National Inclusion Webinar Series (2016)

MEGAN VINH >> Welcome everyone to the webinar, Preschool inclusion, what's the evidence, what stands in the way, and what do stellar programs look like. We're going to go ahead and get started. I'm Megan Vinh from the Early Childhood Technical Assistance Center and the Center for IDEA Early Childhood Data Systems. These centers are funded to provide technical assistance to states and are funded by the Office of Special Education Programs. I'm joined today by Linda Smith, Deputy Assistant Secretary for Early Childhood Development for the Administration of Children and Families at the U.S. Department of Health and Human Services and Phil Strain, the director of the PELE Center, faculty and the Early Childhood Technical Assistance Center and a professor at the University of Colorado Denver. Today's webinar will focus on key research findings related to preschool inclusion, along with program elements that characterize high quality inclusive settings. Just as a note, captioning is provided. You can find the caption link and information in the inclusion webinar notes pod. We're also recording this webinar so if you want to come back to it later, and for those who aren't able to attend today, you can share the link. I'm going to turn it over to Linda Smith.

LINDA SMITH >> Thank you, Megan. And I want to thank the Early Childhood Technical Assistance Center and the Office of Special Education Programs for sponsoring this, what we think is a very important webinar, a part of our efforts to elevate and shine a light on the issues around inclusion, especially in the preschool years. As many of you know, on September 14th of this last year the Department of Health and Human Services and the Office of Special Education Programs, started an effort to call attention to an issue that we really wanted to promote and support around the country. It's our department's position and I stress both department's positions that all children with disabilities should have access to inclusive high quality early childhood programs. And I think that's our focus for all of our programs but particularly for children with disabilities. So we wanted to make sure that we, through this policy statement called attention to that. Inclusion in early childhood programs refers to including children with disabilities in early childhood programs together with their peers without disabilities, holding high expectations and intentionally promoting learning facilitated by individualized accommodations and using evidence-based services to support their development. It's that evidence we want to get at in this upcoming briefing today. We know attitudes and beliefs are the most commonly reported barrier to child inclusion and may be influenced by misinformation, resistance to changing practices, stereotyping children with disabilities and general lack of awareness of the benefits for all our children. These are things Dr. Strain will talk about in the webinar. There's a general lack of expertise in the early childhood workforce. Early childhood providers and teachers don't necessarily have the knowledge and competencies they need and especially when it comes to individualizing instruction. It affects children and parents and who gets in and who doesn't get in to early childhood programs. So a key ingredient to inclusion is this whole issue of how are we working to prepare the workforce for the children that we need to serve? So we want to, through this webinar and through our policies, support a culture of inclusion, one that is very open and accepting and one where all children and families feel welcome and included. So just a few recommendations, going back to the work I did many years ago. We need to look at our professional development of our staff and early childhood programs and make sure that they have the knowledge and competencies and the attitudes that this is something that should be done for all children. When I say that, I mean professional development shouldn't stop with the teachers in the classroom. We need to make sure that our principals, administrators, childcare directors all understand and support this. Because if they don't support it, it just doesn't happen. Then we really need teachers and providers who understand these things. They need the special support of early intervention specialists, special educators, and other personnel as they work on this inclusive model. So we don't think this is an easy thing and we know that we've got a lot of work to do. But we're hoping by shining a light on this issue that we're able to open this up and begin to have our programs being more inclusive.

So what I'm going to do now is turn it over to Dr. Strain who's going to walk you through his briefing on what's the evidence, what stands in the way, what are some of those barriers and beliefs people have or don't have, and what do really stellar programs look like. Let me tell you a little bit about Dr. Strain. He's Professor of Educational Psychology at University of Colorado Denver. He's also the Director of the Positive Early Learning Experiences Center. He's a well-known and prolific educator in the field of special education, contributing in many ways, especially in his work assessing and developing intervention techniques for young children with emotional disorders and autism. Working in the field of intervention since 1974, he's authored over 300 papers and Phil, my hats off to you on that one. He's been awarded more than $38 million in research grants and has served on a number of editorial boards for different professional journals. His primary research interest include interventions for early onset conduct disorder, design and delivery of community-based comprehensive early intervention for children with autism, and analysis of individual and systemic variables affecting the adoption and sustained use of evidence-based practices for children with severe behavior disorders. So he'll be discussing inclusion in early childhood settings in preschool programs and I'm so happy that he's agreed to do this for us. He has such a wealth of knowledge and experience and I'm looking forward myself to hearing what he has to say. So Phil, it's over to you.

