Putting the student with severe and/or multiple disabilities at the core of all planning is the key to truly making a difference in that student’s life. Effective individualized education programs (IEPs) are created through the dynamic, synergistic collaborations of team members who share a common focus and purpose and bring together diverse skills and knowledge (Reiter, 1999). This chapter focuses on these dynamic, collaborative relationships, specifically the 1) rationale for collaborative teams, 2) importance of a variety of disciplines, 3) organizational models of teams, 4) the collaborative approach applied to educational programming, 5) challenges to implementing a collaborative model and approaches to ensure success, and 6) essential components for successful collaborative services. Although the emphasis is on supporting students with severe and multiple disabilities, all students can benefit from a collaborative approach to educational planning and supports (Idol, Nevin, and Paolucci-Whitcomb, 2000).
WHY COLLABORATIVE TEAMS: A RATIONALE
Students with severe and multiple disabilities are those “with concomitant impairments (e.g., mental retardation/blindness, mental retardation/orthopedic impairments), the combination of which causes such severe educational needs that they cannot be accommodated in the special education programs solely for one of the impairments” (CRF Chapter III, Section 300.7 [c], 1999). These students, because of their combinations of physical, medical, educational, and social/
emotional challenges, require collaborative, concerted effort so that their IEPs result in learning outcomes that make a difference in their daily lives. Thus, they need the profound and foundational interconnectedness of a diverse group, including family members, to see that learning does happen (Selby, 2001). The many needs of students with intense, numerous educational challenges call for a collaborative approach in the educational environment to ensure the following:
Services are coordinated rather than isolated and fragmented. Team members who work together, complement, and support the student’s goals and each other provide connected and integrated educational programming. Coordination of services takes place through the actions of team members who learn and implement the components of educational collaboration. Through collaboration, team members experience a sense of collegial belonging and satisfaction (Snell and Janney, 2000).
All team members share a framework for team functioning. An operational framework is shared for team functioning, program assessment, implementation, and evaluation. Team members define their roles in relation to direct and indirect supports that they provide to the student’s educational plan and to other team members. Within a collaborative framework, the contributions of every team member are educationally relevant and necessary to the student’s educational success; gaps in services and overlapping functions are avoided. Involvement in the development of a student’s total plan helps ensure commitment and ongoing collaboration.
The student’s goals belong to the student, and all team members work collaboratively to ensure that those goals are met. Goals, objectives, and general supports are developed from the context of valued life outcomes for the student, family, and team members. Valued life outcomes are those basic components that reflect quality-of-life issues, such as being safe and healthy, having a home now and in the future, having meaningful relationships and activities, having choice and control that matches one’s age and culture, and participating in meaningful activities in various places. Individualized planning, including supports, accommodations, and specialized instructional strategies based on these valued life outcomes and subsequent learning outcomes will be unique for each child and can be seen as benchmarks for determining the success of the student’s program (Giangreco, Cloninger, and Iverson, 1998).
The student’s needs are addressed through a coordinated, comprehensive approach. Students with severe and multiple disabilities face challenges in a number of areas, including 1) physical and medical conditions, such as movement restrictions; skeletal abnormalities; vision and hearing loss; seizure, breathing, and urinary disorders; susceptibility to infections; and management of medications; 2) social and emotional needs, such as friendships, expression
of feelings, affection, giving to others rather than always being passive recipients, and making decisions; and 3) educational challenges, such as appropriate positioning and handling and best use of vision, hearing, and movements for gaining access to materials and people. Appropriate communication methods and modes to match students’ cognitive, visual, hearing, and motor functioning are essential to ensure that students can make choices, have some control over their lives, express basic needs, engage with others, and have access to pre-academics and academics. Although students with severe and multiple disabilities may have physical, medical, social, and emotional challenges, any student’s IEP should be based on individually identified educational needs, not on presumed disability characteristics.
IMPORTANCE OF A VARIETY OF DISCIPLINES
To develop IEPs for students with severe and multiple disabilities, it is necessary to call on individuals from diverse disciplines such as special education, general education, nursing, social work, occupational therapy, physical therapy, and speech-language therapy, as well as from fields less traditionally associated with education, such as rehabilitation engineering, nutrition, and respiratory therapy. Whitehouse recognized in 1951 that one or two people from different disciplines could not meet all of the needs or deliver all of the services for these students. Many others in the field of special education have stressed the importance of multiple services (Giangreco, Cloninger, Dennis, and Edelman, 2000; Snell and Janney, 2000; Thousand and Villa, 2000). According to the Individuals with Disabilities Education Act (IDEA) Amendments of 1997 (PL 105-17), what is key to determining the involvement of any of these professionals in a particular student’s IEP is whether a professional’s services and skills are deemed necessary for a student to benefit from his or her IEP. Within a collaborative framework, the contributions of every team member are educationally relevant and necessary to the student’s success, and, for the most part, gaps in services and unnecessary and contradictory overlapping functions are eliminated.
Although they are called on to work collaboratively, family members and professionals have distinct training backgrounds, philosophical and theoretical approaches, experiences, and/or specialized skills. The success of an educational team depends in part on the competence of the individual team members and on a mutual understanding and respect for the skills and knowledge of other team members.
Roles and Responsibilities of Team Members
All members of a student’s collaborative team share in carrying out their roles so that the team can function successfully and address goals intended to increase
the quality of life of the student. Some roles and responsibilities are generic and shared by all members; some are carried out individually or together; and some are specialized to a specific professional, although shared as necessary and appropriate. Team members include those who provide “specialized education services” as well as those who provide “related services.” “Related services” defined in IDEA include
Transportation, and such developmental, corrective, and other supportive services (including speech-language pathology and audiology services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, social work, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services, except that such medical services shall be for diagnostic and evaluation purposes only) as are required to assist a child with a disability to benefit from special education, and includes the early identification and assessment of disabling conditions in children. (20 U.S.C. 1401 [Sec. 602] )
Team members, other than family members and the student, provide specialized education services and/or related services to enable the student to reach his or her IEP goals and objectives. Special education can be provided without related services, but for the most part, related services cannot be provided without special education services. In a few states speech-language pathology services can be provided as special education services, if the only identified goals and objectives for the student relate to speech-language skills.
