Collaboration with a Multi Disciplinary Personnel

Organization of the Presentation

Introduction Issues affecting effective collaboration
Ethical Issues Turf issues

Professional collaboration with:

SLP (Speech & Language Pathologist) PT (Physical Therapist) OT (Occupational Therapist) Principals Child Study Team Board of Education Other professionals (medical doctor)

Suggestions for the future References

What is collaboration?
Working together to enhance the learners experience Respecting professional expertise

What is collaboration? cont

participation in identifying, designing, and developing inclusive program options with families and other professionals forming partnerships has enhanced professional practice early childhood special educator's experiences, resources, and contacts can be valuable assets to communities as they seek to expand and sustain community-based service options
(Allen & Polaha, 2003)

What are the components of collaboration?

Communication Decision Making Goal Setting Organization Team Process
Nijhuis et. al. (2007)

Why collaborate?
Learners and parents:
How many different people do they see before the child receives instruction? What happens if parents and learners get conflicting information?

Why collaborate? cont

Team Members:
Can we teach effectively in a vacuum? Consistent instruction Share ideas Learn from each other

Effective Collaboration
A basic understanding of: expertise orientation terminology potential role of the other professionals in the collaborating team
(Geroski, Rodgers and Breen 1997)

Helpful to Know
Qualifications + Philosophy + Professional terms + Possible contribution to the team + = Professional respect
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Successful Collaborators
Willing to try strategies Interested in using something new Quick to implement suggestions High adopters had the most knowledge of curriculum and pedagogy knowledge and student friendly beliefs about managing student behavior student-focused views of instruction ability to carefully reflect on students' learning
(Brownell et. al. 2006)

Roadblocks to Effective Collaboration

Excessive paperwork Difficulties identifying appropriate interventions with existing resources Lack of financial support Inadequate training in problem solving procedures No release time for meetings Meeting times difficult to arrange Meetings last too long
(Yetter & Doll, 2007)

Unsuccessful Collaborators
Moderate and low adopters were less knowledgeable Took longer to grasp ideas Did not always implement them well Some of these teachers needed to have ideas explained in detail Would discard ideas they did not appear to comprehend
(Brownell et. al. 2006)

Educating other professionals

Autism is a low-incidence disorder that has received increasing attention as parents have organized seeking more effective education services for their children with autism 1 prepare early intervention practitioners to work with young children with autism, severe physical impairments, and other low incidence disabilities
1

The program features joint course work across the Schools of Medicine and Education and seminars on collaboration and teaming 2
1

Shriver, Allen, Mathews, 1999 2 Able-Boone, Crais, Downing, 2003

Expanding Professional Roles

Will the shift from direct to indirect roles affect:
job satisfaction staff turnover potential for burn-out among early childhood special educators

professionals who were originally attracted to the field because of direct work with young children and families may be less satisfied with roles that are now primarily adult oriented and facilitative in nature

Ethical Issues
Before we can collaborate, we need: Mutual consent form signed by parents and student
Identify specific professionals to include Hand deliver, fax or mail

Make initial contact through a letter

Avoid phone tag due to different schedules

Send parents a copy of the letter Indicate an interest in collaboration in this letter

Collaboration with related service providers

Why should we collaborate?

Coordination between the disciplines is important when adding speech-language therapy to an applied behavioral program. All objectives must reflect a common goal in order to build speech, language, play, and social skills. (Parker 1996) ... SLPs are not the only professionals who target communication outcomes within the scope of their practice. Teachers, occupational therapists, reading specialists, and behavior analysts do so as well, either directly or indirectly. Therefore, crossdisciplinary collaboration is essential. (Koenig and Gunter 2005)

Benefits of Collaboration
The creation of evidence-based therapeutic approaches and practices by individuals with combined expertise in ABA and SLP The ability to improve the integration of support provided by SLP and ABA professionals as participants on home-, school-, and center-based intervention teams A reduction in the number of reinvented wheels
Discrete trial to establish skills and NET to generalize
(Koenig and Gerenser, 2006)

The Role of the SLP

From the ASHA Position Statement Roles and Responsibilities of Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span
Collaboration: Speech-language pathologists should collaborate with families, individuals with ASD, other professionals, support personnel, peers, and other invested parties to identify priorities and build consensus on a service plan and functional outcomes.

What do the fields of SLP and ABA have in common?

