Evidence-Based PracticeBeth Perra, Michelle Mercado,

Stephanie DeSamLazaro and Michelle Barton

Assistive Technology Evaluations in the School System

Beth Perra, MA, OTR/LMoundsview School System

EBP PROCESS

• Developing an EBP question:– Practice Dilemna:• IDEA 2004 mandates all students on IEPs be considered

for assistive technology (AT).

• School district wireless 2011-12

• OT leads AT team

• SETT framework used as guideline for AT assessment (Zabala, 1995, 2005)

EBP Question- Take 1

• Can an AT evaluation tool be modified for school systems?

• Can the SETT framework (Zabala, 1998, 2005) be used to establish AT need & be ‘user-friendly’ to IEP team members?

Summary of FindingsLevel I

• Models and instruments exist– Lack of evidence-based procedures for AT selection– Lack of standardized, reliable, and valid instruments guiding

AT selection process– Instruments often used outside a model as a theoretical

framework (Bernd, Van Der Pijl, & Witte, 2009)

• Lack of individualized assessment of AT equipment (Alper & Raharinirina, 2006)

• Inadequate AT assessment and planning processes & Team model proposed (Copley & Ziviani, 2006)

EBP Question-Take 2

• Revised for Level II search: Is there evidence to support best practice for identifying AT need?

Summary of FindingsLevel II

• Team-based process had benefits for teams: more specific and achievable goals, more effective teamwork (Copley & Ziviani, 2007)

• AT provided by multidisciplinary team helpful in improving performance (Watson et al, 2010)

• Students’ perceptions of AT use: immediate benefits, students using AT fit in, easily accessible (Hemmingsson, Lidstrom, & Nygard, 2009)

• AT assessment should be broad ranging and completed by qualified, multidisciplinary team including family (Hoppestad, 2006)

Summary of FindingsLevel II

Negatives:• Little evidence exists for AT effectiveness in public schools.• Lack of outcome measurement.• Lack of validity or reliability testing with specific AT

evaluations.

Positives:• AT provided by multidisciplinary team.• Comprehensive team approach aligns abilities to

environments.• Students’ perspectives, family input, cultural values.

Limitations & Future Research

• Small sample sizes

• Short data collection periods (1 school year)

• Team members difficulty finding time to commit

• AT outcome measurement needed

Feeding Difficulties in Toddlers: An Overview of Feeding Interventions and the Evidence

Michelle Mercado MA, OTR/L

Introduction to an Evidence Based Problem (EBP) question

• Description of context• Stakeholders• Current approach to the EBP problem• Current outcome in the practice setting

The EBP Question

• The EBP Question: Is the Sequential Oral Sensory Program more effective than behavioral modification/interventions at improving the amount/variety of food eaten by toddlers who are “picky eaters”?

Evidence• Results:

– The behavioral methods studied included the following: nonremoval of the spoon, physical guidance, sequential presentation of food, non-sequential presentation food, reinforcement, escape extinction, presenting single items, presenting multiple items (over the course of treatment) and “treatment packages” (which included one to three of the previously mentioned methods).

– Overall, it is apparent that behavioral methods are effective in increasing the amount and variety of foods a child will eat. In the studies reviewed, it was apparent that the majority of the above mentioned methods are effective when working with children with significantly limited diets. In the case of a single item versus a multiple item presentation, both methods were effective in increasing food consumption, however, the presentation of single items was the most effective (Ahearn, 2002).

– The results from Piazza, Patel, Santana, Goh, Delia, & Lancaster, (2002) found that simultaneous presentation was more effective than sequential presentation for all participants.

– The use of peer models also has positive outcomes on a child’s food consumption. Greer, Dorow, Williams, & McCorkle (1991) found a positive effect that peer eating models have on non-eating participants.

Themes

– Positive outcomes were noted for behavioral interventions.• Interventions included: non-removal of spoon,

simultaneous presentation of food, etc.– No articles about the Sequential Oral Sensory

method were found. – Additional information regarding the Sequential

Oral Sensory method is needed.

Summary

• Overall, it is apparent that behavioral methods are effective in increasing the amount and variety of foods a child will eat.

• The use of peer models also has positive outcomes on a child’s food consumption. The use of peer models can be used alone or combined with other behavioral methods.

• One final method that demonstrated positive outcomes on children’s eating behavior is the training of parents to use behavioral methods at home.

• No journal articles were found for the SOS method.

Recommendations• Implications for occupational therapy practice:

– Parents should be included in the planning and the implementation of interventions.

– Occupational therapists and other providers should :• use the information learned to assist with guiding their decisions to select certain

intervention methods for children who present with specific problems.• present the evidence to parents of children and work together with parents to select the

most appropriate method for their child.• consider a parent’s feelings towards certain methods as certain behavioral methods may

be considered offensive to certain parents (i.e. non-removal of the spoon may be viewed as “force feeding”).

