Senior occupational therapist (OT) Grazel Ng is part of a professional team at SPD@Jurong that supports children with mild to moderate developmental needs in mainstream pre-schools. In this article, Grazel shares how OTs like her work with these children to overcome some of their challenges in learning.
Grazel has been working with children with developmental needs for six years in SPD. She currently supports children from the Early Intervention Programme for Infants and Children (EIPIC) programme at SPD@Jurong. When the piloted Development Support (DS)-Plus programme officially rolls out in July 2019, Grazel would be helping some of these children in their transition to their mainstream pre-schools.
1) What does your work as an OT in the DS-Plus programme entail?
Grazel: The main role of therapists or interventionists in the DS-Plus programme is to help a child who is attending an early intervention programme apply the skills at his/her pre-school.
My role includes gathering information from teachers and parents or caregivers on the child’s capabilities and difficulties in both the EIPIC and pre-school routines. I would then assess the child’s strengths and weaknesses through in-class observations and/or pull-out individual assessments. Therapy sessions are conducted within the pre-school to facilitate transfer of skills from the EIPIC setting to the pre-school setting and to work collaboratively with pre-school teachers to support the child.
2) What difficulties do the children in the DS-Plus experience during their learning?
Grazel: Children with developmental needs often face difficulties in their pre-school routine, for example, paying attention during lessons, remaining at his/her seat for table-top tasks, writing or copying sentences, playing with friends and engaging in outdoor play. They may also display disruptive behaviour and throw tantrums. In addition, teachers and staff at mainstream pre-schools may experience challenges in managing the child’s behaviour or performance in class.
3) What are the areas an OT would work on with children with developmental needs?
Grazel: OTs provide intervention to optimise the child’s performance and engagement in the pre-school.
Improving attention span is one area of intervention. We work on helping the child sit still in class and sustain the child’s attention span so that he/she is able to listen to the lesson in large groups or keep up with his/her peers when completing worksheets. Another area is to help the child learn to plan and organise his/her work, for example, making sure that he/she has the correct materials or worksheets, or turns to the correct page of the book.
We also work with the children on their gross motor skills, such as jumping and climbing steps, and fine motor skills, such as writing and buttoning. These also help promote their participation in various activities in their school routine including outdoor play, work time and bathing.
In the aspects of play and social skills, some children will always want to be the leader and/or want to win. They have difficulties coping with losing and require an OT’s help to learn that it is okay to lose in a game.
OTs also work with them on self-help skills, for instance, brushing teeth and toileting, as well as emotional management skills like coping with anger.
4) Could you share more of the activities conducted during therapy and how they help the children?
Grazel: Therapy sessions are conducted at least two hours weekly. OTs have the flexibility to conduct a two-hour session or two one-hour sessions depending on the child’s needs.
I would spend about an hour in the pre-school with the child. A typical session would include one-to-one activities and small group activities. For a child who needs to improve on his/her handwriting skills, I would teach the child how to form letters correctly or how to write on the line neatly during such one-to-one sessions. I may use materials, such as magnetic letters, textured cards or coloured lines, to teach the child the concept of letter formation and letter placement. This helps the child to write legibly.
In small groups, I may work on social skills, such as getting the child to learn to accept his/her peers’ lead instead of always being the leader, and/or negotiating with peers during group games. These help the child to build social relationships with his peers.
5) What challenges do you face working with children with developmental needs and how do you overcome them?
Grazel: Very often, we see the child achieved our therapy goal(s) in either the EIPIC classroom or in the pre-school with the OT’s support, but has difficulties applying the same skills in the pre-school without the OT’s presence. For instance, the child is able to sustain his attention and sit still for 20 minutes during lessons conducted in a large group when the OT is nearby to provide the right amount of prompts. However, in a similar lesson without the OT, the child could be fidgety and has difficulty paying attention to the teacher.
It is a common feedback from teachers that the child is only able to do a specific task or demonstrate a specific skill when the OT is present. Hence, it is our role to empower the teachers with bite-size strategies knowing that they have a class of 15-20 children to manage. I try to share one to two classroom strategies weekly and would gather the teachers’ feedback on whether the strategy has been useful the following week.
6) From your experience, how is being an OT in DS-Plus different from being in other programmes? What do you enjoy most about being in this role?
Grazel: Being an OT in the DS-Plus pilot programme, I get to work very closely with teachers every week and get to see the child function in the natural pre-school setting. This ties in with one of the core values of occupational therapy, which is occupational engagement in the natural setting. It is very satisfying to see the children happy when they are able to do similar things or do things at the same pace as their typically-developing classmates in their pre-schools.
About the Development Support Plus (DS-Plus) Programme
With the new DS-Plus programme, children who have made sufficient progress at EIPIC centres can now transit to receiving intervention in a pre-school setting. Currently, they receive continued intervention at their early intervention centre until they graduate and move on to primary school. With the new programme, professionals from the early intervention centre will work with the child in his/her pre-school up to twice a week, co-teaching the child alongside the pre-school teacher. This helps the child to adapt to the mainstream pre-school setting, so that he/she can be equipped with skills within a larger class setting.
The DS-Plus pilot programme at SPD@Jurong is supported by a centre manager/team lead, an early interventionist, a speech therapist, an OT and a psychologist. With the two new intervention programmes, EIPIC Under-2s and DS-Plus, SPD will expand the number of early intervention programmes to five this coming July.