Welcome to Part Two of Dr. Beverly Moskowitz’s two-part series on handwriting. Earlier this week, Dr. Moskowitz provided a compelling post on why we still need to teach handwriting (even in this age of technology), how occupational therapists typically work on handwriting, and why we may need to re-think that approach. Read the post from Part One HERE. Today, Dr. Moskowitz is here to give us a front-row seat to her evidence-based approach to handwriting that focuses more on letter size than on letter formation. I recently attended her training and have begun implementing this concept in my own school-based OT practice. And let me tell you a little secret…it works!
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Mama OT: I’ve heard that you have been successful taking a slightly different approach to handwriting intervention, focusing more on letter size than letter formation. Can you please explain a little more about that?
Dr. Moskowitz: For many years, I was a school-based therapist drowning in handwriting referrals. Using my knowledge of neuromotor, fine motor, perceptual and cognitive development as well as popular intervention programs, I worked tirelessly to correct deficits and teach letterforms. I assumed that once interfering factors were controlled, children would be amenable to structured lessons and on the road to neat printing. Unfortunately, I never seemed to get my students to the point of consistency and legibility, carryover and graduation.
That’s when I started playing around with variables that seemed more impactful. I noticed that by focusing on letter size, form followed quickly. On top of that, the overall appearance of the written page changed dramatically if not immediately. In a short amount of time, the special education children were becoming the neatest printers in the school.
Motivated by those achievements, I put my toe into regular education classrooms to see if the strategies translated. The reception was astounding. Teachers reported instant changes in students’ printing. Children consciously and carefully began making letters the right size to earn stars—the incentive that evolved into our scoring system. One teacher shared the story of a parent confessing to scolding her daughter for being so irresponsible, bringing home someone else’s assignment book. She didn’t recognize her own daughter’s printing after one 30-minute lesson.
Those early successes led me to formalize, conceptualize and test my approach. While it is one thing for my students to experience triumph, it’s another matter entirely for other therapists or teachers to replicate the feat, and another still to have it proven.
Once I’d finished my doctoral program, I remained affiliated with Temple University in Philadelphia. I asked my professors that if they ever had students looking for a study, to test my methods. Within a couple years, we had two willing candidates. One did a meta-analytic review of the literature and reached the same conclusion as me. Direct instruction was the most effective way to go, along with embedded lessons, mnemonics, self-monitoring, verbal cuing, visual modeling, home involvement and more—all features of my program.
The other did a controlled empirical study, the largest of its kind. Using two school districts, one in rural upstate New York and another in urban Massachusetts, our demographics included over 200 students in grades Kindergarten, First and Second Grades. Assigned to either a control or intervention groups, each student participated in 8 weeks of instruction using either the Size Matters Handwriting Program (SMHP) or a teacher-directed incidental approach. Comparing the change scores from before and after, the difference was huge. Significance was achieved at a .001 level. In other words, the students in the treatment group showed such a profoundly measurable difference in printing in terms of legibility, form, size, and alignment that the statistician volunteered to write the discussion section for the journal. He wanted ‘in’ on a result of this magnitude.
The Size Matters Handwriting Program is a concept-driven approach. It is not workbook-driven. There is a lot of upfront teaching to insure that children have the knowledge to critique their efforts and to print neatly. Both the OT Practice Framework and the research attest to the importance of empowering patients/clients/students with information and decision-making. It contributes to their investment in the process and the outcomes. On many levels, Size Matters does just that.
On top of that, it is realistic and reflective of the time constraints and economics that plague our educational system. First of all, since it is concept-driven, no materials are actually needed at all. Therapists or teachers can use their own dice, run off good adapted paper, draw writing lines on the board and use colored markers to indicate letter size. Most importantly, by extracting handwriting legibility to its essence—Letter Size—one can embed handwriting awareness into the entire school day for any subject at any time.
The premise is this: Letters come in 3 sizes—Size One, Size Two and Size Three. When you focus on Letter Size, form follows. With only 3 sizes, it is easy to remember ‘The Rules’, especially since they come packaged as a ‘song and a dance.’ Correcting errors in Letter Size makes an immediate difference in the consistency and appearance of the written page. This is the prime variable influencing readability.
The Dice Game is an instant hit. It’s the modality used to determine practice and remediation. In time, the audible sound of clinking dice reminds students to ‘think Letter Size.’ It’s embarrassingly simple but undeniably powerful.
Scoring for Letter Size occurs by noting whether Letter Lines TOUCH the Writing Lines in all the right places. This is an observable and measurable commodity. Students count the number of letters written followed by the number of letters printed the right size. With the first number placed in the denominator and the second in the numerator, all parties can track progress on letter size accuracy. Children learn to score themselves. Parents and teachers can do it, too.
Scoring for spacing is encouraged only after 80% accuracy is achieved on Letter Size. This is done through drawing Spaghetti or Meatballs (i.e. yellow lines or red circles) inside or between words respectively. Equally engaging, students relish the concrete and fun concepts that explain how to make their printing look its best.
Mama OT: Is it really more effective to address letter size vs. letter formation?
