School-based Therapists Research Articles

A mixed-method exploration of return to school needs and experiences following pediatric brain injury

ABSTRACT Background Brain injuries in children disrupt development and can cause long-term changes in behavior, academic achievement, and cognitive abilities. Support for these individuals and families varies by state and uncoordinated care can lead to service gaps and poor school achievement. Successful return to school following brain injury requires systematic support and training. Objective The aim of this study was to explore return to school needs and experiences of both educational team members and caregivers of children with brain injuries in Arkansas public schools. Methods A convergent mixed methods designed was utilized to explore the experiences of both educational team members and families during the return to school process. Quantitative survey data was collected from public school professionals in Arkansas (n = 84) using snowball sampling. Qualitative data was collected via semi-structured interviews with mothers whose children sustained brain injuries and returned to an Arkansas public school (n = 6). Results Educational team survey responses indicated that overall knowledge, confidence, and district support among Arkansas educators is low when serving these students. Analysis of qualitative parent interview data revealed themes of caregiver role shifts, long-term challenges, varied school knowledge, and the impact of parent-school connectedness on outcomes. Results indicate a general lack of preparedness and training among school staff regarding brain injury and highlight the need for improved communication between schools, families, and medical professionals. Results also pose implications for school-based therapists to help with the return to school process as well as provide long-term support to students, educators, and families in contextually relevant settings.

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.

Commentary on "School-Based Therapists' Perspectives of Wheelchair Use in US Schools: A Survey Study".

Commentary on "School-Based Therapists' Perspectives of Wheelchair Use in US Schools: A Survey Study".

School-Based Therapists' Perspectives of Wheelchair Use in US Schools: A Survey Study.

To gather information concerning the current state of students' wheelchair (WC) use in US schools from the perspective of school-based therapists. This descriptive study used a Web-based survey to gather information regarding factors that facilitated or hindered student WC use at school, the frequency at which various tasks related to WC provision were performed, and factors that would facilitate students' independence with WC use. A dependent manual WC was the most common type of WC mobility used at school. Various student and nonstudent factors were reported as a facilitator or a barrier to students' WC use at school. Although most respondents reported working with a student who used a WC, few reported active engagement in tasks related to WC service provision. Future research exploring potential attitudinal issues influencing students' WC use at school and ways to optimally support students' independent WC use is indicated.

A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness.

Cognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. Friends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. First, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. The mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Relatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support.

Children’s Occupations: Enhancing the Representation of the Paediatric Activity Card Sort

ABSTRACT The Paediatric Activity Card Sort (PACS) captures children’s occupational repertoires; however, it is based on a small sample. A research was conducted to increase the sample size of the PACS; examine alternative form reliability of the e-PACS; explore the relationships among sex, grade, language spoken, and school attended, and children’s occupational repertoires. Fifty five children completed the e-PACS; seven also completed the paper version. Children reported doing on average 69.4% of the activities, with personal care the highest (89.3%). No significant differences were found among variables and PACS categories. However, children in public school reported doing more hobbies (p = 0.04) than children at catholic school. Some significant differences were found between boys and girls. The e-PACS had strong alternate form reliability with the PACS. Increasing the sample size of the PACS augments its usefulness providing school-based therapists with a tool to capture children’s occupational repertoires, identify potential participation issues and provide effective, individualized interventions that support academic support and overall wellbeing.

Therapist and supervisor perspectives about two train-the-trainer implementation strategies in schools: A qualitative study.

Train-the-trainer (TT) implementation strategies (in which designated clinicians are trained to then train others in an intervention) are promising approaches to support mental health clinician use of evidence-based interventions in school contexts. However, there is little evidence to date examining clinicians' perceptions of the acceptability and feasibility of TT strategies, or comparing clinicians' perceptions of different types of TT strategies. The current study was conducted as part of a larger hybrid effectiveness-implementation trial, in which school-based therapists and supervisors received one of two different types of implementation support to implement cognitive behavioral therapy (CBT) groups for anxiety: TT (i.e., initial training for therapists and supervisors) or enhanced TT (TT+; i.e., initial training for therapists and supervisors, and ongoing external consultation for supervisors). We used applied thematic analysis to compare qualitative interview transcripts from 28 therapist interviews and 33 supervisor interviews from therapists and supervisors who received TT or TT+ support and report themes that were similar and different across the two groups. Most themes were similar across the TT and TT+ conditions: therapists and supervisors in both conditions perceived the group anxiety intervention as acceptable and viewed supervision as acceptable, helpful, and feasible. Therapists and supervisors in both conditions had mixed impressions of the contextual appropriateness of the group anxiety intervention, and some reported logistical challenges with weekly supervision. Some unique themes were identified among the TT+ condition, including supervisors experiencing professional growth, and therapists and supervisors perceiving supervision as critically important and enjoyable. These results suggest that TT implementation support, using a model in which an internal supervisor receives initial training and then provides ongoing supervision, is acceptable and feasible to support a group CBT intervention in schools. The results also highlight additional benefits that therapists and supervisors perceived when supervisors received ongoing consultation. The clinical trial from which these data were derived was registered at ClinicalTrials.gov (https://clinicaltrials.gov/) prior to the time of first patient enrollment. The registration number is: NCT02651402.

