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Starfish Youth Therapy Center

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Starfish Youth Therapy Center is a program of Waterfall Clinic.
We offer outpatient therapy services to youth ages 3-21 years with an Autism Spectrum Disorder diagnosis.

Therapy services offered:
• Occupational Therapy
• Speech Therapy
• ABA Therapy
• Feeding Therapy

At Starfish, we provide services that support and promote the achievement of a child’s independence and overall development. We believe in a team approach with all of the families we work with – emphasizing effective communication with parents and individualized strategies for home to carry over all of the gains we make within treatment.

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Where is the clinic located?
We are located at 465 Elrod Ave. Suite 101. Coos Bay, OR 97420.

How do I start therapy services?

Patients must register as a new patient by calling 541-751-7948.  The patient services representative in the autism department will assist you with the registration process.

Before an evaluation is scheduled, a physician’s referral is typically required. This referral usually comes from your child’s pediatrician, family physician or psychiatrist. You may call your provider and ask them to fill out our referral form.  For your convenience, a downloadable referral form is available at the top of this web page.
Call 541-751-7948 to schedule an evaluation.

Autism Program Providers

Gina Mastroianni, M. Ed., BCBA, LBA

Board Certified Behavior Analyst

Gina Mastroianni was born and raised in northern California and spent 6 years living in Arizona before moving to Coos Bay in 2021. Gina earned a masters degree in Applied Behavior Analysis from Arizona State University in 2019. Gina began working with individuals with developmental disabilities in 2009, and has worked in the field of ABA for over 10 years. Gina specializes in early intervention, social and adaptive skill intervention, academic consult, and family behavioral skills training. In her spare time, Gina enjoys hiking, biking and spending time with her husband and pets.

Mary T. Manzano, MS, CCC-SLP

Speech/Language Pathologist

Mary T. Manzano is a Speech/Language Pathologist who received her Master’s degree in Communicative Disorders from The University of Redlands, in California. She obtained and maintains a certificate of Clinical Competence from the American Speech-Language-Hearing Association. In 2017, she moved to the beautiful state of Oregon. For the past 20 years, Mary surrounds herself with her passion, to serve the disabled children within her community. Mary and her husband enjoy staying connected with their children and grandchildren virtually, traveling to other countries, tackling major home construction projects and fishing.

Stefanie Austin, OTR

Occupational Therapist

Stefanie Austin is a Michigan native and is a licensed occupational therapist. She has a master’s degree in occupational therapy has experience working with autistic children and adults in a variety of settings. Stefanie loves working as an occupational therapist because she can engage her creativity to help children and families to be able to participate in everyday activities especially in sensory processing and feeding therapy. She holds certifications in feeding therapy with a specialty in autism and is an early intervention specialist. Stefanie enjoys hiking, yoga, gardening, cooking, art and exploring the outdoors with her fiancé Cory and their dog.

Check out our new 11,000+ square foot facility!

Occupational Therapy

What is Occupational Therapy?

Occupational therapy is a profession concerned with promoting a child’s health and well-being through occupation, or all the activities a child needs to do throughout their day. Some children have difficulty meeting their age-appropriate developmental skills and may need some help to achieve these skills that propel them into adulthood. OT’s work to improve a child’s physical development, fine-motor skills, sensory processing skills, social-emotional development, cognition, feeding skills, and visual processing abilities to maximize skills for daily living.

What is an occupational therapy evaluation?

An occupational therapy evaluation includes assessment of your child’s performance related to daily activities. Depending on the child’s individualized needs, your therapist may assess your child's gross motor, fine motor, visual motor, visual perceptual, handwriting, daily living skills or sensory processing patterns. The use of standardized assessment tools, non-standardized assessment tools, parent interview and clinical observations will be used to assess your child's performance. Therapy recommendations will be made at the end of the child’s evaluation appointment. Within 2 weeks of the initial evaluation appointment, you will receive an evaluation report summarizing all information gathered, the clinical impressions of the therapist, and treatment goals that address identified concerns while utilizing your child’s and family’s strengths. The report may also include general recommendations for referrals to other professionals.

What areas are addressed in occupational therapy treatment?

