1 COT Conference BIRMIGHAM– 18 June 2017Pakistani Occupational Therapists and Teachers Collaborate to develop Inclusive Education through Action Research Debbie Kramer-Roy (Brunel University London) Bushra Umair (AMI) Samreen Jawaid (AMI) Areeba Khan (OT-DUHS) Farzana Ashfaq (OT-DUHS) COT Conference BIRMIGHAM– 18 June 2017

2 Developing the role of Occupational Therapy in Inclusive Education in PakistanA collaborative Action Research Project between Brunel University London, Dow University of Health Science, and The AMI School Funded by the British Council and the Higher Education Commission Pakistan.

3 The partners The British Council’s Knowledge Exchange Partnerships required three partners: One UK University: Brunel University London Debbie has rich experience of working in Pakistan (OT, CBR and IE) One Pakistan University: Dow University of Health Sciences Offers a 4-year BSc in OT (one of only two OT schools in the country) One non-university partner: The AMI School One of a handful of schools in Karachi that has chosen to be Inclusive and understands and implements the principles well.

4 The Purpose of the ProjectTo use Action Research (AR) to develop a clear Occupational Therapy (OT) role in supporting Inclusive Education (IE) in Pakistani schools. The purpose of this is to contribute to the development of IE in Pakistan so that MORE children with special needs will be able to gain ACCESS to education and that ALL children will receive a BETTER quality education as they study and play together

5 Subsidiary Objectives:For OTs to develop OT concepts for supporting IE at multiple levels: individual child, classroom, school, community and public policy. To build Pakistani OTs’ research capacity through gaining knowledge and skills for qualitative research, and in particular Action Research. For OTs and teachers to gain Action Research skills. For OTs and school teachers to work together to develop a collaborative approach to maximise inclusion in the school, involving children and parents actively in the process. To develop resource guides for other schools, teachers and OTs to use. To use the resource guides as the basis for workshops / seminars in both Pakistan and the UK.

6 Why Inclusive Education?It is now a globally accepted human right for children with special needs / disabilities to be educated with their peers. It helps schools to improve their teaching approaches and practices and increases the quality of education for ALL children in the school. It is the most efficient way to work towards high quality “Education for All”.

7 The Salamanca Statement - 1994every child has a fundamental right to education, and must be given the opportunity to achieve and maintain an acceptable level of learning every child has unique characteristics, interests, abilities and learning needs education systems should be designed and educational programmes implemented to take into account the wide diversity of these characteristics and needs those with special educational needs must have access to regular schools which should accommodate them within a child-centred pedagogy capable of meeting these needs

8 The Salamanca Statement – 1994 (cont’d)regular schools with this inclusive orientation are the most effective means of combating discriminatory attitudes, creating welcoming communities, building an inclusive society and achieving education for all; moreover, they provide an effective education to the majority of children and improve the efficiency and ultimately the cost-effectiveness of the entire education system.

9 Inclusion versus Integration versus ExclusionThe term inclusion is often used wrongly In many situations children are “integrated” into a mainstream school system that remains unchanged. The child will be welcomed only if they can adjust to the system; i.e. it is conditional. Often children will be physically ‘included’ (present), but educationally excluded. E.g. they are given completely different tasks to do with or without help of a classroom assistant. They are not part of the class learning process and not working with their peers.

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11 In summary, Inclusive Education is:Valuing all students and staff equally Increasing the participation of student in, and reducing their exclusion from, the cultures, curricula and communities of local schools Restructuring the cultures, policies and practices in schools so that they respond to the diversity of students in the locality. Learning from attempts to overcome barriers to the access and participation of particular students to make changes for the benefit of students more widely. Recognising that inclusion in education is one aspect of inclusion in society. Source: CSIE (current website)

12 WFOT Position Statement on OT services in school-based practice (2016)Supports the international policies on Inclusive Education Emphasises the responsibility and skills of OTs to support it OTs need to “provide collaborative support to enable occupation and to remove or reduce barriers to participation of all students, particularly those with special educational needs” Cont’d

13 School-based OT in the UKOTs need to work on three levels of intervention: Primary level: Universal Design for Learning Secondary level: Focus on Differentiation Tertiary level: Focus on accommodation / individual intervention (Arbesman, 2013; COT, 2015; WFOT, 2016) Hutton et al (2016) make a convincing argument for this approach to be taken in the UK as well, in order to: Ensure the maximum number of children receive OT input Help build capacity of teachers to identify and support children with SEND Use available funding and resources as efficiently as possible

14 Activity #1 Play with the material given to you and list which school-related skills and concepts you could help a child develop with it.

