Introduction

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A major focus of the Integrated Services Initiative is maximizing the impact of related services (e.g. occupational therapy, speech language pathology, school counseling, physical therapy, school nurses, etc.) by providing therapy in the general education natural context as much as possible.1 This is in contrast to pulling students out of class to provide services in isolated therapy rooms. Integrated services give practitioners access to all students, not just those on their caseload. Opportunities to provide universal (Tier 1) and targeted (Tier 2) services are enhanced when integrating services throughout the day.

This section of the website provides information about why integrated services represents ‘best practice’ in schools and how it benefits all students with and without disabilities and/or mental health challenges. Examples of how to provide integrated services focusing on mental health at Tiers 1, 2, and 3 are shared.

1Cahill, S., & Bazyk, S. (2019). School-Based Occupational Therapy. In Jane Clifford O’Brien & Healther Kuhaneck (eds.). Case-Smith’s Occupational Therapy for Children & Adolescents (8th edition). Mosby.
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Remember this:

The aim of Every Moment Counts is to maximize the impact of related services by integrating therapy throughout the day in a variety of school contexts.

Integrated services and school mental health

Addressing children’s mental health is far too complex to relegate to a small number of licensed mental health providers (generally 1-2 per school). Leaders in school mental health (SMH) are calling for a paradigm shift to prepare all frontline workers to contribute to children’s mental health.1 In particular, it is important to utilize all indigenous resources - professionals who have a background in addressing mental health and can contribute to mental health promotion and prevention efforts. In addition to school counselors, psychologists, and social workers, the following health professionals have entry-level knowledge and skills in addressing mental health, including:

  • Occupational therapists (OT) and OT assistants (OTAs)
  • School nurses
  • Music therapists
  • Recreation therapists

It is important to include these school providers as team members who can collaborate with licensed mental health providers and frontline school personnel in order to contribute to mental health promotion, prevention, and intervention.

1Atkins, M. S., Hoagwood, K. E., Kutach, K., & Seidman, E. (2010). Toward the integration of education and mental health in schools. Administration and Policy in Mental Health, 37, 40-47.
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Remember this:

HOW to Integrate Services
  • Modify the environment and/or task
  • Co-teaching strategies
  • Coaching strategies
  • Small group interventions
  • Whole-school, universal programs

HOW to provide integrated services?

Related services can be integrated throughout the day using a combination of informal and formal strategies. Informal strategies include modifying the environment (physical, social, sensory) and/or the task to foster successful participation and mental health. Formal strategies include co-teaching, coaching, small group interventions, and universal programs. Learn more about this strategies below.

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Remember this!

Students with disabilities do not attend school to receive related services; they receive services so they can attend and participate in school. (Giangreco, 2001)

Shifting to Integrated Services: The Process

The process for shifting from a pull-out to integrated model will vary depending on the school district and how related service providers are employed. In general, related service providers  are either employed directly by the school district or educational service center or by a private practice company that places therapists in schools. The motivation to provide integrated versus pull-out therapy often starts at the top - with leaders who value and advocate for this type of service provision. Refer to the following sections for suggestions on how to shift to an integrated model and success stories.