Ecology of Integrated Services

Training, Supervision, Evaluation

Elements of Integrated Services

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What if Preschoolers Could Get Interventions All Day Every Day?

Implications for Visiting Professionals

R.A. McWilliam, Ph.D.

Contact

• robin.mcwilliam@siskin.org• www.siskinresearch.org• www.naturalenvironments.blogspot.com

• @RobinMcWilliam1

Collaboration

“Raphael paints wisdom; Handel sings it, Phidias carves it, Shakespeare writes it, Wren builds it, Columbus sails it, Luther preaches it, Washington arms it, Watt mechanizes it.”Ralph Waldo Emerson

Outline

1. Ecology of integrated therapy2. Elements of integrated therapy3. Training, supervision, evaluation

Integrated Services—Teamwork

Integrated Therapy

• OTs, PTs, and SLPs come into the classroom to help the teaching staff meet children’s individualized needs during all the hours the therapists are not in the room

• Teaching staff attend to what therapists are doing and vice versa

• Teaching staff and therapists communicate with each other

Question for Participants

• What are the biggest barriers to implementing integrated services?

Continuum of Service Delivery Models

• 1-on-1 pull-out• Small-group pull-out• 1-on-1 in classroom• Group activity• Individualized within routines• Pure consultation

Research Findings

• Individualized within routines most effective, followed by group activity

• Four times as much communication occurs in in-class methods vs. out-of-class methods

• Teachers more satisfied with integrated than pull-out– Especially when they like the therapist

• It can take parents over a year to acknowledge the benefits, if they are predisposed to a segregated model

Ecology of Integrated Therapy

ConsultationRelationshipRoutinesCulture of Consulting & Receiving Programs

Culture of Consulting Program

• Rehab vs. knowledge sharing• Belief system about how children

learn• Confidence about consulting• Competence at consulting

Culture of Receiving Program

• History with therapists• Understanding of roles• Confidence about intervention• Competence about intervention

Question for Participants

• How can you plan the session and yet follow the teacher’s and the child’s leads?

Ecology of Integrated Therapy

ConsultationRelationshipRoutinesCulture of Consulting & Receiving Programs

Routines

• Chunks of day when stuff happens• Scheduled activities• Caregiving activities that might not

be on schedule• Transitions• Arrival and departureAll are contexts for intervention!

The Four Contexts of Teaching

McWilliam, R. A., de Kruif, R. E. L., & Zulli, R. A. (2002). The observed construction of teaching: Four contexts. Journal of Research in Childhood Education, 16, 148-161.

Activities: Critical Teaching Level

• These are what you have to fit into.• What if the activity doesn’t fit your

plan?• What if “your” child is involved in

something different from your plan?• Wait… what goal(s) are we working

on?– Discussed after DAP

Developmental Appropriateness of Classroom

1. The more play-based the environment, the easier it is to provide integrated therapy.

Developmental Appropriateness of Classroom

1. The more play-based the environment, the easier it is to provide integrated therapy.

2. Relationship with teachers critical for modifying activity, if necessary, when therapist enters.

Developmental Appropriateness of Classroom

1. The more play-based the environment, the easier it is to provide integrated therapy.

2. Relationship with teachers critical for modifying activity, if necessary, when therapist enters.

3. Disadvantage of play-based: Everyone’s scattered.

Elements of Integrated Therapy

• Functional goals• Collaborative consultation• Demonstration• Summary• Implementation

Functional Goals

• Research shows integrated therapy occurs more often when goals are functional.

• Define functional

Functionality Defined

• Skill ensures participation in current routines– Might also prepare for future

• Must be developmentally appropriate or necessary

• Must require the child to do something• Must be something meaningful to

child’s caregivers– Preferably, chosen by family through RBI

The 3 Foundations of Learning

Functional Strategies

1. Regular caregivers can implement them…

2. In regular routines3. “Normal”4. Promote

– Engagement: participation in routine– Independence: control over environment– Social relationships: peer interactions

(sometimes, adult)

Question for Participants

• Why are teachers sometimes not interested in what we have to say?

Ecology of Integrated Therapy

ConsultationRelationshipRoutinesCulture of Consulting & Receiving Programs

Collaborative Consultation

Collaborative Expert

Decide on the problem together

Consultant decides what the problem is

Decide on the solution together

Consultant decides what the solution is

Evaluate the solution together

Consultant evaluates whether the solution has worked

Gaining Trust and Credibility

Social• Get to know

the teachers and let them get to know you

Task• Show you

know what you’re talking about

Rules of Consultation1. Work in the classroom (don’t pull the child out)2. Establish ground rules with the teachers3. Respect whose turf you’re on4. Aim to make routines more successful for

teachers and the child5. Communicate during the activity6. Position yourself to model and to observe7. Model incidental teaching8. Aim for child engagement, independence, and

social relationships9. Debrief before leaving10. Make friends with the teachers

Sucking Up Behaviors

• Sniff out poopy diapers• Clean up after an activity• Distract a disruptive child• Bring in something of personal

interest to the teacher• If meeting at lunch, bring lunch

“How many times we gonna pass the ball before we shoot?”“Four!”

“How many questions we gonna ask before we make a suggestion?”

“Four!”

Why Not Just Give Suggestions?

• Your input should be added value…

• So you need to know background

• You should not be the hero of the visit

• Think about feasibility and implementation

• Partners work together

Question for Participants

• When we demonstrate (model) something in the classroom, why don’t teachers imitate it?

8 Demonstration Steps(From Vanderbilt Home Visiting Script-Expanded)

i. Speak to the adult about your suggestionii. If it seems as though the parent doesn’t understand,

ask him or her if he or she wants you to demonstrate.iii. Tell the parent what you’re going to do.iv. Do it.v. Tell the parent what you did and point out the result

of the strategy.vi. As the parent if he or she would like to try it.vii. If the parent says yes, observe; if no, don’t insist on

it.viii.If the parent said yes, praise the parent and give him

or her a limited amount of constructive feedback.

Training, Supervision, Evaluation

• Integrated Therapy Checklist

Training, Supervision, Evaluation

• Receiving Consultation Checklist

Integrated Therapy

Therapists work in the classroom

Instead of pulling children out

Therapists consult with teachers

Instead of just working with the child

Therapists work on functional skills

Instead of on decontextualized deficits

Cool early interventionists use integrated services