ABA and SLP are the treatment components most frequently requested by parents ABA and SLP therapists are highly focused on the individual, his or her unique learning style, and the outcomes of treatment Both ABA and SLP address skill deficits directly by teaching specific language behaviors rather than treating the problem indirectly using specialized diets or sensory stimulation programs Both fields rely on procedures that are supported by evidence. Most therapists measure the child's performance by collecting data to make decisions about progress and potential changes in instruction.
(Harchik, 2005)

Coordinating Speech-Language Pathology with an Applied Behavior Analysis Program (Parker, 1996)
1. The SLP should develop language goals similar to those developed by the behavior program in order to facilitate generalization.
- Ex. ABA program is working on expressive labels with the Sd, What is this? The SLPs goal can be to use the same vocabulary to request those items in a low structure, play context.

2. The SLP should help to make the discretetrial goals of the behavior program as communicative and functional as possible.
Ex. Work on requesting programs using objects of high interest.

3. The SLP can add valuable information about speech-language goals that are being addressed in the behavior program.
Ex. Suggest a prompt to remediate specific sound errors such as placing a hand on the students throat to teach the /k/ sound.

4. The SLP helps to ensure that all therapists are attempting to use similar vocabulary, commands, and toys in focusing on their goals. 5. The SLP can offer information to the behavior team and parents on developmentally appropriate linguistic forms and the developmentally normal communication sequence.
Ex. Assists with the periodic reassessment of linguistic goals.

6. The SLP can demonstrate how to incorporate specific goals into daily, preexisting activities, such as dinner, bath, and bedtime, which will be helpful with generalization and sequencing.
Ex. A daily activity such as cooking dinner can be used to teach sequencing skills and specific language forms. If the child is working on prepositions, the parent can say, First we put the water in the pot, then the salt in, then the spaghetti in.

7. The SLP should help develop reinforcers- both tangible, such as food, stickers, and toys, and social, such as praise, hugs, and tickles. 8. The SLP should assess the manner in which speech-language skills are used within the classroom or play group in order to ensure maximum benefit from these interactions.
- Ex. Suggest that the teacher give the child a toy that she knows another child likes, then encourage the two children to play together. - Ex. Encourage the classroom teacher to set up activities that require a buddy, and pair the child with a peer who is both a strong language model and a friendly child.

9. The SLP can also help troubleshoot specific linguistic problems.

Ex. If the child is having difficulty remembering the names of objects, the SLP can develop appropriate categorization and world knowledge tasks.

10. The SLP can also aid in the diagnosis and treatment of concurrent disorders (e.g. apraxia or dysarthria)

Three models for team interaction

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Component Philosophy of team interaction

Multidisciplinary Interdisciplinary
Team members recognize the importance of contributions from other disciplines. Generally, families meet with team members separately by discipline. Team members are willing and able to share responsibilities for services among disciplines. The family may or may not be considered a team member. Families may work with the whole team or team representatives. Team meets regularly for case conferences, consultations, etc.

Transdisciplinary
Team members commit to teach, learn and work across disciplinary boundaries to plan and provide integrated services. Families are always members of the team and determine their own roles.

Family Role

Lines of Communication

Typically informal. Members may not think of themselves as part of a team.

Team meets regularly to share information and to teach and learn across disciplines (for consultation, team building, etc.). Staff development is across disciplines and is critical to team development and role transition.

Staff Development

Generally is independent and within disciplines.

Frequently shared and held across disciplines.

Component Assessment Process

Multidisciplinary Interdisciplinary
Team members conduct separate assessments by discipline. Team members develop separate plans for intervention within their own disciplines. Team members conduct assessments by discipline and share results. Goals are developed by discipline and shared with the rest of the team to develop a single service plan.

Transdisciplinary
The team participates in an arena assessment, observing and recording across disciplines. Staff and family develop plan together based on familys concerns, priorities, and resources.

Plan Development

Plan implementation

Team members implement their own plan separately by discipline.

Team members implement parts of the plan for which their discipline is responsible.

Team members share responsibilities and are accountable for how the plan is implemented by one person, with the family.

http://www.njeis.org/NJFoundationsSP.pdf

The Consultative Model of Service Delivery

(Bellone, et. al 2005)

Why should we use this model?

