OTS 163: Making Sensory Integration Work in School Environments
- Jayson Davies
- Dec 2, 2024
- 45 min read
Updated: Dec 18, 2024
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Welcome to the show notes for Episode 163 of the OT Schoolhouse Podcast.
What if there was a way to make sensory integration more accessible, effective, and inclusive for every student you support?
In this episode with Dr. Colleen Cameron Whiting, OTD, OTR/L, shares her research on integrating sensory integration within the school setting. From implementing a flexible 15-week intervention model to adapting strategies within a Multi-Tiered System of Support. Join us as this episode is packed with practical insights to empower us to make a meaningful change.
Listen now to learn the following objectives:
Learners will identify how sensory integration can be effectively implemented within a school setting using a multi-tiered support system (MTSS).
Learners will understand the importance of collaboration between occupational therapists, teachers, and parents to enhance student engagement and classroom performance
Learners will understand how to integrate SI strategies into everyday academic activities and tailor them to fit individual student needs.
Guests Bio
Colleen Cameron Whiting, OTD, OTR/L has worked as an occupational therapist for over twenty years and currently works as an assistant professor in the doctorate program at Johnson & Wales University. Her expertise lies in holistically supporting children, particularly those with sensory integration and processing challenges, autism, and who have experienced trauma, using theoretically based, evidence-informed interventions, and advanced professional reasoning.
Throughout Whiting's career in early intervention, mental health, schools, private practice, and academia, she has modeled the importance of being a lifelong learner and innovating new ideas through her scholarship and service. She has published several peer-reviewed journal articles and chapters as well as a multiple baseline single-subject research study. Whiting has also presented internationally in professional development trainings for practitioners, parents, and educators.
Quotes
"They really felt like they had a breadth of knowledge of really understanding the impact that sensory integration and processing can have on occupational performance and how some of the strategies and approaches that we do, using the ASI principles, can have really nice gains."
-Colleen Cameron Whiting, OTD, OTR/L
"They now had this tool belt of strategies of adapting and modifying the school environment to be more sensory supportive for that particular student, but also understanding that it's really important that we're engaging the student."
-Colleen Cameron Whiting, OTD, OTR/L
"We want to make sure that we have this intentional generalization of what’s happening; otherwise, we’re just in this kind of box in the corner, and we’re not making sure that things are connecting back to the classroom."
-Colleen Cameron Whiting, OTD, OTR/L
“An IEP is designed to be individualized for the student. So long as the IEP team agrees on something, go for it. You might have to get a little crafty in how you do it, but go for it.”
-Jayson Davies, M.A., OTR/L
“Using terminology familiar to educators, like 'common core,' instead of technical terms, can better communicate the impact of occupational therapy in schools”
-Jayson Davies, M.A., OTR/L
Resources
Episode Transcript
Expand to view the full episode transcript.
Jayson Davies
Hey friend, welcome to episode 163 of the OT school house podcast today, we are addressing one of the most pressing issues in school based occupational therapy, whether or not sensory integration can be effectively implemented in a school based ot setting. Now, since gene Ayers first began documenting protocols and data related to this theory, countless articles have been published about the effectiveness and efficacy of sensory integration. However, none of those articles accounted for the unique system that we as occupational therapy practitioners in the schools find ourselves in while working in the schools. Well, that is, until now, in today's episode, we're taking a close look at the first published article aiming to prove whether or not a sensory integration approach can have an impact within the school setting. Joining me to do just that is author of the article, Dr Colleen Cameron Whiting. You may remember Dr whiting from Episode 35 of the OT school OTs podcast, when we discuss trauma informed practices. However, today is all about sensory stay tuned to learn why Dr whiting decided to pursue this research, what the SI program actually looked in the school setting, and the potential implication for this research for both you and the future of SI in school based OT. So let's jump into the research with Dr Colleen Cameron Whiting, owner of the spark sensory clinic and assistant professor at Johnson and Wales University.
Amazing Narrator
Hello and welcome to the OT school house podcast, your source for school based occupational therapy, tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.
Jayson Davies
Welcome back to the OT schoolhouse podcast. Dr Whiting, how are you doing today?
Colleen Cameron
I am doing well. Thanks for having me back. I'm excited.
Jayson Davies
Absolutely. It's always a pleasure to follow up with those who have been on the podcast before, because, you know, people do different things over time. So today I'm excited to talk sensory with you, because last time you were here, we actually discussed trauma informed care. But today we are here to discuss your recent article titled A sensory integration intervention in the school setting to support performance and participation, a multiple baseline study. Now this is the first time I have seen an article with both the terms school setting and the other term sensory integration in it. How did that come to be actually?
Colleen Cameron
Sure. I mean, as probably you're aware, most of the research has really been done on sensory integration intervention in a clinic setting, so I was really anxious to conduct a study whose intervention was being delivered in a school setting. And I also wanted to highlight and utilize a model of service delivery available in the school setting that I use that is multi tiered systems of support, otherwise known as MTSS, and this approach looks to integrated and embedded supports before considering sensory integration intervention as a pull out model. So for my study, the participants had undergone support through MTSS in those lower tiers, but the progress monitoring data had indicated they needed a more restrictive level of intervention in order to make progress in their academic engagement. So this part was really important to me, because I wanted to make sure in the study and the way that we were doing it, we were aligning with least restrictive environment mandates.
Jayson Davies
Yeah, absolutely. And I think a lot of practitioners listening today know that it is really difficult to implement sensory interventions within the classroom, other than doing maybe some accommodations, like incorporating a wiggle cushion, or maybe even teaching the teacher, or having the teacher incorporate some movement breaks through, go noodle, or other methods. But with this article, you went beyond just sensory based interventions, and you took it all the way to sensory integration. So before we dive into the methodology of the article and whatnot. I'd love for you to share your experiences implementing si in a school setting.
