Integrated Services or Pullout? Factors Influencing School-based Occupational Therapy Service Delivery Models

Abstract

ABSTRACT Historically, school-based occupational therapists have used more pullout than integrated therapy. Recent trends for therapy provision in regular classrooms may be a catalyst for changing practice patterns. This study examined current school-based Occupational Therapy delivery methods and perceived barriers to integrated services. Mixed methods. School-based occupational therapists (n = 61) and occupational therapy assistants (n = 2) in Colorado and Utah. Therapists completed an online survey. A subset of therapists (21 occupational therapists, 1 occupational therapy assistant) were interviewed. Descriptive statistics described survey data, with correlations calculated between potential moderator variables and the amount of integrated services. Interviews were coded for themes. Therapists provided 40% of services in an occupational therapy area (pullout services). Therapists favored integrated services for some children but reported the following system barriers to its use: lack of education and training for integrated services, meeting individual student needs, perceived high caseloads and workloads, the variability in the school environments and the relationships and attitudes within the schools. Therapists reported more use of integrated services since previous studies but continue experiencing barriers to its use as a primary service model.