Integrated Specialized Services 2005 Inclusion Institute Chapel Hill, NC Peggy Freund, Ph.D. National Individualizing Preschool Inclusion Project Center for Child Development Vanderbilt University

Integrated specialized services is most successful when provided as a component of the Individualizing Inclusion Model Definition When therapy or specialized instruction When therapy or specialized instruction –Occur in the classroom –With other children usually present –Within the context of ongoing routines and activities

Picture is worth a thousand words

Specialized Services are integrated when: Physical and occupational therapists incorporate opportunities to practice motor goals into daily activities with classmates present Physical and occupational therapists incorporate opportunities to practice motor goals into daily activities with classmates present A speech therapist joins a child in free play to work on generalizing a skill to a new setting A speech therapist joins a child in free play to work on generalizing a skill to a new setting Specialists and teachers together discuss a current concern, develop strategies, try them out, and evaluate success Specialists and teachers together discuss a current concern, develop strategies, try them out, and evaluate success

Who - Everyone’s Roles Who - Everyone’s Roles Therapist and specialist – support caregivers through Therapist and specialist – support caregivers through –Informational support –Material support –Emotional support Teacher – teach and care for children, embed intervention into developmentally appropriate routines Teacher – teach and care for children, embed intervention into developmentally appropriate routines Administrators – support teachers and specialists Administrators – support teachers and specialists Parents – teach everyone about their child and learn from teachers and specialists Parents – teach everyone about their child and learn from teachers and specialists

How - Service Delivery Models 1 on 1 pull-out 1 on 1 pull-out Small-group pull-out Small-group pull-out 1 on 1 in classroom 1 on 1 in classroom Group activity Group activity Individualized within routines Individualized within routines Pure consultation Pure consultation

Models of Service Delivery ModelDescription IndividualPull-out Specialist takes child out of classroom and works with him/her without regard to classroom activities and without peer involvement. Teacher might receive information from specialist at end of session. Small Group Pull-out Specialist takes focal child and at least one other child (with or without special needs) out of the classroom. Teacher might receive information from specialist at end of session.

Models of Service Delivery ModelDescription 1-on-1 in Classroom Specialist stays in classroom but works with child individually, in separate area of the room away from the rest of the class. Peers are present in the classroom but not involved in therapy. Teacher conducts activities with other children and might receive information about session when it is over. Group Activity Specialist works with small or large group of children (with or without special needs) in the classroom. Emphasis placed on meeting special needs of one or more children and peer interactions. Teacher observes, participates in group activities, and might help specialist plan activities.

Models of Service Delivery ModelDescription Individualized Within Routine Specialist works with child in classroom during ongoing classroom routines (i.e., in the activity that the child is naturally involved in). Peers are present and usually involved. Teacher observes specialist’s interactions with child and exchanges information during or after session. Pure Consultation Specialist talks to classroom teacher about topics related to needs of focal child. Consultation can occur in the classroom or in another location and can include observation. Topics are initiated by either specialist or teacher and concerns, priorities, and recommendations are discussed.

Purposes of Therapy To help children and families achieve their goals To help children and families achieve their goals To provide support to regular caregivers so they can help the child To provide support to regular caregivers so they can help the child To provide expert consultation to other professionals To provide expert consultation to other professionals

Basic Principles Intervention occurs between specialist’s visits Intervention occurs between specialist’s visits Therapy and instruction are not tennis lessons Therapy and instruction are not tennis lessons Regular caregivers (parents and teachers) need to own the intervention goals Regular caregivers (parents and teachers) need to own the intervention goals

10 Plus Reasons for Integrated Services Children learn skills in places they will use them Children learn skills in places they will use them Children will have increased practice opportunities Children will have increased practice opportunities Children’s social relationships are fostered Children’s social relationships are fostered Children do not miss out on classroom instruction Children do not miss out on classroom instruction

