Slides before 1st
Section Divider
Ecology of
Integrated Services
Elements of
Integrated Services
Training,
Supervision,
Evaluation
What if Preschoolers Could
Get Interventions All Day
Every Day?
Implications for Visiting
Professionals
R.A. McWilliam, Ph.D.
Contact
• robin.mcwilliam@siskin.org
• www.siskinresearch.org
• www.naturalenvironments.blogspot.com
• @RobinMcWilliam1
Collaboration
“Raphael paints wisdom;
Handel sings it,
Phidias carves it,
Shakespeare writes it,
Wren builds it,
Columbus sails it,
Luther preaches it,
Washington arms it,
Watt mechanizes it.”
Ralph Waldo Emerson
Outline
1. Ecology of integrated therapy
2. Elements of integrated therapy
3. Training, supervision, evaluation
Integrated
Services—
Teamwork
Integrated Therapy
• OTs, PTs, and SLPs come into the classroom
to help the teaching staff
meet children’s individualized needs
during all the hours the therapists are not in the
room
• Teaching staff attend to what therapists are doing
and vice versa
• Teaching staff and therapists communicate with
each other
Question for Participants
• What are the biggest barriers to
implementing integrated services?
Continuum of Service Delivery Models
•
•
•
•
•
•
1-on-1 pull-out
Small-group pull-out
1-on-1 in classroom
Group activity
Individualized within routines
Pure consultation
Research Findings
• Individualized within routines most
effective, followed by group activity
• Four times as much communication
occurs in in-class methods vs. out-ofclass methods
• Teachers more satisfied with integrated
than pull-out
– Especially when they like the therapist
• It can take parents over a year to
acknowledge the benefits, if they are
predisposed to a segregated model
Ecology of Integrated Therapy
Consultation
Relationship
Routines
Culture of
Consulting &
Receiving
Programs
Culture of Consulting Program
• Rehab vs. knowledge sharing
• Belief system about how children
learn
• Confidence about consulting
• Competence at consulting
Culture of Receiving Program
•
•
•
•
History with therapists
Understanding of roles
Confidence about intervention
Competence about intervention
Question for Participants
• How can you plan the session and
yet follow the teacher’s and the
child’s leads?
Ecology of Integrated Therapy
Consultation
Relationship
Routines
Culture of
Consulting &
Receiving
Programs
Routines
• Chunks of day when stuff happens
• Scheduled activities
• Caregiving activities that might not
be on schedule
• Transitions
• Arrival and departure
All are contexts for intervention!
The Four Contexts of Teaching
McWilliam, R. A., de Kruif, R. E. L.,
& Zulli, R. A. (2002). The
observed construction of
teaching: Four contexts.
Journal of Research in
Childhood Education, 16, 148161.
Activities: Critical Teaching
Level
• These are what you have to fit into.
• What if the activity doesn’t fit your
plan?
• What if “your” child is involved in
something different from your plan?
• Wait… what goal(s) are we working
on?
– Discussed after DAP
Developmental
Appropriateness of
Classroom
1. The more playbased the
environment, the
easier it is to
provide integrated
therapy.
Developmental
Appropriateness of
Classroom
1. The more playbased the
environment, the
easier it is to
provide integrated
therapy.
2. Relationship with
teachers critical for
modifying activity,
if necessary, when
therapist enters.
Developmental
Appropriateness of
Classroom
1. The more playbased the
environment, the
easier it is to
provide integrated
therapy.
2. Relationship with
teachers critical for
modifying activity,
if necessary, when
therapist enters.
3. Disadvantage of
play-based:
Everyone’s
scattered.
Elements of Integrated
Therapy
•
•
•
•
•
Functional goals
Collaborative consultation
Demonstration
Summary
Implementation
Functional Goals
• Research shows integrated therapy
occurs more often when goals are
functional.
• Define functional
Functionality Defined
• Skill ensures participation in current
routines
– Might also prepare for future
• Must be developmentally appropriate or
necessary
• Must require the child to do something
• Must be something meaningful to
child’s caregivers
– Preferably, chosen by family through RBI
The 3 Foundations of Learning
Functional Strategies
1. Regular caregivers can implement
them…
2. In regular routines
3. “Normal”
4. Promote
– Engagement: participation in routine
– Independence: control over environment
– Social relationships: peer interactions
(sometimes, adult)
Question for Participants
• Why are teachers sometimes not
interested in what we have to say?
Ecology of Integrated Therapy
Consultation
Relationship
Routines
Culture of
Consulting &
Receiving
Programs
Collaborative Consultation
Collaborative
Expert
Decide on the problem
together
Consultant decides what
the problem is
Decide on the solution
together
Consultant decides what
the solution is
Evaluate the solution
together
Consultant evaluates
whether the solution has
worked
Gaining Trust and Credibility
Social
• Get to know
the teachers
and let them
get to know
you
Task
• Show you
know what
you’re talking
about
Rules of Consultation
1.
2.
3.
4.
Work in the classroom (don’t pull the child out)
Establish ground rules with the teachers
Respect whose turf you’re on
Aim to make routines more successful for teachers and
the child
5. Communicate during the activity
6. Position yourself to model and to observe
7. Model incidental teaching
8. Aim for child engagement, independence, and social
relationships
9. Debrief before leaving
10. Make friends with the teachers
Sucking Up Behaviors
Sniff out poopy diapers
Clean up after an activity
Distract a disruptive child
Bring in something of personal
interest to the teacher
• If meeting at lunch, bring lunch
•
•
•
•
“How many times we gonna
pass the ball before we shoot?”
“Four!”
“How many questions we
gonna ask before we make a
suggestion?”
“Four!”
Why Not Just Give
Suggestions?
• Your input should
be added value…
• So you need to
know background
• You should not
be the hero of
the visit
• Think about
feasibility and
implementation
• Partners work
together
Question for Participants
• When we demonstrate (model)
something in the classroom, why
don’t teachers imitate it?
8 Demonstration Steps
(From Vanderbilt Home Visiting Script-Expanded)
i. Speak to the adult about your suggestion
ii. If it seems as though the parent doesn’t
understand, ask him or her if he or she wants you
to demonstrate.
iii. Tell the parent what you’re going to do.
iv. Do it.
v. Tell the parent what you did and point out the result
of the strategy.
vi. As the parent if he or she would like to try it.
vii.If the parent says yes, observe; if no, don’t insist on
it.
viii.If the parent said yes, praise the parent and give
him or her a limited amount of constructive
feedback.
Training, Supervision, Evaluation
• Integrated
Therapy
Checklist
Training, Supervision, Evaluation
• Receiving
Consultation
Checklist
Integrated Therapy
Therapists work in the
classroom
Instead of pulling
children out
Therapists consult with
teachers
Instead of just working
with the child
Therapists work on
functional skills
Instead of on
decontextualized deficits
Cool early interventionists use
integrated services