Including Students with Severe Disabilities in Preschool Settings PA Department of Education 2007 Annual Conference: Effective Interventions: Meeting the Needs of ALL Students Wednesday, March 29, 2007 ♦ www.udel.edu/cds/conferences.htlm ♦ www.udel.edu/cds/conferences.htlm 1 What We’ll Cover This Afternoon ♦ The Big Picture in Inclusion ♦ Early Intervention, Early Childhood Education, and ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Inclusion Goals Good, best, and recommended practices in early childhood inclusion Benefits of inclusion Necessary components of inclusion Teams Professionalism and Collaboration Planning and Strategies for Children with Severe Disabilities Quality inclusive early care and education An example 2 3 My Office 4 5 But enough about me… What about you? But, REALLY—what about you? ♦ Three things to find out about your group: – Where are you from? – How long have you been involved in early childhood education? – What do you like about EI/HS? ♦ Groups of six (AGH!) ♦ Someone to lead ♦ Someone to record information ♦ Someone to watch the time and hold the group to the time ♦ Use whatever tools you can fashion ♦ One “participant-observer” who watches and will comment on the process 6 Oh, and one last thing… ♦Pay attention to how you are responding to this process But, REALLY—what about you? ♦ Three things to find out about your group: ♦ Six groups (AGH!) ♦ Someone to lead ♦ Someone to record information ♦ Someone to watch the time and – Where are you hold the group to the time from? – How long have you ♦ Use whatever tools you can fashion been working in ♦ One “participant-observer” who early watches and will comment on intervention/Head Start? the process – What do you like about EI/HS? 7 So, some questions about this… ♦ What were the answers to your questions? ♦ Did you want to do a good job at these tasks? ♦ What was your response? Energized? Frustrated? Bored? Asking, why in the world are we doing this? ♦ So—why in the world DID we do this? ♦ You know the story… – even if our work is solitary, we still work in teams and we need to function as members of a team 8 Croatia ♦ Mission: To close institutions and provide communitybased supports and services to children and adults with disabilities; the inclusion of persons with disabilities in general society with control of their services ensures they are equal citizens with equal rights. U.S. ♦ Mission: The Dubai ♦ Mission: The social advancement of services to children and adults with disabilities by ensuring the stability of service providers to be able to address the unexpected costs of business related to transportation, fuel, and other expenses ♦ and the increased wages of persons caring for individuals with disabilities. inclusion of all children and adults with disabilities by promoting comprehensive, quality communitybased services as an alternative to institutionalization. All children and adults with disabilities will live with the full rights of citizens and with full respect for their equal rights. Early Intervention, Early Childhood Education, and Inclusion Goals 9 Early Intervention, Early Childhood Education, and Inclusion Goals ♦ to support families in achieving their own goals for ♦ ♦ ♦ ♦ ♦ ♦ their children to promote child engagement, independence, and mastery to promote development in key domains to build and support children’s social competence to promote generalized use of skills to provide and prepare for normalized life experiences to prevent the emergence of future problems or disabilities What is your vision? What would you add to these goals? 10 Roots of Early Intervention and Inclusion in the United States ♦ Special Education (Behavioral analysis and therapeutic services) ♦ Compensatory Education (e.g., Head Start) ♦ Early Childhood Education (traditional preschool, developmentally appropriate practice, child-centered curricula) Shared Values/Principles/Foundations of Early Intervention/Preschool Education Family-centered services Normalization and services in natural environments Variety of service delivery models Diversity of children and families served Interdisciplinary and transdisciplinary service models Functional and developmental programming strategies Individualized programming Blending of philosophical perspectives (developmental, behavioral, ecological/functional) 11 History of early intervention: 1799-Wild boy of Aveyron 1840s-Seguin and Schools for Students with mental retardation Early 1900s-Settlement House Movement 1950s-Isolated public school programs 1958-Samuel Kirk publishes