Colleen Cameron
Sure, so I definitely was lucky enough. Might be helpful to share a little bit of my journey of how I got to being able to do you know ASI to fidelity. I was really lucky enough to be attending bu for my master's 25 years ago, when they were offering the SIPP certification courses. So I was able to receive that certification. And when I graduated, I had started working in a public school in Massachusetts that had a small sensory gym for its ot room, and I also on the school had arranged for me to be mentored by an ASI therapist from then ot a Watertown which is now the Kumar center. So I was very fortunate that I know many school based practitioners start working out of a closet space, and they're certainly not receiving mentorship from OTs at like a renowned airs si center, with their school district footing the bill, right? So. A way I knew I was, you know, in more of a privileged position to be able to align to those principles of errors as I in the school setting, even before there was a fidelity measure, really, to measure my practice to. And then I had moved to another school district where, again, I had found a place to have sensory space to call home as my ot room in that district as well. And really continued my professional development learning journey in era si, I completed mentorships through on the star Institute. I was really lucky enough to have some wonderful mentoring by Dr Lucy Jayne Miller and Dr Sarah shone, which really shaped my thinking. I developed a course for the star Institute around use of sensory integration intervention with a tiered approach in the school and in teaching this and all of this education, I really found that it was limiting my advocacy for use of OT with an ASI approach, because there wasn't that direct evidence available. So that's really what propelled me to go ahead and to conduct my own research and the study you're discussing today.
Jayson Davies
Wow, yeah. And to be honest, like it wasn't really until I saw the title of your article that said in a school setting that it really hit me that there hadn't been research related to this topic between school setting and SI, it had always been more clinic based. So, yeah, very unique, and also very much needed. And you know, you mentioned a lot of your experience with SI, I actually want to ask you about the fidelity measure. I think it was around 2010 when that came out, maybe a little bit.
Colleen Cameron
Yes, yeah, a little bit later. Yeah, a little bit later. So, yeah. So I'd align my intervention with both the ASI fidelity measure and the star Institute's fidelity measure, which would come out a little bit later than that as well.
Jayson Davies
Gotcha. Okay. So my question is, did the fidelity measure make it easier or more difficult to practice in the schools as a practitioner using a si frame of reference, or did it not really change anything at all.
Colleen Cameron
So I the fidelity measure is definitely incredibly helpful when you're looking to determine whether what you're doing is actually errors. Si, in without the fidelity measure, you know, there's been a lot of problems right in research as far as articles that are not specific to all of the use of all the era principles and the structural elements. And so there's been conclusions drawn about something that's perhaps not effective, but it wasn't actually, in fact, Eris si so I found that incredibly helpful to have the fidelity measures available. I think that the other piece that proved to be more of a challenge is that it is a lot of the research that has been done is specific, more to a clinic based setting. And so when I was trying to determine, really the volume and kind of intensity parameters around what I was going to use for my intervention, and I was looking in the research, there was a lot of discussion around seeing a child three to five times a week for an hour, which you know is not not appropriate or really available for us to do as school based practitioners. And so I really was trying to figure out what was the least amount of times that I could see, them per week and total time per week, in order to ensure still the significant progress that I wanted, but making sure that I was not taking away valuable classroom time in that moment. So I had really good luck with two times 30 minutes a week that I had found success with through the years, of really having some nice demonstration in my progress monitoring and data collection around really incredible performance and participation gains back in the classroom. And so that was really the model that I ended up settling on. The difference for this study, which was a little bit different, is that it's not aligned to that whole year that you have with an IEP. It was a 15 week intervention, which actually is a really exciting approach. That kind of short term piece perhaps offers us a new way of looking at intervention the school, and not just tying us to that year long intervention thinking that we could see some really nice occupational engagement gains over a shorter period of time of intervention.
Jayson Davies
Perfect. And, yeah, you hit exactly like my thinking on the nail right there, right it's like Si. When we think of Si, we think of, you know, hour long sessions multiple times a week. And let's be honest, anyone listening here is going to be like, I can't do that. Most people right? So, yeah, absolutely, that was a big part of this. And I know that some will be a little frustrated with me if I don't ask you this question. You mentioned that there's two fidelity measures. Actually, I'm familiar with the ASI fidelity measure, but you also mentioned a star fidelity measure that one I'm not as familiar with. So I want to give you a second to kind of compare, contrast similarities, or just speak to both of them a little bit. It sounds like you're familiar with both.
Colleen Cameron
Sure. So the star fidelity measure encompasses. A lot of the ASI principles, but they do a really large kind of parent component. So the way, when I had written the course for them, we had kind of tweaked it to really having a lot more of the teacher engagement. So that was part of why, when I was developing this intervention, and, you know, airs si has this piece around working with teachers as well, in their structure, of their fidelity measure that I wanted to make sure that it was a collective approach, that I included consultation weekly alongside my intervention to make sure that these pieces were were generalizing. But the other facet that was is really highlighted with the star approach that I've done a lot of work around, is really that focus on connection and relationship building and really meeting kids where they're at in a really intentional way. A lot of the roots are drawn from a lot of the DIR floor time model and some of those facets. So when I was going into this intervention, I was really collectively using both of those models, having been trained in both and because they dovetail so nicely the intervention, because I had the interventions were taped and seen by an expert in both ASI and in star, and they were rated as far as on that fidelity measure from that third party. And so it dovetailed really nicely so that I was able to meet the fidelity measure for both measures with my intervention.
Jayson Davies
Wow. That is not easy to do. If anyone has read those fidelity measures, that is not the easiest thing to do. I mean, there it is very structured in what your therapy needs to look like. So kudos to you for making that happen. All right, we've alluded to to the research a little bit, but let's really like dive into it, kind of section by section. And I guess the first thing that I want to ask you is just, you've already kind of hinted at it a few different ways, but I just want to explicit. Explicitly ask you, like, what was the specific research question that you had as you began diving into your research.
