Factors Associated With Therapists’ Involvement in Children’s Transition to Preschool

Early Childhood Transitions

Most states provide Part C early intervention services from birth through age 2 (contingent on individual state eligibility criteria) and Part B preschool special education services beginning at age 3. State agencies plan transitions for young children on the basis of general guidelines set forth in the IDEA, including a conference with family members and Part B representatives a minimum of 90 days before the child’s third birthday. Although procedures vary by state, this experience is typically the family’s first with their child’s new preschool, and families have the option of inviting Part C representatives to the meeting. If a child demonstrates eligibility for preschool special education, depending on the state, representatives from the school district (i.e., school psychologists, teachers, therapists) may conduct assessments, and one or more meetings may follow. A meeting may occur with Part B representatives and family members in which the child’s placement in a specific type of preschool program (e.g., inclusive setting) is determined. In addition, an individualized education program (IEP) meeting will be held, usually before the start of or early in the school year. During this meeting, preschool administrators and staff may work with families to identify the child’s special education objectives for the upcoming year.

Proposed by Rous, Hallam, and colleagues (2006, 2007), the Conceptual Framework for Transition of Young Children With Disabilities describes the complex nature of the transition planning process. Child factors, such as type of disability and temperament, provide the crux of individualized planning. Because the child is embedded in the family, family factors (e.g., diversity, resources) also play an important role in the planning process. The community includes providers, programs, local service systems, and the state system, each of which contributes a set of factors to transition planning. Providers bring different levels of experience and training to the process. Individual programs may have differing philosophies of teaching and management that influence their type and amount of involvement. Local service systems are typically made up of many agencies that offer services and participate in transition planning. Supervision and leadership from state agencies inform the participation of early childhood agencies at the local level, thus influencing the quality of transition services provided.

The Conceptual Framework links transition practices and activities, child and family preparation and adjustment, and child outcomes with the following three critical interagency variables: (1) communication and relationships among the child, family, and community (including service providers and agencies); (2) supportive interagency infrastructure with “administrative support in place to ensure that communication and relationship building between agency staff is seen as a part of the overall service delivery system” (Rous, Hallam, et al., 2007, p. 141); and (3) alignment and continuity of programs, curricula, and expectations of personnel.

Support for families throughout this process is critical, because they must often cope with the change from family-centered early intervention services provided in natural environments to the child-focused early childhood special education services provided within the classroom—an adjustment that may contribute to feelings of stress and anxiety (Hanson et al., 2000; Podvey & Hinojosa, 2009). Families and children benefit from strategies and practices identified as helpful and supportive, such as discussing differences between programs, visiting programs before the transition, feeling encouraged to participate in the planning process, and being part of a team that engages in collaborative practices (e.g., sharing information between sending and receiving programs; Hanson et al., 2000; Rosenkoetter, Hains, & Fowler, 1994; Rous, Myers, & Stricklin, 2007).

Occupational Therapy and Early Childhood Transition

In studies of therapy providers’ (i.e., occupational therapists, physical therapists, and speech–language pathologists) participation in the transition process, family support was identified as a frequently used and important aspect of participation in the transition to preschool, as were collaborative practices such as helping to develop the child’s IEP, attending transition meetings, and conferring with the receiving therapist (Myers, 2007b, 2008; Myers & Effgen, 2006). Therapy providers also identified general barriers to participation that interfered with family support and collaboration, including lack of time, not receiving support from employers, lack of reimbursement for attending transition planning meetings, and not being invited to transition meetings. When considered in light of the conceptual framework previously presented, the findings of these studies suggest that the participation of therapy providers is variable and subject to the complex interplay of multiple systems within the transition process.

Myers (2006) appraised the potential role of occupational therapists during transition and identified family support practices such as preparing caregivers for unfamiliar occupations in the new setting and helping caregivers learn to advocate for their child’s needs. With regard to collaborative practices, occupational therapists’ knowledge of activity analysis and environmental adaptation makes them valuable team members who have the skills to anticipate possible problems in the next environment and work in partnership with families and other professionals to identify solutions before the transition.