Early Education of the Mentally Retarded 1961-James McVicker Hunt publishes Intelligence and Experience 1965-War on Poverty begins 1965-First Head Start programs Early Intervention Law Public Law 90-538 (1968) Handicapped Children’s Early Education Assistance Act Public Law 92-142 (1972) Head Start Disabilities Requirement Public Law 94-142 (1975) Education for All Handicapped Act Public Law 99-457 (1986) Amendments to EHA and Infant/Toddler/Family Program Public Law 101-476 (1990), New EHA Title: Individuals with Disabilities Education Act (I.D.E.A.) Public Law 105-17 (1997), I.D.E.A. reauthorization I.D.E.I.A. (2004) 12 Evidence of E.I. Effectiveness ♦ Skeels and Dye, 1939 ♦ Model programs and Head Start ♦ Infant Health and Development Program (1990) ♦ E.I. studies, clinical and statistical significance ♦ Parental reports and satisfaction ♦ Family outcomes vs. child outcomes National and Local Issues in EI and Inclusion 13 Old Recommend Practices in Early Intervention ♦ Special education orientation ♦ Traditional assessment ♦ Academic orientation ♦ 1:1 instruction ♦ focus on skills and products ♦ Mass trial instruction ♦ Highly structured ♦ Adult initiated ♦ Isolate therapy ♦ Classroom teacher role ♦ Segregation New Recommended Practices in Early Intervention ♦ Blending of Special Education, Head ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Start and Early Childhood strategies Naturalistic assessment Play-based orientation Individualized, small group instruction/therapy Focus on interactions and process Activity-based intervention Lightly structured Child initiated, adult supported Integrated therapy Collaborative/consultative roles Inclusion 14 Early Care and Education Childbased Inclusive Early Services ♦ Natural context of services for children and families ♦ Opportunities for physical, communication, and social skill building ♦ With qualified teachers and aids, opportunities for cognitive skill building (specific skills such as literacy, numeracy, and prediction) ♦ Reduction in trips families need to make to acquire services for their children Inclusion/Integration Benefits ♦ For children with disabilities – Increase in language/communication skills – Increase in social skills – Increase in families’ satisfaction with programming – Increase in family contacts in the community 15 Inclusion/Integration Benefits ♦ For children without disabilities – Increase in language skills and communication abilities – Increase in social skills – Increase in tolerance of differences among individuals Sherita 16 17 Necessary Components for Strong Inclusive Partnerships ♦ Low staff:child ratios; ♦ small group sizes; ♦ associate or bachelor level ♦ ♦ ♦ ♦ trained teachers; low turn-over; well-educated directors and administrators Engaged, responsive interactions between teachers and children Planned, purposeful, goaloriented activities that emerge from children’s interests, activities, and backgrounds Challenges to Early Care and Education Services for Children with Severe Disabilities ♦ Skills and training of ALL staff ♦ Turn-over of ALL staff ♦ Resistance of staff program staff ♦ Resistance of families of children without disabilities ♦ Resistance of physicians and other rehabilitation providers ♦ Wide variation in overall quality of child care programs ♦ Lack of monitoring of child care program quality ♦ AND THE BIGGEST BARRIER: Our own attitude 18 Quality Profile of Center-Based Programs Serving 3 to 5-year-olds in Delaware 38.6% N=64 48.2% N=80 26.5% N=44 42.8% N=71 37.6% N=62 9.7% N=16 59.4% N=98 43.9% N=72 45.5% N=60 34.8% N=57 42.4% N=56 21.3% N=35 12.1% N=16 47.9% N=79 42.4% N=70 20.0% N=33 13.3% N=22 30.7% N=51 20.0% N=33 42.4% N=70 20.6% N=34 Figure Legend = rating of “poor” = rating of “mediocre” = rating of “good” Quality Profile of Center-Based Programs Serving Infants and Toddlers in Delaware 21.3% N=24 8.8% N=10 20.4% N=23 53.1% N=60 25.7% N=29 70.8% N=80 33.6% N=38 8.0% N=9 47.8% N=54 23.9% N=27 29.6% N=29 32.7% N=37 46.0% N=52 38.1% N=43 50.4% N=57 50.0% N=49 33.6% N=38 46.0% N=52 14.2% N=16 25.7% N=29 20.4% N=20 Figure Legend = rating of “poor” = rating of “mediocre” = rating of “good” 19 Quality Profile of Head Start Programs in Delaware Designed to Serve Children in Poverty and with Disabilities 62.2% N=51 36.6% N=30 1.2% N=1 52.4% N=43 34.1% N=28 43.9% N=36 18.3% N=15 50.0% N=41 75.6% N=62 6.1% N=5 6.1% N=5 13.4% N=11 68.3% N=56 65.9% N=54 69.1% N=38 17.1% N=14 31.7% N=26 29.1% N=16 14.6% N=12 2.4% N=2 1.8% N=1 Figure Legend = rating of “poor” = rating of “mediocre” = rating of “good” LaKwanda ♦ Undetermined diagnosis ♦ Polydactyl ♦ Tracheostyomy ♦ Gastrostomy ♦ Respiratory distress disorder ♦ Grade IV intercranial ventricular hemorrhage at birth 20 Teams: Models, Approaches and Key Elements Early Intervention Teamwork ♦ It is a MAJOR assumption of early intervention that NO ONE person, discipline, program, or agency can provide the support necessary for a family with a young child with a disability. 