Valentines 2011 on PhotoPeach
Friday, March 18, 2011
Wednesday, March 16, 2011
Learning CPR, Telemetry vs. Data, and RTI
In the Pyramid Response to Intervention (PRTI) framework, Austin Buffum describes Tier II and Tier III interventions as "Learning CPR". He shares a scenario about a student who suffered an asthma attack at school. The student's medical needs were obvious and critical. A clearly articulated school emergency plan was implemented, and ultimately saved the student's life. Buffum goes on to discuss how the typical educational system is so much slower at responding to students' learning deficits and crises. So slow in fact, that students sometimes die a slow academic death as they fall further and further behind. He proposed that a ubiquitous PRTI system would recognize, assess, intervene, and reassess students' learning needs, providing ongoing support by highly qualified professionals. This new culture of learning is timely, targeted, and directive.
A recent "tweet" by John Carver, added to my thinking about this medical analogy for education. He wrote, "Old thinking "Data" is [a] dated snap shot of a condition[.] New thinking "telemetry" is real time input from multiple channels." I envisioned the telemetry monitors that I saw in the nurses stations at the hospital where my mother worked when I was a child. Sitting at the desk, the nurse could glance up and see exactly how each patient was doing at that precise moment. In my mind, "Telemetry may be the key... But, do they use telemetry for every patient? When do they implement it? When do they remove it? ... Telemetry? When do medical professionals use this technology? How does it connect to RTI and learning CPR?"
My husband is a critical care paramedic, who works for Lifeflight at Methodist Hospital in Des Moines. He is a trauma specialist on the front lines of the medical scene. I started questioning him about these thoughts. During his career, he has always worked for hospital-based ambulance or flight services. This means that he works within the hospital setting when not at a scene or transferring patients. Surely if I had seen these telemetry monitors as a visitor, he had a much deeper understanding of their use.
Patients in the hospital intensive care unit (ICU) are directly monitored all of the time. They are hooked up to cardiac heart monitors, automatic blood-pressure cuffs, pulse oximeters, and other specialty devices. They have the most specialized medical staff, and the smallest staff to patient ratio. There is one nurse for every one to two patients. Telemetry is not used with these patients because of the low staff to patient ratio and the constant assessment taking place by all of the medical devices.
A patient is ready to leave the ICU when they are stable - medications and medical interventions are working. The medical team determines that the patient is ready to "step down" at this point. The Step-Down Unit is where telemetry is used. Patients need to be monitored, but are no longer hooked up to many of the specialty devices used in the ICU. The staff to patient ratio changes in the Step-Down Unit to about 5:1. When the medical team determines that patients do not require step-down care to remain stable, they are either discharged or moved to long-term care.
In my mind, the ICU correlates to Tier III interventions, and Step-Down care correlates to Tier II interventions. As educators we very rarely move directly to the ICU stage from Tier I core instruction. From my husband's perspective as a critical care paramedic, this is the opposite. His patients almost always go to the ICU first. In his paradigm, patients rarely move from home or long-term care to Step-Down, and then to ICU. Typically, there is an "event" and medical staff intervene swiftly with the highest intensity. Past educational practice also often moved students from general education directly to a special education placement, Tier I to Tier III. But why? Was there a critical event?
Many students were not having "an event" that would warrant this level of intervention. What happened to the middle ground?
As we grow in our profession, I think we have more skills to provide a comprehensive Tier I and Tier II program. The medical analogy above is missing a piece, the family practice physician. The critical care paramedic has a specialized set of skills, life-saving skills, but they are narrow compared to the skills of a physician. Every time I ask my husband about a rash I get a same response "Are you bleeding? Are you having chest pain? Follow my finger with your eyes? ... Sorry, I don't do rashes. You need to see the doctor."
Most interventions in Tier I are for those "rashes." But even a rash needs diagnosed and monitored. Some are simply rashes. With time, ointment, and some TLC they clear up. But, other rashes are symptoms of a more serious illness. The physician recognizes the rash, and prescribe specific medications. Then, they have patients come back in a few weeks for a check-up, and try other medications if necessary. This usually happens several times before a specialist gets involved.