– Ongoing, continuous research is needed to build on the research already completed.• Research is limited and the sample sizes of previous studies are small.• Results of studies may not be easily generalized to other populations.

– Research is needed to determine the effectiveness of the SOS method.

References• Ahearn, W. H. (2002). Effect of two methods of introducing foods during feeding treatment on acceptance of

previously rejected items. Behavioral Interventions, 17(3), 111-127. doi:10.1002/bin.11• Ahearn, W. H., Kerwin, M. E., Eicher, P. S., & Lukens, C. T. (2001). An ABAC comparison of two intensive

interventions for food refusal. Behavior Modification, 25(3), 385-405. doi:10.1177/0145445501253002 • American Occupational Therapy Association (AOTA) (2011). Critically appraised topics and paper series: early

intervention/early childhood. Bethesda, MD. Retrieved (2/25/12) from http://www.aota.org/CCL/EI/EI-Feeding.aspx• Anderson, C. M., & McMillan, K. (2001). Parental use of escape extinction and differential reinforcement to treat

food selectivity. Journal of Applied Behavior Analysis, 34(4), 511-515. doi:10.1901/jaba.2001.34-511 • Boyd, K. L., (2007). The effectiveness of the Sequential Oral Sensory Approach group feeding program. Colorado

School of Professional Psychology, 1- 97 pages; AAT 3298523 • Greer, R. D., Dorow, L., Williams, G., & McCorkle, N. (1991). Peer-mediated procedures to induce swallowing and

food acceptance in young children. Journal of Applied Behavior Analysis, 24(4), 783-790. doi:10.1901/jaba.1991.24-783

• Linscheid, T. R. (2006). Behavioral Treatments for Pediatric Feeding Disorders. Behavior Modification, 30(1), 6-23. • Kerwin, M. E. (1999). Empirically supported treatments in pediatric psychology: Severe feeding problems. Journal

of Pediatric Psychology, 24(3), 193-241.• McCartney, E. J., Anderson, C. M., & English, C. L. (2005). Effect of brief clinic-based training on the ability of

caregivers to implement escape extinction. Journal of Positive Behavior Interventions, 7(1), 18-32. doi:10.1177/10983007050070010301

• Piazza, C. C., Patel, M. R., Santana, C. M., Goh, H., Delia, M. D., & Lancaster, B. M. (2002). An evaluation of simultaneous and sequential presentation of preferred and nonpreferred food to treat food selectivity. Journal of Applied Behavior Analysis, 35(3), 259-270. doi:10.1901/jaba.2002.35-259

• Shore, B. A., Babbitt, R. L., Williams, K. E., Coe, D. A., & Snyder, A. (1998). Use of texture fading in the treatment of food selectivity. Journal of Applied Behavior Analysis, 31(4), 621-633. doi:10.1901/jaba.1998.31-621

• Stoner, J. B., Bailey, R. L., Andell, M. E., Robbins, J. & Polewski, K. (2006). Perspectives of parents/guardians of children with feeding/swallowing problems. Journal of Developmental and Physical Disabilities, 18(4), 333- 353. doi: 10.1007/s10882-006-9020-x

Questions and Comments

The Transdisciplinary Play Based Assessment – Revised Edition (TPBA2) for intervention planning and eligibility

determination in Early Childhood Special Education

Stephanie de Sam Lazaro, MA, OTR/LOTD Candidate St. Catherine UniversityBirth-3 Program St. Paul Public Schools

Evidence-Based Practice Problem

• MN Rule for DD in Part B– MINN. R. 3525.1321 (2009)

• Types of Assessments Currently Used in St. Paul Public Schools

• Primary Service Provider Model and Routines Based Intervention in St. Paul Public Schools

• What is the TPBA2 and why this tool?

Is there evidence to support using the Transdisciplinary Play Based Assessment – Revised Edition (TPBA2) to plan intervention

and assist in eligibility determination for special education services for children ages 3-5?

Preliminary Findings and Themes• Parent concerns when used in

combination with standardized assessments provide the best information about child’s development (Dworkin & Glascoe, 1995)

• Use of risk factors alone for determining need for evaluation is unreliable (Nelson, Nygren, Walker, & Panoscha, 2006)

• Parent assisted intervention is effective for developmental progress (Nelson et al., 2006)

• Role of parents in assessment, intervention planning

• Use of screening tools in manner in which they were intended should lead to more referrals for early intervention (Poon, LaRose, Pai, 2010)

• Use of parent concerns are an important part of the screening process (Poon et al., 2010).

• Use of curriculum-based assessment tools for eligibility and program planning

Analysis of Themes• “Authentic Assessment” (Macy, Bricker, & Squires,

2005; Macy, Thorndike-Crist, & Lin, 2010; Myers & Others, 1996; Bricker et al., 2008; Keilty, LaRocco, & Casell, 2009).

