School-based Occupational Therapy Research Articles

Structural validity and internal consistency of an outcome measure to assess self-reported educator capacity to support children with motor difficulties

BackgroundPartnering for Change (P4C) is a school-based occupational therapy service intended to build the capacity of educators to support children with motor difficulties.AimsThis paper describes the development of the Partnering for Change Educator Questionnaire and evaluates its structural validity and internal consistency.Methods and proceduresThe P4C Educator Questionnaire was completed by 1,216 educators four times across 2 years. Data from the initial time point were analysed via exploratory factor analysis (n = 436). Subsequently, Cronbach’s alpha and mean interitem correlations were calculated. Finally, the proposed factor structure was confirmed by testing it against data from times two through four using confirmatory factor analysis (n = 688).Outcomes and resultsA three-factor structure was evident and confirmed in hypothesis testing. The factor structure was interpretable according to the framework for building educator capacity used in this study. Internal consistency was high, with the total scale outperforming each subscale.Conclusions and implicationsA novel measure of educator self-reported capacity to support students with motor difficulties demonstrated structural validity and internal consistency. We currently recommend use as a complete scale accompanied by additional validation research.

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.

Effectiveness of School-Based Occupational Therapy Interventions on School Skills and Abilities Among Children with Attention Deficit Hyperactivity and Autism Spectrum Disorders: Systematic Review

ABSTRACT This systematic review aimed to synthesize the best available research evidence regarding the effectiveness of school-based occupational therapy interventions on school skills and abilities among children with ADHD (attention deficit hyperactivity disorder) and ASD (autism spectrum disorder). The review was conducted according to JBI (Joanna Briggs Institute) guidelines . A three-step search strategy was conducted from five electronic databases (CINAHL, PubMed, OTDBASE, Google Scholar, and Oula-Finna) in January 2022. This review considered randomized and quasi-randomized studies that evaluated school-based occupational therapy interventions for children on school skills and abilities, specifically outcomes of social interaction and process skills, and cognitive abilities. This review includes thirteen studies with a total sample size of 375 participants. Results are divided into two categories: school-based occupational interventions for children with ADHD (three studies) and school-based occupational interventions for children with ASD (ten studies). Results from school-based occupational therapy intervention studies for children and adolescents with ADHD indicate that this group of students benefits from manualized interventions that focus on social interaction skills, process skills, and cognitive abilities. Positive responses to these outcomes were found when using interventions concerning mindfulness, weighted vests, and executive function training programs. Results from school-based occupational therapy intervention studies for children and adolescents with ASD emphasize using interventions that affect social interaction skills.

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.

Occupational Therapy Services for Transition-Age Youth with Moderate to Severe Disabilities: A Scoping Review

Purpose: This scoping review seeks to identify specific services, assessments, and interventions utilized by school-based occupational therapy (OT) practitioners working with transition-age youth with moderate to severe developmental disabilities. Methods: A search was conducted in CINAHL, Medline, APA PsychINFO, Education Research Complete, and Academic Search Complete databases. Articles were screened for inclusion and relevant data extracted. Included articles were peer reviewed, referred to any inclusion of occupational therapy services in school-based practice, English-language, and focused on individuals 12-30 years old with moderate to severe disabilities. Results: Twenty articles met criteria for inclusion in the review. All articles included occupational therapy services whether providing direct or indirect services. The top two intervention types used were occupation-based interventions and advocacy-based interventions. The top two assessment types used were task-based and transition-based assessments. Occupational therapists most frequently provided direct services for transition-age youth (78.2%). Conclusions: This review provides a guide for occupational therapy practitioners to advocate for occupational therapy’s role in transition services and overcome the barriers identified: lack of understanding of occupational therapy’s role, lack of resources, lack of measurable assessments, and lack of individualized interventions. This review provides an extensive variety of assessments, interventions, and service delivery approaches available and relevant for occupational therapists working with adolescents and young adults with moderate to severe disabilities.