PHIL STRAIN >> Thank you so much for your kind remarks and very smart introduction outlining some of the broad issues that are pertinent to the topic of inclusion for young children with special needs and typically developing children. Before I launch in to a review of research findings, I wanted to make three brief preliminary remarks. First of all, I want to emphasize that no one has shown to date that children educated only with other children with special needs somehow uniformly fail to make progress. The real question before us is a relative effectiveness one, namely if children are provided with truly high quality inclusive settings, is there a value added that's obtainable and if so what is the real value of that difference? Second point I'd like to emphasize is there's a fairly long and for me a regrettable history of accusations and name calling and attributing, if you will, negative motives to folks who don't necessarily agree or share the same thinking. It may make themselves feel validated by belligerent behavior but there's no evidence that I'm aware of that this kind of posturing ever changed anyone's mind and it might actually have the opposite effect. My hope is that this webinar fosters civil discourse. Finally, I think we all need to acknowledge from the outset that there are good examples and there are poor examples, unfortunately, of service delivery at all points of the LRE continuum. The issue in my mind is whether all children and families have a choice. I would emphasize a choice to participate in high quality inclusion in their communities. Unfortunately, the national database suggests that this is absolutely not the case and that is precisely why the joint statement from the departments of education and health and human services are so important. So there has been 40 years of research on inclusion for young children with special needs and there's no way to capture the richness of all that research in a brief webinar.

I have picked out five general findings that I think are particularly relevant to the logic and the rationale around the joint inclusion statement. And those are the things I want to start by focusing on. There are five general findings that I want to emphasize. The first is high quality inclusive settings are the only environments that I'm aware of with data that consistently support children's superior learning. And importantly, there have been a number of well controlled experimental studies in which children in non-inclusive settings have been shown to have their learning negatively impacted. That is to say after being taught certain social and language skills, subsequent placement in settings with only other similarly disabled children has resulted in rapid skill loss. The second point I want to emphasize is that if you simply look at the number of studies that have been published in peer reviewed journals directly comparing comparable children in inclusive and non-inclusive settings, the ratio with which inclusive settings beat the alternative is about 15 to 1. I could be wrong about this. But I'm not sure there is any other issue in education, special education, early childhood special education, or human services for that matter where the ratio is so extreme. Favoring one option or another.

The third issue, that I'd like to focus on relates to the fact that fully included options have been shown to work across a wide variety of children from different disability groups or categories, if you will, and across varying levels of severity. So the data on inclusion comes from children with developmental delays, mild to severe, children on the autism-spectrum, children with multiple disabilities, children with significant social and emotional needs, children with hearing impairment, and children with limited mobility. It's also important to emphasize that the data come from childcare settings, from head start, from public pre-K, and from private pre-K. Let me add three footnotes to this piece of evidence. The first is to acknowledge that there is something conspicuously missing here and that is data representative of children and families from culturally and linguistically diverse backgrounds and hopefully that's something that can be corrected in future research efforts. The second thing that's important to note is that some of the most powerful outcomes that have been reported in the literature come from children who have some of the most significant developmental needs. As it turns out, the data don't support the common perception that children with who are less involved are better candidates for inclusion. The third point that's vital to keep in mind is that quality inclusion will look real different for different groups of children and different children within groups. So for example, a high quality inclusionary setting for children with limited mobility will be a setting very likely where there have been massive accommodations to the classroom, physical layout, materials, to the building itself, to outside play areas, et cetera. For children who are using AAC of various kinds, be it picture exchange, communication system, Big Mac devices, American Sign Language, obviously those environments are going to have to be those in which adults and peers are competent communication partners. So that's a really important footnote to keep in mind. Quality inclusion is not a uniform one size fits all model.

