1. 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

2. 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.

3. 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

4. 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

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

6. Collaborative Decision Making Process

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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)

16. 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 #)

17. 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.

18. 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

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

20. (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),
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

21. 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, 
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),
US Department of Education, 2016