Homeschool a la mode

Last February, the girls and I took several weeks off from homeschooling.  We decided to go with our own flow, and use a “tidal” approach to schooling, in which we do school year round, but take breaks when we need them.  We’ve taken breaks for appointments, for illnesses, for when guests visit, for fun, and even for our sanity.

This February though, we’re not taking week long breaks.  I think the difference is that I’ve changed my approach to our daily lessons.  It’s probably laughable in its simplicity, but my approach had been to start and finish the lessons I had planned for the day.  My focus was completion, specifically with core subjects like math and reading.  I figured working on specific tasks from beginning to end each day would be a good way for us to both make and measure progress.  I figured that the pace would be a good challenge and the girls would learn the value of persisting.  They would receive a sense of gratification with each lesson completed and checked off.

Also, when people like the girls’ PCP, their post-adoption social worker, friends, and/or family ask me how the girls are doing in school or what they’re doing, it was really easy to answer.  “Oh, they’re 75% of the way through with their reading program.  They should be reading independently by March.”  Or “they’re mastering addition, by next week we will have moved on to subtraction.”

The innate problem with focusing on completion is that it prevents my focus from being on the girls’ needs.  Although each girl has impressive academic strengths, each also has weaknesses which can slow progress.  We all have weaknesses.  The girls’ weaknesses (cognitive and psychological) would pop up surprisingly and in unexpected places.  Here I have to humbly confess that at this point my frustrations would be triggered:  How could you not know this answer?  You knew it yesterday.  Why aren’t you looking at the book we’re reading?  You can’t read what’s on the page if you’re not looking at it…etc.  You get the ugly point.  And then the learning environment would be derailed.

My new focus is proficiency, and we now take however long is necessary for the girls to become proficient in each lesson.  In OT school, we would often discuss an “appropriate challenge” when discussing goals and activities to do with clients.  An appropriate challenge is one that stretches or challenges our skill set in a positive manner, makes us try hard, but does not present a task that is so difficult that a sense of defeat sets in.  A “just right” challenge.  The notion of an appropriate challenge tied in with a focus on proficiency sets the tone for our school days.  This means that some days we only make it through 1/3 of the reading lesson when we begin to go beyond the girls’ competency level.  At this point I have to try and discern if it’s appropriate to push them a bit, stretch their skills, or if it’s time to wrap up reading and move on to something else.  It’s definitely a balancing act.  I’m finding so much of life is about balance.

So, that’s my daily grind philosophy and it’s making school a lot more enjoyable.  My bigger picture what-should-a-first(ish)-grader-know philosophy is something like an overview of:  knowing who you are; knowing where you are; knowing your worldview; understanding beginning logic regarding math and science; reading; and growing a love of the arts.  Ambitious, I know.  But I think it’s important for a child to, as much as she can, understand these foundational ideas before moving on to other things.  In my mind it’s like establishing home base.

To that end, we are loosely following the kindergarten/first grade Sonlight curriculum which includes Horizons math and lots of literature.  We supplement with other books, but this is our main curriculum model.  Honestly, I love the Sonlight curriculum, but buying the whole set is not a feasible economical choice for us.  So instead I make a list based on their suggestions and buy them used.  Many of their supplemental books are Usborne.  I’m a big Usborne fan.  When I get ready to buy school books for the year, lots of these guys are on my list.

One of the Usborne books we’re using is Finding out About Things Outdoors by Usborne Explainers.  I think it’s a great book to help the girls better understand our environment and the natural world.  It explains rain cycles, what makes up soil, seasons, volcanos, water pathways, plant life cycles, and even our solar system.  It’s fabulous.  And timely.  I heard the groundhog said that we’re going to have more winter, but I’m not feeling it.  We’re already getting our spring rains in the valley.  The river is full and so is the (wink wink) wet-weather pond in the backyard.

So the girls and I went outside and found seed samples, checked out the soil, the pond, trees, plants, and enjoyed the fresh air between the rains.  While we were at the pond I reemphasized the rain cycle and we talked about how some of the water in the pond will evaporate.  I was well into my evaporation monologue with wild gestures about tiny air particles when Audrey deadpanned, “I don’t see it.  I don’t see any water rising.”  When I tried to explain the notion of being invisible to the human eye, Eva quipped “like Lord of the Rings!”  Thanks sistas, for keeping me humble 😉

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Time

It’s already the month of love. Every time I start to blog, I look back and am surprised by how long it’s been since the last post.

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Even living way out like we do, life moves by so quickly. Days when we don’t go into town, the pace is softer, less hurried. But still. All this time we have, it just slips by. Maybe I thought by moving to the country we’d feel it less, this rapid loss of time.

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When we leave our little house along the river on our “city days,” I take the girls to therapy.  Occupational, Speech and Language Pathology, and Physical therapies are regular, tri-weekly appointments where the little things are practiced constantly and sometimes big things happen.

