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IES Grant

Title: Write Start: Development of an Integrated Occupational Therapy Writing Intervention
Center: NCSER Year: 2009
Principal Investigator: Case-Smith, Jane Awardee: Ohio State University
Program: Educators and School-Based Service Providers      [Program Details]
Award Period: 3/1/09 - 2/28/12 Award Amount: $556,526
Type: Development and Innovation Award Number: R324A090004

Purpose: Learning to write legibly and fluently is important to children's academic progress. In particular, handwriting appears to be important to the fluency and quality of students' written composition. Often, teachers do not provide explicit and systematic handwriting instruction and rarely use a handwriting program. The handwriting programs that are available have limited evidence for their ability to improve student outcomes. In addition, when students with disabilities, who have handwriting difficulty, are referred to the occupational therapist, these services are often provided one-on-one in a therapy room outside the classroom, or in an isolated area of the classroom. This results in the occupational therapist having little exposure to the student's curriculum and because of this isolation may not have a sufficient understanding of the problems the student is having in the classroom. Also, the teacher may not receive information helpful to understanding the student's performance problems and may not be aware of the student's progress. Therefore, this research study will develop a handwriting program, Write Start, co-taught by teams of occupational therapists and teachers for first grade students. The purpose of the project is to develop a comprehensive handwriting program that enables primary grade students to become proficient in handwriting, and to develop a fully inclusive model for delivery of occupational therapy services.

Project Activities: Year one will focus on program development and assessment of feasibility. With consultation from an expert panel, the investigators will develop and refine the Write Start activities and procedures and the co-teaching processes. The intervention program will be implemented in one first grade classroom. In Years two and three, the Write Start program will be piloted in four additional first grade classrooms to gather and analyze data on usability, feasibility and program effects. This information will be used to refine the program and finalize a Write Start manual.

Products: The project outcomes include a fully developed Write Start program with accompanying manual, and evidence of the potential of this program to improve student writing outcomes.

Structured Abstract

Setting: Public first grade classrooms in Central Ohio. Eligible classrooms are selected based on the following four criteria: (1) all students can print their name; (2) at least two students have Individualized Education Programs (IEPs) with handwriting goals; (3) at least four students demonstrate poor handwriting as reported by the teacher, but who do not currently receive occupational therapy; and (4) the teacher must be willing to use the co-teaching model for handwriting instruction.

Population: The sample consists of first grade students with a range of handwriting skills. Approximately 25 students will participate in the first year of the study, 50 in the second year, and 50 in the third year.

Intervention: The handwriting program includes two- 35 minute sessions each week for 12 weeks. Students will receive a combination of handwriting instruction, small group activities, and writing applications. During the first session of each week, the occupational therapist will provide handwriting instruction using a developmental handwriting program that groups letters similar in form, uses the continuous stroke alphabet, and presents letters in a sequence from easiest to most challenging. The small group activities, led by the occupational therapists and teachers, will focus on the fundamental elements of writing, using motor learning, visual motor integration activities, and cognitive strategies. The motor learning and visual motor activities are designed to promote good letter formation, emphasizing dexterity, motor planning and visual motor integration. The cognitive strategies will promote transfer of skill, memory retrieval, and self evaluation of legibility to increase writing fluency. In the second session of each week, students recall letters and practice formation, participate in small groups to practice fundamentals, and use the letters in writing applications. There is a component of the program that addresses the application the students' learning of handwriting in this program to the classroom writing and literacy curriculum.

Research Design and Methods: In the first year, the research team will convene the expert panel to provide feedback on the program materials and make recommendations about program implementation. The Write Start program will be implemented in one classroom; the research team will observe and interview the teacher and therapist, as well as videotape intervention sessions, and will collect data on student writing performance pre and post intervention. This information will be used to revise the program. In the second year, the revised program will be implemented in two additional first grade classrooms. In the third year, the program will be implemented in two new classrooms, and an additional two new classroom will serve as control classrooms. In years two and three, the research team will complete similar measures (e.g., interviews and observations) used during the first year.

Control Condition: Students in the control classroom receive any writing instruction the students typically receive (e.g., "business as usual").

Key Measures: Researchers will develop a fidelity measure to assess whether or not each instructional element is implemented. Outcome measures include the Evaluation Tool of Children's Handwriting (ETCH), weekly handwriting samples, and a writing fluency test. Usability and feasibility measures will include teacher and therapist interviews and student observations.

Data Analytic Strategy: Percentage of legibility scores for subscales on the Evaluation Tool of Children's Handwriting (e.g., alphabet writing, copying) pre and post intervention will be calculated. Mean scores for legibility and for measures for writing fluency before and after the handwriting intervention will be compared using t tests and effect sizes to reflect level of improvement. Percent legibility and word count for the weekly handwriting samples will be graphed to examine trends in performance. Descriptive data from the interviews will be summarized and categorized to identify themes and concepts related to variables that promote or limit the co-teaching process and to explore program usability and feasibility.


Journal article, monograph, or newsletter

Case-Smith, J., Holland, T., and Bishop, B. (2011). Effectiveness of an Integrated Handwriting Program for First-Grade Students: A Pilot Study. The American Journal of Occupational Therapy, 65(6): 670–678.

Case-Smith, J., Holland, T., and White, S. (2014). Effectiveness of a Co-Taught Handwriting Program for First Grade Students. Physical and Occupational Therapy in Pediatrics, 34(1): 30–43. doi:10.3109/01942638.2013.783898

Case-Smith, J., Holland, T., Lane, A., and White, S. (2012). Effect of a Co-Teaching Handwriting Program for 1st Graders: 1 Group Pretest Posttest Design. The American Journal of Occupational Therapy, 66: 396–405.

Case-Smith, J., Weaver, L., and Holland, T. (2014). Effects of a Classroom-Embedded Occupational Therapist—Teacher Handwriting Program for First-Grade Students. American Journal of Occupational Therapy, 68(6): 690–698. Full text