Occupational Therapy Practice in Mainstream Schools: Results from an Online Survey in Switzerland

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

INTRODUCTION

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.

METHODS

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.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumers were involved in the study design or analysis.

FINDINGS

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.

CONCLUSION

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.

PLAIN LANGUAGE SUMMARY

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.

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.

Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework

BACKGROUND

Establishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context.

METHODS

Using a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately.

RESULTS

We identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve.

CONCLUSIONS

The seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.

'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.

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

IMPORTANCE

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.

OBJECTIVE

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.

DESIGN

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.

SETTING

Inclusive educational setting.

PARTICIPANTS

Seven occupational therapists working in inclusive schools and 39 occupational therapy managers.

RESULTS

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).

CONCLUSIONS AND RELEVANCE

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.

Potential Role of Occupational Therapist Intervention in Elementary School for Children with Additional Support Needs: A Systematic Review

(1) Background: The main activity children engage with is learning through play or formal education. The aim of this systematic review is to analyze the role of occupational therapy in the school setting for children with additional support needs or disabilities. (2) Method: We conducted a systematic review using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. This systematic review was registered in PROSPERO (CDR42022314271). The search was performed in the following databases: ERIC, Dialnet Plus, PubMed, OTseeker, Cochrane, Scopus, CINAHL, and PsycINFO. (3) Results: In total, 1954 studies were identified, from which 18 articles were selected. These studies were heterogeneous and showed different types of intervention of the occupational therapist in school environments. (4) Conclusions: The main conclusions highlighted the effectiveness of the occupational therapist within the school environment, the importance of an interdisciplinary team to cover the special needs students within the school and the need for intrinsic motivation for an active and inclusive participation of the students with special needs. However, there is a need for more homogeneous studies with a larger sample size that specifically focus on the school context and include the involvement of occupational therapists in order to replicate the findings obtained.

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.

Understanding Parents' Experiences With Mainstream Schooling for Their Children With Autism Spectrum Disorder: A Meta-Analysis

IMPORTANCE

Children with autism spectrum disorder (ASD) face school-related occupational challenges. Attending a mainstream school offers benefits for children's learning and their development of social skills; however, parents express frustration with ensuring their child's unique needs and preferences are met.

OBJECTIVE

To gain insight into parents' experiences with the mainstream preschool and primary educational system for their children with ASD.

DATA SOURCES

Eleven electronic databases were systematically searched, and processes were followed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

STUDY SELECTION AND DATA COLLECTION

Study eligibility was determined through the use of selection criteria and paired independent reviewers. Critical appraisal was conducted using a qualitative research hierarchy and a modified version of the Critical Appraisal Skills Programme tool. Two reviewers synthesized the data into themes, following the Joanna Briggs Institute meta-aggregation process. Twenty-six qualitative studies, representing the voices of 397 parents, are presented in this review (spanning 2013-2021). Articles were set in Westernized and non-Westernized settings and represented culturally and linguistically diverse population groups.

FINDINGS

Parents of children with ASD reported a lack of awareness and understanding of their children's unique learning needs in the mainstream school system at all levels.

CONCLUSIONS AND RELEVANCE

This review has various occupational therapy practice implications for supporting school-age children with ASD, their parents, and school staff. These include adopting family-centered and ecological approaches, raising awareness, influencing policy, and facilitating collaboration. What This Article Adds: This review provides guidance for occupational therapists working in schools about their practice in working at the individual, targeted, and whole-school levels to address occupational barriers faced by children with ASD.

Systematic review: Need for high-quality research on occupational therapy for children with intellectual disability

BACKGROUND

Enabling participation in everyday life and supporting development are essential goals in occupational therapy of children and young people with intellectual disabilities (ID).

OBJECTIVE

To gather and evaluate evidence of the effectiveness of occupational therapy interventions for children with ID in terms of participation in everyday life.

MATERIAL AND METHODS

A literature search conducted using electronic databases (CINAHL, Cochrane Library, PubMed and EMBASE) from January 2000 to May 2020. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Quality of evidence was critically appraised with the GRADE.

RESULTS

The search yielded 4741 records, of which 15 studies met the inclusion criteria: 3 randomized controlled trials, 3 case-control studies, 2 case series and 7 case reports. The studies were diverse in quality. The evidence is inconclusive because of the limited amount of methodologically robust studies.