Related services providers, as well as other team members, engage in a variety of functions. Research by Giangreco and colleagues (Giangreco, 1990; Giangreco, Prelock, Reid, Dennis, and Edelman, 2000) found that the four most important functions of related service providers for serving students with severe and multiple disabilities were 1) developing adaptations, equipment, or both to allow for active participation or to prevent negative outcomes (e.g., regression, deformity, discomfort, pain); 2) transferring information and skills to others on the team; 3) serving as a resource, support, or both to the family; and 4) applying discipline-specific methods or techniques to promote active participation, to prevent negative outcomes, or both.
Team membership may be configured differently for each student depending on the array of services required to support his or her educational program. Most often, membership will reflect the people whose discipline-specific roles are emphasized in the following sections.
The student is the core of the team; the reason the team exists is to address his or her educational needs. The student should be present at all team functions,
either in person or through representation by family members, peers or advocates, and other team members. Team members are responsible for educating the student to participate as a team member and teaching self-advocacy skills and ways to have choice and control over decisions affecting him or her.
Family Member or Legal Guardian
Although not always present in the school on a daily basis, a family member or legal guardian or caregiver is an important member of the educational team. Apart from the fact that parents have the right to participate in assessment and planning, it simply makes good sense to invite them to participate in all team meetings as the individuals with the most knowledge of their children and the greatest stake in their children’s future (Giangreco et al., 1998). See Chapter 2 for more on working with families.
The special educator primarily is responsible for the development and implementation of the student’s IEP (IDEA, 1997). The special educator sees that the student with severe and multiple disabilities learns, through direct instruction and by sharing expertise and skills with the student’s peers and others (e.g., paraprofessional, general education teacher, occupational therapist, nurse, bus driver) who interact with the student. The special educator may also serve in roles shared by other team members, such as liaison between the parents and school personnel, supervisor of paraprofessionals, member and coordinator of the team, and advocate for the student.
The general education teacher provides services for and represents students on his or her class roster, as well as those who spend time in a general education class most of the day. The general educator’s role on the team is to contribute expertise and experience about the general education curriculum and standards; weekly, monthly, and yearly curricular plans; class schedule; class routines; class rules and expectations; and the general culture of his or her class. He or she also ensures that students with severe and multiple disabilities have opportunities to participate in class lessons and activities and to interact with other students. He or she shares responsibility for designing or delivering general education components of the student’s program, such as evaluating student progress. IDEA ’97 (PL 105-17) requires that at least one of the student’s general education teachers be on the IEP team, especially related to discussions and decisions about the student’s access to and participation in the general education curriculum.
Paraeducators are vital to the daily operation of the classroom. Their core functions include
Providing academic instruction; teaching functional life and vocational skills; collecting and managing data; supporting students with challenging behaviors; facilitating interactions with peers who do not have disabilities; providing personal care (e.g., feeding, bathroom assistance); and engaging in clerical tasks. (Giangreco, Edelman, Broer, and Doyle, 2001, p. 53)
The physical therapist (PT) focuses on physical functions including gross motor skills; handling, positioning, and transfer techniques; range of motion; muscle strength and endurance; flexibility; mobility; relaxation and stimulation; postural drainage; and other physical manipulation and exercise procedures.
The occupational therapist (OT) focuses on the development and maintenance of an individual’s functional skills for participation in instruction and daily living activities, which include use of the upper extremities, fine motor skills, sensory perception, range of motion, muscle tone, sensorimotor skills, posture, and oral-motor skills.
The speech-language pathologist (SLP) focuses on all aspects of communication in all environments, including receptive and expressive levels, modes, and intent; articulation and fluency; voice quality and respiration; and the use of augmentative and alternative communication (AAC). He or she also may be trained in assessing and facilitating mealtime skills.
Assistive Technology Specialist
The assistive technology specialist focuses on the use of highand low-technology devices and adaptations to facilitate participation in instruction and routine living skills, including communication, environmental management, instruction, social relationships, mobility, and recreation.
The school psychologist focuses on social-emotional issues, including assessment and evaluation, interpretation of testing information, counseling of students and families, behavioral and environmental analysis, and program planning.
The school social worker focuses on helping the student gain access to community and other services and resources; advocating for the child and family; and acting as a liaison among school, home, and community.
Administrators may include the school principal, special education supervisor or coordinator, and program coordinator. At IEP meetings, one of these or another designated person acts as the local education agency (LEA) representative. All of these administrators work together to ensure compliance with local, state, and federal regulations in areas such as placement, transition, curriculum development, transportation, related services, equipment, and scheduling. The school and district administrators are very important in promoting a school culture of high quality, success, openness, and inclusion for all students.
Teacher of Students with Visual Impairments and Certified Orientation and Mobility Specialist
The teacher of students with visual impairments (TVI) provides instruction to meet the unique needs of students with vision impairments and other multiple disabilities. The TVI is responsible for providing direct instruction and adaptations and accommodations in content areas such as tactile communication, use of optical devices, and daily living skills; and adapting general education classroom materials and consulting with the general education teachers. The certified orientation and mobility specialist (COMS) provides instruction in helping students with visual impairments learn how to maneuver safely and efficiently in the environment and may provide adapted equipment and strategies for those with significant challenges (see Chapter 10).
The audiologist identifies different types and degrees of hearing loss using traditional and alternative assessment techniques and equipment. The audiologist also provides consultation on equipment (e.g., hearing aids, FM devices) and their use, as well as environmental modifications (see Chapter 10).
