Autism Topics Part 2: Occupational Therapy Service Provision in an Educational Context Topic 2: Collaboration in the School Setting for Students With an Autism Spectrum Disorder Patti LaVesser, PhD, OTR 1 Learning Objectives 1. Recognize the changes that have occurred in school-based occupational therapy practice as related to services for children with autism with the passage of amendments to the Individuals With Disabilities Education Improvement Act of 2004 (IDEA 2004). 2. Recognize the importance of school-based team collaboration and the role occupational therapists play in collaborating with others to promote success for the student with an autism spectrum disorder (ASD) in the general education setting. 3. Identify the skills necessary for an occupational therapist to be an effective team member in providing services to children with autism in the school setting. 4. Identify intervention strategies using team collaboration concepts for a child with an ASD in the school setting. 2 Introduction Read Chapter 21, pp. 627 631 More students with an ASD are in school systems because of increased prevalence of the disorder and better identification methods. Occupational therapists need to understand autism, IDEA 2004, and their roles in school intervention. 3 1
IDEA 2004 Emphasis on services in naturally occurring contexts Emphasis on what students with an ASD need to be able to do to participate fully in school contexts and activities Emphasis on collaborative planning and teamwork Need for service delivery to include consultation with teachers, families, other professionals, and administrators. 4 School-Based Collaboration School based collaboration is an interactive team process that focuses student, family, education, and related services partners on enhancing the academic achievement and functional performance of all students in school. (Hanft & Shepherd, 2008, p. 3) 5 Collaborative Practice: Team Building Voluntary participation Equality among members Common purpose Joint responsibility for outcomes Shared resources Collective decision making. (DeBoer & Fister, 1995; Shepherd & Hanft, 2008) 6 2
Collaborative Practice: Strategies Mentoring: Emphasis on advising and counseling. Coaching: Emphasis on facilitating and reflecting. (Brockbank & McGill, 2006; Shepherd & Hanft, 2008) 7 Collaborative Practice: Challenges Interpersonal Unwillingness to share expertise Coming across as a boss or supervisor Personal Reluctance to change familiar therapy practice Difficulty managing time or resources System An excessive caseload that doesn t allow for team supports Collaboration viewed as secondary to hands-on services (Dettmer, Thurston, & Sellberg, 2005; Fishbaugh, 2000; Friend & Cook, 2007) 8 Collaborative Practice: Occupational Therapy Roles Hands-on services for students (direct services) In context of school activities and routines Out of context Team supports (consultation, monitoring) Used by one team member to enhance competency of another team member System supports (consultation) Initiatives, programs, and communications (Hanft & Shepherd, 2008) 9 3
Team Assessment For a child with an ASD, the team includes the child and parents and may also include an occupational therapist, a school psychologist, special education and general education teachers, a speech language therapist, a physical therapist, and others. The purpose of the evaluation process is to determine the student s needs so he or she can perform within the school setting (curricular and extracurricular activities). (Swinth, 2010) 10 Team Assessment (cont.) Read Chapter 11, pp. 285 304. The role of occupational therapists in evaluation of individuals with an ASD is endorsed by many professional organizations. Methods of evaluation include Record review, Skilled observation, Interviews, and Standard measures. (American Occupational Therapy Association, 2008; Watling, 2010) 11 Team Assessment (cont.) Read Boxes 11.3 11.16 on pp. 292 299. Interview questions related to education should include the areas of Academic strengths and weaknesses, Relationships with teachers and peers, Modifications used, and Visual supports or attention to routines. Interview questions should also include schoolrelated adaptive skills, social participation, play, and prevocational needs. 12 4
