School-based Occupational Therapists Research Articles

The Ethical Issues of School-Based Occupational Therapy Practice in Quebec-Canada

ABSTRACT In Quebec-Canada, school-based occupational therapy has expanded over the last decade. This emerging practice context poses distinctive ethical issues for occupational therapists, but no empirical studies have documented them. Therefore, the purpose of this study was to describe the ethical issues faced by school-based occupational therapists in Quebec. Using a qualitative inductive research design, 19 school-based occupational therapists practicing in Quebec were interviewed individually. All participants reported experiencing ethical issues in their practice. Nine categories emerged from the analyzed data, covering ethical issues in the micro-environment (n = 4), meso-environment (n = 3), and macro-environment (n = 2). In the micro-environment, occupational therapists face ethical issues relating to collaboration with school teams, management of restraints and seclusion, compliance with practice standards, and accessibility of services. In the meso-environment, they experience ethical issues linked to the cultural clash between healthcare and education, the inclusion of students with disabilities in schools, and the lack of understanding and recognition of occupational therapy. In the macro-environment, they encounter ethical issues arising from the lack of resources, and the lack of intersectoral collaboration between healthcare and education systems. Describing the ethical issues of occupational therapy school-based practice is a first step toward identifying ways of preventing and resolving them.

Exploring Performance Skills in the Occupation of Learning to Read

ABSTRACT Only one-third of U.S. fourth-grade public school students score at or above reading proficiency on national standardized tests. Current language-based reading instruction methods do not appear to meet many students’ needs. This study explores the role of visual perception in word recognition skills amongst typically developing first graders. It is hypothesized that visual perception is a crucial component of word recognition. This quantitative correlational study explored the relationship between visual perception and word recognition skills in first grade students participating in general education. The findings revealed that several statistically significant relationships exist between visual perceptual functions and skills recruited for word recognition. Phonological processing is strongly associated with spatial relations (r = .35) and sequential memory (r = .38). These correlations are significant at the 0.01 level (2-tailed). Form constancy (r = .28) p < .05 is significant at the 0.05 level (2-tailed). These relationships suggest that visual perceptual skills and phonological processing are concurrently developed in these participants and that these skills are likely recruited simultaneously when engaging in occupations, such as learning to read. This study highlights the role of visual perception in early reading development. Educators may consider consulting with school-based occupational therapists to explore the potential impact of visual perception when supporting students who struggle with reading.

A Profile of Occupational Therapists Working in School-Based Practice in Australian Primary Schools.

Inclusive education has increased the demand for school-based occupational therapy services and has reconceptualised the practice in mainstream schools. Therapists are now expected to work collaboratively with teachers within tiered intervention models to support access and participation of all students, including those with disabilities, within the natural classroom context. School-based occupational therapy has become a specialised area of practice, as therapists work within educational, rather than health, systems and processes. While the growth in demand and expanded scope of practice is positive for the profession, predicted workforce shortages and the necessity for specialised and enhanced practice present significant challenges. The ability of the profession to fully support the demands of an inclusive education system remains unclear. As accurate, up-to-date information on the school-based therapy workforce is the foundation for planning future personnel needs, knowledge of the current state of the workforce is critical. There is a paucity of national data regarding this growing area of practice. The aim of this study is to describe a current profile of school-based occupational therapists to better understand the workforce, practice patterns, and the funding landscape in Australia. A convenient and purposive sample of 108 Australian paediatric occupational therapists working in mainstream primary schools in New South Wales, Queensland, and Victoria was surveyed in this quantitative study, which was analysed using descriptive statistics. Results provide some insights into the workforce and practice of school-based therapy in Australia offering preliminary data for future planning in this important and growing area of paediatric practice. While specific to the local context, results invite cross-national and global comparison to reveal universal trends and localised nuances across diverse settings.

