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Abstract

Background Families and children receiving early intervention services benefit from service provider involvement during the transition to preschool special education services.

Objectives This study sought to determine the factors that physical therapists working in early intervention services and/or preschools identified as supportive of their involvement, and associated with their perceived involvement, in transition planning for young children with disabilities moving from early intervention to preschool services.

Design A cross-sectional survey was used.

Methods A survey was mailed to a random sample of 600 members of the American Physical Therapy Association's Section on Pediatrics. Physical therapists working with children transitioning out of early intervention and into preschool participated. Data from physical therapists providing services in preschools were included in this study.

Results The response rate was 56.3%. The highest- and lowest-ranked facilitators of transition planning were: “Staff at my preschool program value my participation in transition planning activities” (highest ranked) (X̅=5.02, SD=1.36, n=142) and “I am encouraged to participate in transition planning activities by the early intervention service coordinator” (lowest ranked) (X̅=1.91, SD=3.50, n=143). Multivariate regression models demonstrated that physical therapists' perceived value and expertise in providing transition planning services were significantly associated with collaboration with professionals from early intervention programs (F1,129=207) and support of families during the transition process (F1,134=48).

Conclusions Physical therapists who identified implementing practices that supported communication, collaboration, and strong, positive relationships between early intervention and preschool programs had greater involvement in the transition planning process.

In 2008, approximately 170,000 three-year-old children entered part B preschool special education services in local public school districts.1 Many of these children transitioned into preschool following participation in part C early intervention programs where they received services (ie, physical therapy) from a team of professionals utilizing a family-centered approach. Research findings suggest that as the process of moving from early intervention to preschool unfolds, some families and children may be worried and anxious before, during, and after the transition takes place.2,3 These perceptions may be partially attributed to the significant changes that are taking place during this time, such as a change in service providers, a change in location of services, (ie, home to school), and a change in the philosophy of service provision (ie, family-centered to child-centered). Involvement of early childhood providers, including physical therapists, in different aspects of transition planning may result in a more positive view of the transition process by families, and possibly better child outcomes in preschool following the transition.4

A typical transition from part C to part B services starts while the child is still receiving early intervention. Guidelines in the Individuals With Disabilities Education Improvement Act of 2004 (IDEA)5 indicate that the child's and family's Individualized Family Service Plan (IFSP) must contain steps for transition planning, including a conference with family members, part B representatives, and invited part C representatives, which should convene no later than 90 days, but possibly up to 9 months, before the child's third birthday. Following the conference, providers from the local school district should conduct assessments and multiple meetings with the family to discuss eligibility and placement, and to develop the Individualized Education Program (IEP). Each of these steps leads up to the first day of the child's participation in the new preschool environment. The transition process does not stop then, but rather continues for several more weeks until the child becomes acclimated to the context and expectations of preschool.6

Rous and colleagues' conceptual model of early childhood transitions highlights the complexity of the transition process for children, families, and team members.4 From an ecological perspective, child factors (eg, type of disability, temperament) are the foundation for transition planning. Surrounding the child are family factors such as resources and diversity. Likewise, child and family are embedded within a community of providers, programs, local systems, and state systems. Critical interagency variables such as communication and relationships among child, family, and community, a supportive interagency structure, and alignment and continuity of programs, curricula, and personnel expectations are associated with 3 areas: transition practices and activities, child and family preparation and adjustment, and child outcomes following the transition. The conceptual model is well-supported by the early childhood transition literature, which suggests that supportive strategies (eg, assisting families to understand the differences between early intervention and preschool programs, having children and families visit preschool programs prior to the transition, encouraging families to participate in transition planning, and collaborating with team members during planning) may lessen the stress of the transition process for children and families.3,7,8

As a part of the community and a member of the early intervention and preschool teams, the physical therapist has a distinctive role during the transition process. Physical therapists focus on functional mobility for activities and participation, remediation and prevention of secondary impairments in body structures and function, and use of assistive devices. Physical therapists may foresee potential issues in a variety of areas prior to the child's move to the new environment, such as transportation (eg, safe bus transport), movement in and around the school, and positioning in the classroom. Twenty-one percent of children receiving preschool services receive physical therapy.9 Physical therapists report using the following strategies with families and children during the transition to preschool: performing evaluations, helping to develop the IEP, attending transition-related meetings, conferring with the child's new physical therapist about the child, working with the family, and referring the child and family for needed services. However, only 43% of physical therapists working in preschools perceived that they were fully participating in the transition process.10 Given the role and scope of services, children receiving physical therapy in early intervention will probably benefit from the involvement of physical therapists in preschool transition planning.

