Naomi Mattanick, MS, OTR/L & Brooke Tubbs, OTD, OTR/L: OT in Surf Therapy
In this episode, we will learn from In this special episode, we will learn from Naomi Mattanick, MS, OTR/L & Brooke Tubbs, OTD, OTR/L two occupational therapists practicing in Surf Therapy
Naomi Mattanick, MS, OTR/L is a pediatric occupational therapist specializing in sensory integration therapy, surf therapy, and childhood and infant development. “Kids are amazing and dynamic individuals. Yet, they have a lot to conquer. In my years of experience, I have served infants to early adolescents in a variety of areas including sensory processing, physical and emotional regulation, organization of behavior and attention, acquisition of vital motor milestones, motor coordination development, and oral-motor therapy for feeding. My mission is for each caregiver and child to feel understood and empowered as they are equipped with life-long tools. My passion is to see children feel joy as they playfully develop a strong identity and sense of self through the skills and knowledge they have obtained.”
Q & A with Naomi:
Please tell us a little about yourself:
I grew up in Kentucky, Malaysia, and Ohio. I think living in vastly different places gave me a spark for adventure and an automatic understanding of the need to belong. I also now love to travel and am fascinated by different ways of seeing the world and how culture influences our daily life. I think occupational therapy found me. I went to OT as a young child for sensory integration. From there, I received my bachelor of science and master of occupational therapy at the University of Findlay in Findlay OH. Not knowing if I would even like being an OT, but jumped in (similar to my personality). When not being an OT, some of my favorite occupations include surfing (of course), backpacking, traveling, and spending quality time with my friends/family.
What motivated you to contribute to this podcast series?
There are so many avenues in which we as OT practitioners can provide intervention and care. It was meaningful to me to find out that I could branch out; participating in a form of intervention that makes me light up. I hope it motivates other OT's to do the same, and I hope it informs families with children; to understand their children better through the specific work I offer. Lastly, I like being a part of the global community. Contributing to this podcast is also contributing to the work you (Patricia) are putting out into the world (connecting everyone).
Please describe the UncommonOT work that you do and the setting in which you work, the population you serve and the needs that you address.
I offer surf therapy-which is defined as using surfing in a therapeutic way to achieve a specific outcome. But in my own words, I'm a pediatric OT; specializing in childhood development (with a specific focus on nervous system integration and organization) to facilitate and support motor skill development, higher level cognition, and physical and emotional regulation (among other physical needs). In my work, this is achieved through the use of surfing. Which includes the process of exploring and being on the sand, preparing for the task of surfing, and the act of being in the water and learning how to surf; while targeting common OT goals. The primary setting for this work is on the beach! However, I offer hybrid models where I service kids in home and the beach. Or, working in conjunction with kiddos who are receiving OT in clinic and use surf therapy as a support. The population I currently serve are children ages 5 to early adolescents in the areas of: sensory processing challenges, ADHD, Autism Spectrum, and challenges that may surface from this such as motor incoordination, delayed reflex integration, or functional difficulties with challenges such as feeding/eating or toileting, dressing, and academic success. The needs addressed directly through surfing include: Sensory Integration, postural strength and normalized movement pattern development, motor coordination, attention, executive function, and physical and emotional regulation---functional skills are supported on the beach, in home, or in clinic.
What inspired you or drew you to this type of OT work?
A couple of things. Number 1: I saw other practitioners doing it and I realized it was possible! It exist! Number 2: I have always loved the ocean and being in nature. As I said, it was vital to me to find work that lights me up. I moved to southern California 4.5 years ago and started learning how to surf. I immediately saw the multiple benefits it brought to my physical and emotional self and started to connect the dots with how it could help the kids I serve. Number 3: I attended OT as a child for sensory processing challenges and one piece I feel that gets overlooked is the child's need to develop a strong sense of self and confidence in how they show up in the world. Surfing is challenging on many levels (sensory challenges, physical, emotional). It provides the child the opportunity to meet those challenges in a safe space, and take ownership of something (building sense of self) and the therapeutic needs will follow.
