by Kelly Conroy
Traditional “pull-out” therapy, meaning a student is pulled out of the classroom for one-on-one therapy, for students to receive occupational, physical and speech therapies is often viewed as the only way for students to partake in these services, yet studies show that when therapy is provided in the classroom, teachers and specialists consult with each other four times as much as they do when a therapy is provided out of class. What this tells us then is that the teachers are more likely to reinforce the learning that is occurring when they are part of the process. Additionally, the skills are more applicable to what is happening in the classroom, and students have more opportunities to practice the skills they need. What we need to do is to move our focus to determining that therapy is not a place, but a process of learning.
Occupational Therapy
Occupational Therapy (OT) focuses on using occupational skills such as fine/small motor and sensory skills. Bringing the therapist into the classroom during art activities, lunch, or even recess can enable the student to practice skills with their peers in a natural setting. If the class will being going outside, the child may practice putting on a coat, mittens and hat with support from the OT. During art, fine motor skills can be practiced such as painting, modeling clay, or drawing. Lunch can provide opportunities of feeding oneself, cutting food and doing so appropriately. Recess can present many fun activities on the playground or gym that involve movement and play. By being creative, this type of “push-in” therapy, providing therapy services within the natural environment, can really benefit the class as a whole.
Joanie, mom to Steven, explains how this has worked in their situation: “For Steven, OT really needs to focus on him receiving a lot of sensory input. We are able to do this during recess time. The therapist brings equipment to the playground and encourages many students to join in their activities. This opens Steven up to more social interaction and makes therapy seem like something fun that happens at recess. What has made a great impact is the ability of others to facilitate the activities, not solely the therapist.”
Physical Therapy
When a child needs Physical Therapy (PT) in school, it usually involves exercises that increase a child’s ability to move about the school safely. One idea for bringing PT into the classroom is to support the child in participating in typical gym class. Being on the same team as their classmates is invaluable to the student’s ability to relate to one another and can lead to more social interaction and fulfillment.
Tara, mom to Christie, tells of their “push-in” PT experience: “For Christie, being up to pull up to stand during circle time was a goal we had for her. With the PT present in the classroom during circle time, this gave Christie opportunities to practice sitting to standing positioning. She is extremely motivated by her classmates and is very eager to work on this goal without even prompting, as it is something she sees her classmates doing and she wants to accomplish as well.”
Speech Therapy
Speech Therapy (ST) aids in helping a student communicate effectively, which includes articulating and comprehending receptive language. Speech can very easily be integrated into the classroom by having the therapist join in cooperative learning exercises. During these times, the therapist can work in the small groups and assess progress and work on goals.
Kate, mom to Evelyn, reports: “Evelyn receives ST three times a week in school. One time is pull-out to provide her with one-on-one time to focus on individual goals, one time is small group pull-out, so she is with other kids in her grade receiving speech therapy, and one time is push-in. This alleviates all three times being individual pull-out. When the speech pathologist started working with Evelyn, one thing I loved was that she called and said ‘I'm a firm believer of speech being meaningful for the child's life. If I'm working on enunciation with Evelyn, and we're for example working on the sound blend of "ch" and I use the word "chair" with her for that sound, we could practice the word "chair" a hundred times until it's perfect. But if Evelyn isn't going to say the word chair in her life outside of school (and really how often do you talk about a chair?), then it doesn't make sense. I have heard that Evelyn is a cheerleader, so I would much rather use the word cheerleader in practicing the “ch” blend than the word chair.’ So then she asked me to provide her with a list of words, activities, people, etc., who are meaningful to Evelyn’s everyday life. She made a list of school-related words and I made a list of home and community-related words. We add to the list every few weeks and the speech pathologist incorporates those words into the work she does with Evelyn. I really love that approach and we have seen such a difference for Evelyn with this approach. The classroom push-in is also really helpful, as Evelyn’s grade has a book chat every Friday and the speech pathologist pushes in for that, and she also helped her with a presentation she had to give on baseball. So it's great for her to push-in and help with skills Evelyn needs directly in the classroom”.
The most important thing to remember regarding therapy is to make it fit your child’s needs. There is not a “one-size-fit-all” approach to creating goals for students who need occupational, physical and/or speech therapy. Outcomes must be appropriate and meaningful for each student so that they can reach their fullest potential. Remember to think outside the box, you know your child best!
Ten really good reasons why therapies should be integrated (R.A. McWilliams and Stacy Scott)
1. So that children learn the skills they need in the places they will use them
2. Children have increased practice opportunities
3. Children’s social relationships are fostered
4. So that a child does not miss out on any classroom activities
5. So that teachers can see what therapists do to help kids and expand their skills
6. So that therapists can see whether or not the strategies they develop are feasible
7. So that teachers and therapists focus on skills that will be immediately useful for a child
8. So that therapists can work with teachers to address problems as they arise
9. So that assessment can be done across a variety of routines
10. It’s the right thing to do!
