TRANSCRIPT
Toileting Strategies for Children Who Are Deafblind
4/7/25
 
>>Sarah: So just really fast, three things kind of plan to talk about are just some common challenges in that toilet training process. Some evidence-based approaches that we can use to support our students. And then ways that we can design a developmentally-appropriate and a safe environment to support our students as we're working on toileting. And I just wanted to add when I was itinerant, this was a topic that I felt very passionately about for all of my students. I began in the life cycles classroom and when I became itinerant, I really wanted to support this for my students. I think it's a skill that's really important and sometimes it kind of gets overlooked, especially when you're the itinerant teacher. Because it's something that a lot of times the classroom teacher will support. But for our students, especially students that are Deafblind sometimes, because there might be multiple aspects at play, no one person really feels confident in how to support that. And then maybe it kind of gets overlooked or isn't the priority that it was. And we know that unfortunately when our students aren't able to toilet independently, sometimes people will not presume the same amount of competence for them as they would for a student who is independently toileting, particularly if perhaps there's language delays involved. So I just think it's a really important skill that we can target. And so we'll talk a little bit about some ways that we can do that. So the first thing that I want to talk about is just some common challenges that we face when we think about toileting with our students. And so we get a lot of requests here at Outreach for support with toileting. And so I was curious -- and I created a Google Survey and we sent it out on our Facebook page and with the projects and to not just teachers but to the regional centers -- not just the teachers but also to families. And so I looked at the results that we got and it was very interesting because a lot of the same questions that we get asked when we get requests were the things that showed up when I sent out the survey. And so the top four things that really kept coming up were consistency, that itinerants especially feel like it's hard to have consistency in the school or in the home or sometimes both. Overwhelmingly there was the challenge of our students being afraid of the toilet, a fear of the toilet. Teaching the concept and the purpose. Does the student really understand why we're asking them to sit on the toilet? What they're supposed to do? And the last one was wiping. We get asked a lot of questions about wiping and how to support that. We're going to kind of touch on all of these today. But those were the four most common challenges that they saw. If you want to, Kaycee's monitoring the chat for me and I'm going to keep going because I have a lot of slides because I'm very excited about this topic. But if you want to put in the chat some common challenges that you see that maybe aren't on the survey, feel free to put it in the chat and we can share those as well. But those were kind of the top four common challenges that we saw in the survey. So I wanted to start off by talking about indicators because I feel like what do we do? Oh, I think we want to support the student with toileting so we hop on Google and ask Google. What are some indicators that the student might be ready to do toilet training or have a toileting routine? And the top three things that we hear a lot are regularity with bowl movements, like no accidents while they're sleeping, they're on a regular schedule. They're staying dry during naps or they can stay dry for a certain amount of time at school. Maybe like they're really solid at home but still struggling at night but they're very solid during the day. These are common indicators that we use for sighted hearing children, if you Google it, this is what you're going to find. These are great indicators but what do we know about our students? Sometimes those skills, especially for our students who are Deafblind, because they lack the same access to incidental learning, sometimes those skills are more splintered and maybe they're doing some of this, maybe they're not. Just because they're not necessarily meeting these skills doesn't mean they aren't ready for toileting. So there's one other hierarchy that we look at and I'm going to talk about some skills unique to our students that would also suggest they are ready. That's this hierarchy of first we would anticipate a student being aware that they have eliminated in their diaper. We want them to understand that this is happening, that they're avoiding. The last piece would be that they're recognizing the urge. Again, when we think about these three things and we think about our students, you know, sometimes the teacher might say they don't understand or they don't know they need to go and we can use that as a reason to not start addressing the skill. But we have to remember that even if the student isn't ready to independently use the toilet, there are still a ton of skills that we can address in a changing routine where we're building those skills and we're teaching them those things. So maybe, no, they're not independently even soon going to sit on the toilet and void, we can still start building in vocabulary. We can still start preparing them, helping them to anticipate. So it's just something important to keep in mind. We don't want to use those stereotypical readiness indicators to not work with a student who might be ready, even if it's just to start anticipating in the routine. So on the team, my team, my Deafblind team, we talked about what are