15 Action Research Integrates theory and action in order to address important organisational, community and social issues together with those who experience them. It is a method of doing research that does not just collect information, but seeks to support the participants to bring about a positive change in their situation.

16 Action Research (2) There are many types of Action Research, but a key feature is that those affected by planned changes have the primary responsibility for deciding on courses of action which may lead to positive change, and in evaluating the results of these actions.

17 The process of Action ResearchExploratory phase to identify issues first Then a spiral of cycles planning action observation of the impact of the action Reflection on that action and its impact. A dynamic process Reference: Kemmis et al (2004)

18 Congruence of PAR and OT (1)PAR is “consistent with the values of occupational therapy and occupational justice” and a particularly suitable choice of research approach. PAR is an occupational form that gives the participants an opportunity “to develop the skills and knowledge necessary to take greater control over their own lives; in so doing, they promote their own health as well as the health of other community members” Participants develop valuable life-skills, such as becoming more aware of their own behaviour, expressing views and opinions, working as a team, planning and decision-making. Reference: Trentham and Cockburn (2005)

19 Congruence of PAR and OT (2)Working as a team of co-researchers is very congruent with the principles of client-centred practice: respect for the person’s skills and insights taking responsibility for one’s own choices enabling participation flexibility and keeping in view the links between person, environment and occupation Reference: Letts (2003)

20 Why Action Research for this project?It is a flexible and emergent / developmental approach It allows professionals to work together to explore the possibilities and barriers together The approach and resource guide that will be developed will be based on experiences from the Pakistani context: more suitable and more likely others will be encouraged to implement it The AR approach has similarities with Reflective Practice, which fosters professional development.

21 Our Course of Action Phase 1: Working At AMI SchoolOTs worked with Teachers at The AMI School in their classrooms. Team members attended conferences and presented work at international platform (COT –UK’ 15) to spread the word and to get exposure to the team members about the on- going inclusive practices in developed countries.

22 Our Course of Action Phase 2:Working At Other SchoolsTeams of OTs and Teachers from AMI have been working with schools of different middle and lower socio-economic background. The teachers team at The AMI School has started a School Improvement Programme, training and providing guidance and support to other staff members who are not directly a part of the research to build inclusive school environment , through provision of relevant books and material etc

23 The teams have been organizing workshops for parents and teachers at AMI /other participatory schools and presenting at conferences nationally /internationally.

24 Our Course of Action - Phase 3: Developing Resource Guide and DisseminationOTs and Teachers from AMI are still working with schools of middle and lower socio economic background The team has been spreading word-disseminating knowledge Visiting government and other institutes for special needs Presenting work and sharing information through - workshops , sessions , exhibitions and seminars for teachers, parents , local and international community . Developing a resource guide based on the research work and disseminating it through out the schools here in Pakistan.

25 How we work Situational Analysis of school as a wholeWhat factors facilitate inclusion? What barriers might there be? Looking at physical and social environment in the classroom, school, playground Classroom Observation May or may not focus on an individual child with special needs. Using Person, Environment and Occupation to reflect on what helps or hinders the child to participate in class. Resource log OTs and teachers working together to fill in a resource log with strategies /activities / lesson plans , developing it, following the action research cycle. Reflective logs Teachers/ Ots to fill in their reflections throughout the process to critically analyze and re plan accordingly

26 Classroom Observation LogDate: Class: Name of observer: Describe the physical environment, e.g. set up, lighting, wall displays. Describe the activity / activities taking place, e.g. materials used, explanation or instructions given, children work or play alone / in pairs / in groups? Whole-class Participation: To what extent are the children participating? Fully participating? Fully participating with help from an adult and/or adaptation of the task? On-looking –involved as an active observer?. Not participating at all? How do you know? Describe what you observe children doing! What facilitates the participation of children, e.g. physical environment, materials, instruction, classmates, adults?