When the specialist joins the team, they don't say, "Let's cut off your arm. That will clear up your rash... Medic!" They continue a cyclic process of testing, treating, monitoring, and testing. Educational specialists include reading and math intervention teachers, special education teachers, school psychologists, school social workers, and other service care providers. These specialists support Tier I interventions, and may recommend Tier II interventions. The goal is to provide treatment, without involving the "medic."
I think the medical analogy for RTI is a good one. The analogy isn't as cut and dry as I first envisioned when I started writing this post a week ago. But then again, the learning process isn't as cut and dry as was once believed either.
A recent "tweet" by John Carver, added to my thinking about this medical analogy for education. He wrote, "Old thinking "Data" is [a] dated snap shot of a condition[.] New thinking "telemetry" is real time input from multiple channels." I envisioned the telemetry monitors that I saw in the nurses stations at the hospital where my mother worked when I was a child. Sitting at the desk, the nurse could glance up and see exactly how each patient was doing at that precise moment. In my mind, "Telemetry may be the key... But, do they use telemetry for every patient? When do they implement it? When do they remove it? ... Telemetry? When do medical professionals use this technology? How does it connect to RTI and learning CPR?"
My husband is a critical care paramedic, who works for Lifeflight at Methodist Hospital in Des Moines. He is a trauma specialist on the front lines of the medical scene. I started questioning him about these thoughts. During his career, he has always worked for hospital-based ambulance or flight services. This means that he works within the hospital setting when not at a scene or transferring patients. Surely if I had seen these telemetry monitors as a visitor, he had a much deeper understanding of their use.
Patients in the hospital intensive care unit (ICU) are directly monitored all of the time. They are hooked up to cardiac heart monitors, automatic blood-pressure cuffs, pulse oximeters, and other specialty devices. They have the most specialized medical staff, and the smallest staff to patient ratio. There is one nurse for every one to two patients. Telemetry is not used with these patients because of the low staff to patient ratio and the constant assessment taking place by all of the medical devices.
A patient is ready to leave the ICU when they are stable - medications and medical interventions are working. The medical team determines that the patient is ready to "step down" at this point. The Step-Down Unit is where telemetry is used. Patients need to be monitored, but are no longer hooked up to many of the specialty devices used in the ICU. The staff to patient ratio changes in the Step-Down Unit to about 5:1. When the medical team determines that patients do not require step-down care to remain stable, they are either discharged or moved to long-term care.
In my mind, the ICU correlates to Tier III interventions, and Step-Down care correlates to Tier II interventions. As educators we very rarely move directly to the ICU stage from Tier I core instruction. From my husband's perspective as a critical care paramedic, this is the opposite. His patients almost always go to the ICU first. In his paradigm, patients rarely move from home or long-term care to Step-Down, and then to ICU. Typically, there is an "event" and medical staff intervene swiftly with the highest intensity. Past educational practice also often moved students from general education directly to a special education placement, Tier I to Tier III. But why? Was there a critical event?
Many students were not having "an event" that would warrant this level of intervention. What happened to the middle ground?
At this point in my thinking about RTI and the Learning CPR analogy, I have wandered away from thinking strictly about "telemetry" and have started thinking about the idea of "learning events" as signals for intervention. Please continue reading at your own risk, as the waters get a little muddy at this point.
As we grow in our profession, I think we have more skills to provide a comprehensive Tier I and Tier II program. The medical analogy above is missing a piece, the family practice physician. The critical care paramedic has a specialized set of skills, life-saving skills, but they are narrow compared to the skills of a physician. Every time I ask my husband about a rash I get a same response "Are you bleeding? Are you having chest pain? Follow my finger with your eyes? ... Sorry, I don't do rashes. You need to see the doctor."
Most interventions in Tier I are for those "rashes." But even a rash needs diagnosed and monitored. Some are simply rashes. With time, ointment, and some TLC they clear up. But, other rashes are symptoms of a more serious illness. The physician recognizes the rash, and prescribe specific medications. Then, they have patients come back in a few weeks for a check-up, and try other medications if necessary. This usually happens several times before a specialist gets involved.
When the specialist joins the team, they don't say, "Let's cut off your arm. That will clear up your rash... Medic!" They continue a cyclic process of testing, treating, monitoring, and testing. Educational specialists include reading and math intervention teachers, special education teachers, school psychologists, school social workers, and other service care providers. These specialists support Tier I interventions, and may recommend Tier II interventions. The goal is to provide treatment, without involving the "medic."
