Interprofessional Collaboration Between Physical Therapy and Special Education Faculty
Posted on: Wednesday, 12 March 2008, 03:00 CDT
By Masin, Helen L Valle-Riestra, Diana Martinez
Background and Purpose. This pilot study investigated a model for interprofessional collaboration between physical therapists (PTs) and early childhood special education (ECSE) teachers. The purpose of the study was to investigate whether a series of sessions in sensorimotor development taught by a physical therapy education program faculty member enhanced intervention planning and classroom instruction for teachers enrolled in a graduate course on child development (TAL 614: Typical and Atypical Child Development). Subjects. Eleven teachers participated in a focus group in which they were asked to assess whether their experiences in sensorimotor classes in TAL 614 impacted their intervention planning and classroom instruction.
Methods. Qualitative analysis was used to gauge the effectiveness of the sensorimotor sessions on ECSE teachers.
Results. Qualitative analysis indicated that the sensorimotor sessions positively impacted the intervention planning and classroom instruction of the ECSE teachers enrolled in TAL 614.
Discussion and Conclusion. The ECSE teachers indicated that they felt that the sensorimotor sessions taught by the physical therapy faculty positively impacted their intervention planning and classroom instruction. They also recommended that sensorimotor classes be taught to general education teachers. They felt that all teachers working with children in the educational setting could benefit from learning about these sensorimotor issues and how they impact the teaching and learning process.
Key Words: Physical therapy, Early childhood special education, Professionalism, Interprofessional collaboration, Teacher.
BACKGROUND AND PURPOSE
Physical therapists (PTs) have been involved in the public school system since the passage of PL 94-142' in 1975. This federal law mandated a free appropriate public education (FAPE) for all eligible students with disabilities between the ages of 3 and 21. As a result, PTs became part of the health team, as related service providers, to assist educators in working with school-aged children with disabilities in their classrooms. In 1986, PL 99-4 5 72 was passed by Congress as an amendment to PL 94-142' that significantly impacted infants and young children with disabilities by specifically outlining service provisions for this population. It recognized the need to enhance the development of infants and toddlers with disabilities by reducing their potential for developmental delays and increasing family functioning. Once again, PTs were recognized as an important part of the team to assist educators and fami lies in enhancing developmental outcomes for children with disabilities. In 1990, PL 99-4572 was reauthorized and amended as the Individuals with Disabilities Education Act (IDEA)' The amendments incorporated Part C which addressed special education for children from birth to 2 years of age. PTs were again included as integral members of the team to assist educators and families in promoting the development of children from birth through 2 years of age. Since 1990, IDEA has been reauthorized twice, once in 1997 and most recently in 2004. These two reauthorizations maintain the focus on the continuing need for educators and related service providers, like PTs, to collaborate and work together as members of the same interdisciplinary team with the ultimate goal of working with the child and the family to improve overall development and functioning.
In order for successful professional collaboration to occur, educators and PTs must demonstrate a knowledge base and a set of skills and rapport in consultation and communication. We believe this type of collaboration can be taught to both graduate-level school educators and graduate-level PTs. When this collaboration works well, educators and PTs work collectively with children and their families to establish and implement mutual and functional goals that benefit the child and the family as a whole.
Interprofessional collaboration has been recommended by professionals in health and education. This interprofessional collaboration has been emphasized in the field of ECSE along with the family-centered approach to service delivery. ECSE is commonly viewed as a dynamic and complex system of coordination and services to young children with disabilities and their families.4 Due to this approach and the amount of individuals, agencies, and services involved, coordination works best when delivery of services occurs within the context of collaborative partnerships between families, educators, and service providers, thereby ensuring that optimal and effective services are provided to young children with disabilities and their families.
Collaboration is a complex, multidimensional, and ongoing process often defined as "cooperation among two or more people concerning a particular undertaking,"5 "a style of interaction,"6 "the exchange of different forms of expertise,"7 and a "means of finding ways to work through the barriers that define our daily work and keep us from working together effectively."8 Specifically within ECSE, collaboration is evident when 2 or more individuals of different disciplines share information and expertise across traditional discipline boundaries to assist children with disabilities to attain intervention goals.9
Physical Therapy Core Values
Understanding and acquiring the behaviors associated with the 7 Core Values10 of the physical therapy profession, which include accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility, may assist PTs in developing the collaborative skills needed to work effectively with educators. Although all 7 Core Values10 support interprofessional collaboration, this study focuses on the 3 values of excellence, professional duty, and social responsibility.