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When we get home: lunch, nap, free play, school, & dinner. And in those spaces, life happens.  Our days are full. In wonderful ways that leave me dizzy with thankfulness: How blessed am I to be able to be with these girls, these little, wild women, throughout the day? How much must my Father love me if he chose Daniel for my husband and these delightful girls to be mine?

I think with children, you are especially sensitive to time flying by because everyday your children are growing and learning and changing. Sure, a lot of it can go under the radar, because the change is subtle and our powers of observation are subject to desensitization.

Despite this, you still see the change and growth when your child surprises you by reading a book for the first time after months and months and months of practice.

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Or when your child has lost her fifth tooth!

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Or when you realize that your child is speaking correctly and politely requesting to be held rather than saying in a high voice with a quirky cadence, “Momma, hold you!”

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Or when you creep up to eavesdrop because of all the giggling during bath time and hear your girls joking with one another and laughing because they keep passing gas and making bubbles in the tub.  Just being kids.

“Bubbles” (yes, this is a clip of Eva and Audrey passing gas and laughing about it)

Or when you give up the tug of war and acknowledge that your child is no longer a size 5/6 but is now a solid seven.  Or you come upon them during their free play and they’re having an epic sword fight involving multiple characters from the Teenage Mutant Ninja Turtles, The Chronicles of Narnia, and The Lord of the Rings.

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There are also those other moments when you slow down and reflect. Those moments that are less of a throat punch and more of a gentle stretching of your heart, when you reflect and slowly recognize those subtle signs of growth, emotional and spiritual maturity, and change in your child.

You visualize rays, where you and your child began together at the same point and where your child is slowly and rightly growing away from that point, towards her future. For our family especially, having two special needs gals, the direction that ray stretches out to isn’t exactly clear. Nor is the future distance between parent and child. The only thing for certain is that time will not slow and our family’s future lies in God’s hands. So we rest in the assurance that God is good on our good days and on our bad days. We rest in the sometimes hard to wrap your mind around fact that it’s okay to trust God. And we commit to have thankful hearts that slow our thoughts and take time to cherish and give thanks to the Giver of Good Gifts.

Our girls are growing up.  It’s wonderful and terrible and happening so quickly.

Weekend Warriors

This Weekend Warrior project was putting up a floating shelf and backsplash in the kitchen.

We used leftover ikea countertop for the shelf and secured it to the studs with steel rods.

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We pushed the shelf into the wall.  Well, Daniel pushed it and I helped a little.  Then he used a massive mallet to knock it in the rest of the way. My husband is Thor.  Basically.

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Then Daniel spent hours cutting the metal backsplash and we (mainly Daniel) secured it with construction adhesive.

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This morning when I walked in the kitchen, I just said, “Ahhhhhh.”  Nice work, liver boy.

Wow, it’s a New Year

I haven’t blogged in a while.  December is over and I don’t even know where it went.  I’ve been mentally wrapped up with Arkansas’s therapy cap (boo) and busy with normal therapy stuff, putting up Christmas, taking down Christmas, family visits, not biting my nails, snow, and getting ready to start our homeschool year back up.  Whoo.  Oh, and my middle sister is engaged!  Congratulations, sisser dear!  The times they are a changin’.

Snow was nice.  Audrey peeked outside and said, “Well, I guess we’ll be staying in today.”  She’s such a little adult.

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The girls liked our house done up for the Holidays.  They decorated the lower 1/3 of the tree and it ended up looking like a fringed skirt because they put the bulk of the ornaments on the very bottom branches.  I’m totally over trying to have things look Pinteresty.  Thank you, girls, for liberating me in the best way possible.

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Eva had another visit to the orthotist to shave ALL the wedge off her AFOs.  Her feet are totally neutral and can even achieve a couple of degrees of dorsiflexion-for the first time ever.  Rock those flat feet, sista.

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Audrey has been working hard at therapy and also had a visit to the orthotist for nighttime stretching splints, a wedged AFO for her right foot, and a 3 degree dorsiflexed AFO (that’s a fantastic thing) for her left foot.

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Aaaaaaaaand, drum roll please, Audrey’s incisions, after her initial brutal swelling which prevented closure and her secondary allergic reaction to her silver sulfate dressing…

THEY ARE CLOSED!

After more than three months of wound care, we are cautiously optimistic that the incisions will stay closed.  Please Jesus, let them stay closed.

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Christmas was put up and Sibby was all over it.

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And since the girls are growing up, their nap time is shorter (yes, they still nap, be jealous) and we’re implementing Free Play in the afternoons.  They play in their room all by themselves without interference from their well-meaning occupational therapist mother.  The only rules are: be kind, play together, and stay on the play blanket (to ensure playing together).  They can speak incorrectly, sit wonky, avoid eye-contact, and do a number of other “offenses” without fear of being corrected.

