Occupational Therapy in Early Childhood Transitions:

Supporting Children and Families

FOTA Conference 2018

Christine Myers, PhD, OTR/L

Department of Occupational Therapy

University of Florida

Objectives

By the conclusion of the presentation, participants will be able to:

1. describe the role of early intervention and related service providers in the continuum of

transitions across early childhood.

2. articulate how positive transition outcomes may be supported through interventions and

strategies that address participation in community and school environments, with an emphasis

on strategies for emotional regulation.

3. prioritize family involvement in all phases of the transition process (planning, implementation,

adjustment) for positive child and family outcomes.

Early Childhood Transitions

How do we define transition?

(Orentlicher, Schefkind & Gibson, 2015)

• Passage from one life state, stage or place to another

• May be planned or unplanned

“to transition successfully [we] may need supports from a variety of social institutions…such as

government or state benefits for education, employment, and community living”

• “PEOPLE WHO ARE PREPARED TO FACE LIFE’S CHALLENGES AND MORE ADAPTIVE AND SO

MORE LIKELY TO SUCCEED” (p. 32)

• Overarching Goal of Transition for Children and Youth

• To support school success through child and family preparation and positive early school

experiences

(Rous, Hallam, Harbin, McCormick, & Jung, 2007; Kang, Horn & Palmer, 2017)

Early Childhood Transitions

In 2015-

• 180,000 children with disabilities transitioned to preschool

• Approximately 120,000 transitioned from early intervention

• Over 300,000 children receiving special education services transitioned to kindergarten

(U.S. Department of Education, 2016)

• Why are school-based transition services so important?

In early childhood …

• Evidence suggests that transitions set the stage for future school experiences of children AND

families

• Successful kindergarten transition related to:

• future school success and increased parental involvement in schooling

(Schulting, Malone, & Dodge, 2005)

• school adjustment and positive attitudes towards school

(Pianta & Kraft-Sayre, 2003; Wildenger & McIntyre, 2012)

• Positive Transitions Support Education Goals

• Prepare students for their future as adults, which includes:

• Employment to be contributing members of society

• Community engagement to provide social participation

• Living as independently as possible to support adult roles

• We know that transition is complex

Conceptual Framework of

Early Childhood Transitions

(Adapted from Rous, Hallam, Harbin, McCormick, & Jung, 2007)

IDEA

• IDEA 2004- No definition of transition for early childhood, but does require:

• Transition plan to be a part of IFSP

• EI program must contact local school district to let them know child will shortly reach

age of eligibility to receive Part B services

• EI program must convene a transition conference with local school district and family

not less than 90 days (or more than 9 months) prior to age 3

• Transition from Early Intervention to Preschool

Transition from Preschool to Kindergarten

• Part B State Performance Plan Indicators Related to Transition

• B–11 (timely evaluation): Percentage of children with parental consent to evaluate who were

evaluated and eligibility determined within 60 days (or state-established timeframe; §

1416[a][3][B])

• B–12 (IEP by third birthday): Percentage of children referred by Part C prior to age 3 and who

are found eligible for Part B who have an IEP developed and implemented by their third

birthdays (§ 1416[a][3][B]).

• Part B State Performance Plan Indicators Related to Transition (Ages 3 to 5)

• B–7 (Child outcomes): Percentage of preschool children with IEPs who demonstrate improved

• Positive social–emotional skills (including social relationships)

• Acquisition and use of knowledge and skills (including early language or communication

and early literacy)

• Use of appropriate behaviors to meet their needs (§ 1416[a][3][A]).

• B–8 (Family outcome): Percentage of parents with a child receiving special education

services who report that schools facilitated parent involvement as a means of improving

services and results for children with disabilities (§ 1416[a][3][A]).