Colleen Cameron
Sure. So our research question was, will sensory integration intervention paired with teacher consultation implemented with children? We looked at kids between five and eight years old for this study who had documented sensory integration differences that had been demonstrated in their comprehensive evaluation. Would this intervention be effective in improving a student's functional regulation and their active participation in the general classroom? And that part of the question was a little bit challenging for me, because I wanted to find specific variables that I knew would represent occupational engagement back in the classroom, we videotaped the kids in the classroom for our data out for our outcome measurement. So it was really important for me to find things that were meaningful, aspects that we could operationally define in order to be able to measure some of the outcomes that we would see as a result of sensory integration interventions. So I also wanted to make sure that I was intentional about my wording, to make sure that they were neurodiversity affirming in the language that I used. So we had really settled on those two of the two measures of functional regulation and active participation. And I had done a single subject design for the study, because this methodology, as you know, as a school based therapist, much more feasible than a randomized controls trial. I am a therapist of one in my school district, and so, you know, and many of you, you know, many of us have a small caseload. We don't have this, you know, big case to draw from. So the guidelines, when you're looking at, because I do get a lot of questions about this, what, it only had three participants, and then it actually follows the guidelines that, in order to, you know, really conduct a high quality single subject research design, the study needs to include three attempts to demonstrate an intervention effect at three different points in time. So for my study, I had three participants that were really acting as their own control, because I took data at it during a baseline period and an intervention period, and it actually worked out really nicely, because my baseline period was the time when I was getting the referral for the evaluation, and we were going through all those processes of IEP meetings and so forth, and then they had qualified, and I had started the intervention, so I wasn't withholding any intervention. Any point was just part of the normal timing process of the IEP process. So having those three participants in the study allowed it to be included alongside other single subject designs as a moderate level of evidence, which is great.
Jayson Davies
Yeah, absolutely. And diving into kind of the next section that we often see within a research paper, I want to talk about the participants a little bit. You did mention that it was a small sample. You did mention, you know, five to eight years old. But I want to ask you, well, just a little bit about the inclusion, exclusion, maybe, right, like, what type of were you looking for? A specific type of student? Did they have to meet some sort of criteria?
Colleen Cameron
So for my inclusion study, they were included, they had to have had a comprehensive evaluation that had revealed significant sensory integration and processing challenges that was affect. Significantly affecting, in fact, their performance and participation in the school setting. And what I actually did for the subjects, we did an exclusion around if they had an autism diagnosis, they were not included. And also, if we had seen embedded support at that tier one and tier two level was successful in mitigating their participation challenges, they were not included for that.
Jayson Davies
How was that defined? And when you say tier one, tier two, are you talking from an OT perspective, from anywhere.
Colleen Cameron
So for these particular students, it was one of the reasons why I really needed them to be in the kindergarten phase. Because, as you know, that on the MTSS support, the kids come in just with a referral, and things just start happening at the preschool level. But there's a little bit more opportunity for us to be moving in and doing some whole class strategies. I do a number of, actually, whole kindergarten I go into all the kindergarten classrooms with my school psychologist and my speech language pathologist, and we do whole class pieces. So we had a lot of tier one pieces included with, you know, all classrooms having integrated supports available in them. They had been referred to kind of that pre referral system. I know they call that different things in different school districts, but pre referral before they go to sped, which we use for our tier two piece, which is more of that focused, small group piece. And so I had gone in and done some consultation with the teacher, and we tried, had tried some small group activities and some different pieces, taken some data around that, and really had shown that it was not really moving the needle for these particular students, that they were still really struggling with their participation in a number of occupations in the school setting.
Jayson Davies
Gotcha. Okay, so you're looking for students who weren't necessarily making progress with you, already supporting that kindergarten class, or those classes a little bit perfect, because that leads directly into the next question. You often don't hear the terms si and MTSS together either. And so again, when we think of Si, we think a lot of you know swings, you know, all that fun stuff, bolsters, we don't think about necessarily supporting teachers or seeing kids in a group at a table or something like that. So I want to give you an opportunity to kind of share how SI can or how it did with with this study fit into an MTSS model?
Colleen Cameron
sure. So I think part of that would be helpful to maybe talk a little bit about what the collaboration with the teachers look like, because that hopefully will help thread how we're not talking about really passive experiences that you get with more sensory based strategies. But how can we use the ASI principles but apply them in a tier one and a tier two fashion, that were active, looking for active engagement. So for the study, we had those weekly consultations, and I would meet with the teachers. We talk about, you know better, understanding the student, their strengths, their goals, what sensory integration and processing is, and we collaborate on a lot of the generalization, the modifications, problem solving challenges. And so for example, one week, I had a teacher that had raised questions in our consult about how one of the participants was having difficulty while sitting on the rug for whole class activities, and the activity was involving multiple steps. So I knew from her comprehensive evaluation that I had done that she had challenges and postural control as well as praxis. So I'd really align my suggestions of the ASI principles of addressing postural control and Praxis along with supporting intrinsic motivation, collaboration and activity, choice and just right challenge. So we discussed opportunities that we could develop more robust postural control and Praxis for the student during whole class academic games, we made sure they were activities that the student had voted for and wanted to participate in and reportedly enjoyed. I provided suggestions such as different visual supports and slower pacing and really the benefits of the rep of repetition for this particular child that I learned from working with the student directly and finding that just right challenge for her. And we also offered different choices of seating options that help the teacher to engage the student more in a partnership in the decision of which new seating options helped her participation and her comfort during rug time. So in part, we really did a lot of discussion and training around the teacher, helping to work with the student to kind of cue into those internal body sensations. So she was playing, the student was playing an active role in all of these elements, so that it was a really a collaborative piece that that the teacher and the student and I were kind of embarking on with that.
Jayson Davies
Yeah, yeah. At the end of the day, it sounds like most of that's directly related to the student, right? So it would be, I would consider that tier three, does that line up with with your tier model?
Colleen Cameron
Yes. So I would, so that was the consultation part of tier three. So the way, I kind of just, and I know people kind of discuss in different ways, so it's. Good. We're kind of making sure we're on the same page of terminology. I really align with the fact that if we're moving toward individualized suggestions, that we need to be in tier three, going through that comprehensive evaluation process and making sure that we're really informed as to the suggestions that we're making to that child's specific sensory profile. So when I talk to talk about these consultation pieces and connected to the direct service I am referring in my wave that I've captured it in more of a tier three approach.
Jayson Davies
Perfect. That's what I had assumed. But as you mentioned, right, everyone, kind of, I'm even seeing tier four pop up in a few different models that are coming out now. So just want to clarify. All right, I'm going to prevent myself from going backwards and asking you about tier one and tier two. Maybe we can do that in a little bit, but it's not directly related to this study. So I want to stay on on topic here. You just talked a lot about the collaboration consultation with the teacher, but on the flip side, what did your intervention look like outside of the consultation collaboration, because you were also seeing the students individually, correct?