21 Team Characteristics ♦ Overall team goals ♦ Decision making abilities ♦ Level of sensitivity ♦ Participation of members ♦ Openness of ♦ Implementation of communication decisions ♦ Handling of conflict ♦ Responsibility to get ♦ Valuing of members work accomplished ♦ Evaluation of self ♦ Source of control and team ♦ Level of cohesion Essential TEAM Components ♦ All members share the same goals and purposes for working together ♦ The team functions by consensus decision making ♦ The team consistently carries out decisions jointly made 22 Interdisciplinary Teams ♦ Multiple professionals and family members working toward common goals ♦ Separately assess children ♦ Jointly discuss results and develop plans for intervention ♦ Individually write own sections of reports OT Assessment PT Educ. SLP Discuss Results and Set Goals OT PT Educ. SLP Child Report Report Report Report Complete Report Transdisciplinary.... ♦ “across disciplines” ♦ studying, learning, working, sharing, providing within one’s own discipline and other disciplines with which one has had exposure and knowledge 23 Transdisciplinary Approach ♦ a team approach to assessing and delivering services ♦ team members are willing to both teach others about their own skills and to learn and take on the roles from other disciplines; ♦ team members continuously communicate their expertise to others so that team members from other disciplines can use that knowledge. Characteristics of Transdisciplinary Intervention ♦ One primary provider works with family members ♦ Consultation occurs with other professionals as needed ♦ Co-intervention (treatment, teaching) occurs in order to share information and teach skills to both each other and the family ♦ Family members are also primary team members 24 Transdisciplinary Approach ♦ A team approach based on sharing of information and skills across disciplines in order to better serve the young child and her family. ♦ Characteristics – Information Sharing – Skill sharing and development – Role release and role sharing – Consultative model of service Levels of Transdisciplinary Services ♦ Role/discipline instruction ♦ Role modeling ♦ Role sharing ♦ Role release – – – – Swapping Enrichment Extension support 25 Transdisciplinary Role Release ♦ When one team member from one discipline teaches another team member from another discipline to conduct some of his or her services ♦ Team members share skills and learn from one another ♦ Role release can occur at the information level, the skill level, or the performance level Transdisciplinary Teams ♦ Parents and caregivers are team members ♦ Members are from at least two disciplines ♦ Members function as a team; decisions are made jointly ♦ Members share their perceptions of a child’s abilities ♦ Consensus is formed regarding a child’s abilities, concerns, and possible methods of intervention ♦ Consensus is formed regarding the services necessary to address desired goals and outcomes ♦ Members participate in “role-release” ♦ Members learn different perspectives of the child through the perceptions of their fellow team members 26 Transdisciplinary Organizational Structure ♦ No “departments” (e.g., OT department, speech department) are used in the transdisciplinary model ♦ Programs are organized by teams with multiple disciplines represented on each team ♦ Changes in approaches, interventions, and strategies are decided by all team members ♦ Teams are responsible for their budgeting, resource management, and outcomes Integrated, Cross-Domain Goals and Objectives ♦ Objectives are decided upon by the child’s function, not necessarily by developmental level ♦ Objectives should result in the child having more independence when they are achieved ♦ Objectives should allow the child to participate in natural environments ♦ Objectives should address skills across multiple domains of development ♦ Objectives are usually taught in context 27 Practices to Avoid for Transdisciplinary Teams ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ More than one primary service provider IFSPs and IEPs that have “PT outcomes,” “speech outcomes” Team members missing