The fourth finding is that fully inclusive options tend to be of higher quality in general. What do I mean by that? I mean when folks have compared inclusionary settings to non-inclusionary settings, what they've also found is that the inclusionary settings tend to be programs that are more evidence based in their selection and use of instructional practices. They tend to be programs that maximize families' involvement throughout the program, and they tend to be simply more data driven in their approach to the provision of special education and related services. The final finding I want to emphasize is that the greatest magnitude of effect is in the peer social domain but it's also true that children in inclusive settings have consistently made very positive gains over similar children in non-inclusive settings in their communicative skills and cognitive skills. Here it's worth digging down a bit deeper and asking the question, what's the big deal about social outcomes? So there has been to date about 40 years of research conducted by professionals in multiple academic disciplines and across generations of children in which people have asked the question, what's the long-term impact of developing friendships, being a part of a friendship network when you're a preschooler and what happens later in life? In fact, I think it's possible to argue with confidence that these are some of the most reliable data in all of the behavioral sciences because there's no counterfactual. There's no data to the contrary.

So what is it that is associated, or what are the constellation of factors that are associated with developing friendships early on in life? Those children have better academic skills, higher high school graduation rates, experience fewer special education services, they have better adult employment status, greater chance of independent living, better adult mental health, and less drug and alcohol use in the teen years. That's actually an abbreviated list. Based upon recent evidence the benefits also include the rapidity of recovery from illness, particularly cardiac illness, and longevity. You just tend to live longer.

So it's also important to keep in mind that these associations between early social relationships and later outcomes in K-12 and in adulthood are not necessarily attributable to magic. A number of us have studied, for many years now, what it is that friends and friendship networks actually do for each other. There are three things that I'd like to share. First of all friends always involve and includes their mates. Friends look out for their friend's best interest. That means that friends don't get teased, don't get bullied, don't always wind up last in line, last to choose a toy or a material. Finally and perhaps more important to long-term outcomes, friends encourage each other to explore the world and learn new things. Here's the bottom line. Friendship networks expose children, typically developing children and children with special needs to untold numbers, perhaps tens of thousands of additional learning opportunities that no number of teachers and no number of therapists can replace. By the way, the most effective intervention known, the most wildly replicated with largest effects are interventions that rely on involving children. What does that mean? The most obvious answer is it means children not in inclusive settings are precluded from receiving the most powerful evidence-based practice available for improving their peer related social skills.

It's also vital as we think about what the research related to inclusion says about typically developing children. Here's what we know. First of all, when there's been a direct comparison of typically developing children who are in inclusive settings with children with special needs and typically developing children who are in toddler and preschool environments with only other typical developing children, we've seen equal or sometimes greater cognitive and language skills in favor of children in inclusive settings. Not a big surprise because after all not only do they have access to high quality early education, but now they have access to the extraordinary technology of teaching incorporated with early childhood special education and related services. Children who are typically developing in inclusive settings have more advanced social skills. And lastly, they've been found to have more accepting attitudes toward individuals who are different. In fact, what we know now is that high quality inclusive settings appear to be able to inoculate, if you will, young children from developing negative stereotypes about those who are perceived to be different. And it's not just that. It's replacing those negative stereotypes with a willingness, pridefulness, and true joy in helping look out for, advocating for, and learning with and from their friends with special needs.

