Professional Collaboration

1. Professional Collaboration Adriane Miliotis Delia O’Mahony Martine Torriero

2. 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

3. Discouraging Search • Advanced Search • Search Terms: professional collaboration • Journal: Applied Behavior Analysis • (Searching: PsycINFO)   • No results were found.

4. What is collaboration? • Working together to enhance the learner’s experience • Respecting professional expertise

5. What is collaboration? con’t • 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)

6. What are the components of collaboration? • communication • decision making • Goal setting • organization • team process Nijhuis et. al. (2007)

7. 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?

8. Why collaborate? con’t • Team Members: • Can we teach effectively in a vacuum? • Consistent instruction • Share ideas • Learn from each other

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

10. Helpful to Know • Qualifications + • Philosophy + • Professional terms + • Possible contribution to the team + = Professional respect

11. 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)

12. 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)

13. 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)

14. 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

15. 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

16. 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

17. Collaboration with related service providers

18. 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, cross-disciplinary collaboration is essential.” (Koenig and Gunter 2005)

19. 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)

20. 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.”

21. 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)

22. 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 SLP’s goal can be to use the same vocabulary to request those items in a low structure, play context.

23. 2. The SLP should help to make the discrete-trial 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 student’s throat to teach the /k/ sound.

24. 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.

25. 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.”

26. 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.

27. 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)

28. Three models for team interaction

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

31. The Consultative Model of Service Delivery(Bellone, et. al 2005)

32. 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)

33. Why?, con’t • 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)

34. 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)

35. 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)

36. Consultative S&L services afford… • Consistent and continuous instruction throughout the child’s day • Skill generalization across people and settings in child’s natural environment • Skill maintenance through practice in naturally occurring and programmed opportunities (Bellone, et.al., 2005)

37. The role of the SLP • Develop curriculum • Select data collection systems • Train teachers • Observe teachers & students • Attend meetings • Modify teaching procedures

38. 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

39. The consultative model in a public school • School administrator contacted NECC’s 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

40. The consultative model in a public schoolPublic 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

41. The consultative model in a public schoolResults • Public school students made progress/met 98% of objectives (2005) • NECC students made progress/met 90% of objectives (2004)

42. What do other disciplines have to say about professional collaboration?

43. 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.

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

45. Guidelines for Responsible Conduct For Behavior Analysts • 9.0 The Behavior Analyst's Responsibility to Colleagues. • Behavior analysts have an obligation to bring attention toand 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

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

47. 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)

48. 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)

49. 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)

50. 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 mandsto age appropriate verbal repertoires. (McClanahan and Krantz, 2001)