team meetings Team members who are reluctant to share information and reluctant to teach colleagues skills about their own discipline Team members who are reluctant to learn about other disciplines Planning or making changes to an intervention plan without the other team members, including the family Lack of time spent with fellow team members to discuss children’s progress and response to interventions Lack of time spent with the family; including time to teach how to be active members of the team Possible Drawbacks of Transdisciplinary Teams ♦ The approach is initially time intensive ♦ Team development takes months; ♦ Replacement of team members takes time to integrate the new members to the process ♦ Some professionals are reluctant to acquire new skills/roles ♦ Questions about legal liability of teaching others and implementing services not formally trained for ♦ Administrative budgeting questions 28 Barriers to Effective Teamwork ♦ Role expectations ♦ Discomfort with conflict ♦ Lack of negotiation skills ♦ Territoriality ♦ Insecurity Professionalism: Communication, Collaboration, and Consultation 29 Team Characteristics ♦ Overall team goals ♦ Decision making ♦ Level of cohesion abilities ♦ Participation of members ♦ Implementation of decisions ♦ Responsibility to get work accomplished ♦ Source of control ♦ Level of sensitivity ♦ Openness of communication ♦ Handling of conflict ♦ Valuing of members ♦ Evaluation of self and team Primary Teamwork Behaviors ♦ Communication---with team members, other staff, administrators, children, families, and other agencies. ♦ Cooperation--with team members, other staff, administrators, children, families, and other agencies. ♦ Consistency--with team members, other staff, administrators, children, families, and other agencies. 30 Teamwork Basic Guidelines ♦ Guideline 1: Staff of a program should be organized into teams serving discrete groups of children and their families. Each team should include all staff members who regularly provide services to that particular group ♦ Guideline 2: The total number of adults who serve each group of children and their families should be kept to a minimum. If possible, each staff member should serve on only one team. ♦ Guideline 3: Teams should be the organizational unit within a program; not departments. ♦ Guideline 4: Teams should be the basic administrative unit for both personnel management and program budgeting. The Team Meeting ♦ A proposal: – Team meetings are held regularly and are the number one priority of the team. – They are missed for no reason other than severe illness or personal emergency of the most significant nature. – Permission to miss a team meeting must come from the team and can only occur in advance. 31 Activity-Based Early Intervention: Scheduling Teaching in Natural Routines Program Planning for Young Children With Severe Disabilities Philosophical Foundations Determining Staff to work on Objectives Planning Activities to Enhance Obj. Early Intervention Principles Establishing Goals and Objectives Embedding Objectives in Routines Determining Program Routines Collecting Data on Children’s Objectives Adapting and updating Objectives 32 Naturalistic Curriculum ♦Curriculum that is based on the – individual needs of the child – the environments within which the child spends times; and – the priorities of the child’s family Steps to Develop a Naturalistic Curriculum 1) Conduct an ecological assessment 2) Establish priorities for goals 3) Determine present levels of performance 4) Identify instructional objectives 5) Develop instructional plans 6) Develop an instructional schedule 7) Provide instruction 8) Evaluate skills learned and monitor for retention and generalization 33 To develop a program plan for a child with a disability, you need to know: ♦ where the child spends time and what the demands are of those settings ♦ the priorities of the child’s family for her skill development and behavior ♦ the developmental level of the child and what developmental sequences are expected as she progresses. Assessment Process to Determine Programming Outcomes/Goals Setting Demands Family Priorities Child’s Skills Outcomes/Goals 34 Activity-Based Intervention Approach Routine, planned, child-initiated activities (normal early childhood programming) Embedded intervention targets (children’s goals and objectives) Logical antecedent & consequences (normal cues/directions and rewards) Generative/functional skills Embedding Objectives ♦ The strategy of incorporating a child’s skill/behavior objectives within the daily program routine ♦ Embedding identifies when and where a child’s objectives can be addressed and who will be responsible for addressing them 35 Steps to Embed Objectives within the Program Routine 1. Identify the routines of the day (general activities and schedule). 