Colleen Cameron
Yes. So I saw the students individually for the 15 week period, and I saw them two times a week for 30 minutes, and then I had the weekly consultation, and that took place in my space, which, luckily, again, did align with the errors si fidelity measure as far as the structural elements, which I completely recognize is not the case for everyone, but it really felt like, for me, for the our first study, that we were really capturing the school based scenario when we wanted to make sure that we were really able to see some of these important outcomes that we know can result as a as a use of ASI in the school setting, I felt like this first go of really aligning with all of the fidelity measures and making sure that everything was really aligned with research that also was happening outside of the clinic so people could draw parallels was important, but I'm really excited at the possibility of this really inviting more researchers to try the same approach of service delivery, and maybe they're going out and doing that on a playground, or they're doing it in different spaces and collecting some of the same data and seeing if we can Get the same amount of, you know, outcomes and differences that we're seeing in occupational engagement. It's something that, I think, a project that I've been kind of passionate about working on with a group of individuals that were, we really feel like a lot of the the school based pieces, there aren't a lot of coursework to help support what that looks like, right? But also the guidelines that I'm referring to, the fidelity measure was developed for more of a clinic based research approach. So we're actually in the midst right now. Dr Roseanne Schaaf had, had asked me to head up a project of developing an adaptation and extension of the ARIS fidelity measure to make a guidelines document that is applicable for the school based setting and specific to a tiered approach, so really outlining what that looks like in each of the tiers. And we're really hoping that this will be a guiding instrument for working in the schools and using ASI I'm doing on that project with Dr Roseanne Shaw, Dr Sarah, shown Dr Maria serice and Dr Kelly. Alt right. And so right now, we have developed the guidelines document. We're in the midst of collecting data for face and content validity, and we're hoping that this will be something that's available soon. So we're really excited about it.
Jayson Davies
Yeah, absolutely. And I want to get into that a little bit more, but first, I do want to take a step back, because a step back, because as you're completing this project, you don't have that right, like you're in the process of creating it. You had a space, you have the training. But even with that, was it still difficult to meet the fidelity measure to it? I mean, not necessarily to a T but But was there anything else within the school what, I guess, kind of, what else within the school makes it difficult to meet the fidelity measure that maybe you had to deal with, whether it be the time that you have with students, whether it be maybe the support from administrators, what do you see as being some of those barriers that really do need To be overcome?
Colleen Cameron
So I think that there are barriers to conducting a study as a school based therapist that, you know, I was the researcher and the treating therapist, so that carried a lot of stress with it. Fortunately, I had an incredibly supportive administration and the teachers and all the assistants and everyone that was kind of really trying to support that. But you know, staying to fidelity as far as two times 30 a week. Vacations happen. Kids get sick. Fire drills happen in the middle of the time that you're supposed to be seeing them. So that was a real struggle to meet the fidelity measure from that lens of making sure that I was consistently offering that two time. 30 a week. And then I would say the other piece that I took very seriously was that we were I wanted classroom videotaping to happen that was representative of an everyday activity, so kind of settling on what that looked like. But the fact of having to go and set up a videotape and then having it there for a period of time beforehand, so all the kindergarteners weren't noticing that the videotape was on and, you know, and all the facets to kind of the technicalities of that were particularly challenging but doable. I, like I said, I was the only therapist in there, in there doing it, but I hear a lot of practitioners not having space or access to equipment, not having administrative support, and even that's even how we kind of redesigned the guidelines that we're working on for the school based setting that we took a step back and said, do we need to have this frog swing specifically, or could we look at the affordances that the frog swing brings to the experience of the treatment session, and can we find those and maybe different different types of equipment that maybe is a little bit more accessible to others? So we kind of changed the narrative on a lot of the structural elements for the fidelity measure to look at more affordances of equipment, to open that so it wasn't as tied to specific pieces of equipment.
Jayson Davies
Yeah, and you mentioned the two times a week 30 minutes. Now, some people are going to hear that and say, Yeah, okay, I could potentially make that happen. Some people are going to say, that's no way. Irregardless of that, I want to ask you, why two times a week for 30 minutes? Where did that come from? I'm sure it just wasn't random. So how did you come up with and you can even also speak to the one time a week. I believe it was collaboration, but why was that the intervention model used, or the frequency used?
Colleen Cameron
So when I initially started working in the schools, a lot of my kids that I inherited were a consultation model, or one times 30, and I had really seen through the years of taking data at different different frequencies, of seeing the kids that my one times 30 kids, I would come back and see them the following week. And it was kind of like Groundhog's Day, that a lot of the gains and things that we had seen in the week before really had been lost in the process. And many times, we were taking a number of steps backward. And I found that even just adding that additional time a week made a real difference for my students, as far as being able to really push forward more efficiently and effectively in the outcomes that we were measuring. And I think having this 15, you know, week interval that I was kind of now moving into, because I wanted to have a reasonable amount of time that we're kind of collecting data, and hopefully having that shorter piece. I know many people will say, you know, they see their kids one times 30, but they see them for years, right? And so this was a model that I was able to move these particular students after they had this more, you know, whether you call it intensive or not, the two times 30 model of service delivery that they were able to shift down by the end of that IEP or to a consultation model only, so we made some really significant gains in that shorter period of time, and that, yes, they did lose some time from the classroom, which I recognize is not ideal for that period of Time, and it's part of why we really take seriously the approach of making sure that that's necessary in order to be able to make these effective gains. But I think having being able to demonstrate those that difference in just 15 weeks, and we asked the teacher in our interviews and the questions at the end in our semi structured interviews with the teachers, did you feel like the time that we they lost in the classroom was worth the gains that they received from having this intervention? And all of them said it was a resounding yes, that they felt it was so that was important too.
Jayson Davies
Wow, yeah. I mean that that's important. I'm glad you also got some data from the teachers. That's great. We're gonna dive into the raw data actually here right now. But before we do, I do just want to, before we get into the numbers, I guess, or the outcomes, I want to give you a moment just to kind of give a brief overview of all the different ways that you did collect data. Again, you mentioned a little bit of this already, but kind of just in one short synopsis, what were the various ways that you were looking at data?
