audioinsight™ seminars presented by: response to intervention: a role for occupational therapy...

AudioInsight™ Seminars

Presented by:

Response to Intervention:A Role for Occupational Therapy

Practitioners

Presented by:Gloria Frolek Clark, MS, OTR/L, BPC, FAOTA

Wednesday, March 7, 2007 2:00 - 4:00 p.m., Eastern Time

.2 AOTA CEUs (2 NBCOT PDUs / 2 contact hours)

Faculty Gloria Frolek Clark, MS, OTR/L, BCP, FAOTA, is AOTA's representative to the National Association of State Directors of Special Education's IDEA Partnership, a project funded through the Office of Special Education Programs. The partnership, composed of 55 national organizations, has been collaboratively working on operationalizing and educating partners about RtI.

Ms. Frolek Clark is a 1977 graduate of the University of North Dakota's Occupational Therapy Program. In 1995, she received a master's degree in early childhood special education from Iowa State University. She is currently a doctoral student there with a focus on early childhood special education.

Faculty cont.During the past 30 years, Ms. Frolek Clark has specialized in occupational therapy services for pediatric clients in home, community, and school settings. From 1993 to 1997, she was cofounder and chair of the AOTA School System Special Interest Section (SSSIS). She is a member of the current SSSIS. While on the Commission on Practice, she contributed to the development of the Occupational Therapy Practice Framework and many other official AOTA documents. Ms. Frolek Clark has presented nationally on early intervention services and school-based practice, has authored several book chapters and articles on school-based practice, and was appointed to the AOTA Specialty Board, Pediatric Panel. Currently, she works for the Heartland Area Education Agency and is a consultant for the Iowa Department of Education in Des Moines.

Description• Response to intervention (RtI) is a process for educational

decision-making promoted by the U.S. Department of Education. General-education students are screened early in their schooling as a way to identify those at risk for school failure.

• High-quality instruction and interventions are matched to the student's needs, and progress is monitored frequently. Occupational therapy practitioners need to understand how federal statute and data-based decision-making have changed how we address the needs of students.

• This seminar will address the evolving role of occupational therapists and occupational therapy assistants who work with students in grades K-12.

AOTA Occupational Therapy Classification Codes for Continuing Education:

• Category 1: Domain of Occupational Therapy, Context

• Category 3: Professional Issues, Legal, Legislative, & Regulatory Issues

Developed by Gloria Frolek Clark for the American Occupational Therapy Association. Copyright © 2007, American Occupational Therapy Association. For personal use only. For all other uses, contact copyright@aota.org.

Course Objectives

On completion of this AudioInsight Seminar, participants will be able to

1. Recognize the core principles of response to intervention (RtI) and early intervening services (EIS)

2. Identify the steps in a 3-tier RtI process3. Select research data and statute inferences to support RtI and

EIS4. Identify occupational therapy’s role in RtI and EIS.

Agenda

1. Introduction of RtI

2. Core principles of RtI

3. Introduction of EIS

4. Statute regarding EIS

5. Occupational therapy’s role

6. Considerations

7. Questions and answers.

From NASDE and IDEA Partnership, 2006. Used with permission. 10

Acknowledgments

Many of the initial RtI slides used in this seminar are from Leaving No Child Behind: Response to Intervention, a PowerPoint presentation created by IDEA Partnership and used with permission.

AOTA is an organizational member of the IDEA Partnership. Gloria Frolek Clark is AOTA’s core representative to this group; Jean Polichino represents AOTA for the workgroup.

The IDEA Partnership acknowledges the work of Mary Beth Klotz, National Association of School Psychologists; Patti Ralabate, National Education Association; Stacy Skalski, National Association of School Psychologists; and Lisa Thomas, American Federation of Teachers,

who collaborated to create the PowerPoint presentation Response to Intervention (RtI): Fundamentals and Practical Implications for Educators and is deeply grateful for being allowed to adapt the original presentation to provide additional access to all education stakeholders.

Response to Intervention

Foundations of RtI Definition Core principles of RtI Example of a tiered model Problem-solving in RtI Moving forward with implementation.

All educators want children to learn.

All parents want children to learn.

All children want to learn.

Belief Statements

Shifts in Thinking

Over the past 30 years, how we address the needs of students has evolved—

We have changed our thinking on how we teach and how children learn.

