Occupational Therapy and Early
Childhood Transitions
August 26, 2013
Collaboration of the Cradle to College and Career
Practice Group of the IDEA Partnership and the
AOTA Early Intervention Workgroup

Speakers
• Kathleen Flecky, OTD, OTR/L earned an Occupational Therapy
Doctorate (OTD) from Creighton University and has taught occupational
therapy and health coursework for over 10 years. She has worked in schoolbased and community occupational therapy practice. Kathy has published,
received external and internal grant funding and presented research and
workshops on infant mental health, children/family healthy lifestyles and
community partnerships. She has interdisciplinary experience teaching
students from the fields of occupational therapy, nursing and physical
therapy.
• Christine Myers, PhD, OTR/L is an Associate Professor in the Eastern
Kentucky University Department of Occupational Therapy. She has an
established line of research related to transition services for young children
and families. She previously provided services to infants, toddlers, and
preschoolers in a variety of hospital-based and community settings. She is
coordinator of the Transition to Preschool Program and serves on the
American Occupational Therapy Association's Transition Workgroup.

Speakers
• Phyllis Mondak, MS, M.Ed. serves as the Early Childhood Special
Education (619) Coordinator for Virginia's Department of Education. She
supports the Part C programs, school divisions, and state technical
assistance centers early childhood initiatives. She previously was a special
education coordinator and teacher in public schools and a developmental
specialist in local Part C programs. She has also worked with Head Start as
a local education/disabilities coordinator. She is an adjunct professor for
Virginia Commonwealth University.
• Arezou Salamat, OTD, OTR/L is an assistant professor at Loma Linda
University, CA., Department of Occupational Therapy. Her emphases are in
research, teaching and mentoring master level occupational therapy
students in working with young children and their families. Dr. Salamat
currently works in a countywide community based mental health program
with children under age of five who experienced maltreatment or prenatal
exposure to narcotics and alcohol. Dr. Salamat believes in empowering
caregivers and identifying strategies to support meaningful relationships
through community integrations and active participation in daily
routines to promote overall health and well being of a child and community
inclusion.

Speakers
• Sandra Schefkind, MS, OTR/L is the Pediatric Coordinator in the
Professional Affairs Division at AOTA. In this capacity she is responsible for
various association and national office activities and projects related to
occupational therapy practice, representing AOTA with pertinent external
organizations, and providing technical assistance and guidance with
practice based inquiries.
• Ashley Stoffel, OTD, OTR/L is a Clinical Assistant Professor at the
University of Illinois at Chicago where she leads and contributes to the
pediatric content of several courses. Her scholarship is aimed at
implementing family-centered early intervention and children’s services in
community settings to individuals from diverse backgrounds. Ashley also
works clinically at Aspire Children's Services in west suburban Chicago,
where she provides family-centered early intervention and specialized
services to children and families. Ashley is a member of the AOTA early
intervention workgroup and co-leads the Cradle to College and Career
practice group of the IDEA partnership.

Poll
• Who is participating on the webinar?
• What state are you from?

