School-based Occupational Therapy Research Articles

Occupational therapy in the Snoezelen® Room: Teachers’ and therapists’ knowledge and perceptions of the changes in children's behaviour and performance

Introduction: The Snoezelen® room, a multisensory environment (MSE), is often used in conjunction with sensory integrative techniques. Therefore, it may be of support in school-based occupational therapy intervention. Research has documented positive changes in children’s performance in the MSE. However, research to suggest that changes could be carried over to external environments is limited. This study aimed to investigate the knowledge and perception of teachers and therapists regarding changes in children's behaviour and performance after therapy in the Snoezelen® room. Methodology: A descriptive quantitative cross-sectional survey design by purposive sampling was used. Teachers and therapists working with children who received occupational therapy intervention in the Snoezelen® room participated. Results: Descriptive and inferential statistics were utilized to determine strong positive, significant correlations found between the total impact of the Snoezelen® room and the children’s level of arousal, as well as their behaviour and scholastic performance, as conveyed by 30 participants. After therapy in the Snoezelen® room, improvement in level of arousal was ranked as the biggest change, which appeared to improve for hours upon return to the classroom. Conclusion: Children’s arousal levels changed positively due to sensory input, which carried over to the external environment. Due to this, most teachers and therapists perceived that the Snoezelen® room positively changed behaviour and scholastic performance, through improved level of arousal. Implications for practice: The use of Snoezelen® rooms in schools, combined with sensory integration therapy (SIT), enhances children's self-regulation, which in turn positively impacts behaviour and academic performance. Strong, positive correlations were found between children's level of arousal and improvements in their behaviour and scholastic performance. Thus, Occupational therapy interventions in the Snoezelen® room significantly contribute to children’s ability to self-regulate, a key factor in achieving positive classroom behaviour and learning outcomes. Teachers and therapists perceive Snoezelen® rooms as beneficial, with 96.7% supporting their presence on school campuses to improve child behaviour through better self-regulation. Consistent with extensive research surrounding self-regulation of children, acquiring self-regulation skills in the early years lays the foundation for positive classroom behaviour and academic performance later.

Developing an initial explanatory theory for Partnering for Change using realist evaluation.

Partnering for Change (P4C) is an innovative practice model for school-based occupational therapy developed in Canada and informed by a program of research spanning nearly two decades. National and international interest in P4C necessitated development of an explanatory theory to guide implementation in varied contexts. The purpose of this study is to document the process of theory development and to provide an overview of the initial P4C explanatory theory. Realist evaluation was used to construct an initial explanatory theory of P4C drawing on P4C developers' conceptualisations of the model, document analysis, and analysis of transcripts from interviews and focus groups. No consumers were involved in the study design or analysis. Four sets of premises expressed as context-mechanism-outcome configurations (CMOCs) comprise the initial explanatory theory of P4C. An abstracted summary of these four sets along with contexts, mechanisms, and outcomes central to the P4C initial explanatory theory is presented. An exemplar CMOC is shared to illustrate how theoretical premises are developed and expressed using realist evaluation. This study advances knowledge regarding the hypothesised core elements of P4C and provides an example of using realist evaluation to advance knowledge in occupational therapy. Preliminary implications for clinical practice are discussed. Partnering for Change (P4C) is a way of providing occupational therapy services in schools that helps all children to learn and participate successfully. P4C was created in Ontario, Canada, and has been researched for almost 20 years. People in different parts of Canada and other countries are interested in trying P4C. As the researchers who created P4C, we think there is a need to explain how it works so it can be used in different places. This study explains how we created a theory to describe P4C. To develop this theory, we used a method called realist evaluation that would help us explain how, why, and in what situations P4C works best. To do this, we analysed documents and transcripts of interviews and focus groups. Our findings are organised into four main ideas, each explained in terms of contexts (the situations), mechanisms (how and why P4C works), and outcomes (the impacts of P4C). One detailed example is given to show how these ideas were formed and work together. In conclusion, our study helps us understand the key parts of P4C and shows how realist evaluation can be used to improve knowledge in occupational therapy. The study also suggests some early ideas on how P4C can be used in practice.

