1. 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

2. 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)

3. 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...”

4. Organising services within a school system: a support continuum

5. 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)

6. 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?

7. Practice Development: Introducing RtI to a residential specialist school

8. 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)

9. 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

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

11. Implementation Experiences

12. 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

13. 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

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

15. 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)

16. 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

17. 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
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
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
World Federation of Occupational Therapists (2016). Position Statement on Occupational Therapy Services in School-Based Practice for Children and Youth. Available: (filter for Position Statements)