The school nurse focuses on health-related issues and needs and his or her responsibilities may include administration of medications and other treatments (e.g., catheterization, suctioning, tube feeding), development of safety and emergency procedures, and consultation with other medical personnel (see Chapter 8).
Nutritionist and Dietitian
The nutritionist and dietitian focus on students’ diet and nutrition. Responsibilities include adjusting students’ caloric intake, minimizing the side effects and maximizing the effectiveness of medications, designing special diets for individuals with specific food allergies or health care needs, and consulting with medical personnel.
The physician focuses on the total health and well-being of the student, including screening for and treating common medical problems and those associated with a specific disability, prescribing and monitoring medications and other treatments, and consulting with other medical personnel. Physicians may include specialists such as a pediatrician, ophthalmologist, neurologist, otolaryngologist, orthopedist, and cardiologist. As related services providers, medical personnel provide services “for diagnostic and evaluation purposes only” (20 U.S.C. 1401 [Sec. 602] ). (See Chapter 8.)
Other specialists may be needed to address specific needs and concerns. They function as occasional team members, usually providing services that are time limited in response to a specific question by the educational team. Occupations in the field of severe and multiple disabilities may include dentist, optometrist, respiratory therapist, pharmacist, and rehabilitation engineer.
ORGANIZATIONAL MODELS OF TEAMS THAT SERVE STUDENTS WITH SEVERE AND MULTIPLE DISABILITIES
How well children are served in educational environments by the variety of people involved in their programs is influenced greatly by how these people work together. Each team member, as noted previously, brings a unique set of professional and personal skills and experiences to the team relationship. The manner in which teams are formed and the way in which they operate influence both the process and outcomes of children’s education. The collaborative team model has proven to be an exemplary model for people working together to bring about differences in the lives of students with severe and multiple disabilities.
This section describes a progression of team models representing a hierarchy of increasingly more coordinated and connected approaches (Giangreco, York, and Rainforth, 1989), with the focus on four organizational structures: multidisciplinary, interdisciplinary, transdisciplinary, and collaborative. Although each
of these models may be appropriate in a given environment or situation, many of the models first adopted by special education originated in medical environments in which people may not have even thought of themselves as belonging to a team. Team models have progressed to best meet the unique needs of students with severe and multiple disabilities in educational environments by following the development of educational best practices, research, and legal mandates. They also are based on the realization that educational teaming requires an educational model—the “collaborative” approach—not a medical model for student assessment, program planning, and delivery.
In the multidisciplinary model, professionals with expertise in different disciplines work with the child individually, in isolation from other professionals. Evaluation, planning, priority setting, and implementation are not formally coordinated with other professionals, although each discipline acknowledges the other disciplines, and information may be shared through reports or informally. The overlaps and gaps in services are addressed only minimally, if at all. Team members may cooperate in scheduling and sharing information in writing with each other or the family, much as one might see in hospital charts or medical specialists’ reports. In the medical profession, where this model originated, various disciplines co-exist to meet the needs of patients whose problems are typically isolated within one particular domain (Heron and Harris, 2001).
Although the multidisciplinary model may be effective for children with short term challenges, children with severe and multiple disabilities have more complex needs that require ongoing interaction among family members and professionals. Team members using the multidisciplinary model carry out isolated, separate assessment activities, write separate assessment reports, and generate and apply separate interventions specific to their area of expertise. The probability is very high that assessment information and intervention priorities will be in conflict, inconsistent, and difficult for other team members to implement. Parents, special educators, and case managers are often left with the task of implementing different or incompatible strategies to address various goals.
Lindsey, a fourth grader with motor (cerebral palsy) and cognitive disabilities, is served by an SLP who has skills in oral-motor eating issues and by an OT who also has skills
in feeding issues. They separately evaluated Lindsey on her eating skills and are both working with her on intervention techniques. Although these techniques could be supportive and provide Lindsey more practice with her eating skills, these professionals’ intervention techniques are not complementary and have not been taught to other team members who work with her daily.
Interdisciplinary Team Model
Representing another team model in the continuum of the ways people can work together, the interdisciplinary model provides a structure for interaction and communication among team members that encourages them to share information and skills (Heron and Harris, 2001). Programming decisions are made by group consensus, usually under the guidance of a services coordinator, whereas assessment and implementation remain tied to each discipline. Team members are informed of and agree to the intervention goals of each discipline; however, team members do not participate in selecting a single set of goals that belong to the student, that is, that are reflective of the student’s needs and supported by all team members.
Although the interdisciplinary model supports group sharing of information and decision making, individual members, often in isolation, carry out assessments. Implementation remains the responsibility of each discipline and occurs separately. Both the multidisciplinary and interdisciplinary models are discipline referenced models, which means that decisions about assessment, program priorities, planning, intervention, evaluation, and team interactions are based on the orientations of each discipline. Such structures “are more likely to promote competitive and individualistic professional interactions resulting in disjointed programmatic outcomes” (Giangreco et al., 1989, p. 57).
An additional problem with the multidisciplinary and interdisciplinary models is their tendency to rely on intervention services that are direct and often isolated from each other (Giangreco, Prelock, et al., 2000). Direct services represent hands-on intervention by therapists, rather than the therapists serving as consultants and/or supports to other team members in a more “indirect” approach.
Why does a direct, isolated therapy approach not best serve students with severe and multiple disabilities?
Assessments generally do not take place in natural environments, thus the outcomes may not be representative of what the student can do in those environments.
Assessments often test specific, isolated skills instead of clusters of skills used in everyday activities.
Assessments often result in diagnostic labels and descriptions of students’ performances, but do not include suggestions for specific goal attainment or accommodations and supports.
Team members cannot collaborate on the performance of individual students in natural situations.
Limitations of time for direct service may result in children receiving less instruction and practice on learning outcomes—such as communication and mobility—that could be addressed throughout the day.
Limited resources may lead to centralized service delivery systems in which students with severe and multiple disabilities are grouped together in order to receive multiple services, thus preventing or minimizing interactions with peers without disabilities and access to the general education curriculum (Orelove and Sobsey, 1996; Rainforth, York, and Macdonald, 1992).
