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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?
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