Data Driven Practice for School-based Physical Therapists ......Data-driven Practice= Purpose...

Data-based Practice Innovations July 2019St. Louis, MO

Laurie Ray, PT, PhDDo not to be used or copied without author permission 1

Data Driven Practice for School-based Physical Therapists

a

http://bit.ly/Innovations_DataLaurie Ray, PT, PhDInnovations 2019

St. Louis, Missouri

Role of Related Service Providers inIEP Development

• Collector of data

• Provider of data

• Active participant at IEP meeting, offering expertise and insight

• Share information prior to meeting if unable to attend

• Synthesizer of data

• From unique perspective of discipline

• In light of health and developmental priorities

• Critical assist for prioritizing needs/goals

• Offer long range perspective

• Team Player

Data-driven Practice= Purpose

Conveying ExpertiseDeveloping

IEP

Monitoring Student Progress

Ensuring Intervention Effectiveness

-Clinicalreasoning anddata-drivendecisions providecriticalcontributions toIEP team

-Both permeateall aspects ourpractice

Student Assessment

Individualized Education PlanIntervention

Evaluation of Progress

Adapted from Bricker & Pretti-Frontczak & McComas, 1998

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Hattie Rankings: Influences & Effect Sizes Related To Student Achievement

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8

1. Teacher esta of achievmt

2. Collective teacher efficacy

3. Self-reported grades

4. Piagetian programs

6. RtI

8. Micro teaching

9. Cognitive task analysis

11. Interv for LD or Disabled

13. Teacher clarity

14. Reciprocal teaching

15. Feedback

16. Formative assessmt

19. Self questioning Hattie 2009 (n=138)

Hattie 2011 (n=150)

Hattie 2015 (n=195)

Hattie (2015-The Applicability of Visible Learning to Higher Education; 2011-Visible Learning for Teachers; 2009-Visible Learning)

www.visible-learning.org

Data-driven Decisions

• Can minimize emotion by deciding from student data versus invested opinion

• Allows for ‘experimental’ IEPs

• Identify the correct focus for intervention

• Promotes efficacy and efficiency

• Avoids decisions based on assumptions or experience which canmislead

• Justifies and validates need for expertise/related services

Data-based: Referral

• Procedure Forms can shape referrals

• Training Develop partners, not a dump site

• Data Feedback loop, assess district level data

• Contextual focus Where? When? With whom?

• Problem-solving framework Set appropriate expectation

Data-based Evaluation

• Clear, comprehensive data from our professional lens

• Drawn from varied contexts

• Utilizing a variety of methods, formats strategies and collectors

• Evaluation is a process of collecting, analyzing andconveying data

Record review Student report Parent report

Teacher report Observation Direct testing

Functional testing Standardized

testing

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Reliance on Data and Clinical Reasoning:

Classroom

School Day RoutinesScheduleExpectations Culture

Gather data • Progress reports• Student observations across

settings• Student interview• Teacher/Parent interview• School day schedule- time

everything!Reason

• Look for patterns or outliers• Assess expectations• Reflect on how and when to

intervene

Interpret the Data

Convey your professional perspective by connecting the dots…

• Forecast high expectations, individualized for this student

• Describe contextual details (e.g. supports, motivators) for situations where this student succeeds

• Provide reference for comparison (e.g. age matched peers, other students in this setting)

• Clarify impairments and limitations and how they manifest

• Describe effects of this student’s disability in this context

Data-driven IEPs:Present Level of Educational Performance =Baseline Data

Standard practice• Current/relevant

• Understandable

• Needs of the student

• Prioritized

• Needs resulting from the disability

Growth mindset practice• Very specific (measurable)

• Data rich (objective)

• Integrated

• Strengths (and needs) of student

• Effects of disability on participation in & progress through general education curriculum

Offer a contextual, data-rich description of student performance

The story of two PLEPs

Laurie is 8 years old and struggles with walking to the lunchroom and gym. She uses a reverse walker and requires assistance. She needs extra time to transition. She is limited in how long she will engage in play. She does not access any playground structures.

