P4C in Practice

Role of the OT at Each Tier of the P4C Model

P4C services are provided universally to support all children in a classroom, with increasingly intensive services being added for children whose needs are not met through whole class strategies of differentiated instruction.

  • Services included in the P4C model are consistent with a Response to Intervention paradigm.
  • Services are based on need so children with higher needs receive increasingly intensive levels of support.

Universal Design for Learning: What does this look like in the P4C model?

The tier at the base of the response to intervention triangle is Universal Design for Learning (UDL). Therapists and educators collaboratively design and change physical, social and learning environments that facilitate participation and foster skill development in children of all abilities.

The therapist may:

  • do a desk audit to ensure that each child’s desk is suited to his/her size.
  • improve the physical accessibility of the classroom.
  • help to design activity centres that promote sensory, cognitive, and motor development.
  • teach a large group lesson that models different ways to support students.
  • modify the Quality Daily Fitness routine to ensure that all of the skills included are developmentally appropriate for the younger students. That way everyone, including the junior and senior kindergarten children, can participate.

Additional information and examples of how P4C OTs use universal design for learning principles are available in a recent publication:

Missiuna, C., Pollock, N., Campbell, W., Dix, L., Sahagian Whalen, S., & Stewart, D. (2015). Partnering for change: embedding universal design for learning into school-based occupational therapy. Occupation Therapy Now, 17(3), 13-15.

Differentiated Instruction: What does this look like in the P4C model?

When using differentiated instruction, the P4C therapist may work with a small group of students and determine (differentiate) among those children. Which children are having trouble with a task due to lack of experience versus which children have more specific developmental needs such as motor coordination or attentional difficulties? Over a few weeks, the therapist and educator monitor children’s responses to any strategies that are suggested.

For example: a child who is having difficulties using scissors in the classroom may not have used them at home and may simply need extra instruction and opportunity to practice in order to acquire that skill. Another child may be having difficulties using scissors in the classroom but may need more direct teaching or the option to use different types of scissors. Other children may have underlying challenges with motor skills and will require specific accommodations.

Together, the educator and therapist try different strategies to determine how to support the child in a scissor-cutting activity and to decide if there is a need for additional intervention for this child. This determination of need is done in context and is also based on the therapist and educator’s observation of the child on the playground, in the gym and in other classroom activities.

Accommodation: What does this look like in the P4C model?

By the time the accommodation level is reached, the P4C therapist would have tried strategies in the classroom or gym in collaboration with the educator, and determined that a child had more complex needs and required more individualized health care involvement and support. The therapist would obtain health care consent from the family to provide additional support. Accommodation-level intervention might be used with a child individually, in a small group setting, or may consist of provision of specific information, environmental adaptations and strategies. All suggestions are documented and shared with the educator and family.

Students receiving this level of support may require access to technology or accommodations during class activities. These suggestions are built into the child’s Individual Education Plan (IEP). In all cases, families are aware of issues and have provided health care consent so the student can have these strategies and accommodations put in place. If the P4C OT determines that there is a need for involvement of another health or education professional, that recommendation can be made.