Partnering for Change: collaborating to transform occupational therapy services that support inclusive education

The United Nations champions inclusive education as a moral obligation, requiring equitable learning environments that meet all individuals’ diverse learning needs and abilities, including children and youth. Yet the practice of inclusive education is variable and implementation challenges persist. A participatory action research framework was used to develop a solution, Partnering for Change (P4C), which is a tiered service delivery model that bridges health and education by re-envisioning occupational therapy services and transforming the role of the occupational therapist from a service provider for individual children to a collaborative partner supporting the whole school community. This perspective article will describe the P4C model and its evolution, and will outline how it has been implemented in Canadian and international contexts to facilitate children’s inclusion and participation in educational settings

Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design

BackgroundAchieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools.MethodsA sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members’ perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison.ResultsStructural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services.ConclusionsOutcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development

Identifying children who are struggling in school

Abstract : Introduction : School-age children with motor coordination challenges typically require formal referral for occupational therapy services and often experience lengthy wait times for one-to-one intervention. In a new service delivery model called Partnering for Change, therapists work collaboratively with educators in classrooms to observe, identify, and support children. This study describes children identified through a traditional referral process and compares them with children identified by occupational therapists through classroom observation and dynamic performance analysis. Methods : Participants included 246 children enrolled in a 2-year evaluative study of the Partnering for Change service delivery. Parents completed a demographic questionnaire, the Developmental Coordination Disorder Questionnaire, and the Strengths and Difficulties Questionnaire. Children’s educators completed the Strengths and Difficulties Questionnaire and the School Function Assessment. Children completed the Movement Assessment Battery for Children. Results : Children identified were significantly younger and more likely to be girls than those referred under the traditional model. Using observation and dynamic performance analysis, occupational therapists identified children who had equally marked difficulties as those who came from the waitlist. In the Partnering for Change model, waitlists for service were eliminated for all children. Conclusions : Occupational therapists can identify children who are experiencing significant challenges participating at school without the need for standardized assessment, formal referrals, and waitlists

Building Bridges Between Education and Health Care in Canada: How the ICF and Universal Design for Learning Frameworks Mutually Support Inclusion of Children With Special Needs in School Settings

Since the 1990s, educators have prioritized inclusion of students with disabilities in general educational settings. Concurrently, health-care professionals have recognized the need to support students’ academic functioning and participation at school. Despite this recognition, integration of health support services in schools remains a significant challenge and the extent to which students with special needs fully participate at school is often less than optimal. In this study, we suggest that combining health and education conceptual frameworks would advance the goal of inclusion by enhancing interprofessional communication and collaboration. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) is a health framework that focuses on functioning and participation via a lens of inclusivity, universality, and a holistic approach to health and disability. Similarly, Universal Design for Learning (UDL) is an educational framework for guiding the design of instructional materials, methods, and assessments to be inclusive and accessible for all. Both frameworks are well established in their respective fields, but they have yet to “cross the border” to influence each discipline’s practices. While researchers have alluded to the potential utilization of both frameworks in education settings, there is limited guidance on how these two frameworks may be combined in practice. In this study, we will compare the ICF and UDL frameworks, and provide insight into how utilization of both frameworks may enhance interprofessional collaboration and support inclusion in school settings

A quasi-experimental study of a movement and preliteracy program for 3-and 4-year-old children

Objective: Approximately 28% of children are not ready for kindergarten, 91% are inactive according to current guidelines, and 21% are overweight/obese. Early intervention to strengthen movement and preliteracy skills may help to curb the concerning rates of poor school readiness, inactivity, obesity, and subsequently positively impact health across the lifespan. The objective of this pilot study was to evaluate the effectiveness of a motor and preliteracy skill program for a community sample of 3- to 4-year-old children. Methods: A quasi-experimental study design was used. The program was run for 1 h/week for 10 weeks and consisted of movement skill instruction, free play, and an interactive reading circle with care-giver involvement throughout each session. Movement and preliteracy skills were assessed in all children pre- and post-intervention using the Peabody Developmental Motor Scales-2nd edition, the Preschool Word and Print Awareness tool, and the Phonological Awareness Literacy Screening tool. Results: Nineteen families (experimental group, n = 8; control group, n = 11) were recruited (mean age = 3 years, 8 m; 47% male). There was a significant effect of group on gross motor raw scores overall [F(1, 16) = 4.67, p < 0.05; ω2p=0.16] and print-concept knowledge [F(1, 16) = 11.9, p < 0.05; ω2p=0.38]. Conclusion: This study was one of the first to examine the impact of a community-based movement skill and preliteracy program with care-giver involvement in preschool children. Future research should continue to explore the effects of the program with larger and more diverse samples on multiple health and developmental outcomes. Clinical Trial Registration: Play and Preliteracy among Young Children (PLAY) NCT02432443

Evaluation of a Direct-Instruction Intervention to Improve Movement and Preliteracy Skills among Young Children: A Within-Subject Repeated-Measures Design

