"I Learn Better Here"
by Trudi Norman-Murch, Ph.D., CCC-SLP, Director, Speech/Language Services, Southwest Human Development, Phoenix, Arizona

Integrated therapy, also referred to as "classroom-based intervention," is increasingly viewed as the preferred service delivery model for preschool children with disabilities. The new Head Start Disabilities Regulations strongly recommend that children receive intervention services (for speech/language, occupational, and physical therapy) in their classrooms, and the Individuals with Disabilities Education Act mandates that therapy be provided in the "least restrictive environment." There are numerous potential advantages to integrated therapy, when it is successfully implemented, such as:
  1. It provides an opportunity for teaching staff and children to observe modeled activities and strategies so they can be used when the therapist is not available. It greatly facilitates close collaboration between parents, teachers, and therapists.
  2. New skills can be taught in a natural, functional context where they can be practiced and generalized. Skills are learned in the context in which they will be used by establishing associative cues. When the therapist is gone, these cues remain to help the child practice the new skill.
  3. Important social and interactive skills (play and language) can be targeted, and the child can receive the powerful, natural reinforcement of playing success fully with a peer.

The philosophy underlying the Integrated Therapy Model (ITM) is consistent with developmentally appropriate practices, with the principles of full inclusion, and with the trend towards merging the expertise of early childhood educators and early childhood special educators. However, as more experience is gained with this approach, it has become clear that there is more involved in successful implementation than simply having the speech/ language, pathologist leave the "therapy room" and enter the class room. Just as mere physical proximity does not assure successful social integration, the ITM also requires a great deal of specialized training and preparation.

In our agency, we have been providing classroom-based intervention for the past five years. We are extremely enthusiastic about it, but more aware than ever of the continuing thought and effort required, as well as the considerable barriers to success. Critical components for successful implementation include:

  1. Adequate preparation, training, and "buy in" at all levels before transitioning to this model. This includes administrators, parents, teachers, and therapists. The model involves substantial
    changes for everyone involved. For example, administrators have to allow for more planning
    time, teachers have to take more responsibility for implementation of goals, parents have to
    give up the concept of direct "laying on of hands" from the therapist, and therapists have to
    practice "role release" and learn to work in the unfamiliar environment of the classroom.
  2. Collaboration between parents, teachers, and intervention staff. This must be facilitated at all levels, staffing with assessment and continuing through IEP development, program implementation, and the transition process. This requires regular planning.
  3. IEPs that emphasize functional goals and objectives. Functional goals are goals that are obviously important and useful to a child in his/her everyday life. For example, the labeling of pictures of food items is not a functional goal, but the closely related skill of saying what you want for dinner when role-playing is. Likewise, sorting different shape blocks does not have an obvious function or usefulness, but putting the blocks away in their right place at clean-up time does. If a goal is truly functional, there should be numerous opportunities to practice and learn it.
  4. Familiarity with appropriate intervention strategies. The therapists working in the ITM need to be skilled in the use of "naturalistic" or ("milieu") therapy techniques such as modeling, incidental teaching, sabotage, scaffolding, and principles of individualized group instruction. They also need to know how to make effective use of peers and how to facilitate social interactions.
  5. Agreement of all team members on a common philosophy and mission. The therapists working in the classroom need to understand the particular curriculum being used and have basic knowledge of classroom dynamics, including behavior management techniques.

Obviously without successful implementation these cannot be achieved overnight, in one year, or in several years. For us it has been an ongoing process involving continual refining, regrouping, and training. It has been tremendously rewarding and we look forward to continuing our efforts. Most recently we had the remarkable experience of having a child tell a substitute therapist who came to take him from the room, "Please stay here. I learn better here."

We are interested in talking with others who are working with this model and would be pleased to share our experiences, as well as our resources and training materials.

For more information, please contact: Trudi Norman-Murch, Ph.D., CCC-SLP, Director, Speech/ Language Services, Southwest Human Development, 202 E. Earll Drive, Suite 140, Phoenix, AZ 85012.

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