some skills that we typically see with our students that are Deafblind that might indicate that they are readiness, that don't seem to connect to toileting and so somebody might overlook it. So we talked about three things. We talked about are they able to understand the calendar? If the student is using the calendar at an object level, especially at a more abstract, if they're participating in that calendar conversation, they're learning language. They're learning to anticipate. Then they're definitely probably ready for a more advanced routine where we can start targeting those skills. Are they ambulatory? Are they walking around? If they're walking to the bathroom, is it appropriate to have them laid out on the table and still be changing their diaper or can we look at having them sit on the toilet and try to help them explore how to meaningfully understand what they're supposed to be doing in the bathroom. And that third one kind of goes with the first one with the calendar. But are they anticipating in routines? If they're anticipating next steps, same thing. We can look at creating meaningful routines around toileting and hygiene and help them build the anticipation with those routines as well. Okay. Sorry! My mouse froze. And, whoops. Okay. So let's talk about some accommodations that we can use when we are working on toileting with our student. So the first thing that's most important to remember is we need our students to access the "what" and the "why" in a meaningful way. It's really important that we help them practice it. We help them experience routines in a way that's going to make sense. And so one of the examples that I often use -- and we'll talk about this more in the next slide. But a lot of times when we want to start working on toilet training with a student who maybe is kind of small or who is young, we might use those mini plastic toilets, you know the ones you can move and you dump the pan when they're finished. Those are handy. They're small and low to the ground, we can dump it when they're finished and put it wherever. For some students that might be understandable and appropriate but for a lot of our students we're asking them to sit on it and they're not really learning about toiletness because that's not really a toilet. We sit on a big porcelain toilet and that is like using a miniature. It's not the same thing. They're not having that same experience. Here we have the little girl and she's playing with the teddy bear and in the picture she's watching the teddy bear use the toilet. That might be appropriate for some students to use a doll, to model with a stuffed animal. But for some of our kiddos they're not going to make that connection. We want to make sure that when we're asking them to participate in these routines that we're helping them get that what and that why in a way that directly relates to the concept we are trying to teach them, which is going to bathroom and using the toilet. Thinking about then, seating accommodations can be a huge one because we talked about before a lot of times our kids are afraid of the toilet, especially if they are little. It's like this big gaping hole. You sit on it. Maybe they don't feel safe. Just as simple as having a seat reducer and having the block or a stool that they can put their feet on, that can help with balance, particularly for our students who are totally blind. If they're on the big toilet and they can't anchor themselves with their feet and we're asking them to lean forward while they wipe or while we're assisting them with wiping, all of that, the balance can be off. And so we want to make sure that we are getting them seated and that they are comfortable. But if we can do it on the actual toilet, so if they're coming in and using the bathroom and using the actual toilet they're going to be toileting in. If you have concerns about that, your OT and PT, we talk about involving the whole sensory team, and I'll talk about that later. But OTs and PTs know how to assist with that so they can come in and they know the seating part, that's their jam, and you can support with the language and that VI part. High contrast soap dishes. There's an article that you guys will get in the handout and it talks about a lot of these things more in depth and it talks the high contrast soap dish. We know when you go into the bathroom, especially the ones in school or a store, everything's very beige, very white, there's not a lot of contrast. So for our students who are low vision, it can be helpful to add in those high-contrast markers. Maybe we're highlighting where the toilet paper is because we want the student to assist us getting the toilet paper out. Maybe we're highlighting where the pull is on the paper towel dispenser because we want the student to participate in that way so that we can call their attention visually. But the other thing that I would like to say that we want to think about is that language piece. And, again, we'll talk about that a little bit more here in just a minute. But it might also be helpful to add in pictures or labels of print or ASL so that way we're helping support and model that language for the students but also for the staff that's going to be supporting. The student might not be able to see the pictures but the staff might need that reminder. So just keeping that in mind as well. The next one is just the use of routines. We'll -- I'll show you some examples here in just a minute. But one of the responses in the survey was that the consistency piece. The consistency between at home and the consistency at school. And it's important that everybody's doing it but it's also important that everybody's doing it the same way. It's very hard to learn a