Assessment of Executive Functions in School Considering Motor and Sociodemographic Factors: A Joint Vision for School-Based Occupational Therapists and School Staff

Executive functions (EFs) and motor skills are essential for many school and daily tasks. Many school-based occupational therapists need help addressing EFs. The current study aims to provide new insights into the relationship between executive functions and motor development by considering confounding factors. Ninety-six second-grade children were tested in one state-funded (public) school and another state-subsidised private school. Children were assessed with the Movement Assessment Battery for Children-2 (MABC-2), Neuropsychological Assessment of Executive Functions in Children, and Test of Perception of Differences–R. Families completed a sociodemographic questionnaire, and teachers completed a previous questionnaire and subsequently evaluated the information the occupational therapist provided. Mixed results were obtained regarding the correlation between motor and executive skills. Furthermore, children who received worse scores on the MABC-2 had more difficulties on the EFs tests. The Impulsivity Control Index was not correlated with any motor variable. Our results show that sociodemographic variables (except gender) correlate more with EFs than motor skills. The teachers showed a high degree of agreement with the occupational therapist (4.0 ± 0.8), even in children with good academic performance. They expressed the need for additional training and classroom interventions. A joint vision of motor-executive functioning can facilitate the design of effective interventions, especially in schools with more disadvantaged populations.

Teacher-therapist collaboration in inclusive primary schools: A scoping review.

Inclusive school environments require collaboration between teachers and allied health professionals to promote student access and participation. Collaboration is a complex phenomenon with no universally accepted definition or measurement and with many challenges to effective practice. The purpose of this scoping review is to describe what is known about interprofessional collaboration between teachers and therapists in inclusive primary schools. A scoping review of health and education literature was conducted using the Joanna Briggs Institute methodology. Peer-reviewed articles reporting on empirical studies with a focus on collaboration between teachers and school-based occupational therapists or speech and language therapists in inclusive primary schools were included. Results summarise how collaboration is reported in the literature. Numerical and descriptive summaries describe how collaboration is defined and measured, the challenges to collaborative practice, the structures required to support effective practice, and the outcomes of such practice. Definitions vary between studies and disciplines but contain common elements. For effective practice, the purpose of the collaboration must be clear, and the intended outcomes of the collaboration are measured. Measurement of collaboration requires further research using tools developed from robust theoretical frameworks and validated within the educational context and with professionals of different disciplines. Consistent measurement tools would allow cross-study comparisons. Barriers to collaborative practice are well documented; thus, future research should be directed to examining effective practice, investigating how professionals circumvent obstacles.

Fidgets and Attention Deficit Hyperactivity Disorder: Teacher Perceptions

ABSTRACT This qualitative study explores the lack of understanding of teacher perceptions on classroom utilization of fidgets with students who have attention deficit hyperactivity disorder. Eight American special education middle school teachers from a midsized suburban public school district in Illinois were interviewed. Interview transcripts were reviewed to establish codes and themes. Three themes were identified: Misapplication of Fidgets, Support to Implement Fidgets Within the Classroom, and When Fidgets Work. Participants reported that fidgets can be a beneficial self-regulation tool in the classroom but may not serve as an appropriate educational tool for all students with attention deficit hyperactivity disorder. Additionally, participants emphasized the importance of establishing ground rules and acknowledged the benefits of seeking support from external resources, such as a school-based occupational therapist, when distributing fidgets in the classroom, especially with more complex student cases.

Promoting Participation-Focused Practices in Inclusive Educational Settings: Stakeholders' Perspectives Following a Knowledge Translation Initiative.

Available participation-focused interventions (e.g., the Pathways and Resources for Engagement and Participation intervention [PREP]), are not well integrated into practice, indicating a knowledge-to-practice gap. To explore the perspectives of school-based (SB) occupational therapists and occupational therapy managers following knowledge translation (KT) programs for facilitating participation-based practices in inclusive education. This was an implementation qualitative study. After taking part in KT programs for implementing PREP, which were tailored to the needs and contexts of each stakeholder group, occupational therapists participated in focus groups, and occupational therapy managers responded to open-ended survey questions. A content analysis was done separately for each group, then integrated and organized according to the Participation-focused KT (P-KT) framework. Inclusive educational setting. Seven occupational therapists working in inclusive schools and 39 occupational therapy managers. We identified 10 themes addressing the micro, meso, and macro levels of the P-KT framework across the two groups. Five themes, common to all participants, addressed micro (e.g., setting participation-focused goals) and meso (e.g., school-PREP fit) levels. Macro-level themes were addressed by managers only (e.g., anchoring PREP to existing policy of the Israeli Ministry of Education). Targeting different stakeholders at the micro and meso levels of the educational system can initiate a shift in practice toward a focus on participation. KT intersectoral initiatives at the macro level (e.g., targeting community services and local policies), and engaging other stakeholders (e.g., students, families, and educators), are required to ensure the sustainability of participation-based practices. What This Article Adds: The authors present two knowledge translation programs that target both occupational therapists and managers in the educational system. The programs promote a shift in school-based occupational therapy services toward a focus on participation and environment.