Position Paper on School-based Occupational Therapy

ZusammenfassungZiel der schul- und kindergartenbasierten Ergotherapie ist es, die Inklusion und Partizipation gemeinsam mit den Pädagog*innen direkt im Klassenzimmer im Schulsetting für Kinder zu ermöglichen. So soll ein wesentlicher Beitrag zur Umsetzung der UN-Konvention zu den Rechten von Menschen mit Behinderung geleistet werden. Ergotherapie steht Kindern und Jugendlichen, die Alltagsschwierigkeiten haben, derzeit nur außerhalb der Schule oder des Kindergartens zur Verfügung. Vereinzelt gibt es bereits Projekte innerhalb des österreichischen Bildungssettings. Ergotherapeut*innen stehen hierfür eine Vielzahl an Befundungsmöglichkeiten und Interventionen zur Verfügung. In Österreich steht eine Umsetzung aber noch vor vielen Herausforderungen aufgrund rechtlicher Strukturen und aufgrund der Finanzierung.

Evidence for Implementing Tiered Approaches in School-Based Occupational Therapy in Elementary Schools: A Scoping Review.

Internationally, it is suggested that school-based occupational therapy (SBOT) has an important role in supporting inclusion in educational settings. In SBOT, multitiered service delivery models are identified as a way forward to maximize school inclusion. Therefore, identifying evidence for the implementation of tiered interventions in SBOT is vital. To identify and map evidence in the occupational therapy literature relating to SBOT interventions delivered in elementary schools for all children, for those at risk, and for those with identified diagnoses. Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database. Included studies were those within the scope of SBOT that reported on school occupations and focused on elementary school-age children (excluding kindergarteners or preschoolers). Forty studies met the criteria. Individual-tier intervention studies (n = 22) primarily reported direct interventions with children at risk or with identified diagnoses (Tier 2 or Tier 3), focusing mostly on remedial approaches. None adopted a whole-school approach. Despite handwriting and self-regulation being dominant areas of concern, these studies were not explicitly related to inclusion outcomes. Evidence for implementing multitiered models primarily used indirect, collaborative consultation, embedded in the school context (n = 18). These studies identified positive school staff and child outcomes when collaboration was timely, consistent, and authentic. More rigorous individual-tier intervention studies are required to inform the design and implementation of multitiered interventions in SBOT and to support participation and inclusion in schools. What This Article Adds: This scoping review provides evidence to support occupational therapists' professional reasoning in developing evidence-based, contextual, educationally relevant multitiered models of intervention in SBOT.

Barriers, Facilitators and Implications for Practice: Secondary Findings from a Program Evaluation of a Novel School Based Community Based Instruction (CBI) Program in Elementary School for Students with Autism

ABSTRACT A mixed methodologies study was completed to evaluate an elementary school-based Community-Based Instruction (CBI) program for students with autism and secondary findings were identified in the focus group analysis related to barriers to program success, facilitators of program success and implications for practice including occupational therapy. Developed and coordinated by an occupational therapist, the program’s mission was to develop work behaviors, job skills, social skills, career interests, and self-determination skills by generalizing knowledge from the classroom through the performance of jobs within the elementary school. Jobs in the school community included running a coffee cart, performing library jobs, organizing a Lost and Found, maintaining a garden, and running a farmer’s market to name a few. The program evaluation results showed positive program knowledge and positive attitudes among three stakeholder groups (staff, parents, and administrators) through quantitative and qualitative findings. Through the thematic analysis of the focus groups, barriers to program implementation, facilitators of program success and implications for practice were identified including implications for school-based occupational therapy practitioners which this article further explains.

Toward Participation-Focused School-Based Occupational Therapy: Current Profile and Possible Directions

ABSTRACT Enabling inclusive participation is an overarching goal of Occupational Therapy services in the school setting; however, evidence is scarce on practices addressing it. This study conducts an in-depth examination of actual Occupational Therapy practices with students with physical disabilities in mainstream schools and explores possible directions toward facilitation of successful participation. Eight Occupational Therapists representing different practice settings and regions of a large Canadian province were recruited, each providing two distinct charts of students with physical disabilities integrated in regular classrooms. Data extracted from charts was analyzed and coded based on the International Classification of Function, Disability, and Health. Chart-stimulated recall interviews were conducted with each therapist and analyzed thematically. Services focused predominantly on academic rather than social activities. Two overarching themes emerged describing the clinical reality including resources (e.g. time and teams) and the impact of occupational therapy (e.g. service delivery and promotion of the profession). Subthemes suggest expansion of practice scope and diversification of service delivery modalities as promising directions. Facilitation of fuller inclusion and participation of students with physical disabilities in the school setting by Occupational Therapy services may require additional resources including knowledge translation initiatives relating to collaboration and facilitation of social participation in schools.

