Related Service
Consultation
Strategies for successful
integrated practice
Goals for session
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Understand what related services bring to the
preschool classroom
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Training of OT/PT/SP
Resources they bring to the classroom
Explain the roles of therapists in early
childhood programs
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How therapists support teachers to achieve
optimal student learning
Goals for session
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Identify best practice models for related
service consultation
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Collaboration/problem solving versus expert
Shared responsibility
Flexible implementation
Appropriate use of paraprofessionals
Identify barriers to implementing these
models.
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Results of a recent Ohio survey
Goals for the session
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Explain what administrative supports can
promote effective consultation.
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Using your vision to empower staff
Critical system supports to make it happen.
Review and assess the research on related
services consultation.
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Studies of related services consultation
What do OT, PT & SLP bring to the
preschool classroom
Related service professionals use a clinical
reasoning/ problem solving approach to every
child and every situation.
OTs and PTs tend to focus on foundational
skills and physiological issues:
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Arousal/ attention
Activity level
Movement and posture
Eye-hand coordination
OT/PT/SLP training
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Therapists think broadly about function
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Often trained in medical schools
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Does the child have adequate stability to safely
get up and down from the floor, can he process
auditory input, can he zip and snap his jacket?
Bring a health perspective to the classroom
Receive extensive anatomy, neuroscience
coursework
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Understand human function from biomechanical
and neurological perspectives.
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Base intervention on careful analysis of
performance and activity demands.
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Need hands on, direct observation to consult on a
child’s program.
Child centered / family centered interventions
are emphasized.
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Use a clinical reasoning model that always begins
with the individual.
Therapists understand the medical
system, but do they understand the
educational system?
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Training therapists on services in schools is
highly variable across allied health programs.
School based practice is not a stated
standard in OT/PT accreditation standards.
How has PT training changed in
recent years?
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All PT programs are doctoral level (by 2020).
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A goal of the DPT is to allow PTs to move into
independent practice.
Early childhood programs may be in a
position of hiring more contract PTs who own
their own practice.
What is the extra year of PT training?
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Diagnostic courses, evidence based practice,
research, medical specialization.
OT and SP training
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Training is primarily at the masters level.
Curricula emphasize science based practice
and evidence based practice.
Therapists are trained to work across settings
(nursing home, hospital, school,
rehabilitation)
They are trained to work with all age groups.
When does medical background
present as an issue?
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OT/PT/SP are best integrated into the
education system when they are employed
by the school district.
Contract therapists, who also work in a
medical center, have a difficult time making
the shift to educational practice.
Contract therapists need to spend time with
teachers in school buildings to understand
the culture, the rules, the system (not always
feasible when paid by the hour)
What do therapists bring to the
early childhood classroom?

Children with medical
needs
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Understanding of
medical issues, how to
accommodate the
equipment, positioning.
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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.
What are roles of therapists in
support of the teaching staff?
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Indirect services (to teaching staff and team)
on behalf of the child
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May reframe the child’s problems; identify and
explain underlying impairments.
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What is perceived as behavior may reflect difficulty in
sensory processing
Behaviors may reflect disorders in motor planning,
arousal, sensory processing.
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.
Sensory corner for child to
calm
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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.
Consultation Styles
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Technical assistance
TA is most appropriate when:
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Defined problem
Equipment needs
May be short-term
Examples:
Create Intellikeys program
Problem solve how child will use new wheelchair
on the playground.
Consultation styles
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Collaborative consultation
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Uses the problem solving method
Requires a relationship of parity
Requires trust and follow through
All parties take responsibility for outcomes
Requires understanding of each others’ roles.
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Examples of collaborative consultation
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Development of a behavioral plan for child with
ADHD
Adapting the preschool space for a child with
severe cerebral palsy in wheelchair.
Creating adapted methods for child with low vision
to participate in snack, playground, art, circle.
Best practice consultation
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Consultation is a structured type of teaming
Begins with establishing a relationship.
Works best when trust and respect have
been established.
The relationship should be one of parity and
mutual respect.
How does consultation work?
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Teachers seek OT/PT/SP involvement early,
prevent problems from escalating.
Teachers and therapists need opportunities to
engage in collaborative problem solving and
functional analysis of behavior.
Child’s problem is understood in
the context of the environment
and the curriculum
Child
Preschool curriculum
Social and physical environment
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)
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Monitoring progress: Both monitor behavior
and progress.
Assessment: Meet to assess effectiveness of
strategy and move to next strategy or plan to
continue
Flexible scheduling
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Consultation involves moving in-between
direct services (activities with the child) and
indirect services (instructions to teaching staff)
It requires frequent monitoring, data collection,
and team interaction.
Flexible Scheduling
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Works best with a 3 and 1 or other flexible
scheduling model.
The 3 and 1 model defines collaboration as a
priority.
Opportunities to collaborate were cited as one
of the biggest barriers to using the
consultation model in recent survey of schoolbased OTs.

Holland (2007)
Appropriate use of
paraprofessionals
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Paraprofessionals should be asked to perform
only techniques that can be easily and safely
implemented.
Should not be given programs likely to result in
rapid change and need for frequent upgrading of
the program
Therapists have certain legal restrictions on how
they can use aides/assistance. Supervision is
required by licensure law, but is loosely defined.
Myths Dispelled
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Consultation takes less time than direct
intervention methods.
Consultation means handing off the problem.
Consultation is not needed until the teacher
can not manage the problem.
Therapists are needed only when a child is
failing to make progress.
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.

Holland (2007)
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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.
Example of consultation for
behavior problem
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Illustrates what an occupational therapist
might bring to problem solving to complement
skills of the teaching staff.
PROBLEM:
Child pushes and hits a child who
sits too close to him during circle
time
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Teacher and OT complete a functional
analysis to identify a basis for the behavior
and to implement a strategy to prevent his
pushing/hitting.
ANTECEDENTS
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Is child angry?
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Child does not appear angry. The children close to
him did nothing to cause anger. NO.
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ANTECEDENTS
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No apparent antecedents other than a child sat
close to him.
Possible cause is sensory defensiveness or
hypersensitivity to touch.
In other situations, the child appears
uncomfortable with touch and avoids being
touched
REINFORCEMENTS
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Teacher attention
Therapist attention
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REINFORCERS
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Pushing/hitting another child is reinforced
because the child does not sit near him again.
Child next to him moves away from him
Antecedent (cause) takes priority:
How can the teachers and peers
accommodate this child’s hypersensitivity?
SOLUTIONS FOR THIS
HYPERSENSITIVE CHILD
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PROCESS:
The teacher and occupational therapist meet
to collaborate on a plan.
Both identify ways to modify the environment
The therapist identifies interventions that use
a sensory processing approach.
The combination of approaches is likely to be
most effective and to address causative
factors and avoid negative consequences.
SOLUTIONS
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Because hitting is serious, the child should be
allowed to sit apart from the other children.
The teachers uses carpet squares to define
the space for each child.
The child is provided with sensory strategies
to decrease his hypersensitivity.
The teacher looks for signs that he is overstimulated or uncomfortable with touch and
gives him opportunities to escape and calm.
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.
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Davies and Gavin (1994) also found no
difference in the gains made by preschool
children when they received direct services
OT compared to a group with consultation OT
services.
Both groups made significant progress in fine
and gross motor performance.
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.