• Welcome
• AOTA is an active member of the
IDEA Partnership

– collaborating – building networks – disseminating resources – monitoring value –
Pediatric Occupational Therapy
Practitioners convene by teleconferencing
to conduct shared work on key focus
areas. Goal is to promote best practices.
Questions? Contact Sandy Schefkind at
sschefkind@aota.org
Early Childhood Workgroup
AOTA Members:
We want you to
join a Community
of Practice
Autism Workgroup
http://www.aota.org/governance/leadership.asp
x
Accomplishments Include:
•
•
•
•
•
•
FAQ: What is OT’s Role in
Supporting Persons With an ASD?
Pediatric Virtual Chat discussing
the new FAQ
Tip Sheet for Caregivers: Living
with an ASD – The Preschool Child
AOTA Resources: Challenges and
Opportunities for Children and
Youth with an ASD
Virtual Chat led by Students with an
ASD
OCALICON presentation
Tip Sheet: Building Play Skills for
Healthy Children and Families
• Pediatric Virtual Chats on Bullying
Prevention and Promoting Play
• FAQ on School Mental Health
• Leadership at Advancing School
Mental Health Conference cosponsored by IDEA Partnership
• Children’s Mental Health
Awareness Day Activities
• Online School Mental Health
Toolkit
2013
• Recess Promotion Powerpoint
•
•
•
•
•
•
Stars indicate
workgroup
members from
around the country
School Mental Health
Workgroup
Accomplishments Include:
Accomplishments Include:
See the AOTA page of the IDEA Partnership web site
www.sharedwork.org
Response to Intervention
(RtI) Workgroup
Transition Workgroup
Accomplishments Include:
•
•
•
•
•
•
•
•
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OT Practice Article on RtI
Consumer Brochure on RtI
Pediatric Virtual Chat on RtI
Practice Advisory on RtI
Speaking with various audiences
about RtI Virtual Chat
Accomplishments Include:
•
•
•
FAQ on Transitions
Fact Sheet on Transitions
Transition Checklist
Two virtual chats on early
childhood and high school
transitions
OT Practice article
Transition powerpoint
New Cradle to College & Career
Practice Group established
•
FAQ: What is the Role of
Occupational Therapy in Early
Intervention?
Contributed to Practice Advisory on
Early Intervention
Pediatric Virtual Chat on the
Practice Advisory
Supported work related to CDC’s
Learn the Signs Act Early Campaign
FAQ for practitioners on dialoguing
with families with cultural
sensitivity in development
Early ID signs of autism chat
Obesity Prevention
Workgroup
Accomplishments Include:
•
•
•
•
Edited new Obesity Prevention
Information Sheet for School
Mental Health toolkit
Virtual chat on childhood obesity
AOTA Conference Presentations
Tip sheet on obesity
OT Consultants in State Dept
of Education
Accomplishments Include:
•
•
Trifold on OT role in school practice
for administrators
Trifold for consumers in
development
Living Life to its
Fullest®
OCCUPATIONAL
– collaborating – building networks – disseminating resources – monitoring value – advancing practice
building
community –
T H E–
RA
PY
– leading by convening – crossing national/state/local levels – collaborating – building networks –
– leading by convening – crossing national/state/local levels – collaborating – building community – disseminating resources
What is Occupational Therapy?
• Occupational therapy promotes function and
engagement in daily habits and routines.
…the “occupation” of life skills…
▫ What is an occupation?

Areas of Occupation
(AOTA, 2008)
•
•
•
•
•
•
Activities of Daily Living
Rest and Sleep
Work
Play/Leisure
Social Participation
Education

Meaningful Occupations
• Infant/toddler
▫ Play
• Young child
▫ School/ Student
▫ Peer/Friend
▫ Dancer/Soccer player
• Adult
▫ Job
▫ Family Member
▫ Hobby


Poll
• HAVE YOU EVER COLLABORATED WITH AN
OCCUPATIONAL THERAPY PRACTITIONER IN THE
FOLLOWING AREAS?
▫ Autism (addressing sensory processing, assistive
technology, social participation)
▫ School Mental Health (addressing bullying, obesity,
depression)
▫ Transitions (EI to EC; EC to Kindergarten)
▫ Response To Intervention (RTI)
▫ Other areas (write responses in the chat)
▫ I have collaborated with an occupational therapy practitioner
in more than one of these areas
▫ I have never collaborated with an occupational therapy
practitioner
What are early childhood transitions?
• Part of life for all children and families
▫ Starting with hospital to home
• Children with delays or disability
▫ Part C and/or Part B services under IDEA
(Individuals with Disabilities Education Act)
▫ Early Intervention to Early Childhood (EC)
program
▫ EC program to Kindergarten

What is the role of OT in early
childhood transitions?
• Collaborate with families to support
understanding of the next steps and changes in
roles/routine and promote advocacy and
empowerment
• Assist with preparing the child prior to the
transition and to perform needed skills
• Evaluate the child’s needs in order to support
participation in the next setting
• Collaborate with the entire team

What are some basic concepts
and evidence?
How do they translate to
practice?

