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Ecology of Integrated Services
Training, Supervision, Evaluation
Elements of Integrated Services
Slides before 1st Section Divider
What if Preschoolers Could Get Interventions All Day Every Day?
Implications for Visiting Professionals
R.A. McWilliam, Ph.D.
Contact
• [email protected]• 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