School-based Occupational Therapy Practice 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.

Occupational Therapy Practice in Schools: National Survey in Spain

Aims Interdisciplinary collaboration between health and education professionals is one of the principles of inclusive education. This study aimed to describe the practices and service delivery by pediatric occupational therapists (OTs) in schools in Spain. Methods Data came from a convenience sample of pediatric OTs recruited through Spanish professional colleges and associations for a web-based survey, mixed-method research study. Thirty-five respondents were excluded because they didn’t meet the eligibility criteria. Ninety-two responses were obtained for data analysis. Twenty-nine OTs (31.5%) work in schools (school-OTs), and sixty-three participants (68.5%) don’t work there but collaborate with schools (non-school OTs). Results Participants support students with and without a medical diagnosis. Services provided by OTs external to the educational system are mainly funded by families or only partially covered. Findings show that most participants use standardized assessments and apply several intervention approaches. They believe there are barriers to the collaboration and implementation of occupational therapy services in schools. Conclusions This preliminary study shows a need for changes in Spain’s State and Regional Education legislation and provides recommendations to improve school service delivery. Pediatric OTs are encouraged to reflect on and identify opportunities for changes to enhance school-based occupational therapy practice in Spain.

How can we evaluate collaborative practices in inclusive schools? Challenges and proposed solutions

ABSTRACT Inclusive education is endorsed for children with disabilities or special needs attending school. In inclusive settings, support services by health care professionals are essential to support their integration and participation in school life. Collaboration between school health professionals, such as occupational therapists, and school personnel is fundamental and deemed as evidence-based practice in the provision of such support services and is considered as effective practice. However, there are differing views of what collaboration entails. An accurate measurement and evaluation of collaboration among school teams is important to adjust team processes and teamwork skills, and to best support students. In research, the study and the operationalization of the construct of collaboration among team members should also be carefully considered especially in the selected methodology. In this column, the difficulties and pitfalls with current measures of collaboration in the context of inclusive education between occupational therapists (OTs) and educators are discussed. Available measures of collaboration that may be suitable for research use in the school environment are presented. Finally, potential solutions that may be useful to assess collaborative practices and enhance clinical research in the field of school-based occupational therapy practice are proposed.

Occupational Therapy Services in School-Based Practice: A Pediatric Occupational Therapy Perspective from Ireland.

Purpose School is a primary setting for pediatric occupational therapy practice, yet little is known about the provision of school-based occupational therapy in many countries internationally. The purpose of this study was to explore current school-based occupational therapy practice for the first time in Ireland to gain insight into current and potential service provision and to identify new directions and potential pathways for development. Methods This descriptive quantitative study utilized a cross-sectional online survey to gain the perspectives of the population of pediatric occupational therapists working regularly in schools across Ireland. Respondents were recruited through convenience and snowball sampling. Data were analysed through qualitative content analysis and descriptive statistics. Results The survey elicited 35 responses, yielding a 21.2% estimated response rate. Findings demonstrated that respondents provided therapy services in schools most commonly on a weekly (28.6%) or monthly (34.3%) basis, with only 5.0% working in the same school on a weekly or fortnightly basis. The majority of respondents (54.3%) used a direct therapy approach with a child, rather than coaching or modelling, to primarily address sensory, hand function, or daily living needs. None used a whole class or whole school (universal or tiered) approach. While respondents (54.3%) generally viewed collaborative practice as a strength of school-based practice, they also identified barriers to collaboration in schools. A core barrier is related to how services are constructed across health and education, with differing philosophies of service provision. The majority of respondents (75.0%) reported that they had not received any training to deliver evidence-based practice in therapy provision specific to school-based practice. Implications for Practice. This study indicates that therapists require continual education on evidence-based school practice as it applies in an Irish context. Furthermore, clarification of school therapy roles and service delivery models are required in order to determine how they contrast with traditional clinic roles. This will enable therapists to strengthen the coordination of service delivery between health and educational services to maximize the outcomes of school-based practice.