For individuals with ASD, exclusive provision of services through pull-out services does not address the underlying challenge of social communication inherent in the disorder, the issues of generalization, functional outcomes, or the importance of collaborating with significant communication partners. (ASHA 2006)

Why?, cont
Research on children with ASD suggests that the greatest effects of any direct treatment are reflected in the generalization of learning achieved by working with parents and classroom personnel.(NRC 2001)

Traditional S&L services are inadequate

1-5 hours treatment per week SLP is sole instructor Isolated setting Skill generalization and maintenance difficult to achieve given these limitations
(Bellone, et.al., 2005)

BUT
The pull-out model of service delivery continues to be the most used model for preschool and school-age children. (ASHA, 2004)

EVEN THOUGH
There is no evidence supporting the long-term effectiveness of individual therapies implemented infrequently (e.g., once or twice a week), unless the strategies are taught to be used regularly by communication partners in the natural environment. (ASHA 2006)

Consultative S&L services afford

Consistent and continuous instruction throughout the childs day Skill generalization across people and settings in childs natural environment Skill maintenance through practice in naturally occurring and programmed opportunities
(Bellone, et.al., 2005)

The role of the SLP

Develop curriculum Select data collection systems Train teachers Observe teachers & students Attend meetings Modify teaching procedures

The role of the teaching staff

Provide multiple daily opportunities Collect & sum data Review data w/ SLP Initiate questions, concerns Troubleshoot w/ SLP Incorporate changes into instruction

The consultative model in a public school

School administrator contacted NECCs consulting department NECC directors met with teachers and administrators
Defined role of SLPs and teaching staff

A letter was sent home to parents inviting them to an informational meeting

After a follow up letter and phone call, 33% (n=24) selected the consultative model

The consultative model in a public school

Public School Contract

Services were provided in 8 children in 3 classrooms 2 hours/mo of consultative (indirect) services from SLP 40 hours/mo direct S&L instruction from lead classroom teacher SLP consult with Head teachers
Head teachers train teaching assistants

The consultative model in a public school

Results
Public school students made progress/met 98% of objectives (2005) NECC students made progress/met 90% of objectives (2004)

What do other disciplines have to say about professional collaboration?

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Guide for Professional Conduct

PRINCIPLE 11 A physical therapist shall respect the rights, knowledge, and skills of colleagues and other healthcare professionals. 11.1 Consultation
A physical therapist shall seek consultation whenever the welfare of the patient will be safeguarded or advanced by consulting those who have special skills, knowledge, and experience.

11.2 Patient/Provider Relationships

A physical therapist shall not undermine the relationship(s) between his/her patient and other healthcare professionals.

11.3 Disparagement
Physical therapists shall not disparage colleagues and other health care professionals. See Section 9 and Section 2.4.A.

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Code of Ethics
Principle 7. Occupational therapy personnel shall treat colleagues and other professionals with respect, fairness, discretion, and integrity. (FIDELITY)

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Guidelines for Responsible Conduct For Behavior Analysts

9.0 The Behavior Analyst's Responsibility to Colleagues.

Behavior analysts have an obligation to bring attention to and resolve ethical violations by colleagues, to make sure their data are accurate and presented truthfully, and they share data with colleagues. 9.01 Ethical Violations by Colleagues 9.02 Accuracy of Data 9.03 Authorship and Findings 9.04 Publishing Data 9.05 Withholding data

Are related service providers a necessary component of an effective program?

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A public program serving children in preschool through eighth grade diagnosed with Autism and related disabilities in Bergen County, NJ The speech-language department works collaboratively with the classroom teachers to promote various communication modes such as the Picture Exchange System, computerized voice output devices, sign language, and fostering expressive language. (McKeon, et.al. 2006)

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Does not employ related service personnel

Curriculum includes teaching programs that facilitate the development of language and fine and gross motor skills Programs are implemented by instructional personnel throughout the day Pull-out related services are rarely necessary because of the breadth and comprehensiveness of the curriculum

If services are deemed necessary, appropriate referrals or

consultations are arranged by ALG staff
(Meyer, et. al, 2006)

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The Douglass School

each class is supported by a half-time speech-language specialist who provides individual and group therapy as well as consultative services to the preschool teachers. An adaptive physical education professional serves the preschool children on the three times a week and acts as a liaison for consulting professionals such as physical or occupational therapists. (Harris, et. al, 2001)

Douglass Outreach
Douglass Outreach employs five licensed part-time speech pathologists for speech-language services. (Harris, et. al, 2001)

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Princeton Child Development Institute

Strong emphasis on language development Does not employ specialists All intervention personnel are trained to teach receptive and expressive language in every activity
Toilet training, outdoor play, lunchtime

Language instruction encompasses discrete trials, incidental teaching, time-delay procedures, and video-modeling procedures. 36 of 41 children entered PCDI before 60 months of age and had no functional expressive language
The skills of these children currently range from using sounds as mands to age appropriate verbal repertoires.
(McClanahan and Krantz, 2001)