Transdisciplinary Team Model
Originally designed for assessment of infants at high risk for disabilities (Hutchison, 1978; United Cerebral Palsy Association National Organized Collaborative Project to Provide Comprehensive Services for Atypical Infants and Their Families, 1976), the transdisciplinary model is the next in the continuum of people working together in a more collaborative way. This model represents a significant departure from the models of service delivery to which medical professionals are accustomed (i.e., multidisciplinary and interdisciplinary models). The purpose of the transdisciplinary model is to minimize the number of people with whom the young child or family has to interact in an assessment situation.
In contrast to the multidisciplinary and interdisciplinary approaches, the transdisciplinary model incorporates an indirect model of services whereby one or two people are the primary facilitators of services and other team members act as consultants (Heron and Harris, 2001; Hutchinson, 1978; Snell and Janney, 2000). Through an indirect or integrative approach, in contrast to the direct approach, therapists involve themselves to a greater extent as consultants to the
teacher and other team members (Giangreco, 1996; Giangreco, Prelock, et al., 2000). Assumptions of an indirect therapy model include the following:
1. Assessment of skills and abilities can best be conducted in natural environments.
2. Students are best taught through functional activities.
3. Therapy should be provided throughout the day and in all appropriate environments.
4. Learning outcomes must be taught and verified in natural environments.
Followers of the transdisciplinary approach may provide some direct services to students as well. Clearly, both direct and indirect modes of service delivery have a place in educating students with severe and multiple disabilities. The team needs to decide on using a particular model at a particular moment on the basis of appropriate outcomes for the student being served.
The transdisciplinary model is characterized by planned role release, which is the sharing and exchange of certain roles and responsibilities across team members. One team member releases some functions of one’s primary discipline to other team members and is open to being taught by other team members (Giangreco, Prelock, et al., 2000; Snell and Janney, 2000). For team members to serve in consulting positions and for services to be delivered integratively (i.e., integrated therapy approach), traditional roles of teachers, therapists, parents, and other team members must become more flexible. For example, the PT may share his or her assessment goal, strategy, and procedures with another professional who has an established relationship with the child and family and with those who provide primary services to the student. A process of role transition leading to role release includes sharing general information about practices and approaches of the various disciplines, sharing detailed information about specific practices or strategies, and teaching specific strategies to other team members (Lyon and Lyon, 1980; Woodruff and McGonigel, 1988).
Even though disciplines share in providing services, they often have separate goals, with role release occurring in one direction only. For example, the PT who serves a student named Lindsey releases some aspects of her role, such as positioning Lindsey, to the special education teacher and OT, who position Lindsey throughout the day in various seating situations. But the OT has not released her skills regarding Lindsey’s feeding goal to the special education teacher or paraeducator; thus, she is the only person who holds the capability to work with Lindsey on this goal. In this way, various providers may address some of a
student’s goals separately (Gallagher, 1997; Rainforth, 2002; Rainforth, Giangreco, Smith, and York, 1995).
Collaborative Approach Applied to Education
The collaborative model is the current exemplary practice in service delivery models for the education of students with severe and multiple disabilities, incorporating all of the best qualities of the transdisciplinary model combined with the integrated therapy model and adding qualities to address the limitations (Giangreco, Cloninger, et al., 2000). Often, the terms transdisciplinary, integrated therapy, and collaborative are used interchangeably, but there are differences, first identified by Rainforth and others in the early 1990s. To emphasize the need for collaboration, Rainforth and colleagues noted, “ ‘collaborative teamwork’ is now used to refer to service provision that combines the essential elements of the transdisciplinary and integrated therapy models” (Rainforth et al., 1995, p. 137). See Table 1.1 for a comparison of models.
A significant difference between the collaborative model and others is that in a collaborative team, individuals bring their own perspectives to the team but these are purposefully shaped and changed by working closely with other team members (Edelman, 1997). The practice of role release used in the transdisciplinary model is essential, yet the collaborative model goes beyond that concept to embrace influences on one’s own practice. The collaborative model is multidirectional and dynamic. All team members acquire not only shared understanding and knowledge of each other’s expertise but also the ability to incorporate that into collaborative evaluation, planning, and implementation. New ideas are generated through group interaction that would not be generated by working in isolation.
Another significant difference is that the collaborative model addresses the provision of services in meaningful or functional contexts as well as who provides the services and how multiple team members can provide the same service (Rainforth and York-Barr, 1997). The collaborative team model makes provisions for who is on the team, how each team member’s expertise will be used, and the functional contexts in which team members will provide their expertise.
A collaborative team is a group of people working in instructionally and contextually integrated ways on the four major areas of educational programming—assessment, development of instructional goals, intervention, and evaluation—based on student and family valued life outcomes. In the other models, collaboration on these four major areas of educational programming is an option rather than the basis of team expectations and operations.
Table 1.1. Comparison of service delivery models for students with severe and multiple disabilities
[Table reformatted by transcriber for clarity]
Assessment and planning are done separately by discipline.
Goals are established separately by discipline.
Interventions are done separately by discipline.
Intervention may not be of educational benefit or relevance.
Implementation is done in physical isolation.
Other disciplines are acknowledged.
Assessment results are shared.
Medical model is the basis of intervention.
Assessment is referenced to educational program.
Services (indirect) are integrated and related.
Role release is practiced.
Skills are applied to one set of shared goals.
Transdisciplinary (Maybe; not guaranteed)
Model makes use of natural contexts and functional activities.
Decisions are shaped and influenced by team members.
Educational model of intervention serves as the basis.
Model incorporates team members’ expertise into own practice.
Program results from melded creativity of all.