These discoveries have resulted in changes in educational laws and practices.

Shifts in the Law

ESEA/NCLB Accountability School improvement Adequate yearly progress (AYP)

IDEA 2004 Effective instruction Progress monitoring Early intervening services (EIS)

ESEA/NCLB and IDEA 2004

Companion laws that address closing the achievement gaps

Underscore importance of high-quality, scientifically based instruction and interventions

Hold schools accountable for the progress of all students in meeting grade-level standards.

Response to Intervention Is…

The practice of providing high-qualityinstruction/intervention matched to student needs

and using learning rate over time

and level of performance to

inform educational decisions.

Source: National Association of State Directors of Special Education (2005).

Response to Intervention

“The main objective of RtI is not to identify students for special education, but rather to help all students achieve at a proficient level and ultimately [schools] make adequate yearly progress.”

Source: Nebraska Department of Education (2005).

RtI Within the School Improvement Movement

Student achievement and behavior improve as a result of early intervention.

May be thought of as a process that fits within school reform and school improvement efforts.

May help reduce disproportionate representation of minority students in special education.

RtI and NCLB

“Utilizing a RtI framework across disciplines as well as grade levels is consistent with NCLB and promotes the idea that schools have an obligation to ensure that all students participate in strong instructional programs that support multi-faceted learning.”

Source: National Research Center on Learning Disabilities (2005).

Core Principles of RtI

Unifying belief: “All kids can learn.”

Problem-solving and problem-analysis.

Parent involvement.

Universal screening of academic, behavioral, and social–emotional indicators of success.

Prevention focused: academic, behavioral, social–emotional.

Core Principles of RtI (cont.)

Evidence-based interventions with fidelity of implementation.

Ongoing and sensitive progress monitoring of student response to interventions.

Data-based decision making.

Multi-tiered system with increasing levels of intensity.

National Research Center on Learning Disabilities RtI is an assessment and intervention process for

systematically monitoring student progress and making decisions about the need for instructional modifications or increasingly intensified services using progress-monitoring data.

National Research Center on Learning Disabilities (cont.)

The following is the fundamental question of RTI procedures:

Under what conditions will a student successfully demonstrate a response to the curriculum?

Thus, interventions are selected and implemented under rigorous conditions to determine what will work for the student.

Applications of RtI in Research

Prevent academic problems through early identification

Intervene with low-performing students

Assist in identifying student with disabilities.

Source: Mellard (2006).

Research Elements of RtI Two or more tiers of increasingly intense scientific,

research-based interventions

Individual problem-solving model or standardized intervention protocol for intervention tiers

Explicit decision rules for assessing learners’ progress

Implementation of a scientifically based, differentiated curriculum with different instructional methods.

Source: Mellard (2006).

An Example Tiered RtI Model

Tier 1: CORE ACADEMIC AND BEHAVIORAL INSTRUCTION; UNIVERSAL SUPPORTS; universal screening and INSTRUCTIONAL and BEHAVIORAL

INTERVENTIONS

Tier 2: TARGETED INTERVENTIONS and progress monitoring

Tier 3: INTENSIVE INTERVENTIONS

Academic Behavior

Significantly Low Underachievement

Insufficient Response to Intervention

RtI StepsStep I: Universal supports for all students.

Step II: Data review by problem-solving team.

Step III: Targeted interventions and progress monitoring for struggling learners.

Step IV: Intense interventions and progress monitoring for struggling learners.

Step V: Referral to special education when student demonstrates little or no response to targeted interventions.

Step VI: General education and special education personnel collaboratively teach and monitor student progress, adjusting IEP and services as needed for eligible students.

Best Practices for Problem-Solving and Problem Analysis Teams

Multidisciplinary team approach Systematic interventions embedded in general

education curriculum and instruction Ongoing systems that address student needs

Intervention to address need Progress monitoring using concrete observable data Data analysis and adjustments to instruction.

Recommended Composition of the RtI Problem-Solving Team

Student’s classroom teacher

Administrator/designee General educators (2–3 recognized by peers for

their expertise)

Parent Student (when appropriate).