Colleen Cameron
So we had collected data. We videotaped the students in the classroom, so that was the main data that we use for the single subject design. And I took data at baseline and during the intervention phase, but then I wanted to get a fuller picture of their occupational performance, making sure that I use goal attainment scaling when I'm developing goals, so making sure that the goals that the families and the teacher and everyone had contributed into developing were making meaningful gains. So we, I had done the scope, which is the short child occupational performance is based on the Moho model. For those of you that aren't familiar, it's very accessible for use in the school setting. We did the Basque and I did. That with the support of the school psychologist, as far as we just talked about categories of interpretation, I didn't go down the road of making a lot of, you know, drawing a lot of conclusions out of the data. And I did do that with the support of the school psychologist. I did goal attainment scaling with them, and then I also did semi structured interviews at the completion of the intervention with the teachers and the students, and I really wanted to do it with the students, but they're younger, right? So they're not as good with their report. They're not very accurate reporters. And so I decided upon actually doing a card sort activity for them. So I had pictures of things that were happening in the classroom, and I had them sort whether they were hard or easy for them. And then I had pictures of things that they had done in the intervention with me, and whether they liked it or didn't like it. And I got these really wonderful kind of capturing of kids moving towards, you know, having less thing feel difficult for them in the classroom, through their lens, through their lived experience, but also that they really enjoyed the intervention. And there was a lot of comments around, you know, joy and kind of relationships and enjoying their time, even with me. And so that was really wonderful that we had. I was really glad we had added that part to like, share their lived experience. It was really the first time that children's perception and their lived experience had been looked at in a study. So that was exciting.
Jayson Davies
Awesome, great. And you kind of went in the direction I wanted to go. I want to kind of break each of those different areas of data down a little bit you, you kind of just went over what the children said, Unless there's anything else to add to that. We can move on to one of the other three areas. It sounds like that you kind of took data in, maybe starting with the videotaping, what were you actually looking at with those videotapes, and what did you see as the intervention went along?
Colleen Cameron
So what we saw was significant changes in the children's functional regulation and active participation for all three participants that we saw their performance, kind of hovering down below and then shooting up and being really significant across the course of intervention. So when I had an outside rater rate the videotapes on different intervals of time, and I think she had operationalized definitions for that, and so that was really the crux of the single subject, kind of outcomes of the research. And then we also saw really significant gains on the scope that they had made some gains from pre to post for that as well the goals that we had set for this children, they had in their we had they were actually in their IEPs centered around occupations of play, education, social participation and health management. So some of the pieces that we saw that were, you know, changes that we noted included increased interoceptive awareness that supported health and wellness, increased social participation with peers, increased participation in non academic and their academic activities, and increased play, exploration and participation. And so that was exciting. You know, we know that there were some proximal gains that we saw with increased skill and praxis, and we saw improved regulation, but these definitely had an impact on these distal outcomes, and that's really what we were looking at measuring so.
Jayson Davies
With the distal outcomes, is that what you use the gas methodology for collecting data, or was that part of the video recording?
Colleen Cameron
Kind of a combination? We just really were trying to capture the so for the goal attainment scaling, we had the teacher and the assistant that was working in the classroom doing that rating, and for the scope as well. So we were able to get some of the teacher's perspective on some of the things that were changed, but we were able to complement that with the kind of hard data that we received from actually measuring the number, you know, amount of times that the children were functionally regulated or actively participating back in the classroom. And they definitely aligned really nicely that we saw gains across the board.
Jayson Davies
Gotcha, okay, all right. And I think that brings us to the final piece of data that you really looked at. And again, you already alluded to this one a little bit, with the teacher questionnaires, interviews, where they felt that the time away getting the intervention was worth the time that a student missed in the classroom. Aside from that, what else was some of the results from those teacher questionnaires that you found meaningful?
Colleen Cameron
So specific to their experience with the consultation they had shared that they really felt like, even though they had worked with me for years, that having this consistent time and really problem solving and talking about the particular student, that they really felt like they had a breadth of knowledge of really understanding the impact that sensory integration and processing can have on occupational performance and how some of the strategies and approaches that we do using the ASI principles can really have really nice gains. So they came away with a better understanding of all of the bigger knowledge base, and they also had said that they now had this tool belt of. Strategies of adapting and modifying the school environment to be more sensory, supportive for that particular student, but also having the understanding that it's really important that we're engaging the student. We're not just passively, you know, throwing this ball chair in the corner, that this is an informed, really thoughtful decision that we're collecting data around and and hopefully making some real differences happen back in the classroom as a result. And, you know, kind of off, you know, not in the taped part of the conversations of semi structured interviews, but they had mentioned that they really liked having this, you know, it's a ripple effect, right? So now they have all of these knowledge of strategies and modifications and things that they can bring forward to future students as well. So I think that's a nice benefit to point out as well as we continue to collaborate with teachers and really engage with them and and pair with them really in this task that we're really helping in them to with future students as well.
Jayson Davies
Yeah, yeah. I completely agree, and almost to the point where, like at this time in my career, it's really hard for me. I'm not practicing right now. But if I was practicing and I was seeing a student individual, by the time I stopped practicing, almost every student who I was seeing individually, especially in a pull out model, I was adding a consultation to that service, because you see that value in actually talking to the teacher. I think as a newer practitioner, it can almost seem easier to avoid the collaboration, avoid the consultation, and just see the student, one on one, no one's watching you. You just have the kid right like you do your therapy, you send them back, and as you start to really see how much of an impact collaboration can have, consultation, talking to a teacher, one on one about a specific student, or even their entire classroom, potentially that just has so much power. So I'm so glad that you incorporated that into the into your work. I guess a question was that kind of leads me to is you put them all together, right? You did both the pull out and you did the collaboration. Are you familiar with any work? And I'm assuming the answer is no here, but maybe I'm wrong where they have potentially separated those out, or maybe multiple researchers, because I doubt there's been one. But have you ever heard of like si in the school, but eliminating or not using that collaboration piece?