The Role of School-Based Occupational Therapy Practitioners in Providing Tier 1 Services to Enhance Sensory Processing and Self-Regulation Strategies Within the Classroom

ABSTRACT A student’s ability to participate effectively within a classroom environment is dependent on a multitude of factors. However, two such factors, sensory processing and self-regulation skills, are often not well understood by teachers due to limited training and education on these topics. Current research indicates that teachers report managing classroom behaviors as a significant challenge. Sensory processing abilities and self-regulation skills can play a large role in behavior thus warranting support for increased teacher training in these areas to optimize the learning environment for everyone involved. Occupational therapy practitioners working in the school system are distinctly qualified to provide support in this manner by training teachers within Tier 1 of the Response to Intervention process due to their role as a related service in the school and their consideration of client factors, performance skills, and the environment on participation. Providing support at the Tier 1 level allows for the implementation of school-wide programming covering a range of topics that both teachers and students can benefit from. Educating teachers on the use of sensorimotor strategies, how to provide social-emotional learning opportunities and considerations for environmental modifications allows school-based occupational therapy practitioners to equip teachers to approach academic instruction in a more holistic manner.

Teachers’ Experiences with Occupational Therapy Multi-Tiered Systems Support: A Qualitative Study

ABSTRACT School-based occupational therapy practitioners participate in multi-tiered systems of support (MTSS) for all students, including general education students who may be at risk for school failure. However, there is little information in the literature on how school-based therapists achieve this and the perceptions of teachers who engage with occupational therapy practitioners providing service within the MTSS framework. This study aimed to understand the experiences of elementary public-school teachers working with occupational therapy practitioners who provided services within an MTSS framework. A qualitative study with a quantitative component was employed to answer the research question. Teachers (n = 13) from four different regions of the United States participated. Data sources included verbatim transcribed interviews, surveys, and documents. Data analysis revealed several constructive themes, including teachers’ learning from occupational therapists, frequent and efficient utilization, students’ progress, and teachers’ positive feelings toward occupational therapy practitioners participating in MTSS. Teachers understood occupational therapists’ workloads, respected occupational therapy practitioners, and expressed a need for more occupational therapy services in MTSS. However, the teachers did not have documentation to verify the occupational therapists’ service within the MTSS framework, which could be a stumbling block for future school-based occupational therapy practitioners’ involvement in MTSS.

Health Promotion and Wellness for All Students: School-Based Occupational Therapy as a Preventive Approach.

The coronavirus disease 2019 pandemic accelerated the impending youth mental health crisis in the United States, necessitating a comprehensive approach to providing mental health education and interventions. School-based occupational therapy practitioners' scope of practice includes wellness promotion, early detection, and evidence-based interventions for mental health challenges. Given the rise of school-based wellness programs, the growing legislation supporting the formation of such programs, and the burgeoning burden of pediatric mental health concerns, occupational therapy practitioners are uniquely positioned to create and implement interventions to support student access to the general education curriculum and can do so by using both prepandemic funding sources and pandemic response funds. This Health Policy Perspectives column is a call to action to refocus the occupational therapy practitioner's role in school settings to include providing high-quality, evidence-based preventive mental health education and interventions. In this column, we examine prevention-based occupational therapy services in Mason City Schools, Mason, Ohio, as a model of success in the execution of this vision for school-based practice. In addition, we outline the importance of expanding the role of occupational therapy practitioners in schools, which will in turn increase the visibility and relevancy of the profession and broaden its impact on mitigating the youth mental health crisis.

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.

