Integrated Classroom Support Service Model for Students with Complex Needs

The umbrella tor special education student services encompasses a variety of needs ranging from discussions to support a student to a student receiving 100% of services in a specialized setting.  It is typically a student with highly complex needs that requires individualized instruction within a smaller classroom setting. This writing will focus on an integrative classroom support service model for students with limited expressive and or receptive communication skills paired with possible intellectual disabilities that may or may not be co-morbid with ASD, defined as the student team committing to shared responsibility, push in minutes being heavier than pull out minutes and intentional focused and informal collaboration.

Shared responsibility is a necessity for effective complex needs instruction.   Karen Bethune et. el from Autism Spectrum News identifies that “whenever more than one person is responsible for client programming collaboration is necessary to best meet the needs of the client and to ensure continuity of care across settings, contacts and caregiver.”  This can play out as supporting student’s skills if they arise organically during your service minutes. For example, if the physical therapist is familiar with a student’s coping skills that they are learning and practicing through direct instruction with the occupational therapist that physical therapist may prompt the use of the skills as well.  Since there is intentional collaboration and opportunities for increased modeling or rehearsal this is more likely to support the skill acquisition.  Shared responsibility is a fundamental aspect for this model it emphasizes the collective effort of all team members to ensure student success.  It spans support across goals, team led activities and supporting direct needs.

Supporting students across goals is nothing but a major win for students.  It is frequent that a simple conversation about a student’s speech and language needs may be relevant for the social worker and vice versa.  It is possible that a minor adjustment in service could support that student’s acquisition of skill that another support service has identified for targeting.  Sharing the support for goals might look as simple as inputting data for a known goal by making the tally on the chart or clicking the data counter when frequency behavior occurs during your service rather than reporting it to the classroom teacher for them to document later for the student’s behavior intervention plan. It might also look like writing a team goal to support a student’s transitions, or the SLP and teacher writing and tracking a goal for expressive communication.  When there is more intentional connection building and increased practice, the goals should be achieved at a faster pace than when provided isolated and infrequent practice opportunities as may occur in a pull out service model.

​

​Team led activities are another way to increase collaboration while sharing responsibility for planning.  This might look like a 45-minute activity that is planned for and conducted by multiple support service staff and that is provided within the classroom setting or across shared building areas. There are many benefits to these type of co-treatment groups.  Often it is in these settings that specific skills can be modeled to the class team.  For example, if a student is working on using a specific strategy, a paraprofessional may be able to more closely observe the support service provider for modeling. There are many benefits to team led activities or co-treatment.  From experience one large benefit is helping to ensure the classroom teacher gets student or duty-free plan time.  Unfortunately for some program models the struggle for plan time is so real that even after thoughtful discussions with an administrator, at times a teachers plan times may even be broken up into 15 minute chunks here or there on ends of lunch or school day, or worst having no plan time scheduled within a day (which you can imagine how ineffective that is and can lead to staff exodus from your program).   Students with complex needs often need very individualized programming across many skills that team led activities can ensure more efficient use of learning time by being able to target multiple skills with less wait time.

Lastly, when it comes to shared responsibility, there's the basic benefits of having more hands for direct needs for students in a complex classroom.  For example, when support service staff are more regularly involved in conversation and modeling for supports such as specific sensory or communication tools, rather than redirect another human resource in the classroom or loose time transitioning to the tools they need, they themselves will be more capable of efficiently supporting the student.  This shared responsibility for direct needs also spans life skills supports such as assisting with shoe tying, using a tissue, or helping to support a transition.  Part of being an all hands-on team member is giving the student the support they need in the moment, that you are capable of, not just the support your certificates decree.   

In an integrated classroom support model, provider’s direct minutes are frequently provided within the special education classroom or other natural school day settings. In the classroom that might look like support services having their own station that they might see students at. It might also look like pushing into the classroom set times to direct instruct sensory support or it may be the speech language pathologist coming into the classroom and hanging out for blocks of time in the reading corner to work on skills during the student’s scheduled visits to that area. Service provider support may also look like attending a regular education class such as art or music with the student on a regular schedule to support goal targets.  When a support service’s direct minutes are provided within the natural school day it can increase the shared knowledge of routines, provide skill generalization opportunities and reduce transition times.