Excellence in physical therapy is characterized by using current knowledge in the field, while understanding personal limits, integrating judgment and the client's perspective, embracing advancement, challenging mediocrity, and working to develop new knowledge that can ultimately be disseminated within the field.10 The PT demonstrates excellence by attending relevant continuing education programs and using evidencebased practices to support decisions related to educational activities. The PT integrates clinical judgment while honoring the client's perspective by practicing family-centered and culturally-competent care. In addition, the PT utilizes and disseminates current knowledge in the field.
Professional duty is the commitment to meeting one's obligations to provide effective physical therapy services to children and their families, serve the profession, and positively impact the health of society.10 PTs demonstrate professional duty when they become involved in professional activities beyond the practice setting. For example, the PT may make an extra trip to the home to ensure that proper body mechanics are carried over into the home environment. Another PT might make multiple calls to physicians/insurance companies for durable medical equipment (DME) that is necessary for positioning and/ or functional movement. This information can assist in preventing injury to the children as well as to their caregivers and teachers.
Social responsibility is the promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness.10 For example, PTs may promote social policy by becoming advocates for children with disabilities at the level of legislative initiatives. They may advise families on issues of accessibility and inclusion that are paramount to the provision of services for children with disabilities. This form of advocacy can lead to families developing the necessary leadership skills to advocate beyond their homes.
The values of excellence, professional duty, and social responsibility are demonstrated when both the PT and the ECSE teachers recognize the value of sharing knowledge and skills and ultimately decide to work together for the benefit of all the children in their care.
SUBJECTS
Early Childhood Special Education Values
The initial collaboration evolved as a result of the interprofessional collaboration between the ECSE teachers at the University of Miami Debbie School's Early Intervention Program and the physical therapy faculty members consulting at the Debbie School. Because the physical therapy education program faculty were consultants in the classroom, the teachers asked the PTs to explain the rationale for their recommendations related to positioning, handling, and feeding the children in their classrooms, thus promoting regular interprofessional collaboration between the educational and therapeutic disciplines. At the same time, several of the ECSE teachers were also attending classes at the University of Miami School of Education and recommended to the special education faculty at the School that sensorimotor development content be incorporated into the ECSE graduate curriculum. We interpreted this action by the ECSE teachers as the beginning of recognizing and understanding the value of sensorimotor education in the teaching and learning process in classrooms. As a result, the ECSE graduate curriculum was redesigned to incorporate a series of sessions dealing with issues in sensorimotor development as a required component of each teacher's program of study. The physical therapist agreed to teach the sessions and then developed the classes based on input and feedback from the ECSE teachers. The teachers suggested topics that they felt were helpful in dealing with children with multiple disabilities in their classrooms. The PT combined the teachers' suggestions into the development of the sensorimotor portion of the classes. This collaboration continues today and interprofessional collaboration remains an important part of the service delivery to the children at the Debbie School and their families.
The field of ECSE is based on a family system and an ecological perspective of child development by acknowledging that many factors can directly and indirectly affect the development and socialization of a child. By acknowledging these 2 perspectives, professionals view human development in context instead of isolation, and recommendations for services and interventions are considered within social and cultural contexts and are thus aligned with the family's everyday life and routines." Furthermore, ECSE is also based on the cootdination of services with the assumption that coordinating among individuals across disciplines will lead to improved family functioning. As professionals begin to understand that development in one domain is influenced by and influences development in other domains,12 it is vital for educators and PTs to work together since motor development will have a direct impact on a child's growth and learning in such areas as cognition, language, and social/emotional development. This interrelatedness between developmental domains can ultimately lead children to organizing their learning experiences in meaningful ways.12
This pilot study investigated whether collaboration between physical therapy education program faculty, special education faculty, and ECSE teachers at the graduate education level impacted intervention planning and classroom instruction for young children with motor and/or sensory processing deficits. This pilot study analyzed a teaching-learning model that has been utilized at the University of Miami to promote interprofessional collaboration between PTs and ECSE teachers. The model is based on teaching graduate-level teachers practical knowledge and skills for working with children with motor and/or sensory impairments in their classrooms.
METHODS
In order to assess the efficacy of this model, the investigators in this study collaborated in developing a graduate special education course (TAL 614: Typical and Atypical Child Development) that incorporated 4 sessions on motor development and sensory processing taught by this physical therapy faculty member. The sessions consisted of 4 lectures and experiential laboratory experiences (Table 1) that were part of the TAL 614 course. The course is a core requirement in each student's program of study that is approved by the State of Florida for teacher educator endorsement in the area of pre-Kindergarten disabilities.