Families, Children, and Transitions:
Key Evidence-Based Findings
▫ Transition is a complex process, not a static event,
that creates stress for families
 (Fowler, Chandler, Johnson & Stells, 1988; Fowler, Schwartz &
Atwater, 1991; Hanson, et al., 2000; Rice & O’Brien, 1990;
Rosenkoetter et al., 1994)
▫ Stress may be decreased through planning and
support from service providers
 (Hamblin-Wilson & Thurman, 1990; Hanline, 1988; Hanline &
Halvorsen, 1989; Lazzari & Kilgo, 1989; McDonald, Kysela,
Siebert, McDonals & Chamber, 1989)

Families, Children, and Transitions:
Key Evidence-Based Findings
▫ Positive working relationships between service
providers and families is the most crucial factor in
a successful transition to an inclusive environment
for children with disabilities
 (Kemp, 2003; Rosenkoetter, et al., 2009)
▫ Families must have their needs met first before
they can help their children with disabilities
transition between programs or systems
 (Rosenkoetter, et al., 2009)

Families, Children, and Transitions:
Key Evidence-Based Findings
▫ Close, positive teacher-child relationship during
transition correlates with better cognitive
outcomes for typical and at-risk children and
social relationships for typical children
 (Mantizicopoulos, 2005; Peisner-Feinberg et al., 2001; Silver,
et al., 2004)
▫ Preparatory activities support positive transition
outcomes for children
 (Chandler, 1993; Hains, Fowler, & Chandler, 1988; Kemp &
Carter, 2000; Rice & O’Brien, 1990; Rule, Fiechtl & Innocenti,

1990)
Strategies that Support
Children and Families include:
(Rosenkoetter, et al., 2009)
• Providing information on
options for placements
• Shared information about
next environment
• Honest information about
child levels and
expectations
• Liaisons between programs
• Parent training in advocacy
• Program visits
• Supplemental community
services
• Parent participation on
transition planning teams
• Linkages with other
families
• Follow-up support after
transition

Occupational Therapy Transition Strategies for
Families and Children:
BEFORE the move
(Myers, 2006; 2008; Podvey & Hinojosa, 2009)
• Engage in occupation-based assessment with
families to determine priorities for transition
• Establish skills necessary for engaging in
occupations in the next environment
• Create opportunities for families and children to
familiarize themselves with elements of the
receiving environment (e.g., play groups)
• Create opportunities for families to gain access
and knowledge about available community
resources

OT Transition Strategies for Families and Children:
BEFORE the move
(Myers, 2006; 2008; Podvey & Hinojosa, 2009)
• Prevent performance problems in the next
environment by:
▫ Discussing the transition process with families in order
to anticipate potential issues and solve problems early
▫ Visiting the receiving environment with the child and
families to assess for potential issues prior to the actual
transition
▫ Meeting with the family and other team members from
the next environment to discuss specific expectations
▫ Participating in transition conferences, IFSP
development, and IEP development

OT Strategies for Families and Children:
AFTER the move
(Myers, 2006; 2008; Podvey & Hinojosa, 2009)
• Modify the context or task in the new
environment to support participation
• Alter the context as needed to support
engagement and ease the child into the new
environment
• Work with children and families to help them
adjust their roles and routines and understand the
roles and routines in the new environment

OT Strategies for Families and Children:
AFTER the move
(Myers, 2006; 2008; Podvey & Hinojosa, 2009)
• Help families understand how their child’s
strengths and challenges fit into the new
environment
• Consistently collaborate with families and
teachers after the move to the new environment,
especially in the early days as the child and family
are in a critical period of adjustment
• Link school-based intervention to issues at home
in order to create a connection between both
environments

