Related Services Consultation

1. Related Services Consultation Strategies for Successful Integrated Practice Jane Case-Smith, O.T.R., Ph.D. The Ohio State University

2. Children with assistive technology needs

3. Children who struggle with feeding or basic functional skills.

4. Children with autism Focus on sensory processing Children with cerebral palsy Focus on posture, movement, strength, transitions within the school building, activities of daily living. Children with underlying physiological problems

5. Therapist roles in support of teachers • Provide information and materials • Create handouts for recommendations • Provide information about a disability or diagnosis • Provide information about evidence based practices. • Teach alternative methods for instruction • Introduce Picture Exchange Communication Systems (PECS) • Help to write Social Stories • Assist in creating Intellitools programs

6. Tools that we recommend for the classroom.

7. Recommend modifications to the classroom environment • Suggest a bean bag chair for a child with sensory needs • Suggest a tent for quiet time of children with high activity levels. • Recommend a rocking chair for calming.

8. Recommend adapting activities or materials • Obtain adapted spoon, cups, plates. • Obtain easel for vertical surface drawing

9. Provide support, encouragement • Assure teaching staff that they are implementing appropriate interventions for difficult medical issues. • Provide feedback about child response to teacher-designed interventions.

10. Examples: • Create Intellikeys program • Problem solve how child will use new wheelchair on the playground.

11. Therapist consultation requires comprehensive evaluation • Therapist needs to observe child in multiple settings, at different times of day. • Interview with teacher is critical to obtain her/his perspective of the problem. • Consultation is based first on the teacher’s perception of the problem. • The child’s problem must be viewed within the demands of the preschool environment and the curriculum.

12. How does consultation work? • Interview with parent, other therapists and staff may be helpful. • Problem solving: Teacher and therapist engage in problem solving (brainstorm first) and identify 1-2 strategies to try first. • Planning: Teacher and therapist identify who is responsible for what action and who collects data on the child’s response (shared responsibility)

13. Barriers Teachers and therapists do not know each other’s roles Teachers and therapists do not feel parity, lack trust. Potential Solutions Make sure therapists are invited to school events, in-services Schedule regular social activities. Create a collaborative culture Work on equity issues, pay, status, support proximity. Barriers to collaborative consultation and how administrators can remove them

14. Barriers Teachers and therapists do not have time to collaborate and plan. Holland (2007) Sometimes therapists and teachers do not value collaboration. Potential Solutions Allow for and build in planning time on a regular basis Use 3 and 1 model (therapists see child for 3 weeks and then have a week for meeting with teacher). Encourage creative use of time, therapists meet with teacher while assistant runs class.

15. Barriers Teacher waits until behaviors are unmanageable. Consulting therapist does not take ownership of the problem Potential Solutions Encourage use of consultation when the problem is first identified to prevent difficult situations. Suggest that both therapist and teacher monitor/assess the effects of the new strategy or equipment. Alternative solutions should be offered.

16. Barriers Therapists are only needed when the child fails to make progress. Potential Solutions Preventive services are optimal. Therapy services are most effective when intervention is early.

17. Is OT/PT/SP consultation an effective service delivery model?

18. Research on Consultation • Dunn (1990) in a pilot study found that children with OT on the IEP made the same progress when a consultation model of services delivery was compared to direct services. • The teachers reported that they valued the consultation model more than the direct services model.

19. Research on Consultation Outcomes • Palisano (1989) compared 14 students who received consultation with OT/PT to 19 students who received direct OT/PT therapy. • Following 6 months of once a week intervention, both groups improved in motor and visual perceptual skills. • The consultation group made greater gains in gross motor skills.

20. Research on Consultation • Consultation by related service personnel has similar child outcomes to direct services. • Teacher outcomes are more positive with consultation versus direct service. • Teachers benefit from learning new techniques, methods. • Teachers appreciate a collaborative approach.

21. Research on Consultation • We have no evidence that consultation requires less time, resources, or funding. • Use of consultation supports the development of interdisciplinary approaches to problems. • Consultation may support sustained effects of related services intervention. • Consultation supports generalization of skills and mastery of skills.

22. Summary • OT/PT/SP bring a health and medical perspective to early childhood programs. • Therapists are trained to analyze performance and to reason by considering the environment, the child, and the activity demands. • Although they know child development and human function well, they may not be knowledgeable about the preschool curriculum.

23. Summary • Best practice consultation uses a problem-solving, collaborative approach • Relationships are established. • The teacher’s perspective is provided first, followed by assessment of the child and environment. • The goal is to support the teacher to affect a child outcome. • Uses collaborative problem solving process • Involves shared responsibility and shared data collecting

24. Summary • Administrators can support collaborative consultation by: • Allowing time for collaborative planning • Allowing flexible scheduling • Encouraging in-services for sharing of skills among team members. • Fostering mutual respect and parity among all school personnel • Allowing creative solutions in a child-first environment.

25. References • Davies, P.L., & Gavin, W.J. (1994). Comparison of individual and group/consultation treatment methods for preschool children with developmental delays. American Journal of Occupational Therapy, 48, 155-161. • Dreiling, D.S., & Bundy, A.C. (2003). A comparison of consultative model and direct indirect intervention with preschoolers. American Journal of Occupational Therapy, 57, 566-569 • Dunn, W. (1990). A comparison of service provision models in school-based occupational therapy services: A pilot study. Occupational Therapy Journal of Research, 10 (5), 300-320 • Holland, T.L. (2007). Survey of Ohio School-based occupational therapists to describe current practice patterns. The Ohio State University.