So given all the data that we have about quality inclusionary settings, and its effect on children with special needs as well as children who are typically developing, a reasonable question is why doesn't everybody do inclusion as the first placement option? As Linda mentioned earlier, we've had about 30 years of research looking at barriers to inclusion and while there are all kinds of categories and types of barriers, what is most prominent in the literature are attitudes and beliefs. So people feel on occasion that inclusive services are too expensive, that it may be somehow illegal to blend funds, and hopefully this joint statement will be the stake through the heart of that idea. That children need to be developmentally ready to benefit from inclusion in spite of the fact that research dating back to the 70s indicates that's not the case. Some people think parents as a uniform group do not want it. It's certainly true some parents prefer some other mode of service delivery. And in my mind, absolutely they should be honored for those choices. But it's also the case that any time researchers have directly assessed parent perceptions when their children have been enrolled in inclusive programs, the responses have been overwhelmingly positive. Some folks think inclusion harms typical child learning. Some folks think the necessary intensity of instruction can't be delivered in an inclusive setting. And sometimes folks feel like inclusive environments are just too stimulating, notwithstanding the fact that there's never been a study in the history of the world in which a systematic reduction of stimulation somehow caused a child to learn better. Well, I guess there are many different hypotheses about why it is that these attitudes and beliefs persist. But I will share my hypothesis. And that is that these attitudes and beliefs exist because actually there are a lot of poor examples of inclusion. And I'd like to end my presentation with talking about good examples. And to drill down deeply and ask the question what characterizes the inclusionary programs that have actually been shown to be superior to non-inclusionary programs. That's one of the reasons why I'm so pleased with the statement, as well as with the prior webinar last week from the Department of Education and HHS with an emphasis on quality inclusion.

So what characterizes these high quality programs? One of the things that characterizes the programs is that they have more typically developing children than children with special needs enrolled. Some of the best data on the topic come from my friends, the three of us, Eileen Schwartz, Gayle McGee and I have all been studying problems and potentials around inclusion for at least 30 years. And it's instructive, I think, that we all began with a 50/50 ratio, we all published data on the efficacy of that with both typically developing children and children with special needs doing quite well. However, over time, we abandoned that 50/50 ratio for good reasons. And at a minimum we've gone now to a 2 or a 3:1 ratio. What that has done for us is that it's provided far more generalization opportunities in that all important peer social domain. That is to say children with special needs have more play partners, more varied interaction, more opportunity to practice their peer-related social skills. Turns out that's a really good thing. The second thing that we were noticing in all our programs is that there are times during the day when children with special needs congregate with only other children with special needs. When that happened we would typically see a brief acceleration in the amount of challenging behavior. The easy fix to that, of course, is to reduce the probability of that event ever occurring. That is children only populating in areas where there are only other children with special needs through altering the ratio. Similarly, and in our own LEAP program, we saw a spike in autistic-like behaviors when children with autism were only in physical proximity with one another. Simply changing the ratio was an effective intervention. And finally, by changing the ratio we avoided what is common and a lot of inclusive preschool programs and that's the phenomenon of buddy burnout, a phrase we use to describe a fairly serious problem over time that can occur when typically developing children are working so hard to get their friends to interact and communicate with them that you need to increasingly provide children with more and more external reinforcement. So that's the first characteristic around quality inclusion.

The second is these high quality programs are inclusive every day and all day long. They're all about social inclusion and they're all about instructional inclusion. By contrast, we all know of so called inclusionary programs that are simply holding areas where children are just waiting for their special education and related service provider to arrive. Those are not environments that have demonstrated their superiority of non-inclusive settings.

The other characteristic I would point out is the highest quality programs have employed a transdisciplinary model of service delivery. My favorite definition of transdisciplinary is this. If you're really doing this, you can walk in to a classroom and based upon what adults are doing, and who they're doing it with and where they're doing it, you would have no idea who the regular education teacher is, who the special education teacher is, who the speech and language pathologist is, who the occupational therapist is, who the paraeducator is, et cetera. Transdisciplinary is about sharing your expertise. But it's more than that. Much more than that. It's also about providing a maximum amount of instructional generalization opportunities. Where children who are practicing using language are practicing with a paraeducator as likely as they are with their speech and language pathologist, as likely as they are when they're in the presence of a parent volunteer. What that also means is that IEPs and IFSP goals get addressed every day and all day long. It changes the intensity of the intervention equation. And also I hope we can all agree that that sort of transdisciplinary service model by definition improves the consistency of adult child interactions.