Early Childhood, Evidence-Based
Practice and Occupational Therapy
• The American Journal of Occupational Therapy- special
issue on early intervention/early childhood (July/August
2013)
• Frolek-Clark, G. & Kingsley, K. (2013). Occupational therapy
practice guidelines for early childhood: Birth through 5
years. Bethesda, MD: AOTA Press.
• Chandler, B. (2010) Early childhood: Occupational therapy
services for children birth to five. Bethesda, MD: AOTA Press.
• Myers, C. & Podvey, M. (2013). Early childhood transitions. In
B. Chandler & G. Frolek-Clark, (Eds.), Best Practices in School
Occupational Therapy. Bethesda, MD: AOTA Press.

What are some examples that show
how occupational therapy contributes
to successful transition for young
children and their families?

Poll
• Do you regularly attend?
▫ Part C transition conferences
▫ Part B eligibility meetings
▫ Part B initial IEP meetings
▫ Check all that apply

OT and Part B Services
• OT role in eligibility for Part B preschool
services
• Initial IEP recommendations
▫
▫
▫
▫
Accommodations to the child's environment
Positioning
Visual supports for schedules
Self-help skills-feeding


CONNECT Modules
http://community.fpg.unc.edu/

Modules
Module Topics
•
•
•
•
•
•
•
Embedded Interventions
Transition
Communication for Collaboration
Family-Professional Partnerships
Assistive Technology
Dialogic Reading Practices
Tiered Interventions

Infant Mental Health and Transitions
• Enhancing a healthy, positive relationship between a
child, siblings, family and caregivers is an important
aspect of occupational therapy’s domain of practice in
the promotion of health for children and families and
infant mental health (IMH) (AOTA, 2008)
American Occupational Therapy Association (2008). Occupational therapy practice
framework: Domain and process. (2nd ed.). American Journal of Occupational
Therapy, 62, 6, 627-630.

What is Infant Mental Health?
• IMH relates to the socio-emotional development and well-being of
the child through family-centered mental health intervention and
prevention of childhood mental health issues (Hinshaw-Fuselier,
Zeanah, & Larrieu, 2009).
• It is a growing interdisciplinary field in health care!
• Hinshaw-Fuselier, S., Zeanah, P. D., Larrieu, J. A. (2009). Training in infant mental health.
In C. H. Zeanah (Ed.), Handbook of infant mental health (3rd ed., pp. 533-548). New York:
Guilford Press.

IMH and Transitions
• Occupational therapists have expertise in IMH and are
key members of interdisciplinary teams who provide
infant mental health services in transitional planning
and intervention.
• Ways occupational therapists can gain or enhance IMH
expertise include: participating as part of an early
childhood mental health coalition in your area, joining
your state infant mental health association, workshops
on relationships, resilience, at risk children and parents;
completing a certificate in infant mental health; locating
a mentor in the field of infant mental health.

Story of Sam & Emily
• Sam is 3 years old with history of failure to thrive,
feeding difficulties and possible FAS;
• Emily is 22 years old with history of depression and
substance abuse;
• Transition from home to preschool pending;
• OT’s impression of Johnny’s behavior in
transitioning from home to preschool;
• The impact of this transition for Sam and Mother
Emily’s daily routines and healthy caregiver
relationships

OT role in setting up a successful
transition-Sam
• Strategies for meeting Sam’s needs through
interdisciplinary problem-solving of Sam’s strengths and
areas of limitation in capacities and skills for successful
preschool participation;
• Strategies for enhancing Emily’s abilities to anticipate
Sam’s needs for transition;
• Strategies for building communication and a healthy,
socio-emotional bond with all caregivers.

