Pakistani Occupational Therapists
and Teachers Collaborate
to develop Inclusive Education
through Action Research
Debbie Kramer-Roy (Brunel
University London)
Bushra Umair (AMI)
Samreen Jawaid (AMI)
Areeba Khan (OT-DUHS)
Farzana Ashfaq (OT-DUHS)
COT Conference
BIRMIGHAM– 18 June 2017
Developing the role of Occupational Therapy in
Inclusive Education in Pakistan
A collaborative Action Research Project between Brunel University
London, Dow University of Health Science, and The AMI School
Funded by the British Council and the Higher Education Commission
Pakistan.
The partners
• The British Council’s Knowledge Exchange
Partnerships required three partners:
• One UK University: Brunel University London
• Debbie has rich experience of working in Pakistan (OT,
CBR and IE)
• One Pakistan University: Dow University of Health
Sciences
• Offers a 4-year BSc in OT (one of only two OT schools in
the country)
• One non-university partner: The AMI School
• One of a handful of schools in Karachi that has chosen to
be Inclusive and understands and implements the
principles well.
The Purpose of the Project
• To use Action Research (AR) to develop a clear
Occupational Therapy (OT) role in supporting Inclusive
Education (IE) in Pakistani schools.
• The purpose of this is
• to contribute to the development of IE in Pakistan
• so that MORE children with special needs will be able to gain ACCESS
to education
• and that ALL children will receive a BETTER quality education as they
study and play together
Subsidiary Objectives:
• For OTs to develop OT concepts for supporting IE at
multiple levels: individual child, classroom, school,
community and public policy.
• To build Pakistani OTs’ research capacity through gaining
knowledge and skills for qualitative research, and in
particular Action Research.
• For OTs and teachers to gain Action Research skills.
• For OTs and school teachers to work together to develop a
collaborative approach to maximise inclusion in the school,
involving children and parents actively in the process.
• To develop resource guides for other schools, teachers and
OTs to use.
• To use the resource guides as the basis for workshops /
seminars in both Pakistan and the UK.
Why Inclusive Education?
• It is now a globally accepted human right for children with
special needs / disabilities to be educated with their peers.
• It helps schools to improve their teaching approaches and
practices and increases the quality of education for ALL
children in the school.
• It is the most efficient way to work towards high quality
“Education for All”.
The Salamanca Statement - 1994
• every child has a fundamental right to education, and
must be given the opportunity to achieve and maintain
an acceptable level of learning
• every child has unique characteristics, interests, abilities
and learning needs
• education systems should be designed and educational
programmes implemented to take into account the wide
diversity of these characteristics and needs
• those with special educational needs must have access to
regular schools which should accommodate them within
a child-centred pedagogy capable of meeting these
needs
The Salamanca Statement – 1994
(cont’d)
• regular schools with this inclusive orientation are
the most effective means of
• combating discriminatory attitudes,
• creating welcoming communities,
• building an inclusive society and achieving education
for all;
moreover, they
• provide an effective education to the majority of
children
• and improve the efficiency and ultimately the costeffectiveness of the entire education system.
Inclusion
versus Integration
versus Exclusion
• The term inclusion is often used wrongly
• In many situations children are “integrated” into a
mainstream school system that remains unchanged. The
child will be welcomed only if they can adjust to the
system; i.e. it is conditional.
• Often children will be physically ‘included’ (present), but
educationally excluded. E.g. they are given completely
different tasks to do with or without help of a classroom
assistant. They are not part of the class learning process
and not working with their peers.
In summary, Inclusive Education is:
• Valuing all students and staff equally
• Increasing the participation of student in, and reducing
their exclusion from, the cultures, curricula and
communities of local schools
• Restructuring the cultures, policies and practices in
schools so that they respond to the diversity of students
in the locality.
• Learning from attempts to overcome barriers to the
access and participation of particular students to make
changes for the benefit of students more widely.
• Recognising that inclusion in education is one aspect of
inclusion in society.
Source: CSIE (current website)
WFOT Position Statement on OT services in
school-based practice (2016)
• Supports the international policies on Inclusive
Education
• Emphasises the responsibility and skills of OTs
to support it
• OTs need to “provide collaborative support to
enable occupation and to remove or reduce
barriers to participation of all students,
particularly those with special educational
needs”
• Cont’d
School-based OT in the UK
• OTs need to work on three levels of intervention:
• Primary level: Universal Design for Learning
• Secondary level: Focus on Differentiation
• Tertiary level: Focus on accommodation / individual
intervention
(Arbesman, 2013; COT, 2015; WFOT, 2016)
• Hutton et al (2016) make a convincing argument for this
approach to be taken in the UK as well, in order to:
• Ensure the maximum number of children receive OT input
• Help build capacity of teachers to identify and support
children with SEND
• Use available funding and resources as efficiently as possible
Activity #1
• Play with the material given to you
and list which school-related skills and
concepts you could help a child
develop with it.