It’s been great.  They look at books, giggle, build complex buildings, play with toys, and do lots of rolling the volleyball back and forth.  They are kind and they work very well together.  Sister is such a beautiful word.

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Here’s to a New Year.  May your 2017 be blessed!

90 Is Not Enough

Our girls go to therapy three times a week.  Audrey receives 120 minutes of physical therapy and Eva receives 180 minutes of physical and speech therapies.  We purchase a private family health plan from healthcare.gov and a secondary “insurance,” TEFRA, a non-income dependent branch of medicaid, if you will, for children with significant developmental delays.  We are very thankful for TEFRA.  Our insurance would only cover about two months worth of therapies, so we depend on TEFRA to cover the vast majority of the girls’ therapies.  TEFRA also works as a secondary insurance that covers our costs after our primary insurance has been billed.  The only procedure that the girls undergo which TEFRA does not cover is Botox.

Eva, specifically, is a poster child for the benefits of 180 minutes of therapy weekly as she has made very significant progress in therapy without dramatic surgeries to benefit her musculoskeletal issues, such as decreased range of motion in her joints.  We know from our attempts at serial casting that Eva’s skin will not tolerate the post-operative cast required to maintain a position after a surgery.  Therefore, through God’s grace, Botox injections, and therapies, Eva has progressed.

Arkansas law makers are currently discussing a 90 minute therapy cap for developmental therapies covered by medicaid, which includes TEFRA.  From what I have read, that means that the new “norm maximum” would be 90 minutes.  The 90 minute therapy cap could be appealed in special cases.  That is, you can go through a pre-approval process in order to appeal the cap, and request more therapy time.  However, as a former practitioner, I believe I can safely say that in many cases, medicaid regulations set the tone and in some cases even determine practice standards.  I also believe that I can safely say that many children with significant special needs are best suited to MORE than 90 minutes weekly.

The number of minutes a therapist recommends for therapy is determined by the client’s performance on at least two standardized evaluations (approved by medicaid) and objective professional observations.  If it is determined that the client has statistically significant delays and the potential for improvement, then a therapist would make appropriate recommendations for the number of minutes of direct therapy services.  Many of my clients were recommended to receive more than 90 minutes weekly.  From my experiences, whenever Medicaid regulations change, therapy often changes with it, because it is a wearying and sometimes fruitless attempt to try and go against the Medicaid grain.

Here’s a hypothetical.  Let’s say a client, Eva, based on a professional’s evaluation and recommendations, qualifies for 180 minutes of therapy weekly.  Then the new therapy cap comes into effect.  This will require Eva’s therapists and office staff at her therapy clinic to complete extra paperwork for an appeal (which takes up a therapist’s time and is of course not reimbursable by medicaid nor insurance).  My guess is that this appeal will also have to be approved and signed by Eva’s Primary Care Physician,  her PCP.  This gives her PCP more time spent on unpaid paperwork and also gives the PCP’s office staff more work.  THEN, the twice-signed appeal with copies of pertinent data will be sent to on to an appeal committee to wait to be reviewed.

Big picture, this will very likely create more stress and work for therapists and support staff to maintain best therapy practices for their clients.  This seems to me another instance where reimbursement and therefore the baseline for medical practices are determined by non-medical professionals.

Not every therapist or special needs parent, currently receiving greater than 90 minutes or prescribed to see more than 90 minutes, will appeal the cut.  I can envision parents unfamiliar with healthcare processes and parents who speak English as a second language as being the two main groups of parents who would be most likely to have their child’s therapy time cut without appeal.

I understand that this proposal was made in order to cut costs in medicaid.  Medicaid reimburses a set amount for every unit (15 minutes of therapy) which does not change with the cap.  Placing a 90 minute therapy cap will not ensure that medicaid pays less money annually on therapy.  Placing a 90 minute therapy cap simply encourages therapists to see a greater number of clients.  Assuming that therapists continue to work the same hours as before, which is a safe assumption, Medicaid will effectively be paying the same amount of money.

If part of lawmakers’ hope for this amendment is to continue with best care practices, I believe they are remiss.  90 is not enough.  Setting 90 for the default therapy maximum tailors therapy services for children with mild to moderate delays and creates just one more obstacle for children who have significant delays, their parents, their therapists, and their physician. 

Adoption definitely changed Eva’s life.  But love, family, and a home are not the only factors that have helped our girl.  Weekly therapy and carry-over therapy at home have helped Eva to make HUGE developmental progressions.

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Eva is standing in her stander all the time.

She’s walking on the treadmill three times a week at therapy.

She can walk up to 300′.

Eva’s feet are now NEUTRAL.

Eva has great trunk control and can scoot on her bottom over 20′.

Eva is speaking in sentences.

Eva is CHEWING her food.

Eva’s speech is becoming more and more clear each week.

Eva is READING.

She is following simple instructions.

Therapy is a big deal.