Examples of OT Role in Transition
• Transition to foster home
• Transition from NICU to home

Story of Johnny
• A 23-month-old boy
• Removed from care of biological mother due to
history of neglect and malnutrition.
• Transition from biological mother to foster home
• Foster mother described Johnny as “quiet”, “easy
baby” who just sleeps a lot.
• OT’s impression of Johnny’s behavior in
transitioning to a new home.
• The impact of this transition to Johnny’s daily
routine

OT role in setting up a successful
transition-Johnny
• Working directly with foster parents to create a safe and
secure attachment by actively engaging in childhood
occupations (activities).
• Create a daily routine that promotes all childhood
occupations.
• Promoting “co-occupations” and having foster parents
play, eat, and go on outings together rather than going
out around Johnny’s sleeping schedule.
• Allowing Johnny to explore his new environment by
actively taking him to each room of the house slowly over
a few days so he can get familiar with his new “home”.
• Decorate his room with him

Story of Jasmine
• A 2-month-old infant who was discharged from
NICU to home
• Parental concerns:
▫ Readiness
▫ Excitement
▫ Nervous
• What happened at home?
• OT’s impression of Jasmine’s behavior in
transitioning to home

OT role in setting up a successful
transition-Jasmine
• Consult with pediatrician/medical team about any medical or
nutritional concerns with her spitting up.
• Continue using successful calming techniques that the family
learned in the NICU
• Support parents in being aware of their own state of arousal
• Maintain calm
• Evaluate the environment
▫ Decrease the stimulation in Jasmine’s room and her crib.
▫ She basically moved from a quiet environment to an environment
with colors, sounds and noises.
• Decrease and monitor the number of visits by family and
friends
• Introduce one toy at a time and allow Jasmine time to explore
the toy by looking or attempting to reach.

What resources are available to share?
• AOTA Transition resources
http://www.aota.org/Practice/ChildrenYouth/Transitions.aspx
• AOTA Tip Sheet for Parents: Transition to Preschool
for Children with Autism (in press)
• AOTA Early Intervention
http://www.aota.org/en/Practice/ChildrenYouth/Early-Intervention.aspx
• National Early Childhood Transition Center
http://www.hdi.uky.edu/nectc/NECTC/Home.aspx
▫ Tool kit lists transition activities
 Transition TIPS
http://www.hdi.uky.edu/nectc/NECTC/practicesearch.aspx

Resources continued
• Early Childhood TA Center
www.ECTAcenter.org
▫ (Part C to Preschool)
http://ectacenter.org/topics/transition/transition.asp
▫ (Preschool to Kindergarten)
http://ectacenter.org/topics/transtoK/transtoK.asp

Resources continued
• Article: “Understanding Early Childhood
Transition: A Guide for Families and
Professionals” by the Early Intervention
Subcommittee of the North Dakota Interagency
Coordinating Council
www.dpi.state.nd.us/speced/early/guide.pdf
• World Association of Infant Mental Health
http://www.waimh.org/i4a/pages/index.cfm?pa
geid=1
• Zero To Three http://www.zerotothree.org/

Resources continued
• Head Start Early Childhood Knowledge and
Learning Center (Training and TA)
▫ Parent, Family, and Community Engagement
http://eclkc.ohs.acf.hhs.gov/hslc/ttasystem/family/center
▫ Quality Teaching and Learning Center
http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/teaching
• Special Quest Multimedia Training Library
http://ncoe.pointinspace.com/trainingmaterials/

What are some action steps?
•
•
•
•
Share fact sheets on EC
Ask an OT to do an in-service
Share the link to this webinar
Contact state or national OT organizations
▫ www.aota.org
• Access and be active on sharedwork
▫ www.sharedwork.org

Thank you!
• Kathleen Flecky, OTD, OTR/L
• Kristin Hildebrand, MSOT, OTR/L
• Phyllis Mondak, MS, M.Ed; Va. Dept of
Education
• Christine Myers, PhD, OTR/L
• Arezou Salamat, OTD, OTR/L
• Sandra Schefkind, MS, OTR/L; AOTA Pediatric
Coordinator
• Ashley Stoffel, OTD, OTR/L