Intervention Key considerations for school-based occupational therapy intervention: School-based occupational therapy services are directed to support a child s success in school and in after-school activities. Occupational therapists are part of a team for service delivery. Intervention needs to be provided in context whenever possible (e.g., in the classroom, on the playground, in the cafeteria, or on the bus) and involve related school personnel. (Swinth, 2010) 13 Intervention (cont.) For the child with autism in the school setting, the Ziggurat Model, which outlines five hierarchical levels of intervention, is useful: 1. Sensory differences and biological needs 2. Reinforcement 3. Structure and visual/tactile supports 4. Task demands/environmental modification 5. Skill development (Myles, Grossman, Aspy, Henry, & Coffin, 2007; Swinth, 2010) 14 Case Study Blake is a 7-year-old boy diagnosed with an ASD. He attends his neighborhood school where he is enrolled in an inclusive 2nd-grade classroom (Daby, 2010). 1. Review Blake s strengths and areas of difficulty, which were identified through the team evaluation process; see Slides 16 and 17. 2. Download and complete the Team Collaboration Worksheet provided on the CD. 15 5
Case Study (cont.) Blake s strengths include the following: He is an intelligent, curious, funny, and loving child. He is very interested in knowing how things work and asks great questions (e.g., interested in school keys, door locks, computer cables, pencil sharpeners). He appears to enjoy being around his peers and wants to make friends (doesn t always know how). He is creative and has an advanced vocabulary. 16 Case Study (cont.) Blake s areas of difficulty include Joining in activities (classroom, physical education, and playground); Needing to do things his way when playing or working; A strong desire to touch other students, rock in chairs, touch walls as he walks, and seek hugs; Becoming easily overwhelmed by noise, changes in the schedule, and transitions between activities; Getting his work done in allotted time has some fine motor/handwriting difficulties; Poor frustration tolerance and frequent meltdowns; and Difficulty talking with peers about things that interest them. 17 Worksheet 1. Stop the CD and print the Team Collaboration Worksheet included on the CD. 2. Note that Blake s areas of difficulty have been sorted on the worksheet to reflect the five levels of the Ziggurat Model. 3. Follow the instructions on the worksheet to complete it. 18 6
Sensory Differences and Biological Needs Specific difficulties: Seeks sensory input Easily overwhelmed by noise (e.g., cafeteria). Intervention ideas: In-service program to team members or all school staff the Alert Program; teach to child (hands on [HO], team support [TS], system support [SS]) Sensory strategies and other regulation tools (TS) Schedule for sensory breaks throughout the day (e.g., errands to the office; pencil sharpening duty) (TS) Lunch in the classroom with a few peers (HO, TS). 19 Reinforcement Specific difficulties: Frequent meltdowns Decreased frustration tolerance Getting work done in allotted time. Intervention ideas: Behavior checklist; communication log (TS) Sticker chart (use key stickers to earns points to unlock treasure chest at the end of the day) (TS) Earn points toward favored activity (sharpening pencils) (TS) All staff reinforce good behavior consistently (TS) In-service program for team or all staff on use of behavior principles with children with an ASD (TS, SS). 20 Structure and Visual/Tactile Supports Specific difficulties: Transitions Joining in classroom activities Following instructions. Intervention ideas: Classroom schedule listed on board; use of timer to warn of approaching transition (TS) Set up peer buddy routine for joining in activities (TS) Visual schedule for required physical education activities (TS) Written instructions to supplement instructions provided orally (TS). 21 7