Additional Resource Team Members (to be included as needed)

Behavioral/mental health specialist (e.g., school psychologist, social worker, nurse, counselor)

Special education representative (e.g., learning specialist, speech pathologist)

Other Specialists (e.g., OT, PT, adaptive P.E., vision/hearing specialists, assistive technology, transition coordinator).

Early Intervening Services (EIS) Foundations Definitions Core principles

IDEA 2004 Amendments

20 U.S.C. refers to EIS.

34 C.F.R. refers to EIS.

Early Intervening Services (EIS) Not special education Required if the district has significant

disproportionality with respect to identification of children as those with disabilities or placement issues

Process to assist appropriate learning experiences in general education

RtI is one way to assure differences are addressed.

Local education agencies cannot use more than 15% of federal IDEA Part B dollars for EIS.

For students in K–12, with emphasis on K–3. For students who have not been identified as

needing special education or related services but who need academic or behavioral support to succeed in general education environment.

Source: Individuals with Disabilities Education Improvement Act of 2004.

Early Intervening Services (EIS) cont.

Activities—

Professional development Providing education and behavioral

evaluations, services, and supports, including scientifically based literacy instruction.

Reporting—

Each LEA that develops and maintains EIS shall annually report to the state on

Number of students receiving EIS Number of students who received EIS who

subsequently received special education and related services within preceding 2 years.

Rule of construction—

“The screening of a student by a teacher or specialist to determine appropriate instructional strategies for curriculum implementation shall not be considered to be an evaluation for eligibility for special education and related services.”

Source: IDEA (2004,1414 (a)(1)(E)).

Committee Report—

“…and early intervening services to reduce the need to label children as disabled in order to address the learning and behavioral needs of such children.”

Source: Office of Special Education Programs (2006), slide 23

Progress Monitoring (PM)

A manual by the National Research Center on Learning Disabilities (NRCLD) defined progress monitoring as

A set of assessment procedures for determining the extent to which students are benefiting from classroom instruction and for monitoring effectiveness of curriculum.

Source: Johnson et al. (2006).

Use of PM

When using PM in Tiers 2 or 3, you are attempting to determine if the intervention or instruction is successful.

Monitoring should be frequent. Preset rules help determine when a student

is not responding to intervention.

Example of Bobby

Let’s think about a student, Bobby, who is having difficulty in the general education program. Data is collected on Bobby’s performance and compared with two typical peers in that setting.

Let’s look….

Peers 1

Peers 2

Bobby (cont.)

Using an RtI model, the general education teacher would probably determine Bobby is an “at-risk” student.

The teacher would provide supplemental instruction targeted to enrich Bobby’s performance (e.g., more practice, more instruction, more hands-on learning).

Let’s look at Bobby’s performance….

Tier 2 – Targeted InterventionBobby's Chart

10121416

Bobby (cont.)

Bobby has progressed….but did he meet the goal desired? Did his rate of learning change?

By adding an aimline when he started, the teacher could determine the rate Bobby had to progress to meet his goal.

Tier 2 – Targeted InterventionBobby's Chart

10121416

Bobby (cont.)

But how does he compare now with his peers?

His teacher screened the classroom again to determine performance (under curriculum-based measurement [CBM], data are collected systematically).

After 7 Weeks on Tier 2

BobbyPeers 1Peers 2

Bobby (cont.)

Typical peers are scoring around 20–22. The classroom range is 13–28.

How does Bobby’s score of 15 look?

Teacher determines that Tier 2 services may not be needed; Bobby will return to Tier 1 and be monitored carefully during the next probe (data collection).

Question—

What is the role of occupational therapists and occupational therapy assistants in RtI and EIS?

OT’s Role Under RtI and EIS RtI and EIS are for general education

students. IDEA “evaluation” for occupational therapy

services under special education. Consider your state regulatory statute for

occupational therapy services: Screening Interventions prior to evaluations Training others prior to evaluations.

Occupational Therapy Practice Framework: 7 Areas of Occupation Activities of daily living Instrumental activities of daily living Education Work Play Leisure Social participation.Source: American Occupational Therapy Association (2002).

Areas of Occupation (cont.)

Activities of daily living Eating and feeding Dressing Toileting

Instrumental activities of daily living Communication devices Meal preparation Community mobility

Education Academics, nonacademics, and extracurricular

Area of Occupation (cont.)

