CHAPTER 16

Co-Teaching with an Occupational or Physical Therapist

Several years ago, a ski accident resulted in four breaks in my right leg. Midnight surgery was followed by casting, a quick lesson on safe crutch use, and several weeks of boring bed rest. Eventually, the surgeon faxed a referral to a physical therapy practice in the office next door for biweekly therapy sessions. After six weeks the physical therapist faxed a progress report back to the surgeon. Several months later, still experiencing significant pain and mobility issues, it was time to see the surgeon again. X-rays showed that the bones had healed, and the surgeon declared his role finished. Limping out of the office, down the hallway, past the physical therapy office, I had to wonder if there was a better way.

Occupational and physical therapy services originated as part of a medical model. This approach could be described as multidisciplinary—several disciplines involved in the process of healing or correcting a problem. Each member of a multidisciplinary team brings a unique skill set and perspective to the problem. While communication occurs between disciplines, it is not often face-to-face or extensive communication. In some cases, usually the simple ones, the multidisciplinary approach is enough. But when problems are complex, the multidisciplinary approach often fails.

Struggling students in inclusive educational settings present a complex set of needs that challenge us to move beyond the multidisciplinary model for the delivery of occupational and physical therapy (OT/PT) services. What works in the medical field doesn’t translate well to the educational field. Instead, a transdisciplinary approach is a more effective solution. The prefix “trans” means “across.” In transdisciplinary teaming, professionals from different disciplines work much more closely together to cross traditional disciplinary boundaries and collaboratively design and implement an individualized education plan. The OT/PT no longer works with the student in a separate space, but integrates his expertise into the classroom setting. The most effective application of this transdisciplinary approach in education is co-teaching.

IDEA encourages co-teaching for OTs and PTs. It defines “related services” as being services required to assist a child with a disability to benefit from education. As nationally recognized OT Tere Bowen-Irish writes, “OTs need training that focuses on school-based delivery services that are collaborative in nature. The fact that we have only been in education for 34 years puts us at a disadvantage. Each year is bringing more insight and application” (personal communication, 2011). If the goal of therapy services truly is to help a student access and benefit from their education, it is crucial for the therapist to participate in the setting where that education is taking place.

“If the goal of therapy services truly is to help a student access and benefit from their education, it is crucial for the therapist to participate in the setting where that education is taking place.”

In addition, IDEA encourages co-teaching through its provisions for Least Restrictive Environment (LRE). The law requires that children with disabilities be educated with children who are nondisabled to the maximum extent appropriate. Removal from general education classes is only allowed when the education cannot be achieved satisfactorily with the use of supplementary aids and services. This provision implies that OT/PT services should be attempted in the regular class before pull-out services are determined to be necessary.

Best Models

Any of the models that allow for small-group work lend themselves well to co-teaching with an OT or PT. This would include the Skill Groups, Station Teaching, or Parallel models. In the small-group setting, the therapist can work with the targeted student(s) with enough intensity to satisfy their therapeutic goals, and yet still provide a context of nondisabled peers.

As with other co-teaching partnerships, the best end result is achieved when the teammates begin with collaborative planning. The classroom teacher may present the curricular goals and the intended lesson plan. The therapist can then suggest adaptations to the plan that will address the therapeutic objectives while simultaneously making education more accessible (see Table 16.1).

TABLE 16.1: Co-Taught Lesson with an OT

GENERAL PLAN—KINDERGARTEN MATH—MR. JENNINGSOT ADAPTATIONS TO PLAN—MRS. BOWEN-IRISH
Students will be rotating through math centers.

1. Counting math cubes by tens
2. Matching game with squares, circles, rectangles
3. Distributing pizza slices
4. Sorting photos by season		Bina and Torrie’s goals can be worked into center #1. Let’s provide chopsticks to the students and have them place the cubes into a bowl as they are counting. This will work on muscle strength for pencil grip. I will sit at this station.

While occupational and physical therapy goals may be woven into many of aspects of a student’s school day, subjects such as art and physical education can be especially accommodating. Because these teachers already provide frequent tactile and kinesthetic activities, it is easy to incorporate therapeutic movement (see Table 16.2).