The investigators assessed whether knowledge of motor development and sensory processing affected the special educators' intervention planning and classroom instruction for young children with motor and/ or sensory processing deficits. To assess their knowledge and perceptions pertaining to the usefulness of the sessions, the investigators conducted a 1-hour focus group during fall 2006 with teachers who successfully completed the course in spring 2006. Eleven teachers out of the 18 who participated in the course consented to participate in the focus group. The focus group interview consisted of 10 questions developed by the researchers (Table 2) and followed the procedures recommended by Vaughn, Schumm, and Sinagub. 16 Data were collected using an audiotape recorder and transcribed for accuracy. The focus group interview data were analyzed using qualitative methodology of triangulation of data including observer notes, focus group transcription, and investigator discussions and negotiations.
RESULTS
The focus group data analysis indicated that the sensorimotor sessions positively impacted the intervention planning and classroom instruction of the ECSE teachers. The responses gathered from the teachers for each question are presented in summary form followed by numeric totals and supported by representative quotes.
1. How has your understanding of typical motor development as taught in TAL 614 affected your intervention planning and classroom instruction when working with young children with motor development deficits?
The teachers indicated that they learned what to look for in their students (4) in order to be able to appropriately modify the classroom environment. Another teacher indicated (1) that she had a better idea of how to teach and sequence concepts and skills reflecting a developmentally appropriate curriculum. One teacher stated, "I feel I have more of an idea of what to expect and how to establish goals for students in my class..." Another teacher added, "Now I know better the sequence of how to teach things..."
2. How has your understanding of atypical motor development as taught in TAL 614 affected your intervention planning and classroom instruction when working with young children with motor development deficits?
The teachers' responses varied for this question. Three of the teachers mentioned the child's ability to cross midline (3); two mentioned using adaptive equipment to enhance a child's ability to focus (2); one mentioned the relationship between attention and posture (1); one mentioned naming a syndrome gave meaning to the behavior (1); one mentioned calming techniques (1); and one mentioned that the knowledge she gained from the sessions allowed her to disseminate the information (eg, after school workshops) to her colleagues, including her colleagues in general education (1). This teacher shared, "I found that giving whatever syndrome we're noticing or whatever syndrome it is, giving it a name, having some kind of basis to understand why its happening makes more [sense]." Another teacher commented, "Teachers don't understand what their own general [education] kids are going through and some of those things that they could utilize, and now we are doing a whole workshop after school on things like that."
3. How has your experience of personally going through the typical and atypical developmental sequence yourself during the developmental sequence lab as taught in TAL 614 affected your intervention planning and classroom instruction when working with young children with motor and/or sensory processing deficits?
Two teachers commented that going through the developmental sequence helped them empathize with the students that they work with and recognize the frustration they might feel when they have challenges in movement (2). One teacher stated, "When you put your body in a specific position we easily get frustrated...putting ourselves in our children's shoes and realizing what they are going through on an everyday basis." A second teacher shared, "A sense of empathy for the students that go through these problems and for the parents that have to deal with them."
4. How has your understanding of sensory processing disorders as taught in TAL 614 affected your intervention planning and classroom instruction when working with your children with sensory processing disorders?
Four teachers indicated that they had an increased awareness of sensory integration issues when they see a child with disabilities acting in a certain way (4); one mentioned recognizing the importance of sensory breaks (1); one mentioned recognizing that behaviors may have a sensory base (1); and one mentioned recognizing strategies she has seen other providers implement (1). One teacher said, "You always talk about sensory breaks and how important they are...it's a lot of preventative teaching... behavior problems, academic problems, when you just give that kid a needed break." Yet another teacher commented, "I just know on a day to day basis I have become more aware when I see a child acting in a certain way." This teacher said, "Sensory integration is an important goal in its own right...for its own sake."
5. How has your understanding of positioning and adaptive equipment as taught in TAL 614 affected your intervention planning and classroom instruction when working with young children with positioning and adaptive equipment needs?
Three teachers indicated that these sessions prepared them for the future in working with children with disabilities (3); another recognized that poor posture does not necessarily mean laziness or tiredness (1); one felt that it demystified the work that is done by a PT (1); and one said that it decreased the potential for feeling intimidated (by physical therapy) in the future (1). One teacher stated, "Positioning affects every area of developmentespecially cognitive-which I never would have thought." Another said, "Learning about it or being exposed to it sort of demystified all the stuff that happen [s] with physical therapy." A third teacher commented, "I don't currendy work with anyone who uses positioning devices, but I think it prepared me for the future when I will be working with students with severe disabilities."
6. How has your personal experience of assuming an obligatory reflex (eg, ATNR, STNR or TLE) as taught in the reflex lab in TAL 614 affected your intervention planning and classroom instruction when working with young children with needs for positioning and adaptive equipment in your classroom?
