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David SugdenUniversity of Leeds
Cork November 17th
Ecological Intervention: From Planning to Implementing a Programme
Ecological Intervention:Step by Step Summary
Recognising a difficultyCollecting information to plan the
programmePlanning the ProgrammeImplementing the programme
Recognising a difficulty
Someone has suggested there is a problem.
Parent, family member, teacher, friend, child him/herself.
Decision to investigate the problem
Key Features of Ecological Intervention
Intervention outcomes are a function of the interaction of the child’s resources, the environmental context and the manner of presentation of tasks to be taught.
Or put another way
The difficulties do not solely reside in the child!
Ecological InterventionResources of the Child
Outcomes
Environment Manner of
in which Activity presentation
occurs
Child’s Resources
Accurate assessment of the child and the context in which s/he functions is essential.
The child’s wishes are key variables in the intervention process. This will usually include identifying functional tasks, choosing priorities, establishing targets for success and engaging in monitoring their own progress.
Resources of the childStandardised tests-MABC, BOT,EYMSC, othersDynamic assessment-observation by skilled
OT/PTCriterion referenced tests-various checklists
for teachers, parents and othersInterviews, child, teachers, parents, othersSchool reportsExclusionary criteria-C and DNon motor, co-occurring characteristics-
attention, personal and social, cognitive, other.
Targets, Objectives and Priorities
Setting Targets and Objectives-come from Collecting Information and should involve the child at all times.
Assigning PrioritiesOne causing most problemsOne with knock on effectsOne that is achievableQuick winsEnjoyment factor
Family and homeDaily life and routines
Family circumstances
Cultural values
Informed decisions in the family
School settingSchool policy on SENFormal proceduresResources in school Practices in schoolSupport practicesOutside help
Implementing Ecological Intervention
Two prerequisites for the approach
Participation through engineering the environment
Successful learning through good teaching
Ecological Intervention EI is a way of thinking and acting , an
approach, rather than a rigid package which must be delivered by a highly skilled professional in a specified way.
Our starting point is that intervention cannot be viewed as an add-on to normal daily life. Instead, intervention should be an integral part of daily living.
Different individuals playing different, but equally important, roles- child, parents, health professionals, teachers, others.
Participation and SuccessfulLearning
7 points for guidance
The Movement Coach Organising the context Working in a meaningful context Learning specific skills through task analysis,
task adaptation and expert scaffolding. Learning specific skills is not enough:
broadening the learning through generalisation
Instructions, practice and feedback Monitoring and evaluation
The Movement Coach
The person responsible for the organisation, delivery and monitoring of EI.
Need for central person to argue case and take responsibility
Plan of actionNegotiate with significant personsCoordinate with familiesWho is it-possibilities.
Organising the contextData on:
Child, targets s/he has setTargets others see as importantSupport systems and possibilitiesIndividuals and their roles
Meeting and firm commitmentScheduling and practiceCommunication and timetabling for actionLearning to move-moving to learn
relationship
Working in a meaningful context
Functional tasksRealistic and relevantEveryday activities-formal and informalActive movements
Teaching specific skills through task analysis, task adaptation and expert
scaffoldingAnalysingAdaptingStrengths –weaknessesExpert scaffoldingBike riding example
Choice of tasksFunctional activities- from assessment,
objectives and priorities. Very strong research evidence for this.
Group tasks for generalisation eg same body parts, same cognitive processes, similar demands but vary the detail. Helps ‘solving a movement problem’.
Specific tasks according to need. Eg handwriting, buttoning, bike riding.
Task adaptation and task Analysis
Task adaptation mainly function for participation.
Task analysis mainly for learning
Together they interact and achieve both participation and learning.
Task adaptation and task analysis
We are always keen to stress that it is always preferable to teach the functional activities holistically in a manner as close as possible to its naturalistic setting
However……..
Task Analysis
Break down the task into components
Each component has to be: achievable
a whole in itself-for motivation
easy to build into the overall task
Lead up Activities for Bike Riding-Gwent NHS
Standing on left holding bike and pushing the bike while steering.
Braking to verbal command and visual target. Steering in and out of cones and around corners. With brakes, getting on and off bike. ‘Scooting’ –sitting on bike with pedals removed on lowered
seat, walking the bike followed by raising of legs. ‘Scooting’ and steering and braking. With a handling belt, pedal with support repeating all of the
above stages. Prepare pedal for push off with belt. Push off and prepare second foot to move to pedal still with
belt. Once this can be accomplished remove belt but ‘shadow’
support. Once confident with this, start to make context
unpredictable with cones and moving others.
Task Adaptation
Change the context/environment- modify the pitch, numbers, rules.
Modify the ball, bats, etc., self help aids, shoes, shirts, pencils, rulers, lines, scissors.
Adapt the game, wall ball, jump rope etc.
Teaching specific skills is not enough: broadening the experience through
generalisation
Prior learning affecting new learning
Taking information, skills, knowledge learned in one context and using them in another
Performing new skills in a slightly different manner to ones learned
Generalisation
Continuum of ability to do this but in many populations who have atypical development, a lack of spontaneous generalisation is often a core characteristic.
GeneralisationWhat is required to generalise
The acquired knowledge, strategies, dispositions, abilities, information for a particular task
A recognition, automatically or consciously, that the new context requires the above.