Laurie (8yo/2nd grade) is highly motivated by her peers and responds well to peer modeling. She struggles to walk and play independently. Laurie likes to play with peers but does not play on her own (1.6-1.9 minutes on average with 2 verbal cues to continue). She refuses to climb or use available playground equipment despite supports (peer model, verbal and manual cues).Laurie can: • walk in line, using her personal walker for 4 minutes

with repeated (>5) verbal cues to straighten her path and keep pace

• walk for a maximum of 8 minutes/1148ft with hand over hand assist with her personal walker; then needs seated rest (peers walk to lunchroom in 7minutes/1580ft)

• moves on the playground independently with personal walker without falling during recess

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PLEP Considerations What baseline data do you have…

• Context of student performance

• Current supports for student performance

• Student’s participation in any/all aspects of the GenEd curriculum

• Expectations (student, peers, instructional staff)

• Assistance required for routines and activities

• Part(s) of the day or routines when student’s participation is limited

• Skills available and needed by the team and/or student to improve access and participation

• Supports & barriers to accomplishing these skills

• Performance gap to be closed; anticipated rate or progress? past progress?

GET SPECIFIC!!

Data-driven IEPs: Student Goals

1. Clear and specific identification of the skill or student function

2. Contextual, specific description of the movement or activity to perform

3. Educationally relevant connection of the movement/activity to a specific function within school routines

4. Specific conditions or routine in which the activity will be performed

5. Factors or criterion for measuring performance

6. Time frame for achieving goal

Specificity and correct priority is THE key to progress.

Adapted from Physical Therapy Reimbursement News, Volume 13, Number 3

Remain Student CenteredWhat data do you have to:• Determine the required rate of progress to attain long-term goals• Incorporate student interests, goals, what they want to be able to do• Write goals that are meaningful, fostering not only independence

but self-determination • Think about the big picture, what the student needs to be doing-

-next year, -5 years from now,

-in middle school -when s/he is 21…

Would YOU be willing to collect this data?

1. Laurie will walk in line with her classmates to the lunchroom, safely and independently, using her personal reverse walker within 12 minutes.

2. Laurie will access 2 different play structures, safely with contact guard and manual cues only during recess for 2 out of 5 school days.

3. Laurie will engage in a 20min class activity (cooking, literacy or calendar) in the classroom stander, given verbal cues, with purposeful movement or eye contact >5 times with peers or adults.

4. Laurie will actively participate in a game during PE for >5 minutes with peers, given a graphic schedule.

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Model Location Therapeutic Focus Peers Context Data/ Rationale

Individual Pull-out

Away from the regular class

Skill development Not present

Different from class/routine

• Short attention span• Need for quiet, control

Small group pull-out

Away from the regular class

Skill development & functional performance

One to six peers

Different form the rest of the class

• Peer models with limited degrees of freedom

One-on-one in classroom

In the classroom but away from the rest of the class

Preparation for skill performance, guided practice of skill

Not involved in therapy

Different form the rest of the class

• In setting• Need for prep/pre-rehearsal

Group activity In the classroom,small or large group

Skill performance in context, peer interaction, engagement, scaffoldedfunction

All or somepresent

Within class/routine

• Peer model in context• Minimal generalization

requirement

Individual during routine

In the student’s classroom or environment

Immediate, contextual feedback, peer model, scaffolded function, skill mastery

Usually present

Within class/routine

• Intensive feedback requirements

• Minimal generalization requirement

Collaborative or expert

consultation

In or out of the classroom

Skill mastery, independence, consistent performance

Present if occurring in class

Within or outside class/routine

• Set appropriate expectation• Functional performance in

context

Data to Determine Service Delivery

Data-driven IEPs:Monitoring Student Progress=Data Plans!

• Specify ‘what’ we want to measure

• Define and clarify (operationalize) all aspects of measure

• Decide who, where (location & context), and how often (how much) data must be collected

• Collect baseline data

• Intervene and collect data according to plan

• Score and summarize data (graphs are great!)