• Part C State Performance Plan Indicators Related to Transition (Prior to age 3)

• Indicator 4 (family outcomes): The percent of families participating in Part C who report that

early intervention services have helped the family:

• Know their rights

• Effectively communicate their children's needs

• Help their children develop and learn

• Indicator 7 (early childhood outcomes): Percentage of infants and toddlers with IFSPs who

demonstrate improved

• Positive social–emotional skills (including social relationships)

• Acquisition and use of knowledge and skills (including early language or communication

and early literacy)

• Use of appropriate behaviors to meet their needs

• Part C State Performance Plan Indicators Related to Transition (Prior to age 3)

• Indicator 8 (early childhood transition): The percentage of toddlers with disabilities exiting Part

C with timely transition planning for whom the Lead Agency has:

• Developed an IFSP with transition steps and services at least 90 days, and at the

discretion of all parties, not more than nine months, prior to the toddlers third birthday;

• Notified (consistent with any opt-out policy adopted by the State) the State education

agency (SEA) and the lead education agency (LEA) where the toddler resides at least 90

days prior to the toddler’s third birthday for toddlers potentially eligible for Part B

preschool services; and

• Conducted the transition conference held with the approval of the family at least 90

days, and at the discretion of all parties, not more than nine months, prior to the

toddler’s third birthday for toddlers potentially eligible for Part B preschool services.

• Examples of how addressing indicators supports transition outcomes

• Addressing social-emotional and behavioral needs improves school readiness (Part C Indicator

B-7; Part B Indicator B-7)

• Addressing family outcomes may improve ability of caregivers to advocate for their child’s

needs (Part C Indicator B-4)

• Parent involvement may improve school adjustment (Part B Indicator B-8)

• Engaging in transition planning may decrease stress associated with transition (Part C Indicator

B-7)

Transition Outcomes for Children

• Children and Transitions:

Key Evidence-Based Findings

• Close, positive teacher-child relationship during transition correlates with better

cognitive outcomes for typical and at-risk children and social relationships for typical

children

(Mantizicopoulos, 2005; Peisner-Feinberg et al., 2001; Silver, et al., 2005)

• Preparatory activities support positive transition outcomes for children

(Kemp & Carter, 2000)

• “Higher levels of adaptive behaviors and fewer problem behaviors in preschool

significantly predicted positive transition outcomes”

(Welchons & McIntyre, 2017, p. 91)

Strategies for Supporting Children Before Transitions

(Myers, 2006; 2008; Myers et al., 2011; Podvey & Hinojosa, 2009; Podvey et al., 2013; Rous, Myers, &

Stricklin, 2007 )

• Establish skills necessary for engaging in occupations in the next environment

• Create opportunities for children to familiarize themselves with elements of the

receiving environment (e.g., play groups)

• Visit the receiving environment with the child and family to assess for potential issues

prior to the actual transition

Strategies for Children in the New Environment

(Myers, 2006; 2008; Myers et al., 2011; Podvey & Hinojosa, 2009; Podvey et al., 2013)

• Modify the context or task in the new environment to support participation

• Alter the context as needed to support engagement and ease the child into the new

environment

• Transition Outcomes for Families

Families and Transitions:

Key Evidence-Based Findings

• Transition is a complex process, not a static event, that creates stress for families

(Hanson, et al., 2000)

• Stress may be decreased through planning and support from service providers

(Starr, Martini & Kou, 2016)

• Positive working relationships between service providers and families is the most

crucial factor in a successful transition to an inclusive environment for children with

disabilities

(Kemp, 2003; Rosenkoetter, et al., 2009)

• Families must have their needs met first before they can help their children with

disabilities transition between programs or systems

(Rosenkoetter, et al., 2009)

Strategies that Support Families include:

(Rosenkoetter, et al., 2009; Rous, Myers, & Stricklin, 2007)

• Providing information on options for placements

• Shared information about next environment

• Honest information about child levels and expectations

• Liaisons between programs

• Parent training in advocacy

• Program visits

• Supplemental community services

• Parent participation on transition planning teams

• Linkages with other families

• Follow-up support after transition

Strategies for Families Before Transitions

(Myers, 2006; 2008; Myers et al., 2011; Podvey & Hinojosa, 2009; Podvey et al., 2013; Rous, Myers, &

Stricklin, 2007)

• Engage in assessment with families to determine priorities for transition

• Coach parents/caregivers on ways to address self-determination in their child (even from a

young age!) and address self-regulation*

• Create opportunities for families to familiarize themselves with the receiving environment

• Create opportunities for families to gain access and knowledge about available community

resources

*Behavioral regulation necessary for success in kindergarten (Welchons & McIntyre, 2017)

