Supporting Children with Special Educational Needs
through an Outcome-Focused, Family-Centred and
Multi-Tiered Model of Integrated Service Delivery
Dr Sidney Chu
FRCOT, PhD, MSc(Health Psychology), BDADip(Dyslexia)
Post.Dip(Biomechanics), Prof.Dip.Occupational Therapy, OTR
Fellow, Royal College of Occupational Therapists (UK)
Honorary Fellow, Brunel University London
Honorary Member, Sensory Integration Network – UK & Ireland
OMEP Lecture 19.05.2017 HK
Outline of the Lecture
A. Brief review on model of service delivery
B. Key components of a successful integrated service
C. Key concepts of family-centred care practice in service
delivery
D. Models of team approaches
E. Collaborative goal setting process and outcome measures
F. A 3-tiered model of integrated service delivery
A.
Brief Review on Model of Service Delivery
1. Traditionally, therapists provided direct hand-on treatment
- in an artificial treatment environment
- therapy strategies may / may not be integrated into the
child’s real life environment.
2. This traditional model did not deliver the best outcome for
children.
A.
Brief Review on Model of Service Delivery
3. Practice- and research-based evidence in the model of
integrated service delivery demonstrates that
- positive student performance gains have been obtained
- parents and school staff are empowered to support
children within home and school environment.
B.
Key Components of an Integrated Service
1. Family-centred care practice
2. Interagency collaboration
3. Developing service with defined outcomes
4. Team Approaches
5. Collaborative goal setting process with the use of
outcome measure
6. Service delivery through a 3-tiered model
+ the use of clinical pathways and packages of care
Components to be Covered in this Talk
1. Family-centred care practice
2. Team Approaches
3. Collaborative goal setting process and outcome measure
4. Service delivery through a 3-tiered model
C.
Family-Centred Care Practice
1. The focus of intervention is guided by the needs of the
entire family.
2. Family members are valued and considered to be equal.
3. It builds on partnerships between parents and
professionals.
Goals are family-centred.
CanChild’s Definition of Family-Centred Service
 Family-centred service is made up of a set of values, attitudes and
approaches to services for children with special needs and their
families
 Family-centred service recognizes that each family is unique; that the
family is the constant in the child’s life; and that they are the experts
on the child’s abilities and needs.
 The family works with service providers to make informed decisions
about the services and supports the child and family receive.
 In family-centred service, the strengths and needs of all family
members are considered.
Law et al (2003)
McMaster University Conceptual Framework for Family-Centred Service
(Rosenbaum et al, 1998, for revised version see Law et al, 2003)
Premises (basic assumptions)
 Parents know their children best
and want the best for their
children.
 Families are different and
unique
 Optimal child functioning
occurs within a supportive
family and community
context: the child is affected
by the stress and coping of
other family members.
Guiding Principles (“should” statements)
 Each family should have the
opportunity to decide the level of
involvement they wish in
decision-making for their child.
 Parents should have ultimate
responsibility for the care of their
children.
 Each family and family
member should be treated
with respect (as
individuals).
 The needs of all family
members should be
considered.
 The involvement of all family
members should be
supported and encouraged.
Elements (key service provider behaviours)
 To encourage parent decisionmaking
 To assist in identifying strengths
 To provide information
 To assist in identifying needs
 To collaborate with parents
 To provide accessible services
 To share information about the
child
To respect families
To support families
To listen
To provide individualised
service
 To accept diversity
 To believe and trust
parents
 To communicate clearly