2. Review each child’s objectives 3. Identify when, during the routines of the day, each child's’ objectives can be addressed 4. Determine what activities can be planned during the identified routines to foster the acquisition of the objectives 5. Determine what teaching strategies are necessary to foster the acquisition of the objectives 6. Assign staff to assist children in their acquisition of skills Organizing the Day to Meet Children’s Individual Objectives ♦ Ensure that everyone on staff knows the daily schedule ♦ Ensure that everyone knows the children’s objectives ♦ Ensure that everyone knows at what times during the schedule there are opportunities for staff to assist children to meet their objectives ♦ Plan activities within your schedule that will help children to meet their objectives 8:30 Arrival 8:40 Breakfast 9:10 Morning Circle 9:30 Centers 10:30 Story Circle 10:50 Outside 11:30 Clean-up 11:45 Lunch 36 Team Ideas that Can Help ♦ Post staff schedules ♦ Decide which staff are responsible for which children or activities ♦ Post children’s objectives so everyone is aware of them ♦ Post a schedule that shows what objectives can be worked on during which activities Adapting Materials ♦ Brighten, make more reflective ♦ Increase texture ♦ Decrease texture ♦ Add handles, knobs, Velcro ♦ Increase size ♦ Add an auditory component ♦ Simplify 37 Adapting Planned Activities for Young Children with Severe Disabilities ♦ Review the child’s (children’s) objectives ♦ Determine which of the objectives might possibly be met during the activity ♦ Pinpoint what changes or adaptations need to be made to address the child’s objective ♦ Determine what combination of MATERIALS, EQUIPMENT, PROCEDURES, STAFF BEHAVIORS, or PEER BEHAVIORS will need to be adapted to address acquisition of the objective(s) Obligations of the IFSP & IEP That all services will be provided That classroom and family activities will be conducted that promote the acquisition of the stated objectives That professional effort will be made to assist the child in meeting the stated objectives That children’s progress will be documented We promise... 38 Activity-Based Intervention Approach Routine, planned, child-initiated activities (normal early childhood programming) Embedded intervention targets (children’s goals and objectives) Logical antecedent & consequences (normal cues/directions and rewards) Generative/functional skills Embedding Objectives ♦ The strategy of incorporating a child’s skill/behavior objectives within the daily program routine ♦ Embedding identifies when and where a child’s objectives can be addressed and who will be responsible for addressing them 39 What IS a quality Early Care and Education Program? ♦ Plan and implement curriculum specifically to develop children’s social, emotional, cognitive, physical, and language abilities ♦ Staff have responsive, interpersonal relationships with the children they serve – They listen – They get down to the child’s level – They respond to both verbal and non-verbal interactions – They initiate and continue interactions with children – They expand children’s communications – They place child-teacher interactions above all else except the health and safety of children What IS a quality Early Care and Education Program? (cont.) ♦ Child-teacher ratios allow for quality program planning and interaction: – Infants: 1 teacher to three infants – Toddlers: 1 teacher to four toddlers – Preschoolers: 1 teacher to eight preschoolers – Kindergarten/1st grade: 1 teacher to 12 children – School-age: 1 teacher to 15 children ♦ Highly trained and experienced teachers ♦ A program structure that supports teachers as they plan and implement curriculum 40 What IS a quality Early Care and Education Program? (cont.) ♦ Opportunities for teachers to continue their education ♦ Supervision of teachers that provides them with on-going feedback, opportunities to self-critique, and resources to improve their teaching ♦ Management practices that oversee all operations of the program (fiscal, service, family interactions) and provide the support for staff to improve their skills ♦ Management that removes staff that do not perform to quality levels ♦ flexibility of programs to meet individual needs of children ♦ inclusion of children of all