Client-Centered and Multidisciplinary Approaches in School-Based Occupational Therapy: Perceptions of Therapists and Parents

This study aimed to explore the perspectives of occupational therapists and parents who receive therapeutic support services for their children with special needs in school. We focused on school-based occupational therapy (SBOT) service goals, delineating how participants prioritize necessary services and perceive multidisciplinary collaboration. In this cross-sectional study, we employed an online survey methodology. We used a purposive sampling method to reach all school-based therapists registered in therapeutic support centers and a snowball sampling method to recruit parents. The final sample included responses from 29 therapists and 120 parents. We found that parents reported a greater need for service provision and multidisciplinary collaboration compared to school-based occupational therapists. Although therapists felt competent in their service provision, there is an urgent need to address the service needs expressed by parents. The participating therapists reported working with lower-functioning students and prioritized goals such as “providing task skills through Individualized Education Programs (IEPs)” and “enhancing student participation in educational activities.” In contrast, parents reported supporting higher-functioning children and prioritized goals such as “therapeutic activities within school environments” and “helping with important learning activities in natural environments.” This study underscores the need for ongoing research to develop integrative occupational therapy services in the school environment.

School-Based Occupational Therapy Interventions for School-Aged Children : A Systematic Review

School-Based Occupational Therapy Interventions for School-Aged Children : A Systematic Review

General education inclusion of students with significant disabilities: the role of the school-based occupational therapy practitioner

ABSTRACT Since the passage of The Individuals with Disabilities Education Act (IDEA) in 2004, it has been mandatory for disabled children to be educated with non-disabled children within public agencies to the greatest extent possible. While school systems have responded by creating academic and functional programs better suited for educating students with disabilities, they tend to be self-contained environments with limited opportunities for exposure to typical peers throughout the school day. The inclusion of special education students, especially those with significant impairments, is currently not meeting the expectations set forth by IDEA. The reasons for this vary widely and have led to the pervasive restrictive placement of students with extensive support needs (ESN) despite the numerous benefits of inclusive placement presented in available research. This manuscript will compile the existing evidence on the educational placements of significantly disabled students and use it to paint a picture of the current state of inclusion, identify the barriers to its implementation, list the benefits of inclusion for all students, and discuss how occupational therapy practitioners can facilitate, enhance, and expand inclusion of these children. This manuscript serves as a call to action for school-based occupational therapy practitioners to expand their role in this setting by emphasizing their unique skill sets to educators and fully utilizing their strengths to act as advocates for the significantly impaired students they serve.

School-Based Occupational Therapists' Roles Supporting Transitions Into and Throughout Kindergarten to Grade 12: A Scoping Review.

Large educational transitions occur when students enter and exit school or move between grades or divisions within the kindergarten to Grade 12 (K-12) school system. For students with disabilities, the quality of large educational transitions affects academic and postschool outcomes, which is germane to school-based occupational therapists. To explore the school-based occupational therapy literature to describe the roles of occupational therapists in supporting large educational transitions and to identify relevant terminology. We searched six databases (CINAHL, EMCare, Embase, ERIC, MEDLINE, and PsycINFO) for peer-reviewed publications in English with no date limitations. We included articles focused on children and youth with disabilities and school-based occupational therapy services supporting large transitions within K to 12 education. Using directed content analysis, we reported on publication characteristics, occupational therapy roles, and terminology. We included 46 publications spanning 37 yr that addressed transitions into school (n = 3), within K to 12 grades or divisions (n = 10), or to exit secondary education (n = 33). Occupational therapists assumed many roles in supporting large transitions, some much more frequently than others; 125 transition terms were used across included articles with few terms explicitly defined. School-based occupational therapists' involvement in educational transitions is extensive, with potential for expansion. Consistency in terminology would support future research and practice. Plain-Language Summary: A large educational transition occurs when students move between a school, grade, or division as part of their K to 12 education. For students with disabilities, the quality of a large educational transition affects their academic and postschool outcomes. This review provides an understanding of how school-based occupational therapists support educational transitions for youth with disabilities. The review found that occupational therapists took on many roles, with the potential for expanding their roles. The review also identified 125 transition terms that were used across the literature review and found that few terms were explicitly defined. Consistency in terminology would support future research and expanded occupational therapy practice in this area.