10 Plus Reasons for Integrated Services Strengthens all team members, stretching them to be more knowledgeable and skillful in more areas Strengthens all team members, stretching them to be more knowledgeable and skillful in more areas Teachers can expand their skills by seeing what specialists do Teachers can expand their skills by seeing what specialists do Specialists can see if strategies are working Specialists can see if strategies are working

10 Plus Reasons for Integrated Services Communication between teachers and specialists increases – creating an avenue for collaboration Communication between teachers and specialists increases – creating an avenue for collaboration Teachers and specialists can focus on skills immediately useful for children Teachers and specialists can focus on skills immediately useful for children Specialists can work with teachers as problems arise Specialists can work with teachers as problems arise Elimination of therapy rooms Elimination of therapy rooms

Individualized Within Routines Most useful because: Most useful because: –Ongoing classroom activities are not disrupted –Children are engaged in normal activities –Can work within the context of the children’s engagement –Teachers can see how interventions fit into regular routines –Potential for high peer involvement –Specialists can assess child’s functioning in normal routines –Specialists can work with more than one child at a time

Emerging Consensus DEC Recommended Practices DEC Recommended Practices –Interdisciplinary Model Teams including family members make decisions and work together Teams including family members make decisions and work together Professionals cross disciplinary boundaries Professionals cross disciplinary boundaries Intervention is focused on function, not services Intervention is focused on function, not services Regular caregivers and regular routines provide the most appropriate opportunities for children’s learning and receiving most other interventions. Regular caregivers and regular routines provide the most appropriate opportunities for children’s learning and receiving most other interventions.

Emerging Consensus ASHA ASHA –“A natural setting must serve as the intervention context…” –“Services should be integrated with the natural setting such that intervention strategies can be implemented with the ongoing stream of activities typical for that setting” –“The design and delivery of services should involve collaboration with families and other professionals and support personnel…” (Wilcox & Shannon, 1996).

Evidence Base Child outcomes research Child outcomes research – Most child outcome studies comparing integrated to segregated services show little to no difference in outcomes – But, what difference is found, favors integrated services

Evidence Base Specialists’ Perspective Specialists’ Perspective –Professionals report they would ideally use more integrated practices than currently using (McWilliam & Bailey, 1994) But … –Most common model used is 1 on 1 pull out

Evidence Base Specialists’ Perspective Specialists’ Perspective – Specialists report they are likely to choose the model of service delivery on the basis of the child’s characteristics … but in fact most often it is Professionals’ discipline Professionals’ discipline Specific interventions Specific interventions Caseloads Caseloads Family preferences, and Family preferences, and Classroom characteristics that influence their choices (McWilliam & Bailey, 1994) Classroom characteristics that influence their choices (McWilliam & Bailey, 1994)

Implementation Functional Intervention Planning Functional Intervention Planning –Routines-based Interview –Functional goals Decide as a team to move to a more integrated approach Decide as a team to move to a more integrated approach Look at current practices Look at current practices

Current Practices Individualizing Inclusion Checklist - IndIA Individualizing Inclusion Checklist - IndIA Specialist Documentation Form (SDF) Specialist Documentation Form (SDF)

Individualizing Inclusion Checklist (IndIA)

Specialist’s Documentation Form (SDF)

Implementation Implementation Seek balance of power between teachers and therapists – reciprocal consultation Seek balance of power between teachers and therapists – reciprocal consultation Discuss expectations, roles, and responsibilities Discuss expectations, roles, and responsibilities Set aside sacred time for consultation Set aside sacred time for consultation Help families learn about integrated services Help families learn about integrated services

Consultation Checklist

Jacob, age 2 Articulation

Joshua, age 3 Outdoor play

Zach, age 4 Handwashing

Contact information (615) (615) Center for Child Development Center for Child Development – mid=342 mid=342http:// mid=342 National Individualizing Preschool Inclusion Project National Individualizing Preschool Inclusion Project –

Activity List three ways in which moving to an integrated approach is like remodeling your kitchen. List three ways in which moving to an integrated approach is like remodeling your kitchen.