TABLE 16.2: Co-Taught Lesson with a PT

PHYSICAL EDUCATION—5TH GRADE—MRS. CONLINPT ADAPTATIONS TO PLAN—MR. LEE
Spelling Word Relay Teamsc04uf003
Individual Stretching
Basketball
Cool Down and Fitness Logs		Kyle will join a team and use his motorized wheelchair. Can we have students use stretching partners? I will trio with Kyle and his partner to work on his range of motion.
During the game I’ll work with Kyle on passing to his left. One of his goals is to perform cool down exercises independently.

c04uf003See Appendix A

After the instruction phase is complete, the therapist is on the move to the next location. Collaborative grading is unlikely to occur when co-teaching with a therapist. The therapist will usually assume the responsibility for reporting about progress on IEP objectives related to motor skills, whereas the classroom teacher handles other assessment decisions.

Challenges

Due to the low incidence of students requiring OT/PT services, therapists are usually itinerant, traveling from school to school in the course of a single day. They are often employed by an outside agency, rather than the school district. Questions about scheduling, supervision, responsibilities, and caseloads can be complicated and exacerbate a disconnectedness between the co-teachers. As Bowen-Irish states (personal communication, 2010), “Therapists are so spread out that it is hard to develop chemistry. Teachers usually see your rear end leaving to run to another school. In the ideal world the therapist would be on staff and be able to connect with the staff and learn the curriculum.”

Although it is unlikely schools will have budgets to hire full-time OTs and PTs, the administration can turn their awareness of this disconnectedness into corrective action. One school principal arranged to hold monthly staff meetings on an afternoon when therapists were scheduled to be in the building. He placed issues specifically related to them first on the agenda so that they could participate for a few minutes, without adding significantly to their time commitment in the building.

Scheduling challenges make it difficult enough to arrange common planning time for two professionals who share a building site all week long; the schedules of itinerant therapists make weekly common planning time close to impossible. Without common planning time, it becomes much more difficult to share responsibilities. Anyone partnering with an itinerant therapist will need to accept the major responsibility for lesson planning, and give the therapist permission to tweak the plan to meet student needs. Other responsibilities, such as grading, classroom management, and handling daily routines, will necessarily fall under the purview of the classroom teacher.

When co-teachers do not have time to engage in conversation and get to know each other, misconceptions can be common. Classroom teachers may only think of occupational therapists as handwriting experts, and not realize the wide array of other skills they bring to the table. Teachers may be anxious that physical therapists will rile up students with lots of activity, and then move on to their next appointment, leaving the classroom in chaos. The challenge for therapists will be to educate their partners about the talents they can contribute to enrich the learning experience for all students.

Essential for Success

Most people who choose to work in school settings don’t consider themselves to be good at sales. They may say they don’t have a head for business or don’t like trying to sell others on an idea or a product. Itinerant therapists will be most successful in co-teaching if they can overcome this hesitation and sell themselves. Consider for a moment how excited a teacher might be to learn that her co-teaching therapist can add an unexpected breadth and depth to her bag of classroom strategies. Consider for a moment how relieved a teacher might be to hear that her co-teaching therapist has the skills and knowledge necessary to work within the curriculum, rather than adding extraneous, unconnected activities. A therapist who sells herself—the talents and ideas that make her a valuable, desirable asset—will find herself working with an enthusiastic partner.

“A therapist who sells herself—the talents and ideas that make her a valuable, desirable asset—will find herself working with an enthusiastic partner.”

In order for a therapist to feel comfortable selling her ability to make classroom connections, it is essential that she have at least a general understanding of the curriculum standards at each grade level. For example, it will be discouraging for all involved if a therapist comes to class not knowing that first graders are expected to manipulate and understand coins. Most college programs do not provide this type of detailed information. Therefore, therapists may need professional development workshops to help them become acquainted with the district’s common standards. It will also be an enormous help if therapists have easy access to a copy of curriculum guides, student texts, or relevant concept maps. The expectation is not that the therapists should know these materials inside and out, but that they have a familiarity that makes it possible to effectively integrate therapeutic and academic objectives.

c16uf001TO SUM UP

c16uf002DISCUSSION QUESTIONS