The main purpose of assessment in the collaborative approach is to determine relevant educational goals. As York, Rainforth, and Giangreco (1990) observed, the emphasis should be on planned quality assessment conducted in priority educational environments on activities identified by the team, with team members (including the family and student). Once assessment is complete, the team establishes content priorities for the learning outcomes to be taught to the student and writes educational goals and objectives that address those learning outcomes identified as goal priorities for the year.
Development of Instructional Goals and Objectives
Goals and objectives should be selected based on criteria such as whether performing the activity will make a real difference in the student’s quality of life— that is, whether the activity will support the student’s valued life outcomes.
Taylor is a sixth-grade student with cognitive, motor, and hearing disabilities. This goal is listed on his IEP: “Taylor will reliably answer ‘yes’ or ‘no’ symbolically to a variety of questions to indicate wants and needs.” The questions the team needs to address are these: Will teaching Taylor to use a communication device to indicate “yes” or “no” increase his quality of life? Will it provide him the capability to make choices or to participate in more meaningful activities?
The goals and objectives on students’ IEPs dictate the supports and accommodations, schedule, instructional materials and strategies, and the required involvement of specific team members. Therefore, the way in which educational goals and objectives are developed for students with severe and multiple disabilities is absolutely critical to the success of operating within a collaborative model. An IEP developed by a collaborative team is not simply goals and objectives written from individual disciplines and compiled into a single document, with the individual team members responsible for implementing and evaluating progress on their individual goals. No option is given for the members to write separate goals as they are allowed to do in other models. A collaborative IEP is based on goals and objectives that belong to the student and originate from priorities that the student and family select, with input from other team members. It is the responsibility of the team to provide future planning strategies such as Choosing Outcomes and Accommodations for Children (COACH) (Giangreco, Cloninger, and Iverson, 1998) and Making Action Plans (MAPs) (Pearpoint, Forest, and O’Brien,
1996) for the student and family to truly be part of the team and involved in making educational decisions. The goals and objectives are based on what is best for the student educationally for a given year from a family-centered perspective.
The student’s goals target educationally relevant learning outcomes that are not tied to any one discipline. For example, “Omar will improve postural stability and increase antigravity of head, trunk, and extremities,” is an example of a discipline-specific and jargon-filled goal written by a PT (Giangreco et al., 1998). Instead, a goal should be stated so that everyone can understand clearly what is expected, it can be carried out in natural environments, and it provides an answer to the question, “So what difference will this make in the student’s life?” Restating a goal for Omar in a discipline-free, jargon-free manner results in “During lunch, Omar will walk in line, get his lunch tray, reach for two food items, and carry his tray to the table.”
In another example, “Moira will extend her dominant hand to an augmentative device for expressive communication requesting of salient items.” Stated without reference to disciplines or use of jargon, “Moira will point to pictures on her communication board to make requests for preferred people, toys, and food.” For more examples of discipline-free, functional goals, see Chapter 3.
Delivery of Instruction and Related Services
The collaborative model incorporates integrated therapy and teaching, in which team members provide at least some services by consulting and teaching other team members, but all team members have the capability for intervention. Skills and expertise of team members are integrated not only in the writing of the student’s goals but also in deciding where and how the student’s goals and objectives are taught. The team works together to support the student in all school and community environments and activities as indicated on the IEP. Team members share their personal and professional expertise and skills so that the team can determine how best to address the student’s goals and objectives without gaps or unnecessary overlaps in services. In the collaborative model, “planning is referenced to a common set of goals and needs whereby each team member applies his or her disciplinary skill to the shared goals, and therapeutic techniques are implemented in concert with other instructional methods in the context of functional activities” (Giangreco et al., 1998, p. 61).
Evaluation of Program Effectiveness
Teams participate in ongoing evaluation processes by which they make necessary changes in response to the student’s needs and priorities. Responsive evaluation addresses questions at various levels, including 1) student-focused
questions concerning progress, satisfaction, and needs; 2) program-focused questions concerning methods, curriculum, and environments; and 3) team-focused questions concerning efficacy in implementing the educational program and in working together collaboratively. The last level, team-focused evaluation, can be addressed through two questions:
1. What was the effect of our collaboration on student outcomes? In other words, did team members work together in such a manner to enable the student to be successful in his or her educational program?
2. Did we maintain positive relationships throughout the process?
A later section of this chapter, Essential Components of Collaborative Teaming, lists additional ways to address these two questions.
CHALLENGES TO IMPLEMENTING A COLLABORATIVE MODEL
No matter how useful is the collaborative approach in meeting the educational needs of students with severe and multiple disabilities, collaborative teams inevitably encounter a variety of challenges along the way. These may be similar to challenges or limitations in other models such as the transdisciplinary model. Anticipation and team preparation can alleviate difficulties that often result from lack of understanding, lack of personal experience with the model, and logistics. Challenges in implementing the model are discussed from three perspectives: 1) philosophical and professional, 2) personal and interpersonal, and 3) logistical.
Philosophical and Professional Challenges
Philosophical and professional challenges arise from differences in professional training and philosophy (Edelman, 1997). Team members from different disciplines often approach instruction and therapy differently. Many related service providers, such as OTs and PTs, psychologists, nutritionists, and SLPs, receive their professional preparation in a medical model in which one looks for the underlying cause of a behavior and then directs therapy toward “fixing” the presumed cause. Special educators, especially those who work with children with severe and multiple disabilities, receive their professional preparation in an educational model in which one administers functional or authentic assessment with the goal of teaching functional learning outcomes for the student, not to fix the student (Giangreco, Prelock, et al., 2000).
In too many professions, preparation occurs in isolation from other disciplines; thus, teachers and related services providers neither learn about each other’s disciplines or jargon nor have opportunities to work together as
members of an educational team. When serving as a member of an IEP team, they are unprepared for the change in roles necessary to be part of a collaborative team (Snell and Janney, 2000).
Releasing part of one’s professional role may threaten some professionals’ perceived status. Collaborative teams that operate smoothly, however, can actually enhance the status of team members by fostering greater respect and interdependence, providing opportunities to share expertise with others, and being part of a creative team (Edelman, 1997; Idol et al., 2000).