The purpose of this study was to investigate the factors that influence the involvement of physical therapists in the transition planning of children moving from early intervention to preschool. We used survey data to delineate the factors that physical therapists identified as supportive of their involvement, and to determine which factors were associated with their perceived involvement in preschool transition planning. The term involvement refers to participation in the transition process for children moving from early intervention to preschool, and includes collaboration with professionals, consultation with families, and assessment for intervention planning.11 Facilitators are the factors that therapists perceive as supportive of their participation in transition planning.

Method

Study Procedure and Participants

Data collection occurred between March and May 2008. Study participants were 600 randomly selected members of the American Physical Therapy Association's (APTA) Section on Pediatrics. The data collection procedure was adapted from the work of Dillman.12 Participants were mailed a cover letter describing inclusion criteria for the study and the purpose of the study, the survey questionnaire, and a prepaid business-reply envelope. The cover letter contained language stating that the completion of the survey implied consent to participate in the study. A second survey questionnaire, cover letter, and prepaid business-reply envelope were mailed to 400 participants who had not replied by mid-April. Anonymity was maintained by using a coding system.

Instrument

The survey instrument, Physical Therapists' Involvement in Preschool Transition Planning (PTIP), was adapted from a well-validated tool used in previous studies of school psychologists' and occupational therapists' involvement in early childhood transition planning.11,13 The survey consisted of 2 scales: (1) the Involvement Scale (25 items), which measured physical therapists' perceived involvement in transition planning, and (2) the Facilitator Scale (15 items), which measured physical therapists' perceptions of strategies and activities that supported their involvement in transition planning. Internal consistency of the 2 scales was high in the adaptation of the tool for occupational therapists (α>.90). 11

Item choices were in a Likert scale format (1=never involved/not at all facilitative, 2=rarely involved/minimally facilitative, 3=sometimes involved/moderately facilitative,4=often involved/fairly facilitative, 5=almost always involved/quite facilitative, and 6=always involved/very much facilitative). A draft of the PTIP was sent to an expert panel for review. The panel consisted of 3 doctorate-level physical therapists with extensive clinical and research experience in early intervention and school-based services. Based on panel feedback, 1 item was removed from the Facilitator Scale. The final version of the survey included 40 items in the Involvement Scale and the Facilitator Scale, followed by a short demographic section (6 items) designed to obtain information regarding the therapists' level of education, work experience, and work environment. Two sets of the Involvement Scale and Facilitator Scale were included in the survey: 1 for physical therapists working in early intervention and 1 for physical therapists working in preschools. The data and findings for physical therapists working in preschools are reported here. Data from physical therapists working in early intervention have been reported elsewhere.14

Data Analysis

SPSS version 15.0* was utilized for data analysis.15 Facilitators of involvement and demographic information were analyzed through descriptive statistics, frequencies, and percentages. Principal factor analysis of the data from physical therapists working in preschools was performed. Internal consistency of scales and subscales was determined through calculation of Cronbach alpha. To distinguish the variables associated with the respondents' perceived involvement in transition planning, hierarchical regression was performed. Data were screened for missing data, and less than 1% of missing data was identified in the response items for the Involvement Scale and the Facilitator Scale; therefore, there was no treatment of the missing data, and participants with missing data were removed from the principal factor analyses and hierarchical regressions.

Results

The response rate was 56%, with 5 survey questionnaires returned as undeliverable and 338 completed survey questionnaires received. Of these respondents, 145 (43%) identified themselves as working in preschool programs with children who were transitioning from part C early intervention to part B preschool special education services. All 50 states were included in the respondent pool. Demographic data for the respondents are presented in Table 1. To verify reliability of data entry, 68 (20%) of the completed survey questionnaires were randomly selected for review for accuracy of data entry; no discrepancies were found upon review.

Table 1.

Respondent Demographics

Facilitators of Transition Planning

To identify respondents' perception of the importance of specific strategies and practices to transition planning, the Facilitator Scale items were ranked. Table 2 lists the 5 highest- and lowest-ranked facilitators of involvement in preschool transition planning. “Staff at my preschool program value my participation in transition planning activities” (X̅=5.02, SD=1.36, n=142) was the highest-ranked facilitator, and “I am encouraged to participate in transition planning activities by the early intervention service coordinator” (X̅=1.91, SD=3.50, n=143) was the lowest ranked.

Table 2.