Another important dimension of high quality inclusive programs is what I call the full utilization of peer influence. We know from the developmental literature that peers exert an incredibly powerful influence over one another. Sometimes we choose to harness that influence and sometimes we do not. Let me just address with an abbreviated list the fundamentally important things peers can do within toddler and preschool settings to improve outcomes for all children. They can initiative social interactions. They can invite other children to activities to improve transition times and compliance. They can take someone's hand and lead them from place to place. They can respond to social bids that other children emit. They can pass out and pick up materials and props and engage in further simple but important social interactions. They can model desired actions, how to play with a new toy in a classroom for example. They can praise and compliment their peers when they build a beautiful tower or draw a beautiful picture. They can give play directions. They can help others with tasks by providing assistance. So let's just look at a brief video of how peer influence might play out in a preschool classroom.

PHIL STRAIN >> So just a brief example of peer influence at work. The next dimension of quality that I want to emphasize is the necessity to have a predictable and comprehensible routines in the classroom. We call this routines to the third power. What does that look like? In every classroom, if you ask the teacher do you have a daily schedule? They'll most likely tell you yes. In this teacher's daily schedule, the third activity that happens every day in the third order is an opening circle and that begins to help children predict and understand what's going to happen, but that's not sufficient for children with special needs. We need to get to routine to the second power and ultimately to the third. So opening circle in this classroom also has a routine. And that routine is invariant from day-to-day. The order doesn't change. Begins with a greeting song, then there's calendar, child choice song, social skill lesson, et cetera. And from there we can get to ultimately routines to the third power such that calendar also has predictable sequence to it, starting out with clapping out the syllables in the month, days of the week song is sung, add a day to the calendar, so on and so forth. What we find is once we get teachers to plan to get routines to the third power, we see wonderful increases in child engagement and not surprisingly corresponding decreases in child challenging behavior. Another important ingredient of quality inclusion are these predictable and comprehensible routines. By the way, it makes life predictable and comprehensible for adults as well once you do this kind of planning. Beginning with the pioneering work of Dianne Bricker in the 1970s, we have learned over the years that inclusive settings can be very intensive in high dosage learning environments where hundreds of learning opportunities are embedded in fun, engaging, and meaningful and developmentally relevant contexts. What I'd like to show you here, in a moment, is this video of a story time activity with one of my favorite books, The Mitten. I want you to focus on the fact that this teacher has embedded social goals, receptive language goals, expressive language goals, motor imitation goals, pre-literacy goals and cognitive goals for four children on the autism-spectrum who are in this video. So let's take a look.

PHIL STRAIN >> Okay. I hope you enjoyed that video. I love The Mitten myself. And I hope you caught all of the instructional goals that were being taught. Let me just say that the cues the teacher was providing are not the product of an accident. This is carefully planned out sequence. And oh, by the way, the first four kids in the mitten were the kids on IEPs.

So let's move on to another important dimension of high quality inclusion. That is the use of a wide range, emphasis on wide, wide range of evidence-based practices used and their efficacy assessed frequently. So what's true is that the high quality inclusionary programs are not one-trick ponies. They're not designed to deliver one modality of intervention to everybody who walks through the door. What exactly does this it mean to have a wide range of evidence-based practice? Well, for me, it means that programs originally choose an evidence-based practice from the range of practices incorporated in the 2014 DEC Recommended Practices document. It means the choice is made depending upon the particular developmental domain that is the focus of intervention and the particular child and her strengths and needs and preferences and past history with intervention. Secondly, it means the program collects data on the application of the evidence-based practice to ensure for everyone that it was delivered and to monitor its immediate effects on the behavior in question. Third, it means practitioners meet often. Perhaps even daily if necessary to review progress and to make plans. And fourth and finally, it means practitioners are ready, willing, and able to go to an intervention plan B if the data so dictate.

