3. Piloting The Alps manual: evaluating successful delivery of The Alps by school teaching assistants

Piloting of The Alps

I have had the most amazing support from a number of schools' head teachers, teaching assistants and teachers. As a result, The Alps manual describing how to deliver to deliver evidence-based activities for children with motor skill difficulties has really taken shape. Most of the activities are now illustrated with photographs of children demonstrating the activities and teaching assistants report that they understand the descriptions and don't believe that they will have any difficulties delivering the activities. It will still need further refinements; these will take place during and after the piloting of the progamme in schools. 

The Alps motor skills programme manual

Starting in January 2020, three schools began piloting The Alps.  This testing of an evidence-based programme of motor skills activities was the culmination of several years of hard work, and the schools have friendly staff and children, so this was big moment for my research.

What is the aim of piloting of The Alps? 

The aim of piloting the manual is to identify any difficulties that teaching assistants experience when they use the manual, and any obstacles they encounter with delivery of the activities. 

How is piloting carried out?

Teaching assistants were presented with the manual at least two weeks before they were expected to deliver The Alps motor skills progtrmme activities during the school day to children that they knew had poor motor skills. One school delivered the activities to Reception class; one school used a group of 10 - 15 children; and the third school implemented the programme on three children with poor motor skills. Once they had delivered the activities on a few occasions, I visited the school to  observe the teaching assistants delivering the activities and the to meet the assistants afterwards.  In this way, I was able to gather information from teaching assistants to find out what obstacles they met with delivering any activities, whether there were any unclear instructions in the manual, and why (if at all) any activities were not delivered as the manual intended. From this feedback, I could amend the manual and make the final changes to improve its clarity.

Some of the children who are participating in The Alps programme piloting were assessed using a new outcome measure called FUNMOVES. It is being developed be PhD student Lucy Eddy and is designed to be delivered by school teachers in PE, in order for school staff to identify those children who could experience academic difficulties and restricted physical activity due to poor fundamental motor skills.

How is piloting progressing?

The COVID pandemic quickly put a halt to the piloting phase of this research but I did receive useful feedback from two schools before the lockdown began.This has improved the clarity with how to deliver the programme of activities. Since the children returned to schools, I have received a written summary from a third school which suggested that the manual is clear and easy to use, and that the activities are easy to deliver using the manual.

How can schools help now?

I am seeking more schools to pilot the manual and activities using the procedure above, with teaching assistants delivering activities to children using the manual and then meeting me, to discuss any difficulties that they encountered. 

All schools that help to develop the manual will receive a copy of the manual, including an updated version every time we make changes to improve the manual. These schools will not be able to participate in the future scientific trial  - the randomised controlled trial - that is planned to evaluate properly the benefits of The Alps but it seems unfair to deny them the opportunity to implement The Alps after they have been so helpful in contributing to its production. It is important to remember, though, that although the activities are evidence-based, and that research studies have suggested that they produce large improvements in children's motor skills, we don't yet have any evidence that The Alps will produce similar improvements.

2. Developing a manual that enables teaching staff to deliver an evidence-based programme of children's motor skills activities (The Alps)

Introduction

We know that poor fundamental motor skills have a profound impact on children's life chances. Poor motor skills affect children's physical, emotional, social, psychological and educational development, and children are more likely to grow up to experience drug and alcohol abuse, trouble with the police and mental health difficulties. There is a relationship between poor motor skills and physical fitness, body weight and physical activity, suggesting that the rising epidemic of obesity in the UK could be reduced by improving children's motor ability.

What can be done?

I have developed a programme of physiotherapy activities called Towards Healthy Education: Accelerated Learning of Playground Skills (The Alps). The activities have strong evidence for producing large improvements in children’s motor skills. The programme is designed for Key Stage 1 children with poor fundamental motor skills. However, it could be used for the whole class although it will take more staff to supervise each session, as each child needs to undertake the appropriate level of difficulty for each activity. 

1. Why do we need a motor skills programme for younger children in schools?

Why is a motor skills programme even necessary for young children?