Assistive technology and specific learning disability: a case report

ABSTRACT Specific Learning Disability is an educational category within special education that identifies an impairment area such as reading, writing, or math despite a student’s intelligence. Individualized Education Plan teams address learning disabilities with educational interventions and accommodations. One accommodation for students with a specific learning disability is assistive technology. Occupational therapists need evidence to inform decision-making regarding assistive technology tools to meet the individualized needs of students with learning disabilities. This case report describes how a school-based occupational therapist evaluated one student’s assistive technology needs to accommodate her specific learning disability in reading and writing. This evaluation resulted in student-specific and evidence-based recommendations pertinent to age, need, and preferences. Reported outcomes include increased independence with accessing educational materials, increased access to age-appropriate reading material, and increased pleasure reading participation.

Students with emotional and behavioural difficulties in Irish post-primary schools: a role for occupational therapy

Purpose Higher levels of participation in school are linked to greater academic performance, better health and well-being and positive long-term outcomes for young people. Evidence shows that for students with emotional and behavioural difficulties (EBD), participation in school-based occupations is often restricted in comparison to their peers. Given the recent advancements towards introducing a new model of school-based occupational therapy in Ireland, this paper aims to discuss how occupational therapy can support students with EBD to increase their participation within the post-primary school context. The opinions in this paper are derived from the authors’ experience in the development of this practice in the Republic of Ireland. Design/methodology/approach The authors reviewed current literature and reflected on current practice to describe the unique role of occupational therapy in supporting students with EBD in the school environment. Findings Occupational therapists have potential to play a key role in school-based support for students with EBD. The authors describe how occupational therapists can promote whole school understanding of EBD and enable skill development, self-regulation, participation and school belonging, among youths with EBD. There is a significant lack of literature guiding practice in this area. Further research is required to explore professional issues and identify best practice. Originality/value This paper aims to provoke consideration of how school-based occupational therapists can play a crucial role in supporting students with EBD who are otherwise at risk of occupational injustice.

Development of a Decision Support System to Provide an Occupational Therapy Service for Students with Disabilities During Transition Periods

ABSTRACT The decision support system (DSS) provides systematic data for improving effective decision-making by school-based occupational therapists (SBOTs) in healthcare services. The purposes of this study were to develop the DSS and investigate its usability in providing the occupational therapy (OT) service for students with disabilities during transition periods. This study was conducted by using the Research and Development (R&D) design. There were two phases of methodology. Phase I explored the needs of SBOTs regarding DSS development. Six SBOTs were appointed for their opinions by in-depth interview with semi-structured questions. Content analysis was conducted in this phase. Phase II investigated usability of the DSS in providing the OT service to students with disabilities during transition periods. The participants comprised 18 SBOTs and 18 teachers, who worked together in providing educational programs for students with disabilities. The System Usability Scale (SUS) was used for investigating efficiency of the web-based DSS. Results found that the web-based DSS comprised two main parts of content and three main functions. In terms of content, the web-based DSS included personal and OT service information. In terms of function, syncing information from the Special Education Technology (SET) software program, making decisions on OT intervention programs and sharing OT service information were included. The SUS was used for investigating usability of the web-based DSS. The SUS score was 72.98, which indicated good usability. These findings indicated that the web-based DSS was meant to support decisions made by the SBOTs in providing OT intervention for students with disabilities during transition periods. In addition, it could be a collaborative tool, which supports sharing student information between SBOTs, teachers and other professionals in preparation for transition planning before moving to higher education levels.