Objective: School readiness involves the development of foundational skills such as emergent literacy and fundamental movement skills as well as the capacity to attentively engage in instructional situations. Children do not develop these skills naturally; therefore, they need the opportunity to develop these skills in their early years prior to entering school. The objective of the current study was to evaluate the effectiveness and feasibility of a direct-instruction movement and preliteracy intervention in children aged 3-4 years. Methods: A within-subject repeated-measures design, embedded within a wait-list control study, was used to evaluate the intervention. The intervention was run across 10 weeks with 1 h weekly sessions. Each weekly session consisted of 30-min of movement skill instruction (e.g., through single-step acquisition strategies), 15-min of free play during which time children had access to a variety of equipment (e.g., balls, hula hoops, etc.) or toys (e.g., puzzles, building blocks), and a 15-min interactive reading circle during which children read a storybook and were taught 1-2 preliteracy skills (e.g., alphabet knowledge, narrative knowledge, etc.). A convenience sample of 11 children (mean age = 45.6 months, SD = 7.3) was recruited. All children were assessed four times: baseline (Time 1), pre-intervention (Time 2), post-intervention (Time 3), and 5-week follow-up (Time 4). Gross motor skills and preliteracy skills were assessed at each time point. Results: There was a statistically significant effect of time on the change in gross motor skills (Wilks' lambda = 0.09, p =.002), print-concept skills (Wilks' lambda = 0.09, p =.001), and alphabet knowledge (Wilks' lambda = 0.29, p =.046). Post hoc analyses reveal non-significant changes between time 1 and 2 for motor and print-concept skills and significant changes in all three outcomes between time 2 and time 3. Conclusion: Participation in a direct-instruction movement and preliteracy program led to positive improvements in gross motor skills, print-concept knowledge, and alphabet knowledge in 3-to 4-year-old children over time. Future research needs to evaluate the effectiveness of this movement and preliteracy skill intervention on various other indicators of child development and health

Implementation Science: Buzzword or Game Changer?

PURPOSE: The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. METHOD: Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science theories and methodologies are provided, including an overview of hybrid research designs that simultaneously investigate clinical effectiveness and implementation as well as an introduction to approaches for engaging stakeholders in the research process. A detailed example from education is shared to show how implementation science was utilized to move an intervention program for autism into routine practice in the public school system. In particular, the example highlights the value of strong partnership among researchers, policy makers, and frontline practitioners in implementing and sustaining new evidence-based practices. CONCLUSIONS: Implementation science is not just a buzzword. This is a new field of study that can make a substantive contribution in communication sciences and disorders by informing research agendas, reducing health and education disparities, improving accountability and quality control, increasing clinician satisfaction and competence, and improving client outcomes

Evaluation of a Direct-Instruction Intervention to Improve Movement and Preliteracy Skills among Young Children: A Within-Subject Repeated-Measures Design

ObjectiveSchool readiness involves the development of foundational skills such as emergent literacy and fundamental movement skills as well as the capacity to attentively engage in instructional situations. Children do not develop these skills naturally; therefore, they need the opportunity to develop these skills in their early years prior to entering school. The objective of the current study was to evaluate the effectiveness and feasibility of a direct-instruction movement and preliteracy intervention in children aged 3–4 years.MethodsA within-subject repeated-measures design, embedded within a wait-list control study, was used to evaluate the intervention. The intervention was run across 10 weeks with 1 h weekly sessions. Each weekly session consisted of 30-min of movement skill instruction (e.g., through single-step acquisition strategies), 15-min of free play during which time children had access to a variety of equipment (e.g., balls, hula hoops, etc.) or toys (e.g., puzzles, building blocks), and a 15-min interactive reading circle during which children read a storybook and were taught 1–2 preliteracy skills (e.g., alphabet knowledge, narrative knowledge, etc.). A convenience sample of 11 children (mean age = 45.6 months, SD = 7.3) was recruited. All children were assessed four times: baseline (Time 1), pre-intervention (Time 2), post-intervention (Time 3), and 5-week follow-up (Time 4). Gross motor skills and preliteracy skills were assessed at each time point.ResultsThere was a statistically significant effect of time on the change in gross motor skills (Wilks’ lambda = 0.09, p = .002), print-concept skills (Wilks’ lambda = 0.09, p = .001), and alphabet knowledge (Wilks’ lambda = 0.29, p = .046). Post hoc analyses reveal non-significant changes between time 1 and 2 for motor and print-concept skills and significant changes in all three outcomes between time 2 and time 3.ConclusionParticipation in a direct-instruction movement and preliteracy program led to positive improvements in gross motor skills, print-concept knowledge, and alphabet knowledge in 3- to 4-year-old children over time. Future research needs to evaluate the effectiveness of this movement and preliteracy skill intervention on various other indicators of child development and health.Clinical Trial RegistrationPlay and Pre-Literacy among Young Children (PLAY) NCT02432443

A Quasi-Experimental Study of a Movement and Preliteracy Program for 3- and 4-Year-Old Children

ObjectiveApproximately 28% of children are not ready for kindergarten, 91% are inactive according to current guidelines, and 21% are overweight/obese. Early intervention to strengthen movement and preliteracy skills may help to curb the concerning rates of poor school readiness, inactivity, obesity, and subsequently positively impact health across the lifespan. The objective of this pilot study was to evaluate the effectiveness of a motor and preliteracy skill program for a community sample of 3- to 4-year-old children.MethodsA quasi-experimental study design was used. The program was run for 1 h/week for 10 weeks and consisted of movement skill instruction, free play, and an interactive reading circle with care-giver involvement throughout each session. Movement and preliteracy skills were assessed in all children pre- and post-intervention using the Peabody Developmental Motor Scales-2nd edition, the Preschool Word and Print Awareness tool, and the Phonological Awareness Literacy Screening tool.ResultsNineteen families (experimental group, n = 8; control group, n = 11) were recruited (mean age = 3 years, 8 m; 47% male). There was a significant effect of group on gross motor raw scores overall [F(1, 16) = 4.67, p &lt; 0.05; ωp2=0.16] and print-concept knowledge [F(1, 16) = 11.9, p &lt; 0.05; ωp2=0.38].ConclusionThis study was one of the first to examine the impact of a community-based movement skill and preliteracy program with care-giver involvement in preschool children. Future research should continue to explore the effects of the program with larger and more diverse samples on multiple health and developmental outcomes.Clinical Trial RegistrationPlay and Preliteracy among Young Children (PLAY) NCT02432443