 To consider psychosocial
needs of members
 To encourage participation
of all members
 To respect coping styles
 To encourage use of
community supports
 To build on strengths.
Standardised Tools for Measuring
Outcomes of Family-Centred Care Practice
1. The Measure of Processes of Care – 56 (MPOC-56)
(King, Rosenbaum and King, 1995).
2. The Measure of Processes of Care – 20 (MPOC-20)
(King, King and Rosenbaum, 2004).
3. The Measure of Processes of Care for Service Providers
(MPOC-SP) (Woodside, Rosenbaum, King & King, 2001).
Available from the website of the CanChild Centre
for Childhood Disability Research. http://www.canchild.ca/en/
D.
Models of Team Approaches
1. Teamwork is critical for effective service delivery.
2. The emphasis is on collaborative working between
different team members in order to support the child within
the family unit.
The Three Models of Team Approaches
1. Multi-Disciplinary Team Model
2. Inter-Disciplinary Team Model
3. Trans-Disciplinary Team Model
1. Multi-Disciplinary Team Model
Assessment
OT
SLT
T
PT
SW
Treatment
Planning
SLT
PSY
OT
T
PT
PSY
SW
Service
Delivery
PSY
SLT
PARENTS
PT
OT
SW
CHILD
T
Multi-Disciplinary Team Model
1. Each team member functions almost independently, both
in terms of interactions with the child, parents and other
members of the team.
2. Team members are responsible for implementing their
section of the plan.
3. The lines of communication between team members are
very informal.
2. Inter-Disciplinary Team Model
Coordinated
Assessment
SLT
PT
OT
SW
PSY
T
PSY
T
PSY
T
PARENTS
Integrated
Treatment
Planning
SLT
PT
OT
SW
PARENTS
Coordinated
Service
Delivery
SLT
PT
OT
SW
PARENTS + CHILD
Inter-Disciplinary Team Model
1. Team members share their findings, opinions, and
treatment plans with one another in an organised way.
2. The child & parents can receive coordinated services and
are able to benefit from the expertise of professionals
from several disciplines.
3. To ensure the success of this approach, the team
members must respect one another’s roles, develop
effective formal and informal communication patterns.
3. Trans-Disciplinary Team Model
Coordinated
Assessment
SLT
PT
OT
SW
PSY
T
PSY
T
PARENTS
Integrated
Treatment
Planning
Integrated
Service
Delivery
SLT
PT
OT
SW
PARENTS
One of the team members appointed
as the PRIMARY PROVIDER
PARENTS + CHILD
Trans-Disciplinary Team Model
1. All team members participate together in assessment and
intervention planning.
2. A designated team member (primary provider) carries out
the actual intervention activities, with support provided by
other team members.
3. Implementation of this model requires role release, or the
relinquishing of some or all of one professional’s
functions to another professional.
The Application of Team Models in Service Delivery
1. All three team models have pros and cons.
2. Need to consider the needs of children and also resources
available.
3. Parents prefer the model of interdisciplinary team as
- there are coordination of goal setting and
integration of treatment plan, and
- their children are still being seen
by the actual “expert”.
E.
Collaborative Goal Setting Processes
and Outcome Measures
1. Goals should be established in conjunction with the
parents and professionals, and possibly the child.
 collaborative goal setting process
E.
Collaborative Goal Setting Processes
and Outcome Measures
2. Setting specific goals of treatment is the cornerstone in an
effective process of service delivery.
3. It is important to identify a mechanism to measure the
achievement of the treatment goals i.e. use of outcome
measures.
Hierarchy of Outcome Measures / Methods
1. There is a wide range of outcome measures used by
different disciplines:- ‘Hard’ outcome measures are mostly quantitative,
standardised child-centred or family-centred tools.
- ‘Soft’ outcome measures are mostly qualitative, nonstandardised and home-made outcome measures.
Hierarchy of Outcome Measures / Methods
HARD
Measures / Methods
QUANTITATIVE
Child-Centred Outcome Measures
Family-Centred Care Outcome Measures
Functional / Developmental Skills Outcome
Measures
Structured Outcome Measures / Methods
e.g. Goal Attainment Scaling (GAS)
Self-Rating Analogue Scale
SOFT
Outcome Survey of
Children, Parents and Other Stakeholders
QUALITATIVE
Chu (2017)
Hierarchy of Outcome Measures / Methods
2. It is common to use a combination of hard and soft
outcome measures.
3. It is important to set SMART Goals for functional
outcomes.
What is SMART Goal?
SMART stands for
Specific
Measurable
Attainable
Relevant
Time-bound
F.
3-Tiered Model of Integrated Service Delivery
1. Based on the Public Health Model in the UK and the
Response to Intervention (RtI) Model in the USA.
2. It has been adapted for delivering therapy services.
Chu (2014b)
Structure of the 3-Tiered Model
1. Tier 1: Universal Interventions (Whole School) e.g.
- training for whole school / nursery staff and parents
- information and resources
- universal screening
- curriculum development, etc.
Structure of the 3-Tiered Model
2. Tier 2: Targeted Interventions (Classroom-based) e.g.
- classroom-based assessment and treatment
- targeted training for classroom staff and parents
- modification of the physical and sensory components
of the classroom environment
- group programme, etc.
+ Tier 1 interventions
Structure of the 3-Tiered Model
3. Tier 3: Intensive Interventions (Individual) e.g.
- specialist individual assessment  SMART goals
- integrate treatment activities into home and classroom
environments
- individual hand-on interventions
- adaptation of the curriculum, etc.
+ Tiers 1 & 2 interventions
The Application of the 3-Tiered Model In Practice
1. Therapists work as a collaborative member of the team.
2. Change from the traditional, individually focused deficitdriven model of intervention to a whole-school / nursery
strength-based approach. (Ivey et al, 2012)
Summary
Key Components of a Successful Integrated Service
1. Family-centred care practice
2. Interagency collaboration
3. Developing service with defined outcomes
4. Interdisciplinary Team Approach
5. Collaborative goal setting process with the use of
outcome measure
6. Service delivery through a 3-tiered model
+ the use of clinical pathways and packages of care
References and Further Readings