routine if I do it one way when I come and the classroom teacher does it another way and at home mom is doing something completely different. By building in those routines and everybody knows what the routine and following it, not only are we teaching the student a what and a why but we're teaching them a what and where. I had a student and we worked on toilet training and for my classroom it made sense. We had one of those plastic shoe organizers. Instead of putting shoes in there, we put the steps of his routine. That way it was on the back of the door and we typically left the door open. One of the things we hear a lot is I can't have that out because the other students are going to see it and they are going to want to use it. That left it out but it left it visually hidden unless the door was shut. So our student knew that his stuff was there but we recreated that in the home as well. So that way he wasn't looking one place here and one place there. That worked out very well. Just making sure that we are being consistent with what we're doing and where the things are so that the student can, again, build that anticipation and understand. The other pieces -- we want to make sure that we're not only accommodating how they access the bathroom, but, again, like I said the literacy and the language that's involved with using the bathroom. A lot of times we will see the really cute board maker pictures. First we do this, then we do that. That might not be visually accessible for our students. Some of our students are not at picture level. They can see the pictures but that doesn't have meaning. Make sure we are incorporating objects and our tactile symbols so our students have that same access to the steps that their peers do. Another thing to keep in mind is a reason that we often encourage folks to start with routines based around toileting or hygiene or eating is because that's something that happens multiple times in a child's day, whether they're at home or at school. They're going to do those things. And we know what do we talk about first? We talk about the things that we're highly motivated for that we really want. And we talk about the things that we encounter the language of often. If I'm hearing the words a lot, then I'm going to learn those words faster because they have been introduced. So if we can build in that literacy and that language piece to the routine every time we do it, we're helping to broaden those concepts and to build that language. And then extra practice. A lot of times, you know, we'll come in and we'll ask how often -- and the kiddo got the opportunity to practice, you know, maybe two or three times and they didn't get it. And so staff quit working on it. We all need the opportunity to practice, especially something that maybe is more complex or something that's scary. So just keeping in mind that we want to build in time to the day for our students to practice this. If we're thinking of the part that might be scary, like maybe the student is scared to go in the bathroom because they're scared of the toilet flushing, maybe there are other routines that we can practice in the bathroom that are meaningful. Maybe we go in after every snack and meal to brush our teeth so we're still experiencing going into the bathroom and we're doing it with a purpose but we don't always have to do the scary thing, which is flushing the toilet. Building in that extra practice of toileting but also building in that familiarity and that comfort level of the environment can be critical for a kid, especially the ones that are kind of afraid. Something else we hear about a lot of times is perhaps there was some sort of medical issue that's caused the student to struggle with toileting. That can be traumatic. If you know that when I go to the bathroom it's going to hurt or something scary happens when I go in there, again, if we can think about that extra practice and rebuilding that relationship before we expect them to be able to independently toilet, that can be really powerful as well. Again, like I said, we get asked a lot about wiping. And so I'm not going to spend a lot of time on it now because I have a ton of slides, like I said, but I'm happy, if you have questions and you want to reach out, we can talk about this further. There are some good videos that I can share with you that talk about wiping and teaching that skill. But just keeping in mind tactile feedback. You know, there's a variety of toilet paper textures. But we want to work on, with our students, if they're able, if they have the language to understand it, more so that focus of what it feels like. We can also incorporate smell if we need to, like what does it smell like. We want to make sure we're teaching a consistent wiping technique, especially for little girls. We want to make sure we're wiping correctly so we don't accidentally cause UTIs or other health issues. Using a wet wipe might be a way to circumvent, if you're having trouble with the student understanding they're clean or getting clean, but keep in mind if you incorporate a wet wipe, that's changed the feel. If you're going by feel, that might become a learning curve. And making sure we are teaching them to wash their hands after. That's another thing that we often see a lot. We come in and rather than having the student use the sink, they just give them a wet wipe because they didn't really participate in the diaper change routine and the toileting. The staff did it for them and the staff had gloves on. But we really want to make sure that our students know how to wash their hands. That's a really important skill, and that they understand they need to wash their hands when they leave the restroom. If we can have