I think the medical analogy for RTI is a good one. The analogy isn't as cut and dry as I first envisioned when I started writing this post a week ago. But then again, the learning process isn't as cut and dry as was once believed either.
Sunday, March 6, 2011
The Leader in Me
I'm interested in getting feedback from other educators who have started incorporating these ideas in their schools
http://theleaderinme.org
http://www.theleaderinme.org/students/
http://www.facebook.com/pages/The-Leader-in-Me/227493350254
http://onecrazyteachertoanother.blogspot.com/2009/04/leader-in-me.html"
http://finance.yahoo.com/news/400th-Elementary-School-bw-2779555759.html?x=0
http://theleaderinme.org
http://www.theleaderinme.org/students/
http://www.facebook.com/pages/The-Leader-in-Me/227493350254
http://onecrazyteachertoanother.blogspot.com/2009/04/leader-in-me.html"
http://finance.yahoo.com/news/400th-Elementary-School-bw-2779555759.html?x=0
Tuesday, March 1, 2011
What do they do during those late starts anyway?
It has been a busy year with teacher professional development. While various teacher groups have tackled many tasks, there is a common vision.
The district vision is, “FCSD will be the world’s dreamers, thinkers, and leaders. Dream. Think. Lead. Act.” Dreaming represents the creativity and dynamic problem solving that will play a major part in the world in which our children will work and raise families. Thinking represents critical thinking, independent problem solving, and looking beyond the issue at hand. Leading represents refining the gift within every student, because each one is special and has much to contribute to the world. Leading is not just about positions, roles, and titles, but is about character, quality, and empathy. Act represents the urgency we have in our mission to serve our students.
During professional development at the beginning of the year, teachers planned common lessons in grade-level teams. This was especially important because we just adopted new standards-based mathematics curriculum. At that time, special teams wrote action plans for the year. These teams included Title I reading, fine arts, PE, and pre-school teachers, and school counselors. Special education teachers have supported classroom planning, as well as worked as a team to develop progress monitoring plans to better track student progress toward specialized goals.
Parents who have kindergarten and 1st grade students this year are familiar with the new standards-based report cards. Standards-based report cards support parent-teacher communication. They detail what a child knows and can do, rather than assigning a letter or numerical value to a subject area. This kind of communication tool is incredibly valuable in helping families, students, and educators ensure that all students are mastering concepts. Mid-fall, it was decided that 2nd - 4th grades would implement standards-based report cards starting with the 2011-2012 school year. To accomplish this lofty goal, teachers rolled-up their sleeves and dug in, never looking back. We have reviewed our grade-level benchmarks, aligning them with the Iowa Core Curriculum (and now the Common Core Curriculum), and making sure that they spiral and build in complexity from kindergarten to 4th grade.
Teachers are in various stages of finishing the alignment process needed to build the standards-based report cards. Grade-level teams are naturally moving to the next phase in planning, which is to create and organize common assessments for each grade-level. Common assessments are tests, projects or tasks that teachers use to determine whether or not students have mastered the concepts and benchmarks on the report card.
Teachers are working hard during our professional development late-starts to create robust tools. This work will support our students, families, and community so that together we can dream, think, lead, and act!
The district vision is, “FCSD will be the world’s dreamers, thinkers, and leaders. Dream. Think. Lead. Act.” Dreaming represents the creativity and dynamic problem solving that will play a major part in the world in which our children will work and raise families. Thinking represents critical thinking, independent problem solving, and looking beyond the issue at hand. Leading represents refining the gift within every student, because each one is special and has much to contribute to the world. Leading is not just about positions, roles, and titles, but is about character, quality, and empathy. Act represents the urgency we have in our mission to serve our students.
During professional development at the beginning of the year, teachers planned common lessons in grade-level teams. This was especially important because we just adopted new standards-based mathematics curriculum. At that time, special teams wrote action plans for the year. These teams included Title I reading, fine arts, PE, and pre-school teachers, and school counselors. Special education teachers have supported classroom planning, as well as worked as a team to develop progress monitoring plans to better track student progress toward specialized goals.