Having shared knowledge of day-to-day routines and happenings allow for skill connections and generalizations. When support staff are inside the classroom across multiple transitions, they see the student beyond their isolated targeted skill work and potentially can better plan for next steps.  There have been times where a speech pathologist has added words to AAC supports because they were not aware that the words were so frequently used within the structure of the classroom. There has also been adjustment with occupational therapists on how to better integrate and or adjust sensory activities that may not have happened without them frequently seeing the flow of the classroom through their lens of specialization. These two opportunities for improvement and many others I have experienced would not have been recognized if support staff were only pulling students from the room.  Without the connections that can be made by thoroughly understanding the student’s classroom it may take longer to generalize desired student skills
​

If you've worked with very young students where just one student requires support in regulation, expressive communication, joint attention skills while working on your specific objective, then you'll know how difficult transition times can be.  By having support staff push in with the integrated model you reduce lost time in your schedule for transition out of the classroom (if your skill practice did not purposely include transition-based skills practice that is).  Within the classroom, particularly at the beginning fo the year, the additional support assists with students building more independent transition skills as support staff can provide faded prompts or even suggest positive momentum activities to assist with a student’s transition.  There can even be a balance of transitions where perhaps beginning of the year the students are not transitioning out of the class as frequently but as the year progresses support staff begins to develop their transitioning skills depending on the student, where they currently are in regard to transitions.  Transitions can take up a lot of time and most students with complex needs thrive in a predictable environment where prolonged transitions may throw off a classroom schedule. ​

Although all three are important, shared responsibility, push in service model and collaboration, through my experience I have found that the intentional collaboration, focused and informal., is most important.  I have worked wihtin several types of program dynamics, and you can have push in and shared responsibility every day but without intentional (think maybe of structured) and informal communication opportunities the student rate of growth is not as high.  Effective intentional collaboration is both focused and informal, shares skillsets, and provides multiple perspectives.

Intentional collaboration combines both scheduled and spontaneous interactions among team members to address student needs.  We can't rely on informal opportunities alone so must schedule focused collaboration to routinely review caseloads, ensuring continuous attention to all students. I've worked through several models where there have been no whole team planning times or weekly for team planning times. I've found at least once a week 30-45 (depending on caseloads) minutes with the whole team is most beneficial.  My favorite years were when I had the whole team plan time weekly and I had 20 minutes where I could communicate with my paraprofessionals without students each day (most years I have worked the paras are paid bell to bell).  With 20 minutes outside of student attendance time intentional collaboration was increased.  I could divide 10 minutes as a standup meeting and 10 minutes as a stand down to address information sharing as the school day itself, We know the informal will happen, but we must be very intentional and ensure we schedule the focused collaboration to best support our students. ​

Sharing skill sets is another major benefit of collaboration.  When support services model within the classroom it allows opportunity for discussion and or acquisition of new skills by the classroom team.  I have participated on teams in the past that have left spaces on the agenda specifically for skill/tip share out where one week the SLP would share a strategy and the next week the OT shares one.  There are many structures that your collaboration agendas can take but most important is that you have a structure and clear agenda for collaboration as it can be incredibly easy to get sidetracked with all the impromptu conversations that can arise when discussing a handful of neurodivergent students.  When sharing skill sets in a formal manner it allows opportunities for questions and promotes deeper understandings.

An integrated support service model that allows for co-treatment can provide multiple perspectives for one event.  When there are more eyes, more evidence can be taken.  For example, when a student hit another child, my perspective was that this student was angry as I only saw the hit and the facial expression, and it appeared over the past few days that the aggressive student targeted a particular student.  However, a specialist in the room for a co-treat group was able to see that the ‘aggressive’ student had been hovering and following this other student and he believed that the aggression could have come from an attempt to make a connection. After discussion, the ‘aggressive’ student was given more guided practice opportunities with getting attention from this student in a more positive manner.  It is hard to always have eyes on all students so the extra opportunities for multiple perspectives can be a net gain when problem solving for students.

The integrated classroom support service model for students with complex needs emphasizes shared responsibility, prioritizes push-in services, and fosters intentional collaboration. This approach not only supports skill acquisition and goal achievement but also enhances the overall learning environment through reduced transition times and increased opportunities for skill generalization and multiple perspectives. Despite the challenges, the benefits of this model make it a valuable approach in modern special education.
​

Read more:
https://teacch.com/event/fundamentals-of-structured-teacching-virtual-14/
 
https://autismspectrumnews.org/effective-collaboration-models-for-individuals-with-complex-needs/
 
https://www.tandfonline.com/doi/full/10.1080/13603116.2020.1735540
 
https://ctrinstitute.com/blog/basic-needs-for-people-with-autism/
 
https://vcuautismcenter.org/resources/factsheets/printView.cfm/1201