them wash their hands across many varieties in a day, that's an important skill to have. You know, wet wipes are great but if we can wash our hands, let's wash our hands and make sure they understand the steps to that and how they do that. The last accommodation piece that I want to talk about is family access. So we know that sighted and hearing students, how do they learn how to use the bathroom? By watching. They see it. Like little kids -- I don't have children of my own but I hear from my friends who have children that their children follow them into the bathroom all the time. Very curious. Want to see what's going on. Our kiddos don't necessarily have the ability to incidentally learn in the same way so we have to find ways to create access and still make it meaningful. And so that can be getting the family on board and finding out what does the family do. The family might have a really good routine and we can partner with them. The family might not know what to do and so that might not where we as a sensory team need to step in and support them and help them create a routine and help them give that student the access. Another thing that we talk about often is it can be really hard for a student who has very little hearing and vision to understand meaningfully. Talking to the family about how comfortable are they and giving them an experience, would a tactile experience be meaningful? How do we want to approach that? But really making sure that we are including the family in these conversations and that we're supporting them and letting them support us so that, again, there's that consistency piece. We can't expect the family to be consistent with what we're doing if we're not telling them. So if you're creating a routine, sharing it with the family so they know the steps you're practicing at school might be very helpful for them and it might also get you some good feedback about ways you can structure your routine to make sure it matches what they're doing in the home. Okay. So the next piece is language and teaming. I picked this because in the survey another concern that we got was -- and there were some questions specifically about language support. And two of the biggest challenges for specifically for our students who are Deafblind, two common answers were, as a TVI they weren't sure how to communicate with the student. If the student was a manual language user or might be, and then also concern about the student not being able to communicate that they need to use the restroom or staff doesn't understand that the student is communicating that need. So that language support piece. And, again, if the student is an emergent communicator, are they really understanding the point of what we're trying to teach them. The point of the routine, the point of using the bathroom. So I want to talk a little bit about that language piece and ways that we can incorporate language in. The first thing that I want to mention is just language is how we build concepts. So language is very critical. We want to expose all of our students to a lot of meaningful language. But unfortunately a lot of times when we look up -- like if you get on and you Google again for toilet training, you're going to find these cutesy books and videos but a lot of our students aren't there conceptually. If they're not ready for a picture book that uses cute little cartoon drawings, sometimes we struggle with how do we create those opportunities for building and teaching language. I want to encourage you to think about what kind of everyday words and concepts we can target within a toileting or a hygiene routine. Like, we go into the bathroom to do a lot of things besides just use the bathroom. We brush our teeth, we wash our face, we take a shower. We take out the trash. We put things in the trash. So there's a lot of words that we can support within a toileting and hygiene routine that can help build that language outside of the bathroom and tie in with language we might be targeting inside the bathroom. On and off. Dry, wet, dirty, clean, stand up, sit down. Open, close. Off, on. With the water, is it on, is it off? Is it hot? Is it cold? Your hands are wet. Now we're going to dry them. There's a ton of language we can support within these routines but that takes us working together as a team and really trying to target it. When we think about that language and we think about those books that maybe aren't appropriate, doesn't mean that we have to use appropriate books. We talk about experience stories and experience books and how they are motivating in a meaningful way for our students to learn language. And so we can create books around their routines. I had a student working on a hygiene routine and that's the caddy. She was a student who was afraid to use the toilet so we found other reasons for her to go to the bathroom to kind of get over that fear. One of them was a hygiene routine. So we had a picture of the caddy and each item. We would read the book. She was getting to practice the ASL sign for the object. It was tying that ASL sign to print and to English. It helped her remember the steps in the order that she was supposed to do the routine. But these were pictures that had meaning to her and pictures that she could understand. So we can incorporate literacy into those routines and really support vocabulary in a way that is meaningful and that our student is ready for. If they're not ready for pictures, you could use the actual objects and you could have an experience story where you're using the actual objects that the student encounters to practice that vocab. It doesn't have to be pictures. Maybe you have a student who is ready for videos. Obviously you wouldn't video them