TherapyTimes.com: Preventing Failure of ‘At-Risk’ Students: A therapist’s role in the response to intervention process

When considering all the screening tools, paperwork, treatment tools, and models to employ in the classroom, a question that provokes ongoing discussion among administrators, teachers, specialists, and diagnostics experts is: “What’s the best way to assess learning disabilities in children?”

Some experts recommend using the cognitive assessment approach, believing it provides a more comprehensive model for psychological assessment and educational evaluation of the whole child; however, this process can delay intervention.

Others argue in favor of the response to intervention (RTI) model, which is aligned with the Individuals with Disabilities Education Act (IDEA), or the new IDEA ’04 law, and No Child Left Behind. RTI takes a problem-solving approach that assesses students’ achievement several times a year to identify if there are problems in the effectiveness of the curriculum. If achievement is not attained, then they may receive altered instruction. Their response to intervention is then measured and reviewed.

Success in Learning

Since RTI’s multitiered intervention model and screening method intends to catch problematic issues before they become critical issues regarding a child’s academic success, teachers and therapists can work together to get the child where they need to be academically.

Figuring out the manner by which each student learns can be a difficult task, especially when it comes to teaching a classroom of students with varying physical, mental, and learning disabilities.

According to Debbie Neuschwander, a Norristown, Pa.-based preschool teacher for special needs students at the Montgomery County Intermediate Unit (MCIU), “When a child comes in to the preschool program, they are given a battery of tests. There has to be a delay of 25 percent or more in order to qualify for intervention services.”

The case manager assesses their file to determine their needs, and then writes the first individual educational program (IEP) in accordance to them. Then, a year later when the child is still in the program, the teacher writes the IEP. “Weaknesses from the test results become the goals and objectives that will be worked on for the year by everybody,” Neuschwander says, which includes a team of occupational, physical, and speech therapists, and classroom assistants.

Neuschwander adds that if the child isn’t progressing at a sufficient rate, then “we do interventions and change the IEP. We might change our approach; we might break it down into smaller pieces, or change or introduce a reinforcer to motivate them more to work on the goals.”

According to Gaskin’s law, children should be put in the least restrictive environment, which means that if a child is suspected to have a learning disability, they have to be placed in a normal classroom first and fail. And then an assistant may be introduced into the classroom to help the child; but if the child fails again, they may be moved to a special-ed preschool.

For instance, a nonverbal autistic student may be deemed more of a visual learner, especially in regards to language. “Because they don’t have language skills, we use something called the picture exchange communication system (PECS). They are taught using these icons or pictures of what they want since they don’t have verbal skills. It might be a PECS book or a poster on the wall in the classroom, and they show the teacher the picture so they can communicate what they want or need,” says Neuschwander.

“Some people say ‘don’t use PECS’ but that actually helps the child talk. If they hand you a picture of an apple you say, ‘oh you want an apple’ and eventually the child will say apple,” Neuschwander says. “We sometimes use sign language if the child doesn’t understand PECS. And, sometimes, we use all three together; they use the picture, the sign language, and the word. We usually look at what the child goes to or what they are most successful with and go from there.”

Occasionally, teachers and therapists switch the learning modality and try to use all the approaches – visual, tactile, auditory, and kinesthetic – to teach the child. “We might even have the child make the letter with their body if that’s how they learn best. It kind of depends. Sometimes, we use all four together – and that might be the most effective,” Neuschwander says.

For instance, an occupational therapist (OT) might work on prewriting skills, with the objective of copying a horizontal or vertical line, says Neuschwander. “The OT might simply use paper and a pencil and draw a line to get [a visual learner] to trace or copy it. If that doesn’t work, then the therapist might backtrack and use a different modality.”

If the student responds more to the sense of touch during class activities (a tactile learner), then an OT might teach the child in a tactile way, such as getting a tray of sand and having the child make the line with their finger, she says. “If the child learns best in an auditory medium, however, then the child is an auditory learner. The OT might make up a rhyme, such as ‘Up and Down,’ and this may be what will make it ‘sink in’,” says Neuschwander.

Neuschwander stresses that when it comes to assessing learning disabilities, early intervention is better than waiting until it’s too late. At MCIU, the program is set up so that some of the students come for half a day and then, in the afternoon, go to a standard preschool to socialize with non-special-needs peers. “The earlier you get to the child and put a communication system in place, the better the outcome of the child … If what we are doing is not working, then we are required to change the way we are teaching it so there is more success,” she says.

A Change in Approach

Crucial to the process of identifying, intervening, evaluating or re-evaluating current methods of practice in the classroom are occupational and physical therapists, and speech-language pathologists.

Together, they implement RTI to assess what students have or haven’t learned in order to know where to begin. Some are finding that a team approach in assessment and treatment using the RTI method is the best way to reach these children. This way, teachers and therapists can closely monitor how students are responding to different types of services and instructions.

Ann Marie Brown, SLP, has worked in the classroom for MCIU the early intervention preschool program for the MCIU as well as the conducting the diagnostic screening part of evaluation process. She says that when working outside of the classroom, Brown says the response to intervention model was facilitated using a team approach, which provided an avenue to help children reach their full potential. Browns cite the team-based method as the most beneficial aspect of the MCIU program.

“Depending on the personalities and philosophies of different professionals or our way of working with the children, then the dynamics within the team changes, slightly,” Brown says.

The team-to-student ratio in the classroom consisted of one teacher, two assistants, one PT, one OT, one SLP, and a maximum of 12 children per class. According to Brown, they used a more integrative or collaborative approach to teaching students. For instance, if they notice a child isn’t responding to the intervention strategy, then the teachers and the therapists would use different strategies or alter the child’s goals and objectives.

Parents walking into the classroom during an activity session may observe three to four children with one team member. The children periodically rotate among the team leaders’ groups, who facilitate a “center” that focuses on the predetermined goals. Brown explains that the idea of this approach is to observe what the other person is working on with the child during an activity, which helps to coordinate everyone’s efforts when teaching.

Observing the interaction among team leaders and student groups helps therapists to incorporate the academic goals of the other therapists into their own activities. For instance, says Brown, a speech therapist may notice that an OT is instructing a child in a way that is too “wordy,” when the speech therapist has already developed visual icons that the child understands. The speech therapists could demonstrate to other therapists, teachers, and classroom assistants how to instruct the child using the icons with which the child is already familiar.

Fostering an environment of open communication between the therapists is crucial to the child’s learning progress and further development in school. Also, having these different therapists in the classroom with the teacher allows an opportunity for the team to share other techniques and knowledge with the other team leaders.

Timely Treatment

Although learning-disability-assessment experts have held differing views on what is the appropriate way to reach at-risk children, they all agree that early identification of children with special problems by an interdisciplinary team of professionals is critical. For instance, the optimal time to resolve academic and behavioral problems in children is early – when they are 5, 6 or 7 years of age, not when they are 10 and older.

Those in favor of RTI have posed the question, “Why wait for kids to fail when there is another option available to avoid academic failures?” This argument could also be a reason why RTI has become an increasingly popular approach for evaluating learning disabilities among schools.

Recently, schools and therapists involved in implementing this new classroom method are suggesting promising results in relation to the educational success of students with learning disabilities.

As it stands, experts have suggested that RTI is likely to improve many decisions about educational interventions, especially when combined with universal screening procedures. When implemented properly by teachers and therapists, RTI identifies struggling children, provides immediate help, and determines whether or not more intensive care is needed.

— Haley K. Jestice is a staff writer for Therapy Times. Questions and comments can be directed to hjestice@therapytimes.com.