Task Demands and Environmental Modification Specific difficulties: Joining in classroom and playground activities Talking with peers Sensory issues (noise, touching others) Getting work done in allotted time. Intervention Ideas: Institute Circle of Friends curriculum (TS, SS) Assign peer buddy (TS, SS) Modify seating arrangements (TS) Take test out of room; break up assignments into smaller components; use computer as needed (TS). 22 Skill Development Specific difficulties: Needing to do thing own way Poor frustration tolerance; emotional meltdowns Talking to peers Fine motor difficulties. Intervention Ideas: Social skills groups; social stories; skill rehearsal (HO, TS) Practice positive self-talk; strategies to prevent meltdowns (HO, TS) Practice fine motor skills during art/writing time (HO, TS) In-service program to share ideas and resources with teachers or curriculum committee (TS, SS). 23 Summary The case study illustrates collaborative team planning of intervention for a child with an ASD in the school system. The Ziggurat Model provides one way of framing the strengths and challenges faced by children with an autism spectrum diagnosis to guide development of intervention ideas. The case study interventions illustrate how hands-on interplays with team supports and system supports. 24 8
Data Collection Read Chapter 24, pp. 743 776. Data gathering Formative evaluation data Summative evaluation data. Progress monitoring Define the behavior of interest Gather baseline data and document current performance Collect data; graph data Make decisions based on child s performance over time. (Clark, 2010; Linder & Clark, 2000; Moyers & Dale, 2007; Shapiro, 2008) 25 Early Intervening Services Read Chapter 21, pp. 638 639. Response to Intervention Services provided to struggling students not in special education as early as possible. Generally used three-tiered approach to support: Tier 1: Core instruction emphasizing preventative and proactive interventions Tier 2: Targeted group intervention with some at-risk students Tier 3: Intensive individual intervention. (Clark, 2008; Swinth, 2010) 26 Other Team Possibilities: Early Intervention An interdisciplinary team approach, with family members as an integral part of the team, is often used in early intervention practice. Children with an ASD are not often identified early enough to qualify for early intervention services, but work is progressing on the early identification of these children. 27 9
Evidence to Support Collaboration Bayona, McDougall, Tucker, Nichols, & Mandich (2006) Case-Smith (2002) Davies & Gavin (1994) Dreiling & Bundy (2003) Dunn (1990) Fertel-Daly, Bedell, & Hinojosa (2001) Kemmis & Dunn (1996) King et al. (1999) Oliver (1990) Palisano (1989) Vandenberg (2001) 28 Summary and Conclusion Occupational therapists play an important role in school-based teams working with children with ASDs. Collaboration with a team of professionals to provide the best possible services for children with an ASD requires commitment on the part of each team member to a shared goal. It is the conduit through which professionals can ensure that students receive the most effective educational services to which they are entitled. (Friend, 2000, p. 132) 29 References American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625 683. Bayona, C., McDougall, J., Tucker, M., Nichols, M., & Mandich, A. (2006). School-based occupational therapy for children with fine motor difficulties: Evaluating functional outcomes and fidelity of services. Physical and Occupational Therapy in Pediatrics, 26(3), 89 110. Brockbank, A., & McGill, I. (2006). Facilitating reflective learning through mentoring and coaching. Philadelphia: Kogan Page. Case-Smith, J. (2002). Effectiveness of school-based intervention on handwriting. American Journal of Occupational Therapy, 56, 17 25. Clark, G. F. (2008). Getting into a collaborative school routine. In B. Hanft & J. Shepherd (Eds.), Collaborating for student success: A guide for schoolbased occupational therapy (pp. 105 138). Bethesda, MD: AOTA Press. 30 10
References (cont.) Clark, G. F. (2010). Using data to guide your decisions. In H. M. Kuhanek & R. Watling (Eds.), Autism: A comprehensive occupational therapy approach (3rd ed., pp. 743 776). Bethesda, MD: AOTA Press. Daby, K. (2010). The Ziggurat Model and Comprehensive Autism Planning System: A case study. Retrieved October 4, 2010, from www.ttac.vt.edu/documents/autism_docs/the_ziggurat_model_ Comprehensive_Autism_Planning_System.pdf Davies, P., & Gavin, W. (1994). Comparison of individual and group consultation treatment methods for preschool children with developmental delays. American Journal of Occupational Therapy, 48, 155 161. DeBoer, A., & Fister, S. (1995). Working together: Tools for collaborative teaching. Longmont, CO: Sopris West. Dettmer, P., Thurston, L., & Sellberg, N. (2005). Consultation, collaboration, and teamwork for students with special needs (5th ed.). Boston: Allyn & Bacon. 