using the restroom but you could video them brushing their teeth and talking about the steps for that. There's a lot of ways we can build in that language and practice it. The other piece that's important is we want to document it so that we can make sure that we're all saying the same thing. If I ask her to go to the potty and someone else asks if you're ready for the restroom and somebody else asks if you want to go use the toilet, that's three different words for the same thing. So within those routines, if we have a place where we are documenting the phrasing that we are using, especially when we're first teaching that routine, that is huge. We can make sure we're all calling it the same thing. Another thing that we see a lot is that sometimes we don't use the most appropriate language with our students. We don't mean to but I still say that I need to use the potty but a 15-year-old doesn't want to use the potty. They want to use the restroom. So we can make sure that all staff are using the words that are appropriate for that student and that age. So it's really important that we have a place that everyone can see. You can take those routine sheets and you can post them where the routine is happening, so that way you know everybody has access to it. And we'll talk about some other ways we can share our sheets in just a minute. The other thing that I want to encourage is besides just worrying about just toileting, we can work together on goals and we can find other things within our hygiene and our toileting routines that the students are doing. Again, I would hate to think, well, I know that the student can't toilet independently so I'm just not going to work on it. We don't wait until the student is reading chapter books to teach reading, we have to teach skills to build up to that. It's the same thing with the toileting. And, again, with that consistency piece. The more related service providers, the more of the sensory team that's working together on this, the more practice and consistency the student gets. So there are lots of ways we can think about targeting the bathroom. Maybe the student isn't ready to be independent within the bathroom but maybe we work on walking to the bathroom and maybe PT and O&M can be involved in supporting what that looks like. Maybe the student isn't completely ready to be independent in toileting but they can help manipulating their clothing. Maybe they can work on helping to pull up or pull down their pants. Washing the hands, drying the hands, throwing away their paper towel, turning off and on the lights, there are lots of things a student can do within a routine that isn't just using the bathroom and there are a lot of service providers that can support you in that. Same thing with when we write the goals. It doesn't just have to be the student is going to tell me they need to use the bathroom or the student is going to void when they are on the toilet. There are a lot of things they can do within the routine that makes a student a more active participant that doesn't expect them to be independent. Maybe we're working on them anticipating the whole routine. Maybe we're working on them anticipating one step in the routine, maybe they're assisting with getting the wet wipe out. Maybe they're assisting with throwing their diaper away. Maybe they're ready to complete a certain amount of steps on their own. Maybe we want them to understand that when we hand them the diaper they need to stand up and go to the bathroom. We need to work together to write goals that are meaningful for everyone on the team and that are also meaningful for the student. The other teaming piece is just remembering that the more organized you can be the better. So organization, collaboration, and good old Google Drive, those are all your friends. We had a student who was pretty complex and so he had all the service providers. We were all on board, all working together. And when we recreated it with other teams, we found that Google Sheets was great because we could put our information in. As we made routines, we could hyperlink in the routine sheet so we could open the first page, the sample schedule. We could click on the routine sheet. We could link in a video from the YouTube. So everything's just right there. We always have our cell phones. If you've got somebody who doesn't know, if a sub comes in, whatever, you can give them immediate access where they can click, look, and see. It's also hard to meet as a whole team, especially when your student has a big team, so things like that that are electronic, we can hop on Zoom, pull it up. We can see what's been updated. So if consistency and buy-in is hard for you, reach out and we can talk more about ways to make that happen. But the more organized and accessible it can be the better for everybody. All right. So lastly, let's talk a little bit more just specifically about routines and what those routines might look like. So as I said before, there are a lot of different reasons that we go into the bathroom, and it's not just to use the toilet. You go to the bathroom to shower, like I said. We go to the bathroom to wash our hands, to wash our face. We go to the bathroom to get certain things that are kept only in the bathroom. So there are a lot of concepts, again, that we can teach. There are a lot of routines that we can target that involve the bathroom and involve hygiene. Before I talk a little bit more about routines, I'm going to plug two resources. They are also on the handout. If you are not familiar with them, look them up. The first one is the sensing and learning book and that is by Millie Smith and Stacy Chambers. It's an update to the old Sensory Learning Kit. It is fantastic. It