Introduction
Tara: Hello and thank you for having me. I always enjoy doing these presentations. Lately, I have worked really closely with two different schools on consulting on a couple of students. Both have high functioning autism with some pretty significant behaviors. I have been helping the teachers and the school team with both the functional behavior assessment and behavior intervention plan. I am going to go through a lot of these strategies on how to collaborate with teachers. I always say that the majority of challenging behaviors will be fixed or will significantly decrease when you really look at the classroom environment. I think as occupational therapists that it is really important for us to collaborate and work with teachers as we view the environment just a little bit differently.
What is Collaborative Consulting?
- Problem-centered approach in which two or more professional teams work together to create a solution.
- Team support that is emerging as a best practice standard for school-based occupational therapy.
- Different from “expert” model.
(Morris, 2013)
Collaborative consulting is kind of a new trend. The literature for occupational therapy is encouraging more of a collaborative consulting model versus an expert model. We have to get over this thought that we are the experts. When we think that, it is really hard to develop relationships with other team members. What I have learned over the years is that change cannot happen unless you have a good relationship with people. I remember in my first 5 to 10 years of practicing, I had all these new ideas and strategies, I would come in and say, "Well, try this." I have learned to chill out and really work more collaboratively versus taking control.
A collaborative model is a problem-centered approach in which two or more professional teams work together to create a solution. It is thinking of us as more of equals versus a hierarchy. I might be an expert in occupational therapy, but the teacher is the expert in their classroom. They are going to know their classroom and students best. I say the same thing for parents. I might be the expert in behavior, but they know their child the best.
Team support is emerging as a best practice for school-based occupational therapy. As I said, this is an emerging area. This is taking a step back and really listening to what people are telling us. Using active listening has been the biggest challenge for me.
Components
- Active listening
- Shared goals
- Mutual decision making
- Effective communication
- Learning from each other
- Mutual response
(Morris, 2013)
There are a lot of components in the motivational interviewing literature that are also some great strategies to use with a collaborative approach. Active listening has been a big thing for me. I saw this quote once that I love, "Listen to understand and not to respond." Often, when we come into a classroom, we are already thinking, "Okay, they need to do this, and they need to do that." I had to practice taking a step back and really listening for what they were trying to tell me.
We might have an idea of what we think they need to be doing, but if they do not have buy-in, they are not going to implement what we recommend. We need to have shared goals. For example, I was really trying hard with a teacher and we were not getting anywhere. I finally just said to her, "What would you like to be different about your classroom? What is your biggest challenge in here?" As soon as I said that, she was able to say that it was transitioning from one activity to another. "I don't know how to get them to transition." Having those shared goals is so important.
Along with shared goals it also mutual decision making. This is something I learned from a workshop last year. We can provide something, but they do not have to do it. We need to make sure that we ask permission. "Do you care if I come in and watch your classroom?" Or, "What would be the best time for me to come watch your classroom? " "Do you care if I try something with your students?" This helps with developing rapport and trust.
Effective communication is figuring out how they communicate. When I am doing a lot of consulting, I make sure I start with at least two to three positive comments and then I can transition to something like, "Let's try this." It is important that we both have the ability to respond and learn from each other.
We are going to talk about a little bit more strategies at the end of this talk, but I wanted to just introduce this idea of this collaborative consulting. As I said, I use a lot of information from the motivational interviewing. It is really good information about how to communicate with people, and it comes from addiction literature. It gives you some really good strategies on how to deal with people who are in a grieving situation or who need to change. We need to learn how to communicate with people as we do not always learn this is school. I always say to my team, "It's not what you know, but it's how you communicate it." If you know every strategy in the world, it does not matter if you are not able to develop a rapport with people. This is when you really see change happen.
Universal Design for Learning
Now, we are going to talk about this idea of the Universal Design for Learning.
“Approach to curriculum design that can help teachers customize the curriculum to serve all learners, regardless of ability, disability, age, gender, or cultural and linguistic background. UDL provides a blueprint for designing strategies, materials, assessments, and tools to reach and teach students with diverse needs”
https://lincs.ed.gov/sites/default/files/2_TEAL_UDL.pdf
Some of you guys are probably more familiar with it than others. I am just starting to get my feet wet. I know a lot about the autism piece, and we are going to talk a lot about that here in a few minutes, but I also want to introduce you to this as well. If it has not come your way yet, it should soon.
Universal Design for Learning looks at what we need to put in place so that everybody benefits. One example I heard was about Walmart. There is an accessible button that you can push when your hands are full of groceries and the door will automatically open. While it was not intended for those purposes, everyone can benefit from it.
Three Components of Universal Design
- Multiple means of engagement (the hooks that draw students in)
- Representation (alternative ways to present information)
- Expression (alternative ways students can express their knowledge)
Universal Design has essentially three main components. The first one is this multiple means of engagement. This is the hook that draws students in. Representation is alternative ways to present information. Finally, expression is alternative ways students can express their knowledge. We need to be looking at these things. Here is an example. The other day I was watching a circle time in a classroom. It was way too long, and the only way the kids could say they knew an answer a question was by raising their hand. I am sure you have seen that before. It is typically the same one or two kids that always raise their hand over and over. Looking at this from a Universal Design for Learning perspective, do the students have multiple ways to express information? No, they did not. All they had access to was their hand.