Colleen Cameron
I know it happens just anecdotally, talking to other practitioners, right? But it's certainly not a model that the you know, if you're following along with the airsi fidelity measure, even as it's written now, it says parent or a teacher, you know, correspondence. So it's definitely an expectation for you to be collaborating, and we're making and it's really it's important, because we want to make this sure that we have this intentional generalization of what's happening and that otherwise we're just, we're just in this kind of box in the corner, and we're not, we're not making sure that things are connecting back to the classroom. And as I mentioned, we have, you know, in that collaboration, you have so much power, more power to make even more of an influence, because they're with the student all day. You're only with them two times 30. So I really think that that is, you know, important, and people will, you know, speak to and I totally get this that there's not time that's dedicated in their day. I know I've worked in school districts before where they don't have kind of a dedicated meeting time that that's happening after school, or they're having to give up lunch, right? These are the realities that we see as school based therapists. So I one of the pieces with this that I've talked about with school based practitioners. You know, it's definitely doable. I did it. I'm a school based I was a school based therapist. I did it when I was did for the study, and did it for years. But I think that short term intensive support model can be really interesting and available to some to maybe think about more and ideally, if you're using a really robust MTSS system, your the number of students that actually come to needing this more intensive service delivery, you know, model should be lower. So I've encouraged some practitioners that are kind of newer to trying this that, you know, you just say, maybe I'd like to go to the administrator and try it with just this one student, and take the data, interviewing the teacher afterwards, seeing how effective it can be. And that can really help build support in the district. So you don't have to go from, you know, not doing any of these pieces to everything with every one. So I think that that's important. And then also, you know, I conducted the treatment in more of a typical other si space, so considering other places that they could potentially work, or advocating, if there's one particular piece of equipment that they feel like when they look at the affordances of the guidelines, when they come out like, this is one piece I'm really missing, maybe it's advocating for just that one piece. Of equipment that fills that gap for you.
Jayson Davies
Yeah, and you talk about, thank you, first and foremost, for like, kind of giving a little bit of guidance to everyone out there listening who's maybe really wants to do this and has had some struggles, but I wanted to it made me want to ask you here is, was this actually embedded on an IEP. That just depends on how I phrase the next question, were these 15 weeks on an IEP, or was it kind of off the IEP as a tier three without being on the IEP?
Colleen Cameron
It was on the IEP.
Jayson Davies
All right, perfect. So I often get that question then, like within an IEP, do I have to keep the same service for the entire year. Can I have multiple services on an IEP? And I know my answer, my answer is always, an IEP is designed to be individualized for the student. So long as the IEP team agrees on something, go for it. You might have to get a little crafty in how you do it, but go for it. And so that kind of, I want to see how you went about doing this. How did you put this onto an IEP for a short period of time, but then it sounds like you moved them to potentially a consult afterwards, or whatever it was. I don't know if you want to share kind of how that conversation went with IEP team, potentially, or kind of just, yeah, how that worked.
Colleen Cameron
So over the years, I've kind of approached this in different ways. For this, for the purpose of this particular study, I had written out the service delivery to be for the entirety of the IEP term, because I wanted the to ensure that everything, timing wise, was going to work out okay. And typically, how I will usually approach this is kind of talking to the parents about how we I'd like to the research around ASI use in general, is really around more of this intensive model of multiple times a week, and that's where all of the efficacy results have shown. And so I would like to propose seeing the child a couple of times a week for initially, but thinking about this as more of a short term intervention span, with the hopes that then I would be able to move toward more of an inclusion model and just see them maybe one times 30 in the classroom to help support those and then be able to fade that I would prefer to go with more of an evidence based model use of ASI, and get some really effective gains, and be able to shift from that. You see speech language pathologists have, you know, their whole model where they have kind of that fading level of support that they're kind of built and write it into the IEP. So the way that I've done that is, you know, say that I give myself a little wiggle room, where we have maybe a 20 week period where this was written in for the IEP within it shifts in the IEP to one times 30 inclusion for the rest of the IEP period. And I put a caveat in there that if the data is showing that they're not making significant gains, and if at any point, the parents would like to revisit the service delivery model, that that's something that they're they're open to doing. But yeah, so it's, I think it's the way that you're framing it as as it begins, and really trying to provide the reasoning and the understanding behind the choices that you're making, that you're not just, you know, on a whim, deciding that you're taking the child out, and that they understand that you're taking this seriously, that they're losing time from the classroom, and that we want to make sure that the reason that they're doing that is for an effective service delivery, that they're going to be making some gains back in the school setting.
Jayson Davies
Yeah, yeah, absolutely. And yeah. I mean, an IEP is meant to be adapted, and so it's always they call it right, a living document, an addendum can always be called right, to change it up if things aren't working, and you have the power to call an addendum, the parent has the power to call it an amendment. So, I mean, everyone kind of It's a team effort here. And yeah, I I don't think I ever actually put into an IEP where a student would be seen for maybe twice a week, or even once a week for part of the IEP, and then it would decrease after that, but I could see how it would work out again. Every district might want it done a little bit differently. But yeah, if you talk to your administrators, talk to the special education department, I'm sure you can find a work of a workaround for it. So yeah, all right, before we get into a few more practical, you know, takeaways, I want to give you an opportunity to also share a little bit about just some of the overall limitations. You know, in hindsight, now that you see about this research that if someone, whether it be you or someone else, were to kind of take this and say, I want to replicate it, what were some of the limitations that you think maybe in the future could be updated?