Apoiando estudantes com deficiência durante períodos de transição para atingirem um elevado potencial por meio de serviços de terapia ocupacional

Abstract Introduction Transition periods are integral parts of a person’s life span, characterized by phases of life and shifts in activity before adapting to new situations. Objectives This study aims to understand the high potential characteristics of students with disabilities and evaluate the roles of school-based occupational therapists (SBOT) in assisting these students during transition periods. Method This study comprised 196 students and five SBOT. Research instruments included a characteristic checklist for potential learners and an in-depth interview methodology. The checklist, developed from related literature, consisted of three domains: physical and socio-emotional health, self-determination, and communication and academic performance. Students’ performance levels were rated by teachers, with high potential characteristics being defined as achieving an average total score ≥2.0, without obtaining a zero in any checklist item. Results Most participants achieved full scores for high potential characteristics in the physical and socio-emotional health domain. Most SBOT provided direct, indirect, and integrated services using various service delivery models that were tailored to different types of disabilities. Conclusion This study provides fundamental information for SBOT and school professionals to foster high-potential characteristics in students with disabilities during transition periods. Suitable services in the domains of physical and socio-emotional health, self-determination, and communication and academic performance can enhance these high-potential characteristics.

School-Based Occupational Therapists’ Perceptions of Sensory Processing Interventions for Students With Autism Spectrum Disorder

ABSTRACT There is no research on the lived experience of school-based occupational therapists providing sensory-based interventions for students with autism spectrum disorder (ASD). The purpose of this study was to investigate how school-based occupational therapists are addressing sensory processing limitations for students with ASD. A phenomenological qualitative approach was used to understand participants’ experiences. In total, six occupational therapists provided responses to qualitative natured questions during virtual interviews. Thematic analysis was performed through line by line coding of interview transcripts and five key themes were discovered that illustrate their experiences. Occupational therapists face a complex, multi-faceted, challenge when addressing sensory processing limitations in students with ASD in the educational context. One size does not fit all and participants utilized a variety of approaches and sensory tools to address student’s needs. Factors involved in the process can be facilitators or barriers to perceived successful implementation, depending on the level of support and collaboration from interdisciplinary staff. The results of this study should be used to facilitate and guide team discussions around how-to best address students with sensory processing limitations.

Understanding and Enhancing Occupational Therapists' Use of Standard Family-Centered Measures.

The use of standard family-centered measures (FCMs) is imperative to guide family-centered care (FCC) interventions and monitor their outcomes. To measure the frequency of FCM use and evaluate the effectiveness of experiential learning and reflection to increase their use. Descriptive and two-group pre-post comparative training study. Continuing education center. Phase 1 included 145 health care providers. Phase 2 included 44 school-based occupational therapists who participated in Phase 1. Phase 2 participants enrolled in 30-hr FCC training that included a 2-hr workshop on FCM. One group (n = 22) conducted an FCM with a family and wrote a reflective report. All participants completed the Measure of Processes of Care-Service Provider (MPOC-SP) questionnaire and reported how frequently they used FCMs. FCM use rates were low (50%, not at all; 26%, to a very small extent). The extent of FCC was correlated with FCM use (r = .24-.30, p < .01). A Wilcoxon signed-rank test demonstrated that participants who administered an FCM with a family and reflected on this experience showed significant increases (Z = 176.0, p = .001) in FCM use compared with participants who were only instructed about available FCM. A Mann-Whitney U test confirmed the difference (U = 3.54, p = .012). FCM use is sparse, but experiential and reflective activities are simple keys to promoting FCC and integrating FCM into practice. What This Article Adds: Training designers, educators, and managers should consider integrating experiential learning to enhance providers' expertise and quality of care.

The Phenomenological Study on Work Experience of School-Based Occupational Therapists

목적 : 본 연구의 목적은 학교 작업치료사의 근무 경험에 대한 의미를 탐색하는 것이다. 연구방법 : 본 연구는 현상학적 연구이다. 참여자는 학교 작업치료사 7명으로 모두 여성이고, 평균 근무경 력은 5년이었다. 이들을 대상으로 학교 작업치료사로서의 근무 경험에 관하여 일대일 인터뷰를 진행하였 고, 부가적인 인터뷰 내용 확인은 이메일을 활용하였다. 인터뷰 내용은 대상자의 동의를 얻어 녹음하였 고, 연구자가 녹음을 여러 번 듣고 전사하여 Colaizzi 연구 방법에 따라 분석하였다. 결과 : 인터뷰 내용을 분석하여 2개의 주제와 10개의 하위 주제가 도출되었다. 주제로는 어려움과 희망이 도출되었다. 어려움에는 행정업무에 대한 부담, 물리적 환경 제약, 교사 또는 교직원의 인식 부족, 불안정 한 고용, 학교에 근무하는 ‘의료기사’ 작업치료사가 있었고, 희망에는 아동에 대한 사명감, 같은 목표를 가진 팀원, 학교 작업치료를 원하는 아동들, 교사의 만족, 작업치료발전에 대한 책임감이라는 하위 주제 가 있었다. 결론 : 특수교육대상자에게 질적으로 향상된 학교 작업치료를 제공하기 위하여 학교 작업치료에 대한 제도 적 개선과 정책적 지원이 마련되어야 한다.