This blog entry describes the background to the development of The Alps motor skiills programme.

Background

The Born in Bradford research study is one of the largest cohort studies ever carried out to improve the health and well-being of the population, and is following over 13,000 children from prenatal care through to adulthood. A huge amount of data is being gathered on children's health, and their physical, educational and psychosocial development and progress. Data gathered from the oldest children, whose mothers were recruited in 2007, have already guided the development of promising research and interventions into improving children's health, education and dental health. 

Born in Bradford data has identified that a significant proportion of children have poor fundamental motor skills. Recognising that poor motor skills are damaging to children's life chances, teaching staff have asked Born in Bradford researchers "How we can help to improve these children's motor skills?" My research sets out to answer this question.

What is the impact of poor motor skills on children's life chances and health?

Poor motor skills have a devastating impact on children's development and life chances. Poor movement skills affect children's physical, emotional, social, psychological  and educational development. Improving children's motor skills could potentially make a significant impact on children's education and physical health, as well as prevent other psychosocial developmental issues. 

Most research into children affected by poor motor skills has been conducted on children with developmental coordination disorder. DCD affects up to three children in every classroom, and is a diagnosis usually given quite late: children's motor skills at the more difficult end of human motor activity, such as balancing on a narrow beam and other agility or gymnastic activities, are still developing aged six or seven years. One study found that a large number (80%) of seven year old children with DCD went on to experience drug and alcohol abuse, trouble with the police and mental health difficulties by the age of 22, compared to 11% of the children with typical movement skills. Further evidence also suggests that children’s motor skills have a positive association with physical fitness, body weight and physical activity. Because physical activity tracks across the lifespan, increasing physical activity in childhood can have huge benefits in population health (including mental health) and academic achievement.

Reducing physical inactivity could therefore reduce morbidity but it could also reduce premature deaths and save money. In 2006, research showed that physical inactivity caused 16.9% of premature deaths and costs £8.2 billion per year. However, only 22% of children meet Department of Health recommendations for physical activity, figures which are worsening over the years.  One in five children in Reception and one in three children in Year 6 are obese or overweight. In 2007 obesity cost the economy  £15.8 billion per year, including £4.2 billion in direct costs to the NHS.

What can be done to help children's motor skills? 

The evidence for activities designed to improve children's fundamental motor skills comes from research carried out with children who have DCD. To answer the question posed by teaching staff - how can teaching staff help to improve children's motor skills - we conducted a systematic review to search for and identify activities supported by good evidence for improving children's motor skills. A systematic review summarises the best of the available research evidence, and is held within medical circles to represent the highest level of evidence for or against treatments, interventions and policies.

Hierarchy of evidence

Our systematic review found nine studies which investigated a total of 16 interventions. Three well-conducted trials in particular found some physiotherapy activities that had produced large improvements in the children's movement skills. But these activities were delivered to children by trained, experienced health professionals, and in the UK, there is a long waiting list for children to get the help they need from these professionals. Before 2007, children with poor movement skills made up 60% of occupational therapy team's waiting lists, and some had to wait up to four years just for an assessment! My qualitative research at a PE teachers and head teachers conference, at meetings with head teachers and from piloting of the evidence-based activities in a school suggests that head teachers and school staff are keen and willing to deliver an appropriate motor skills programme. For this reason, I have developed these evidence-based activities into a physiotherapy programme designed to be delivered in schools by school staff, called The Alps (Towards Healthy Education: Accelerated Learning of Playground Skills).

The Alps manual, designed to enable teaching staff to deliver
evidence-based activities to children with poor motor skills

The long term aim is to evaluate, in a randomised controlled trial, whether there are similar benefits of The Alps on children's motor  skills, academic attainment, social and psychosocial development, and physical activity. Before we carry out the randomised controlled trial, we will pilot the manual in schools to iron out any misunderstandings or obstacles to effective delivery of the activities. But first, it is essential to ensure that teaching staff find The Alps manual easy to understand and that it gives them confidence to effectively deliver the activities. For this reason, teaching staff are helping to develop The Alps manual.