Team Based Learning: Decision Making Across the Educational Lifespan for Children with Autism Tammy Blake, OTD, OTR/L Connie Johnson, PT, DscPT Patricia Laverdure, OTD, OTR/L, BCP Deborah Rose, PT, DPT March 9, 2019

Objectives Develop knowledge and skills that enable OT and PT practitioners to engage their school teams’ collective knowledge and expertise, provide evidence of best practices, and interpret policy and legislative mandates to problem-solve and make clinical decisions for students with autism and their families across the lifespan Analyze influencing factors that impact a student’s educational experience Discuss best practices in designing evaluation and choosing evidence based assessments and outcome measures across a student’s educational experience   Establish collaborative tools develop intervention plans and strategies to optimize performance, health, wellness and/or quality of life.

Analyze Influencing Factors: International Classification of Function Model Review ICF Q and A: What are common body structure function impairments? What are common activity restrictions? What are common participation restrictions? Name environmental and personal factors that influence activity

Analyze Influencing Factors: Common Language ICF and Physical Therapy Guide Occupational Therapy Practice Framework Body Function and Structures Performance Skills, Performance Patterns Activities Occupations Participation Environmental Factors Environment, Context Personal Factors Client Factors Review ICF Q and A: What are common body structure function impairments? What are common activity restrictions? What are common participation restrictions? Name environmental and personal factors that influence activity

Clear Decision Making Processes Support implementation of effective evidence based interventions Overcome implementation barriers Facilitate data based decision making (US Department of Education, 2016)

Collaborative Decision Making Process

Gather Data IDEA and ESSA What are the student’s, family’s, and school team’s concerns about his/her participation in the learning environment? IDEA and ESSA ~ Relevant and functional data across school environments ~ Data must come from multiple sources ~ Data must point to functional outcomes

Identify Strengths and Challenges Given what is known about the student’s diagnostic, developmental, and contextual factors that influence participation, consider the influences that might be impacting the student’s participation. IDEA and ESSA ~ Address function and participation in the classroom OT PT Guidelines ~ What does student want and need to do to actively and meaningfully participate

Evaluation IDEA and ESSA ~ Address all areas of suspected disability Authentic evaluation Natural contexts and environments Natural activities IDEA and ESSA ~ Address all areas of suspected disability ~ Evaluate skills that “directly assists” in determining educational needs ~ Use a variety of strategies

Strengths vs. Impairment Based Approach Identifies environmental supports and constraints Identifies gaps between student performance and supports Identifies internal and external assets, competencies, and resources Engages student’s motivation improving goal attainment, satisfaction, and QOL. Focus on disability rather than curricular demands, context, environment, and teacher expectation Focus on deficit rather than participation Leads to remedial approach Limits generalization of skill

Strengths vs. Impairment Based Approach Identifies environmental supports and constraints Identifies gaps between student performance and supports Identifies internal and external assets, competencies, and resources Engages student’s motivation improving goal attainment, satisfaction, and QOL. Focus on disability rather than curricular demands, context, environment, and teacher expectation Focus on deficit rather than participation Leads to remedial approach Limits generalization of skill

Assessment IDEA and ESSA Select tests and measures that avoid discrimination and bias (language, racial or cultural characteristics) Reflective of the student’s aptitude, achievement IDEA and ESSA ~ Test scores do not always paint the full picture ~ Scores do not “qualify” a student for services ~ Must provide a clear baseline

Autism What it is and what it’s not Lets ground them in statistics and info on autism. I added some relevant slides from some of my presentations but we can delete. What it is and what it’s not

Body Function/Structure Environmental Factors Health Condition Autism What is Autism? Activities Completing in tasks in isolation; Restrictive, repetitive and stereotyped routines Participation Limitations in social participation and activities school, home and community settings Body Function/Structure Decreased sensory processing, strength, coordination, motor planning, balance, mobility Personal Factors Limitation and restrictions in emotional regulation, volition, interests, task initiation, self-determination Questions: What are IEP program targets? Where do these tasks happen? How do they influence each other? What is student’s current educational programming/setting? What is student’s transition plan? What does the student like to do? What are the student’s current job opportunities? Which domain of the iCF do they occur in? Environmental Factors May require accommodation for access curriculum, work sites, social environments

Costs of Autism Spectrum Disorders in the United Kingdom and the United States US and UK The largest cost components for children were special education services and parental productivity loss. During adulthood, residential care or supportive living accommodation and individual productivity loss contributed the highest costs. Medical costs were much higher for adults than for children. OTHER COSTS Higher unemployment rate More likely to die in poverty Dependent on public assistance Live in isolation, Less involved in community Develop mental health issues and depression/anxiety Sedentary lifestyles lead to obesity, diabetes, heart disease, HTN (Beauscher, 2014)

Assessment Toolbox These may not include other measures that should be included. These are the ones I Have been using. Timed up and go: norms up to age 13 and brazililan, Timed up and down stairs: havent had 14 steps. Recommendations: Fitness Measures and Health Outcomes in Youth, Survey should include: measures of cardiorespiratory endurance, body composition and musculoskeletal fitness (BMI, waist circumference, skin fold thickness) Progressive shuttle run (or 20 meter shuttle run, submax treadmill, cycle erg) Musculoskeletal fitness: Hand grip strength Standing long jump test 30 second walk test (use NYC #)

Team Based Learning Activity Everyone’s perspective is important. Choose the best answer of the multiple choice questions. Decision making entails consideration of environmental and personal factors that vary greatly. Consider each answer and select the one you feel provides the best overall answer. Give reasons for your decisions, perhaps used to defend your decision making in an IEP, evaluation, staffing with team members. Consider, in your decision-making process, evidence based decision making, and implicit and explicit reasoning.

Identify Goals and Outcome Measures Focus shifts from impairment to participation Identify participation of meaning for the child, teacher and caregivers Describe participation in terms of engagement and the supports that enhance it and the barriers that inhibit it Describe the interaction between the supports and the barriers and its impact on meaningful and desired participation Prioritize successful and inhibited participation IDEA and ESSA ~ Goals based on clear baseline data ~ Identify the impact of interventions ~ Inform decision making

Data Collection IDEA and ESSA ~ Enables ongoing progress measurement Explicit Visual IDEA and ESSA ~ Enables ongoing progress measurement ~ Enables appropriate trajectory changes when necessary

(Srinivasan, Pescatello, & Bhat, 2014) Srinivasan, S., Pescatello, L., & Bhat, A. (2014). Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Physical Therapy, 94(6), 875-889. Seminal article: PA and exercise recommendations for autism Really translates to many youth that we have with disabilities. Our students have specific impairments related to their disability…in the case of autism they may have cognitive imapirmetns affecting awareness….and go on to explain the points Figure Contributing factors for obesity in children and adolescents with autism spectrum disorders (ASDs) and the direct and indirect pathways by which autism-specific impairments and environmental factors contribute to the development of obesity in individuals with ASDs. (Srinivasan, Pescatello, & Bhat, 2014) 20

References Beauscher, 2014 Johns Hopkins the Hub Sudha M. Srinivasan, Linda S. Pescatello, Anjana N. Bhat; Current Perspectives on Physical Activity and Exercise Recommendations for Children and Adolescents With Autism Spectrum Disorders, Physical Therapy, Volume 94, Issue 6, 1 June 2014, Pages 875– 889, https://doi.org/10.2522/ptj.20130157 Srinivasan, S., Pescatello, L., & Bhat, A. (2014). Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Physical Therapy, 94(6), 875-889. US Department of Education, 2016