Allard, A., Fellowes, A., Shilling, V., Janssens, A., Beresford, B. and Morris, C. (2014).
Key health outcomes for children and young people with neurodisability: qualitative
research with young people and parents. BMJ Open 2014;e004611.

Bonnard, M. and Anaby, D. (2016). Enabling participation of students through schoolbased occupational therapy services: towards a broader scope of practice. British
Journal of Occupational Therapy, 79(3), 188-192.

Cahill, S. M., Egan, B. E., Wallingford, M., Huber-lee, C., & Dess-Mcguire, M. (2015).
Results of a school-based evidence-based practice initiative. American Journal of
Occupational Therapy, 69, 6902220010. Http://dx.Doi.Org/10.5014/ ajot.2015.014597

Chu, S. (2009). The contributions of paediatric occupational therapists to the education
of children with SEN. Education Public Law and the Individual, volume 13, issue 2, pp 4
– 10.

Chu, S. (2013). A model for commissioning school-based occupational therapy.
Occupational Therapy News (monthly publication of the British Association of
Occupational Therapy), 21(2): 38-39.

Chu, S. (2014a). Reform of the Special Education Needs System. Occupational Therapy
News (monthly publication of the British Association of Occupational Therapy), 22(6):
26-27.
References and Further Readings

Chu, S. (2014b). Best practice in delivering school-based occupational therapy service
to children with special educational needs and disability. Education Public Law and the
Individual, volume 17, issue 1, pp 34 – 49.

Chu, S. (2015). Developing, Costing and Marketing School-based Occupational Therapy
Service to Health and Education Commissioners – Course Manual (2nd Edition). Derby,
England: Kid Power Therapy and Training Co. Ltd.

Chu, S. (2017). Outcome Framework and Goal Attainment Scaling (GAS) – Course
Manual (8th Edition). Kildare, Ireland: Kid Power Therapy and Training Co. Ltd.

Chu, S. and Reynolds, F. (2007) Occupational therapy for children with attention deficit
hyperactivity disorder (ADHD), part 2: a multicentre evaluation of an assessment and
treatment package. British Journal of Occupational Therapy, 70(10), 439-448.

Clark, G.F. & Polichino, J. (2013). Chapter 17: Best Practices In Early Intervening
Services and Response to Intervention. In: Clark, G.F. and Chandler, B.E. (Eds). Best
Practice for Occupational Therapy in Schools.
American Occupational Therapy
Association: Bethesda, MD.

Department of Health (2000). Framework for the Assessment of Children in Need and
Their Families. London: The Stationary Office.
References and Further Readings

Dupaul, G.J., Power, T.J., Anastopoulos, A.D. and Reid, R. (2016). ADHD Rating Scale – 5
for Children and Adolescent. New York: Guilford Press.

Fingerhut, P. E., Piro, J., Sutton, A., Campbell, R., Lewis, C., Lawji, D., & Martinez, N.
(2013). Family-centered principles implemented in home-based, clinic-based, and
school-based pediatric settings. American Journal of Occupational Therapy, 67, 228–
235. HTTP://DX.DOI.ORG/10.5014/AJOT.2013.006957

Graham, F., Rodger, S. & Ziviani, J. (2009). Coaching parents to enable children’s
participation: an approach to working with parents and their children. Australian
Occupational Therapy Journal, 56(1), 16-23.