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 within the Response to Intervention Team: Focus Group Identifies Opportunities and Barriers

ABSTRACT Evidence indicates that universal screening can support academic participation. Response to Intervention (RtI) is a model that has been designed to identify student needs and support them within the academic setting. A focus group was held with 20 school-based occupational therapy practitioners to explore the existing role of occupational therapy within different tiers of intervention and identify barriers and further opportunities for collaborating on interdisciplinary teams. Four themes emerged identifying 1) Developmental, academic, and health-related needs, 2) Key periods for universal screening, 3) Communication and systematic barriers in interdisciplinary collaboration, and 4) Lack of identified roles for occupational therapy practitioners within RtI teams. Findings of the focus group indicate a need for advocacy using data to establish the occupational therapy role across all RtI levels. Through advocacy efforts, role release, and interdisciplinary knowledge sharing opportunities can support students during academic participation.

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.

Implementation of Best Practice in the School-based Setting

ABSTRACT A clear gap exists between what evidence states as best practice for school-based occupational therapy and what is feasible for practitioners to implement. Evidence establishes that collaborative and contextual practice have a positive effect on student outcomes. Emerging evidence demonstrates that workload models, as opposed to caseload models, could help meet the range of demands on practitioners in order to improve student outcomes. This study aimed to answer the question: What does the implementation of best practices look like for practitioners following a caseload approach compared to those following a workload approach? As described in this study, a caseload approach is when expectations are based on the number of direct intervention minutes or assigned students, while a workload model considers all of the activities and range of demands on practitioners to meet students’ needs (e.g. indirect services, teacher consultation, and documentation time). School-based practitioners recruited via social media platforms and e-mail completed an online survey to explore their practices. Responses were analyzed using descriptive statistics and nonparametric tests. Results showed a statistically significant difference between the caseload and workload models and the following practices: professional learning community membership, collaboration with teachers, and the amount of time devoted to direct intervention, teacher/staff consultation, family/caregiver training/consultation, behavioral supports, and contextually-based services. The results support the hypothesis that workload models allow for practitioners to better implement best practices in the school setting. Implications for practice include the need for educating school staff on occupational therapy’s role and advocating for a transition to school-based models of practice, such as workload approaches.

Exploration of Common Sensory Interventions Utilized in School-Based Occupational Therapy

ABSTRACT Occupational therapy practitioners provide sensory-based interventions to support children as they learn academically, develop self-regulation skills, and participate in play and activities of daily living skills alongside their peers. These interventions are used both for children who have a specific sensory-related diagnosis as well as children who do not have a specific diagnosis. This study explored common occupational therapy sensory interventions utilized within the United States school settings along with implementation barriers for sensory intervention services for children ages 3–18 years old. Occupational therapy practitioners completed an electronic survey and a focus group. Results indicated that many occupational therapy practitioners frequently used sensory interventions through indirect services with children in preschool and elementary school. Occupational therapy practitioners must provide interprofessional training for education teams for effective sensory intervention implementation in school-based settings.

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

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

Understanding the Current Role of School-Based Occupational Therapy Practitioners in Addressing Childhood Grief and Loss and Identifying Next Steps to Expand their Current Practice

ABSTRACT This study was designed to determine how occupational therapy practitioners currently approach their interventions with students on their caseloads who are grieving, as well as to identify what occupational therapy practitioners believe they require in order to expand their current practice as it relates to supporting the needs of grieving students on their caseloads. A qualitative research design was utilized. 10 school-based occupational therapy practitioners participated in the study. Data were collected via semi-structured virtual interviews, using the Zoom platform. Data were collected to understand how occupational therapy practitioners approach their interventions with students on their caseloads who are grieving. Data were also collected to determine what types of resources that occupational therapy practitioners are required to support them in expanding their role as it relates to addressing the needs of grieving students. 10 occupational therapists participated in the study. The results of the study revealed various ways in which occupational therapy practitioners (1) identify a grieving student, (2) provide intervention to grieving students, and (3) obstacles therapists encounter while addressing grief and loss at school. Results from the study also revealed potential ways in which occupational therapy practitioners can be supported to address students on their caseloads who are grieving. School-based occupational therapy practitioners can provide support to the grieving students on their caseloads; however, they require additional support to address barriers and expand their current intervention approaches. These resources may include staff in-services, continuing education opportunities, topical resources about grief-related challenges, and research articles to support their interventions.