Action Research
• Integrates theory and action in order to address
important organisational, community and social
issues together with those who experience them.
• It is a method of doing research that does not just
collect information, but seeks to support the
participants to bring about a positive change in their
situation.
Action Research (2)
• There are many types of Action Research, but
a key feature is that those affected by
planned changes have the primary
responsibility for deciding on courses of
action which may lead to positive change,
and in evaluating the results of these actions.
The process of Action Research
Exploratory phase to identify issues first
Then a spiral of cycles
>planning
>action
>observation of the impact of the action
>Reflection on that action and its impact.
A dynamic process Reference: Kemmis et al (2004)
Congruence of PAR and OT (1)
• PAR is “consistent with the values of occupational therapy
and occupational justice” and a particularly suitable choice
of research approach.
• PAR is an occupational form that gives the participants an
opportunity “to develop the skills and knowledge necessary
to take greater control over their own lives; in so doing, they
promote their own health as well as the health of other
community members”
• Participants develop valuable life-skills, such as becoming
more aware of their own behaviour, expressing views and
opinions, working as a team, planning and decision-making.
Reference: Trentham and Cockburn (2005)
Congruence of PAR and OT (2)
• Working as a team of co-researchers is very
congruent with the principles of client-centred
practice:
•
•
•
•
•
respect for the person’s skills and insights
taking responsibility for one’s own choices
enabling participation
flexibility and
keeping in view the links between person,
environment and occupation
• Reference: Letts (2003)
Why Action Research for this project?
• It is a flexible and emergent / developmental approach
• It allows professionals to work together to explore the
possibilities and barriers together
• The approach and resource guide that will be developed
will be based on experiences from the Pakistani context:
more suitable and more likely others will be encouraged to
implement it
• The AR approach has similarities with Reflective Practice,
which fosters professional development.
Our Course of Action
Phase 1: Working At AMI School
•OTs worked with Teachers at The AMI School in their classrooms.
•Team members attended conferences and presented work at
international platform (COT –UK’ 15) to spread the word and to
get exposure to the team members about the on- going inclusive
practices in developed countries.
Our Course of Action
Phase 2:Working At Other Schools
•Teams of OTs and Teachers from AMI have been working
with schools of different middle and lower socioeconomic background.
•The teachers team at The AMI School has started a
School Improvement Programme, training and providing
guidance and support to other staff members who are
not directly a part of the research to build inclusive
school environment , through provision of relevant books
and material etc
• The teams have been organizing workshops for parents
and teachers at AMI /other participatory schools and
presenting at conferences nationally /internationally.
Our Course of Action - Phase 3:
Developing Resource Guide and Dissemination
•OTs and Teachers from AMI are still working with schools of middle and
lower socio economic background
• The team has been spreading word-disseminating knowledge
•Visiting government and other institutes for special needs
•Presenting work and sharing information through - workshops ,
sessions , exhibitions and seminars for teachers, parents , local and
international community .
•
Developing a resource guide based on the research work and
disseminating it through out the schools here in Pakistan.
How we work
• Situational Analysis of school as a whole
• What factors facilitate inclusion?
• What barriers might there be?
• Looking at physical and social environment in the classroom, school,
playground
• Classroom Observation
• May or may not focus on an individual child with special needs.
• Using Person, Environment and Occupation to reflect on what helps
or hinders the child to participate in class.
• Resource log
OTs and teachers working together to fill in a resource log with
strategies /activities / lesson plans , developing it, following the
action research cycle.
• Reflective logs
Teachers/ Ots to fill in their reflections throughout the process to
critically analyze and re plan accordingly
Classroom Observation Log
Date:
Class:
Name of observer:
Describe the physical environment, e.g. set up, lighting, wall displays.
Describe the activity / activities taking place, e.g. materials used, explanation or
instructions given, children work or play alone / in pairs / in groups?
Whole-class Participation:
To what extent are the children participating?
- Fully participating?
- Fully participating with help from an adult and/or adaptation of the task?
- On-looking –involved as an active observer?.
- Not participating at all?
How do you know? Describe what you observe children doing!
What facilitates the participation of children, e.g. physical environment,
materials, instruction, classmates, adults?
Classroom Observation Log
What barriers are there to the participation of children, e.g. physical
environment, materials, instruction, classmates, adults?