Approximately 38% of children in Part C early intervention and 34% of children in Part B preschool special education receive occupational therapy services (Hebbeler et al., 2007; Markowitz et al., 2006). A previous study found that, despite having much to offer, <50% of the occupational therapists in early intervention and 40% of respondents working in preschools perceived that they were not fully participating in the transition process (Myers, 2008). Although occupational therapists have a promising contribution to the support of families, children, and teams during the transition process, no previous studies have examined the factors that facilitate occupational therapists’ involvement in the transition planning process.

The current study attempted to answer the following research questions: (1) What factors do occupational therapists identify as supportive to their involvement in transition planning? and (2) What factors are associated with occupational therapists’ perception of their involvement in preschool transitions?

Method

Results

The return rate was 59.6% (n = 596); however, several respondents did not work with young children and families who were transitioning into preschool programs (n = 333) and were excluded from the study. The proportion of respondents working with children transitioning into preschool programs at the time they completed the survey was 44.1% (n = 263), and 43 states were represented in the respondent pool. Demographic data for those respondents are provided in Table 2.

Identifying Factors That Facilitate Involvement

Items describing factors that facilitate involvement in transition planning were ranked according to levels of importance. A table providing the means, standard deviations, and sample sizes for all ranked items is available online at www.ajot.ajotpress.net. Four of the five highest ranked facilitators were the same for therapists from both settings:

The highest ranked item for respondents working in early intervention programs was I understand my role in transition planning (mean [M] = 4.96, standard deviation [SD] = 1.26, n = 78), whereas the highest ranked item for respondents working in preschool programs was Staff … value my participation in transition planning activities (M = 4.84, SD = 1.46, n = 248). Two of the lowest ranked items for both sets of therapists were I have training in transition planning and I am encouraged to participate in transition planning activities by the early intervention service coordinator (or preschool teachers and coordinators). The lowest ranked item for therapists working in early intervention (M = 3.71, SD = 1.52, n = 78) and therapists working in preschools (M = 3.00, SD = 1.71, n = 252) was Staff at the preschool programs [or early intervention programs] formally and consistently communicate with me regarding child and family needs for transition.

Determining Which Factors Are Associated With Involvement

To determine which factors were associated with the occupational therapists’ involvement in preschool transition planning, two sets of hierarchical regression analyses were performed after data screening (n = 246). A regression was performed to test Mahalonobis’ Distance (Mertler & Vannatta, 2005) with a p < .001 criterion, and no multivariate outliers were identified. Linearity, normality, and homoscedasticity of the independent variables were demonstrated through inspection of bivariate scatter plots, skewness, and residual plots comparing standardized residuals to the predicted values of the dependent variable. Tolerance values were >0.1, indicating that multicollinearity of the independent variables was not present (Norušis, 1998).

Independent and dependent variables were determined from the Conceptual Framework for Transition of Young Children With Disabilities, as informed by the review of literature on early childhood transitions and previous studies on therapy provider participation in transitions (Myers, 2006, 2007b, 2008). The dependent variables family support and collaboration with early intervention have been identified in the early childhood literature as essential to the transition process. The results of data screening indicating that the variables were appropriate for analysis also contributed to selection. For instance, the caseload subscale was not used as a variable in either analysis because of its poor reliability. Pearson correlations were computed for the following pairs of independent variables used in the regression analyses: early intervention relationship and external supports (r = .65, p < .01); early intervention relationship and therapist knowledge (r = .62, p < .01); early intervention relationship and years working in preschool transitions (r = .10); external supports and therapist knowledge (r = .59, p < .01); external supports and years working in preschool transitions (r = .12); and therapist knowledge and years working in preschool transitions (r = .23, p < .01). Definitions of the independent and dependent variables and descriptive statistics are included in Table 3.