Let me end with a research footnote if you don't mind. So I've completed this section on what do the stellar intervention programs look like, and I hope that's been instructive for folks and along the way, just incidentally, you've gotten some answers to your questions from my colleague here, Ted Bovey who's sometimes known as my left brain, sometimes known as my left and right brain, but more significantly, he works on our inclusionary programs in the PELE Center here in Denver. Thank you to folks answering questions along the way. Appreciate that very much. Let me just suggest the following for your consideration. And that is that preschool inclusion shouldn't be an endpoint. It should be a launch point. It should be a launch point to a lifetime of being welcomed and a lifetime of inclusion. Here's some data that drive home that point for me. About five years ago Ted and I did the largest at the time, still may be, largest randomized study of early childhood special education service delivery for young kids with autism. In this case, in an inclusive model preschool. We found excellent outcomes for children who participated in the program. We subsequently received federal dollars from the Institute from Education Sciences that originally funded the randomized study to do a follow-up following children in first, second, and third grade. In the course of this study, an accidental experiment occurred and these are the results of that accidental experiment if you will. We were able to identify 20 pairs of children. They became pairs because they were matched in terms of the severity of their autism symptoms and their cognitive skill at the end of preschool. Matched in the sense that they were remarkably similar on both those assessment measures. As it turns out for these 20-pairs of children matched in terms of severity of autism and cognitive ability, one member of the pair attended an inclusive classrooms from preschool to grade 3. The other member of the pair just so happened to be in a school district with a different policy. These children were in a non-inclusive autism class in kindergarten, first, second, and third grade. The results here show the differences between the members of those 20 pairs going in to a non-inclusive setting and in an inclusive setting. There are four measures on this graph that include the cognitive achievement test, the test of oral language development, which is an expressive language inventory, the lighter intelligence scale, and the vineland adaptive behavior scale. For each of these measures, 100, the scale score, represents either age level performance or grade level performance. What you can see is the children that had a longitudinal inclusive experience are fundamentally different. The effect sizes are all greater than one. They're very large effect sizes. That's, again, consistent across measures. So that's why I say preschool inclusion is a great starting point, but should not be the end point around pushing and advocating for parents having greater choices as their kids proceed through K-12 education. And that ends my portion of the webinar. Thanks to everybody who's helped me out. And those of you who have been on the call. Megan, it's over to you.

MEGAN VINH >> Thanks so much, Phil. That was really great information. To end the session we wanted to talk about a couple resources that are available to help you in your work. So, first the Early Childhood Technical Assistance center or ECTA has available resources that span a wide range of topics. The link on the bottom of the page will take you to ECTA Center's inclusion topic page. There you can find information on federal law and guidance, tools for understanding the environment, resources developed by states related to inclusion such as planning materials, self-evaluations and tip sheets. There's also the position statements from national organizations. We also have resources on infrastructure supports such as financing strategies and collaborative funding and personnel development for inclusion. So, today's webinar focused on research related to inclusion. On the ECTA Center website you can click the research and studies on inclusion tab to find helpful fact sheets that may support your current efforts to message and improve high quality inclusive settings. These materials are great because they support all of what Phil has said and are put in to a nice fact sheet format that could help you when you're working on improving inclusion.

You can also find information on inclusion at the Department of Education and Department of Health and Human Services website. You can find these links in the PowerPoint provided. If you have additional questions you can e-mail the ECinclusion@ed.gov. Thank you for attending today's webinar. As a reminder, we got great information in the chat and great questions and we’ll make sure to follow up on any missed questions. Also this is one webinar in a series of webinars that's focused on research, practice, and public awareness of inclusion in early childhood programs that's going to be held over the next several months. The next webinar will occur in March and that webinar will be on planning, policy, and investing in inclusion. So we'll highlight the top four recommendations in the policy statement and it will show how states are using the policy statements in their work. The webinar information will be posted on the Ed website. Thank you for attending and we hope to see you on the next webinar. Thanks so much, everyone.

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