CONCLUSIONS AND SIGNIFICANCE

Results support the notion that occupational therapy in daily environments for children with ID may enhances participation in everyday activities. Further research with appropriate study designs and outcome measurements is needed. Although the research evidence was limited, the results encourage focussing on occupational therapy for children with ID to enhance participation in school and home environments.

Targeting the school environment to enable participation: A scoping review

BACKGROUND

Children with special educational needs experience limited levels of participation at school; their participation is influenced by the physical and social environment. Interventions that have been applied in school environments are described in the literature.

AIMS

To illustrate the main features of interventions targeting school environments to support participation of children with special educational needs in mainstream education.

MATERIALS AND METHODS

A scoping review using a qualitative, thematic analysis was conducted in May 2021.

RESULTS

We included a total of 20 articles. We found that intervention features contributed to children's participation and targeted social and physical school environments. The majority of the intervention features focussed on applying supportive teaching methods to enable individual children's participation. A small number of interventions described a systemic holistic approach that involved changes to the school environment. In these interventions, different professionals such as occupational therapists collaborated with teachers to adapt the school environment.

CONCLUSIONS AND SIGNIFICANCE

A shift from individual child-focussed to environment-focussed approaches that target all children's participation could impact classroom setup and teachers' roles. Occupational therapists' expertise in matching school environments and task requirements with individual children's needs could be valuable in their collaboration with schools to support this transition.

Information and communication technology to improve school participation among upper secondary school students with special educational needs

BACKGROUND

Evidence-based information and communication technology (ICT) interventions to enhance school participation among students with special educational needs (SEN) are required.

AIM

To evaluate the impact of an ICT intervention on school participation among upper secondary school students with special educational needs.

MATERIALS AND METHODS

Data on 300 students' assessments with the School Setting Interview (SSI), grades and school attendance were used in this quasi-experimental study, with a one-group pretest-posttest design. Descriptive and inferential statistics and effect size were used, as well as Rasch analysis to generate interval data on the students' ordinal SSI ratings.

RESULTS

In the ICT intervention (median time eight hours), 54% of the students received a tablet, and software concerned with planning and structure was received by 85%. After the ICT intervention, a significant decrease in perceived need for adjustments in school activities was found on a group level and 30% of the students improved their school attendance. Students who benefitted the most from the ICT intervention had few adjustment needs in school activities and no special educational support at baseline.

CONCLUSION

An ICT intervention is promising for improving school participation among upper secondary school students with SEN.

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

IMPORTANCE

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.

OBJECTIVE

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.

DATA SOURCES

Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database.

STUDY SELECTION AND DATA COLLECTION

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).

FINDINGS

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.

CONCLUSIONS AND RELEVANCE

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.

Facilitating practices to support children's self-regulation in classrooms: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to describe practices for supporting children's self-regulation in the classroom.

INTRODUCTION

Self-regulation is an integral component of children's well-being and learning in the classroom. Self-regulation is a broad concept that encompasses behavioral, emotional, cognitive, or sensory regulation processes. Children often struggle to self-regulate in class and teachers have difficulty supporting them, which impacts on children's participation and academic achievement, and teachers' self-efficacy and well-being.

INCLUSION CRITERIA

This review will consider studies that include mainstream primary school children regardless of diagnosis or disability, classroom teachers, and allied health professionals who provide services in mainstream public or private school settings. Self-regulation-support practices may include pedagogical, classroom- or curriculum-based practices, environmental modifications, class-management strategies, adult-child relationships, and trauma-informed classroom practices.

METHODS

The review will be conducted using the JBI three-step search strategy. The databases to be searched include MEDLINE (Ovid), PsycINFO (Ovid), Scopus, CINAHL (Ovid), OTSeeker, and ERIC (ProQuest). Documents from 2010 to the present in English will be included. Data will be extracted and charted by two reviewers using a data extraction tool based on JBI recommendations. Study findings will be presented in tabular or diagrammatic format that aligns with the objective and a narrative summary will be provided.

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

PURPOSE

School is a primary setting for pediatric occupational therapy practice, yet little is known about the provision of school-based occupational therapy in many countries internationally. The purpose of this study was to explore current school-based occupational therapy practice for the first time in Ireland to gain insight into current and potential service provision and to identify new directions and potential pathways for development.