Executive Functioning in the Schools: Perspectives from Occupational Therapists

ABSTRACT Awareness of executive functioning and its relevance to both occupational participation and special education is expanding. This study describes how school-based occupational therapists address executive functioning in practice and determined if this differs from traditional areas. Fourteen occupational therapists from four districts in Michigan completed the 36-item online survey consisting of closed and open-ended questions. A majority of these participants agreed that executive functioning impacts school function and occupational therapists should address it in school; yet, only 33% provided intervention using this lens and 77% indicated this as the area they feel least prepared to address in school-based practice. Executive function practice significantly differed from handwriting (p < .05), sensory (p < .01), and fine motor competency (p < .01); fine motor and sensory evaluation (p < .05); and handwriting intervention (p < .05). Participants described their role with executive functioning as collaborative, supplemental to enhance participation, and applicable to functional organization tasks. Although some occupational therapists are embracing an occupation-based process explicitly considering executive functioning, a majority need continued education, role clarity, and advocacy to more intentionally align their team’s services with emerging best practice.

Occupational therapy intervention to address handwriting deficit in elementary-aged school children: How to, how much, and how often? A scoping review

ABSTRACT Handwriting is a key occupation for school-aged children and one of the common reasons for referral to a school-based occupational therapist. There are many interventions offered by school-based occupational therapists and this scoping review aimed to examine specific intervention approaches and compare their mode of service delivery (i.e., direct and/or indirect), recommended dosage (i.e., frequency and duration), embedded theoretical frameworks, and identify if the intervention caused statistically significant changes in a child’s handwriting ability. Eight (8) studies were reviewed (seven Level III; one Level V) identified through a comprehensive database search. Of the eight studies that met the inclusion criteria, five were curriculum-based programs, all of which incorporated task-specific motor learning approaches and showed statistically significant improvement in handwriting (both direct and indirect OT involvement). Two studies reviewed devices (iPad and weighted pencil) and one study did not involve performing handwriting during treatment sessions. The studies reviewing the use of devices and the study where task-specific handwriting was not completed in treatment sessions did not demonstrate statistically significant benefit on improving a child’s handwriting ability. Curriculum-based interventions that have an embedded motor learning practice component, with either direct or indirect involvement from occupational therapy, may have a positive impact on a student’s handwriting ability; however, more rigorous studies need to be completed. The use of devices (i.e., iPad & weighted pencils) to improve handwriting is not currently supported in the literature.

The Value of Collaboration with Occupational Therapists in School Settings: Elementary Teacher Perspectives

ABSTRACT Collaborative practices are espoused in the literature as best practice. Following a needs assessment, data indicated that collaborative practices between teachers and occupational therapists were not happening consistently and were in need of improvement. Further research is needed to determine elementary teachers’ perceptions of the value of collaboration with occupational therapists in order to ensure maximum benefit for the students. This study focused on identifying elementary teachers’ perceptions of the value of collaboration with occupational therapists and validating the need for improved occupational therapy supports in the school environment. An anonymous electronic survey approach was used as the data collection method. The invitation to participate and the survey link were distributed to five school administrators, within the chosen geographic area, who forwarded the invitation and survey link to their site’s teaching staff. The survey included nineteen close-ended questions and one open-ended item for additional comments. While the majority of the participants indicated having had students receive occupational therapy services (96.05%), only 36.84% (N = 28) of the participants reported collaborating often with the occupational therapist to address the needs of the students. 73.68% (N = 56) of the participants perceived collaboration with the occupational therapist as valuable for providing effective classroom strategies and having a positive impact on student success. 82.89% of participants reported that more education about school-based occupational therapy would be beneficial. Findings indicated that school-based occupational therapists need to find ways to improve their collaborative practices with teachers. Teachers would like to learn more about the role of occupational therapists and the classroom strategies they can offer.

