Integrated Specialized Services 2005 Inclusion Institute Chapel Hill, NC

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Integrated Specialized Services 2005 Inclusion
InstituteChapel Hill, NC

• Peggy Freund, Ph.D.
• National Individualizing Preschool Inclusion
  Project
• Center for Child Development
• Vanderbilt University

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Integrated specialized services is most
successful when provided as a component of the
Individualizing Inclusion Model

• Definition
• When therapy or specialized instruction
• Occur in the classroom
• With other children usually present
• Within the context of ongoing routines and
  activities

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Picture is worth a thousand words
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Specialized Services are integrated when

• Physical and occupational therapists incorporate
  opportunities to practice motor goals into daily
  activities with classmates present
• A speech therapist joins a child in free play to
  work on generalizing a skill to a new setting
• Specialists and teachers together discuss a
  current concern, develop strategies, try them
  out, and evaluate success

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Who - Everyones Roles

• Therapist and specialist support caregivers
  through
• Informational support
• Material support
• Emotional support
• Teacher teach and care for children, embed
  intervention into developmentally appropriate
  routines
• Administrators support teachers and specialists
  
• Parents teach everyone about their child and
  learn from teachers and specialists

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How - Service Delivery Models

• 1 on 1 pull-out
• Small-group pull-out
• 1 on 1 in classroom
• Group activity
• Individualized within routines
• Pure consultation

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Models of Service Delivery
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Models of Service Delivery
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Models of Service Delivery

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Purposes of Therapy

• To help children and families achieve their goals
• To provide support to regular caregivers so they
  can help the child
• To provide expert consultation to other
  professionals

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Basic Principles

• Intervention occurs between specialists visits
• Therapy and instruction are not tennis lessons
• Regular caregivers (parents and teachers) need to
  own the intervention goals

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10 Plus Reasons for Integrated Services

• Children learn skills in places they will use
  them
• Children will have increased practice
  opportunities
• Childrens social relationships are fostered
• Children do not miss out on classroom instruction

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10 Plus Reasons for Integrated Services

• Strengthens all team members, stretching them to
  be more knowledgeable and skillful in more areas
• Teachers can expand their skills by seeing what
  specialists do
• Specialists can see if strategies are working

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10 Plus Reasons for Integrated Services

• Communication between teachers and specialists
  increases creating an avenue for collaboration
• Teachers and specialists can focus on skills
  immediately useful for children
• Specialists can work with teachers as problems
  arise
• Elimination of therapy rooms

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Individualized Within Routines

• Most useful because
• Ongoing classroom activities are not disrupted
• Children are engaged in normal activities
• Can work within the context of the childrens
  engagement
• Teachers can see how interventions fit into
  regular routines
• Potential for high peer involvement
• Specialists can assess childs functioning in
  normal routines
• Specialists can work with more than one child at
  a time

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Emerging Consensus

• DEC Recommended Practices
• Interdisciplinary Model
• Teams including family members make decisions and
  work together
• Professionals cross disciplinary boundaries
• Intervention is focused on function, not services
  
• Regular caregivers and regular routines provide
  the most appropriate opportunities for childrens
  learning and receiving most other interventions.

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Emerging Consensus

• ASHA
• A natural setting must serve as the intervention
  context
• Services should be integrated with the natural
  setting such that intervention strategies can be
  implemented with the ongoing stream of activities
  typical for that setting
• The design and delivery of services should
  involve collaboration with families and other
  professionals and support personnel (Wilcox
  Shannon, 1996).

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Evidence Base

• Child outcomes research
• Most child outcome studies comparing integrated
  to segregated services show little to no
  difference in outcomes
• But, what difference is found, favors integrated
  services

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Evidence Base

• Specialists Perspective
• Professionals report they would ideally use more
  integrated practices than currently using
  (McWilliam Bailey, 1994)
• But
• Most common model used is 1 on 1 pull out

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Evidence Base

• Specialists Perspective
• Specialists report they are likely to choose the
  model of service delivery on the basis of the
  childs characteristics but in fact most often
  it is
• Professionals discipline
• Specific interventions
• Caseloads
• Family preferences, and
• Classroom characteristics that influence their
  choices (McWilliam Bailey, 1994)

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Implementation

• Functional Intervention Planning
• Routines-based Interview
• Functional goals
• Decide as a team to move to a more integrated
  approach
• Look at current practices

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Current Practices

• Individualizing Inclusion Checklist - IndIA
• Specialist Documentation Form (SDF)

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Individualizing Inclusion Checklist (IndIA)
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Specialists Documentation Form (SDF)
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Implementation

• Seek balance of power between teachers and
  therapists reciprocal consultation
• Discuss expectations, roles, and responsibilities
  
• Set aside sacred time for consultation
• Help families learn about integrated services

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Consultation Checklist
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Jacob, age 2 Articulation
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Joshua, age 3Outdoor play
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Zach, age 4Handwashing
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Contact information

• Peggy.J.Freund_at_Vanderbilt.edu 
• [phone]
• Center for Child Development
• http//www.vanderbiltchildrens.com/interior.php?mi
  d342
• National Individualizing Preschool Inclusion
  Project
• www.IndividualizingInclusion.us

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Activity

• List three ways in which moving to an integrated
  approach is like remodeling your kitchen.