abilities, including those with specific disabilities What IS a quality Early Care and Education Program? (cont.) ♦ Excellent family-program relations ♦ Incorporation of families’ cultures, backgrounds, and preferences ♦ Appropriate materials and equipment to address children’s needs ♦ Preventative environments and interactions that promote positive behavior ♦ Safe and healthy environments 41 Some possible strategies to increase quality ♦ Provide concentrated, on-going, targeted continuing education for staff that includes: – Child development information – Curriculum assessment, development, implementation, and evaluation skills – Emergent curriculum knowledge and skills – Specific training in language, literacy and cognitive development – Move staff toward AT LEAST an associates degree in early childhood education (not another field) ♦ Hire teachers with at least an associates degree AND knowledge and experience with children (no one under 21 years of age) Some possible strategies to increase quality (cont.) ♦ Individualized teacher staff development plans to enhance their knowledge and skills ♦ Resources for workshops, conferences and other training opportunities ♦ Provide time for planning and curriculum development and expect that teachers will develop plans; review those plans ♦ Reduce teacher-child ratios (see above) ♦ Provide rich, flexible, age-appropriate materials and equipment for teaching staff 42 Some possible strategies to increase quality (cont.) ♦ Program management that is highly knowledgeable about child development, emergent curriculum, individualization of instruction, and supervision ♦ Management structures that provide on-going feedback to staff including observations that occur weekly with feedback ♦ Management staff that know and use reflective supervision ♦ An organization that does not tolerate low quality service, poor consumer interactions and responsiveness and/or interactions that do not promote children’s development Some possible strategies to increase quality (cont.) ♦ Full integration of families’ cultures, backgrounds, and preferences in program implementation ♦ Inclusion of services to all levels of child ability and background ♦ Programs that put in place pro-active positive behavior management strategies ♦ Development of high quality familyprogram communications; development of a home-visiting program 43 Ensuring High Quality Inclusive Services ♦ Meaningful partnerships with children’s families and specialists ♦ Teachers with associate or bachelor degrees in early care and education and significant knowledge of child development and curriculum development and implementation ♦ Programs that embrace and incorporate the cultures and communities of the children they serve Ensuring High Quality Child Care and Early Intervention (continued) ♦ Program directors with advanced expertise and experience in early care and education, including the ability to manage and lead ♦ Excellent capacity to address language, literacy, and numeracy components of children’s development ♦ Excellent capacity to address socialemotional components of children’s development ♦ On-going training and development for teachers and administrators that focus on special needs 44 University of Delaware Early Learning Center ♦ Child care center for 225 children birth to 12 years of age ♦ 20% children with disabilities ♦ 40% children living in poverty ♦ provides state of the art, evidence-based, education, prevention, and intervention services ♦ Currently conducts 18 research studies within the Center focusing on neurological development; PT, OT, and speech treatments strategies, and a host of other topics ♦ Currently provides training to over 2,000 undergraduate and graduate students through clinical and research experiences each semester ♦ Currently provides training and technical assistance early care and education providers throughout the state University of Delaware Early Learning Center Examples ♦ 4 year old with Down syndrome ♦ 28 month old toddler with spastic diplegic cerebral palsy and blindness ♦ 10 month old infant with visual impairment, mild cerebral palsy and a 40% cognitive delay 45 Contact Information Karen Rucker, Director University of Delaware Early Learning Center 489 Wyoming Avenue Newark, DE 19716 USA krucker@udel.edu +1 302 831 6205 Michael Gamel-McCormick, Director Center for Disabilities Studies 166 Graham Hall University of Delaware Newark, DE 19716 USA mgm@udel.edu +1 302 831 6500 www.udel.edu/cds ♦ www.udel.edu/cds/conferences.htlm ♦ www.udel.edu/cds/conferences.htlm 46