Building Better Teams: Impact of Education And Coaching Intervention on Interprofessional Collaboration Between Teachers and Occupational Therapists in Schools

ABSTRACT Most American school-based occupational therapy (SBOT) practitioners do not report utilizing research-supported collaborative models of therapy (Gallagher & Richards, 2020). The purpose of this quantitative, quasi-experimental study was to determine whether a 4-month-long training and coaching program could improve interprofessional collaboration skills, measured by pre- and post-self-scoring. Training and coaching content built upon theoretical foundations of Universal Design for Learning, where learning is intentionally designed to maximize access for all learners, and Distributed Cognition, where each group member contributes unique knowledge to the team. Interprofessional collaboration was operationalized into three discrete skills: communication, role perception, and conflict resolution. Research questions investigated whether training and coaching strategies could improve communication, role perception, and conflict resolution, measured by improved posttest scores. Sample consisted of 27 pairs of school-based occupational therapists and classroom teachers from central New Jersey. For data analysis, sum for each item pre and post was calculated then classified by variable. Paired-sample t-test determined whether sums showed significant differences. For communication, role perception, and conflict resolution, the paired sample t-test analysis revealed significance at .000. Participants’ self-reported scores showed statistically significant increase on all three variables. Overall, this study provided a precedent for potential effectiveness of longer-term training/coaching sequences to improve interprofessional collaboration for occupational therapists and teachers in school-based settings.

Implementing Pathways and Resources for Engagement and Participation (PREP) for Children with Disabilities in Inclusive Schools: A Knowledge Translation Strategy

Aims: To examine the effectiveness of PREP (Pathways and Resources for Engagement and Participation) knowledge translation (KT)-program on (a) change in practice behaviors and improved knowledge of school-based occupational therapists, and (b) participation of children with disabilities in inclusive education. Methods: A mixed-methods design was employed. Therapists (n = 39) completed a 30-hour program. Each therapist applied PREP intervention to one child (n = 39) aged 4-15 (Mean = 9.31, SD = 2.4). Therapists’ outcomes included: (a) knowledge of PREP evaluated using a clinical vignette, analyzed descriptively, (b) change in practice behavior measured by the Professional Evaluation and Reflection on Change Tool (PERFECT), analyzed thematically. Change in children’ participation pre- and post-KT-program and during follow-up was measured by the Canadian Occupational Performance Measure (COPM), analyzed using ANOVA. Results: Therapists acquired knowledge of PREP (vignette mean score 17.7/20). PERFECT revealed therapists’ self-perceived changes in practice: incorporating an environmental perspective, expanding partnerships, and redirecting focus on participation. Completing the KT-program was a primary enabler and reason for change. Children’s participation significantly improved post KT-program and during follow-up in both performance (p < 0.001) and satisfaction (p < 0.001). Conclusions. KT strategies, as illustrated in this study, accelerated the uptake of evidence-based interventions, minimizing existing ’know-do' gaps and promoting children’s health through participation.

Pediatric Mental Health Treatment and Confidence through the Lens of the School Based Occupational Therapist’s Role

Given the rise in mental health needs in children and adolescents and the historical roots of occupational therapy in psychiatry, occupational therapists may be well-equipped and well-suited to offer expert contributions on school-based mental health teams. Occupation-based assessments and interventions for schoolchildren with mental health conditions are essential but are often overlooked because occupational therapy is traditionally solicited to support children with physical health concerns. The research problem for this study was that it was unclear how school-based occupational therapists perceive pediatric mental health treatment preparedness and confidence. The purpose of this basic qualitative study was to explore school-based occupational therapists’ perceptions of their preparedness and confidence to offer pediatric mental health treatment. Semistructured interviews were conducted through video conferencing. Self-efficacy and adult learning theories were used as guiding frameworks. Results of thematic analysis exposed five themes: the importance of university and fieldwork education; professional self-directness and intrinsic motivation; readiness to learn and role clarity; collaboration and communication; and advocacy. These findings have significant implications for occupational therapy students as well as their educators and employers.