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.

The development of quality indicators to increase effectiveness and efficiency in school-based practice

ABSTRACT Effective measures of the quality of services provide transparent and accountable standards to examine and illustrate high-quality care and contributions to client outcomes. They identify priorities for professional development action planning and allow practitioners to detect gaps in knowledge. Drawn from the need to measure and articulate effectiveness and to guide quality improvement efforts, the Quality Indicators of School Practice (QISP) was developed to provide school-based occupational therapy practitioners and collaborators a mechanism to examine occupational therapy practice, consider its contextual meaning, and illustrate the application of the indicators in practice. A rigorous and extended process grounded in content analysis, reflection, and member checking was used to develop the resource. The QISP creates a baseline to strengthen the profession’s knowledge of school practice, reduces barriers to evidence implementation, provides meaningful data for practitioner reflection and best practice decision making, and offers occupational therapy and its collaborators a deepened and consistent understanding of what effective and efficacious occupational therapy looks like in school settings.

‘Finding the play’ – exploring with occupational therapists practice possibilities in the context of Irish schoolyards

Background Research has identified diverse constraints to the adoption of school-based occupational therapy approaches and a lack of attention to addressing the barriers to children’s play opportunities. Critical contextualised research is advocated to inform practice possibilities. Aims/Objectives This inquiry aimed to explore with occupational therapists their existing practices in Irish schoolyards to generate practice possibilities concerned with play, as an issue of occupational justice. Materials and Methods Using the theory of practice architectures, six occupational therapists from diverse sites of practice participated in the first phase of a critical action research process using dialogical focus group and occupational mapping methods. Results Three themes were generated (1) Existing practices as situated (2) (Re)mattering play and practices as occupations and (3) Practice possibilities – ‘Finding the play’ between responsiveness and responsibilities. A further interrelated dimension was how the research methods provided mechanisms of raising consciousness. Conclusions, and Significance Alongside constructing knowledges on existing practices in an Irish context, this inquiry contributes to understandings of practices as socially embedded generative processes of ‘finding the play’, highlighting ethical responsibilities to make visible inequities reproduced in habitual practices and engage in relationships of solidarity to (re)construct alternative shared practices.

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.

Teachers’ Perspectives on Best Occupational Therapy Service Provision in School-Based Practice: A Qualitative Study

ABSTRACT There is currently limited evidence regarding teachers’ perspectives of push-in and pull-out occupational therapy services in the school-based setting. Occupational therapy services can be delivered in different combinations and often vary based on the needs of the student, needs of the teacher and classroom, need for academic time, and need for social interactions. To examine teachers’ perspectives of push-in and pull-out services, a qualitative approach was used. Thirty-nine participants were recruited using a combination of convenience, snowball, purposive, and voluntary response sampling. Data was collected via a multiple choice and open response online survey. Thematic analysis was completed with the identification of six themes. Pros and cons of both push-in and pull-out service delivery, carryover, and modifications were discussed. Conclusively, most teachers preferred a combination of push-in and pull-out services, highlighting the importance of communication, collaboration, carryover, and finding the just-right fit for each student to best support their needs and learning styles. The findings of this study will better provide school-based occupational therapy practitioners with context for selecting the most appropriate service delivery model for each student.

Effects of Occupational Therapy Professional Development Training on School-Based Practice