has a lot of great information about how to write routines, how to use routines. How to take data on routines. And it's geared towards students that are sensorimotor learners, those kids who have access needs and it's harder to help staff understand how we can help them participate. And but the information is very usable. By looking at it, by reading it, you can see how you can use that with other students. So sensing and learning, great book. Highly recommend it. The other one is communication: A guide for teachers of students with visual and multiple impairments. You can get that through the TSBVI publications store. But both of them have a lot of really great information on routines, how to write them, how to use them. If that's something that's new to you or you haven't done it in a long time, highly recommend them. Before I show you the sample routines, though, I just want to point out a couple of things to keep in mind when you are writing routines. The first one is you want to remember that you want them to be short, easy, predictable steps. If you're student is a sensory learner routine, we probably don't want to have a 20-step routine. It needs to be a consistent beginning and an end. The student needs to know we're going to do something now and the student needs to know this is over. And we need to have a consistent place, time, person, and objects. Especially when we're first starting. Because, again, if I'm trying to teach you the steps and I teach you one day and someone else teaches you another day and none of us are doing it the same, we're not going to build anticipation because we can't anticipate if it's always changing. It's really important that it's happening consistently. Same place, same people, same time. When you're developing routines, there are three steps. First you want to introduce the routine. So we just want to, you know, let them see this is what we're doing, these are the steps. This is what we're going to be doing. Then, as they start to understand the routine, we go to step two, which is infusing in those communication objectives. So starting to target more of that communication and that language. And then, when we see that they are participating and they're anticipating, we can go to step three, which is where we can start to expand the routine or start to change it. Maybe then somebody else starts to do the routine with them as well. Or maybe the student had three choices, now we change one of the objects. So we're starting to make it bigger and broader. We're expanding the skills. The other thing that I want to point out is nowhere on here does it say that we introduce the skill for a week and the student has it, because that's not what happens. Learning any routine or any skill, but especially something kind of complex like toileting and hygiene, that takes time and it's really important that we have that in our mind as we start to write these routines. We might need to change them. But even though they're not going to maybe get it the first week or two weeks, the student can still be expected to learn parts or to learn the steps and to participate. We want to presume competence and we want to give them as many chances and be willing to change it up so they can learn that school skill and participate. Okay. So I'm going to show you now -- first I'm going to show you a couple of pictures and then I'm going to show you a sample routine. On the left of the screen, there's two pictures. The picture on the left, you can tell it's from COVID times because I am wearing a mask. But I am sitting with a student and we were teaching him a hygiene routine. And the toileting was a step within his hygiene routine. And so this picture was taken very early on in the routine when in the picture he's sitting on the changing table and the sequence box is to his left. I'm sitting kind of beside and behind so that I can hand under hand assist him in going through the steps and understanding what the objects are. But the second picture, the picture on the right, is him standing at the changing table. Same sequence box. Same objects in the same order but he is now independently has the deodorant and is talking the top off because he has now learned independently how to do the steps of the routine. One of the ways that we knew he was understanding, besides the fact that he was appropriately using the items of the routine, was that third step where we expand. One day his O&M specialist came in to do his routine with him, versus myself or the para. You can see on the picture on the right there are small pictures of how you would sign the names of those objects. And it has it in print as well. But she accidentally switched two of the items and so he would find his box and scan left to right. Prerequisite for reading, left, right. He would scan the items and it was the deodorant and toothbrush, they were in the wrong order. He switched them because he knew that's not the order. I do my deodorant first and then I brush my teeth. That was an exciting moment. Below the pictures, there is a goal. It says: Given a four-step sequence bocked, the student will reach into the first box to tax eventually explore the object. Perform its action. And then reach into the second box continuing left to right until the routine is complete with no more than one tactile prompt. Is that the best goal? Maybe not but it's a sample goal of how you can take data using then routine. It's a four-step sequence box. You can use that on a snack routine, any four-step routine would do but we knew we had four steps to our hygiene routine and we used that goal to take the data and his objectives were broken down so that initially he was just participating in finding