Related Services
Consultation
Strategies for Successful
Integrated Practice
Jane Case-Smith, O.T.R., Ph.D.
The Ohio State University
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Children with assistive
technology needs
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Children who struggle with feeding or basic
functional skills.
Children with underlying
physiological problems
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Children with autism
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Focus on sensory
processing
Children with cerebral
palsy
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Focus on posture,
movement, strength,
transitions within the
school building, activities
of daily living.
Therapist roles in support of
teachers
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Provide information and materials
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Create handouts for recommendations
Provide information about a disability or diagnosis
Provide information about evidence based practices.
Teach alternative methods for instruction
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Introduce Picture Exchange Communication Systems
(PECS)
Help to write Social Stories
Assist in creating Intellitools programs
Tools that we recommend
for the classroom.
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Recommend modifications to the classroom
environment
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Suggest a bean bag chair for a child with sensory
needs
Suggest a tent for quiet time of children with high
activity levels.
Recommend a rocking chair for calming.
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Recommend adapting activities or materials
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Obtain adapted spoon, cups, plates.
Obtain easel for vertical surface drawing
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Provide support, encouragement
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Assure teaching staff that they are implementing
appropriate interventions for difficult medical issues.
Provide feedback about child response to teacherdesigned interventions.
Examples:
Create Intellikeys program
Problem solve how child will use new wheelchair
on the playground.
Therapist consultation requires
comprehensive evaluation
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Therapist needs to observe child in multiple
settings, at different times of day.
Interview with teacher is critical to obtain
her/his perspective of the problem.
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Consultation is based first on the teacher’s
perception of the problem.
The child’s problem must be viewed within the
demands of the preschool environment and the
curriculum.
How does consultation work?
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Interview with parent, other therapists and
staff may be helpful.
Problem solving: Teacher and therapist
engage in problem solving (brainstorm first)
and identify 1-2 strategies to try first.
Planning: Teacher and therapist identify who
is responsible for what action and who
collects data on the child’s response (shared
responsibility)
Barriers to collaborative
consultation and how
administrators can remove them
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Barriers
Teachers and
therapists do not know
each other’s roles
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Teachers and
therapists do not feel
parity, lack trust.
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Potential Solutions
Make sure therapists
are invited to school
events, in-services
Schedule regular social
activities.
Create a collaborative
culture
Work on equity issues,
pay, status, support
proximity.
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Barriers
Teachers and
therapists do not have
time to collaborate and
plan.
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Holland (2007)
Sometimes therapists
and teachers do not
value collaboration.
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Potential Solutions
Allow for and build in
planning time on a
regular basis
Use 3 and 1 model
(therapists see child for
3 weeks and then have
a week for meeting with
teacher).
Encourage creative use
of time, therapists meet
with teacher while
assistant runs class.
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Barriers
Teacher waits until
behaviors are
unmanageable.
Consulting therapist
does not take
ownership of the
problem
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Potential Solutions
Encourage use of
consultation when the
problem is first
identified to prevent
difficult situations.
Suggest that both
therapist and teacher
monitor/assess the
effects of the new
strategy or equipment.
Alternative solutions
should be offered.
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Barriers
Therapists are only
needed when the child
fails to make progress.
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Potential Solutions
Preventive services are
optimal.
Therapy services are
most effective when
intervention is early.
Is OT/PT/SP consultation an
effective service delivery
model?
Research on Consultation
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Dunn (1990) in a pilot study found that
children with OT on the IEP made the same
progress when a consultation model of
services delivery was compared to direct
services.
The teachers reported that they valued the
consultation model more than the direct
services model.
Research on Consultation
Outcomes
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Palisano (1989) compared 14 students who
received consultation with OT/PT to 19
students who received direct OT/PT therapy.
Following 6 months of once a week
intervention, both groups improved in motor
and visual perceptual skills.
The consultation group made greater gains in
gross motor skills.
Research on Consultation
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Consultation by related service personnel has
similar child outcomes to direct services.
Teacher outcomes are more positive with
consultation versus direct service.
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Teachers benefit from learning new techniques,
methods.
Teachers appreciate a collaborative approach.
Research on Consultation
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We have no evidence that consultation
requires less time, resources, or funding.
Use of consultation supports the
development of interdisciplinary approaches
to problems.
Consultation may support sustained effects of
related services intervention.
Consultation supports generalization of skills
and mastery of skills.
Summary
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OT/PT/SP bring a health and medical
perspective to early childhood programs.
Therapists are trained to analyze
performance and to reason by considering
the environment, the child, and the activity
demands.
Although they know child development and
human function well, they may not be
knowledgeable about the preschool
curriculum.
Summary
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Best practice consultation uses a problemsolving, collaborative approach
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Relationships are established.
The teacher’s perspective is provided first,
followed by assessment of the child and
environment.
The goal is to support the teacher to affect a child
outcome.
Uses collaborative problem solving process
Involves shared responsibility and shared data
collecting
Summary
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Administrators can support collaborative
consultation by:
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Allowing time for collaborative planning
Allowing flexible scheduling
Encouraging in-services for sharing of skills
among team members.
Fostering mutual respect and parity among all
school personnel
Allowing creative solutions in a child-first
environment.
References
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Davies, P.L., & Gavin, W.J. (1994). Comparison of individual
and group/consultation treatment methods for preschool children
with developmental delays. American Journal of Occupational
Therapy, 48, 155-161.
Dreiling, D.S., & Bundy, A.C. (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
Holland, T.L. (2007). Survey of Ohio School-based occupational
therapists to describe current practice patterns. The Ohio State
University.