Occupational therapy treatment encompasses several areas of performance. All treatment plans and therapy goals are created and implemented based on the child's individual needs.
Fine Motor Skills: Pertaining to movement and dexterity of the small muscles in the hands and fingers. (e.g. handwriting, coloring, buttoning, manipulating fasteners, opening a container).
Gross Motor Skills: Pertaining to movement of the large muscles in the arms, legs and trunk. (e.g. actions like pumping legs on a swing, jumping, skipping or hopping).
Visual Motor Skills: Referring to a child's movement based on the perception of visual information. (e.g. hand-eye coordination tasks such as coloring, tying shoes, catching a ball).
Oral Motor Skills: Pertaining to movement of muscles in the mouth, lips, tongue and jaw, including sucking, biting, crunching, chewing and licking. (i.e. skills used to eat food and drink from a cup/straw).
Self-Care Skills: Pertaining to daily dressing, shoe tying, grooming/hygiene, teeth brushing, feeding (e.g. accepting a variety of foods, utensil and straw/cup use) and toileting tasks.
Sensory Integration: The ability to take in, sort out and respond to the information we receive from the world. (e.g. auditory, tactile, and movement sensitivities or under responses).
Motor Planning Skills: The ability to plan, implement and sequence motor tasks. (i.e. slow to learn basic skills and takes longer than typical to complete physical tasks like tying shoes or brushing teeth).
Neuromotor Skills: Pertaining to the underlying building blocks of muscle strength, muscle tonicity, postural mechanisms and reflex integration (i.e. difficulty maintaining posture or balance due to low muscle tone).
Self-regulation: Managing emotions, behavior, and body movement (e.g. coping with disappointment or failure, demonstrating appropriate levels of energy or arousal).
Transitions (i.e. moving from one activity to another; adapting to changes).
Social Skills (e.g. sharing, turn taking, play with peers, playing in creative ways)
Organizational and Life skills (e.g. time management, meal preparation, money management, home management, shopping).

Sensory Integration Therapy for Sensory Processing Disorder

Starfish Youth Therapy Center is proud to offer sensory integration-based therapy for children who display sensory processing differences and/or sensory processing disorder (SPD). Our sensory gym provides a state-of-the-art multi-sensory environment, providing every child positive play in a therapeutic environment.

Your child’s sensory processing patterns will be assessed at their initial evaluation. This provides the therapist and the rest of the therapy team with insight on your child’s responses to sensory experiences during the natural course of daily life. Knowing how a child reacts in various contexts (home, school and community) provides a way to understand what influences a child’s behavior throughout the day and determines how sensory processing may be contributing to or interfering with participation in daily activities.

During therapy sessions, exploration takes place through play-based experiences in the sensory gym. Through play in the gym, your child will become more comfortable with different sensory experiences and adventure into areas that were once avoided or hard for them. This will foster development of new motor, social and cognitive skills as well as facilitate a new sense of well-being. Your child will start to perceive their sensory processing differences as strengths and learn to navigate their world in a way that brings them joy and success.

What is Sensory Processing?

Sensory processing (sometimes called “sensory integration”) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Our senses give us information about the physical condition of our body and the environment around us. Sensory processing involves the brain’s ability to receive, organize, and make sense of different kinds of sensations entering the brain all at the same time. When sensations flow in a well-organized or integrated manner, the brain can use those sensations to form perceptions, behaviors, and learning. When the flow of sensation is disorganized, simple tasks may be difficult, which leads to frustration and avoidance of sensory opportunities or movement challenges. Sensory processing refers to the mechanisms of how we feel and underpins every aspect of human functioning. Everyone processes sensation. Sensory integration-based therapy helps the neurological systems to process, interpret, and organize the stream of sensations, and therefore improves children’s behavioral and motor responses to make everyday tasks easier.

What senses make up the sensory system?

Sensory processing is the brains ability to process information from our senses (8 of them) and connect that information with what we already know about the world around us. It is our brain’s ability to use our senses to make connections about what is happening to us, around us, and with us. Our 8 senses include vision, auditory, tactile (touch), gustatory (taste), olfactory (smell), vestibular (movement, balance), proprioception (body awareness, position), and interoception (ability to sense the internal state of the body—for instance, to accurately identify sensations such as hunger, thirst, pain, and internal temperature).
In children with autism, sensory processing deficits have been theorized to cause difficulties that affect behavior and life skills. This means that they may not filter out extraneous sensory stimulation or do not process sensory stimulation in a typical way. As a result, some children may be over-sensitive or under-sensitive to events or objects in their surroundings. Children with sensory processing deficits may also have difficulty with motor skills, balance, and eye-hand coordination impacting participation in all daily activities.