References
• Chandler, L. K. (1993). Steps in preparing for transition: Preschool to
kindergarten. Teaching Exceptional Children, 25(4), 52-55.
• Fowler, S. A., Chandler, L. K., Johnson, T. E., & Stells, E. (1988). Individualizing
family involvement in school transitions: Gathering information and choosing
the next program. Journal of the Division for Early Childhood, 12(3), 208-216.
• Fowler, S. A., Schwartz, I., & Atwater, J. (1991). Perspectives on the transition
from preschool to kindergarten for children with disabilities and their families.
Exceptional Children, 58(2), 136-145.
• Hains, A. H., Fowler, S. A., & Chandler, L. K. (1988). Planning school
transitions: Family and professional collaboration. Journal of the Division for
Early Childhood, 12(2), 108-115.
• Hamblin-Wilson, C., & Thurman, S. K. (1990). The transition from early
intervention to kindergarten: Parental satisfaction and involvement. Journal of
Early Intervention, 14(1), 55-61.
• Hanline, M. F. (1988). Making the transition to preschool: Identification of
parent needs. Journal of the Division for Early Childhood, 12(2), 98-107.
• Hanline, M. F., & Halvorsen, A. (1989). Parent perceptions of the integration
transition process: Overcoming artificial barriers. Exceptional Children, 55(6),
487-492.
References
• Kemp, C., & Carter, M. (2000). Demonstration of classroom survival skills in
kindergarten: A five-year transition study of children with intellectual
disabilities. Educational Psychology, 20(4), 393-405.
• Lazzari, A. M., & Kilgo, J. L. (1989). Practical methods for supporting parents in
early transitions. Teaching Exceptional Children, 22(1), 40-43.
• Mantzicopoulos, P. (2005). Conflictual relationships between kindergarten
children and their teachers: Associations with child and classroom context
variables. Journal of Social Psychology, 43, 425-442.
• McDonald, L., Kysela, G. M., Siebert, P., McDonals, S., & Chambers, J. (1989).
Parent perspectives: Transition to preschool. Teaching Exceptional Children,
22(1), 4-8.
• Myers, C. T. (2006). Exploring occupational therapy and transitions for young
children with special needs. Physical and Occupational Therapy in Pediatrics,
26, 73–88.
• Myers, C. T. (2008). Descriptive study of occupational therapists’ participation
in early childhood transitions. American Journal of Occupational Therapy,
62(2), 212-220.
References
• Peisner-Feinberg, E., Burchinal, M. R., Clifford, R. M., Culkin, M. L., Howes, C., Kagan, S.
L., et al. (2001). The relation of preschool child-care quality to children’s cognitive and
social developmental trajectories through second grade. Child Development, 72, 1534 1553.
• Rice, M. L., & O'Brien, M. (1990). Transitions: Times of change and accommodation.
Topics in Early Childhood Special Education, 9(4), 1-14.
• Rosenkoetter, S. E., Hains, A. H., & Fowler, S. A. (1994). Bridging early services for
children with special needs and their families: A practical guide for transition planning.
Baltimore: Brookes.
• Rosenkoetter, S., Schroeder, C., Rous, B., Hains, A., Shaw, J., & McCormick, K. (2009). A
review of research in early childhood transition: Child and family studies. Technical
Report #5. Lexington: University of Kentucky, Human Development Institute, National
Early Childhood Transition Center. Available at
http://www.hdi.uky.edu/nectc/NECTC/Home.aspx
• Rule, S., Fiechtl, B. J., & Innocenti, M. S. (1990). Preparation for transition to
mainstreamed post-preschool environments: Development of a survival skills curriculum.
Topics in Early Childhood Special Education, 9(4), 78-90.
• Silver, R. B., Measelle, J. R., Armstrong, J. M., & Essex, M. J. (2004). Trajectories of
classroom externalizing behavior: Contributions of child characteristics, family
characteristics, and the teacher-child relationship during the school transition. Journal of
School Psychology, 43, 39-60.