The developing role of occupational therapists in school-based practice: Experiences from collaborative action research in Pakistan

Introduction Occupational therapists around the world increasingly seek to support the participation of children with disabilities and special educational needs in mainstream education. Contemporary school-based occupational therapy practice is progressing from an individual, impairment focus towards collaborative, universal interventions at the whole class and whole school level. Participation-focused practice and collaboration is particularly important, but uncommon, in low-resource contexts such as Pakistan. Methods This article reports on collaborative action research that developed the role of occupational therapy in inclusive education in Karachi, Pakistan. A research team consisting of occupational therapists and teachers worked with five local primary schools, using the action research cycles of plan–implement–observe–reflect to develop practical strategies, materials and inclusive lesson plans to facilitate the participation of all children in all school-based occupations. Findings Support from school management and interdisciplinary collaboration were crucial for implementing change. In addition, strategies like inclusive lesson planning were found to benefit all children in class. Collaborative action research led to increased professional confidence in the teachers and occupational therapists, and skill development through developing a resource guide, running workshops and presenting at (inter)national conferences. Conclusion Collaborative action research was an effective means to develop the occupational therapy role in inclusive education practices in Pakistan, develop culturally appropriate educational resources, and upskill local therapists and teachers.

Development of a Tablet Application for Collaborative Goal-setting in School-based Occupational Therapy: The Aid for Decision-Making in Occupation Choice for Schools (ADOC-S)

ABSTRACTIntroduction: This study aimed to develop a new tablet application named the Aid for Decision-making in Occupation Choice for School (ADOC-S). It aims to assist with conducting collaborative occupation-based goal-setting by sharing decision-making with a team member (child, parent, teacher, and occupational therapist) using a consultation model of school-based occupational therapy (SBOT). Method: This developmental study involved two phases: (1) using a focus group technique to develop the concept and prototype of the ADOC-S, and (2) using a Delphi-style method to reach a consensus among eight experienced occupational therapists regarding the ADOC-S items, text, and images. Then, we reported its use in SBOT practice with a single case example of a school-aged child in Japan. Results: First, the concept and the prototype application of ADOC-S was created. Then, after two Delphi rounds, the eight occupational therapists reached a consensus that 68 items in four categories were included in the ADOC-S: Self-care (17 items); Communication (9 items); School life (22 items); and Play (20 items). The case study illustrated how to use the ADOC-S and its efficacy for collaborative goal-setting in SBOT. Conclusion: The ADOC-S appears to promote collaborative goal-setting in SBOT. This application now needs to be clinically tested.

Perspectives on the use of a telehealth service-delivery model as a component of school-based occupational therapy practice: Designing a user-experience.

Telehealth is an accepted service-delivery model in a variety of health professions, including occupational therapy. Telehealth holds potential for school-based occupational therapy evaluation, intervention, consultation, monitoring, and supervision. As the use of telehealth becomes prevalent, it will be important to describe the benefits and barriers to potential types of occupational therapy evaluation, intervention, consultation, monitoring, and supervision delivered via a telehealth service-delivery model. Querying stakeholder perceptions of telehealth may help guide additional precipitating factors that have not yet been explored. This study gathers information regarding perceptions, perceived barriers, and benefits of the use of telehealth in school-based occupational therapy practice. School-based occupational therapy practitioners (OTP), district administrators, and related technology staff were invited to complete a survey intended to explore attitudes about the use of telehealth. 28.57% of respondents stated that their districts were likely to adopt the use of telehealth. Participants noted perceived barriers and benefits to the use of telehealth. This study provides preliminary feedback regarding school-based OTP and administrator perceptions of telehealth as a component of school-based OT practice.

School-based occupational therapists’ service delivery decision-making: Perspectives on identity and roles

ABSTRACTThe purpose of this qualitative study was to explore the context of service delivery decision-making in school-based occupational therapy practice. Participants included 14 occupational therapists. The primary source of data came from semi-structured, open-ended interviews. Open inductive coding was used for in-vivo data analysis. Themes in the data revealed that decision-making is impacted by therapists’ professional identity and their conception of the role of occupational therapy in school settings. Therapists in this study relied mostly on traditional interventions that focused on skill development and was found to be the primary driver of decision-making about service delivery.