What is Sensory Integration Based-Therapy?

Sensory Integration-based therapy is designed to help children with sensory processing challenges and cope with the difficulties they have processing sensory input. Sensory integration-based therapy helps children’s neurological systems to process, interpret, and organize the stream of sensations, and therefore improves children’s behavioral and motor responses. Therapy sessions are play-oriented and may include using the sensory gym and it’s equipment such as swings, trampolines, and slides. Sensory integration also uses therapies such as deep pressure, brushing, weighted vests, and swinging to assist in calming, or self-regulation. In addition, sensory integration therapy is believed to increase a child’s threshold for tolerating sensory-rich environments, make transitions easier, and reinforce positive behaviors. Recommendations for managing sensory processing challenges at home, school and the community will be made during therapy sessions to support the child’s individualized sensory processing patterns.

What behaviors are associated with Sensory Processing Disorder (SPD)?

An over-responsive child seeks less sensory stimulation. Over-sensitivity to sensory input may look like:

• Extreme response to or fear of sudden, high-pitched, loud, or metallic noises like flushing toilets, clanking silverware, or other noises that seem unoffensive to others
• Is upset by tags in clothing only wears clothing with particular textures
• Avoids messy play (i.e. finger painting) or becomes very concerned when hands get dirty
• May notice and/or be distracted by background noises that others don’t seem to hear
• Fearful of surprise touch, avoids hugs and cuddling even with familiar adults
• Seems fearful of crowds or avoids standing in close proximity to others
• Doesn’t enjoy a game of tag and/or is overly fearful of swings and playground equipment
• Extremely fearful of climbing or falling, even when there is no real danger i.e. doesn't like his or her feet to be off the ground
• Has poor balance, may fall often
• Is picky about food textures and frequently gags on food or the smell of non preferred food
• Has extreme difficulty with changes in routine, novel activities, and anything unexpected

An under-responsive child seeks more sensory stimulation. Under-sensitivity to sensory input may look like:

• A constant need to touch people or textures, even when it’s inappropriate to do so
• Doesn’t understand personal space even when same-age peers are old enough to understand it
• Clumsy and uncoordinated movements
• An extremely high tolerance for or indifference to pain
• Often harms other children and/or pets when playing, i.e. doesn't understand his or her own strength
• May be very fidgety and unable to sit still, enjoys movement-based play like spinning, jumping, etc.
• Frequently crashes and bumps into people and objects
• Seems to be a "thrill seeker" and can be dangerous at times
• Does not seem to respond when name is called repeatedly
• Extreme preference for sedentary activities
• Mouths non-food objects
• Overstuffs food in mouth

Sensory Integration Approaches at Starfish:

Remedial Intervention: involving the skilled use of sensory and motor treatment activities and equipment, including engagement in activities that provide increased sensory input, motor planning, and much more.
Accommodations and Adaptations: adapting daily tasks to manage over-sensitivities and improve attention, self-regulation, or organizational difficulties to increase effectiveness in performing school or work.
Sensory Diet/Lifestyle Programs: involving a daily routine/plan with a menu of individualized, supportive sensory strategies to help manage sensory needs and related emotions and behaviors such as anxiety or self-injury, to help change sensory processing patterns, minimize crisis escalation, or promote calming for overall health and wellness.
Environmental Modifications: and adaptations to increase or decrease the sensory stimulation a space provides.
Education: to family members, caregivers, and individuals, about the influence of sensory functions on performance in daily activities.

Feeding Therapy

The goal of feeding therapy is to help children develop normal, effective feeding patterns and behaviors.

What is a feeding disorder?

A child with a feeding disorder is more than a picky eater. Children with feeding disorders often have had serious medical and developmental issues that led them to fear some or all foods. Your child may have a few "safe" foods but will panic when asked to eat any other foods. Some children have sensory food aversions, or consistently refuse to eat certain foods related to the taste, texture, temperature, smell and/or appearance.

What is sensory food aversion?