How did you get there? Can you describe your path?
Truly, I got to where I am now with surf therapy through curiosity and leaning into that curiosity. I have been a pediatric therapist since the beginning of my career. It was hard for me to know at first where I wanted to direct my learning and focus. However, I have had incredible mentors along the way who have really helped guide me in finding that; including the encouragement to do what I'm doing now. My primary focus has been in sensory integration therapy ( and the higher level functions children need support in when this is impacted) as well as in the early intervention population; supporting infant development. I also have a background in oral-motor and feeding therapy. I'm so grateful for the knowledge I've obtained in the traditional setting which equips me for the work I'm doing. I have always loved the water and in 2020 learned that surf therapy exist. I took a training through Groundswell Community Project and began to consider what this could look like for the population I serve. The research is new but it's there and I can't wait to keep building on this path for others to utilize.
Please describe a typical day or OT session at your uncommon setting? What OT skills do you utilize?
Like all settings, a typical session is very child specific but does have a general framework. The session begins on the beach; doing a body check in (physical sensations, emotional sensations/feelings) from there, we pick body tools based on where the child is physically/emotionally. During this portion, I utilize the sand, I utilize being on the board in the sand.. to prep our body for surfing. Next, we prepare to get in the water, expressing feelings or needs surrounding that. The child is then able to choose how they want to get in (jump waves, boogie board, surf etc.). After the water, we dive into any necessary motor skills or goals and have a closing time to check in with our bodies. I'm very much using the lens of a sensory-motor based OT. So I am using my SI background, my neuromotor background, my social-emotional background etc. and using the sand, using the board, using the ocean as the therapeutic tool.
Can you talk about some recent highs (successes) and lows (challenges) of your current role?
Some areas of success include the joy of seeing this intervention work. When the child is feeling timid in their body, and then overcoming those fears and challenges to participate and be more connected to their body. Another high or success is connecting the work I do with others who are doing this work in other capacities. Some challenges include navigating the uncertainty with my kiddos. It is less predictable than a clinic setting. So, in a sense, you must critically think faster than in a clinic environment in order to still allow the setting to be therapeutic. Which can be done, with practice and awareness of the child's needs from moment to moment. Another challenge is showing the community that this is a valid therapeutic intervention. It is still very new but showing that it holds value and worth even though it looks different than what we think about when we think therapy.
How do you continue to learn in order to stay on top of things within your role?
This is similar and different to every therapist. I am still continuing to learn about clinical knowledge through self study and conversations with my colleagues that I have outside of this role. In this role, I am a part of a surf therapist collective which provides continued education and support for providers who are offering surf therapy. My hope is to become more closely connected with the international surf therapy organization in order to provide data I have collected to continue to build on ways in which this role is clinically sound.
Can you share a little bit about salary and compensation in this setting? How do OT or the services you provide get funded?
Many surf therapy companies are non-profit and receive funding through grants and donations. However, my company is not yet a non-profit and I am an independent contractor. I am out of network and the rate is decided on by each individual therapist. Like a clinic setting, families can receive authorizations for OT services and super-bills are provided.
Any career advice for our followers and listeners on how to get started on this path?
Surround yourself with the people who are doing what you want to do. If you are a new therapist, it is still vital to build strong clinical skills which may be best first achieved in being in a more traditional setting. Or, it could look like working under a surf therapist. Don't be afraid to do both at once. Ask questions, become a participant, and think about the lens you want to offer this service through. Go for it, it can be scary to forge a new path but it's worth it. PS, I will be looking for student volunteers!
What’s a common myth or misconception about your job/role you’d like to call out or demystify?
-That surf therapy is just surf lessons. -That surf therapy is only about the act of surfing or surfing well. That is a part of it but not the whole. The focus is still on the child and then using surfing as a tool -That surf therapy automatically means the child won't feel challenged. My goal is for children to feel safe and have fun; but it can be challenging.