Work Pre-vocational job performance

Play Exploration and participation

Leisure Exploration and participation

Social participation Interaction with peers, family, educational staff, etc.

Activities Outlined Under EIS

Professional development

Evaluations, services, and supports

Professional Development

For teachers and other school staff—

Purpose: So they can deliver scientifically based academic and behavioral interventions.

Professional Development (cont.)

Suggestions: Instruction on use of adaptive instructional

software In-service on strategies to enhance fine motor

development In-service on environmental modifications for

children.

Evaluations, Services, and Supports

Purpose: Identify instructional or interventions to enhance the student’s rate of learning in the general education program.

Evaluations, Services, and Supports (cont.)

Follow your state’s licensure requirements.

If your state regulatory laws allows— Assist teacher in whole-class screening Provide screening to a student (with parent

and teacher consent) Provide suggestions to parents or teachers Provide ongoing screening or short-term

activities.

Once determination has been made that students should be evaluated, screening ends, and referral for special education should be obtained.

So, where do we go with this?

Let’s talk about some examples of students and activities

CASE STUDY A

Case Study A (cont.)

Mrs. Taylor is a kindergarten teacher. The school where she works uses an RtI model. During a recent class-wide screening, she found several children whose fine motor skills were discrepant from their peers.

In a discussion with her, you determined that her concerns are with strength and in-hand manipulation skills.

Your state regulatory laws does not allow you to screen individual students and provide suggestions.

So, you provide the teacher with general suggestions, based on evidence-based research, to use with the whole class to enhance these areas.

For example, you work with the teacher To identify ways to incorporate additional fine

motor activities within the current centers (e.g., store, computer, sensory table) or

Set up an additional center with fun fine motor activities (e.g., those targeting hand and wrist strengthening, dexterity, prehension, coordination).

CASE STUDY B

Case Study B (cont.)

Mr. Knoll is a 4th-grade teacher. His school uses RtI. He provided screening probes to his class and found 2 students whose rate of progress were below the norm in reading and writing.

Mr. Knoll provided Tier 2 activities for these 2 students. Data collected indicated that 1 student was not making the expected progress.

Mr. Knoll contacts you about this student and his concerns (e.g., the student skips words as he reads and has poor spacing of letters/words when writing).

Your state regulatory laws allow you screen clients and provide suggestions.

You talk with the school nurse who completed school-wide vision screening and told you this student passed.

Your quick screening indicates that this student’s visual–perceptual skills appear to be significantly delayed.

You suggest an in-depth evaluation by an eye care professional.

You provide the teachers with some strategies for this student.

When you follow-up with Mr. Knoll in 3 weeks, he indicates that the student did need glasses and that the strategies you provided have helped. The student’s reading and writing has been improving.

New Roles How does this

apply to you in your state and in your agency?

What types of activities are you able to use?

New and Expanded OT Roles OT has much to contribute to districts using

RtI or EIS. OT roles need to expand to include

prevention and identification of at-risk children.

Services may be direct or indirect and for children, families, educators, and colleagues.

OT needs to be in general education settings.

New and Expanded OT Roles (cont.)

Use your expertise as an OT to assist educational teams with In-hand manipulation and the

relationship to literacy (writing) Visual–perceptual skills and the

relationship to literacy (reading and writing).

Use your expertise as an OT to assist educational teams with Environmental adaptations, including

incorporating frequent movement breaks into the daily routine

Use of cardboard “offices” to narrow visual distractions.

Use your expertise as an OT to assist educational teams with Assistive technology that can enhance

student participation in educational program

Positioning students for more efficient performance.

Use your expertise as an OT to assist educational teams by Providing modified or adaptive

equipment so children can engage in general education classroom activities

Suggesting fine motor activities for classroom centers (e.g., play, household).

New and Expanded OT Roles (cont.) Use your expertise as an OT to assist

educational teams by Collaborating with teachers to

promote routine use of activities that enhance strengthening, fine motor coordination, etc. for all students in classroom

Promote classroom activities to enhance alertness for learning.

Yesterday and Tomorrow

What will be the norm with effective implementation of a RtI process/model in our

school?