31 References (cont.) Dreiling, D., & Bundy, A. (2003). A comparison of consultative model and direct indirect intervention with preschoolers. American Journal of Occupational Therapy, 57, 566 569. Dunn, W. (1990). A comparison of service-provision models in school-based occupational therapy services: A pilot study. Occupational Therapy Journal of Research, 10(5), 300 320. Fertel-Daly, D. Bedell, G., & Hinojosa, J. (2001). Effects of a weighted vest on attention to task and self-stimulatory behaviors in preschoolers with pervasive developmental disorders. American Journal of Occupational Therapy, 55, 629 640. Fishbaugh, M. (2000). The collaboration guide for early career educators. Baltimore: Paul H. Brookes. Friend, M. (2000). Myths and misunderstanding of professional collaboration. Remedial and Special Education, 21, 130 132. Friend, M., & Cook, L. (2007). Interactions: Collaboration skills for school professionals (5th ed.). Boston: Allyn & Bacon. 32 References (cont.) Hanft, B., & Shepherd, J. (2008). 2 4 6 8 How do you collaborate? In B. Hanft & J. Shepherd (Eds.), Collaborating for student success: A guide for school-based occupational therapy (pp. 1 34). Bethesda, MD: AOTA Press. Idol, L. (1990). The scientific art of classroom consultation. Journal of Educational and Psychological Consultation, 1, 3 22. Individuals With Disabilities Education Improvement Act of 2004, Pub. L. 108-446, 20 U. S. C. 1400 et seq. Kemmis, B. L., & Dunn, W. (1996). Collaborative consultation: The efficacy of remedial and compensatory interventions in school contexts. American Journal of Occupational Therapy, 50, 709 717. King, G., McDougall, J., Tucker, M. A., Gritzan, J., Malloy-Miller, T., Alambets, P., et al. (1999). An evaluation of functional, school-based therapy services for children with special needs. Physical and Occupational Therapy in Pediatrics, 19(2), 5 29. 33 11
References (cont.) Linder, J., & Clark, G. F. (2000). Best practices in documentation. In W. Dunn (Ed.), Best practice occupational therapy (pp. 135-145). Thorofare, NJ: Slack. Moyers, P., & Dale L. (2007). The guide to occupational therapy practice (2nd ed.). Bethesda, MD: AOTA Press. Myles, B. S., Grossman, B. G., Aspy, R., Henry, S. A., & Coffin, A. B. (2007). Planning a comprehensive program for students with autism spectrum disorders using evidence-based practice. Education and Training in Developmental Disabilities, 42(4), 398 409. Oliver, C. E. (1990). A sensorimotor program for improving writing readiness skills in elementary-age children. American Journal of Occupational Therapy, 440, 111 117. Palisano, R. (1989). A comparison of two methods of service delivery for students with learning disabilities. Physical and Occupational Therapy in Pediatrics, 9, 79 99. 34 References (cont.) Shapiro, E. (2008). Best practices in setting progress monitoring goals for academic skill improvement. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology (Vol. 5, pp. 141 157). Bethesda, MD: National Association of School Psychologists. Shepherd, J., & Hanft, B. (2008). Teamwork vs. the Lone Ranger. In B. Hanft & J. Shepherd (Eds.), Collaborating for student success: A guide for schoolbased occupational therapy (pp. 73 104). Bethesda, MD: AOTA Press. Stackhouse, T. M., Graham, N. S., & Laschober, J. S. (2002). Occupational therapy intervention and autism. In R. L. Gabriels & D. E. Hill (Eds.), Autism: From research to individualized practice (pp. 155 177). Philadelphia: Jessica Kingsley. Swinth, Y. (2010). Occupational therapy in school-based settings for children with an autism spectrum disorder. In H. M. Kuhanek & R. Watling (Eds.), Autism: A comprehensive occupational therapy approach (3rd ed., pp. 627 663). Bethesda, MD: AOTA Press. 35 References (cont.) Vandenberg, N. (2001). The use of a weighted vest to increase on-task behavior in children with attention difficulties. American Journal of Occupational Therapy, 55, 621 628. Watling, R. (2010). Occupational therapy evaluation for individuals with an autism spectrum disorder. In H. M. Kuhanek & R. Watling (Eds.), Autism: A comprehensive occupational therapy approach (3rd ed., pp. 285 303). Bethesda, MD: AOTA Press. 36 12