Five Highest-Ranked and Five Lowest-Ranked Preschool Facilitator Scale Items

Factor Analysis

A Kaiser-Meyer-Olkin measure of sampling adequacy was performed, and the value was .87 for the Involvement Scale items and .91 for the Facilitator Scale items, above the .60 necessary to demonstrate that the data were adequate for a factor analysis. Prior to the factor analysis, the data were screened for normality of distribution. One abnormal item was identified from the Involvement Scale and removed from the analysis: “I develop intervention recommendations based on assessment results.” Two factor analyses then were performed using varimax rotation (1 with the Involvement Scale items and 1 with the Facilitator Scale items). The criteria used to determine the number of factors to retain for each analysis were: an eigenvalue greater than 1, the results of the scree test, and the relationship of the items within the factors.16 The items with loadings greater than .40 on each of the factors were considered to be meaningful to that factor. When an item loaded on more than 1 factor, the item was placed with the factor that had the higher loading.

For the Involvement Scale items, both the eigenvalue rule and the scree test suggested a 5-common factor solution with eigenvalues of 9.1 (37.5% variance), 3.3 (13.7% variance), 1.8 (7.4% variance), 1.3 (5.6% variance), and 1.1 (4.4% variance). Factor loadings ranged from .58 to .82 with all 24 items loading onto the 5 factors: collaboration with early intervention, family support, evaluation, teaming in preschool programs, and working with preschool teachers (Tab. 3).

Table 3.

Analysis Item Loadings: Involvement

The eigenvalue rule and the scree test for the Facilitator Scale items suggested a 2-common factor solution with eigenvalues of 8.5 (57.0% variance) and 1.4 (9.6% variance). Factor loadings ranged from .53 to .88, with all 15 items loading onto these 2 factors: perceived value and expertise and external supports (Tab. 4).

Table 4.

Factor Analysis Item Loadings: Facilitators

Reliability

Summated scales were constructed based on the factor structure. The internal consistency (Cronbach alpha) of the 24-item Involvement Scale was α=.93. The internal consistency of each factor subscale was: α=.91 for collaboration with early intervention (7 items), α=.87 for family support (6 items), α=.79 for evaluation (4 items), α=.83 for teaming in preschool programs (5 items), and α=.87 for working with preschool teachers (2 items). The internal consistency (Cronbach α) of the 15-item Facilitator Scale was α=.94. The internal consistency of each factor subscale was: α=.91 for perceived value and expertise (6 items) and α=.92 for external supports (9 items).

Factors Associated With Involvement in Transition Planning

Two hierarchical regressions were performed to ascertain which factors were associated with the physical therapists' involvement in preschool transition planning. Previous studies on the role of therapy providers in early childhood transitions,10,17,18 as well as the conceptual model of early childhood transitions,6 were used in determining the independent variables and order of input for the dependent variables. Additionally, the independent variables, collaboration with early intervention and family support, were chosen because previous literature has identified collaboration and family support as central aspects of building relationships between teams and families in family-centered early childhood programs.19,20 In both models, perceived value and expertise was entered into the model in step 1 and external supports was entered into the model in step 2.

The results of the regression models are presented in Table 5. In the first regression, the overall model was significantly associated with collaboration with early intervention (F2,128=103, P<.001). Perceived value and expertise explained 61% of the variance (F1,129=207, P<.001), and the addition of external supports did not explain any additional variance. In the second regression, the overall model was significantly associated with family support (F2,133=24, P<.001), Perceived value and expertise explained 26% of the variance (F1,134= 8, P<.001), and the addition of external supports did not explain any additional variance.

Table 5.

Hierarchical Regression Models

Discussion

A discussion of early intervention transitions must first acknowledge the wide range of service delivery models and team interactions used across the nation. Part C of IDEA gives each state a considerable amount of latitude in determining service delivery.5 Therefore, any national study must recognize this state-to-state variation and the influence it might have on the results.

Overall, our return rate was exceptionally good at 56.3%, considering that not all of the 600 therapists surveyed actually worked in the early intervention and preschool settings. The return rate was higher than for other occupational therapy (41.6%) and physical therapy (44.3%) transition planning studies.10,17 The perceptions of being valued by staff at early intervention programs and having expertise in transition planning were found to be associated with preschool physical therapists' early intervention team collaboration and support of families during the transition process. These findings echo recommended practices for early childhood transitions that include aspects of communication and relationships between sending and receiving programs that are crucial to transition planning, such as families having the opportunity to jointly meet with sending and receiving providers, program providers receiving adequate training to work with families during transition, and service providers visiting each other's programs and sharing observations during transition planning.21

Having staff at the respondents' preschool programs value their participation in transition planning was ranked highly as a facilitator of their involvement. Similar findings were discovered in a study of preschool occupational therapists' involvement in the transition planning process,22 and correspond with the assertion that both provider and individual program factors have an effect on transition planning.4 In contrast, being encouraged to participate in the transition process by service coordinators from the early intervention program was the lowest-ranked factor, a result similar to that found in the study of preschool occupational therapists' involvement in transition planning. Recommended practices suggest that the building of relationships between programs is a support to the transition process.4,21,23 The perception of low encouragement by service coordinators may indicate weak relationships between programs, may be related to a lack of understanding by service coordinators regarding the role that physical therapists may have in supporting children and families during the transition process,10 or might be a sampling artifact, as only the responses of physical therapists working in preschool programs are reported.