• Strategies for Families Before Transitions

(Myers, 2006; 2008; Myers et al., 2011; Podvey & Hinojosa, 2009; Podvey et al., 2013;

Rous, Myers, & Stricklin, 2007 )

Prevent performance problems in the next environment by:

• Discussing the transition process with families in order to anticipate potential issues

and solve problems early

• Visiting the receiving environment with the child and families to assess for potential

issues prior to the actual transition

• Meeting with the family and other team members from the next environment to

discuss specific expectations

• Participating in transition conferences, IFSP development, and IEP development

Strategies for Families in the New Environment

(Myers, 2006; 2008; Myers et al., 2011; Podvey & Hinojosa, 2009; Podvey et al., 2013; Rous, Myers, &

Stricklin, 2007 )

• Work with families to help them understand the roles and routines in the new environment-

be sensitive to the impact a change in service delivery systems may have on families

• Need for advocacy perceived as more important post-transition than pre-transition

(preschool to K)

• Parents less satisfied with school services than EI (Siddiqua & Janus, 2017)

• Need to build relationships with providers in receiving environment BEFORE transition

(Starr, Martini & Kuo, 2016)

• Use a family-centered perspective in school-based assessment- help families understand how

their child’s strengths and limitations fit into the new environment

• Consistently collaborate with families and teachers after the move to the new environment,

especially in the early days as the child and family are in a critical period of adjustment

• Timeliness of service provision, lack of communication from service providers,

disorganized information, uncertainty about information sharing between sending and

receiving providers

(Siddiqua & Janus, 2017)

• Link school-based intervention to issues at home in order to create a connection between both

environments

• Collaboration to Improve Transition Outcomes

• Policies and procedures that support interagency collaboration

(Rous, Myers & Stricklin, 2007; Myers et al., 2011)

• EI providers described how “open communication with school personnel…facilitated

transitions” for children with ASD

• allows for a beneficial exchange of child-specific information

• Helps avoid behavioral problems and maximize the child’s likelihood of success

(Starr, Martini & Kuo, 2017)

• Emotional Regulation and Transition in Early Childhood

• Emotion(al) Regulation

• The ability of children to adjust the experience and expression of feelings in context

(Cole, Michel & Teti, 1994)

• A foundation for social participation and self-determination

• What school experiences require emotion(al) regulation in early childhood?

• Learning Emotion(al) Regulation

Ways children learn emotion regulation:

• Language ability assists in emotion(al) regulation because children have a way to talk about

their emotions and co-regulate with others

• Empathetic caregivers (i.e. parents, child care providers) who listen and coach the child through

their feelings and responses

• Caregivers who model and teach self-regulation strategies

• Emotion(al) Dysregulation

• Regulation of emotions in ways that impair a child’s ability to successfully adapt to classrooms

(Herndon et al., 2013)

• Tantrums

• Aggression

• Negative emotions and behaviors

• Who are our students who are dysregulated?

• Link between emotion(al) regulation and school adjustment

• Typical students in early childhood classrooms who have emotional dysregulation:

• Are more highly rated as “socially incompetent” by their teachers and peers

• Are more often boys

• Have less positive relationships with their teachers

• Have difficulties with school adjustment

(Bailey, et al., 2016; Herndon, et al, 2013)

• Transition to Kindergarten

• Focus on school readiness in preschool

• Objective is the child’s successful adjustment to school

• There is a strong relationship between early school success and long-term school outcomes

(Ramey & Ramey, 1994 ; Rous, Hallam, Harbin, McCormick, & Jung, 2007; Yoshikawa, Wieland & Brooks-

Gunn, 2016)

• School Readiness

• Parents of children with and without disabilities report having concerns about kindergarten

readiness

(McIntyre, Eckert, Fiese, Reed, & Wildenger, 2010)

• Supporting school readiness for transitioning preschoolers is a promising practice for with the

potential for improving transition outcomes

(Rosenkoetter, et al., 2009)

• Students with disabilities will usually need more supports to be successful in school

• The foundations for success in adulthood

must start early!