Individual child participation:
Choose one child who is not participating fully and consider possible reasons
for this.
Describe the child:
Person (child):
Environment:
Occupation/task:
Reflect:
What can you conclude from the above about what facilitates or hinders the
child’s participation?
Plan:
LOG SHEET for RESOURCE DEVELOPMENT
(teaching materials, educational games, lesson plans, classroom strategies, etc)
Date
Stage of cycle
Observe:
What is the issue or challenge to be addressed?
Explore:
Gain more info (e.g. from records / teachers / parents/ OT
assessment)
Reflect:
What is the reason for the problem (use PEO)
Plan:
Discuss options, list them and choose one
Plan:
Think / read / explore www / use experience to design
Reflect:
Does it look like it will work? Any doubt?
Act:
Make final adjustments
Observe:
Describe what you see when it is used
Reflect:
Does it look like it will work? Any doubt?
Plan:
Think / read / explore www / use experience to design
Act:
Make adjustments OR
Continue using it
What did I/we do?
Examples of Inclusion in
Classrooms from our
Research
Example of Inclusion – Nursery (AMI)
Special Education Need: A 3.6 year old boy, studying in
Nursery who had been showing inappropriate
beahviour, short attention span and was stubborn.
•Stubborn Behaviour and Restlessness
To improve his behaviour with his peers and sharing skills, he
was made to sit with other children and share his favourite toy
such as blocks/car (which he used to bring from home) with
them.
•Visual cues for “good” and “not good” behaviour
Thumbs up and thumbs down illustration were introduced
to depict good and not good/unacceptable behaviour.
•Increasing Concentration Span
Microphone activity was planned, (microphone was made by the
teacher using kitchen roll) children had to take turns during
discussion to learn that the other children have to remain quiet
when listening to the speaker. The same child had to decide who
will speak next and pass the microphone to the next child. It was
effective as his concentration span increased and he waited for his
turn. His participation also improved as he showed interest in what
others were doing i.e. when the other children were singing on the
microphone he enjoyed it a lot.
Examples of Inclusion – Grade 6 -Meezan School
Problem /Issue / Challenge to be addressed :
• The children didn’t follow class rules
• Got up from their places without teacher’s permission,
talked, laughed, complained about each other during
the lessons
• Most of the children were unable to pronounce and
understand the text in the text books
• They made fun of other children by laughing at them and
donot support the children with any learning difficulty
Reflection
After reflection we realized that children required
• Challenging activities to keep them involved
• Movement breaks to maintain concentration , daily time for
physical activities
• For better understanding of difficult vocabulary, sessions
where the children involve in hands on activities to
understand the meaning of the difficult vocabulary.
• A combination of active and passive activities to calm them
down as well as satisfy there urge to get actively involved
• Group seating arrangement to facilitate group work
Strategies
• Each period of teaching/ lesson was divided into these
sessions
• 5 minutes -Recap time - Active time
• 5 minutes – Brainstorming –Active time
• 10 minutes – Introduction – Passive
• 10 minutes – Hands on- Active
• 10minutes-Recording after the lesson has finished -Passive
• 5 minutes- Conclusion - Active
Recap
• A quick activity to review what has been done earlier
• Activity:
• A ball was brought. Students were asked to say a fact or
anything learnt from the previous lesson and then throw the
ball to another child to continue.
Brainstorming
• Teacher showed a picture about the related topic or any other
interesting thing like share an interesting fact about the topic
to be introduced .
Introduction
• The topic / concept was introduced using concrete material
pictures , diagrams , models , videos, books etc.
• The information that has to be read later in the text was
shared during this time using easy vocabulary or with pictures.
Group work
• Mix ability students were included in groups.
• They read information from the text book / informative
books. They discussed and wrote important points about the
given topic and drew illustrations.
• They presented the work.
• The group was given marks regarding thier behaviour and
effort . Each day the groups performing best were given
incentives such as extra play time or computer time .
The seating
arrangement to group
setting, with assigning
group leaders to
remind children to
follow class rules and
for ease in group work
Activity 2
Use the action research cycle to plan inclusive strategies
/ lessons according to given scenarios.
-Identifying problem
-Devising a plan
-Analyze data
-Form and share
conclusions
Plan
Act
Reflect
Action
Research
Cycle
Observe
-Collect data through
observation
Acting on the plan
Scenarios
• Scenario no 1 # Short concentration Span
Abdullah, aged 5 cannot sit in his place for more than 5 minutes.
He cannot concentrate and work on the given task for more
than 5 minutes.