• Provide data to team, evaluate/discuss, brainstorm any needed change= employ data

Reallocating Time Invested: Collaborative IEP Development

This Photo by Unknown Author is licensed under CC BY-SA

PLEP

Goals

Data Plan

This Photo by Unknown Author is licensed under CC BY-SA

Goals

PLEP

Balancing the Data Set

Student Outcomes

Student Performance

Data

Program Artifacts/ Staff Data

Therapist Data

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https://creativecommons.org/licenses/by-sa/3.0/

http://stackoverflow.com/questions/17511614/half-filled-circle-with-d3-js

https://creativecommons.org/licenses/by-sa/3.0/



Data Collection by Students-Reinforcing Math

Can students keep their own data?

Kindergarten• Answer ‘How many?’ up to 20

Grade 1• Use data to answer questions

(“How did you do on your goal last week?)

• Compare data using bar graphs

Grade 2• Draw a bar graph• Identify odd or even

Data collection resources:• National Center on Student Progress Monitoring-http://www.studentprogress.org•National Center on RTI –http://www.rti4success.org •Google data collection forms!•Eastern Upper Peninsula Intermediate School District -http://www.eupschools.org/Page/3253

Data Planning>>Guiding Questions

• Will collected data give us what we need?

• Is there an easier way to get this data?

• Will we use it?

• Is it easy/simple to collect? All agreed and willing?

• Is it adaptable throughout school day/ needed routines?

• Can the student collect the data? Families? Note: Teacher is last ask!

• Who is tasked? Is it relevant to her/his work?

Data Collection Ideas/Samples

At the meeting:

Date Tally each time seen: Total

•Ask teacher to describe thing you want to measure (falls, on task, engaged, use of equipment)

•Operationally define together, work out all differences

•Decide who collects, where, when/what routine and how often•Provide tally to all collectors

•Schedule turn in dates and discussion times

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Conveying and Discussing Data

Graphic displays:• Compare progress with: • anticipated progress, • known factors, • what else?

• Provide clear visual report student progress or lack of progress• Improve communication of performance• Focus IEP meetings on needed change• Allow most students to track her/his own progress• Can motivate students to invest in goal, progress and increase effort

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4 consecutive points above line: Raise the goal!

Points above and below the line: Keep as is.

4 consecutive points below line: Change

Student Ambulation Progress

Dis

tan

ce A

mb

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ted

In

dep

end

entl

y

?

Alton: Self-report & Observed Walking

0

20

40

60

80

100

Observed Self-report

Alton: PE Participation

0

2

4

6

8

10

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14

Individual Teams Small groups Skills test

GM skills Games Fitness

LaTwan’s Transfers with < Mod Assist

0

0.5

1

1.5

2

2.5

3

3.5

# < Mod

GOAL

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Matthew’s % Time Spent in Peer Play During Recess

0

5

10

15

20

25

30

35

40

45

50

4-O

ct

6-O

ct

8-O

ct

10-O

ct

12-O

ct

14-O

ct

16-O

ct

18-O

ct

20-O

ct

22-O

ct

24-O

ct

26-O

ct

28-O

ct

30-O

ct

1-N

ov

3-N

ov

5-N

ov

7-N

ov

% Time

GOAL

0

20

40

60

80

100

120

4-O

ct

6-O

ct

8-O

ct

10-O

ct

12-O

ct

14-O

ct

16-O

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18-O

ct

20-O

ct

22-O

ct

24-O

ct

26-O

ct

28-O

ct

30-O

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1-N

ov

3-N

ov

5-N

ov

7-N

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9-N

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11-N

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Distance

GOAL

Distance Laurie Ambulates with AD

Display Multiple Goals

0

2

4

6

8

10

12

14

16

18

18-A

ug

25-A

ug

1-Se

p

8-S

ep

15-S

ep

22-S

ep

29-S

ep

6-O

ct

13-O

ct

20-O

ct

27-O

ct

3-N

ov

10-N

ov

17-N

ov

24-N

ov

1-D

ec

8-D

ec

15-D

ec

22-D

ec

29-D

ec

5-Ja

n

12-J

an

19-J

an

26-J

an

2-Fe

b

9-F

eb

16-F

eb

23-F

eb

2-M

ar

9-M

ar

16-M

ar

23-M

ar

30-M

ar

6-A

pr

13-A

pr

20-A

pr

27-A

pr

4-M

ay

11-M

ay

18-M

ay

25-M

ay

1-Ju

n

Distance On-time PE Participation

Put the Data to Work!