• Social and behavioral competence is an outcome of emotional regulation

• Social-emotional learning

• Self-regulation

• Awareness of others’ emotions

• Positive peer interactions

• Making friends

• Conflict management

• “Overall, components of emotional competence are highly associated, likely in a bidirectional

relationship, with broad indices of social functioning from early to middle childhood.” (Zeman et

al., 2006)

• Development of social and behavioral competence must start early!

• Social and behavioral competencies appear to be particularly important for a positive transition

to kindergarten, and may predict school adjustment

(Welchons & McIntyre, 2017)

• The foundations for self-determination, necessary for a successful transition to adulthood,

develop through constructive experiences in early childhood classrooms

• Student interactions that require self-regulation, choice-making, and engagement in school

routines build self-determination skills

(Erwin et al., 2016)

• How can we help children be…

• School ready?

• Emotionally regulated?

• Well-adjusted after transition to their new school?

• Addressing Social and Behavioral Competence

• Everyday classroom activities and interactions between students and teachers support the

development of executive functioning necessary for social and behavioral competence

(Moreno, Schwayder and Friedman, 2017)

• Helping to increase appropriate social interactions between students with special needs and

their peers

• Supporting positive teacher-student relationships

• Addressing Social and Behavioral Competence

Work with preschool and kindergarten teachers to provide:

• Emotional supports- behavioral qualities related to the creation and maintenance of

relationships characterized by warmth, respect, sensitivity, and individualization

• Organizational supports- qualities related to creating and maintaining an organized classroom,

characterized by setting clear expectations, effectively redirecting misbehavior, ensuring

students are productive, and providing engaging learning opportunities

(Baily et al., 2016)

• Addressing Social and Behavioral Competence

Pyramid Model for Supporting Social Emotional Competence in Infants and Young Children

From the Center on the Social and Emotional Foundations for Early Learning

• Social and Behavioral Competence- Example

• Interdisciplinary program incorporated occupational therapy and special education to provide

transition-related interventions for 2- and 3-year-olds transitioning to preschool

(Myers, Michael, Nowak & Purcell, 2015)

• Positive child outcomes included improvement in developmentally appropriate social

behaviors, such as separating from their parent, following directions, and participating in

program routines

• The 2020 Federal Youth Transition Plan: A Federal Interagency Strategy

Youth with disabilities and all youth will have an equal opportunity to:

• Access health care services and integrated work-based experiences in high school

• Develop self-determination and engage in self-directed individualized planning

• Be connected to programs, services, activities, information, and supports for which they are eligible

• Develop leadership and advocacy skills

• Have involvement from families and other caring adults with high expectations

• Relationship between social/behavioral competence and secondary transition

For self-determination, youth need to know how to:

• Make appropriate choices

• Make decisions

• Solve problems

• Set goals

• Advocate for themselves

• Engage in self-management

BEFORE THEY CAN DO ANY OF THESE, THEY MUST BE ABLE TO CONSISTENTLY REGULATE THEIR

EMOTIONS

Age 14 or 16 is TOO LATE

to start addressing

social and behavioral

competence needs

for transition to adulthood

WE MUST START EARLY!

• Involvement of Therapy Providers in Transitions

• The transition process can be complex and even confusing for service providers as well as for

families

(Starr, Martini, & Kuo, 2016)

• Knowledge about the transition process to preschool was related to more collaboration with

early intervention programs and more family support for occupational therapy practitioners

working in preschools

(Myers, Schneck, Effgen, McCormick & Shasby, 2011)

• Ongoing training should be provided with the goal of an efficient and trained staff

(Branson & Bingham, 2009)

• I challenge you to…

• Educate yourself about transitions for children and youth

• Identify ways that you can become more involved in transitions from planning to school

adjustment phases

• Advocate for involvement of related service providers in school transitions

• Address social and behavioral competence with your PreK – young adult students

• What is YOUR first step to supporting successful transitions?

References and Resources

• Bailey, C.S., Denham, S.A., Curby, T.W. & Bassett, H.H. (2016). Emotional and organizational

supports for preschoolers’ emotion regulation: Relations with school adjustment. Emotion,16,

263-279.

• Branson, D. M., & Bingham, A. (2009). Using interagency collaboration to support family-

centered transition practices. Young Exceptional Children, 12(3), 15-31.