One teacher responded to this question by reflecting on an experience that she had relating to the impact of obligatory reflexes on family members. She knew a teacher whose daughter had cerebral palsy. This teacher stated that "her daughter was always turning away from her and it was very hard to bond with her. She felt all these weird feelings as a mother until a physical therapist was able to pinpoint that it was [like] an obligatory reflex and it really changed the way she viewed her daughter.. .she realized that her daughter was actually looking at her and making eye contact and all those things she had wanted for so long." 7. How has your understanding of typical and atypical feeding behaviors as taught in TAL 614 affected your intervention planning and classroom instruction when working with young children with challenges in feeding behaviors in your classroom?
The teachers recognized a variety of issues related to feeding and eating. These included: the use of adaptive spoons to help kids leam self-help skills (1); what to look for and what to expect from children (1); and the complexity of the chewing process (1). One teacher stated, "I just think about the different cool spoons that you had.. .that can really help children leam those self-help skills." A second teacher shared, "Ever since we sat in that class and you broke down the whole chewing process...I think about it and I am more conscious now."
8. How has your experience of feeding another person and being fed yourself as a part of the feeding lab in TAL 614 affected your intervention planning and classroom instruction when working with young children with feeding and eating disorders in your classroom?
Three teachers stated that the experience increased their empathy for the children with feeding and eating disorders (3). One teacher stated, "I used to work with a little boy with Down Syndrome and he would tilt his head back and let it [food] slide down. After taking your course, it made me realize he wasn't just playing.. .it was a way for him to consume it." Another teacher commented, "[I am] pretty sure that my awareness of what it felt like when someone else is putting something in your mouth will cause me to be a little slower and a little more keen on his or her reactions."
9. How has your experience of being fed while demonstrating an atypical feeding pattern (lack of lip closure) as part of the feeding lab in TAL 614 affected your intervention planning and classroom instruction when working with young children with feeding and eating disorders in your classroom?
Two teachers mentioned that they realized how difficult eating can be and that we take it for granted (2). Two teachers stated that they experienced the feeling of how frightening feeding can be and this increased their empathy for their students. One teacher stated, "You just realize how difficult it is...I have a better idea of what the child is going through." Another teacher said, "I agree with that because what is atypical for us is typical for them and what is typical for them is atypical for us." Yet another teacher commented, "Like we do it [eating] for fun, we go out to eat as a way of socializing and it is a very big part of our culture. It helps to realize..how people who have that issue must feel."
10. What part of TAL 614 most affected your intervention planning and classroom instruction when working with young children with motor development and/or sensorimotor processing disorders?
The teachers had a wide variety of responses to what most affected them in the sensorimotor sessions. Three teachers mentioned the videos (3); two mentioned acting out atypical postures and learning strategies to deal with them (2); one mentioned being the class example (1); another mentioned learning about typical and atypical development (1); one mentioned sensory integration (1); and another mentioned learning about intervention (1). One teacher stated, "I think the experience that you gave us-acting out the different disabilities and the videos-made us realize what [the children] are going through." Another teacher shared, "I think the most powerful tool that I got from the class is knowing that there are actually interventions that you can do for a lot of these things." Last, two teachers said, "The sensory integration stuff...I never understood it but now I actually... have an understanding of it and realize that it is ...a legitimate thing...I think it is so much information, so valuable...you can make a whole course on it."
DISCUSSION AND CONCLUSION
The implementation of the Core Values10 of excellence, professional duty, and social responsibility in physical therapy were supported by the qualitative analysis of the focus group data from the ECSE teachers participating in this pilot study. The teachers stated that the sessions provided them with numerous insights and strategies that have impacted both their intervention planning and their classroom instruction. The sensorimotor knowledge and skills taught in the course reflected current knowledge in the field (excellence), positively impacted the health of society (professional duty), and promoted mutual trust between the PTs and teachers across disciplines and the larger public (social responsibility). For example, many teachers stated that they developed greater awareness and empathy for the challenges faced everyday by children with disabilities and their families. They also gained a better understanding of the value of physical therapy input in the educational setting and no longer felt mystified by it. They recognized the value of integrating sensorimotor principles into the teaching and learning process to enhance a child's development and learning. The teachers felt that the information shared in the sessions was practical and could be realistically implemented and embedded within the educational setting. Indeed, they recommended that the sensorimotor sessions be taught for general education teachers as well as special education teachers, which would lead to further interprofessional collaboration between educators in different fields. This collaboration continues to support the notion of providing services in natural environments for young children with disabilities and in least restrictive environments for school- age students with disabilities.
