, 100%. And it's that problem solving piece where the therapist isn't trying to jump in and be the hero, but rather to help the [00:22:00] caregiver think about what have you already tried? What do you think might be good to do next? And get more details about what's going on because. I don't know about you, but when I get kind of nervous or when I was a new therapist, I would try to just start spitting out ideas that I had right away, rather than really taking time to sit and listen.

Michele: Yeah, and have that collaborative conversation where the parent really is the expert in this scenario. They know their child best, they know the context best, and you're just there to try to help support their problem solving and find a path forward that maybe they haven't thought of already. So it's more of the role of a guide instead of a hero.

Lacy: Yes. Exactly. Exactly. And then that leads us to our fourth step. Once you've heard, listened, collaborated, then the therapist and the caregiver come together to come up with a new joint plan, in this case, for the potty training, so that the parents will work on that plan and [00:23:00] implement it over the next two weeks before the next telehealth visit together.

Michele: Yeah, I think that is the way to go instead of handouts and fancy things. It's like just let's come up with a strategy, try it for a couple weeks, let us know how it goes, and we'll adjust from there.

Lacy: Yeah, and it really builds on, like you said, that parent centered, parent driven intervention within real context, because the parent knows the kid the best and they know, you know how their home works, their idiosyncrasies, what time the kid wakes up, what time they go to bed, what they like to have for snacks, how the bathroom is set up. All of those things are really important that you just cannot replicate in a school, a clinic, else. So that makes sense why the researchers saw so much growth, because it's parent driven and really true to the authentic day-to-day routines.

Michele: And I also think this is a win for the families because they're [00:24:00] not gonna have to be in therapy for 25 months. They're learning the tools that they need so that they can then continue on and not necessarily need ongoing support through the whole process. And that's huge as our wait lists are growing and kids are waiting so long to get in, to be able to provide kind of the quick and dirty intervention that empowers the parent and now you've expanded their capacity to really work with, with their child long term.

Lacy: Yeah, 100%. It's all about expanding that parent's capacity so that they can continue along this road with the child as they continue to make those incremental gains.

Michele: Gosh, though I think about how intimidating that would be as a new grad. I can see myself doing that now. But as a new grad, you just wanna come in with a plan. You wanna be the hero, you wanna have all the answers. 'cause it helps you feel like you know what you're doing. So this would be, I think, pretty tough for a new grad to pull off and they'd have to really brainstorm ahead of time, 

Lacy: Yeah. And I [00:25:00] think that's why those more behavioral base are more common in occupational therapy

Michele: Yeah.

Lacy: yes, do 1, 2, 3, get a sticker, and then count the stickers and say, yay, we did it. You know, it's easier to like structure and explain and feel like an authority figure. But with this, I feel like it's just more authentic and real, and

Michele: mm-hmm.

Lacy: it’s making more of a real impact. And the research backs it up too. A lot of those quick,

Michele: Nice.

Lacy: behavioral base, behaviorally based like weekend long potty training that I see.

Michele: Mm-hmm.

Lacy: the researchers said that with our autistic population, they might show initial success and then regress afterwards so it could actually become causing harm. Um, going with some of those other strategies. 

Michele: So occupation based coaching, it is just another tool in our toolbox to be able to help these families in a really effective way. Lacy, let's do our wrap [00:26:00] up where we cover the three most important elements of this study, starting with the population.

Lacy: Yeah, our population is families who have children on the autism spectrum, and those children are between the ages of two and eight years old.

Michele: And what were the key ingredients of this research study? So the key ingredients are the things that we wanna try to replicate in our session if we're gonna try to do this with our kids.

Lacy: So the key ingredient is the occupation based coaching, where you are meeting with the, the parent, listening to them, collaborating with them, coming up with a joint plan, and then checking back in with them week after week. That is an evidence-based intervention. The therapist just took it to the next level to see, Hey, how can we make this work in telehealth and do we need telehealth plus resources? But at the end of the day, it really all comes back to that parent directed intervention. With the occupation-based [00:27:00] coaching,

Michele: Great. And then what is the proposed mechanism of action or why do they think that works?

Lacy: I touched on this a little bit before, but it is family implemented intervention where the family is, the driving force behind the intervention, and that works so well because the family knows the child best, they are sensitive to their own family dynamics and needs, and it's within their authentic routines.

Michele: I definitely see that context specific learning for early intervention, but once you get past that three years of age, sometimes it's harder 'cause you're seeing 'em in the clinic. And that's been one of the beautiful developments that came out of COVID is that we were able to do telehealth services where we could push into the client's home and see them in their natural context. I'm a little nervous because the waiver that Medicare gave so that we could do telehealth all this time is expiring. And then after that, it'll be up to every individual insurance company, whether or not they're gonna continue to cover telehealth [00:28:00] services.

And these kind of studies are so important for demonstrating how effective that intervention is so that hopefully our organization can advocate for continued access to telehealth services.

Lacy: Yeah. Right now, as of the date we're recording this, is in limbo as to whether or not telehealth is going to continue to be a tool for occupational therapists and other service providers. I think if it does expire without getting extended, that would be extremely unpopular and would make a lot of people mad. So at least we have this great article in addition to all of our advocacy efforts to try to continue to use telehealth to support our great families.