• Center on the Social and Emotional Foundations for Early Learning. Pyramid Model for

Supporting Social Emotional Competence in Infants and Young Children.

http://csefel.vanderbilt.edu/

• Cole, P.M., Michel, M.K. & Teti, L.O. (1994). The development of emotion reulation and

dysregulation: A clinical perspective. Monographs of the society for Research in Child

Development,59, 73-100.

• Erwin, E. J. et al. (2016). Fostering the foundations of self-determination in early childhood: A

process for enhancing child outcomes across home and school. Early Childhood Education

Journal, 44, 325-333.

• Federal Partners in Transition Workgroup. (2015). The 2020 Federal Youth Transition Plan: A

Federal Interagency Strategy. Retrieved from https://www.dol.gov/odep/pdf/20150302-fpt.pdf

• Hanson, M. J., Beckman, P. J., Horn, E., Marquart, J., Sandall, S. R., Greig, D., . . . Brennan, E.

(2000). Entering preschool: Family and professional experiences in this transition process.

Journal of Early Intervention, 23, 279–293.

• Harbin, G., Rous, B., Peeler, N, Schuster, J. & McCormick, K (2007). Desired family outcome of

the early childhood transition process, NECTC Research Brief #5.

• Herndon, K.J., Bailey, C.S., Sheward, E., Denham, S.A. & Bassett, H.H. (2013). Preschoolers’

emotion expression and regulation: Relations with school adjustment. Journal of Genetic

Psychology,174, 642-663.

• Lexington, KY: National Early Childhood Transition Center.Individuals With Disabilities Education

Improvement Act of 2004, Pub. L. No 108–446, 20 U.S.C. § 1400 et seq.

• Kang, J., Horn, E. M., & Palmer, S. (2017). Influences of family involvement in kindergarten

transition activities on children’s early school adjustment. Early Childhood Education Journal, 45,

789-800.

• Kemp, C. (2003). Investigating the transition of young children with intellectual disabilities to

mainstream classes: An Australian perspective. International Journal of Disability, Development,

and Education, 50, 403–433.

• Kemp, C., & Carter, M. (2000). Demonstration of classroom survival skills in kindergarten: A five-

year transition study of children with intellectual disabilities. Educational Psychology, 20, 293–

411.

• Mantzicoupoulos, P. (2005). Conflictual relationships between kindergarten children and their

teachers: Associations with child and classroom context variables. Journal of Social Psychology,

43, 425–442.

• McIntyre, L. L., Eckert, T. L., Fiese, B. H., Reed, F. D. D., & Wildenger, L. K. (2010). Family

concerns surrounding kindergarten transition: A comparison of students in special and general

education. Early Childhood Education Journal, 38, 259–263.

• Moreno, A. J., Schwayder, I., and Friedman, I. D. (2017). The function of executive function:

Everday manifestations of regulated thinking in preschool settings. Early Childhood Education

Journal, 45, 143-153.

• Myers, C. T. (2006). Exploring occupational therapy and transitions for young children with

special needs. Physical and Occupational Therapy in Pediatrics, 26, 73–88.

• Myers, C. T. (2008). Descriptive study of occupational therapists’ participation in early childhood

transitions. American Journal of Occupational Therapy, 62, 212–220.

• Myers, C. T., Michael, S., Nowak, T., & Purcell, M. (2015, December). An interdisciplinary

program for children transitioning to preschool. Early Intervention & School Special Interest

Section Quarterly, 22(4), 1–4.

• Myers, C. T., Schneck, C. M., Effgen, S. K., McCormick, K. M., & Shasby, S. B. (2011). Factors

associated with therapists’ involvement in children’s transition to preschool. American Journal

of Occupational Therapy, 65, 86–94. http://dx.doi.org/10.5014/ajot.2011.09060

• Orentlicher, M.L., Schefkind, S.S. & Gibson, R.W. (2015). Transitions across the lifespan: An

occupational therapy approach. Bethesda, MD: AOTA Press.

• Peisner-Feinberg, E., Burchinal, M. R., Clifford, R. M., Culkin, M. L., Howes, C., Kagan, S. L., &

Yazejian, N. (2001). The relation of preschool child-care quality to children’s cognitive and social

developmental trajectories through second grade. Child Development, 72, 1534–1553.