METHODS

This descriptive quantitative study utilized a cross-sectional online survey to gain the perspectives of the population of pediatric occupational therapists working regularly in schools across Ireland. Respondents were recruited through convenience and snowball sampling. Data were analysed through qualitative content analysis and descriptive statistics.

RESULTS

The survey elicited 35 responses, yielding a 21.2% estimated response rate. Findings demonstrated that respondents provided therapy services in schools most commonly on a weekly (28.6%) or monthly (34.3%) basis, with only 5.0% working in the same school on a weekly or fortnightly basis. The majority of respondents (54.3%) used a direct therapy approach with a child, rather than coaching or modelling, to primarily address sensory, hand function, or daily living needs. None used a whole class or whole school (universal or tiered) approach. While respondents (54.3%) generally viewed collaborative practice as a strength of school-based practice, they also identified barriers to collaboration in schools. A core barrier is related to how services are constructed across health and education, with differing philosophies of service provision. The majority of respondents (75.0%) reported that they had not received any training to deliver evidence-based practice in therapy provision specific to school-based practice. Implications for Practice. This study indicates that therapists require continual education on evidence-based school practice as it applies in an Irish context. Furthermore, clarification of school therapy roles and service delivery models are required in order to determine how they contrast with traditional clinic roles. This will enable therapists to strengthen the coordination of service delivery between health and educational services to maximize the outcomes of school-based practice.

Contextual, Client-Centred Coaching Following a Workshop: Assistants Capacity Building in Special Education

Assistants serve an essential role in special education to support children with disabilities, but they should be properly trained and supervised. The coaching approach represents one trend that has been gradually implemented in occupational therapy (OT) and rehabilitation services. Still, few studies clearly define the coaching intervention, measure the fidelity of coaching practices, or evaluate capacity building of the caregivers in the long term. This quasi-experimental study compared one-on-one coaching in natural environments following a workshop with a training workshop. Both public schools do not have regular OT services. The primary outcome was the assistant's performance, measured with the Goal Attainment Scaling (GAS). The secondary outcome was the fidelity of coaching implementation, measured with the Coaching Practices Rating Scale (CPRS). The GAS showed an increased performance of the assistants after the intervention, with significant differences between groups post-intervention (p = 0.015) and large effect size (r = 0.55), but no long-term significant improvements were found at the follow-up (p = 0.072). The CPRS showed an adequate implementation of the five coaching components (joint planning, observation, action, reflection, and feedback), with a total score of 3.5 ± 0.72 (mean ± SD). The results suggest that coaching sessions provided by OTs in schools may improve assistants' skills to facilitate the student's participation.

Perceptions of occupational therapy threshold concepts by students in role-emerging placements in schools: A qualitative investigation

INTRODUCTION

Traversing threshold concepts has been identified as crucial in becoming an occupational therapist. To support this learning, previous research has emphasised the value of students engaging in practice-based learning, accompanying reflection, and a curriculum which makes threshold concepts explicit to students. Role-emerging placements form part of students' practice-based learning in many universities and could offer a valuable opportunity for students to learn threshold concepts. Understanding the value of threshold concepts to enhance role-emerging placement learning from both the students' and educators' perspectives warrants further research. The aim of this study was to examine how occupational therapy students on role-emerging placements in school settings experienced applying threshold concepts and how it impacted on their learning.

METHODS

An epistemological position of social constructionism and a qualitative research design was used. This included semi-structured focus group interviews and reflective logs that enabled exploration of 13 student's and one supervisor's perspectives of learning during the placement. Template analysis was used to analyse the data.

RESULTS

Students spoke of their learning of the threshold concepts of client-centredness, occupation, and understanding and applying occupational therapy theory in practice. These are expressed within the three emergent themes; 'curriculum supports in placement', 'uncertainty when applying their own knowledge', and 'placement context and expectations'.

CONCLUSION

Results suggest that learning happens within the liminal spaces which occurred from an intersection with the threshold concepts, the curriculum, knowledge generation and use, and the context and expectations of the role-emerging placement. Engaging with uncertainty may be considered a vital part of this process and something which should be valued.