In an integrated related services and teaching approach, there may be a few highly specialized procedures for evaluation or intervention that only specifically designated, trained individuals should perform based on their professional judgment or as designated by a physician. For example, in some states only nurses can perform catheterization or dispense medication at school. In other instances, only a PT could appropriately deliver range of motion to a student returning to school after surgery. Other team members should learn and perform only those procedures appropriate for them, with the assurance that legally required supervision by licensed or certified professionals is planned for and regularly occurs.
Team members using the collaborative model may have difficulty deciding who should provide what services because this is not as clear as it is in the other models. The paraeducator and special educator may be carrying out feeding techniques daily at snack time after being taught by the SLP, who provides his or her support to the student via indirect consultation and biweekly direct consultation. Parents or other team members may feel that the child is not receiving adequate related services when the process for integrating related services and instruction is not clear. An important step in enhancing team functioning is for all members to understand the model and the ways in which a specific array of instruction and related services can ensure the best educational results for the student. When team members understand their changing roles, they see the numerous opportunities for involvement in planning, implementation, and evaluation, and consequently, the numerous opportunities for their expertise and resources to benefit the student and other team members.
Personal and Interpersonal Challenges
Team members also encounter personal and interpersonal challenges when implementing a collaborative team model. One of the tenets of the collaborative model is the need for team members to share information and skills with others and to accept and learn from other team members. Some may find meeting this need threatening because it places the team members’ skills under scrutiny and requires release of expertise and training on how to teach adults. Thus, sharing one’s expertise with others is a matter of trust and a challenge for some team
members. Team members can use strategies such as modeling, practice, feedback, and coaching to share their expertise (Heron and Harris, 2001). As these skills increase and trust develops, teaching others and being taught becomes easier, more effective, and enjoyable.
Another source of interpersonal problems may be a lack of clear differentiation of responsibilities among team members. Within a collaborative approach, functions are shared and purposefully melded, which makes it even more essential to clarify roles and responsibilities. At team meetings, members identify who does what (e.g., contact parents, take minutes, repair equipment). Over time, as roles and responsibilities change, team members must be involved in and informed about these changes. The collaborative model advocates strategies to promote shared responsibilities; it does not advocate that related services or accommodations be reduced or that one person provide all of the services needed by the student.
Implementing a new service delivery model takes time and concerted effort as well as administrative support and technical assistance. People respond to change in various ways, from total resistance to exuberance. Understanding how people respond to change should be anticipated and addressed through strategies for fostering dialogue, resolving conflicts, solving problems, and proving the benefits to the student.
Some of the most difficult challenges are ones that often seem out of the control of the team. These include such difficulties as finding the time for meetings and “on the fly” communication, running efficient meetings, and ensuring team communication and consistency among team members. Addressing these challenges often requires the involvement of administrators and others in the school and may include strategies such as training and adapting the collaborative approach for everyone in a school or agency, scheduling team planning time for everyone, training and use of problem-solving processes for a variety of school or agency challenges, and providing e-mail access for all team members (Snell and Janney, 2000; Thousand and Villa, 2000).
Stages of Team Development
The process of working together as a collaborative team does not just happen; the practice of skills must be part of the process. Although all team members enter the process at different levels, new learning occurs for all. Being part of a team is a dynamic, ever-changing process, with most teams going through stages of learning and implementation and then recycling through these stages continuously as new people join the team or as conflict or new situations arise.
ESSENTIAL COMPONENTS OF COLLABORATIVE TEAMING
A collaborative team is defined as an approach to educational programming that exhibits all of the following five components:
1. Appropriate team membership
2. A shared framework of assumptions, beliefs, and values
3. Distribution and parity of functions and resources
4. Processes for working together
5. A set of shared student goals agreed to by the team (Giangreco et al., 1998; Snell and Janney, 2000; Thousand and Villa, 2000)
Component 1: Appropriate Team Membership
Teams include “those who will be most directly affected,” rather than “everyone who might be affected” (Giangreco et al., 1998, p. 23). With the potential for a large number of people on a student’s team, and the recognition that weekly or biweekly team meetings of all of the team members is neither possible nor necessary, a tiered team membership can be used consisting of core, extended, and situational levels. Membership at each level is related to the student’s IEP and is influenced by professional qualifications, regulations, personal skills, and experiences of each member. A thoughtful process for making decisions regarding who is to be involved at each level in each situation facilitates the best use of everyone’s expertise and avoids unnecessary overlaps and gaps in delivery of services. Related services providers, serving as other team members, are involved at each level depending on their function (i.e., direct, indirect, consultation) and frequency of contact with the student.
Core level: At the core level, team membership consists of those members who have daily contact and interaction with the child, usually the special and general education teachers, the paraeducator, the parents, and perhaps one or more of the related services personnel such as the SLP, nurse, PT, or peers, as appropriate.
Extended level: The next level or circle of membership, the extended level, includes those who have weekly, biweekly, or some other regular contact with the student such as related services personnel and a school administrator.
Situational level: The last level or circle of membership is at the situational level. It consists of those members such as a dietitian recruited for specific situations and questions and other teachers or related services providers
(e.g., psychologist, counselor). Information is shared and solicited from all, but attendance at meetings depends on function and relation to educational planning and implementation and is determined by the agenda (Giangreco et al., 1998).
Component 2: Shared Framework of Assumptions, Beliefs, and Values
Teams need to agree on their beliefs about the purpose of the team, best ways to educate students with severe and multiple disabilities, and involvement of families and professionals. Dialogue takes place in order for members to share perspectives and come to consensus on various educational programming concepts such as valued life outcomes, collaborative relationships, integrated related services and instruction, and team communication strategies.