Another comparable finding to the study of preschool occupational therapists was the low ranking of the use of formal and consistent communication with personnel from other programs as a facilitator of involvement. Communication among personnel is both a recommended and a well-researched practice for supporting families and children during early childhood transitions3,8,21,23 and is an important element included in many of the physical therapy early intervention and school-based competencies.24,25 This item is a part of the perceived value and expertise subscale, thus suggesting that physical therapists engaging in formal and consistent communication with early intervention program personnel have greater involvement in transition planning. From a logistical standpoint this makes sense, given that many preschool physical therapists do not know the children on their caseloads until after the school year begins; however, many children turn 3 years of age and transition during the school year. It also may be related to the wording of the item, which states that the communication is “formal and consistent” and does not take into account any informal or occasional communication between preschool physical therapists and early intervention programs prior to the transition, an important aspect of practice identified in a previous study of therapy providers and transitions.18 An additional possibility is that the service delivery model used by the early intervention programs might have negatively influenced communication. Despite these possibilities, several studies and policy statements have identified formal communication methods as a supportive practice for children and families during transition.8,21,22,2528

Because expertise in transition planning (eg, having participated in training, understanding the physical therapists' role) was one aspect associated with greater involvement, the roles of pre-service and in-service training and mentorship should be considered. Pre-service training in early intervention and early childhood for physical therapists has been identified as a weak area in physical therapy curricula.29 In a previous study of physical therapists' role in early childhood transitions, most respondents reported obtaining information about transitions from other therapists.10 A lack of formal, specialized training in early childhood transitions may result in decreased physical therapist involvement, thus limiting potential important contributions for the child and family throughout the transition process.

That external supports were not associated with collaboration with early intervention programs or family support was an unexpected finding. This finding differs from the results of the preschool occupational therapists' study in which supports from employers were found to be significantly associated with both collaboration and family support.22 The reason for this discrepancy may be the respondents' significant amount of experience in early intervention and the fact that they reported having manageable caseloads and employers who encouraged collaboration.

Future Research

This study was an initial evaluation of physical therapists' involvement in the transition from early intervention to preschool and is a starting point for future research in this sparsely studied area. Future research should explore how physical therapist involvement in early childhood transitions is related to positive transition outcomes for children and families. Analysis of outcomes of professional (entry-level) education programs or continuing education courses that seek to increase therapists' knowledge of the transition from early intervention to preschool could be performed in order to identify the efficacy of transition training programs and activities.

Limitations

In our study, we used only members of APTA's Section on Pediatrics for our sample, which was a limitation, as many therapists involved in early intervention and preschool settings may not be APTA members. Members of a national organization may constitute a biased sample and might be more likely to participate in a survey that could influence the findings. It also is difficult to assess transition planning from a national point of view, because each state has specific requirements regarding early intervention and preschool transitions that could vary and make results less likely to extrapolate to all states.

Conclusion

Overall, the perception of being valued by team members in both the early intervention and the preschool programs significantly predicted therapist collaboration with preschool programs during transition planning. This finding is consistent with that of a similar study of occupational therapists, in which relationships between preschool and early intervention programs was associated with involvement in transition planning.22 Best practices for early childhood transitions include those that support communication, collaboration, and strong, positive relationships between sending and receiving programs. Physical therapists who identified implementing these practices as a part of their participation in transition planning were more involved in the transition process.

Footnotes

  • Dr Myers, Dr Effgen, Dr Blanchard, and Dr Miller provided concept/idea/research design. All authors provided writing. Dr Myers, Dr Blanchard, Dr Southall, Dr Wells, and Dr Miller provided data collection. Dr Myers, Dr Effgen, Dr Southall, and Dr Miller provided data analysis. Dr Myers and Dr Effgen provided project management. Dr Effgen provided participants and facilities/equipment. Dr Myers, Dr Wells, and Dr Miller provided consultation (including review of manuscript before submission).

  • This study was approved by the University of Kentucky's Institutional Review Board.

  • A poster presentation of this research was given at the Annual Conference and Exposition of the American Physical Therapy Association; June 10–13, 2009; Baltimore, Maryland.

  • * SPSS Inc, 233 S Wacker Dr, Chicago, IL 60606.

  • Received August 30, 2010.
  • Accepted January 9, 2011.

References

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