Embedding a response to intervention (RtI) multi-tiered approach in a specialist school setting for children and young people with profound and multiple learning disabilities (PMLD) Sharon Tuppeny Melanie Burrough Emily Frost June 2018 @Childrens_Trust @sharontuppenyot @MelanieBurrough @EmilyFrost01

School Based Occupational Therapy is: “Solution-focused, strengths-based, occupational-based, collaborative and context-based, educationally relevant and evidenced-based” (WFOT, 2016) “Enabling participation in school-related occupations is the goal of school-based occupational therapy services” (Bonnard and Anaby, 2017)

World Federation of Occupational Therapists Position Paper (2016) “...Work towards inclusion, participation and well-being” “...Enable participation of ALL students = occupational justice...” “...Can support at ALL levels of the education system...”

Organising services within a school system: a support continuum

Support continuum: Response to Intervention (RtI) Intensive 1:1 Intervention Group supplemented instruction Typical classroom instruction/ core curriculum Differentiation Universal design for learning Accommodation Ardoin et al., 2005 Adapted from WFOT (2016)

Specialist Schools RtI demonstrate effective identification of school participation challenges in mainstream schools (Missiuna et al., 2017) RtI has not yet been used to consider participation challenges for C&YP with PMLD How does RtI support ALL C&YP attending a specialist school provision?

Practice Development: Introducing RtI to a residential specialist school

The Children’s Trust School 43 children and young people (day and residential provision) 25 in TCT School 7 attend the ‘Cedar Centre’ post 19 provision 11 in early years service (from September) Profound and multiple disabilities (PMLD) and severe learning disabilities (SLD) Multi-disciplinary therapy team (OT, physio, SLT, music therapists)

Practice Development Previous way of working: Reactive service High levels of direct therapist input RtI introduced to 4 specialist school classrooms, nursery & post 19 provision Member of the OT department spends 0.5 days per week within each of the classrooms

Accommodation Differentiation Individualised approaches for learning Differentiation Task adaptations Universal design for learning (Physical, social and learning environment) Enabling environmental access/ capacity building

Implementation Experiences

Dynamic Performance Analysis Observation based - Engagement within a classroom context to increase children's participation in school-based occupations Working collaboratively ‘in the moment’ with classroom team Young Person Environment Task Missiuna et al., 2000

Implementation across the support continuum UNIVERSAL DESIGN FOR LEARNING Preparation for activities: e.g. sensory cues and hand washing before cooking sessions Transforming a ‘trip to the shops’ into ‘shopping’ Incorporating assistive technology within activities, rather than being used in isolation

Implementation across the support continuum DIFFERENTIATION Altering the environment to support engagement during meal times Grading activities whilst gardening Groupwork during baking sessions

Implementation across the support continuum ACCOMMODATION Using assistive technology, e.g. Eye Gaze Technology to develop skills for communication Using powered mobility to arrive at school (via GVMS platform) Recommending strategies to maximise participation in personal care activities Implementing strategies to optimise states for learning (calming or alerting)

Lessons Learned Focus on PARTICIPATION led interventions! School is your client Take time for relationship building Address ALL levels of the support continuum Time for peer support School readiness to engage Focus on PARTICIPATION led interventions! Lessons Learned

References Ardoin, S., Witt, J., Connell, J. And Koenig, J. (2005) Application of a three-tiered response to intervention model for instructional planning, decision making and the identification of children in need of services, Journal of Psychoeducational Assessment ,23, pp. 362-380 Bonnard, M. and Anaby, D. (2016) Enabling participation of students through school-based occupational therapy services: Towards a broader scope of practice. British Journal of Occupational Therapy, 79(3) 188–192. Missiuna, C., Pollock, N., Campbell, W., DeCola, C.,   Hecimovich, C., Sahagian Whalen, S., Siemon, J.,  Song, K. Gaines, R., Bennett, S., McCauley, D., Stewart D.,  Cairney, J.,  Dix, L. and Camden, C. (2017), Using an innovative model of service delivery to identify children who are struggling in school. British Journal of Occupational Therapy, 80 (3), pp.145-154. Missiuna, Polatajko, H. J., Mandich, A., & Martini, R. (2000). Dynamic Performance Analysis: A framework for understanding occupational performance. American Journal of Occupational Therapy, 54, 65–72. Polatajko, H., Mandich, A. and Martini, R., (2000) Dynamic performance analysis: a framework for understanding occupational performance. American Journal of Occupational Therapy, 54 (1), pp. 65-72. World Federation of Occupational Therapists (2016). Position Statement on Occupational Therapy Services in School-Based Practice for Children and Youth. Available: http://www.wfot.org/ResourceCentre.aspx (filter for Position Statements)