Colleen Cameron
Sure. So I mean, an obvious limitation is the generalizability of the results, given the small, you know, number of participants that are involved in a single subject design. And that's really why I'm hoping that other practitioners will take up the charge do some replications of the study to increase. The evidence they've got the model already set for them. Just trying to do some replication, we had really good results that many times you see studies having challenges with the particular outcome measurements that they had, the variables that they chose to measure, and ours held pretty well for all of all three of the participants. So, you know, I invite people to replicate the study. I've recently moved into full time academia at Johnson and Wales University, so I'm no longer able to do the direct service and do another study myself, but happy to offer mentoring of anyone who wants to replicate my study reach out to me. And I think another limitation of the study is that I wish I had taken some more longitudinal data to be able to see to make sure that they realize the gains that they realized post intervention. You know, I only took it through when they when they finish intervention. I know, anecdotally, you know what happened with the students, but I don't have specific data on that. And so I think going forward, if someone was to do another study like this, that they would take into account and maybe do some longitudinal data, maybe six months post, or even three months post, to see how if the gains, you know, continued. But in general, I think, you know, given its limitations, I'm it's a start, and I totally recognize that it's just a start, but I'm really hoping it sparks more research, and we really need occupational therapy practitioners advocating for the use of ASI in school based practice. And there's actually an article coming out in January, in eight OT, an issue is article on this topic that's titled occupational therapy using air sensor integration in school based practice, a call to action. So keep an eye out for it. I'm actually first author on that, and my co authors are Dr Sarah shone, Anita Bundy, Shelly lean Zoe mayo, Susanne Smith, really, Theresa May Benson and Roseanne Schaaf. So we had really a wonderful collaboration, lots of really rich discussions in writing it. It was a blast, and we have a bunch of detailed next steps that are needed in practice, advocacy and education, because there's definitely work to be done.
Jayson Davies
Oh, my goodness, I got like chills when you mentioned all those names. I was like, Man, I would love to be a fly on the wall in that Zoom Room or whatever, because there's just a lot of knowledge between that group of y'all. And I've spoken to several of you, not all of you, but yeah, it that is a lot of, a lot of knowledge to be shared in that room. So thank you kind of going a little bit, and you went practical here a little bit, right? People that want to take this, take your research and do something with it, outside of, you know, someone taking a research and saying, I want to replicate it, but for, you know, the the practitioners out there who are just like, All right, I've got this now. I've been looking for research related to si in schools, and now we have this. Everyone, if you haven't already, print this out, put it in your research like little binder, right? So the next time you're at an IEP, when someone asks, Is there research on Si, you're like, hey, just happen to have something. But I guess let's kind of break this down, because there are different levels or different affordances that people have, and so let's assume someone has some si training. They have a room that can kind of meet the fidelity measure, but maybe they're struggling to get some people on board with whether it be getting that two times a week for 30 minutes so that they can kind of have that fidelity a little bit, or just getting even that idea of pulling a student out to do sensory integration, what recommendations do you have for them when it comes to kind of overcoming those barriers a little bit?
Colleen Cameron
It's a great question. I recognize that they're really significant barriers for many practitioners, and so for kind of at that starting place that they've had some advanced training, because we know that that's an important piece to have when you're enacting and using ASI in the school setting. And they have some of the structural elements that can approximate what is needed. I think it really comes down to first, that really larger scale of working with administrators in your district and having an open conversation about multi tiered ASI and how that can best fit so not going and just talking about, I want to add this pull out model, but really talking about it as this, the entirety of this plan, of this kind of scope and sequence where I'd like to work with the teachers to help them, you know, have a greater understanding. Could I offer some professional development trainings? You know, at that tier one piece, I'd like to start going in and have advocate with my special education director to have some time to go in and do some work in the classroom, because it it doesn't work, right? If this, it's just this model that we're just kind of dropping in, and it's really disconnected from the rest of the school and not individualized to the culture of your school. So everywhere is going to have different different states even have different mandates and ways that they've set up support. So I think it's offering a conversation. And not coming in with this is the way it has to look, but really off making it a conversation, an open conversation, where we're going back and forth and really coming together on a model that can work for everyone. And as you said, kind of printing out those pieces of documentation. As far as articles, I know that CLASI just put out a summary of research and effectiveness, kind of a cheat sheet of the latest research that my article was included on that's an incredible resource. And sometimes it comes down to just becoming comfortable with having your own elevator pitch of what is multi tiered use of errors si in the school. Why is it important? And how can I help the students you know, perform better in the school setting. I really want to move away from this whole conversation, and we talk about this in the issue is as well, as far as this medical model versus the school model, and from my lens, and we talk about this in the article as well, from my lens. It's really almost a justice piece of if this is an evidence based model of service delivery. It should not just be available to those that have these wonderful funding of OTs, that have a lot of support, and they have one home school that they're working in, and they have all these pieces. We need to find ways that we can bring this to other districts and increase the support of these kids. And you know, we know we see increased needs of of sensory needs across the way from the pandemic, certainly, and we know that it impacts in the school setting, their performance and participation. So we need to be moving away from, we're not the handwriting specialists. We are holistic. And this is holistic practitioners. And this is one piece, you know, it's certainly and I've spoken a lot to the sensory piece, and I understand that it is one element to the to the full breadth of what we're looking for, but it is one approach and intervention that can be an evidence based approach that we can bring to the table to particularly help support the sensory and really making sure that we're hitting home the fact that this is to bring back gains back here in the school setting. That's what that's what it's about, and it's we need to be client centered and make sure it's individualized as well.
Jayson Davies
Yeah, yeah. And I think the same would go for if you're kind of in a similar position that we just talked about, maybe you have the training, but you don't have the space. I think you kind of follow that same type of model there, right? You need to figure out who you can talk to to try and get a space. There are a lot of different ways to get funding for a space. I didn't even I was working at my school, working in an SI prepared gym, if you want to call it that. I didn't realize it, but the parents had actually funded it. They had gone through, basically asked parents for donations, and that is what funded the room. You know, in other situations, a grant can fund a room, and another situation, like, there's so many different ways to fund a room, and so you just got to get in front of the right people. The other thing that I'll add to it is, I think it's Dr Amy Pilar and Dr Sultan alfrez. I'm sure alfrez, I'm pretty sure you're familiar with them. They are in the process of working to link really related to sensory integration, linking sensory integration to Common Core state standards, which is another perfect way to kind of get in the door, right? Because speaking Common Core is the way that you speak to teachers and educators, right? Like they understand common core, they don't understand proprioception, vestibular all that good stuff. So we kind of have to speak in that language. And I don't know if you want to add anything to that Colleen?