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.

The use of aggressive toys in schools: Insights and experiences of school-based play therapists.

The use of aggressive toys in schools: Insights and experiences of school-based play therapists.

Changes in Writing and Addressing Student Goals During COVID-19 for Virtual and Hybrid School-Based OT, Physical Therapy, and Speech-Language Pathology: A Qualitative Analysis

Abstract Date Presented 04/01/2022 During the 2019–2020 school year, school-based therapists working in the school setting quickly migrated to online and hybrid service delivery as a result of the COVID-19 pandemic. Changes continued throughout the 2020–2021 school year. The purpose of this research is to describe how OTs, physical therapists (PTs), and speech-language pathologists (SLPs) developed and addressed goals for students who received therapy services via online or hybrid schooling during the COVID-19 pandemic. This research was recently presented at ASHA and APTA, 2021. Primary Author and Speaker: Sonja Burmeister Contributing Authors: Kimberly D. Wynarczuk, Rebecca Bawayan, Eric Sanders, Brianna Milstrey

Stress and Coping Strategies among Arizona School-Based Therapists Impacted by COVID-19

ABSTRACT The COVID 19 pandemic created unprecedented challenges for health professionals, including therapists working in school settings who experienced increased stressors and decreased support. The goal of this study is to analyze the impact of COVID 19 on the stress levels of school-based therapists (SBTs), determine the methods they used to effectively deal with this stress, and review retrospections on how they could have been better supported. An investigator-created survey was emailed to SBTs through convenience and snowball sampling from February 2021 to March 2021. A total of 144 SBTs provided usable responses. Results were then analyzed by the study personnel. Stress increased by an average of 26% among SBTs during the pandemic. The most common stressors were scheduling problems, the need to learn new technology, and concern for students’ well-being. Exercise, time management, and social support were the most successfully employed techniques to manage this stress. The increased stressors affecting SBTs due to COVID 19 diminishes SBTs’ perception of their quality of work and requires collaboration between employers and employees to resolve. Lessons learned provides insights for improved supports in the future.

Concurrent Validity of the School Outcomes Measure and the School Function Assessment in Elementary Students.

Examine the concurrent validity of the School Outcomes Measure (SOM) and the School Function Assessment (SFA) in students kindergarten through sixth grade. Twenty-four school-based therapists completed the SOM and the SFA for 42 students, representing Gross Motor Function Classification System (GMFCS) levels I to V. Correlation coefficients between SOM Self-Care, Mobility, and Assuming Student's Role median total scores and the 21 SFA Activity Performance scale median criterion scores were statistically significant. There were significant correlation coefficients between SOM Expressing Learning and Behavior and SFA median criterion scores. The SOM differentiated between GMFCS groups for all physical tasks but not cognitive/behavioral tasks, and the SFA for half of the physical tasks. Overall, student performance on the SOM was consistent with participation on the SFA, which lends support to the preliminary validity of the SOM. The GMFCS analysis suggests that the SOM differentiates between the GMFCS levels for physical tasks.

A Structured Goal-Setting Process to Promote Functional and Measurable Outcomes in School-Based Physical Therapy: A Knowledge Translation Study.

Goal setting is an important component of school-based physical therapy; however, evidence suggests that therapists may not consistently write goals that are relevant, context specific, and measurable. The aims of this knowledge translation study were to evaluate implementation of a goal-setting method for school-based therapists. This study was created to align with the Knowledge to Action framework and included 1-day training and follow-up mentorship. Goals were assessed pre- and posttraining, and questionnaires assessed barriers and facilitators. Twenty-two physical therapists participated. Nineteen participants (90%) strongly agreed/agreed that the training helped change their perspectives about goal setting in the school environment. There was a statistically significant difference in goal quality pre- and posttraining. Therapists identified barriers and facilitators to implementation of effective goal setting in practice. Results indicate that this method may be effective at improving goal writing that is relevant, context specific, and measurable in school settings.

Telepractice for School-Based Speech and Language Services: A Workload Management Strategy

Purpose This article discusses the combination of onsite and telepractice services as an effective way for professionals working in multiple schools to maximize their time and professional services in an effort to manage their workload. The combined onsite and telepractice services were used by district-wide school-based professionals to deliver direct and indirect services across various locations, thereby reducing time-consuming travel and increasing scheduling efficiency. The possible uses of telepractice as a workload management tool are discussed, as well as some challenges that the team overcame in order to successfully use this method. Conclusions Telepractice, in combination with onsite services, is an effective workload strategy for school-based therapists.