Recommendations for Continued Collaboration

Share treatment efficacy data Share innovative teaching procedures Share basic information Share successful collaboration experiences Read articles in journals associated with the other profession Share your concerns Share lunch
(Koenig and Gerenser, 2006)

State of New Jersey Department of Human Services Department Of Education

The Office of Early Care and Education (OECE) SPAN/COSAC/

Autism Society of America

BOE - Local School / Sending School District Child Service Team

Board of Education (Receiving School)

Director of Special Services

Parents / Home / Family Physician Dentist, Doctor

School Principle Bus Teacher

Child

ST OT PT ART Music BCBA

Siblings Family Celebrations

Community

Neighborhood, Shops, Restaurants

After school services (latch key) Employment Sheltered Living

DDD DVR

Collaboration with Administration

Who are the possible collaborative partners? How can we develop a collaborative relationship?

NJDOE Press Release: February 20, 2007

Approximately 7,400 New Jersey children between the ages of 5 and 21 have been diagnosed with autism spectrum disorders. Fifty-five New Jersey school districts will share $15 million in state funds to establish, expand or enhance public school programs and services for students diagnosed with Autism Spectrum Disorders..

Administration
State of New Jersey
Department of Human Services
The Office of Early Care & Education (OECE)
Division of Family Development Department of Children and Families Build NJ: Partners for Early Learning Coalition of Infant/Toddler Educators (CITE)

Administration
Child care services are coordinated through
Department of Human Services' Office of Early Care and Education for information, policy and resources the Division of Family Development for child care operations the Division of Developmental Disabilities the Office of Licensing in the Department of Children and Families (DCF) all in cooperation with Child Care Resource and Referral Agencies in every county

Services include:
information and referral to help parents locate child care resources and to answer typical questions regarding types of child care how to pay for care how to become family day care and licensed child care providers.

Administration
Department of Education
Division of Early Childhood Education
The Division of Early Childhood Education (DECE) of the New Jersey Department of Education has programmatic responsibility for preschool through 3rd grade (PK3) programs. responsible for the development, implementation, and alignment of program components with a focus on standards, curricula, and assessment. The creation of this division:

Acknowledges that a continuum of developmental stages constitute what is traditionally known as early childhood, Protects New Jerseys investment in high quality preschool by providing high quality kindergarten through third grade educational experiences for young children.

PK3 work will be organized within a framework that includes

structural (administration, class size, teacher-child ratio, etc.) process (quality of classroom environments, teacher-child interactions, etc), alignment (standards, curriculum, assessments) components that are associated with childrens
social and academic outcomes.

The DECEs work will be:

Research-based, with a series of advisory committees consisting of nationally recognized experts representing a range of early childhood-related areas Cross-departmental to align all DOE PK3 initiatives, Supportive of the efforts of the Division of School Improvement.

Office of Special Education Programs

Implements state and federal laws and regulations governing special education to ensure that pupils with disabilities in New Jersey receive full educational opportunities. Provides statewide leadership through the development of policy and implementation documents and provides guidance to school districts and parents regarding the implementation of special education programs and services. Responsible for administering all federal funds received by the state for educating pupils with disabilities ages 3 through 21. Monitors the delivery of special education programs operated under state authority, provides mediation services to parents and school districts, processes hearings with the Office of Administrative Law, and conducts complaint investigations requested by the public. Funds four learning resource centers (LRCs) that provide schools and parents with information services, materials circulation, technical assistance, consultation services and production services. Plans and implements program and personnel development activities in areas such as implementing the least restrictive environment provision, planning the transition of students with disabilities from school to adulthood, planning programs and services for preschool children with disabilities,developing Individualized Education Programs (IEPs) and accessing individual rights and entitlements.

LEARNING RESOURCE CENTER - NORTH 7 Glenwood Avenue, 2nd Floor, Suite 201 East Orange, New Jersey 07017 Regions served: Bergen, Essex, Hudson, Morris, Passaic, Sussex, and Warren Counties (973) 414-4491 - LRC General Service (973) 414-4496-FAX (973) 266-1849-TTY (973) 631-6349 - Preschool Technical Assistance e-mail: lrcnorth@doe.state.nj.us

A collaborative model
The Child Study Team
Composed of teachers, specialists, administrators, and parents Responsible for identifying and evaluating students aged 3 21 for special education programs and services. Required to conduct both an educational evaluation and a psychological evaluation. (A neurological examination is also required before a child becomes eligible for special services.) Develops an Individual Education Plan with parent/child. Assigns a case manager
Visits receiving school or agency with parent/child Organizes placement and transportation
(Walther-Thomas, Korinek, & McLaughlin, 1999)