• Importance of both norm-referenced and curriculum-based or criterion-referenced (Macy et al., 2005; Sterling, Candler, & Neville, 2011; Bricker et al., 2008)

• Play-based tools role in eligibility determination (Macy et al., 2005; Myers & Others, 1996; Bricker et al., 2008)

• Curriculum-based or criterion-referenced related to program planning (Calhoon, 1997; Myers & Others, 1996; Keilty et al., 2009, Macy et al., 2005)

• Role of parents in assessment (Eddey, et al., 1995; Macy et al., 2010)

• Increased ease and ability in play-based tools (Macy et al., 2010)

• What is missing from the literature?• Need for more professional

development related to assessment tools and eligibility in Part C and Part B (Keilty et al., 2009; Harrington & Tongier, 1993)

• Need for more research related to specific types of tools and specific tools and eligibility requirements in Part C and Part B (Bricker et al., 2009; Macy, 2012; Harrington & Tongier, 1993; Calhoon, 2009)

• Screening tools have high variability in over- and under-identification (Macy, 2012)

Implications for Practice

• MN has it right– Part B triangulation approach to eligibility determination– Part C – use of curriculum-based or criterion-referenced

with condition known to hinder• Role of play-based tool results for program planning

– Play-based vs. age-norm checklist type tool– Triangulation within curriculum-based or criterion-

referenced tools• Move towards developing more evidence related to

types of tools used for eligibility and program planning

Limitations and Future Research

• The level of evidence – Limited comparative data– Limited sampling procedures– Small size studies

• Future Research– Assessment tools, screening tools, and eligibility – More RCT or comparative studies related to various

types of tools– Caregiver’s role in assessment process (caregiver as part

of assessment administration)

Questions and Comments

ReferencesBricker, D., Clifford, J., Yovanoff, P., Pretti-Frontczak, K., Waddell, M., Allen, D., & Hoselton, R. (2008). Eligibility determination using a curriculum-based assessment: A further examination. Journal of Early Intervention, 31(1), 3-21.Calhoon, J. (1997). Comparison of assessment results between a formal standardized measure and a play based format. Infant-Toddler Intervention, 7(3), 201.Dworkin, P. H., & Glascoe, F. P. (1995). The role of parents in the detection of developmental and behavioral problems. Pediatrics, 95(6), 829-836. Eddey, G. E., Robey, K. L., Zumoff, P., & Malik, Z. Q. (1995). Multidisciplinary screening in an arena setting for developmental delay in children from birth to six years of age. Infant-Toddler Intervention, 5(3), 233-241.Harrington, R. G., & Tongier, J. (1993). The compatibility between state eligibility criteria for developmental delays and available early childhood assessment instrumentation. Diagnostique, 18(3), 199-217.Keilty, B., LaRocco, D. J., & Casell, F. (2009). Early interventionists’ reports of authentic assessment methods through focus group research. Topics In Early Childhood Special Education, 28(4), 244-256.Macy, M. (2012). The evidence behind developmental screening instruments. Infants and Young Children, 25(1), 19-61.Macy, M. G., Bricker, D. D., & Squires, J. K. (2005). Validity and reliability of a curriculum-based assessment approach to determine eligibility for part C services. Journal of Early Intervention, 28(1), 1-16.Macy, M., Thorndike-Christ, T., and Lin, Y. (2010). Parental reports of perceived assessment utility: a comparison of authentic and conventional approaches. Infants and Young Children, 23(4), 286-302.MINN. R. 3525.1321 (2009) Myers, C. L., & Others, A. (1996). Transdisciplinary, play-based assessment in early childhood special education: An examination of social validity. Topics in Early Childhood Special Education, 16(1), 102-26.Nelson, H. D., Nygren, P., Walker, M., & Panoscha, R. (2006). Screening for speech and language delay in preschool children: systematic evidence review for the US preventive services task force. Pediatrics, 117 (2), e298-e319, doi:10.1542/peds.2005-1467 Poon, J. K., LaRosa, A. C., & Pai, G. S. (2010). Developmental delay timely identification and assessment. Indian Pediatrics,47(5), 415-422.Sterling, S., Candler, C., & Neville, M. (2011). Comparison of developmental age derived from the Transdisciplinary Play-Based Assessment and the Peabody Developmental Motor Scales-2. Journal of Occupational Therapy, Schools, and Early Intervention, 4(2), 121-128. doi: 10.1080/19411243.2011.590738

EVIDENCE ON INTERVENTIONS TO SUPPORT SLEEP IN INFANTS/TODDLERS

By: Michelle Barton, MA OTR/L

Introduction to an Evidenced-based Problem:

Helping infants and toddlers sleep

What is the problem? Why is it a problem?