How do we find you, follow you, be in touch with you, and promote your unique work?
The number one place to find me and see my current work is on my Instagram : @hang_ten_therapeutics which directs you to my website and shares all of my offerings. This has my contact information. Promote my work by sharing my post or telling your friends! I would also love to have you at some of my upcoming events.
Brooke Tubbs, OTD, OTR/L is a recent graduate from Northern Arizona’s Occupational Therapy Doctorate Program. She now lives and practices as an acute care OT in a community hospital and as a surf therapist in Rhode Island. Brooke graduated from Alma College in Michigan with a B.S in Integrative Physiology and Health Science and a Minor in Spanish. After graduation, Brooke was a U.S Fulbright Scholar in the Philippines, performing research on Filipino teacher’s perceptions of inclusive education practices. During her OTD program, Brooke participated in a research residency in the Philippines, working with an interdisciplinary team to create an immersive research project surrounding multi-modal perceptions of aging. She also completed a graduate research certificate through the University of South Florida, in partnership with NAU, in Translational Research Education in Adolescent Behavioral Health. With this project Brooke worked with peers to develop a life skills curriculum and assessments for youth aging out of foster care; she is passionate about this work and continues to be involved in projects related to it. She is involved with additional research projects relating to CRPS and sensory processing and practice scholarship for OTs. Brooke will complete an additional graduate research certificate in the spring of 2023 on the topic of Culturally Competent Addictions Research Training. Brooke’s intentional drive for the unknown led her to becoming a surf therapist in Rhode Island. She has a recently published article in the OT Practice Magazine titled “Riding the Wave: Occupational Therapy’s Role in Surf Therapy”. Brooke has large aspirations for promoting OT’s work in uncommon settings, practicing at the full scope of her license, and transitioning to a role in academia down the line.
Q & A with Brooke:
Please tell us a little about yourself and a few favorite occupations.
I like to say that I live my life creating experiences that I can share during ice breakers and get-to-know-yous. I am a Michigander at heart. I was born, raised, and went to undergrad there. After I graduated college, I spent a year in the Philippines on a Fulbright Scholarship. From there I moved to Arizona and graduated from Northern Arizona University’s occupational therapy doctoral program. During the last 3 months of my OTD program, I complete my capstone project in part with a surf therapy company based in Rhode Island called Gnome Surf. I now live in Rhode Island and work at a community-based hospital as an acute care OT. During summer months, I work as a surf therapist in the evenings/weekends. On the side, I am in the process of earning a graduate certificate in Culturally Competent Addictions Research Training. I label myself as a practice scholar and enjoy being involved in research. Some of my favorite occupations include: being in/near the ocean, surfing, rollerblading, traveling and exploring, writing, collecting odd facts.
What motivated you to contribute to this podcast series?
The reach and growth of podcasts has been incredible in the last few years. They allow individuals to share stories, experiences, opportunities and network with other individuals. Surf therapy is a global profession that OTs fit squarely within, but it is uncommon to find OTs in the US working in this space. When Patricia offered me the opportunity to contribute to this podcast series, I jumped on it because I think this niche can resonate with people and that our profession can bring our biopsychosocial skillset to provide a therapeutic framework for surf therapy.
Please describe the UncommonOT work that you do and the setting in which you work, the population you serve and the needs that you address.