Vision for Schools of Tomorrow Shared ownership, accountability, and

leadership All struggling students referred to the RtI

school teams for support, with a prevention focus on academics and social/emotional/behavioral issues

Eligibility for special education considered after intervention and ongoing progress monitoring of RtI.

Vision for Schools of Tomorrow (cont.)

EIS accessible to any student in need Authentic assessments and progress

monitoring throughout the curriculum; less focus on standardized assessments to determine eligibility for special education

Flexible delivery of support services the norm.

Quality growth opportunities to increase knowledge and skills must be provided for all stakeholders

Administrators Practitioners Families Higher education Policymakers.

Beginning to Build Partnerships Who are the key stakeholders with whom we

need to partner?

What initiatives are in place that connect to RtI and need to connect more closely to one another?

What do we need to do differently to move forward with RtI implementation?

For more information, see IDEA Partnership’s RtI Initiative

www.ideapartnership.org

A Partnership Collection on RtI Many Journals, Many Voices Results for Kids: Resources

Web Resources

OSEP provides free Web-based progress-monitoring materials at

http://www.studentprogress.org http://www.progressmonitoring.net

We are moving forward into tomorrow…

Reflections!

Questions?

Discussion.

References & Resources

American Occupational Therapy Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609–639.

Barnett, D. W., Daly III, E. J., Jones, K. M., & Lentz, F. E. (2004). Response to intervention: Empirically based special service decisions from single-case designs of increasing and decreasing intensity. Journal of Special Education, 38, 66–79.

Beghetto, R. (2003, April). Scientifically based research. ERIC Digest 167.

Center for Mental Health in Schools. (2006). Response to intervention. Addressing Barriers to Learning, 11(4), 1–3.

Individuals with Disabilities Education Improvement Act of 2004, P.L. 108-446, 20 U.S.C. Chapter 33.

References & Resources (cont.)

Clark, G. F., & Miller, L. E. (1996). Providing effective occupational therapy services: Data-based decision making in school-based practice. American Journal of Occupational Therapy, 50, 701–717.

Fletcher, J. M. (2006, January). Why RtI? Research and policy foundations. Paper presented at Texas RtI Summit, Austin.

Fletcher, J. M., Coulter, W. A., Reschly, D. J., & Vaughn, S. (2004). Alternative approaches to the definition and identification of learning disabilities: Some questions and answers. Annals of Dyslexia, 54, 304–330.

Hosp, J. L., & Reschley, D. J. (2004). Disproportionate representation of minority students in special education: Academic, demographic, and economic predictors. Exceptional Children, 70(2), 185–199.

Johnson, E., Mellard, D., Fuchs, D., & McKnight, M. (2006). Response to intervention (RtI): How to do it. National Resource Center for Learning Disabilities. Available online at www.nrcld.org.

Linder, J., & Clark, G. F. (2000). Best practice in documentation. In W. Dunn (Ed.), Best practice occupational therapy. Thorofare, NJ: Slack.

Mellard, D. (2006, March 2). Presentation at the IDEA Partnership Meeting, “Integrating IDEA Provisions With School Reform: EIS & RTI” (from National Research Center on Learning Disabilities).

National Association of State Directors of Special Education. (2005). Response to intervention: Policy considerations and implementations. Alexandria, VA: Author.

National Research Center on Learning Disabilities. (2006). Responsiveness to intervention in the SLD determination process. Available online at http://www.nrcld.org.

Nebraska Department of Education. (2005). Response to intervention. Available online at www.nde.state.ne.us/SPED/reg/documents/ResponseToIntervention-Admdays2005.pdf.

Office of Special Education Programs (2006). Response to Intervention (RTI) and Early Intervening Services (EIS). Washington, DC: U.S. Department of Education. Retrieved from http://idea.ed.gov/explore/view/p/%2Croot%2Cdynamic%2CPresentation%2C16%2C. Feb. 16, 2007

Reschly, D. J. (2005, December). Response to intervention (RtI) in general remedial and special education. Paper presented at the 2005 IDEA and NCLB Collaboration Conference, Arlington, VA.

U.S. Department of Education. (2006). Assistance to states for the education of children with disabilities and preschool grants for children with disabilities: Final rule (71 FR 46540).

Vaughn, S. (2006, January). What is RtI (response to intervention)? Paper presented at Texas RtI Summit, Austin.

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