The second bullet point is the one that often proves to be very problematic and particularly resistant to
improvement in children with atypical development
GeneralisationSo do we focus on:
Tasks? Type and range
Learners? Cognitivists and learner’s perception of
similarity
Contexts? Sociocultural perspectives and social
interactions in context
Facilitation of Transfer/Generalisation
Clinical/educational setting and practices
Variability of examples/practice in class of actions
(Task)
Importance of explicit task analysis (Learner)
Metacognitive strategies-explaining to each other, teaching of self regulation, monitoring (Learner)
Expert scaffolding (Context)
Practice in context (Context)
Example of handling the learning process
Instructions and practice Understanding the skill
Short and simple, move straight into task; pick out 1 or 2 major points the child needs to understand. Feedback the same. Cognitive awareness
Acquiring and refining the skillGradual progression to looking at errors and how to
correct. Cognitive awareness Automating and generalising
Dual tasks and different contexts/cognitive awareness
Freezing and releasing degrees of freedom
Early part of skill learning or early development-dfs are frozen. Eg painting a window; child throwing
As skill develops and/or learning progresses dfs are selectively released- still being controlled-to increase flexibility and adaptability.
Skilful therapist and teacher uses this when working with child
Physical disability?
Monitoring and Evaluation
Ongoing monitoringCheck with child-enjoyable-progressCheck with others-carryon? Adjustments?Realign targets and priorities?
Evaluating the whole programmeChilds viewMeeting of original targets-view of the teamTest dataOther data
38
Case study Gary 7 yrs 8 months
Referred by health visitorBorn 6 weeks prematurelyConcerns since reception - fidgeting,
concentration, shouts out, clumsyExtra help in school - real problems holding a
pencil, handwriting “appalling”Good memory, conversation & computer skills
39
GOALS:
Writing - parents choice but he agreed & set following goals for himself Sitting properly, holding paper,
g,l,p,q,z,R,S,V,Z Laces Ball gamesNot worked on but identified by child: Trying new things on the playground - a bit
scared Running - in races mostly win
41
Intervention methods Group –resource efficient, provides a peer
group, novice learner model 8 times over 2 weeks – 50 minutes Based on functional tasks identified by
applying criterion B Child & parent agree goals Task specific approach with use of motor
learning & cognitive strategies
42
Results
Coordination improved –observation at camp Writing improved - sitting position, hand on
paper, mum says she can now understand writing in homework book.
Can now do own laces (occasionally come undone)
Ball skills - no change on MABC but improvement in football skills noted by parents, child and OT
Running & trying new things on the playground – he says no longer an issue
Other Work in Leeds
Supported for 4-5 years by Action Medical Research Longitudinal – 31 children – multiple assessments Periods of intervention, non intervention & monitoring Dilemmas:
We wanted to helpLong waiting lists-up to two yearsSpecific Professionals, PTs, OTs & others – high skill –
low contact timeOthers – Teachers & Parents – unknown skill/potential
– high contact time
Children in the Study31 children aged 7-9 yearsInitially teacher selectedChecked by MABC23 in lowest 5% - 8 in 5-15% on movement
ABC
Comply with DSMIV on exclusionary conditions
Questions
Can teachers and parents, with help, enact an effective intervention programme?
Can children with DCD be helped in this way?
Are there some children who require other forms of intervention
Procedures, Profiles and Programmes
Asked teachers for children with movement difficulties
Movement ABC Test and ChecklistKept 15% as well as originally planned 5%After 1st assessment individual profiles developed.Strengths, weaknesses and prioritiesEach week guidelines given to parents and
teachersAbilities to work on, activities and ways to present
(later)Principles from Ecological Intervention
(Henderson and Sugden 2007)
Sequence of events over project period
Assessment of total Group7 weeks No Intervention
Assessment of total GroupGroup 1 Teacher Intervention 7 weeks Group 2 Parent
Assessment of total GroupGroup 1 Parent Intervention 7 weeks Group 2 Teacher
Assessment of total Group7 weeks No intervention
Assessment of total Group
Monitoring
Monitored and assessed regularly for 2 years 26 followed through, testing plus interviews with parents
and teachers and children. Formed 3 group
14 stayed out of lowest 5%-10 out of lowest 15%8 variable- some (5)staying out as long as intervention
continuedThus 19 out of 26 improved as long as intervention is
present2 minor changes and 2 children stayed in lowest 5% -
no improvement
Movement ABC Test scores for Child 4
0
2
4
6
8
10
12
14
16
18
Test 1 Test 2 Test 3 Test 4 Test 5 Test 6 Test 7 Test 8 Test 9
Movement ABC Test
Tota
l Sco
re
Movement ABC Test scores for Child 8
0
2
4
6
8
10
12
14
16
18
Test 1 Test 2 Test 3 Test 4 Test 5 Test 6 Test 7 Test 8 Test 9
Movement ABC Test
Tota
l Sco
re
Movement ABC Test scores for Child 26
0
2
4
6
8
10
12
14
16
18
Test 1 Test 2 Test 3 Test 4 Test 5 Test 6 Test 7 Test 8 Test 9
Movement ABC Test
Tota
l Sco
re
Answers to questionsTeachers and parents with help can
enact a programme of intervention for children with DCD
A majority of children with DCD can be helped in this way
Some children will need more specific intervention
Not possible as yet to predict which ones will stay out of category post intervention
Concluding Comments• Participation is essential for learning to take place. ‘Little and often’-amount of appropriate practice is the
major influencing variable. Clever use of professionals and significant others. Remember the problems never resides solely in the
child.
Final Thoughts Much of the definition and particularly intervention
success is in our control-optimistic model-we have seen this in many intervention studies.
Engineer the environment and deliver good therapy/teaching