Colleen Cameron
Yeah, no, I know they did a wonderful presentation on that at the last a OT. I think that their their planning, their plan, is to follow up with that upcoming in a OTA. And so, yeah, I would encourage people to follow their work as well, because I know that many school districts and states require for you to make those connections back to the standards, so hopefully, again, the more tools that we can put into I feel like there is the conceptual of what's the best practice, and then there's the reality of being a school based practitioner, and we're all coming with these different challenges. I guess. I'm hoping this article shifts the narrative of, yes, this can be appropriate and can be effective now, is it something that would be appropriate to use in our school district, or how can we, you know, kind of make that plan to make that come true in our district, but it might look different for different individuals, for sure.
Jayson Davies
Yeah. And then the other piece that we talked about, just talked a little bit about, like, if you need to develop a room right, who to go to, what to talk about. But for those who are maybe interested in some training, you mentioned you have a course with star, I believe, obviously there is the CLASI training out there. What are your recommendations to someone who's just like, hey, I'm newer to school based occupational therapy. I'm newer to OT in general. I really want to get some education in sensory integration. Do you have any tips for them?
Colleen Cameron
Yeah, so it's definitely a need. One of the pieces that I feel like is is so important, is that we need things that are accessible and affordable, because a lot of professional development trainings are incredibly expensive and they're not accessible for school based practitioners to be able to take off. Four days, five days from their school day, right? So I'm actually in a work group that's working on developing more of like an entry level course, so this would be a step down from a certification level course, but an entry level course that's specific to multi tiered use of ASI and its principals in the school setting. So we're hoping that will help meet this that need. And then I'm also presenting with some of those same individuals at a ot Inspire. We're doing a yes, I can a road map for incorporating areas sensor integration in the schools. So we're hoping that we can put out some general entry level coursework, but also some professional development short snippets to help people start to be able to understand and figure make an action plan for themselves. Right. As far as how we can make this happen.
Jayson Davies
Absolutely, and you can pencil me in for being at that session. Definitely. If anyone wants to join me, you know where to find me, but awesome. Well, the last thing I want to discuss with you real quick. You've already mentioned it a little bit, but you are working on that fidelity measure. And I just want to give you an opportunity to kind of share just a little bit about maybe the evolution and the progress of how that's working out.
Colleen Cameron
Yeah, so it's really exciting that, as I mentioned, Dr Schaaf had had asked me about, how can we make what we people are saying the ARIS fidelity measure, it's not accessible for the school setting, you know, how can in but people feel like they're really resonating with your article and the research that you did. How can we help to kind of bridge that? And so we talked about an adaptation, or kind of extension of the fidelity measure, not for, necessarily for the purpose of research purposes. So we're, you know, labeling it more of a guidelines document, but starting to really discuss, so in a measurable way, what does this look like at tier one? We kind of go through each of the elements at tier one, what this can look like. What does this look like at tier two and tier three? How can the structural elements be different? And so we, we had a lot of really important conversations about, I think the original fidelity measure was maybe 40 or 50 hours of training. Like, do, how many hours is kind of like the minimal amount of hours we can to get people, like boots on the ground going to work with that. So we really tried to break down each of those pieces and look at it through. We have a number of school based practitioners on this work group. How can we really look through the lens of a school based practitioner of the practicality of this, while also not losing the integrity of the intervention itself? So it's been kind of dancing and gentle line across that, but right now we're in the midst of doing face validity. So what we've done is put it out to a number of school based practitioners that have had some training in sensory integration intervention over the years, and seeing their Yes, and you were one of them seeing where, seeing their feedback as far as the feasibility or the usefulness of this. And then going forward, we're going to be taking a lot of the original authors of the original Aris fidelity measure, and returning to them and seeing from a content validity, is it in this form, after we've made some adaptations, given the feedback from the school based practitioners, are these more theorists? Are they still feeling that with these changes that we've made? Does it still align with errors, sensory integration, intervention, can we still capture it as that even with this, these accommodations, so we're going to be going through that content validity piece after we're done with the face validity, and then hopefully be able to pull those two together and make this, these guideline documents, readily available for school based practitioners.
Jayson Davies
Yeah, yeah. Well, Dr Whiting, it has been a pleasure. Thank you so much for all of this wonderful information. Before I let you go, aside from creating a Google Scholar alert for any time you publish something, where can everyone go just to kind of keep tabs on on things that you might be working on, like the fidelity measure and whatnot, is there a place where people can kind of just learn a little bit about you and keep maybe not keep in touch necessarily, but just know when things are coming out about you.
Colleen Cameron
Sure, definitely my contact information and I have background information on my current research projects that I'm working on are on my Johnson and Wales University occupational therapy, my faculty page. But I try to keep up with LinkedIn if I'm posting new projects, or if I have a publication or I'm presenting somewhere, I usually do some sort of a post there. So I welcome people connecting with me on that.
Jayson Davies
Absolutely. And we will definitely post the links to those places over on the show notes. So be sure to check out the show notes. And I will also be sharing most of whatever you share that comes from your LinkedIn and whatnot, because, as you mentioned, that's where you like to post a lot of your updates. And we like to post your updates because they typically have to do a school based occupational therapy. So yeah, thank you so much for being here. We really appreciate it, and can't wait to learn more about that school based si fidelity measure. It's gonna be awesome.
Colleen Cameron
Excellent. Thanks so much.
Jayson Davies
All right, and that brings us to the end of another insightful episode of the OT school health podcast. A massive thank you to Dr whiting for sharing her invaluable research and practical strategies on integrating sensory integration within the school setting. Truly, Dr Whiting, your expertise and dedication are greatly appreciated by the entire school based ot community for what you are doing, and also thank you for tuning in and taking a keen interest in enhancing your practice to better support the students you work with. Remember, every small step that you take toward bettering yourself as a practitioner has a profound impact on a child's school experience. Honestly, you all are the real MVPs. So keep it up. Don't forget to check out the OT schoolhouse collaborative over at ot schoolhouse.com/collab there, you can earn a certificate of completion for listening to this very episode of the OT school house podcast, as well as other episodes, and also find some very helpful resources. It's an excellent way to continue your professional development and get more support on implementing the strategies in your own practice. Remember stay inspired, keep learning and together, let's make a difference, one student at a time until next time, take care and keep up the great work.
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