Who wants this information and why?

What is the practice setting and current approaches to the

problem?

The Evidenced-based Question and Level One Search OverviewResearch Question: Is a weighted blanket more effective than behavioral extinction for decreasing the amount of time it takes for a child 18-36 months of age with self-regulation issues to fall asleep and stay asleep?

Level One Search: Systematic ReviewsGreenhalgh, T.(2010). How to read a paper.West Sussex, United Kingdom: Wiley-Blackwell.

Level One SearchDatabases used:

National Clearinghouse http://www.guideline.gov/index/aspx

SUMSearch www.sumsearch.org

OT Seeker www.otseeker.com

Physiotherapy Evidence Database www.pedro.org.au

Information found from the four most relevant articles:

Little research on weighted blankets Strong support for behavioral interventions

The Revised Evidenced-based Question and Level Two Search Overview

Revised Question: Is deep pressure more effective than behavior strategies to decrease bedtime resistance and night awakenings for infants and toddlers with sleep disturbances?

Level Two Search: Individual studiesGreenhalgh, T.(2010). How to read a paper.West Sussex, United Kingdom: Wiley-Blackwell.

Level Two SearchDatabases

Google Scholar Scholar.google.com

OT Search www1.aota.org/otsearch/

psychINFO www.apa.org/psycinfo/

SciVerse www.sciencedirect.com

Information found: Limited evidence to support deep pressure strategies Strong evidence to support behavioral strategies

Themes, Summaries, and Recommendations

Themes: Sleep interventions are important Strong support for behavioral strategies, routines, and

parent education Parent perceptions are important to consider

Summary: Sleep is important for development. At this time, behavior

extinction, bedtime routines, and parent education are the most strongly supported.

Recommendations: Parents play an important role Additional research is needed

ReferencesGalland, B. & Mitchell E. (2010). Helping children sleep. Archives of Diseases of Childhood.(95)850–53.Germo, G., Goldberg, W. Keller, M.(2009). Learning to sleep through the night: solution or strain for mothers and young children. Infant Mental Health Journal(30)3:223-224.Greenhalgh, T.(2010). How to read a paper.West Sussex, United Kingdom: Wiley-Blackwell.Hall, W. A., Clauson, M., Carty, E. M., Janssen, P. A. & Saunders, R. A. (2006) Effects on parents of an intervention to resolve infant behavioral sleep problems. Pediatric Nursing(32)3:243–250.Hall, W. A., Saunders, R. A., Clauson, M., Carty, E. M. & Janssen, P. A. (2006) Effects of an intervention aimed at reducing night waking and signaling in 6-to-12-month old infants. Behavioral Sleep Medicine(4): 228–241.Hodgetts, S. & Hodgetts, W. (2007). Somatosensory stimulation interventions for children with autism: literature review and clinical considerations. Canadian Journal of Occupational Therapy(74)5:393-400.Kuhn, B. & Elliott, A. (2003). Treatment efficacy in behavioral pediatric sleep medicine. Journal of Psychosomatic Research (54): 587-597.Lou, J & Durando, P. (2008). Asking clinical questions and searching for the evidence. In M. Law & J.MacDermid (Eds), Evidence-based rehabilitation: A guide to practice.. Thorofare, NJ: SlackMay-Benson, T. & Koomar, J. (2010). Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. American Journal of Occupational Therapy(64)3:403-414. Mindell, J., DuMond, C. Sadeh, A. Telofski, L., Kulkarni, N., et.al.(2001). Efficacy of an internet-based intervention for infant and toddler sleep disturbances. Sleep: Journal of Sleep and Sleep Disorders Research(34)4:451-458.Mindell, J., Kuhn, B., Lewin, D., Meltzer, L. Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep(10): 1263-1276. Mindell, J., Sadeh, A., Kohyama, J., & How, T. (2010). Parental behaviors and sleep outcomes in infants and toddlers: a cross-cultural comparison. Sleep Medicine(11):393-399.Mindell, J., Telofski, L., Wiegand, B., & Kurtz, E.(2009). A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep: Journal of Sleep and Sleep Disorders Research(32)5:599-606.Skuladottir, A., Thome, M., & Ramel, A.(2004). Improving day and night sleep problems in infants by changing day time sleep rhythm: a single group before and after study. International Journal of Nursing Studies(42):843-850.doi:10.1016/j.ijn urstu.2004.12.004. Tse, L. & Hall, W.(2008). A qualitative study of parents’ perceptions of a behavioural sleep intervention. Child: Care, Health, and Development(34)2:162-172.Underdown, A., Barlow, J., Chung, V. & Stewart-Brown, S. (2006). Massage intervention for promoting mental and physical health in infants aged under six months. Cochrane Database Systematic Review (4).

Comments and Questions