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.

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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 therapy 2.Elements of integrated therapy 3.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 Consultation Relationship Routines Culture 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?

pptPlex Section Divider Ecology of Integrated Services The slides after this divider will be grouped into a section and given the label you type above. Feel free to move this slide to any position in the deck.

Ecology of Integrated Therapy Consultation Relationship Routines Culture of Consulting & Receiving Programs

Routines Chunks of day when stuff happens Scheduled activities Caregiving activities that might not be on schedule Transitions Arrival and departure All 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,

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.

pptPlex Section Divider Elements of Integrated Services The slides after this divider will be grouped into a section and given the label you type above. Feel free to move this slide to any position in the deck.

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 routines 3.“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 Consultation Relationship Routines Culture of Consulting & Receiving Programs

Collaborative Consultation CollaborativeExpert 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 Consultation 1.Work in the classroom (don’t pull the child out) 2.Establish ground rules with the teachers 3.Respect whose turf you’re on 4.Aim to make routines more successful for teachers and the child 5.Communicate during the activity 6.Position yourself to model and to observe 7.Model incidental teaching 8.Aim for child engagement, independence, and social relationships 9.Debrief before leaving 10.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 suggestion ii.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.

pptPlex Section Divider Training, Supervision, Evaluation The slides after this divider will be grouped into a section and given the label you type above. Feel free to move this slide to any position in the deck.

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