ABSTRACT Purpose A training program was provided to school-based occupational therapy practitioners (SBOTPs) in Massachusetts to support practices aligned with educational policies and regulations. The purpose of this study was to determine the impact of this training program on school-based practice patterns. Methods This study used a researcher-designed online exploratory survey to determine occupational therapy practice patterns in Massachusetts public schools following the training program. The survey was emailed to the 309 SBOTPs who participated in a Massachusetts Department of Education sponsored training between 2007 and 2019. The survey questions analyzed the frequency of reported participation-based intervention methods, in-context and out-of-context services, and interdisciplinary collaboration used by these practitioners. A Chi Square Goodness of Fit Test was performed to determine if there were categorical differences in the frequency of responses to each research question. Results After analyzing our 29 responses we determined that the training program was effective and had an impact on how SBOTPs practice within their schools. After the training, SBOTPs in Massachusetts reported engaging more frequently in participation-based practice in natural school contexts, and collaborating with teachers and other school professionals. Contribution to Occupational Therapy This research serves as evidence that professional development courses can impact how SBOTPs practice. This study suggests that practice patterns of SBOTS can be influenced by participating in trainings that include a model with rationale and facilitated practice for providing occupation-based services in the least restrictive environment and for increasing collaborative practices in schools. School-based occupational therapy (SBOT) is integral to the educational development of children who require this service as part of their individual educational program (IEP). SBOT helps students to achieve success in occupations within the school setting, such as education, play and leisure, activities of daily living (ADLs), and social participation. Students who receive special education services are eligible for occupational therapy if the IEP team determines that SBOT is necessary to achieve the prioritized student goals developed by the team, enhancing the student’s ability to succeed in the educational program. The overarching goal of school-based occupational therapy in working with eligible students with disabilities under the federal special education law, the Individuals with Disabilities Education Act (IDEA), is to support students’ abilities to successfully participate (academically and functionally) in their educational program in the least restrictive environment in order, ultimately, to prepare them for adult living (AOTA, 2017; IDEA, 2004).

School-Based Occupational Therapy and Multitiered Systems of Support in the United States: A Scoping Review

ABSTRACT Multitiered systems of support (MTSS) are an effective and efficient framework burgeoning in schools across the United States. School-based occupational therapy practitioners (SBOTPs) have much to offer in the MTSS framework and can influence school-based outcomes. Understanding the current literature and its implications for practice is imperative for SBOTPs. The purpose of this scoping review was to determine what is in the literature related to SBOTP and MTSS in the United States, the implications for practice, and directions for future research. The authors searched PubMed, CINAHL, Nursing and Allied Health (ProQuest), PsycINFO, Scopus, ERIC, and Education Source using keywords multitiered support systems, problem-solving teams, early intervening services, and response to intervention, and school-based occupational therapy. Guided by Arksey and O’Malley’s scoping review methodology, the authors identified, screened, and selected peer-reviewed articles related to school-based occupational therapy and MTSS in the United States. Twenty-three articles published between 2008 and 2022 met the inclusion criteria. Expert opinion articles (n = 8), qualitative studies (n = 5), and quantitative studies (n = 10) yielded valuable information to enhance SBOTPs success in MTSS. Many distinct areas for future research were uncovered. This review provides SBOTPs with implications to consider, such as their ability to build teacher capacity, the vast array of student skills that could be addressed through MTSS, the need to articulate their scope and role in MTSS, the significance of data and documentation and the potential to impact outcomes in more significant numbers of students in relatively short periods.

Comprehensive Sexuality Education for Autistic Youth: School-Based Occupational Therapy Practitioners’ Capacity Development Needs

ABSTRACT This study used a cross-sectional survey design to explore school-based occupational therapy practitioners’ (SBOTPs) perceived capacity development needs to support comprehensive sexuality education (CSE) with autistic youth K-12 in the school setting in the United States (US). An online survey was distributed to SBOTPs via social media platforms. Thirty complete responses from SBOTPs across 18 states in the United States were received. Findings indicate that despite participants’ overall positive beliefs about the sexuality of autistic youth and support for SBOTPs teaching most CSE key concepts, they do not currently teach most CSE key concepts. Also, few to no materials and tools to teach sexuality to autistic youth in the school setting were reported. Participants reported a lack of CSE policies for all learners in their schools. These findings support a need for capacity development activities directed toward occupational therapy (OT) practitioners to build their comprehensive sexual education knowledge, skills, and school-based practices for autistic youth in the United States.

Effects of school-based occupational therapy program for children with disabilities in elementary school in Korea: a case study

BackgroundThe purpose of this case study was to explore the effects of a school-based occupational therapy on children’s attention, school adaptation, sensory processing, and motor function for children in special classes in elementary school in Korea.Case presentationThe subjects of this study were a 7-year-old boy with autism spectrum disorder and a 9-year-old girl with intellectual disability. The school-based occupational therapy program consisted of 10 sessions and was conducted once a week for an hour and a half. The program consisted of classroom activities, use of school facilities, emotional management, and activities based on sensory integration, and was conducted as individual and group programs according to sessions. As a result of the study, all improved when the pre- and post-scores of the two children’s attention assessment, school adjustment scale, sensory processing evaluation tool for the children in school and BOT-2-SF were compared.ConclusionsAlthough the results from two cases cannot be generalized, the findings suggest the school-based occupational therapy program may help a positive effect on the school life of children with disabilities. Further investigation is necessary.