I work as a Surf Therapist in Rhode Island at a company called Gnome Surf. Gnome Surf is a non-profit company providing surf therapy services to individuals across the lifespan. About 90% of our population are considered neurodivergent or have a diagnosis of some sort, however those that don’t fit into that category generally also experience anxiety or other mental health challenges. Every one of the athletes experience the biopsychosocial benefits that surfing can provoke. o What is surf therapy Quickly defined, surf therapy is the use of surfing as a therapeutic medium for athletes. In the surf therapy world, there are numerous individuals who call themselves “surf therapists”; there are a majority of these individuals who are surfers themselves, but don’t always have formal training with “therapy”. As an occupational therapist, I define it as providing OT using surfing as an intervention strategy. Surfing as the opportunity to address the majority of the 9 areas of occupation according to the OTPF-4. It also addresses Contact, Performance Skills, Performance Patterns, and Client Factors. o Individualized sessions Throughout the globe there are over 40+ surf therapy organization registered with ISTO. The majority of those provide weekend or monthly camps for individuals to participate in surf therapy. A small handful provide individualized sessions and an even smaller number allow for weekly sessions with a surf therapist. Gnome Surf is one of those few. When I was searching for an organization to partner with, I was looking for one that offered individualized, weekly sessions as I thought this most mimicked traditional OT practice. o Camps Gnome Surf also provides weekend camps that are generally free to individuals who sign up for them. There is limited space but they fill up very quickly. In this format, Athletes surf for a short time, but there is a sense of community on the beach as volunteers, families, and spectators cheer on the athletes. It also involves the family more as there is yoga and crafts for the families to partake in. After each camp, the athletes receive a certificate of awesomeness and are celebrated for their participation.
What inspired you or drew you to this type of OT work?
My origin story for loving surf therapy begins when I was living abroad. When I moved abroad I felt a wave of culture shock, loneliness, and depression. I was in a country and a city where I was very much the minority. The first thing to really break me out of that darkness was surfing. I travelled to a little island called Siargao, hired a surf instructor, paddled into the aquamarine water, and failed. And I failed so many times; paddling, standing, and crashing into the water. But I got back on the board and tried and tried again. And the first time I caught a wave, I felt like I was floating. Part of surfing is looking forward toward the world, and for the first time since I had been abroad, my eyes were open to this new country I was in and I felt like I could breathe. That feeling is an adrenaline rush and it is intoxicating. I return to surfing because it challenges you, it forces you to connect your mind and body, and it forces you to fail and try again. It also provokes a flow state, which is something that we search for in OT interventions. When I started to think of ideas for my capstone project, nothing quite felt right until I thought about surf therapy. Like I said, I am a collector of experiences to share during ice breakers, and being a surf therapist certainly is one of those.
How did you get there? Can you describe your path?
Truthfully, I started thinking about participating in Surf Therapy for my Capstone project when my capstone coordinator said, and I quote, “Don’t be the student that tries to go to Spain and do Surf Therapy in the winter”. I immediately googled surf therapy and my journey began. All of my Google searches for OTs in the US that did surf therapy lead me to one person, an OT by the name of Carly Rogers. She actually gave a TedX Talk that I watched about surf therapy. I saw her name on some publications related to the subject and that she helped to found a program as the Director of Programs for the Jimmy Miller Memorial Foundation and helped found the International Surf Therapy Organization (ISTO). I knew I needed to find her contact information. I won’t tell you how long I searched for it, but I did eventually find it. I sent her an email and crossed my fingers. Lucky, our profession is willing to help in whatever way possible and we set up a Zoom meeting. Unfortunately, she had transitioned out of being a surf therapist, but she introduced me to the Kris Primacio, who had more information about surf therapy organizations and contact persons. I met with Kris over Zoom and she immediately was a huge supporter of my idea and of me. She got me in contact with an OT in Australia who runs a surf therapy organization that provides individualized, weekly sessions to kids with disabilities. I was all set to travel to Australia for my capstone and work with Emma Brackman and her organization Ability Surf, however, the country still had its borders closed due to COVID. I had to pivot to a different strategy and Kris got me in contact with Chris from Gnome Surf. While Chris is not an OT himself, there was an OT who was volunteering with the organization. So, I changed my plans and decided to move to Rhode Island for my Capstone. Now Gnome Surf doesn’t provide lessons on the East Coast in the winter because it’s too cold, however Chris had been developing a “Happy Camp” based out of Nosara, Costa Rica as a place for athletes and their families to go to continued surf therapy, but also as a place of relaxation and memory building for everyone in the family. It was in Costa Rica that I first witnessed surf therapy and that I caught my first wave with an athlete. It was equal parts nerve-wracking as it was invigorating. I couldn’t tell who had a bigger grin at the end of the wave, me or my athlete. I spent a lot of time that trip observing the technique for surf therapy and also taking note of how surfing affected each athlete differently; from providing much needed sensory input for self-regulation, to achieving goals, to building confidence, to regulating attention to enhance their learning skills – there are so many areas that surfing impacts. Fast forward to the end of my Capstone/graduation and Chris from Gnome Surf offered me a summer job as a surf therapist. I couldn’t think of a better way to spend a summer and study for the NBCOT. I spent the summer as a surf therapist working with athletes of all ages and diverse skill levels, including at risk youth through a program though the YMCA. I built relationships with families and athletes and saw them grow. I also was appreciated for my OT knowledge and taught other instructions techniques to better support our athletes.
