In recent years, there has been a broad trend in schools towards inclusive education. Although the general preference for inclusive education models is encouraged on an international and national level (UN, 2006, Art. 24), speech therapy and psychomotor therapy in Switzerland almost exclusively continue to be carried out separately, outside the classroom, in single-person and micro-group sessions. With the new requirements in the education system, however, there is an explicit expectation that psychomotor therapists (PMT) will offer their support for larger groups or entire classes (Vetter, et al., 2009). In order to meet these demands and the different needs of all the children in an inclusive setting, multiprofessional collaboration between the teacher and the PMT is indispensable.

Psychomotor abilities play a key role in giving every child a successful start at school, especially in the areas of "visuo-motor coordination" and "fine motor skills", which are central to graphomotor processes (e.g. Fischer, 2018, McClealand & Cameron, 2019). During 30-60% of the school day, fine-motor and graphomotor activities are performed in first-grade classes (McHale & Cermak, 1992), with between 12% and 44% of children experiencing difficulties in these areas (Santangelo & Graham, 2016). The development of fine-motor and visuo-motor systems interacts closely with cognitive development and language, and is an important predictor for general school learning and performance as well as for subsequent academic success (e.g. McClealand & Cameron, 2019, Oberer et al., 2018). Without handwriting instructions and support graphomotor difficulties can lead to poor automatic handwriting and to disadvantages for the affected children. The automaticity of (grapho-) motor skills is of significant importance for the acquisition of written language. As long as  handwriting is not automatic, writing and composing a text can only be performed sequentially due to the limited capacity of working memory (Olive, 2012). As a result, writing with non-automatic handwriting results in lower cognitive capacity for the content, composition and grammatical design of texts (ibid.). The frustration that is related to this can have far-reaching negative consequences in terms of motivation, self-concept and school performance (e.g. Guay, Ratelle, Roy & Litalien, 2010, Eckhart & Sägesser, 2016).

When the PMT collaborates with the teacher, they can address these issues together, adapt the handwriting support to the curriculum while allowing the student to remain in his or her natural context (Case-Smith et al., 2011). The few study results that exist on classroom-embedded handwriting interventions show that this type of teaching benefits all students and improves their graphomotor performance (Case-Smith et al., 2011, Vetter et al, 2009). In addition, not only do all the students benefit from the PMT's broad knowledge: teachers also become better educated and more aware of handwriting difficulties in children (Case-Smith et al., 2011).

Objectives:

For targeted, inclusive handwriting support for all children a concept for multiprofessional collaboration between the PMT and the teacher is developed and evaluated. This concept allows graphomotor knowledge to be sustainably transferred from psychomotor therapy into the classroom.

In a theory-led approach, materials for inclusive teaching are developed, tested and evaluated. This aims to support all the children, regardless of their graphomotor skills, and assist them in achieving automatic handwriting.

Research questions:

The following questions are of major interest: 1) What materials enable all the children in a heterogeneous first grade to be optimally supported in their graphomotor development (e.g. with regard to automaticity and legibility of handwriting)? 2) Which didactic method is suitable for providing the various elements of the graphomotor course for the inclusive teaching of handwriting? 3) What tools exist and are helpful to support and promote equal collaboration between PMTs and teachers in inclusive education?

Based on the results of the evaluation of the GRAFOS screening and the differential diagnosis for children with graphomotor difficulties (Sägesser & Eckhart 2016), as well as findings from research on effective handwriting instruction (e.g. Santangelo & Graham, 2015), an, inclusive, classroom-embedded handwriting program has been developed and tested at the University of Teacher Education in Bern. The programme consists of the following three components: A) Graphomotor teaching and support materials B) Didactic method for inclusive lessons C) Concept for multiprofessional collaboration between PMTs and regular teachers The intervention lasted 12 weeks and included 36 exercise units for graphomotor skills. The testing and evaluation of the intervention programme took place from March to July 2018 in 16 classes (N = 291) within German-speaking Switzerland. Of these, 11 classes consisted of children in one school year (only first grade, N = 224) and five classes of children in two school years (first and second grade, N = 67). During a weekly lesson, the PMT and the regular teacher worked together and taught as a team. Contrary to common practice in Switzerland, children who needed support with their motor skills were not sent for psychomotor therapy outside the classroom. But instead, the PMT came into the school class. In order to subsequently evaluate the feasibility and content of the program, focus group interviews were conducted with different groups of people (experts, participating regular teachers and PMTs). These were qualitative structured interviews that included questions about the three components of the program. The interviews lasted about 2 hours, were filmed and then transcribed and evaluated with the program MAXQDA. The children completed a reflection booklet after each lesson, which included simple questions about their motivation and the difficulty level of the lesson. These reflection booklets were also assessed during the evaluation and taken into account for the further development of the programme. In addition, graphomotor performance was measured using the diagnostic instrument GRAFOS (Sägesser & Eckhart, 2016). The pre-intervention data (baseline) and the post-intervention data are intended to provide initial evidence for the development of graphomotor skills during the intervention. Inter alia, they are the basis for the impact analysis in the planned follow-up project in which graphomotor performance will be assessed electronically.

The results of the evaluation showed that multiprofessional collaboration in inclusive, classroom-embedded handwriting program was perceived as challenging and time-consuming by teachers and PMTs, but in principle was considered to be profitable and enriching. The collaboration tools provided were used by the teachers and PMTs and facilitated the cooperation. Many teachers reported that they were able to see an improvement in the graphomotor performance of all the children, and that they themselves gained expertise. The program was judged to be extremely successful: the students as well as the teachers and PMTs were consistently motivated. The main negative points concerned the time management of the lessons, which were often considered to be too short, and the challenge of teaching cooperative learning strategies to first-grade students. The intervention program which had been developed enables all children to receive support for their graphomotor development, and support measures can be adapted to the everyday school life (see Case-Smith, Holland & Bishop, 2011, Vetter, Amft, Sammann & Kranz 2009). In addition, it meets the education policy requirement for an inclusive school system (see UN, 2006, Art.24). In the german speaking area there are still only a few theory-based teaching materials available for the inclusive, classroom -embedded handwriting support. This intervention program aims to close this gap. The concept includes both the level of individual support, inclusive didactics and multiprofessional collaboration. The final program that was revised after testing and evaluation will be presented and discussed. As a follow-up project, an intervention study is planned to investigate the effect of separate versus integrative and inclusive promotion of graphomotor skills.

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