the object. Then using the object. We built it up to where he was independently then exploring the object and performing the action. But we didn't start with that. So just a sample of how you could write a goal about routines and you could use it to target toileting and/or hygiene. This is an example of what the routine sheet looks like. And so there's four columns. The first one is the steps of the routine. The middle one is scaffolding. And so that's how it was broke down. The third column is vocabulary. So those were the words that we were targeting. And then the last column is open for comments and for data. And you could make the routine sheet look any way that you would like. We have sample ones we can share so if you would like access to sample routine sheets, e-mail me. My e-mail's at the end of the thing, and I will gladly share them with you. You can change them to fit whatever works best for your team. This one was nice because there was a place where we could actively take data, as we were doing the routine. Again, you notice everything is very detailed so we can make sure that everyone is doing the same things in the same order and we're focusing on that same language. But we all knew what to expect when we first sat down to do the routine with him. Another thing that we did was we would video, as he became more independent with the routines, we videoed him doing the routines. We attached them to a QR code and put the QR code on the second page. Right now you may have subs and you may need the sub to do something. But having that video for them to look at can be super helpful, real fast to understand what they're supposed to do. Another piece that's important, data collection, obviously, like we said, in the column of the routine. But another reason that I challenge you to think about taking really solid data is because a lot of times we come in and people will say how long should I have them sit on the toilet? What time of day should I take them? How often should I be taking them? And I can't tell you that because data is what tells you those answers, right? It's important that we are tracking the things about our student and their day so that we have an idea of where to start. And a good data sheet can really help understand where the student's at. It can also be really helpful for parents, as they're kind of trying to either assist you with also taking that data on the weekends or trying to implement it on the weekends in the home. One of the resources, like I said, is an article called toilet training children with DeafBlindness. It's on the handout that you guys will get. And this sheet is actually in there. You can Google "toilet training data sheets" and you'll find a plethora of them. This one is nice. It has a key at the top, the time, day of the week. We used to print ours and have them on a clipboard outside the bathroom and we could just grab it. If you don't know how frequently these things are happening, then it's hard to target them. So data. Data is key. Another reason that data can be really important is when we think about building the student's schedule to support them, having that information can be very helpful as well. So, for example, perhaps we know that our student is going to be ready around 10:00, so maybe we have breakfast and then we have a routine where they're up and moving and so O&M and PT are coming in and also supporting in this movement routine, but that gets things stimulated so they are ready when we try for our first bathroom break at 10:00. If we can think about that, if we can think about how we're programming the student's day to support them, that might help us, especially if you're trying to do trip training, where you're trying to catch them when you put them on the toilet. If you don't know what time things are happening, that makes it hard to do. The other piece, when we're being creative and thinking about data and scheduling, is that invites all the team to be involved and to support you and know what their role is and how they're going to support you in this endeavor. Okay. I have one more thing and then I might actually have a few minutes if people have questions. But I mentioned a survey, if you will, a toilet training survey. I have the QR code. Y'all should be able to scan it. If it's not working, put that in the chat and I can put the link. But I would love information from y'all. We get asked a lot about resources for toileting. If you've Googled -- a lot of you are probably here because you have and you know there aren't a lot of resources out there that are specific to students who are blind, low vision, or Deafblind. So we would love your feedback. It asks some questions about your caseload, how many students you're currently working on toilet training with. There's also a question that asks if you could have a magical resource that helped you, what might that look like? We are very interested in making resources and tools that support itinerants and families where they're at. We know that might be something short. We know that might be something that's a little more informative. But we don't know unless you tell us. So if you could be so kind as to check out that link and give us your feedback, we would love to use it to help make things that are useful for you all. So I'll leave it up for just a moment more. And then I'm going to put up my contact information. All right. So, again, I am Sarah Mossberger and my e-mail address is Mossbergers@tsbvi.edu. If you have any questions, I love to talk about a routine of any nature but particularly routines involving hygiene and toileting. Please reach out. We would be happy to answer any questions and work together to see what needs you have.