Please describe a typical day or OT session at your uncommon setting? What OT skills do you utilize?
o I will say that surf therapy at Gnome Surf is not anywhere close to the same as traditional settings. The system that Gnome was using for booking sessions didn’t allow for any additional information regarding strengths, weaknesses, communication styles, diagnoses, swimming ability, etc. for athletes. We really went in blind unless someone else knew the athlete. Sometimes this was beneficial to remove any internal biases I has surrounding diagnoses, but other times it was challenging as I didn’t know the athletes skill level or communication style, or if they could swim or not. My initially interaction with a child usually involved asking them their name and age and if they’d ever surfed with us before and them observing them as we grabbed a life jacket. I used a lot of activity analysis for this task, including observing their balance walking across the sand and rocks, and their standing balance when putting on a life jacket, along with any sensory changes or communication styles, and their ability to follow instructions and attend to task. I usually then addressed the child and parent regarding safety in the water, along with asking about any important additional information that I needed to know. Finally, before we left the beach, depending on the athletes age and skill level, I would teach them how to perform a pop up on the board. Then we’d get in the water. Technique in the water varied based on the athlete. Sometimes, we could go deeper into the water and catch a wave. Other times, the athlete need a slow progression to go deeper and catch larger waves. o Out in the water, different activities take place depending on the athlete. Some athletes are ready to roll, all you need is to cue them when stand and give a little push as they practice motor planning movements and demonstrating the strength, coordination, and balance necessary to stand and catch a wave. Some athletes need a little more stability in order to stand on the board, so we practice standing (and falling) from the board before the waves come in. Sometimes I give them a push when they are standing on the board to catch a wave to practice the balance and give them a feeling of the wave beneath them, and build their confidence! Finally, there are athletes that need a little more support. For these athletes, they sit on the board and I paddle and catch the wave with them, me on the back of the board. Sometimes I can just lay on the board as another aspect of balance/stability for them to stand themselves, and other times I pop to my knees and help lift them up into standing while we catch the wave. Once standing, some athletes need more support to maintain stability and others can maintain their balance. We ride the wave in or we crash and fall off the board together. I give a check in with the athlete to determine if they are ready to go again or if they need a break or want to stop. We surf for about 45 minutes during a session. o I use a lot of OT skills throughout sessions including activity analysis, examining the environment, adapting technique and skills, grading up and down activity, sensory regulation strategies, boundary and rule setting, progression towards parent and athlete goals. I also use principles of teaching an advocacy as I educate on OT’s role in surf therapy but also educate other staff on different techniques. Less obvious skills including addressing ADLs for donning wetsuits and social-emotional regulation skills to help athletes adjust their emotions as catching a wave or crashing can lead to overwhelming feelings.