Sensory food aversion is a type of feeding disorder that describes a sensory overreaction to particular types of food. The heightened sensory issues are trigged by the qualities of certain foods such as taste, texture, temperature and smell. In children with a diagnosed sensory processing disorder or Autism spectrum disorder (ASD), food selectively feeding issues are a major issue, with food texture and consistency being one of the most cited underlying factors in whether the child will consume or reject specific foods. Sensory food aversions can lead to restricted diet, nutrient deficiencies, increased family stress, and social isolation.

What is feeding therapy?

Feeding therapy is more than just “teaching a child to eat.” Feeding therapy is performed by a trained occupational or speech therapist. Dependent on your child’s underlying issues, whether they be sensory, motor, or a combination of both, your therapist will devise a plan for working on addressing the underlying barriers to your child’s ability to eat an age-appropriate meal and make the entire process of eating easier and more enjoyable.

Symptoms of Feeding Disorders:

• Choking/coughing during meals
• Gagging or vomiting while eating
• Spitting out food
• Refusal to eat all or most foods
• Weight loss or failure to gain weight
• Mealtime distress or tantrums
• Overreliance on supplement drinks (e.g., Pediasure)
• Trouble with different textures, avoids foods with certain textures
• Refusal or inability to chew or swallow
• Problems with oral motor coordination, such as difficulty using a straw or food spilling from mouth
• Slow eating, long meal duration
• Trouble self-feeding
• Food selectivity or extreme picky eating (only eating from 1 food group or only eating 1-2 foods) that leads to nutritional deficiencies
• A food range of fewer than 20 foods, especially if foods are being dropped over time without new foods being added to replace them
• Has not weaned off baby foods/purees after 16 months

What skills are taught in feeding therapy?

During feeding therapy, therapists work with children to provide them with the skills they need to make mealtime more enjoyable and nutritious. The skills taught to each child are determined based on the child’s needs and may differ from those below. The most common skills taught include:

Oral motor skills: Some children may lack the skills needed to eat and/or drink due to developmental delays, illness, allergies and a variety of other factors. When this is the case, the therapist works with the child to teach them how to control and coordinate chewing, sipping, sucking swallowing and the like while eating and drinking. Therapists also work to increase each child’s oral strength and range of motion.

Food orientation: Due to sensory aversion or developmental delays, some children may need assistance broadening the amount and type of foods they eat. This will allow the child to better enjoy meals and eat a more balanced, healthy diet. Therapists work with children and their families to increase the amount and types of foods the child is willing to eat. Many children, especially those with sensory aversion or those who have had limited exposure to a variety of foods, may be taught skills on how to reduce their sensitivities to foods and their textures.

Improve the overall eating experience: Whether a child has struggled to eat because of a sensory aversion food aversion and/or reduced oral motor skills, he or she may have developed negative feelings toward eating and mealtime in the process. As a result, many children, and their families, benefit from learning how to create positive eating and drinking experiences. Therapists work with patients and their families to improve the child’s overall mealtime routine and create positive associations with food. Therapists also work with children to help them gain the self-feeding independence that many of them crave by teaching skills like drinking from a cup, eating with a spoon or fork or drinking from a straw. By teaching the child how to enjoy mealtime and training the child’s caregiver on how to create a positive mealtime experience, meals and snacks may become easier for the entire family.

What roles do caregivers play in feeding therapy?

Caregivers play an important role in feeding therapy. As a vital member of the child’s care team, your therapist will stay in close contact with the child’s family in between appointments so that the therapy and strategies used can be changed as needed. While the child is learning skills in order to become a better eater, caregivers must learn the skills and strategies they can use at home in order to help the child progress and become a better eater and/or drinker. The child’s caregivers and therapist are a team, working together to make sure the child receives the therapeutic, physical, social and emotional support to improve his or her feeding skills and habits. In order to provide the child what they need at home, your therapist will teach the child’s caregivers:

• Feeding strategies and general advice for eating at home.
• Tactics for addressing negative mealtime behaviors.
• How to continue encouraging the child to eat the new foods introduced during therapy at home.
• To keep a food log of what the child eats and how he or she acts at mealtime and reacts to foods.