Parents who have kindergarten and 1st grade students this year are familiar with the new standards-based report cards. Standards-based report cards support parent-teacher communication. They detail what a child knows and can do, rather than assigning a letter or numerical value to a subject area. This kind of communication tool is incredibly valuable in helping families, students, and educators ensure that all students are mastering concepts. Mid-fall, it was decided that 2nd - 4th grades would implement standards-based report cards starting with the 2011-2012 school year. To accomplish this lofty goal, teachers rolled-up their sleeves and dug in, never looking back. We have reviewed our grade-level benchmarks, aligning them with the Iowa Core Curriculum (and now the Common Core Curriculum), and making sure that they spiral and build in complexity from kindergarten to 4th grade.
Teachers are in various stages of finishing the alignment process needed to build the standards-based report cards. Grade-level teams are naturally moving to the next phase in planning, which is to create and organize common assessments for each grade-level. Common assessments are tests, projects or tasks that teachers use to determine whether or not students have mastered the concepts and benchmarks on the report card.
Teachers are working hard during our professional development late-starts to create robust tools. This work will support our students, families, and community so that together we can dream, think, lead, and act!
Sunday, December 5, 2010
Cognitive Behavior Therapy - Implications for the Elementary
I need to preface this post with the disclaimer that my understanding of Cognitive Behavior Therapy (CBT) is limited, and that I am not a therapist.
Cognitive Behavior Therapy techniques may help educators support behavior and character development of elementary students. The National Associate of Cognitive Behavioral Therapists (NACBT) (http://www.nacbt.org/whatiscbt.htm) states, "Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change."
While the NACBT applies this methodology of problem-solving to adolescents, I think that we elementary educators can benefit from understanding this process. CBT is most commonly used when dealing with people who have moved beyond the concrete operations phase of cognitive development. The concrete operations phases typically occurs from age 7-12 (Child Development Institute http://www.childdevelopmentinfo.com/development/piaget.shtml). As children reach the next phase of cognitive development, formal operations, they are able to reason more abstractly.
I believe that a key piece in building students' ability to manage their behavior and choices comes with the development of empathy. Vygotsky's viewpoint regarding the development of empathy was different from Piaget (The Brain From Top to Bottom http://thebrain.mcgill.ca/flash/i/i_09/i_09_p/i_09_p_dev/i_09_p_dev.html). "Because young children could not imagine the [physical] viewpoint of someone on the other side of a table, Piaget concluded that they are incapable of empathy. But in later experiments that gave children the same age the chance to imagine social situations rather than spatial ones, the results were quite different." This is a key understanding for elementary educators regarding student behavior, and why I think that parts of CBT are applicable to elementary students as they learn about behavior and choices.
Elementary students tend to demonstrate organized, logical thought, which consists of concrete problem-solving. When you pair this with empathy development, their ability to put themselves in someone else's shoes, skilled questioning can assist students in exploring alternate solutions to problems, and considering actions and consequences.
Here are some tenets of CBT which I believe elementary educators can utilize to help students with behavior development (http://www.nacbt.org/whatiscbt.htm):
- If we are upset about our problems, we have two problems -- the problem, and our upset about it. This often happen with children. Not only are they upset about the problem, but they're upset about being in trouble about the problem.
- Therapists (in our case, educators) often ask questions. They also encourage their [students] to ask questions of themselves, like, "How do I really know that those people are laughing at me?" "Could they be laughing about something else?"
- CBT Therapists do not tell their clients what to do -- rather, they teach their clients how to do. Much of behavior development in small children is about learning how to have different responses. This includes planning for and practicing different responses. The least effective response to any problem is to "ignore it."
- CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned. Therefore, the goal of CBT is to help [students] unlearn their unwanted reactions and to learn a new way of reacting. The educational emphasis of CBT has an additional benefit -- it leads to long term results. When people understand how and why they are doing well, they know what to do to continue doing well.
- Often, we upset ourselves about things when, in fact, the situation isn't like we think it is. If we knew that, we would not waste our time upsetting ourselves. Therefore, the inductive method encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested. If we find that our hypotheses are incorrect (because we have new information), then we can change our thinking to be in line with how the situation really is.