Can you talk about some recent highs (successes) and lows (challenges) of your current role?
o One of my favorite success stories involves this athlete who had faced some trauma in the waves the year before where he was tumbled in the whitewash. He used to love the water but since then had been very afraid and reluctant of even being near it. One of my colleagues had been working with him and when she went to college, the parents chose me to continue to provide his lessons. He was very reluctant to even get his feet in the water or touch the surfboard. I spent a lot of time getting him more comfortable with the surf board, including things like lining up and counting rocks on the board and then throwing them into the water, tracing the words on the board, and standing on the board for x number of seconds on the sand. Eventually, I moved the board closer and closer to the water. Soon we were in about ankle-deep water and I was having him step on and off the board, sitting on the board, or interacting with the board. By the end of the season, he was able to sit on the board and catch a very small wave while holding my end and one of the very last waves we caught, he was standing. I’m pretty sure his mom and I both cried. o There are definitely challenges with surf therapy, from the seaweed to large waves, to the toll it takes on your body. In Rhode Island, there is something we called the “Red Tide” which is this mass of seaweed that sweeps through beaches and is very thick. It’s very challenging to confidence athletes to wade through it, or fall into it when you don’t want to yourself. We also get larger waves from time to time and they are scary to our athletes (and to me). It can be extremely challenging to keep athletes safe when charging through those waves. And with that comes a large tole that it takes on your body as you’re strapping children down for safety using just your body. My hands were raw by the end of the season just from using our boards. o I think another challenge of this role is managing safety among the beach. I will say that I was one of the oldest instructors that we had, most others were 18 and younger. While they were great with our athletes, I always felt I needed to be extra on top of safety awareness, including head counts and seeing where the tide was taking everyone. My co-instructors were wonderful, but the ocean is a dangerous place so safety is a top priority.
How do you continue to learn in order to stay on top of things within your role?
o I learn a lot from watching other instructors and surfing myself. o There is also an international surf therapy organization conference that I haven’t been able to go to yet, but I plan to in the future. To add to this ISTO has different working groups that I am in the middle of becoming a part of just to be able to talk to people in the field as well. o I am a big research gal as well and have read a lot of literature regarding surf therapy. There is not a ton that is published frequently though. o I also talk with colleagues that work in pediatrics about different skill-building ideas for regulation, social-emotional learning, and other skill building techniques.
Can you share a little bit about salary and compensation in this setting? How do OT or the services you provide get funded?
o Gnome Surf is a non-profit organization. As a new instructor, I was paid $25 per 45-minute session, which is the normal starting pay for that organization. The funding comes from grants, donations, and how individuals pay for sessions through the non-profit organization. o I am a big believer that this type of intervention could be covered by insurance though (similar to aquatic therapy)
Any career advice for our followers and listeners on how to get started on this path?
o Truthfully, most of the Surf Therapy organizations would love volunteers. Start by volunteering to understand more in-depth about that organization and how they practice surf therapy. Take the leap and just try it to start. We, as OTs, have so much knowledge to disseminate within surf therapy that I think you’ll find your OT brain turning as soon as you see it for the first time. I think reading research on the benefits of surf therapy OR about blue space is also very important so you understand just how this can affect individuals.
What’s a common myth or misconception about your job/role you’d like to call out or demystify?
o You don’t have to know how to surf and/or be the best surfer in the world to be a part of a surf therapy organization. o Not every person who is a “surf therapist” has therapy experience/training
How do we find you, follow you, be in touch with you and promote your unique work?
You can email me (bmt263@nau.edu) or follow me on Instagram (@brooketubbs), Facebook (Brooke Tubbs) or on Twitter (@brooketubbs). You can also follow Gnome Surf (@GnomeSurf) or ISTO (@intlsurftherapyorg). You can reach out to me with ideas, partnerships, questings, really anything!
I plan to take two Level 1 Fieldwork students this summer to complete their fieldwork with surf therapy.
Gnome Surf also provides a program called “surf fit” which is a land-based program that includes skill building for skills for surfing that I am a part of and hopefully will be able to help grow.
Just as a side note, I also love love love research and plan to get involved with research projects related to surf therapy if anyone has an interest in partnering, I'd be so excited about that!
As always, I welcome any feedback & ideas from you or if you are interested in being a guest on future episodes, please do not hesitate to contact Patricia Motus at transitionsot@gmail.com or DM via Instagram @transitionsot
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