Facilitating a Sustainably Healthy School Community Through Multi-Tiered System of Support

 

Background:
For my 3^rd clinical rotation, I was placed at Wake County Public Schools. From lectures pertaining to school-based therapy, I knew there were multiple different laws that regulated school-based practice and that school-based therapy was centered around increasing student participation. One day, I observed an Individualized Educational Program (IEP) meeting, in which the student had just moved to Wake County from a different state. In his previous state, he had received physical therapy in school and was actively working on fundamental movement skills with the therapists. This included running, hopping, jumping, and ball skills. In North Carolina, the goal of school-based physical therapy services are to support the students in accessing their school environments and educational programs per their IEP. Therefore, school-based physical therapy in NC will likely not address these fundamental movement skills, as they are not considered educationally relevant. I remember reflecting after this meeting and reminding myself that participation in the school environment and educational program is integral to school-based therapy. I then found myself wondering, “well, wouldn’t fundamental movement skill training influence participation?.” In my Evidence-Based Practice class, I reviewed the literature for an assignment and found that fundamental movement skill training had positive effects on child participation. After conversing with my faculty advisor, Laurie Ray, MPT, PhD, who serves as the physical therapy consultant for the NC Department of Public Instruction, I learned about how a specific framework could address this situation. This framework is known as Multi-Tiered System of Support, which is mainly utilized by speech and occupational therapy, and currently does not have much physical therapy involvement. However, the use of the MTSS framework in schools could have implications for addressing this discrepancy while enhancing the participation of all children in the school system.

 

Statement of Need:

Currently, there is not much physical therapy involvement with the MTSS framework in public schools. Under this framework, school-based physical therapists would serve as consultants for all the adult staff in the school to ensure that each child’s needs are met. Therefore, if this was to be implemented in the NC public school system, as it likely could be in the future, there would need to be considerable training, education, and guidance provided to school-based therapists.

The purpose of this Capstone project is to propose a manual focused on how to facilitate a sustainably healthy school community through the MTSS framework for physical therapists. School-based physical therapists can use this manual to guide their interactions within their school community to help support student participation and overall wellness and also to generate ideas for physical therapy involvement under MTSS.

 

Products:

My main deliverable for this Capstone project is an educational manual, briefly explaining MTSS and providing actions that a physical therapist can take at several different levels, including individual, small group, school community, and school district. On the individual level, one of my suggested actions is to lead an in-service to teachers to help them recognize motor impairments. Therefore, as a supplement to this manual I also included a power point presentation that school-based physical therapists can use to lead an in-service training to teachers and other school staff so that they can best meet the needs of their students. I provided the presentation in both a pdf format, as well as an editable version that they can tailor the presentation to their schools’ needs.

Manual

PowerPoint Presentation

Editable How to Recognize Motor Impairments Presentation

 

Evaluation Component:
Throughout my project, I utilized the expertise and suggestions from my committee and faculty advisor to provide content ideas and determine feasibility. I took their suggestions and advice to ensure that my products were feasible, useful, and appropriate for physical therapists in the school system. I received feedback from school therapists in both large counties, such as Wake County, and smaller counties, such as Avery County. As there is currently not any physical therapy involvement in the MTSS framework, my committee members had questions about implementation, funding, and student confidentiality. Therefore, I incorporated these aspects into my manual to provide information regarding what school-based physical therapists in NC are most concerned about MTSS involvement.

To evaluate the effectiveness of my educational manual, I utilized a pre and post-test survey. I had my committee members and other people giving me feedback take the pre-test before they consumed any of my material. I then had them repeat the test after they read the materials. This showed a difference in their answers and application of the material before and after going through my deliverables. Therefore, I could see how they learned about MTSS and its implementation over time.

Manual Evaluation

Presentation Evaluation

 

Self-Reflection:
This project challenged me to create something useful and appropriate for school-based physical therapists in NC, despite having a short 8 week experience in the school system. I had to ensure that I fully understood the ways in which students receive physical therapy services in school in order to write this manual. I also had to brainstorm ways for physical therapists to offer their expertise and knowledge in order to be involved.

While the idea for this project originated from seeing children that could benefit from physical activity and physical therapy intervention that do not receive special education services, I believe that this manual can benefit more than just these students. I made a strong effort to suggest actions that were mutually beneficial for multiple parties. For example, high school students receiving credit for helping lead physical activity programs in classrooms. This is advantageous for the students in the class, the individual high school students, and the teacher. In a time where teachers have a great deal of demand on them, some of the interventions suggested can provide support to them during the school day. Through completing this project, and communicating with school-based physical therapists, teachers, and a consultant for school-based therapists, I learned that ensuring that programs are mutually beneficial is key to the feasibility and likeliness of it being successful. In addition, through working on this project I gained valuable experience in ensuring that I was keeping participation at the core of the interventions, which will be useful in my career as a physical therapist in any setting.

 

Acknowledgements:

To my faculty advisor, Laurie Ray, MPT, PhD: Thank you for sparking my interest in MTSS and being available to answer my questions. I appreciate your encouragement to seek a project that is meaningful to me, as well as the emphasis you placed on ensuring my project is feasible and applicable to school-based physical therapists across NC. I’m so glad that I had the opportunity to learn from you in your school-based lectures and modules, as well as through this project!

To Ruffin Ayers, PT: Thank you for your flexibility and commitment to helping with this project. I appreciate the valuable perspectives that you provided, as you have such a unique role in Avery County. I am thankful for your involvement!

To Michelle Bevil, PT, DPT: Thank you for your support and guidance throughout this project, as well as for asking the hard questions. I appreciate you sharing your experience with me during my clinical rotation. I will always remember my rotation in WCPSS as my most fun rotation!

 

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