Michele: And that's it for our research review. We hit the highlights and we shared our own thoughts. But you should check out the article yourself, especially 'cause this one is free, open access and let us know how it impacts your therapy [00:29:00] sessions.

Lacy: Up next is People, Places, and Products where we shine a spotlight on something that is making our therapy hearts happy. Michele, what are you shouting out today?

Michele: Okay. Speaking of the autism preschool that I've been covering in recently, we do circle time with these littles and they're in their little cube chairs and we're singing songs and we have props and we try to really engage them and target their language. And one of the strategies we use to help them with being able to sit and stay put during the circle time is rocking their cube chair back and forth.So we're giving 'em some movement while, you know, they're listening to the songs, but that's actually exhausting if you're the therapist trying to do it.

Lacy: Does it actually rock? Like I, I thought a cube chair was

Michele: No.

Lacy: pretty stable.

Michele: It's a cube. You have to like, fully like lift it up onto one of the points and rock it back and forth. So it's very physically active intervention. And one of our therapists found [00:30:00] rocking cube chairs, so they're made of the same material as the cube chairs, but they're like, um, kind of like little rocking courses where you sit on 'em and they just easily rock back and forth. And then you can flip 'em and then they become like a regular chair for a hunt to sit at. So they're really cool. So we got these rocking cube chairs, but the funny part is I was trying to demo it to a kid to be like, look how amazing this is. And I like squatted on it and I, you know, of course don't fit on it. And I'm just like trying to balance myself and I fully face planted on the rocking chair, just lost my footing and it was, it was quite the show. Yeah, this is a bonus, failed it for everybody. But no, these rocking cube chairs are really cool for that younger crowd where you wanna be able to give a movement.

Lacy: that's awesome. I'm gonna have to check 'em out. Can you buy 'em on

Michele: Well, Lacy, if you email me at IdeasAtPlayPodcast@gmail.com, [00:31:00] I'd be happy to give you the link to the Rocking Cube chair. Or maybe I'll put it on our Instagram account so people can check it out.

Lacy: Our next segment is our listener question. Our question this week comes from Ann in California. She was curious to know if we have any pets. Michele, I know you have a couple you wanna tell us about it?

Michele: Oh my goodness. I love my pet so much. It's funny, Lacy, because I know you remember when I was debating whether or not we should get a dog. My son really wanted a dog, and I grew up with dogs, so it seemed like a good thing to do, but I just thought like, oh, there's so much work and should we get him? So I actually made my decision because I was listening to a podcast of all things where they were talking about research on how dogs make you happier. And I thought, okay, if dogs make you happier, we're gonna get a dog. So my son's 10th birthday, we picked out our precious little maltise spaniel mix that we got [00:32:00] and my son named him Nixon. So we call him Nixy for short. He's like a white, fluffy little guy. And then when the pandemic hit, my husband and my son were home all of the time and they decided that we needed a second dog. So we went back and we got a rescue chihuahua who was so tiny that we decided to name him Biggie. And the funny thing about that is that now he's like the fattest chihuahua you've ever seen. So we say he lived up to his name. Um, so we have Nixey and Biggie and they're part of our family and we love them so much. What about you, Lacy?

Lacy: I have had dogs, but I currently have two cats and I love my cats. They are so soft and snugly. I have two of 'em. One is 19 years old. We call him old man Fritz. And he is just chugging along. He walks like a [00:33:00] little old man. He meows like a little old man, but, uh, we just had the biggest heart for him. We got him right after we got married. So we've had him our, our whole married life, um, 19 years. And then we have another cat, um, named Smokey, and he is all gray and he's just like a little tank so snugly. He just looks at you and just starts purring. And he always sleeps at the foot of my bed right between my feet, which makes it a little hard to sleep, but I just love it.

 Michele: And I think this answer explains everything you need to know. I have dogs, Lacy has cats. That's what you need to know about us.

Lacy: I'm a cat lady. I'll claim it. I'll claim it.

Michele: Ann, thanks so much for that question. And if you have questions for us, we have answers. You can email us at IdeasAtPlayPodcast@gmail.com or dms on social media, and we may include your question in a future [00:34:00] episode.

Lacy: This week we reviewed an article about telehealth for toilet training. It was all about occupation-based coaching. Here are the four steps. Start off your session with a positive discussion about the child. Two, discuss the plan that you came up with from the previous session. Three, ask those good, reflective, active listening questions to your caregiver so that you can really learn more about the difficulty that they're having. Come up with new ideas, help them feel listened to and heard. And then four, create your joint plan together where you're collaborating and discussing what the parents should try over the next week or two before the next telehealth session.

Michele: And that's it for Ideas At Play. If you've learned something from today's podcast, be sure to leave a rating and a review. It makes my heart so happy when I read a new [00:35:00] review, and it helps others find our podcast so we can all be evidence-based therapists. If you want more ideas for your sessions, you can find us on Instagram under Ideas at play, or email us at Ideas at Play podcast@gmail.com.

Lacy: Until next time, stay informed, stay curious, and stay playful!

Michele: I just think every therapist when's like, oh God, toilet training, not

Lacy: I know I don't even wanna talk about it.