Saturday, October 30, 2010
Thank you Jeff Utecht
http://www.jeffutecht.com/
I had the pleasure of attending an SAI 21st Century Learning training last Monday with guest presenter Jeff Utecht. I wanted to share my learning with teachers in real time, so I took notes on our shared wiki. I was really tickled that several teachers did check in during their planning time and sent e-mail comments to me regarding the notes. As we continue our journey in developing our professional learning network, sharing information and communicating effectively and efficiently continues to seem like information overload for many educators. So, here are the major points from the workshop.
A New Learning Landscape is Developing
I had the pleasure of attending an SAI 21st Century Learning training last Monday with guest presenter Jeff Utecht. I wanted to share my learning with teachers in real time, so I took notes on our shared wiki. I was really tickled that several teachers did check in during their planning time and sent e-mail comments to me regarding the notes. As we continue our journey in developing our professional learning network, sharing information and communicating effectively and efficiently continues to seem like information overload for many educators. So, here are the major points from the workshop.
A New Learning Landscape is Developing
- We live in a society that is always on. We discussed the rescue of the miners in Chile. People could see this anywhere in the world for free via the internet. When did we, as a society, expect this access? At the movies, they don't tell people to turn their cell phones off, but to put them on vibrate. The shift has happened that people will be connected. We blame kids for always being on their cell phone, but it's a shift in society.
- Seniors today (born in 1993) will never know a time without internet. By 1996, mobile computing/palm pilot has come out. This is the world that they've gown up in.
- Is there another generation that has created their own global language (shorthand in texting)?
- By 1999, the first iPod comes out. Our kids will always know digital music - won't know tapes, or even CDs.
- By 2001, wikipedia comes out. Many kids will never have an entire set of encyclopedias.
- By 2003, Skype comes out and they'll never have a long-distance bill.
- By 2005, YouTube redefines media
- By 2006, kids are called the MySpace, and then the Facebook generation.
- 500 million users are on Facebook - They went from 400,000 to 500,000 users in under 100 days. This is how the world is. You can either block it or embrace it.
- Book: Millennials Rising. We're in the middle of an education revolution. There are 300,000 more incoming freshmen across America than the year before. Suicide rates are at an all time low. They believe it's their environment and they're going to fix it. They believe we screwed it up and they're going to fix it. Homocide, violent crimes, and abortion are at an all time low.
- Digital Natives born 1976-1991 - This is the hardware generation. They grew up with "the stuff" - Atari, computers, the first Nintendo. This time period was when all of the hardware was made. People born in this timeframe are good with the hardware. They can program the blinking lights on the VCR because they're not afraid of pushing buttons on the remote.
- Web Natives born 1991-2007 - They don't always know the hardware side of things. They don't always organize their files with folders like the Digital Natives. They are constantly on the web.
- Mobile Natives 2007-??? - (2007 is the first year that the iPhone came out). These kids will change schools. They live in a time where laptop computers have always outsold desk top computers. They are expected to use the trackpad/touchpad, and the mouse is hard for them (kindergarteners). This generation will expect to be mobile. Go to a computer lab? What's that? They expect to be mobile.
- 66% of text messages during school comes from parents
- Idea: Work Life vs. Social Life. There used to be a clear line between our work life and our social life. That line is now blurred. We now answer e-mail at home, send text messages from home, etc. School life and social time - schools are still trying to keep a clear line, when society isn't as much. Should schools be understanding that homework can be done a different way? Should we be blurring these lines?
- Can students multi-task? Are they able to listen to music, talk, text, and do homework at the same time? Possibly it depends on the level of cognitive work that we're asking them to do. If they are doing low-level tasks, they probably can multi-task with some of these other things and still accomplish their work. 100 questions instead of 50 questions doesn't make something hard, just tedious and boring.
- Constuctivism - our learning theory
- Connectivism - an extension of our learning theory "Learning occurs within shifting environments, not entirely under the control of the individual." Examples - Chilean Mine; Oil Spill
- Bloom's Revised Taxonomy - "Create" is at the top at the pyramid. Create - Evaluate - Analyze - Apply - Understand - Remember. What about kids who jump straight to create without going through the other phases? Are we scaffolding these skills in schools? - "My kids do good stuff, they made a video." Yeah, but did they analyze, etc. along the way?
- Today's Digital World - Includes: Global Connections, Social Connections, Access to Information
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