IEP Meeting
Who should attend?
Student (if appropriate) Parent At least one general (or special) education teacher At least one Child Study Team member Students case manager School district representatives Persons invited by parent or school Representatives of agencies providing payment for services

Typical School Operations Network

Council of the Borough

(duly elected by town)

Board of Education (elected by Council)

Superintendent
Hired by the BOE to direct operations Manage the fiscal year budget Hire all school staff including Child Study Team members, teachers, and professional support staff (ST, OT, PT, BCBA, librarian, etc.)

School
Effective collaboration emerges out of concerns by individuals who are like-minded in some ways and very different in others. Walther-Thomas, Korinek, McLaughlin & Williams (2000) Principals tend to focus on issues such as achievement trends, financial implications, professional development, student placement, professional schedules, and community relations. Teachers are concerned with individual and group performance, IEP planning, and new responsibilities. Families care about the impact of new initiatives on their children.

Improving student bus-riding behavior through a whole-school intervention (Putnam, Handler Ramirez-Platt & Luiselli, 2003)
Intervention developed through collaboration with students, school personnel and bus drivers 624 students participated during 5 phases of the study Disruptive behavior that resulted in referrals or suspensions was targeted and measured in an ABAB reversal design Results indicated an overall decrease in bus suspensions

Parents have power!

Parents and children are the service users Parents and children have the most to gain/lose regarding adequate effective services The child is at the center and the parent needs to learn to collaborate with all the service providers and get them to collaborate with each other from the time of diagnosis to adult development. Parents can enlist the work of nonprofit agencies and foundations to work with one another to map the terrain of a problem They should talk to public officials about providing long-term funding for vital programs both in their community and at the State level. Parents should know their rights and not accept anything less.
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Suggestions for the Future

develop and evaluate new methods of preparing early childhood special educators whose primary role now consists of consultation and collaboration, rather than teaching Use the case method of instruction Prepare professionals to become independent and competent problem solvers in the role of consultant personnel training programs must be systemic in nature
(Dybvik, 2004)

Suggestion for the Future, cont

changes in professional roles create opportunities for interactive learning for professionals who function in a variety of roles, including administrative ones ensure a shared knowledge and values base among all professionals who serve young children and families Remedy roadblocks
(Skrtic, 1991)

Suggestion for the Future, cont

21st century changes:
"the entire history of special education is (and should continue to be) one of incremental progress toward more socially inclusive instructional placements for students with disabilities"

Efforts aimed at early childhood community integration will continue to present profound challenges to practitioners in ECSE
Effectively change our roles in response to the changing times, in support of young children with and without disabilities growing up together
(Skrtic, 1991)

Able-Boone, H., Crais, E. R., Downing, K., Preparation of Early Intervention Practitioners for Working with Young Children with Low Incidence Disabilities, Teacher Education and Special Education, v26 n1 p79-82 Allen K. D., Barone V.J., Kuhn, B., A Behavioral Prescription For Promoting Applied Behavior Analysis Within Pediatrics, Journal Of Applied Behavior Analysis, 1993, 26, 493-502 Allen K. D., Polaha J., Bridging The Disconnection Between Applied Research And Practice: A Review Of Treatments That Work:Empirically Supported Strategies For Managing Child Behavior Problems by E. Christophersen and S. Mortweet, Journal Of Applied Behavior Analysis 2003, 36, 141146 American Speech-Language-Hearing Association. (2004c). 2004 Schools survey report: Caseload characteristics. Rockville, MD: Author. American Speech-Language-Hearing Association. (2003b). A workload analysis approach for establishing speech-language caseload standards in the schools: Implementation guide. Rockville, MD: Author. American Speech-Language-Hearing Association. (2006). Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span [Guidelines]. Available from www.asha.org/policy. "APTA Guide for Professional Conduct." American Physical Therapy Association. Jan. 2004. American Physical Therapy Association. 10 Oct. 2007 <www.apta.org>. Bellone, Beth, Nicole Conley, and Laura Hutt. Consultative Services for Children with Autism and Severe Developmental Disabilaties. 2005 ASHA Convention, 18 Nov. 2005, New England Center for Children. 12 Oct. 2007 <http://convention.asha.org/2005/handouts/293_Hutt_Laura_071407_112905091151.pdf>.

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