So as you all know, here at the OT School House Abby and I are all about Response To Intervention (RTI) and working in partnership with our teachers. So with my partial day off due to presenting at my high school alma mater for career day, I spent part of the day digging for some research about collaboration.
I searched the American Journal of Occupational Therapy (AJOT) and initially found an article from 1996... I have nothing against 20-year-old articles, but I was just looking for something a bit more contemporary today. So I dug a little further, and I came across a brand new article (2018) titled, "Effectiveness of the Co-PID for Students With Moderate Intellectual Disability". The article was put together by a group of researchers out of Israel and was aimed at looking at the effectiveness of a "Collaborative Consultation" model versus a traditional "in-service" model
Selanikyo, E., Weintraub, N., & Yalon-Chamovitz, S. (2018). Effectiveness of the Co-PID for students with moderate intellectual disability. American Journal of Occupational Therapy, 72, 7202205090. https://doi.org/10.5014/ajot.2018.024109
The acronym Co-PID, in case you are wondering, stands for "Collaborative Consultation for Participation of students with Intellectual Disabilities". And by their account, the Co-PID Model is characterized by 3 key processes which are:
1. Freely sharing knowledge between the OTs and teachers
2. Jointly setting intervention goals and programs, and
3. Sharing responsibility for the student outcomes
As soon as I read these 3 key ingredients, I was hooked. This is what I have been begging for from the admin and teachers in my district. Constant communication, collaborative goals, and the shared responsibility for goals and interventions! I'll be the first to sign up for a team that works like that!
After calming down I continued reading. I was a little sad that they were not comparing this collaborative model to a direct pull-out model, but who knows, maybe that's next on their agenda.
Anyways, as opposed to the traditional in-service model which for this study included a hour and a half in-service on participation and two additional 45-minute meetings spread over 4 months, the Co-PID experimental group of teachers partook in the hour and half in-service along with a workshop session where the teacher and OT basically went through a mock lesson and follow up discussion. The Co-PID group also held 45-minute consultation meetings every two weeks during the 4 month period to brainstorm activities that could increase participation.
With participation being the "P" in Co-PID, it makes sense the outcomes looked at by these researchers was participation in the classroom - specifically communication, choosing, and initiating - and the transferability of these participation skills into other environments.
To measure these outcomes, they used a structured observation developed alongside the Co-PID model called The Structured Observations of Students Participation in Classrooms (SOSPiC). The SOSPiC was designed to evaluate functional communication, the ability to make choices, and the ability to initiate. The SOSPiC is designed to be a 45-minute classroom observation in which the observer completes a 4 point Likert scale. The Goal Attainment Scale (GAS) and the Participation section of the School Function Assessment (SFA) were also used as part of their pre/post testing.
So they went about their intervention and came to find some mixed conclusions. Between the two groups, no significant difference was found in improved communication or initiation skills. However, the Co-PID did make greater improvements in "choosing", goal progression on the GAS, and increased participation in areas other than just the classroom on the SFA.
Now before I get into my own analysis of what this means to me and possibly you as a school-based OT, the study did have a few limitations that should be noted. One limitation pointed out was the design and length of the in-service group, which wasn't fully detailed in the article. In my opinion, they also had a relatively small sample size (12 teachers and ~65 students at two school sites).
I also feel that it is just really difficult to complete a study at a school site. There is just so much going on that it is hard to account for external factors such as teachers and aides training experience, recess time and activities, attendance, etc. Despite these factors though, the study seems to have been completed with acceptable rigor.
How Does This Study Impact Us?
Well, I already mentioned this aspect, but I hope the researchers will complete a similar study with their model compared to a direct pull out model. By definition and cited in this article, students with Intellectual disabilities demonstrate poor carryover so I would be interested to see how skills carried over from OT session back into the class.
Recently, we have also been having a problem in our district with IEP team members wanting us to pull a student with moderate intellectual disabilities out of the classroom to work on skills that are likely out of their developmentally appropriate range. Regarding that problem, I like that this article clearly states the importance of participation in class and other activities rather than specific skill sets. Students are school to participate in class
My biggest concern with this model in relation to my district (and quite possibly yours, too) is the time constraints. Every 2 weeks the OT met individually with each teacher for 45 minutes. If you have multiple school sites that you service, you know how difficult it can be to schedule a 45-minute period when both you and the teacher would be available, especially if you have 5+ teachers to do this with. It would be a struggle, but not completely impossible in my district, I think.
I think it's safe to say that I see the pros and cons of this model and will definitely be keeping it in my research binder for when I need to reference the importance of collaboration to an IEP team. I think sometimes our IEP teams (me included) still gets stuck on a deficits models rather than a strengths and participation model. It's an article like this that reminds me a student is at school to participate in his/her class, not to be pulled out for OT sessions where carryover to their classroom is minimal
What about you, do you keep a research binder or journal in your workspace? Or better yet, do you reference articles in your reports or at IEPs? Let us know in the comments!
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Until next time,