It is only worth collecting IF it is reviewed, interpreted and APPLIED!• Is the student making adequate progress?• Consult the whole IEP team• Ask. The. Student.• If not, something should change:

• Environment• Task complexity/size/pace• Intervention methods

/procedures/routines• Resources and materials• Group size/peer presence

• Sequence of skills taught• Amount of (response or service) time

allocated • Level of support• Type/intensity of feedback • Student motivation/responsibility

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Reporting Progress on Annual Goals

• Data measures and aligns with criteria stated goals, objectives or benchmarks

• Synthesized data provides clear evidence of progress

• Report clearly explains extent to which the progress is sufficient to achieve each goal

• Identifies contributors, especially when progress varies by discipline focus/emphasis

• Burden eases and communication improves with functional data/ progress monitoring plan

Variable progress, working on increasing independence. Good attendance.

Thanks for sending in snacks!

Laurie Ray,PT

Which would you want to receive?GOAL: In 36 weeks, Laurie will walk in line with her classmates to the lunchroom, safely and independently, using her personal reverse walker within 12minutes.

• Week 3; required average of 4 manual prompts to correct path, adjust speed. Average=19 minutes

• Week 6; required average of 3 manual prompts to adjust speed, correct path. Average=19 minutes

• Week 9; required average of 2 manual prompts to correct path & 1 verbal prompts to adjust speed. Average=17 minutes

Laurie has improved her speed and attention to peers in line. She still requires some manual prompts but responds to verbal prompts more quickly. Laurie is on target to meet this goal.

Karen Tartick,Physical Therapist

Use data-based decisions to:

Student

➢ Analyze student progress

➢ Assess intervention context, effectiveness and efficiency

Therapist

➢ Assess therapist effectiveness

➢ Support

➢ clinical reasoning

➢ service delivery recommendations

➢ interventions

➢ Plan professional development

Program➢ Assess programs:

➢ workload / capacity

➢ service trends (e.g., individualization, generalization)

➢ Transition

➢ Individual, school, region or LEA

➢ Inform decision-making

➢ IEP team

➢ practitioners

➢ supervisors

➢ Plan professional development

LEA PT Programs: Data-based decisionsWhat do you need to do/advocate for and how can you

demonstrate it with data?!?!

➢What do you need to forecast staffing?

➢How are you allocating workloads?

➢How are you planning professional learning for team?

➢Relationships between: ➢ service hours and program capacity

investment

➢Appropriate equipment and student engagement outcomes

➢positioning programs and student attendance

➢ transfer training and sick leave/longevity

• Percentage of EC students receiving PT

• Number of EC students per FTE/1 full-time PT or PTA

• Average workload/ PT or PTA

• Average IEP hours per PT or PTA

• Number of sites served

• Service on specialty teams (e.g., AT, PS Evaluation, MTSS, Universal Design for Learning, Renovation committees)

• Student time on task

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Individual Data:Professional Development

• What does the data suggest I am doing well? not doing well?

• Does therapist demonstrate sufficient capacity for variety of diagnoses, adequate knowledge and range of skills?

• What new skills and knowledge are needed?

• What mentoring partner or professional learning is suggested?

Questions to Propel Change: Knowledge Translation

1. How can I rely more on data for my clinical decision making?2. How can I improve the data I use?3. How can I collaborate with instructional staff, related service

providers and administrators to collect useful data?4. What data collection systems can we experiment or devise with

to promote better, easier data collection?5. What is too much to ask from my collaborators?6. Can I devise a system that relies on the student for data

collection? Reporting?

Comments, Questions??

Thank you for your kind attention.

[email protected]

www.med.unc.edu/ahs/physical/schoolbasedpt

www.seekfreaks.com

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Data Driven Practice for School-based Physical Therapists ......Data-driven Practice= Purpose...

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