27 Classroom Observation LogWhat barriers are there to the participation of children, e.g. physical environment, materials, instruction, classmates, adults? Individual child participation: Choose one child who is not participating fully and consider possible reasons for this. Describe the child: Person (child): Environment: Occupation/task: Reflect: What can you conclude from the above about what facilitates or hinders the child’s participation? Plan:

28 LOG SHEET for RESOURCE DEVELOPMENT(teaching materials, educational games, lesson plans, classroom strategies, etc) Date Stage of cycle What did I/we do? Observe: What is the issue or challenge to be addressed? Explore: Gain more info (e.g. from records / teachers / parents/ OT assessment) Reflect: What is the reason for the problem (use PEO) Plan: Discuss options, list them and choose one Think / read / explore www / use experience to design Does it look like it will work? Any doubt? Act: Make final adjustments Describe what you see when it is used Make adjustments OR Continue using it

29 Examples of Inclusion in Classrooms from our Research

30 Example of Inclusion – Nursery (AMI)Special Education Need: A 3.6 year old boy, studying in Nursery who had been showing inappropriate beahviour, short attention span and was stubborn. Stubborn Behaviour and Restlessness To improve his behaviour with his peers and sharing skills, he was made to sit with other children and share his favourite toy such as blocks/car (which he used to bring from home) with them.

31 Visual cues for “good” and “not good” behaviourThumbs up and thumbs down illustration were introduced to depict good and not good/unacceptable behaviour.

32 Increasing Concentration SpanMicrophone activity was planned, (microphone was made by the teacher using kitchen roll) children had to take turns during discussion to learn that the other children have to remain quiet when listening to the speaker. The same child had to decide who will speak next and pass the microphone to the next child. It was effective as his concentration span increased and he waited for his turn. His participation also improved as he showed interest in what others were doing i.e. when the other children were singing on the microphone he enjoyed it a lot.

33 Examples of Inclusion – Grade 6 -Meezan SchoolProblem /Issue / Challenge to be addressed : The children didn’t follow class rules Got up from their places without teacher’s permission, talked, laughed, complained about each other during the lessons Most of the children were unable to pronounce and understand the text in the text books They made fun of other children by laughing at them and donot support the children with any learning difficulty

34 Reflection After reflection we realized that children requiredChallenging activities to keep them involved Movement breaks to maintain concentration , daily time for physical activities For better understanding of difficult vocabulary, sessions where the children involve in hands on activities to understand the meaning of the difficult vocabulary. A combination of active and passive activities to calm them down as well as satisfy there urge to get actively involved Group seating arrangement to facilitate group work

35 Strategies Each period of teaching/ lesson was divided into these sessions 5 minutes -Recap time - Active time 5 minutes – Brainstorming –Active time 10 minutes – Introduction – Passive 10 minutes – Hands on- Active 10minutes-Recording after the lesson has finished -Passive 5 minutes- Conclusion - Active

36 Recap A quick activity to review what has been done earlier Activity:A ball was brought. Students were asked to say a fact or anything learnt from the previous lesson and then throw the ball to another child to continue.

37 Brainstorming Teacher showed a picture about the related topic or any other interesting thing like share an interesting fact about the topic to be introduced .

38 Introduction The topic / concept was introduced using concrete material pictures , diagrams , models , videos, books etc. The information that has to be read later in the text was shared during this time using easy vocabulary or with pictures.

39 Group work Mix ability students were included in groups.Mix ability students were included in groups. They read information from the text book / informative books. They discussed and wrote important points about the given topic and drew illustrations. They presented the work. The group was given marks regarding thier behaviour and effort . Each day the groups performing best were given incentives such as extra play time or computer time .