Component 3: Distribution and Parity of Functions and Resources
Team members value each member’s input and expertise and alternately take on the roles of both teacher and learner and giver and receiver of expertise. Ways to share expertise, perspectives, experiences, and resources are applied in meetings; in written communications; and in assessment, planning, and evaluation.
Component 4: Processes for Working Together
Team members use processes for working together in four ways: face-to-face interaction, positive interdependence, interpersonal skills, and accountability.
1. Face-to-face interactions: Ongoing, regularly planned times for face-to-face interactions provide members with the opportunities to problem solve creatively, get to know each other, share and receive expertise of others—and most important—plan for the implementation of the student’s educational program. Core, extended, and situational tiers of team members are used to designate who needs to be at what meetings. When members are not at meetings, a system of sharing what happened and receiving input is set up so that all can be informed.
2. Positive interdependence: Positive interdependence is “the perception that one is linked with others in a way so that one cannot succeed unless they do (and vice versa), and that their work benefits you and your work benefits them” (Johnson and Johnson, 1997, p. 399). Team members agree to provide educational services from a shared operational framework and set of values that not only greatly benefits the student but also benefits each member of the team.
Positive interdependence can be fostered in a variety of ways:
Stating group and individual goals publicly and in writing
Sharing team functions, roles, and resources equitably by defining team roles and responsibilities (e.g., recording minutes, facilitating meetings, keeping time, communicating with absent members, using jargon-free language, completing paperwork) and taking turns fulfilling these roles
Identifying norms or ways team members want to work together (e.g., take turns, listen respectfully, “be nice,” give compliments, celebrate successes)
Creating shared accomplishments and rewards by scheduling time at meetings to present positive achievements of the student and team members, attending workshops together, presenting at workshops together, having a team party, and participating in other wellness activities
3. Interpersonal skills: Interpersonal skills are essential to effective team functioning. Adults often need to learn, use, and reflect on the small-group interpersonal skills needed for collaboration. These skills include trust-building, communication, leadership for managing and organizing team activities, creative problem solving, decision making, and conflict management. The priority skills in each of these categories that are reflective of how the team desires to behave and work together can be written in mutually agreed-on group norms and incorporated into the meeting agenda. These products also provide a set of behaviors that can be used as benchmarks for monitoring, discussing, and reflecting as team members learn together and practice teaming skills.
4. Accountability: Individual and group accountability is necessary for members to inform each other of the need for assistance or encouragement, to identify positive progress toward individual and group goals, and to recognize fulfillment of individual responsibilities. At each meeting the agenda should include a brief time for processing, that is, for sharing observations and suggesting changes in team process as needed. The responsibility for processing is best rotated among members, as are other team roles. The content of the agenda also provides opportunities for accountability reporting (e.g., “Report from physical therapist on co-teaching activity with physical education teacher—5 minutes”). One or two times per year, a team may take more time to evaluate team operations, celebrate, and make adjustments for the next semester or year.
Component 5: Shared Student Goals Agreed to by the Team
The IEP goals and objectives are derived from the needs of the student and indicate what the student will be able to do as a result of instruction. By establishing
common student goals, teams avoid the problem of each member having his or her own separate, discipline-specific goals. All team members agree to collaboratively supply their expertise and resources so that the student can achieve his or her goals and objectives. All team members pull in the same direction for the student.
Reasons for a collaborative team approach to the education of students with severe and multiple disabilities stem from the educational difference this approach can make for students. Team members work in a collegial culture, within a community of caring and supportive adults, not in isolation. Team members share a diversity of perspectives and experiences integrated in creative ways to address the many and ongoing learning challenges of students with severe and multiple disabilities. Team members provide context-specific, embedded instruction in meaningful activities that promote learning and generalization. Team members are able to address the learning characteristics of students by designing and implementing coordinated, integrated services.
Just as excellent teaching does not just happen, collaborative teaming does not just happen. Team members must learn from and teach one another. Team members must take the time to learn, practice, and evaluate teaming skills. Team members must take the time to work on challenges and celebrate successes. They do this so that they will provide effective, efficient, creative, truly individualized programs for students.
For other helpful resources on collaborative teamwork, refer to works by Thousand and Villa (2000), Snell and Janney (2000), and Idol and colleagues (2000).
Zach, who is 11, rides to his neighborhood school on the bus with his brother and other children in his neighborhood to attend a fifth-grade class. Zach likes being in places where there is a lot of activity, and he enjoys music, books, and the outdoors. He presently does not have a formalized communication system; he communicates through facial expressions, vocalizing, crying, and laughing and seems to understand more than he is able to communicate. Zach does not have vision or hearing impairments; however, he does have physical disabilities that affect the use of his extremities. He is beginning to learn to use a power wheelchair for mobility and is beginning to use communication assistive technology.
Zach’s IEP was developed using COACH (Giangreco et al., 1998), which identified the priority learning outcomes through an interview process with Zach and his parents followed by general supports and objectives identified by the team working collaboratively. Decisions about the specific roles and responsibilities of each team member for implementation of Zach’s IEP were made using the Vermont Interdependent Services
Team Approach (VISTA) (Giangreco, 1996, 2000), a process for coordinating educational support services. Zach’s IEP is supported by a special educator, classroom paraeducator, physical therapist, occupational therapist, and speech-language pathologist. See Figure 1.1 for Zach’s educational program and support plan. Educational relevance and necessity determine how and where these professionals’ expertise is used. By knowing the expertise of each team member, overlaps and gaps can be eliminated, and teaching of goals and objectives occurs more frequently throughout the day. Not all team members will be involved in supporting all educational program components. The PT and OT on Zach’s team have shared expertise in a number of motor areas, thus both do not need to be involved on all of the goals (e.g., “doing classroom and school jobs with peers”). The SLP and OT both have expertise in feeding, so the decision was made by the team that the OT would be involved with this general support, not the SLP. As each team member is providing direct instruction to the student for a particular goal, he or she is incorporating the “released” skills from other team members into his or her teaching as well as teaching other adults (e.g., paraeducator).