Plan a story telling session for Abdullah’s class
• Scenario no 2 # Takes Time in Understanding and Retaining
Beena, aged 4.5 takes time to recognize letters and numbers . She is
unable to recognize and seems to have forgotten the letters and
numbers even after two days.
Make a lesson plan for the introduction of a letter or number
• Scenario no 3 # Takes Time to Comprehend
Christina, aged 7 cannot understand and follow multiple and detailed
instructions and remains on the first one while the whole class reaches to
the third one. Needs material to understand concepts while the other
children now mostly do not need concrete material to understand abstract
concepts .
Make an Inclusive Lesson Plan for the introduction of
prepositions
• Scenario no 4 # Weak Fine Motor Skills
Douah, aged 4 doesn’t have the normal height and weight of
her age. Her grasp over objects / pencil is too loose. She
complains of pain in her fingers while tracing / colouring.
Make a lesson plan for introduction of the formation of letter
Feedback
• Present your ideas to the rest of the group.
Thank you for listening and
thinking with us!
• Contact:
• Debbie Kramer-Roy
• Email: [email protected]
Information Sources Online
• Centre for Studies in Inclusive Education (SCIE)
• UK based, but have both national and international focus –
good source of information and resources.
• EENET
• Enabling Education Network.
• International network of people working towards inclusion.
Links to lots of resources.
• UNESCO Inclusive Education.
• A web page with many useful, freely downloadable
resources, including practical teacher guides
References and Resources IE (1)
• Canadian Association of Occupational Therapists (2009). CAOT Position Statement: Healthy
Occupations for Children and Youth. Ottawa: CAOT. Available at:
http://www.caot.ca/default.asp?pageid=1138
• CanChild Centre for Childhood Disability Research (current). Partnering for Change (OTs working
alongside teachers to work at school and child level). Available:
http://www.canchild.ca/en/ourresearch/partneringforchange.asp
• Centre for Studies in Inclusive Education. Available: http://www.csie.org.uk/
• College of Occupational Therapists (2015). Occupational Therapy Evidence Fact Sheet:
Occupational Therapy with Children and Young People. COT. Available:
https://www.rcot.co.uk/about-occupational-therapy/ot-evidence-factsheets
• Education.gov.uk (online). https://www.gov.uk/government/publications/special-educationalneeds-sen-a-guide-for-parents-and-carers-revised-2009
• Enabling Education Network. Available http://www.eenet.org.uk/index.php
gov.uk (online) https://www.gov.uk/children-with-special-educational-needs/overview
• Handicap International (2011). Six Questions about Inclusion. Available: http://www.handicapinternational.org.uk/what_we_do/inclusion/inclusive_education/six_questions/
• Hutton, E, Tuppeny, S and Hasselbusch, A (2016). Making a case for universal and targeted
children’s occupational therapy in the United Kingdom. BJOT 79(7), pp450-453.
• Kemmis, S., McTaggart, R. and Retallick, J., 2004. The Action Research Planner. Karachi, Pakistan:
Aga Khan University Institute for Educational Development.

References and Resources (2)
• Make Development Inclusive (current). Policy Papers on Disability and Development.
Available: http://www.inclusive-development.org/countrypolicy.php?spk=en (see UK
and EU policies).
• UNESCO (online) Inclusive Education. A web page with many useful, freely downloadable
resources, including practical teacher guides. Available:
http://www.unesco.org/new/en/education/themes/strengthening-educationsystems/inclusive-education/children-with-disabilities/
• UNESCO (2005). Guidelines for Inclusion: Ensuring Access to Education for All. Available:
http://unesdoc.unesco.org/images/0014/001402/140224e.pdf
• UNESCO (1994). The Salamanca Statement and Framework for Action on Special Needs
Education. Available: www.unesco.org/education/pdf/SALAMA_E.PDF
• UNICEF Child Info website. Links to documents about the protection of disabled children in
developing countries. Available: http://www.childinfo.org/disability_resources.html
• United Nations, 2008. The Convention on the Rights of Disabled Persons. Available:
http://www.un.org/disabilities/default.asp?navid=14&pid=150
• United Nations, 1989. The Convention on the Right of the Child. Available:
http://www2.ohchr.org/english/law/crc.htm
• World Federation of Occupational Therapists (2016). Position Statement on Occupational Thearpy
Services in School-Based Practice for Children and Youth. Available:
http://www.wfot.org/ResourceCentre.aspx (filter for Position Statements)
• World Federation of Occupational Therapists (2006). Position Statement on Human Rights.
Available: http://www.wfot.org/ResourceCentre.aspx (filter for Position Statements)