A Transdisciplinary Team Model for School-Based Sensorimotor Programming

Abstract Date Presented 3/31/2017 This qualitative research proposes a model for transdisciplinary team collaboration and sensorimotor program implementation in special education for adolescents with autism spectrum disorder, intellectual disabilities, or both. This new model will advance school-based occupational therapy practice. Primary Author and Speaker: Laura GreissHess Contributing Authors: Brooke Czuleger, Emily Garnica, Jessica Phung, Maciej Rzepka

Use of a journal club for professional development: Outcomes in a school-based occupational therapy practice

ABSTRACTThis article investigates the outcomes of a journal club on the evidence-based practice (EBP) skills of school-based practitioners. Participants’ knowledge, attitudes, and perceptions of EBP were collected using pre- and postsurveys following 6 monthly journal club sessions. Participants identified time, availability of articles, and decreased understanding of results as barriers. On the postsurvey, participants reported improvements in comfort with evidence-based skills, including leading an EBP discussion, using evidence in documentation, and referring colleagues to appropriate evidence-based resources. Journal club sessions improved practitioners’ comfort with the ability to discuss and utilize evidence-based resources.

Enabling Outcomes for Students with Developmental Disabilities through Collaborative Consultation

Collaborative consultation has been widely adopted in school-based occupational therapy practice; however, limited research has examined how collaboration between educators and occupational therapists contributes to students’ outcomes. The purpose of this study was to describe the nature of collaborative working in two cases of school-based occupational therapy service delivery. This paper reports a cross-case analysis, comparing findings about the nature of a joint effort in each case study to identify workplace practices that facilitated educator-occupational therapist collaboration. Ethnographic case study methods (Stake, 1995; Wolcott, 2008) and socio-cultural activity theory (SCAT; Engeström, 2001) were used to examine multiple perspectives concerning school-based occupational therapy collaborative consultation for two students with developmental disability in one region of Ontario, Canada. Cross-case analysis (Stake, 2006) facilitated examination of the similarities and differences in teamwork. Specific ways that educator-occupational therapist collaboration can be facilitated were identified in three areas: (a) focus for educational programming; (b) communication practices; and (c) leadership practices of educators. SCAT provided a robust framework for describing the depth, quality, and context of interactions from multiple stakeholder perspectives. As such, this research contributes to the development of theoretical and empirical perspectives on the processes of collaborative working and the relationship of these processes to outcomes.

School-Based Occupational Therapy Practice: Perceptions and Realities of Current Practice and the Role of Occupation

The purpose of this study was to explore how school-based occupational therapists describe current practice including the role of occupation. Participants included 16 occupational therapists currently practicing in the schools. Data were collected via an interview. The methodology used in this study was a mixed qualitative design based on multiple-case study analysis and grounded theory. The participant interviews were analyzed for themes. The results indicate that school-based practitioners have a high level of satisfaction with their job. Participants report a belief that the natural context of the school supports occupation, and occupation is a strong influence during the intervention process as well as the overall daily practice of the school-based practitioner. Teams are also reported to strongly influence current practice.

Learning together for effective collaboration in school-based occupational therapy practice

School-based occupational therapy (SBOT) practice takes place within a complex system that includes service recipients, service providers, and program decision makers across health and education sectors. Despite the promotion of collaborative consultation at a policy level, there is little practical guidance about how to coordinate multi-agency service and interprofessional collaboration among these stakeholders. This paper reports on a process used to engage program administrators in an examination of SBOT collaborative consultation practice in one region of Ontario to provide an evidence-informed foundation for decision making about implementation of these services. Within an appreciative inquiry framework (Cooperrider, Whitney, & Stavros, 2008), Developmental Work Research methods (Engeström, 2000) were used to facilitate shared learning for improved SBOT collaborative consultation. Program administrators participated alongside program providers and service recipients in a series of facilitated workshops to develop principles that will guide future planning and decision making about the delivery of SBOT services. Facilitated discussion among stakeholders led to the articulation of 12 principles for effective collaborative practice. Program administrators used their shared understanding to propose a new model for delivering SBOT services. Horizontal and vertical learning across agency and professional boundaries led to the development of powerful solutions for program improvement.

A critical examination of school-based occupational therapy collaborative consultation

Although collaborative consultation has been widely adopted in school-based occupational therapy practice, there is limited conceptual understanding of how collaboration contributes to educationally relevant outcomes for students with disabilities. Even without a clear understanding of the evidence related to school-based occupational therapy services, there continue to be decisions about funding and delivery of services. This paper synthesizes and critically appraises the research literature on collaborative consultation services in school-based occupational therapy in order to provide program administrators with direction for critically examining decision making for service delivery in their districts. Advancing occupational therapy practice in education settings requires a sound theoretical understanding of collaborative consultation. Distributed cognition offers a more robust understanding of the relationship between educator-therapist collaboration and outcomes of school-based occupational therapy services. This review concludes with two fundamental conditions necessary for collaboration between educators and occupational therapists to flourish.