For Zach’s goal of “making requests for food, people, places, and activities using a photo communication system and eye gaze,” each of the team members contributes his or her expertise in a specific way as determined by the whole team. All of the team members have the responsibility of assisting in instructional design, in teaching Zach, and in data collection, so that he may attain this goal.
The special educator designs the specialized instructional program that includes the instructional strategies for teaching “making requests,” such as antecedent directions Zach receives, prompting procedures, material and physical cues, consequence reinforcement and correction, and data collection procedures. She also co-teaches with the general educator and teaches Zach in small groups and in pregroup sessions.
The general educator identifies the class lessons and activities so that Zach can learn and practice “making requests,” provides opportunities for Zach to make requests in these lessons and activities, teaches Zach’s peers natural supporting and interaction strategies when he makes requests, and shares responsibility for designing and delivering instruction to Zach in general education group activities.
The paraeducator teaches Zach in various school situations such as small groups in the classroom, provides instructional support in large groups and one-to-one teaching in learning centers and computer labs, records data on Zach’s learning outcomes, keeps Zach’s equipment in working order, and supports Zach in his personal care activities, using these contexts for Zach to practice “making requests.”
Figure 1.1. Zach’s individualized education program (IEP) and supports plan reflecting a collaborative approach. (Key: SE special educator; PE paraeducator; SLP speech-language pathologist; OT occupational therapist; PT physical therapist; GE general educator; P peers)
Goal or general support: Making choices using eye gaze
Support needed: SE GE PE SLP OT
Mode of service (Indirect/Direct): D/I D D I/D I
Location of service: Fifth-grade classes
Goal or general support: Responding to yes/no questions using eye gaze and head movements
Support needed: SE GE PE SLP OT
Mode of service (Indirect/Direct): D D D I/D I
Location of service: Fifth-grade classes
Goal or general support: Making requests for food, people, places, and activities using a photo communication system and eye gaze
Support needed: SE GE PE SLP OT
Mode of service (Indirect/Direct): D D D I/D I
Location of service: Fifth-grade classes, cafeteria
Goal or general support: Doing classroom and school jobs with peers
Support needed: GE PE PT P
Mode of service (Indirect/Direct): D D/I I D
Location of service: Fifth-grade classes, around school
Goal or general support: Engaging in active leisure by activating devices (e.g., toys, CD player, page turner, computer, appliances) using an adaptive switch
Support needed: SE GE PE P
Mode of service (Indirect/Direct): D/I D D/I D
Location of service: Fifth-grade classes, library, computer lab
Goal or general support: Personal supports: Needs to be given food and drinks, dressed, assisted with personal hygiene
Support needed: SE PE OT
Mode of service (Indirect/Direct): D/I D I/D
Location of service: Cafeteria, bathroom
Goal or general support: Physical supports: Needs repositioning at regular intervals, environmental barriers modified to wheelchair access, equipment managed, moved from place to place
Support needed: SE GE PE PT P
Mode of service (Indirect/Direct): D/I D D I D
Location of service: Fifth-grade classes
Figure 1.1. (continued)
Goal or general support: Teaching others: Staff and students need to learn about Zach’s augmentative and alternative communication system, other communicative behaviors, and how to communicate with Zach
Support needed: SE GE PE SLP
Mode of service (Indirect/Direct): D D D I/D
Location of service: Around school
Goal or general support: Providing access and opportunities: Access to general education classrooms and activities, instructional and material accommodations prepared in advance for multilevel and curriculum overlap instruction in general education activities
Support needed: SE GE PE SLP
Mode of service (Indirect/Direct): D/I D/I D I/D
Location of service: Fifth-grade classes, around school
The speech-language pathologist takes the lead in identifying Zach’s communication system, in designing the sequence in his learning to “make requests,” and in teaching other team members how the system works and how to troubleshoot.
The occupational therapist provides information on positioning of objects, the communication device, and Zach’s body for optimal use of eye gaze. He or she also provides instruction to other team members and Zach’s peers on placement of objects to teach “making requests.” The OT’s role in providing accommodations and adaptations for Zach’s eating and drinking is related to this goal; he or she could provide input on Zach’s preferences used in his “making requests” instructional program.
The success of students’ educational programs and the quality of their lives depends on the team of people who provide services being highly connected and coordinated. The myriad educational, health, social, and emotional needs of students with severe and multiple disabilities require organization for systematic planning, implementation, and evaluation of their programs. Although other models for delivering services were explored, in this chapter the emphasis is on collaborative teaming for designing educational services for students with severe and multiple disabilities. The collaborative teaming model developed from other models of service delivery with subtle and not so subtle transformations along the way. The most
similar model, the transdisciplinary model, differs in several ways. The collaborative model arose from an educational emphasis, whereas the transdisciplinary model holds its roots in the medical approach, as do other models (i.e., interdisciplinary, multidisciplinary). The philosophy and practice of the collaborative model is that the team members not only will share their expertise and resources but also will be purposefully changed by other members and will use their acquired skills to influence their own discipline. The collaborative approach offers benefits to the student by having not just a collection of people providing services but also a team with a shared vision, a shared framework, and shared strategies that are more likely to ensure that the student will reach his or her IEP goals and objectives.
The inherent dynamism of teaching and learning, the ever-changing goals and needs of students with severe and multiple disabilities, and the variable nature of people mean there always will be questions without defined answers, and new information to learn. The need for collaborative creativity and flexibility, open minds, and the willingness to share dreams and challenges is ongoing. When team members let values and visions larger than their fears and doubts lead their work, when what they do is designed so that every child attains his or her valued life outcomes, when they are committed to being a team together, then educational programs can lead to meaningful, positive changes in the lives of children with severe and multiple disabilities and their families.
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by: Chigee J. Cloninger
[Footnote:] Thanks to Ruth Dennis, Susan Edelman, Michael Giangreco, and Ginny Iverson for sharing their invaluable assistance and support.