In the first model, collaboration with early intervention (Involvement subscale) was used as the dependent variable, and in the second model, family support (Involvement subscale) was the dependent variable. For both models, the independent variables were the same: early intervention relationship (Facilitator subscale) on Step 1, external supports (Facilitator subscale) entered into the model on Step 2, and therapist knowledge (Facilitator subscale) entered into the model on Step 3. For the first model, years working in preschool transitions was added in Step 4 because therapists in a previous study (Myers, 2007b) identified that they received information about transitions through their previous or current employment in the schools, and it was anticipated that this might support involvement in transition planning. Years working in preschool transitions was initially considered for Step 4 of the second model; however, during data screening, this variable was not found to be significantly correlated with family support (r = .04), so it was not included.

Results of the two regression models are presented in Table 4. The results of the first regression demonstrate that the model in Step 3 explained 58.7% of the variance (p < .001). Years working in preschool transitions was added to the model in Step 4, but it did not add significantly to the model. Results of the second regression indicate that the model in Step 3 was significant, explaining 31.5% of the variance (p < .001).

Discussion

Findings suggest that relationships with early intervention program personnel, employer and preschool program supports, and therapist knowledge are associated with occupational therapists’ involvement in two areas of preschool transition planning: collaborating with early intervention professionals and supporting families. Both regression models reflect the recommended practices for early childhood transitions, which stress communication and relationships among programs. The Conceptual Framework for Transition of Young Children With Disabilities identifies specific program factors that affect transition planning (Rous, Hallam, et al., 2006, 2007), and in previous research on therapists’ participation in early childhood transitions, findings suggested that a lack of support from employers was a barrier to participation (Myers, 2007b, 2008; Myers & Effgen, 2006). The findings from the current study indicate that therapist involvement in preschool transition planning is enhanced when employers support involvement by encouraging and paying occupational therapists to attend planning meetings and encouraging collaboration with other members of the preschool program.

Therapists working in early intervention and therapists working in preschools identified similar factors as critical to involvement in transition planning. Of the utmost importance was the value that staff in their own program placed on transition planning. These findings concur with Rous, Hallam, and colleagues’ (2006, 2007) Conceptual Framework, which suggests that both provider and individual program factors influence the transition process for children and families.

An unanticipated finding was the ranking of the use of formal and consistent communication with personnel from other programs as the least important factor in facilitating involvement in transition planning by respondents in both settings. As illustrated by the Conceptual Framework, communication is a recommended practice for early childhood transitions (Bruder & Chandler, 1996), and previous research suggests that families benefit from communication between sending and receiving programs during the transition process (Hanson et al., 2000). One possibility for the discrepancy is that the wording of the item—Staff at the preschool (or early intervention) programs formally and consistently communicate with me regarding child and family needs for transition—does not account for informal or periodic communication between occupational therapists in sending and receiving programs (a definition of consistent was not provided to participants). Informal communication has been identified in previous research as a practice used by therapy providers during transition planning (Myers, 2007b). However, formal communication methods have been described in the literature as particularly supportive of the transition process for children and families (Conn-Powers, Ross-Allen, & Holburn, 1990; Fowler, Donegan, Lueke, Hadden, & Phillips, 2000), and implementation of policies and procedures that delineate formal and consistent communication between programs is considered essential to a smooth transition (Rous, Myers, & Stricklin, 2007).

Being encouraged to participate in the transition process by coordinators from the early intervention or preschool program was also a low-ranked factor. This finding is in contrast to the recommended practice of building relationships between programs to support transition planning, as described in the Conceptual Framework (Rous, Hallam, et al., 2006, 2007). Limited encouragement by coordinators may indicate weak relationships between programs or decreased understanding of occupational therapists’ role in the transition process. In previous studies, occupational therapists have reported not being invited or informed of transition-related meetings by the transition coordinator, suggesting that the occupational therapist role is not recognized by all team members (Myers, 2007b; Myers & Effgen, 2006).

