Occupational Therapy for All: Merging Head Start and Early Intervention
Photo: The preschool program depends heavily on university students who generate and help to implement ideas and gain real-world experience in the process.
By Ashley Opp
How do occupational therapy services adapt when an early intervention facility serving only children with special needs becomes an integrated early learning preschool—with almost three times as many students?
Seven years ago, Philadelphia’s Kensington Center, now one of nine preschool sites operated by KenCrest Children and Family Services, shifted from an early intervention center exclusively for children with special needs between 3 and 5 years of age to an integrated program funded by federal and state Head Start and early intervention dollars. The partnership was intended to expand the range of services for children, engender parent involvement, and provide children with a rich early learning environment. With this promising new structure in place, occupational therapy practitioners had to develop practices within early childhood programming that would benefit all children—not just those with special needs.
“Given there was federal and state posturing for inclusion, KenCrest saw an opportunity for children with disabilities by expanding the enrollment with Head Start children who may or may not have learning needs,” says Barbara Macks, MS, OT, KenCrest’s director of clinical services. With the enrollment of the new children, the preschool grew from three to eight classes with about 16 students in each. “When the typically developing children came in, the walls literally erupted with more activity and playfulness. The language just exploded.” The children receiving early intervention services at Kensington typically have language delays; exposure to the children in Head Start significantly elicited the use of language to start relationships and make friends.
With the preschool’s new vibrancy came practical challenges, such as how to provide occupational therapy for the children with special needs without disrupting other activities. Siobhan Ideishi, OT/L, Kensington’s occupational therapist, knew she would have to rethink her approach. “I needed to reflect on how I could make my practice more effective,” she says. “I couldn’t strictly go in and do one-on-one with special needs students.” Siobhan began to think about how all of the children could participate in occupational therapy as peers, rather than just serving those with special needs. She developed programming for the entire group; everyone benefited from occupational therapy, and it was more efficient.
Fortunately, when it came to implementing new programming for Kensington, she had a valuable ally in her husband, Roger Ideishi, JD, OT/L, assistant professor of occupational therapy at the University of the Sciences in Philadelphia. “Over the dinner table we were having conversations, trying to figure it out,” says Roger. “I told her, ‘This would be a great place for my students to learn about development and help you with the resources you need to make some of the changes you’re thinking about.’”
The Ideishis approached KenCrest about forming a partnership between the preschool and the university, and the idea was enthusiastically embraced. Roger began teaching his labs at the preschool, and occupational therapy students supported Kensington’s programming. In doing so, they had the opportunity to fully understand early childhood development and they gained practical, real world experience.
This approach to programming for the whole group depended heavily on the university students who generated and helped to implement ideas. Although occupational therapy practitioners worked with staff to create programs directed toward those with special needs, having all students participate quickly proved beneficial. “Head Start children really are at risk because of their economic status,” Roger says.
Siobhan agrees. “All the children have needs. Some of the Head Start children have developmental delays, but [these delays] are not severe enough to qualify for early intervention. As the Head Start children participate in the class programming, we can really see what those delays are and create opportunities for learning.”
As the class programming evolved it increasingly lent itself to activities and routines reflective of typical early childhood environments. Siobhan created a cultural arts program that focused on painting, dancing, music, museums, and concerts to introduce the children to new experiences. The program has been immensely successful. “Because children learn in a variety of ways, it gives them a new way to experience learning,” she says.
This approach to occupational therapy is not in one classroom with one child, Macks points out. “It’s in the Kensington Center. It’s outdoors, indoors, in the garden, in the classroom—they are all learning places.”
Shifting to an integrated early learning preschool also created the need to address the curriculum structure. The High/Scope® Preschool Curriculum supplied a foundation where child-led, active learning set the stage for educational and therapy staff to enable each child to fully participate throughout the program day. One aspect of High/Scope identifies and reinforces routines. “It makes the children feel familiar and comfortable in the environment so that new learning can occur,” Roger says.
Class programming for occupational therapy fits in well to this curriculum. For example, in the dance program, the children have a reliable routine where they learn and do the same movements, stretches, and jumps. Staff noticed that children with poor attention spans and self-control improved their behavior. “They understood what was going to happen. They were able to predict it and follow along; they had more self-control,” says Roger.
As the occupational therapy programming developed, efforts among the Ideishis, the program coordinator, teachers, occupational therapy students, and other staff became collaborative. “It’s a wonderfully powerful way to work as a clinician,” says Macks. The Kensington center reflects “a wonderful mix of minds—from the students at the university to the staff on site.” Occupational therapy practitioners recommend and support activities that have meaning for the child, that touch parents, and that extend into home life.
In this collaborative environment, evidence- and theory-based occupational therapy informs, shapes, and drives what the practitioners recommend and implement. The work and learning that take place at Kensington bridge academia and occupational therapy practice, putting research and theory into practice. And staff have seen powerfully positive results.
“The movement program really tapped into a lot of the children’s needs,” Siobhan says. Staff noticed that the children—typically developing and with special needs—have improved focus and can better regulate themselves. For example, the dance program resonated with a boy with autism who would not participate in any class activity without adult assistance. When a professional ballerina conducted a dance program with the children, within 3 weeks the boy progressed from staying on the sidelines to fully participating with the other children, without adult assistance. “To see how positively the children respond and to be able to see change is really quite exciting,” Siobhan says.
Roger recalls a girl who became so enthralled with the ballet activities that she did the movements at home. Her mother noticed her interest, bought her a tutu, and is, Roger says, “really supporting her child in this new experience.”
Kensington’s greatest feature, though, is that it reflects the Philadelphia community. Everything the preschool does is infused by the community’s culture. “No matter what setting we’re in, we can utilize community resources to help expand our practice and learn what possibilities are available to us and to our clients,” Siobhan says. “It is really stimulating and exciting for me. It has changed the way I think about my practice in this setting. It is authentic occupational therapy.”
Ashley Opp is AOTA’s production editor.