Dr. Moskowitz: Yes.
There are 62 different letterforms. There are only 3 letter sizes. When children concentrate on shape, they may make recognizable letters in isolation. But within the context of the entire page, the inconsistencies and poor regard of the letter lines contribute to the perception of the writing as a whole as illegible and messy.
When children focus on letter size, the overall appearance of the written page changes dramatically and immediately. The variability of letter placements is now removed. Form seems to self-correct as children focus on making their letters touch the writing lines in all the right places. Letters are more easily identifiable as they now sit accurately between the writing lines.
Plus ‘The Rules’ on Letter Size are playful, concrete and informative. Children easily learn to score the accuracy of their printed letters based on whether their pencil strokes are properly touching the correct lines. Empowered with knowledge on what Star-Worthy printing looks like, students are able to self-monitor and self-score.
Mama OT: Are OTs the only ones who can teach this approach to handwriting, or is it something that parents and other professionals can use as well?
Dr. Moskowitz: OTs are not the only ones who can teach this approach. Teachers, parents, aides… even the students themselves can learn the program and turn others onto it. In the Handwriting Clubs I’ve run, it is the veterans of the program that bring the newest members up to speed.
If anything, the simplicity of the Rules and the fact that this is a concept-driven approach speaks to the beauty and applicability of SMHP. It is grounded in the very real life circumstances—the need to still teach handwriting but the demand to do so the most efficient way possible.
Add to that the limited time, the call for data, the slashed school budgets….
There really is no mystery to handwriting legibility. It’s just that we’ve been looking in the wrong place and placing unrealistic demands on administrators to invest in yearly workbooks.
Mama OT: Where can people learn more?
Dr. Moskowitz: There are several ways to learn more.
1. Check out our website: www.realOTsolutions.com. Read the blogs and view the product videos. They give you snippets of how to use the materials and the program.
2. Host a workshop. As an approved provider of continuing education through AOTA, I can bring a full day Size Matters Handwriting Program to your school or therapy group.
3. Write to me. The service part of our business is equally important. I love brainstorming, problem solving and otherwise teaming with therapists. We can talk about SMHP or any other practice issues. After 38 years as a pediatric therapist, most of which were spent in the schools and a number of years as a national lecturer, I have a unique and broad perspective. Plus, the stories shared by therapists like you across the country round out the communal experience of school life. Don’t hesitate to call me at 877-864-2010 or to write bev@realOTsolutions.com.
4. Sign up for a Webinar. We are currently in the process of expanding our approved providership to include distance education. This will enable me to host Live Webinars as well as offer recorded ones. Send me your email address now. As that paper process is completed, I will be able to notify you about the series. Live Webinars will be supported through Go-to-Webinar and will be scheduled at various times and days. The Independent Study Webinars are supported by Go-to-Meeting and allow you to view a prerecorded meeting at your convenience. Both require a score of 70% or above on a posttest to earn credit. The content covers the learning objectives clearly and multiple times. I promise…this is not a difficult step.
5. Attend a BER conference. Go to www.BER.org to learn about my touring dates. As a national lecturer for the Bureau of Education and Research, I travel the country presenting “Practical Strategies for Increasing the Effectiveness, Efficiency and Impact in your School-Based Occupational Therapy practice.” While SMHP is included in the day, it is only a preview. Still the products are on display for you to peruse. Plus I’m available for questions.
6. Come to AOTA’s national conference in Baltimore in 2014 or Nashville in 2015. If your state conferences are interested in speakers and exhibitors, we are happy to join you there, too.
7. Friend us on Facebook and Twitter. We are constantly sending out little updates and posts. Invite me into a discussion group. We are the new kids on the block but we have a growing following. After 3 years, Real OT Solutions and the Size Matters Handwriting Program are already being used in over 40 states. Become an early adopter and turn your friends onto this researched and evidence-based approach that is already changing how we teach and remediate handwriting.
This is not rocket science. But there are methods that are more effective than others and that are realistic responses to the very real state of education today.
Learn more about the Size Matters Handwriting Program.
And let’s graduate your students into the ranks of legible printers already!!
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Dr. Beverly Moskowitz is a nationally recognized speaker with over 37 years of experience as a pediatric Occupational Therapist and a specialist in educationally based practice. Her broad exposure to varied teacher methods, administrative concerns and treatment interventions confirmed her resolve to insure function, participation and inclusion for all students without wasting time or money.
In 2010, Bev launched Real OT Solutions, Inc. Its mission, as both a service and product-oriented business is to provide consumers–therapists, teachers, schools, parents and kids, with Effective, Efficient, Affordable and Fun solutions to school needs. Guided by the research and demands to address printing skills, Bev developed a unique approach to teaching and remediating handwriting based on letter size. Authoring the largest research study ever on the topic, her approach showed significant, observable and immediate changes in the legibility and consistency of students’ written work. Concept-driven, fiscally responsible, easy and now proven, the Size Matters Handwriting Program is already in 40+ states and is poised to change the way handwriting is taught and embedded into the curriculum
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