• Pianta, R., & Kraft-Sayre, M. (2003). Successful kindergarten transition. Baltimore, MD: Paul H.

Brookes.

• Podvey, M. C., & Hinojosa, J. (2009). Transition from early intervention to preschool special

education services: Family-centered practice that promotes positive outcomes. Journal of

Occupational Therapy, Schools, and Early Intervention, 2, 73–83.

• Podvey, M. C., Hinojosa, J., & Koenig, K. P. (2013). Reconsidering insider status for families

during the transition from early intervention to preschool special education. Journal of Special

Education, 46, 211–222. http://dx.doi.org/10.1177/0022466911407074

• Ramey, C. T., & Ramey, S. L. (1994). The transition to school: Why the first few years matter for a

lifetime. Phi Delta Kappan, 76, 194–198.

• Rosenkoetter, S., Schroeder, C., Rous, B., Hains, A., Shaw, J., & McCormick, K. (2009). A review of

research in early childhood transition: Child and family studies (Technical Report No. 5).

Lexington: University of Kentucky, Human Development Institute, National Early Childhood

Transition Center.

• Rous, B., Hallam, R., Harbin, G., McCormick, K., & Jung, L. A. (2007). The transition process for

young children with disabilities: A conceptual framework. Infants and Young Children, 20, 135–

148.

• Rous, B., Harbin, G., & McCormick, K. (2006, September). A child outcome framework for the

early childhood transition process. (Research Brief). Retrieved from

www.hdi.uky.edu/nectc/Libraries/NECTC_Research_Briefs/A_Child_Outcome_Framework_for_t

he_Early_Childhood_Transition_Process.sflb.ashx

• Rous, B., Myers, C., & Stricklin, S. (2007). Strategies for supporting transitions of young children

with special needs and their families. Journal of Early Intervention, 30, 1–18.

• Schulting, A. B., Malone, P. S., & Dodge, K. A. (2005). The effect of school-based kindergarten

transition policies and practices on child academic outcomes. Developmental Psychology, 41,

860–871.

• Siddiqua, A., and Janus, M. (2017) Experiences of parents of children with special needs at

school entry: a mixed method approach. Child: Care, Health and Development, 43, 566–576.

• Silver, R.B., Measelle, J.R., Armstrong, J.M. & Essex, M.J. (2005). Trajectories of classroom

externalizing behavior: Contributions of child characteristics, family characteristics, and the

teacher-child relationship during the school transition. Journal of School Psychology,43, 39-60.

• Starr, E. M., Martini, T. S., & Kuo, B. H. (2016). Transition to kindergarten for children with

autism spectrum disorder. Focus on Autism & Other Developmental Disabilities, 31(2), 115- 128.

doi:10.1177/1088357614532497

• U.S. Department of Education, Office of Special Education Programs. (2016). IDEA section 618

data products: State level data files: 2015 Child count and educational environments. Retrieved

from https://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/index.html#bcc

• U.S. Department of Education, Office of Special Education Programs. (2017). Part B state

performance plan/annual performance report 2017 indicator analyses. Retrieved from

https://osep.grads360.org/#communities/pdc/documents/14725

• U.S. Department of Education, Office of Special Education Programs. (2017). Part C state

performance plan/annual performance report 2017 indicator analyses. Retrieved from

https://osep.grads360.org/#communities/pdc/documents/14724

• Welchons, L. W. & McIntyre, L. L. (2017). The transition to kindergarten: Predicting socio-

behavioral outcomes for children with and without disabilities. Early Childhood Education

Journal,45, 83-93.

• Wildengar, L. M., & McIntyre, L. L. (2011). Family concerns and involvement during kindergarten

transition. Journal of Child and Family Studies, 20, 387–396.

• Wildengar, L. M., & McIntyre, L. L. (2012). Investigating the relation between kindergarten

preparation and child socio-behavioral outcomes. Early Childhood education Journal, 40 (3), 169-

176.

• Yoshikawa, H., Weiland, C., & Brooks-Gunn, J. (2016). When does preschool matter? The Future

of Children,26(2), 21-35.

• Zeman, J., Cassano, M., Perry-Parrish, C. & Stegall, S. (2006). Emotion regulation in children and

adolescents. Developmental and Behavioral Pediatrics,27,155-168.