1. Universal Design- Multiple Means of Engagement
- Schedules
- Routines & procedures
- Priming
- Special interests/reinforcement
There are many different ways to engage. I am going to talk more specifically about the autism piece; however, there are some strategies that can benefit all students. If students are not engaged, they may demonstrate challenging behavior, and they are not learning. One thing that I have done is to set my timer for one minute. Once that timer goes off, I look around and see what percentage of the class is engaged in the activity. Engagement can look different. For example, circle time is going to look different than engagement during center time. And, engagement in high school is going to look different than engagement in elementary school, but I challenge you to do that and think about why are the students engaged. Do they have materials they can access? Do they know what they are supposed to do? Do they have those routines and procedures in place? Engagement is one of the biggest predictors of how well kids do in school. We are going to go through some of these.
Schedules
- Plan for day’s events
- Visual warning for transitions
- Improve understanding of expectations
- Reduce anxiety = increase student’s attention to classroom activities
- Teach independence
- Reduce the amount of verbal instruction
The first thing that I look for in a classroom is a schedule. I do a lot of work with one school in a rural area here in Oklahoma. They are going through a lot of positive behavior support right now, and last year, we went through a big transformation with them. The first thing that we implemented was a schedule in every classroom. Students should know what they need to be doing and where they need to be at all times during the day. If somebody walks into their classroom, they should also be able to see a schedule. It was the first thing that we changed, and it helped. Again, we did this because we were trying to better support students with autism, but we were surprised by how many students needed and benefited from it.
Another one is a visual warning for transitions. We need to help students prepare for a transition. It is not just students with autism who have anxiety around transition, but I have seen this in a lot of kids. The more that we can prepare them for those transitions, the better.
Schedules also improve understanding of expectations. When students can see what is going to happen, then they know the expectations. It is also going to decrease their anxiety. If it is a high school classroom, teachers can use the dry erase board to put up the schedule.
Schedules also teach independence. When students are asking questions about their schedule, that means they need a schedule. It can help teach that independence. It also reduces the amount of verbal instruction. Instead of the teacher having to say repeatedly, "PE happens after library which is after recess." The teacher can instead say, "Check your schedule."
The other thing I did not mention is that schedules can help when a change happens. If a student has trouble with change, they need a schedule so that way when a change is happening, they can be okay with it. Schedule examples include:
- Object, photo, or symbol of daily activities – listed sequentially
- Highlight changes
- Mini schedules
- Schedules for routines
I work in a preschool here in Oklahoma City. We have little ones that range in age from 18 months to 4 years old. It is an inclusive preschool so there is usually about three kids with autism in the class out of 10 kids. They have little object schedules, and these can highlight any changes that might happen. I also use a lot of mini-schedules so for my students with or without autism. For example, is a child has a hard time with multiple steps in an activity, I will use a dry erase board to draw out a mini schedule for them. These can also include a schedule for routines. If you have students who forget what to do when they are finished with their work, make a schedule for them. If they have trouble knowing what to do when they are in the bathroom or how to wash their hands, create a schedule for them that they can go back and see.
Routines and Procedures
- Procedures – how teachers want things done in the classroom
- Routines – what students should do without prompting or supervision
- Can improve task completion and behavior by providing consistency and clarity for classroom expectations
- Must teach the routines and procedures (similar to academic content)
Another big area is routines and procedures. This is another incentive that I have been supporting at the school I mentioned. The classrooms were having a lot of behavior issues. We determined that this behavior was happening because there were no routines and procedures in place, and these are needed for classroom management. If you have problems with only 1-2 kids, behavior issues may stem from not understanding expectations. The supports probably need to be individualized in these cases. But if it is more than 1-2 students, then it is the classroom procedures and management that needs to be addressed.
Thinking about procedures, you need to know how teachers want things done in the classroom. This is another great way that occupational therapists can get involved. Sometimes teachers have in mind what they think the procedure should look like, but they do not know how to change it when it does not work. Having an outside view can be really helpful.
Routines are what the students should do without prompting or supervision. In a really well-run classroom, students know what to do at any time during the day. When I am going into a classroom with a substitute teacher, I can gauge whether or not there have been good routines established. If there is crazy behavior, this is because good routines and procedures were not put in place. In contrast, if the students still know what to do no matter who is in charge, that means that the classroom has good routines and procedures.
Routines and procedures can improve task completion behavior by providing consistency and clarity for classroom expectations, and it can help significantly with behavior. What we had to do with this aforementioned classroom is have the teacher identify her top five behaviors and the times during the day when it occurred. For every one of those times, we wrote a routine around that. If the behavior was that the kids could not wait in the cafeteria line, we wrote a procedure for that. We have to teach the routines and procedures and disseminate it similarly to how we teach academic content. We have to break it down and teach it.
One area that I see a lot of trouble with is the wait time. Students will most likely demonstrate behavior issues if they have to wait too long. We need to help teachers with that by reducing wait time and teaching students how to wait.
Priming
Another area is priming. This is exposing students to school assignments before the activities are presented to the classroom. I have seen work really well with the two students. These are two smart boys in the fourth grade, but they are highly anxious. They assess an assignment within 10 seconds, and they are either, "I can do this 100%," or "I'm not doing it at all." There is no in between. What I have found that is really helpful for them is to prepare them for what is coming up. For one child, I just gave him an outline of what was going to happen the next day. It was not a big deal. For this to work, you have to have teachers who are organized and know what they are going to do ahead of time.