Working as a team, the caregivers and therapist decide which foods to introduce or target during the therapy. This decision includes many factors including the child’s oral motor skill level (what he or she is able to chew, sip or swallow), the family’s culture and lifestyle choices, the child’s specific nutritional needs and any sensory or food texture experiences the overall therapy is addressing. After sharing a meal with the child and caregiver or observing a meal between the child and caregiver, the therapist may provide feedback and advice on ways to incorporate things being learned in feeding therapy and make the meal more enjoyable.

How long does feeding therapy take?

The length and frequency of therapy depends upon each child’s needs. The child’s therapist will work with the child and his or her caregivers to make sure the child gets the right amount of therapy so that he or she can progress without feeling too overwhelmed.

Frequently Asked Questions (FAQ):

What do I do if I think my child may need your services?

If you are wondering whether or not your child needs our services, you should contact our office and let them know that you are interested in talking to our occupational therapist, speech therapist, or ABA therapist about your child. The office staff will collect basic information and one of our therapists will give you a call as soon as possible (usually within a day or two). The therapist will answer your questions and help you determine which kind of evaluation might most benefit your child.

What happens during an evaluation?

This is an opportunity for the child, parent(s) or caregiver and occupational or speech therapist to meet and share information. The occupational or speech therapist considers the child's medical, developmental and academic history, formal testing results and parent feedback before developing a treatment plan. This initial meeting lasts 60-90 minutes. A parent or legal guardian must be present at your child’s initial therapy evaluation; this is important so that you can give consent for your child to be treated. Being present at the evaluation will give the therapist a chance to speak with you about your concerns and goals for your child.

What paperwork do I need to complete for the evaluation?

Patients are asked to arrive 15 minutes early to their evaluation appointment to complete necessary paperwork, including insurance verification, patient identification and consent to treatment.

What should I bring to my child’s initial evaluation appointment?

• A current photo ID (license)
• Insurance card
• Referral if needed
• Prescription
• School Reports (optional)
• Prior evaluations
• Name/addresses of individuals you might want the report sent to

Can I bring my other children?

If possible, it is recommended that siblings stay home so that the parent can give their undivided attention during the evaluation. Understanding that childcare is sometimes difficult, when bringing siblings, it may be helpful to bring another adult and activities to occupy the siblings during the evaluation.

Do parents sit in on therapy?

Sometimes. Some children do better in therapy when a parent is present and some do better without. Between sessions, parents are usually given activity tasks to complete with their child in an effort to maximize progress. One of our primary goals is to give your entire family skills and knowledge to help your child gain the greatest benefit from therapy.

How is therapy scheduled?

Most children are scheduled for 45-60 minute sessions weekly. The duration of the treatment depends on the severity of the child's delay or disorder and the child's progress.
If therapy is recommended by my therapist, will my insurance pay for it?
Medical coverage will vary, but many health insurance plans cover our services. Please contact your insurance company to verify if your plan offers a benefit for occupational therapy services. If therapy is recommended, our Patient Services Representative will obtain authorization for treatment. Once the treatment is approved, you will receive a phone call from our scheduling department to schedule an appointment for treatment. There may typically be a waitlist for therapy times which need to be scheduled in the late afternoon, after school times.

When will I get an Occupational Therapy Evaluation report?

You should receive a written report within 2-3 weeks.

How are your therapy services different than my child’s therapy in school?

School-based therapists are considered a "related service."  Their job is to observe and assess a child to determine their needs in order to best access their education. Therapists may use direct treatment and pull the child out of the classroom or push inside the classroom by providing equipment for the student to access.  Or a therapist may consult with an educator in the classroom to better accommodate the student. School based therapy uses an educational model that focuses on education and academic performance and is governed by IDEA (Individuals with Disabilities and Education Act). Goals in the schools are specifically related to education. In contrast, Starfish Youth Therapy Center provides outpatient clinic-based therapy using a medical model that focuses on working with the diagnoses prescribed by a doctor and often directed by insurance. Our therapists help children access and participate in activities in the home, community, and any other environment a child may find themselves. Goals are functional and based around the activities and environments specific to the child, not necessarily tied to their education. Goals are individualized based on the child's needs and family's priorities.  Children are able to receive school and outpatient therapies in conjunction with each other. A child may qualify for services in an outpatient setting, but not in school because their skills and compensations do not impact their ability to learn.