How Can We Overcome the Challenges of Providing School-Based Fluency Services?

Providing speech and language services in the school setting can be challenging, especially for complex problems such as stuttering and other fluency disorders. Speech-language pathologists (SLPs) feel less comfortable working with students who have fluency disorders, which makes problem solving around delivering these services even more difficult. The purpose of this article is to identify three categories of challenges school-based therapists may face when evaluating and treating this population. The challenges discussed in this article are drawn from our literature, interviews with several practicing therapists, and the authors' experiences providing assessment and therapy to school-age children, as well as consultations and in-services for school-based SLPs. We provide suggestions for facilitating positive change across these challenges.

Implementation and Evaluation of the FUERTE (Family Reunification and Resiliency Training) Program for Recently-Immigrated Latino Adolescents

Background Thousands of children attempt to emigrate to the U.S. each year from Latin America. Many have experienced significant trauma, and the process of reunification with families after prolonged separation is a known stressor. School-based group therapy has the potential to connect this vulnerable population with mental health resources. Through a collaboration with school-based caregivers, therapists, and pediatricians, a five-module curriculum for recently immigrated youth called FUERTE (Family Reunification and Resiliency Training) was created. After refining FUERTE’s modules using stakeholder focus groups, the program was successfully piloted across schools city-wide …

Therapists’ perceptions of the 3:1 Service Delivery Model: A workload approach to school-based practice

ABSTRACTIn recognition of their many roles, school-based practitioners have been encouraged to reframe their job-related responsibilities in terms of their workload, rather than their caseload. The purpose of this phenomenological study was to explore school-based therapists’ perceptions of the 3:1 Service Delivery Model, which aligns with a workload approach, and to determine if practitioners felt that when using the Model, they were able to manage their workload responsibilities, more so than when using a traditional service delivery approach. Five occupational therapy practitioners and five speech-language pathologists, working in school-based practice, with experience utilizing the 3:1 Service Delivery Model, completed an online survey and a semi-structured interview to explore their perceptions of their use of the 3:1 Model in their practice. All the interviews were recorded and analyzed for recurring themes once the data was transcribed verbatim and coded. A thematic analysis revealed that practitioners felt the 3:1 Model supported their use of differentiated service delivery that was contextually based, expanded their scope of practice, increased work efficiency, and was heavily influenced by stakeholder support. Implications for practice included the need for transparency and consistent expectations when utilizing a workload approach, including determining how time is utilized outside of direct service delivery, and the need to advocate for manageable caseload numbers, allowing for service delivery that meets the individualized needs of students and stakeholders.

Alternative Seating Systems for Students With Attention Difficulties: A Systematic Review

Abstract Date Presented 4/1/2017 This systematic review appraised the effectiveness of the use of alternative seating systems for students with attention difficulty. Results provide implications for school-based therapists regarding a strategy showing promising effects for students with attention difficulty. Primary Author and Speaker: Brittany Gochenour Additional Authors and Speakers: Gail Poskey

Use of online training modules for professional development with school-based therapists: Outcome project

ABSTRACTThis evidence-based project provided a professional development opportunity for school-based therapists to gain knowledge about evidence-based practice and learn strategies to integrate newly learned knowledge for the purpose of becoming an evidence-based practitioner. The purpose of the project was to determine whether a six-module online course about evidence-based practice would increase school-based occupational therapists’ knowledge of evidence-based practice. Current literature reveals that teaching allied health professionals about evidence-based practice increases their knowledge about this topic. Literature also supports the use of online teaching as an effective tool for learning about evidence-based practice. Through web-based delivery, participants viewed six narrated PowerPoint presentations at individually convenient times. Results, measured by discussion forum responses and pre- and postsurveys, indicated that six lessons of contextually based, online learning was an effective means to teach 15 postgraduate school-based OTs about evidence-based practice. After the training, all participants’ knowledge of evidence-based practice increased. All participants reported an increase in using evidence-based practice to make decisions about student goals and benchmarks. Knowledge of research findings and knowledge of professional literature was considered more useful in day-to day-work. Participants’ knowledge and preparedness to incorporate evidence-based practice into their work settings increased. Perceptions of 10 out of 13 barriers to evidence-based practice were reduced after the intervention. After training, 13 out of 15 participants modified their definition of evidence-based practice to include consideration of their clients’ motivations and desires. This reflected a more holistic understanding of evidence-based practice.

Factors Influencing Occupational Therapy Practitioners' Use of Push-In and Pull-Out Service Delivery Models in the School System

Abstract Date Presented 4/8/2016 This study examined the current practice patterns of school-based therapists to determine whether more push-in than pull-out services were being used. This study also identified facilitators and barriers to providing more push-in services by school-based therapists. Primary Author and Speaker: Heather Watt Additional Author and Speaker: Lorie Gage Richards