Implications for Occupational Therapists

The findings present several implications for occupational therapists practicing in early intervention or preschool settings. As described by the Conceptual Framework on transitions, “a supportive interagency infrastructure… . . .  must be in place to allow for relationship building and communication between and among agencies and families” (Rous, Hallam, et al., 2006, p. 20). Established transition policies and procedures may form the core of transition planning yet may not specifically include therapist involvement or formal communication among occupational therapists and team members at different sites. By becoming familiar with policies and procedures, occupational therapists may find specific aspects of planning that fit well within their current role but have not already been identified. For instance, if transition planning includes visiting the receiving preschool program, the family and preschool providers would likely benefit from having the early intervention occupational therapist participate in the visit, because the occupational therapist knows the family and child well and could assist in communicating the child’s needs. This opportunity for formal communication between the occupational therapist and preschool providers may better prepare the family, child, and preschool team for potential challenges before the first day of school.

In addition, formalized transition plans and activities that include therapist involvement are more likely to survive staff turnover and change, because formal procedures are institutionalized and not dependent on the memory of a particular provider or coordinator (Rous & Hallam, 2006). Employers may be more willing to support and reimburse occupational therapists’ efforts to engage in formal practices if evidence demonstrated the cost-effectiveness of their involvement. Future research investigating the relationship between positive transition outcomes for children and family and occupational therapist participation in transition planning is needed.

Specialized training presents an avenue for increased occupational therapy involvement in early childhood transitions. Occupational therapists at all levels of experience should be encouraged to attend training programs and to demonstrate their competency in transition planning; however, results of the study indicate that occupational therapists from both settings ranked training in transition planning low in importance. This finding is consistent with previous research in which a minority of occupational therapists in early intervention and preschool settings have reported receiving training in transition planning (Myers, 2007b, 2008). Although transition training was ranked low, occupational therapists in this study simultaneously ranked understanding their role in transition planning among the five most important factors that facilitate involvement. This discrepancy may indicate that occupational therapists do not recognize how participation in specialized training potentially supports involvement and, hence, provides for role clarification in the transition planning process. Training that focuses on the unique role of occupational therapy in transition planning should occur as a part of the curriculum in university programs and agency- and employer-based training.

Limitations

Generalizability of the study is limited because of the sample size, which represents a small percentage of occupational therapists working in early intervention and preschool settings. Using the AOTA SSSIS as the basis for the final participant sample was another limitation, because many occupational therapists working in early intervention were members of the Developmental Disabilities SIS. Also, occupational therapists who are AOTA members may be more likely than their nonmember colleagues to participate in survey research as well as to take part in continuing education.

An additional limitation is the possibility that the wording of survey items may have been confusing or misleading (e.g., use of the term “formally and consistently” in the communication item, as described previously). This wording may have resulted in findings that are not completely accurate. Although we used well-accepted methods to establish the validity of the survey, such as review by an expert panel and piloting of the survey (Myers, 2007a), there is no assurance that respondents read the survey items in the anticipated manner (Dillman, 2007). Moreover, because of the nature of survey research, all variables of therapist involvement in transition planning could not be addressed completely by the survey questions. Although we attempted to include questions that would apply broadly to the transition experiences of occupational therapists across the country, the wide variability between the practices in early intervention and preschool programs made this challenging.

Conclusion

The current study describes the use of the OTIP to identify (1) activities and practices that occupational therapists perceived as facilitating their involvement in preschool transition planning and (2) factors associated with therapists’ involvement in preschool transition planning. Practices that enhanced communication and relationships among preschool and early intervention programs were associated with occupational therapists’ involvement in transition planning. Contrary to recommended practice for early childhood transitions, however, occupational therapists working in both early intervention and preschool programs ranked formal and consistent communication with the sending or receiving program as the lowest in importance for facilitating involvement. Areas for future research include exploring child and family outcomes associated with occupational therapists’ participation in the transition process and studying the effectiveness of training on occupational therapists’ involvement in transition planning.

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