There are so many things to consider when determining what the best model of service delivery should be for each child. How many goals do they have? Can they perform them somewhat consistently in session but not at all within the classroom? Do they benefit from peer models? Do their goals require a lot of movement to optimize arousal that is difficult to achieve during instruction? And on and on and on.
There are pros and cons to pull-out vs. push-in services, depending on the answers to all the above questions but let’s focus on the positives of push-in services.
The Pros of Push-in Services
1. No loss of instructional time
If the class is working on a craft, the OT can guide and facilitate many goal areas such as a functional grasp when coloring or improved motor accuracy when cutting shapes. If the task is more academic in nature the OT can support executive functioning skills such as organization of information for a writing assignment or a system to maintain an organized desk so they can always find their materials.
2. Less stress for students
Many kids worry about the assignments they miss while they’re at their occupational therapy session. And the anticipation of having to make up the classwork can make them very anxious. Even though students are on an IEP (Individualized Education Program), many teachers hold them to the standards and rigor of the rest of the class. In reality, students should be given additional time to complete the assignments at school (NOT as home) or be exempt from completing them if it’s not required for a grade.
3. No loss of therapy time during push-in services
The transition from the classroom to the therapy room can often take up to 5 minutes there AND back depending on where the 2 rooms are located! Therapy minutes can also be affected if the child struggles with transitions.
4. Minimize the chances of behavioral outcomes
Many kids have FOMO (fear of missing out) so when they have to leave during their favorite book or center rotation that can cause frustration and have negative effects, occasionally prohibiting positive therapeutic outcomes in the isolated setting. Staying in class allows all successful outcomes for all participants.
5. Increased functional application of the goal areas
Children get a better sense of understanding why they need to work on certain skills because it is required of them at that moment in the classroom, but out of context in a therapy setting, there may be a disconnect and/or a limited desire to engage.
6. Prevents the added step of generalizing skills in the natural environment
After students master goals in a one-to-one therapeutic setting, the student shouldn’t automatically “graduate from OT” or discontinue services. The therapist should confirm that the child is successful with those same skills when the environment is different and additional skills are required of the child. This could include increased auditory distraction from other students, overwhelming visual input from the decor in the classroom, the materials are different, or the instructions are given in a different way.
Occupational therapists have a better sense of how to support their students when they understand the teacher’s style, expectations, and working environment. Push-in services eliminate the extra step of understanding all these things.
7. Use of peer models when providing push-in services
Sometimes (ehmm, oftentimes), children are more motivated by seeing what or how a classmate completes a project rather than prompting and modeling from an adult. As a school OT, I love watching students improve when working side by side with a friend.
8. Communication with the teacher and aides
The staff who works with the child for several hours per week can observe the child’s posture/positioning, learn simple strategies, accommodations, and consistent prompts when those activities are completed at other times during the week. This helps since the OT might only see a child for 30-60 minutes a week. The teacher can also be a liaison to the parents who might have questions about how specific skills are progressing. Plus, it’s difficult to find additional time within the week to meet with each teacher about every student.
Remember that each child is on an Individualized Educational Program which is NOT a one size fits all model. Look carefully at the delay in skills, the expectation within the classroom, and how to best serve each child to meet their goals.
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I love pushing in to assist with carryover!
Yep! I never feel 100% comfortable discharging a student if I’m not confident they’re meeting their goals in their natural setting. Push-in is necessary.