40 The seating arrangement to group setting, with assigning group leaders to remind children to follow class rules and for ease in group work

41 Activity 2 Use the action research cycle to plan inclusive strategies / lessons according to given scenarios.

42 Action Research Cycle Plan Act Reflect Observe Acting on the plan-Identifying problem -Devising a plan Plan Acting on the plan Act -Analyze data -Form and share conclusions Reflect Action Research Cycle -Collect data through observation Observe

43 Scenarios Scenario no 1 # Short concentration SpanAbdullah, aged 5 cannot sit in his place for more than 5 minutes. He cannot concentrate and work on the given task for more than 5 minutes. Plan a story telling session for Abdullah’s class  Scenario no 2 # Takes Time in Understanding and Retaining Beena, aged takes time to recognize letters and numbers . She is unable to recognize and seems to have forgotten the letters and numbers even after two days. Make a lesson plan for the introduction of a letter or number

44 Make an Inclusive Lesson Plan for the introduction of prepositionsScenario no 3 # Takes Time to Comprehend Christina, aged 7 cannot understand and follow multiple and detailed instructions and remains on the first one while the whole class reaches to the third one. Needs material to understand concepts while the other children now mostly do not need concrete material to understand abstract concepts . Make an Inclusive Lesson Plan for the introduction of prepositions Scenario no 4 # Weak Fine Motor Skills Douah, aged 4 doesn’t have the normal height and weight of her age. Her grasp over objects / pencil is too loose. She complains of pain in her fingers while tracing / colouring. Make a lesson plan for introduction of the formation of letter

45 Feedback Present your ideas to the rest of the group.

46 Thank you for listening and thinking with us!Contact: Debbie Kramer-Roy

47 Information Sources OnlineCentre for Studies in Inclusive Education (SCIE) UK based, but have both national and international focus – good source of information and resources. EENET Enabling Education Network. International network of people working towards inclusion. Links to lots of resources. UNESCO Inclusive Education. A web page with many useful, freely downloadable resources, including practical teacher guides

48 References and Resources IE (1)Canadian Association of Occupational Therapists (2009). CAOT Position Statement: Healthy Occupations for Children and Youth. Ottawa: CAOT. Available at: CanChild Centre for Childhood Disability Research (current). Partnering for Change (OTs working alongside teachers to work at school and child level). Available: Centre for Studies in Inclusive Education. Available: College of Occupational Therapists (2015). Occupational Therapy Evidence Fact Sheet: Occupational Therapy with Children and Young People. COT. Available: https://www.rcot.co.uk/about-occupational-therapy/ot-evidence-factsheets Education.gov.uk (online). https://www.gov.uk/government/publications/special-educational-needs-sen-a-guide-for-parents-and-carers-revised-2009 Enabling Education Network. Available gov.uk (online) https://www.gov.uk/children-with-special-educational-needs/overview Handicap International (2011). Six Questions about Inclusion. Available: Hutton, E, Tuppeny, S and Hasselbusch, A (2016). Making a case for universal and targeted children’s occupational therapy in the United Kingdom. BJOT 79(7), pp Kemmis, S., McTaggart, R. and Retallick, J., The Action Research Planner. Karachi, Pakistan: Aga Khan University Institute for Educational Development.

49 References and Resources (2)Make Development Inclusive (current). Policy Papers on Disability and Development. Available: (see UK and EU policies). UNESCO (online) Inclusive Education. A web page with many useful, freely downloadable resources, including practical teacher guides. Available: UNESCO (2005). Guidelines for Inclusion: Ensuring Access to Education for All. Available: UNESCO (1994). The Salamanca Statement and Framework for Action on Special Needs Education. Available:   UNICEF Child Info website. Links to documents about the protection of disabled children in developing countries. Available: United Nations, The Convention on the Rights of Disabled Persons. Available: United Nations, The Convention on the Right of the Child. Available: World Federation of Occupational Therapists (2016). Position Statement on Occupational Thearpy Services in School-Based Practice for Children and Youth. Available: (filter for Position Statements) World Federation of Occupational Therapists (2006). Position Statement on Human Rights. Available: (filter for Position Statements)