Part C of the Individuals with Disabilities Act (IDEA)3 recognizes the importance of the significant brain development that occurs during a child's first years of life by providing young children with disabilities a free and appropriate public education that emphasizes both special education and related services. Physical therapy is one of the related services that are included under IDEA.' Physical therapy includes services to address the promotion of sensorimotor functioning through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation.14
Both PTs and educators agree that sensorimotor development is foundational to learning in children. Children with sensorimotor delays may not spontaneously move and explore their environment. In order to facilitate sensorimotor development in these children, PTs may recommend adaptive toys, adaptive positioning and/or environmental modifications (eg, natural versus fluorescent lighting, use of room dividers or sound barriers) to promote optimal learning through movement and exploration in the classroom environment. A study by Miedaner and Finuf15 found that adaptive positioning improved the performance of children with neuromotor impairment in areas such as speech intelligibility, upper-extremity function, head control, and pulmonary function, which supports the principle of how development is interrelated across domains of growth and learning.
We believe in the effectiveness of this model and hope that this research will contribute to the advancement of knowledge regarding the efficacy of interprofessional collaboration. Indeed, the Frank Porter Graham Child Development Insitute" at the University of North Carolina, featured an article in August of 2006 stating that early childhood teachers are "often ill prepared to care for children with disabilities" due to limitations in their professional development and practical hands-on training. We believe that our research may suggest a model that may provide ways to meet these identified training needs for teachers of children with disabilities.
As pediatric physical therapy education program faculty and special education faculty with many years experience in special education settings, the authors have found that collaboration between PTs and educators promotes learning in a variety of ways. Adaptive positioning for children with motor deficits in the classroom or the natural environment facilitates interaction with toys and other children and promotes activities of daily living. Utilization of prone or supine Standers with trays enables children to play with toys or utensils otherwise inaccessible to them. Proximal postural stability supported by the adaptive equipment is important for the development of midline skills of the upper extremities, such as feeding and eating. These feeding and eating skills then promote the development of speech and language skills by enabling the child to practice lip, tongue, and cheek movements essential for the development of movement specific to speech and language. The development of speech and language then impacts social and emotional development by allowing children to interact and socialize with adults and peers.
For children with sensory deficits and attention disorders, the PT may recommend modification of the classroom and/or natural environment to promote learning. Children with light hypersensitivity may react negatively to fluorescent lighting and may perform better in settings with natural and/or incandescent lighting. Children with hearing deficits may react negatively to noisy classrooms in which they cannot discriminate foreground from background noises. These children may perform better in small groups in rooms with minimal background noise. Children with vestibular disorders may move constantly and have difficulty participating in structured classroom activities and may benefit from interventions that involve joint compression, firm tactile inputs, and resisted movement activities to modulate their need for constant movement. Excellence, professional duty, and social responsibility were also demonstrated by the exchange of knowledge, skills, and developing rapport between professionals in fields that are typically prepared in discipline-specific ways. PTs and ECSE teachers recognized that their work became more meaningful for children with disabilities and their families when interprofessional collaboration was taught and implemented because knowledge across disciplines was being shared and "demystified."
Research Implications
This research indicates that there were positive benefits from the interprofessional collaboration among PTs and ECSE teachers at the University of Miami. Because this is a pilot study with a small sample size, additional research needs to be conducted with larger sample sizes. Additional research could be conducted regarding the efficacy of the content incorporated into the education curriculum and its application in the school setting. In addition, research regarding optimal ways to develop the rapport and collegiality essential to interprofessional collaboration should be conducted.
In conclusion, this pilot study describes a model that appears to promote effective collaboration between PT and ECSE for the mutual benefit of children with disabilities and their families. Future studies can explore and expand this model to provide additional resources for the development of more interprofessional collaboration.
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Helen L Masin, PT, PhD, and Diana Martinez Valle-Riestra, PhD
Helen Meriti is a clinical associate professor at the Department of Physical Therapy, Miller School of Medicine, University of Miami, 5915 Ponce de Leon, 5th Floor, Coral Gables, FL 33146 (hmasin@miami.edu).
Diana Martinez Valle-Riestra is an assistant professor in the Department ofEducational and Psychological Studies at Florida International University, ZEB 247-B, 11211 SW8tA Street, Miami, FL 33199 (riestrad@fiu.edu).
Received August 17, 2006, and accepted June 26,2007.
Copyright Journal of Physical Therapy Education Winter 2007
(c) 2007 Journal of Physical Therapy Education. Provided by ProQuest Information and Learning. All rights Reserved.
Source: Journal of Physical Therapy Education
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