School-Based Practice Patterns: A Survey of Occupational Therapists in Colorado

This purpose of this study was to describe school-based occupational therapy practice for kindergarten through twelfth-grade students in Colorado and to examine occupational therapy practice in light of current education policy and published views of best practice. Study data were provided by 105 occupational therapists and occupational therapy assistants who completed a 24-item questionnaire. Occupational therapists carried an average caseload of 43.68 students; most frequently served kindergarten through third-grade students with perceptual or communicative disabilities; and delivered services most often in pullout treatment areas. Practitioners spent most of their work week providing direct services. Remedial or developmental approaches were used 62% of the time and compensatory and educational approaches 37% of the time. Individualized education program goals addressed by occupational therapists were most frequently developed by the occupational therapist and targeted students' sensory or motor impairments. Workshops on autism and sensorimotor intervention techniques were reported as the primary and preferred forms of professional development. The strong majority of reported occupational therapy services contrasted with emerging views of best practice. They were, however, consistent with the Colorado Department of Education's guidelines for "motor specialists" that address occupational therapy, physical therapy, and adaptive physical educators working in schools. Study findings are discussed.

Interprofessional vs. interdisciplinary services in school‐based occupational therapy practice

Interdisciplinary or transdisciplinary service is strongly advocated in school-based occupational therapy practice. The terms, interdisciplinary and transdisciplinary, however, are not accurate in their use. This paper examines the difference between the terms of discipline and profession and recommends the more precise and appropriate use of interprofession and transprofession related to school-based occupational therapy practice. Occupational therapy is a profession, not a discipline. Using the terms of interprofession and transprofession can benefit the occupational therapy profession by increasing language use precision, facilitating professionalism, and improving interprofessional interactions and collaborations based upon accuracy.

Facilitating Participation of Students with Severe Disabilities

School-based occupational therapy is the largest employer of occupational therapists. School-based occupational therapists work extensively with students with severe disabilities. Over the past decade, one significant change in the field of severe disabilities has been the advocacy of best practices. This paper discusses the implications of best practices for school-based occupational therapy practice and examines strategies that occupational therapists use to tackle such challenges. Focuses of the discussions are centered on the issues relative to curriculum, educational setting and instructional strategies. The theme of Activity and Participationproposed in International Classification of Functioning(WHO, 2001) guides our discussions. Specific strategies in aligning school-based occupational therapy practice with best practices in severe disabilities are proposed and highlighted.

Fieldwork in Schools: A Model for Alternative Settings

An exploratory study was conducted at the University of New Hampshire to increase the number of school-based fieldwork opportunities for occupational therapy students and to guide the development of a model for first-time fieldwork supervisors in schools. Responses to a questionnaire completed by 119 occupational therapists working in schools in northern New England provided a description of both school-based occupational therapy practice and of their needs as supervisors. Interviews with 12 occupational therapists who had supervised fieldwork students in schools provided qualitative information. Findings suggested that school-based practice issues such as working part time, traveling between schools, and using a variety of service delivery models created particular challenges for fieldwork supervisors in schools. A process of addressing fieldwork supervisors' concerns during recruitment and in a fieldwork supervisor seminar and providing ongoing support resulted in successful fieldwork experiences for occupational therapy students. This process of studying a practice setting in order to develop a model for fieldwork that addresses the uniqueness of the setting may be used to develop fieldwork opportunities in other practice settings as well.

The Application of the Client-Centred Approach to School-Based Occupational Therapy Practice

The Guidelines for the Client-Centred Practice of Occupational Therapy (Department of National Health and Welfare and Canadian Association of Occupational Therapists, 1983) have been successfully applied to various institutional and community settings. However one of the most challenging appears to be the application to school-based practice. In this article the conceptual frame of reference and the practice stages in the occupational therapy process are directly applied to school settings. Philosophical differences are apparent and these are likely influencing the development of occupational therapy services in schools. A case study is used to illustrate some of the issues andthe preparation of guidelines for school-based occupational therapy services is recommended.