Graham, F. and Rodger, S. (2010). Chapter 10: Occupational Performance Coaching:
Enabling Parents’ and Children’s Occupational Performance. In: Rodger, S. (Eds).
Occupation-Centred Practice with Children – A Practical Guide for Occupational
Therapists. Chichester, West Sussex: Wiley-Blackwell.

Graham, F., Rodger, S. & Ziviani, J. (2010). Enabling occupational performance of
children through coaching parents: three case reports. Physical and Occupational
Therapy in Pediatrics, 30(1), 4-15.
References and Further Readings

Graham, F., Rodger, S., & Ziviani, J. (2013). Effectiveness of occupational performance
coaching in improving children’s and mothers’ performance and mothers’ selfcompetence.
American
Journal
of
Occupational
Therapy,
67,
10–18.
http://dx.doi.org/10.5014/ajot.2013.004648

Hoggarth, L. and Comfort, H. (2010). A Practical Guide to Outcome Evaluation. London:
Jessica Kingsley Publishers.

Holloway, E. and Chandler, B.E. (2010). Chapter 3 - Family-centered practice: it’s all
about relationships. In: B.E., Chandler (eds.). Early childhood occupational therapy
services for children birth to five. Bethesda, MD: the American Occupational Therapy
Association, Inc.

Ivey, C., Clark, G.F., Cahill, S., Mcguire, B., Mcclosky, S., Jackson, L. and Polichino, J.
(2012). Response to intervention in the classroom – your questions answered. OT
Practice, February 20, 2012, pages 18 – 20.

King, S., King, G., and Rosenbaum, P. (2004). Evaluating health service delivery to
chiildren with chronic conditions and their families: development of a refined Measure of
Processes of Care (MPOC-20). Children’s Health Care, 33(1), 35-57.

King, S., Rosenbaum, P. and King, G. (1995). The Measure of Processes of Care (MPOC)
– A means to assess family-centred behaviours of health care providers. Hamilton,
Ontario: McMaster University.
References and Further Readings

Kiresuk, T.J., Smith, A. & Cardillo, J.E. (1994). Goal Attainment Scaling: Application,
Theory and Measurement. Hillsdale, NJ: Erlbaum.

Law, M., Rosenbaum, P., King, G., King, S., Burke-Gaffney, J., Moning-Szkut, T., Kertoy,
M., Pollock, N., Viscardis, L., & Teplicky, R. (2003) What is Family-Centred Service?
CanChild Centre for Childhood Disability Research, McMaster University.

McDougall, J. and King, G. (2007). Goal attainment scaling: description, utility and
applications in pediatric therapy services (2nd Edition). Thames Valley Children’s Centre,
London, Ontario.

National Association of State Directors of Special Education, Inc. (2005). Response to
Intervention: Policy Considerations and Implementation. Alexandria, VA: Author.

National Association of State Directors of Special Education, Inc. (2006).
Partnerships Project. Alexandria, VA: Author.

Popp, T.K. and You, H-K. (2016). Family involvement in early intervention service
planning: links to parental satisfaction and self-efficacy. Journal of Early Childhood
Research, vol.14, no.3, 333-346.
IDEA
References and Further Readings

Rosenbaum, P., King, S., Law, M., King, G., & Evans, J. (1998). Family-centered service:
a conceptual framework and research review. Physical and Occupational Therapy in
Pediatrics, 18(1), 1-20.

Simeonsson, R.J. and Bailey, D.B. (1990). Family dimensions in early intervention. In:
S.J. Meisels & J.P. Shonkoff (Eds.). Handbook of early childhood intervention.
Cambridge University Press.

Steenbeek, D. (2010). Goal Attainment Scaling in Paediatric Rehabilitation Practice – a
useful outcome measure. The Rehabilitation Centre Breda, the Netherlands.

Taylor, P., Peckham, S. and Turton, P. (1998). A public health model of primary care –
from concept to reality. Public Health Alliance. ISBN 188-331419-0

Turner-Stokes, L. (2009). Goal Attainment Scaling (GAS) In Rehabilitation – A Practical
Guide. The North West London Hospitals NHS Trust.

Woodside, J.M., Rosenbaum, P.L., King, S., & King, G. (2001). Family-centred service:
developing and validating a self-assessment tool for paediatric service providers.
Children’s Health Care, 30, 237-252.