Occupational Therapy’s Role within the Middle and High School Settings in the United States

ABSTRACT There is a need for occupational therapy (OT) in the middle and high school settings, yet the role practitioners (OTPs) play in these settings is not clearly defined. School-based OT is in alignment with the Occupational Therapy Practice Framework (OTPF) which recognizes health is supported and maintained when clients are able to engage in their home, school, workplace, and community (American Occupational Therapy Association, 2020). OTPs serving students in the middle and high school settings ensure successful engagement while at school by addressing not only the occupations specific to education but also by addressing the factors that disrupt or empower these occupations American Occupational Therapy Association (2020). Evidence suggests OTPs are struggling to provide relevant service due to limited clarity of their role . A scoping review was conducted to describe the role of American-based OT in the middle and high school settings, identify barriers that affect practitioners, and provide practitioners with information about the role of the OT. Researchers utilized Preferred Reporting Items for Systematic Reviews and Meta Analyses-Scoping Review extension guidelines. Inclusion criteria included were articles published in English, peer-reviewed journals, within the past twenty years and within the scope of OT practice. A total of 1,107 records were identified of which 24 articles were included. Three themes emerged: 1. specific interventions used in middle and high school settings such as transition readiness, social participation, fine motor/handwriting, assistive technology, literacy participation, and life skills; 2. barriers to service delivery; 3. and the need for advocacy. More research is needed to develop conclusive evidence relating to the current practices of occupational therapy in the middle and high school settings.

Comparing Telerehabilitation and In-Person Interventions in School-Based Occupational Therapy for Specific Learning Disorder A Randomized Controlled Trial.

This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population. The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests). Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes. In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR's transformative role in enhancing the holistic well-being of children with SLDs.

Sensory-Based Interventions in School-Based Occupational Therapy: A Scoping Review

ABSTRACT Education is a primary childhood occupation. Dysfunction in sensory processing can make it challenging for children to succeed in school. School-based occupational therapy (SBOT) services address these differences through sensory-based interventions. Limited research exists to support the use of sensory-based interventions in school-based settings. The purpose of this study is to summarize existing research supporting the use of sensory-based interventions in SBOT and to identify gaps in the literature. A scoping review methodological framework was used to search seven databases. Descriptive numerical summary and qualitative thematic analysis were used to summarize and report the results. Nineteen articles met the inclusion criteria for this study. Quantitative results describe variations in diagnoses, outcomes, and intervention types. Major qualitative themes include the impact of sensory-based interventions on classroom participation and engagement, and the efficacy of treatment methods used in SBOT. Gaps in the literature include the long-term effects and specificity of sensory-based interventions. There are many factors that may influence the effectiveness of interventions. Individualized OT services are needed to consider the intricacies of the child-environment interaction. Additional research is needed to support the efficacy of sensory-based interventions in SBOT.

School Administrators’ Perceptions of Occupational Therapy’s Role in General Education Initiatives

ABSTRACT The Every Student Succeeds Act of 2015 has outlined an expanded role for school-based occupational therapy practitioners (OTPs) as specialized instructional support personnel in general education. However, OTPs have continued to be viewed as related service professionals under special education due to barriers of high caseloads and decreased administrative support. This study sought to understand school administrators’ perceptions of occupational therapy’s role in general education initiatives. A qualitative sample of ten Connecticut school administrators was utilized to answer the research question. Data was acquired through individual semi-structured interviews. Data analysis indicated three key themes which include school administrators highly regard OTPs, believe occupational therapy’s role should be expanded in general education, and are open to occupational therapy’s full scope of practice in the educational setting. However, administrators noted time and budget barriers hindered OTPs’ role expansion to support general education initiatives.

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.